Rosh fam med eor boost exam Flashcards
____ ml of blood is heavy bleeding during menses
80
low estradiol and low progesterone causes ___ GnRH, FSH, LH
increased (all three)
A 25-year-old woman presents with a rash for the last 2 weeks. She reports it started with an approximately 2 cm oval salmon-colored patch on her anterior abdomen that began to clear about 1 week before more lesions appeared on her trunk. Lesions are pruritic. On physical exam, the patient has multiple oval-shaped salmon-colored patches with a collarette of scale over her trunk that follow the lines of cleavage in the skin. An image of her rash is shown above. Physical exam is otherwise unremarkable. dx?
pityriasis rosea
A 25-year-old woman presents with a rash for the last 2 weeks. She reports it started with an approximately 2 cm oval salmon-colored patch on her anterior abdomen that began to clear about 1 week before more lesions appeared on her trunk. Lesions are pruritic. On physical exam, the patient has multiple oval-shaped salmon-colored patches with a collarette of scale over her trunk that follow the lines of cleavage in the skin. An image of her rash is shown above. Physical exam is otherwise unremarkable.
Which of the following is the best therapy, given the suspected diagnosis?
topical corticosteroid
pityriasis rosea
-resolves in 2-3 mo
-hypothesis: viral in etiology
-tx: antihistamines, topical corticosteroids x3wks, severe = acyclovir, systemic glucocorticoids.
2 seizure types
focal and generalized
seizure type where there is no impairment of consciousness
simple partial seizure
seizure type where consciousness is impaired
complex partial seizure; with post ictal state
focal onset seizure
affect 1 cerebral hemisphere
seizure activity in both hemispheres and originate in midbrain or brainstem before spreading to cortices
generalized seizures
myoclonic seizures
<1 second, occur in mornings
take B6 with which TB med to prevent peripheral neuropathy
isoniazid
A 19-year-old man presents to his primary care provider with recurrent episodes of mild intermittent jaundice. He states these episodes began several years ago and seem to recur when he is stressed. He reports no other symptoms. Physical examination reveals mild scleral icterus and yellowing of the skin. Laboratory testing is significant for a slightly elevated indirect bilirubin. Which of the following best describes the pathophysiology of the most likely diagnosis?
Reduced production of uridine 5’-diphospho-glucuronosyltransferase
intermittent asx jaundice and scleral icterus
gilbert syndrome
-episodic jaundice triggered by stress, illness, physical exertion, hemolysis, fasting, menses, etoh use.
-no tx
-dx by labs showing high indirect bilirubin levels or genetic testing
pathophysiology of gilbert’s
inability to convert unconjugated bilirubin to conjugated bilirubin for excretion because of deficiency of youridine diphosphoglucuronosyltrasnferase
serum level of bilirubin associated with jaundice
> 3mg/dL
causes of unconjugated hyperbilirubinemia
hemolysis, gilbert syndrome, crigler najjar syndrome, drug reactions
causes of conjugated hyperbilirubinemia
dubin johnson syndrome, rotor syndrome, intrahepatic cholestasis, hepatitis, cirrhosis, sepsis, biliary obstruction
tension headache
bilateral in frontal occipital regions, vague tendernses of pericranial myofascial tenderness/trigger points
-stress and mental tension, fatigue, loud noise, glare, stress
-photophobia phonophobia
-not aggravated by routine physical activity
-triptans not effective
-amitriptyline is first line preventative tx
can also do cbt, stress management, relaxation, lifestyl
first line tx to prevent tension headaches
amitriptyline
-abortive tx for tension = nsaids
A 2-year-old boy who weighs 15 kg presents to the urgent care after his parents caught him eating acetaminophen 1 hour ago. They estimate he ingested between 6 and 10 tablets of acetaminophen 500 mg. The patient appears to be in no acute distress, and his vital signs are within normal limits. Which of the following clinical interventions is best to administer to this patient?
activated charcoal if dose is over 150 mg/kg and is within 4 hr of presentation
(not gastric lavage (risks>benefits), mag citrate (only adults), syrup of ipecac)
protocol for acetaminophen overdose
-if dose is over 150 mg/kg and is within 4 hr of presentation: activated charcoal unless AMS and intestinal obstruction
get serum acetaminophen level >4hrs after ingestion and then q1-2 hours after to plot elimination curve (Rumack Matthew Nomogram)
-administer N acetylcysteine if toxic levels
loss of central vision
age related macular degeneration
dry macular degeneration
atrophic
-more common
-gradual vision loss
-drusen deposits (protein deposits = yellow spots on retina)
wet macular degneration
wet macular degneration
supplements to slow down progression of macular degeneration
vit c, vit e, lutein, zeaxanthin, zinc, copper.
tx for wet age related macular degeneration
antivascular endothelial growth factors: bevacizumab and ranibizumab
-and/or photodynamic therapy
70-year-old man with a 50 pack-year history of cigarette smoking is being evaluated for possible community-acquired pneumonia. He has been coughing for 2 days but is currently afebrile. Physical exam is unremarkable. His chest radiograph reveals a single, well-circumscribed nodule, approximately 1 cm in diameter, at the periphery of the right lung. Which of the following is the best next step in management?
review a previous chest radiograph
(not CT, PET, or repeat chest imaging in 3 months)
-CT if no previous films for comparison or increased in size for >2 yrs, suggestive of ca, or no nodule on previous radiograph.
-PET for >1cm nodules
-if CT shows benign nodule then repeat chest imaging in 3 months
causes of lumbar radiculopathy
nerve root compression from spondylosis or disc herniation
most common site of disc herniations
L4-5, L5-S1
menopause
absence menses for 12 mo
-due to low estrogen and primary ovarian failure
-response: FSH increase
-mild sx: conservative measures like avoiding triggers, layers, lowering room temp
-persistent mod to severe sx: estrogen (in women with no uterus) or estrogen-progestin combo tx
constipation
MCC of acute bacterial sinusitis
strep pneumo
then Haemophilus influenzae
MCC chronic bacterial sinusitis
staph aureus
acute sinusitis
2 or more major criteria or 1 major and 2 minor criteria
major: facial pain/pressure/fullness, nasal obstruction, nasal discharge, purulence, hyposmia, fever
minor: headache, halitosis, fatigue, dental pain, cough, ear pain/pressure/fullness
highly suggestive of bacterial sinusitis:
sx>10days without improvement, acute onset of severe sx including 102 fever and purulent nasal discharge at onset, double sickening of fever, headache, rhinorrhea improving then suddenly worsening after 5-6 days.
tx for viral sinusitis
NSAIDS for pain, nasal saline sprays, mucolytics like guaifenesin, intranasal glucocorticoids, oral decongestants like sudafed, topical nasal vasoconstrictors like phenylephrine (<3days) or oxymetazoline.
first line tx for acute bacterial sinusitis
high dose amox or augmentin or doxy if penicillin allergy
painless hematochezia and iron deficiency anemia associated with what kind of colorectal carcinoma
right sided
-will see a decreased MCHC on CBC and decreased iron, ferritin, iron sat, increased TIBC and transferrin
changes in bowel habits and bowel obstruction associated with which type of colorectal carcinoma
left sided
increased MCV associated with
folate or vitamin b12 deficiency leading to megaloblastic anemia as well as seen in alcohol use disorder
breast cancer screening recommendations by USPSTF
breast ultrasound is not recommended for pts with previous breast cancer bc increased false positive rates
flashes, floaters, and curtain moving across visual field
retinal detachment
-rhegmatogenous (full thickness tear) more common than non rhegmatogenous
-most often related to posterior vitreous detachment
RF: proliferative diabetic retinopathy, retinal neovascularization, inflammatory conditions
-tx: surgical repair with laser or cryoretinopexy
OA vs RA
OA: worse in evening, aggravated by activity, alleviated by rest, morning stiffness<30 min, joints are cold, hard, bony, affects knees, shoulders, hips, CMC joints, PIP joints (bouchard nodes), DIP joints (heberden nodes), unilateral
RA: bilaterally, affect MCP PIP joints but spares DIP joints, joints are warm/soft/tender, pain is worse after resting, better with mild activity, morning stiffness>60 min.
tx of OA
non pharm: weight loss, low impact exercise, braces and orthotics
pharm: NSAIDS like naproxen, glucocorticoid injections <4times/yr per joint, if CI to nsaids then duloxetine or capsaicin, definitive for advanced OA is surgical joint replacement
radiographs of OA joints show
osteophytes, subchondral sclerosis, subchondral cysts, joint space narrowing
tx for aortic regurgitation/insufficiency
cardiac rehabilitation, initiation of lisinopril
definitive: aortic valve replacement
low pitched, early diastolic murmur best heard in left lateral decubitus position
mitral stenosis
blowing, holosystolic murmur best heard at apex
mitral regurgitation
MCC of aortic regurgitation
endocarditis
others: aortic dissection, congenital bicuspid.
high pitched holodiastolic murmur best heard at left upper sternal border. decreases with valsalva maneuver
chronic aortic regurgitation
low pitched early diastolic murmur
acute aortic regurgitation
aortic insufficiency
exertional dyspnea and CHF sx
hyperdynamic apical pulse, bounding peripheral pulses, wide pulse pressure
water hammer pulse, de musset sign (head bobbing with pulse), muller sign (pulations of uvula), quincke pulse (fingernail bed pulsations with light compression).
initial imaging of choice: TTE echo
definitive imaging choice: cardiac cath
definitive management: surgical repair/replacement
asx wihth mild regurg tx with: acei, CCB, vasodilators and cardiac rehab
COPD
-FEV11/FVC ratio decreased to <0.7
-hereditary disorder of alpha 1 antitrypsin deficiency
hordeolum is pain____
painful inflamed bump at base of eyelash (external) or oil gland/ beneath eyelid (internal)
tx: warm compresses and topical abx
chalazion is pain___
painless
firm painless bump
blocked oil gland (meibomian or zeis)
MCC above eyelashes on upper lid
tx: warm compresses, steroid injection, surgery
trochanteric bursitis is aka
greater trochanteric pain syndrome
-TTP over greater trochanter. reproduced with movement of hip. normal pelvic radiograph.
tx: NSAIDS, activity modifications, steroid injections for immediate relief.
-if >3 mo, MRI to look for tendon tears.
1st line smoking cessation drugs
-nicotine replacement therapy: gum and patches
-wellbutrin/buproprion (not for seizures!)
-varenicline
aphthous ulcers vs herpes
aphthous ulcers are inside the mouth and not contagious, while herpes are outside the mouth and contagioues.
aphthous ulcers
pain up to 1 week
- small ulcerations with yellow center and red halo
-on non keratinized mucosa
-recurrent
-tx: chlorhexidine 0.2% mouth rinse, topical anesthetic agents like 2% viscous lidocaine, dexamethasone elixir, oral prednisone for complex dz
DEXA score categories
osteopenia: between -1 and -2.5
osteoporosis: >-2.5
osteoporosis tx
pharm: bisphosphonates, estrogen therapy, parathyroid hormone analogs depending on etiology.
lifestyle: stop smoking, do weight bearing exercise, maintain healthy body weight, avoid excessive alcohol, get calcium
adverse effect of bisphosphonates
osteonecrosis of the jaw
when to screen for osteoporosis
women>65 yrs old or postmenopausal women <65 if at increased risk for osteoporosis.
-no screening for men.
all patients between 19-64 with underlying medical conditions/RF ORRRR >65 adults should receive which immunization?
PCV20 or PCV15
After, the PPSV23 should be administered 1 year later.
cellulitis
-infected dermis and subQ tissue by group A strep and staph aureus (gram pos organisms)
-tinea pedis can lead to cellulitis due to fissuring of interdigital saces.
-tx: abx that cover strep and staph nafcillin, cefazolin, clinda, dicloxicillin, keflex, doxy, bactrim.
how to manage menopause
avoid triggers, dress in layers, lower room temp
-tx of persistent sx: estrogen or estrogen/progestin combo therapy
tinea versicolor
fungal infection by a yeast that is part of normal flora (not contagious) but will opportunistically infect immunocompromised people.
-RF: fhx, warm humid envt, immunosuppressed, malnourished, corticosteroid use, cushing’s.
-MC in 15-24 yo bc active sebaceous glands
-oval round hyper/hypopigmented patches on trunk and extremities
-topical: selenium sulfide, zinc pyrithione, sodium sulfacetamide, ciclopirox olamine, tacrolimus, azoles, allylamine. oral: fluconazole
h pylori induced PUD treatment
amoxicillin, clarithromycin, and PPI for 14 days
cushing’s syndrome
excess glucocorticoids from endogenous and exogenous causes like pituitary adenomas
-dx by high cortisol level in morning after overnight low dose dexamethasone suppression test; 24hr urine free cortisol 3x normal; high acth = pituitary or ectopic acth tumor, low acth = adrenal tumor; high dose dex suppression test = 50% suppression in cushings since pituitary adenomas are partially resistant to neg feedback; if ectopic acth tumor then cortisol suppression doesn’t occur no matter high dose of dex.
2 meds to give for acute pulmonary edema
loop diuretic (furosemide) and vasodilator (sodium nitroprusside, nitroglycerin) to reduce afterload.
which HPV types are most commonly associated with condyloma acuminata
HPV 6 + 11
verruca warts by HPV
management: spontaenous resolution, salicylic acid plaster, cryo, bleomycin, trichloroacetic acid, imiquimod
bell’s palsy
affects the forehead (no wrinkles)
hyperacusis, retroauricular pain, lip droop, tongue numb, loss taste
stroke
spares the forehead
4 types of melanoma
MC subtype of melanoma = superficial spreading
most common ekg finding in anorexia
bradycardia
lab abnormalities due to anorexia
low creatinine, hyponatremia, hypokalemia, hypomagnesemia, hypophosphatemia
cardiac complications due to anorexia
mitral valve prolapse and myocardial fibrosis
which antidepressant is avoided in patients with eating disorders?
buproprion bc it lowers seizure threshold
MC type of hernia
inguinal (75%)
which type of injuinal hernia passes through inguinal canal into scrotum through the internal inguinal ring?
indirect
which inguinal hernia type will go behind superficial inguinal ring and doesn’t extend into scrotum
direct
what type of inguinal hernia is more common: indirect or direct?
indirect
tx for plantar fasciitis
-conservative: activity mods, rest, ice, stretching, NSAIDS, heel shoe inserts.
invasive: steroid/PRP/autologous blood injections
Resistant: extracorporeal shock wave therapy or radiation therapy.
Last: surgical plantar fascia and gastrocnemius release
celiac is associated with
autoimmune pancreatitis
What medication improves intermittent claudication in patients with peripheral artery disease?
Cilostazol
salmonella most associated with which food
poultry and eggs
tx for salmonellosis
fluid replacement, electrolytes, or fluoroquinolones for severe illness.
which gene is associated with familial adenomatous polyposis?
APC mutation
-100% risk colorectal cancer
-lifelong annual colonoscopies starting 12 years until colectomy is performed.
outpt treatment of PID consist of:
-single IM injection ceftriaxone
-doxycycline x14d
-metronidazole x14d
dm type 2 = ophth evaluation when?
at time of diagnosis to evaluate for diabetic retinopathy
which vaccines should be given to dibetics?
flu, pneumo, hep B, tdap, shingles
first line tx for T2DM
metformin
beryliosis is associated with which occupations?
nuclear power, nuclear reactor, dental, metal machine shop, aerospace industries
what does inhaled beryllium cause?
granulomatous hypersensitivity reaction: latency from 3mo to 30 years.
tx for berylliosis
flu/pneumo vaccines, stop smoking, supportive suppl o2 or pulm rehab, systemic glucocorticoids like prednisone, immunosuppressant if unresponsive to steroid
tx for fibromyalgia
non pharm: CBT, leep hygiene, low impact aerobic exercise
pharm: tri cyclic antidepressants (amitriptyline), SSRIs (fluoxetine), SNRI (duloxetine), cyclobenzaprine, pregablin, gabapentin.
first line tx for bipolar major depression
quetiapine or lurasidone as monotherapy.
-if ineffective, olanzapine + fluoxetine, valproate, or first line agent + lithium or valproate.
-refractory patients: electroconvulsive therapy
g6pd deficiency
-has hemolysis after oxidative stressor like meds (macrobid, dapsone, antimalarial drugs, fava beans, infections, chemicals like naphthalene).
-acute hemolysis: jaundice, paollor, abdominal pain, dark yourine.
-lab findings: increased retics, bili, LDH. decreased hgb, haptoglobin.
-blood smear: heinz bodies, bite cells.
-tx with aggressive hydration and blood transfusion if severe anemia.
-for chronic hemolysis: take folate supplement
auspitz sign:
punctate bleeding spots when psoriasis scales are scraped off.
dressler syndrome
acute pericarditis after MI
tx: aspirin and colchicine
pericarditis tx
ibuprofen (NSAIDS) and colchicine
-if severe or refractory: steroids
wilson dz is excess ___
copper
