Random Review Flashcards
What is patellofemoral syndrome (chondromalacia)
idiopathic softening/fissuring of the patellar articular cartilage
S/S of patellofemoral Syndrome
anterior knee pain “behind” or around the patella, worse with knee hyperflexion
Dx for patellofemoral syndrome
+ apprehension sign
(examiner applies pressure medial-lateral patella with pain or patient refuses test in anticipation of pain)
Mgmt of patellofemoral syndrome
NSAIDS
rest & rehab
strengthen vastus medialis obliquus of the quadriceps
weight loss
elastic knee sleeve
What is MOI for anterior cord syndrome?
MC after direct injurt: blowout vertebral body burst fractures (flexion)
indirect injury to anterior spinal artery
What deficits are present with anterior cord injury?
bilateral loss of motor function and pain and temperature sensation below the level of injury
vibration sense and proprioception are preserved
POOR PROGNOSIS!
What is the MCC of chlamydial cervicitis?
chlamydia trachomatis
Tx for chlamydia trachomatis
Azithromycin 1g single dose
Doxy 100mg BID x 7 days
What medication is known to reduce calcium absorption?
PPIs: decrease gastric acidity which leads to a decrease in calcium absorption. However, it is thought that calcium citrate does not have this same consequence when taken with omeprazole.
How does Botulinum Toxin cause paralysis?
It inhibits acetylcholine release at presynaptic receptors
What are the 3 ways someone can get botulism?
- ingestion of honey contaminated w/spores
- food-borne: inadequately preserved or undercooked foods
- wounds contaminated by spores
What are the S/S of Botulism?
- descending, symmetric, flaccid paralysis (upper>lower)
- Cranial Nerve deficits
Tx for Botulism
>1 y/o: equine serum antitoxin
<1 y/o: human-derived botulism Ig
abx for wounds
floppy baby
botulism
What labs should be ordered if suspecting acromegaly?
initial: IGF-1 (elevated), postprandial serum GH, TRH stimulation test
Secondary: oral glucose tolerance test (conclusive if failure to suppress serum GH to < 2 ng/mL after an oral load of 100 g glucose)
What is the MCC of acromegaly?
pituitary adenoma
Tx for acromegaly
ocreotide (a somatostatin analog)
transsphenoidal resection
What physical exam finding suggests globe perforation?
Hyphema
What is the most common type of knee dislocation?
anterior knee dislocation
“dimple” sign on PE w/ posterolateral dislocation
knee dislocation
Cause of knee dislocations
anterior: hyperextension of the knee
posterior: a direct blow to the anterior tibia w/knee flexed
What is the tx for anterior knee dislocation?
reductiona nd knee splint w/ 15-20 degree flexion
What nerve may be injured during anterior knee dislocation?
common peroneal nerve
What artery may be injured in an anterior knee dislocation?
popliteal artery
What are the 3 main types of polyps?
- hyperplastic (nonmalignant)
- adenomatous MC*
- malignant
AAFP routine colorectal cancer screening guidelines
Fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at 50 until 75
AAFP colorectal cancer screening guidelines if 1 relative w/colon cancer
colonscopy at 40
OR
10 yrs before the age at which relative was diagnosed
AAFP colorectal cancer screening guidelines if familial adenomatous polyposis
sigmoidoscopy at age 12, then every 1-2 years
What is volume of distribution?
describes how far a drug will partition from the bloodstream to the surrounding tissues.
Drugs with low volumes of distributions tend to stay in the ___________.
bloodstream
drugs with high volumes of distribution preferentially accumulate in ________ and ______.
drugs with high volumes of distribution preferentially accumulate in extravascular tissues and fluids.
What is a knee effusion?
A knee effusion is defined as fluid within the knee joint.
What abnormality can ethanol toxicity cause?
hypoglycemia
What is the mechanism of injurty for scaphoid fracture?
fall on an outstretched hand (FOOSH)
S/S of scaphoid fracture
dorsal radial wrist pain w/decreased ROM of wrist and thumb
tenderness to palpation of anatomic snuffbox
scaphoid fx tx
thumb spica splint
What are the live attenuated vaccines?
- Herpes Zoster
- Influenza
- MMR
- Rotavirus
- Typhoid (bacterial)
- Vaccinia (smallpox)
- Yellow fever
What is the triad for Grave’s disease?
- Diffuse goiter
- exophthalmos
- pretibial myxedema
S/S of hyperthyroidism
Patient will be complaining of heat intolerance, palpitations, weight loss, tachycardia, and anxiety
What will PE of hyperthyroidism (graves dz) show?
hyperreflexia, goiter, exophthalmos, pretibial edema
Tx for hyperthyroidism
Methimazole or PTU
PTU if Pregnant
What is the 1st line tx for latent TB infection?
Isoniazid
What will CXR for Primary TB show?
Ghon FOcus
Tx for subarachnoid hemorrhage?
nimodipine
S/S of retinal detachment
painless loss of vision, floaters, flashing lights, curtain lowering sensation
reduced brightness in involved eye
Hydroxychloroquine is an anti-malarial drug used for which two diseases?
RA and Lupus
S/S of systemic Lupus Erythematosus
fever, lymphadenopathy, weight loss, general malaise, or arthritis
What will PE of Systemic Lupus Erythematosus show?
butterfly rash/malar rash
What will labs of SLE show?
(ANA), anti-dsDNA antibodies, anti-smith antibodies, anti-histone antibodies
Dx for osteoporosis
DEXA scan - T-score ≤ -2.5
Tx for osteoporosis
bisphosphonates
MC fractures associated w/osteoporosis
vertebral body compression fractures
What electrolyte imbalance is a child with pyloric stenosis at most risk for?
hypokalemia
hot potato voice
peritonsillar abscess
Which medication is recommended for patients with atrophic vaginitis and dyspareunia who do not want to use a vaginal route of medication delivery?
The selective estrogen receptor modulator ospemifene
What is stasis dermatitis and in what disease can you see it?
Stasis dermatitis occurs with venous insufficiency and valvular incompetency. The proximal skin appears thin and brown, and may occur with distal macules, papules, red irritation, skin thickening and edema.
Dx for varicose veins
duplex ultrasound
Tx for varicose veins
compression stocks + leg elevation
What is the initial tx for hypercalcemia?
normal saline
What does EKG for hypercalcemia show?
shortened QT interval
What are most kidney stones composed of?
calcium oxalate or calcium phosphate
Is peptic ulcer disease a risk factor for developing nephrolithiasis?
Yes, b/c pts with PUD usually ingest a lot of calcium to ease their symptoms.
What are the clinical signs of Kawasaki Disease?
- high fever for 5 days (necessary)
- C/o of 4/5 of the following:
- bilateral bulbar conjunctival injection
- oral mucous membrane changes “strawberry tongue”
- peripher extremity changes (erythema/edema of hands or feet)
- Polymorphous rash
- Cervical lymphadenopathy
CRASH and burn
Conjunctivitis
Rash
Adenopathy
Strawberry tongue
Hand/feet edema
BURN (uncontrolled high fever)
KAWASAKI DISEASE
What is tx for Kawasaki Disease?
IVIG + ASA
Hx of hyphema
hx of trauma to eye w/ foreign object
s/s of hyphema
dec. vision, photophobia, pain, red reflex is absent
PE of hyphema
blood in ant. chamber
what PE sign shows globe perforation?
hyphema in anterior chamber
what is a complication of tibial-femoral dislocations?
popliteal artery rupture
which nerve is at most risk of direct damage with a tibial-femoral dislocation?
common peroneal nerve
dx for tibial-femoral dislocation
arteriography (popliteal artery injury)
tx tibial femoral dislocation
immediate orthopedic consult: severe limb threatening emergency
pathophysiology of pulmonary hypertension
increased pulm vascular resistance –> RVH –> R-sided heart failure
primary vs secondary pulm HTN
primary: BMPR2 gene idiopathic
secondary: COPD
s/s of pulm htn
dyspnea on exertion
PE findings pulm HTnqaccentuated S2 due to prominent P2
Increased JVD, peripheral edema, ascites
dx of pulm HTN
- CXR: enlarged pulm arteries
- ECG: cor pulmonale: RVH, right axis deviation
- GOLD STANDARD: right sided heart cath = def dx
- CBC: polycythemia w/ increased hematocrit
tx for pulm htn
primary: CCB 1st line
2nd line: sildenafil (PDE 5 blocker)
s/s of acute pyelonephritis
fever, dysuria, frequency, urgency, flank pain, CVA tenderness, N/V
tx acute pyelonephritis
FQ or bactrim
if inpatient/pregnant: ampicillin/gentamicin
Where is leviteracetam eliminated through?
kidneys
caution in patients wCrCl of 30-50 mL/min
Tx for bacterial conjunctivitis
ofloxacin topical eye drops
Why should you avoid neomycin solutions in the eye?
hypersensitivity reactions
What score is osteoporosis defined as on a bone density scan?
-2.5 or more standard deviations
Tx for osteoporosis
bisphosphonates
MC fx in pt with osteoporosis
vertebral body compression fractures
s/s of idiopathic pulmonary fibrosis
chronic dry cough and dyspnea
smoking hx
PFT for idiopathic pulm fibrosis
decreased FVC and FEV1
normal FEV1/FVC ratio
PE of idiopathic pulm fibrosis
honeycombing
Tx for pulseless electrical activity
CPR for 2 min
Epi q 3-5 min
check for shockable rhythm q 2 mins
Dx (major/minor) for Duke’s Criteria
To confirm a diagnosis, 1 of the 3 must be:
- 2 major criteria
- 1 major, 3 minor
- 5 minor
What are the major criterias for infective endocarditis?
- 2 positive blood cultures/hx of valve
- + echo showing vegetation (TTE)
- New murmur valvular regurgitation
What are the minor criteria for infecive endocarditis? (Duke’s Criteria)
- Fever
- Vascular issues (petechiae, Roth spots in fundus, Jane Lesions)
- Immunologic issues (RA, Osler’s Nodes, nephrotic syndrome)
- Predisposition(IV drug user, prosthetic heart valve)
- Microbiology culture unlike major criteria
If IV drug users get infectious endocarditis, which valvewill it most likely effect?
S aureus, Tricuspid
What valve will you see infectious endocarditis in if pt has hx of native valve?
mitral valve
What is the MC valve involved in infective endocarditis?
mitral EXCEPT if IVDA = tricuspid
Tx for acute IE w/native valve
nafcillin OR vanco (MRSA) + gentamicin
Tx for IE w/prosthetic valve
vanco + genta + rifampin
Tx for fungal IE
amphotericin B
amphoterrible B
Which abx are effective against gram +
Penicillin + vanco
Which abx are effective against gram -
gentamicin
