Rosh Flash Card
Patient with glucose-6-phosphate dehydrogenase deficiency and a recently diagnosed urinary tract infection. Treatment?
Risk of hemolysis with medications (antimalarials, sulfonylureas, quinolones, nitrofurantoin), fava beans, infections
Oxidant drugs such as nitrofurantoin, phenazopyridine, dapsone, and sulfonamides can cause hemoglobin precipitation within the RBC, which leads to the removal of the cell from circulation via the spleen. Patients with severe G6PD enzyme deficiency who ingest oxidant drugs can experience severe hemolysis and cardiovascular collapse.
Cipro. is safe.
Treatment for takotsubo cardiomyopathy?
Initial management is similar to that of acute coronary syndrome, by first addressing acute complications and then treating stable patients with diuretics, beta-blockers, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Treatments may be withdrawn once symptoms subside, which usually takes about 1 month.
Acute urinary retention treatment?
Using an indwelling catheter for 48–72 hours is an appropriate treatment for acute urinary retention.
Time for excision of hemorrhoids in ED or clinic?
Acutely thrombosed hemorrhoids < 72 hours can be excised in the ED or some clinics
Risk factors for hemorroids?
Risk factors Pregnancy, genetic predisposition, colon cancer, inflammatory bowel disease, Crohn disease, rectal surgery, chronic diarrhea, and spinal cord injury
Primary amenorrhea age?
Absence of menses by the age 15
Work up for primary amenorrhea. What age?
No menses by age 15 and no developmental of secondary sexual characteristic by age 13
Common causes of primary amenorrhea?
Gonadal dysgenesis, Mullerian agenesis, Physiological delay of puberty, transverse vaginal septum, weight loss or anorexia nervosa and hypopituitarism.
Psoriasis treatment <5% of body
<5% of body involved
– Topical corticosteroids
– Calcipotriene (Dovonex)
* Vitamin D3 analog
– Calcitriol (Vectical)
– Tazarotene (Tazorac)
– Anthralin
– Salicylic acid
– Localized UVB phototherapy
– Tacrolimus, Pimecrolimus
Psoriasis treatment >5% of body
> 5% of body involved (phototherapy)
– UVB
* Broad band, narrow band (II-III, B-C)
* +/- topical, systemic, biologic agents
– Narrow band UVB
– Excimer laser (IIB)
Postherpetic Neuralgia – Treatment?
- Anticonvulsants
– Pregabalin (Lyrica)
– Gabapentin (e.g., Neurontin) - Tricyclics
- Opioid analgesics
- Sympathetic nerve blocks
– Bupivacaine
– Must be given within 2 months of onset to be effective
Herpes Zoster Treatment?
- Analgesics
- Wet compresses (Burow’s solution – aluminum acetate)
- Antiviral therapy
– Acyclovir (e.g., Zovirax) 800 mg 5x/day x 7 days
– Famciclovir 500 mg TID x 7 days
– Valacyclovir (e.g., Valtrex) 1 g TID x 7 days
Allergic to lidocaine than what to use?
Esters: Procaine or Chloroprocaine
One way to remember which class each anesthetic belongs to is to use the following trick: all of the amides have two i’s in their spelling, whereas the esters have only one i.
Other name for procaine is “Novocaine”
Local anesthetics side effects?
Benzocaine side effect?
Methemoglobinemia
Lidocaine side effect?
Seizures, hypotension
Bupivacaine side effect?
Cardiotoxicity
For which two immunizations is it more cost effective to perform serologic testing for immunity than to administer vaccines without serologic testing first?
Varicella and hepatitis B
Loud S1 and opening snap murmur?
Mitral Stenosis
RSSR. Systolic
TPAM
SRRS. Diastolic
Murmur sounds?
AR: Blowing diastolic
AS: Crescendo-decrescendo
MR: Loud holosystolic murmur
PS: Systolic ejection murmur
What is the most commonly associated complication of mitral valve stenosis?
Atrial Fibrillation
Hyper vs Hypothyroidism
Hypo: Weight gain, constipation and cold intolerance
Hyper: Weight loss, palpitation, increase bowel movement, heat intolerance.
Drugs for hyperthyroidism?
- Beta blocker (Propranolol)
- Methimazole or Propythiouracil
Is PTU safe during pregnancy?
PTU in the first trimester of pregnancy
P for P
Management of auricular hematoma?
Tx: drainage + conforming pressure
- Acute (< 48 hr) and small (< 2 cm): needle aspiration
- Large (> 2 cm) or 48 hrs to 7 days: incision and drainage
- > 7 days: referral to ENT/plastic surgeon
What is premenstrual syndrome?
Premenstrual syndrome (PMS) is a combination of physical and behavioral symptoms that occur monthly in the luteal phase of a patient’s menstrual cycle.
1–2 weeks prior to menstrual cycle
Sleep disturbances, decreased focus, emotional lability, breast tenderness, or HA that resolves after menses begins
Treatment is decreased caffeine intake, exercise, stress reduction, NSAIDs, SSRIs, OCPs
Symptoms do not hinder personal or professional life (unlike premenstrual dysphoric disorder)
Treatment of PMS (premenstrual syndrome)?
lifestyle modifications, such as regular exercise, relaxation techniques, and dietary changes, including smaller, more frequent meals and reduced consumption of caffeine, salt, alcohol, and simple carbohydrates.
In patients whose symptoms are not resolved with lifestyle modifications, pharmacologic therapy with selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, paroxetine, or citalopram is first-line treatment.
Patients who do not respond to one SSRI may respond to a different agent, so a trial of a second SSRI should occur prior to moving to second-line treatment options.
Additionally, combined oral contraceptives containing drospirenone may be used. SSRIs may be taken daily or during the luteal phase of the menstrual cycle only.
Painless vs Painful penile ulcer?
Painless: Chancre (Syphilis)
Painful: Chancroid (H. ducreyi)
HSV 2: Difference is tender inguinal lymphadenopathy.
Left untreated, how long do chancres typically take to spontaneously heal?
3-6 weeks.
Treatment for Syphilis.
Tx:
Primary or secondary: IM benzathine penicillin G, 1 dose
Tertiary: IM benzathine penicillin G qwk for 3 weeks
Primary: painless chancre
Secondary: lymphadenopathy, condyloma lata, rash on palms and soles
Tertiary: gummas
Which diabetes medication puts patients at a heightened risk for leg and foot amputations?
Canagliflozin and other sodium-glucose cotransporter-2 inhibitor.
Following amputation injuries, which replantation finger is most important?
Replantation of an amputated appendage is indicated for amputations occurring in children, and for thumb injuries since the thumb is responsible for a significant portion of the function of the hand.
Rapid Bio.
Standard deviation:
Standard error of the mean:
Positive skew:
Negative skew:
Null hypothesis (H0):
Type I error:
Type II error:
Alpha:
Beta:
Power:
Increase power and decrease beta:
Confidence interval:
T-test:
ANOVA:
Chi-square:
P value:
Standard deviation: variability from mean
Standard error of the mean: variability between sample mean and true mean
Positive skew: mean > median > mode
Negative skew: mean < median < mode
Null hypothesis (H0): theory that the exposure or intervention that is being studied is not associated with the outcome of interest
Type I error: H0 incorrectly rejected (rejecting H0 when it is true)
Type II error: H0 incorrectly accepted (failing to reject H0 when it is false)
Alpha: probability of type I error
Beta: probability of type II error
Power: probability of correctly rejecting H0
Increase power and decrease beta: increase sample size, increase expected effect size, increase precision of measurement
Confidence interval: range in which real mean expected to fall
T-test: compares means of two groups
ANOVA: compares means of three groups
Chi-square: ≥ 2 percentages or proportions of categorical outcomes
P value: measure of the effect of chance within a study
How is oxygen administered as an acute alternative treatment for cluster headache?
Via face mask at 100% FiO2 at a rate of 8–15 L/min for up to 15 minutes.
Pathophysiology behind cluster headache?
Hypothalamic and circadian rhythm dysfunction
Severe temporal or periorbital headaches lasting between 15 and 180 minutes associated with ipsilateral trigeminal autonomic signs such as lacrimation, nasal congestion, rhinorrhea, conjunctival injection, eyelid edema, ptosis, miosis, and forehead or facial swelling. Type of headache?
Cluster headache
Management of cluster headache?
Management includes abortive therapies (e.g., oxygen, sumatriptan, zolmitriptan), prophylaxis (e.g., verapamil), and avoidance of triggers.
Pathophysiology behind migraine headaches?
Cortical activation with initial brain hyperemia followed by prolonged oligemia
Pathophysiology behind tension headaches?
Multifactorial involving peripheral myofascial factors with central nervous system (pain) response and seem related to central sensitization and lowered threshold for pain in the trapezius, frontalis, and temporalis muscles.
How does PPI work?
PPIs work by inhibiting gastric acid secretion by irreversibly binding to and inhibiting the hydrogen-potassium (H-K) ATPase pump.
What is a severe complication that can occur from long-standing chronic gastroesophageal reflux disease (GERD)?
Barrett esophagus.
GERD treatment?
Gastroesophageal reflux disease (GERD), the first line of therapy typically involves the use of proton pump inhibitors (PPIs).
PPIs are generally indicated in patients who have either failed twice-daily H2-receptor antagonist (H2RA) therapy (with underlying erosive esophagitis), and/or experience frequent (eg, 2 or more episodes per week; as in this case) or severe symptoms of GERD that impair their quality of life.
<2 episode of gerd in a week: H2RA
>2 episode in a week: PPI
Why is the use of topical benzocaine not advised for pain control in patients with oral lichen planus?
Due to a rare risk of potentially fatal methemoglobinemia with even one application.
First-line treatment for oral lichen planus?
Topical corticosteroids
High specificity will have ?
Few false-positive results
High sensitivity will have?
Few false-negative results
How should children with severe obstructive sleep apnea be treated?
Prompt adenotonsillectomy or positive airway pressure therapy with continuous positive airway pressure or bilevel positive airway pressure.
Which class of antibiotics are contraindicated in patients with risk factors for torsades de pointes?
Fluoroquinolones.
Most common root causes of sentinel events?
Communication, leadership, and human factors consistently remain the most common root causes of sentinel events.
What reproductive complication can occur in female patients infected with mumps virus?
Oophoritis, or inflammation of the ovaries.
Cytologic evidence of elongated macrophages and distinctive multinucleated giant cells, characteristic cells of what pleurisy?
Cytologic evidence of elongated macrophages and distinctive multinucleated giant cells, characteristic cells of rheumatoid arthritis, in a background of amorphous debris is diagnostic of rheumatoid pleurisy.
Light’s criteria?
Transudate: Pleura : Serum protein <=0.5
Exudate: >0.5
LDH
<=0.6 (Transudate)
>0.6 (Exudate)
Most common genetic cause of chronic kidney disease and is often clinically silent.
Autosomal dominant polycystic kidney disease
How often should patients with unruptured intracranial aneurysms that are not treated with endovascular methods or open surgery be radiographically monitored?
Serially with computed tomography angiography or magnetic resonance angiography annually for two to three years, then every two to five years thereafter if stable.
What is increased risk in patients with autosomal dominant polycystic kidney disease?
Incidence of cerebral aneurysm
Diabetes screening age?
35 to 70
Screening for colon cancer age?
45 to 75
Screening for cervical cancer?
21 to 29: Pap every 3 year
>30 to 65: Cytology + HPV every 5 year
What is the treatment for Chlamydia trachomatis in nonpregnant patients?
Doxycycline 100 mg PO BID x 7 days
Azithromycin 1 g PO single dose (pregnancy)
Where do superficial basal cell carcinomas most commonly present?
On the trunk.
Perianal itching. Dx and treatment?
Enterobiasis, or pinworm.
Treatment option includes mebendazole, albendazole, or pyrantel pamoate
Dose is repeated in 2 weeks
Which dietary vitamin deficiency is associated with an increased risk for complete mole?
Vitamin A
What vitamin deficiency, aside from vitamin B12 deficiency, is a common cause of megaloblastic anemia?
Folic acid (vitamin B9) deficiency.
What is decreased in a patient with vitamin B12 deficiency anemia?
Serum cobalamin levels will be decreased in a patient with vitamin B12 deficiency anemia.
Most common cause of intestinal obstruction in infants?
Intussusception
6 months to 3 years old
Periosteal new bone formation with the formation of Codman’s triangle and sunburst pattern. In what type of cancer?
Osteosarcoma
Most common opportunistic infection when CD4 counts drop to less than 200 cells/mm3 and treatment?
The most common opportunistic infection is Pneumocystis pneumonia, which is likely when CD4 counts drop to less than 200 cells/mm3. It can be prevented with trimethoprim-sulfamethoxazole prophylaxis.
CD4 counts drop below 50 cells/mm3/ prophylactic treatment?
Azithromycin is given prophylactically for the prevention of disseminated Mycobacterium avium complex. It is typically seen when CD4 counts drop below 50 cells/mm3.
CD counts less than 150 cells/mm3 prophylactic treatment?
Itraconazole is given to those at high risk of occupational or communal exposure to Histoplasmosis capsulatum infection and is typically seen at CD counts less than 150 cells/mm3.
Should patients with HIV get the flu vaccine?
They should get the inactivated influenza vaccine annually, however, live-attenuated vaccine is contraindicated in HIV-infected patients.
Dialysis for lithium toxicity?
- Impaired kidney function with lithium concentration of >4
- Lithium concentration of >5
- Seizure, AMS and dangerous dysrhythmia
What are absolute contraindications to prescribing lithium?
Lithium is contraindicated in patients with significant renal impairment, sodium depletion, dehydration, or significant cardiovascular disease.
Hallmark laboratory findings for hemolytic anemia?
Hallmark laboratory findings include increased lactate dehydrogenase, reticulocytes, and indirect bilirubin but decreased haptoglobin.
What is the most common cause of hemolytic anemia due to a red cell membrane defect?
Hereditary spherocytosis.
Rice water, and may be profuse, leading to dehydration. Dx and treatment?
Cholera and Doxycycline for treatment.
Ciprofloxacin, azithromycin, or tetracycline as reasonable alternatives depending on local patterns of susceptibility and resistance.
Which serogroups of Vibrio cholerae cause disease in humans?
Serogroups O1 and O139.
Abrupt onset of vaginal bleeding after 20 weeks gestation accompanied by abdominal pain, hypertonic uterine contractions with a firm uterus (may be rigid and tender), and a non-reassuring fetal heart rate pattern.
Classic clinical manifestations for placental abruption (abruptio placentae)
A classic ultrasound finding is a retroplacental hematoma.
Developmental dysplasia of the hip. Risk, Screen?
Infants who were breech in utero have an increased risk for mild deformations, including developmental dysplasia of the hip.
All infants should be screened for developmental dysplasia of the hip using the Ortolani and Barlow maneuvers between birth and 3 months of age.
Universal routine screening with ultrasonography is not recommended. However, infants at high risk of developmental dysplasia should have an ultrasonography assessment between four and six weeks of age.
In addition to developmental dysplasia of the hip, what other mild deformations are associated with neonates who were breech in utero?
Prominent occiput, frontal bossing, torticollis, upward-slanting eyes, and low-set ears.
What type of nystagmus is considered hallmark and associated with phencyclidine intoxication?
Rotary nystagmus.
Caloric testing. Finding both with cold and warm water?
When using cold water in the ear canal, the fast beating portion of nystagmus moves toward the opposite ear.
If warm water is used, the fast beating nystagmus moves toward the ipsilateral ear.
The mnemonic COWS is helpful to remember the expected responses with intact brain stem function: Cold Opposite, Warm Same.
Immediate knee pain and usually develop a joint effusion over the next 24 to 48 hours. May report feeling that the knee is “locking up,” clicking, or popping. Dx?
A meniscal tear is an injury to either the medial or lateral cartilage layer and is usually due to a “twisting” injury with a planted foot.
First-line treatment is NSAIDs and physical therapy; however, early surgical intervention should be considered in young patients with a lack of mobility.
An Apley or McMurray test may be positive, but neither of these is very sensitive or specific.
Immediate, severe knee pain followed by an inability to bear weight and the development of a joint effusion. Dx?
Anterior cruciate ligament (ACL)
Diffuse, anterior knee pain often localized or described as being behind the patella. Pain is aggravated by climbing stairs or squatting. Dx?
Patellofemoral pain syndrome (PFPS)
What is the best clinical indicator of meniscal tear?
Joint line tenderness.
What is the autoimmune disorder that causes hyperthyroidism?
Graves’ disease.
Honeycombing on CT scan of lungs?
Pulmonary fibrosis.
Classic manifestations include the onset of dyspnea on exertion with nonproductive cough over a period of several months. Fever, fatigue, myalgias, and arthralgias are usually absent. Chest auscultation typically demonstrates bibasilar crackles. Hallmark findings on high-resolution CT include peripheral (subpleural) bibasilar reticular opacities associated with architectural distortion such as honeycombing and traction bronchiectasis.
Prognosis is poor, but pirfenidone and nintedanib appear to slow the course of disease
Pleural plaques with linear bands of calcification on high-resolution CT lung. Dx?
Asbestosis
RA presentation? Lab?
Morning stiffness that lasts for at least 30 minutes.
Symptoms should be present for a minimum of 6 weeks.
More classic joint abnormalities associated with rheumatoid arthritis such as ulnar drift, swan neck, and boutonniere deformities, tend to appear with patients who have chronic disease.
Rheumatoid factor, anti-citrullinated protein antibody, C-reactive protein, and erythrocyte sedimentation rate are all recommended laboratory studies to aid in the diagnosis of rheumatoid arthritis.
Rheumatoid factor, however, is not specific for rheumatoid arthritis and may be positive in other diseases as well. Patients do not need a positive rheumatoid factor to be diagnosed with rheumatoid arthritis. Anti-citrullinated protein antibody is much more specific for rheumatoid arthritis.
Joints involved in RA?
PIP and MCP
Positive anti-double-stranded DNA antibodies, and positive antiphospholipid antibody would coincide with a diagnosis of?
Positive anti-double-stranded DNA antibodies, and positive antiphospholipid antibody would coincide with a diagnosis of systemic lupus erythematosus.
Negative rheumatoid factor, a positive anti-SS-A antibody, and a positive anti-SS-B antibody. Dx?
Sjögren syndrome
If a young man presented with joint pain following a recent genitourinary infection with Chlamydia trachomatis, what would be the most likely diagnosis?
Reactive arthritis.
SSI treatment?
Evidence of purulence indicates that the patient will require incision and drainage of the infected wound, including debridement of necrotic tissue, followed by dressing of the open wound which can then be closed by secondary intention.
Open wound dressings commonly consist of gauze that is moistened with saline before being placed into the wound.
The surrounding tissue involvement and systemic signs indicate that this patient also requires a course of antibiotics with broad-spectrum coverage.
Although the typical duration of antibiotic therapy for uncomplicated cellulitis is five days, a duration of 14 days is warranted in this patient due to his history of diabetes mellitus.
Topical antiseptic adds NO benefit to wound healing over drainage and debridement.
Parkinson disease pathophysiology?
It is due to loss of the substantia nigra with resultant depletion of dopamine.
Parkinson clinical findings?
Clinical findings include tremor, bradykinesia, and rigidity as well as postural instability, shuffling gait, and dementia. Diagnosis of Parkinson disease is clinical.
What two prescription drugs can cause drug-induced parkinsonism?
Antipsychotics and antiemetics.
Campylobacter jejuni is associated with development of?
Guillain-Barré syndrome, an immune-mediated polyneuropathy characterized by acute onset of symmetric ascending paralysis. Unlike botulism, Guillain-Barré syndrome usually also presents with sensory deficits.
Acute onset of bilateral cranial neuropathies and symmetric descending weakness 24 to 48 hours after ingestion. Dx?
Foodborne botulism
In what type of angina should beta-blockers not be used?
Prinzmetal (vasospastic) angina, as they may increase the risk of coronary vasospasm with unopposed alpha-receptor activity.
Therapy for acute stable angina?
Nitrates
First-line therapy for chronic stable angina?
Beta-blockers
Types of B- blocker?
Beta-blockers are classified into two main groups: non-selective, which act on both beta 1 (cardiac muscle) and beta 2 (cardiac muscle, bronchial tissue, peripheral smooth muscle); E.g: Carvedilol, Labetalol and Propranolol and cardioselective, which act primarily on cardiac muscle, although at higher doses, they lose much selectivity).
Cardioselective beta-blockers (e.g., atenolol, metoprolol, bisoprolol) are most commonly used in stable ischemic heart disease.
Carvedilol (with both alpha- and beta-blockade) is also an effective anti-anginal drug.
Dosage is very important in the antianginal efficacy of beta-blockers, as higher doses are often required for maximum benefit. Side effects of beta-blockers include bradycardia, bronchoconstriction, insomnia, fatigue, nightmares, and impotence.
Side effects of beta-blockers?
Side effects of beta-blockers include bradycardia, bronchoconstriction, insomnia, fatigue, nightmares, and impotence.
Where does prostate cancer preferentially metastasize?
Axial skeletal bones.
PSA > 4 (prostate-specific antigen)?
Refer to urologist
Diagnosis of diabetes in adult?
The diagnosis of diabetes can be made with a
fasting plasma glucose level of 126 mg/dL or greater on more than one occasion;
a glycosylated hemoglobin A1C level of 6.5% or greater;
a random plasma glucose level of 200 mg/dL or greater in a patient with classic symptoms of hyperglycemia;
or a 75-g two-hour oral glucose tolerance test with a plasma glucose level of 200 mg/dL or greater.
Diagnosis of diabetes in children?
Children have a body mass index greater than the 85th percentile for age and sex, plus two additional risk factors such as
family history,
high-risk ethnicity,
acanthosis nigricans,
polycystic ovary syndrome,
hypertension, or dyslipidemia.
They should be screened every two years with a fasting plasma glucose test.
However, the diagnostic utility of glycosylated hemoglobin A1C is not well-established in children.
Distinguish type 1 vs type 2 DM?
Antibodies detected against islet cells, tyrosine phosphatase-like protein, and glutamic acid decarboxylase help distinguish between type 1 and type 2 diabetes mellitus.
Autoimmune pancreatitis test?
Carbonic anhydrase II antibodies
Ulcerative colitis antibody test?
Perinuclear antineutrophil antibodies
Treatment of ulcerative colitis?
Treatment of ulcerative colitis involves medications such as 5-aminosalicylates, steroids, azathioprine, cyclosporine, infliximab or vedolizumab, and surgery including proctocolectomy.
Children and adolescents with diabetes are at increased risk for what psychiatric complications?
Anxiety and depression.
What topical therapy is approved by the FDA for the treatment of superficial basal cell carcinomas in low-risk sites?
Imiquimod 5% cream.
Low risk site: trunk, limbs, cheeks, forehead, scalp, and neck
What teratogenic exposures can result in phenotypic similarities to DiGeorge syndrome?
Isotretinoin and ethanol.
DiGeorge syndrome findings?
Conotruncal cardiac anomalies, hypoplastic thymus, and hypocalcemia. (CATCH 22) A: Abnormal face, C: Cleft, H: hypocalcemia
Recurrent sinopulmonary infections to severe combined immunodeficiency. Patients may also present with palatal abnormalities and developmental delays.
22q11.2 deletion
Metatarsal shaft fracture. Ortho referral indications?
Indication for orthopedic consultation or referral for metatarsal shaft fracture.
- Fractures of multiple metatarsal
- Displaced fracture near the metatarsal head.
- Intra articular fracture
- Displaced fracture of the first metatarsal, even if displacement is minimal, because anatomic position is necessary for optimal weightbearing function.
- Unstable fracture of the first metatarsal, judged by clinical finding on stress radiograph.
- Concurrent injury of other structures including injury of the tarsometatarsal that his Lisfranc ligament complex and fracture of other foot or ankle bone.
Surgery for aortic stenosis indication?
Severe aortic stenosis is identified by an aortic jet velocity ≥ 4.0 m/s, a mean transvalvular pressure gradient ≥ 40 mm Hg, or an aortic valve area ≤ 1.0 cm2
Valve replacement for severe aortic stenosis is recommended for patients who have symptoms by history or on exercise testing, in asymptomatic patients with left ventricular ejection fraction < 50%, and in patients undergoing other cardiac surgery.
Surgical aortic valve replacement and transcatheter aortic valve implantation are the only effective treatments for severe aortic stenosis.
Chest pain, Dyspnea and Syncope?
Aortic Stenosis
Most sensitive diagnostic study for the diagnosis of achalasia?
Esophageal manometry is the most sensitive diagnostic study for the diagnosis of achalasia. Achalasia is a primary esophageal motility disorder characterized by loss of peristalsis in the distal esophagus and a failure of the lower esophageal sphincter to relax with swallowing.
Which infectious disease can cause loss of esophageal ganglion cells?
Chagas disease.
Esophageal manometry demonstrating aperistalsis in the distal two-thirds of the esophagus and incomplete lower esophageal sphincter relaxation. Dx?
Achalasia
Risk factors for both ulcerative colitis and Crohn disease?
Risk factors for both ulcerative colitis and Crohn disease include age in the 20s (ulcerative colitis has another peak in the 50s), positive family history of inflammatory bowel disease, and northern European or Ashkenazi Jewish heritage. Studies have shown a link between gastroenteritis and the immune response thereof to the development of inflammatory bowel disease.
Management of Acute Bronchitis?
Dextromethorphan is a non-opioid antitussive shown to be effective at decreasing cough symptoms, and guaifenesin is an expectorant with some benefit in decreasing cough frequency and intensity. The combination of dextromethorphan with guaifenesin is beneficial for the management of acute bronchitis.
What conditions should be included in the differential diagnosis of a patient who presents with plantar heel pain and pain in the sole of the foot?
Tarsal tunnel syndrome, neuropathic pain, and S1 radiculopathy.
Mucin, the primary substance of mucus, is produced and secreted by ?
Goblet cells
Type 2 pneumocytes function?
Secrete pulmonary surfactant.
What is the most common type of jaundice in newborns?
Physiologic jaundice.
Jaunice during stress, infection. Dx?
Most patients with Gilbert disease are asymptomatic however, jaundice and further elevation of the bilirubin level may occur during periods of stress, fasting, or illness.
Elevated conjugated bilirubin level. Syndromes?
Dubin-Johnson and Rotor syndrome both have elevations in conjugated bilirubin levels.
Gilbert Syndrome increased risk for?
Increased risk of cholelithiasis
Microangiopathic hemolytic anemia, thrombocytopenia, neurologic manifestations, fever, and renal disease. Dx?
Classic pentad.
Thrombotic thrombocytopenic purpura
Schistocytes, anemia, elevated lactate dehydrogenase, indirect hyperbilirubinemia, and thrombocytopenia. Dx?
Thrombotic thrombocytopenic purpura
Hemolytic anemia, AKI, Thrombocytopenia. DX?
Classic triad
HUS
Caused by E.Coli O157:H7 (Shiga toxin)
Ovarian cancer screening?
Increased-risk family history is defined by the USPSTF as
1) having two or more first- or second-degree relatives with a history of ovarian cancer or a combination of breast and ovarian cancer, or 2) Ashkenazi Jewish ancestry with a first-degree relative (or two second-degree relatives on the same side of the family) with breast or ovarian cancer.
Fractures most commonly nonoperative in adults?
Radial head fracture
In what age group are supracondylar fractures common?
They typically occur in children between 5 and 10 years of age.
X-ray: posterior fat pad sail sign. Dx?
Radial Head Fracture
What level of lead in children needs treatment?
Venous blood lead level of 45 ug/dl higher should be treated.
Treatment for lead toxicity?
Oral succimer or IV EDTA
Palpitations, lightheadedness (or near syncopal episodes), hypokalemia, and hypomagnesemia are suggestive of. Dx?
Acquired torsades de pointes
Torsades de pointes is commonly caused by drugs?
antidysrhythmics, antihistamines, macrolide antibiotics, antifungals).
Labs: hypokalemia, hypocalcemia, and hypomagnesemia.
Conventional radiography is not as sensitive for detecting acute osteomyelitis, especially if symptoms are of ——– duration?
Less than two weeks’ duration.
Radiographically, the presence of what is pathognomonic of chronic osteomyelitis?
Radiographically, the presence of a sinus tract is pathognomonic of chronic osteomyelitis.
Other radiographic findings include sequestra (separated pieces of dead bone) and involucra (layers of new bone growing from the periosteum).
Sudden onset of unilateral warmth, erythema, and swelling over the foot or ankle, often with a history of minor trauma. Dx?
Charcot arthropathy
What blood test may be helpful in distinguishing restrictive cardiomyopathy from constrictive pericarditis?
A plasma brain natriuretic peptide level of 400 pg/mL or greater is suggestive of restrictive cardiomyopathy rather than constrictive pericarditis.
Restrictive cardiomyopathy VS Constrictive pericarditis?
First, palpation of the left ventricular impulse is usually normal with restrictive cardiomyopathy.
In contrast, a nonpalpable impulse is suggestive of constrictive pericarditis.
Second, a third heart sound (S3 gallop) is frequently present with restrictive cardiomyopathy because of the abrupt cessation of rapid ventricular filling.
This sound is not heard in constrictive pericarditis; instead, a pericardial knock that occurs earlier than a third heart sound can be heard in the majority of patients with constrictive pericarditis.
Proteinuria, hypoalbuminemia, edema, and hyperlipidemia are characteristic clinical features of. Dx?
Nephrotic syndrome.
Episodic hematuria 1-2 days after URI?
IgA nephropathy (Berger disease)
Hematuria weeks after URI?
Post streptococcal glomerulonephritis
Classic triad of hypertension, hematuria, and dependent edema. Dx?
Nephritic Syndrome
What is the leading primary cause of nephrotic syndrome in adults?
Focal segmental glomerulosclerosis. It is the most common primary glomerular disease leading to end-stage kidney disease in the United States.
What are risk factors for developing adhesive capsulitis?
Patients at greater risk of developing adhesive capsulitis include those with diabetes mellitus, thyroid disease, prolonged immobilization, stroke, and autoimmune disorders.
herpes labialis treatment?
Episodic therapy is recommended for patients with an identifiable prodrome because initiation during the prodrome stage (burning, numbness and tingling) or within 72 hours of rash onset has been shown to lessen the duration and severity of the lesions. Recommended episodic therapy includes famciclovir 1,500 mg once by mouth or valacyclovir 2 g twice daily for 1 day by mouth.
In patients with frequent recurrences, defined as more than four episodes per year and with no identifiable prodrome, chronic suppressive therapy is recommended, which includes valacyclovir 500 mg daily.
In this patient with more than four episodes per year, no identifiable prodrome, and presenting within 72 hours of rash onset, the best management option is to treat with valacyclovir 2 g PO bid for 1 day, then suppress with valacyclovir 500 mg PO qd.
Hirschsprung disease, or congenital aganglionic megacolon, is a developmental disorder (neurocristopathy) of the enteric nervous system characterized by?
Absence of ganglion cells in the submucosal and myenteric plexus.
Most common cause of lower intestinal obstruction in neonates,
Hirschsprung disease, or congenital aganglionic megacolon
Rectal suction biopsy is the gold standard for diagnosing Hirschsprung disease
Parkinson Disease.
Decrease of dopamine released from the basal ganglia
Management of PDA?
Management includes indomethacin, conservative observation, surgical ligation, or percutaneous transcatheter occlusion
Which of the following classes of diabetic medication is recommended by most experts to be avoided in patients starting from 3–4 days before surgery because of an increased risk of hypovolemia?
Sodium-glucose cotransporter 2 inhibitors.
Sodium-glucose cotransporter 2 inhibitors (e.g., dapagliflozin, canagliflozin, empagliflozin) can increase the risk of hypovolemia since they promote glucose excretion through the kidneys and can result in excess water loss. These medications are recommended to be discontinued 3–4 days before surgery.
What unusual complication has been reported in patients with type 2 diabetes mellitus taking sodium-glucose cotransporter 2 inhibitors?
Euglycemic diabetic ketoacidosis.
Dysmenorrhea, menorrhagia, dyspareunia, post-coital bleeding, pelvic or abdominal pain, and infertility.
Endometriosis
Endometriosis treatment?
Nonsteroidal anti-inflammatory drugs such as naproxen are an appropriate first-line treatment for endometriosis.
Which vitamins is used as pharmacotherapy for the treatment of nonalcohol-related fatty liver disease?
Vitamin E
Vitamin E supplementation should be avoided in patients with a personal or strong family history of what type of cancer?
Prostate cancer.
Gold standard for the laboratory confirmation of malaria?
Microscopy
Which malarial parasite is most likely to result in severe infection and, if not promptly treated, can result in death?
Plasmodium falciparum.
Fever, malaise, headache, and a stiff neck in immunocompromised patients (e.g., AIDS patients) is suggestive of?
Cryptococcal meningoencephalitis
Name three contraindications to performing a lumbar puncture?
Local skin infection at the lumbar site, thrombocytopenia, and vertebral abnormalities.
Treatment of cluster headache?
100% oxygen
Sumatriptan
What medication is recommended for initial preventive treatment of cluster headache?
Verapamil.
Types of botulism?
infantile botulism, foodborne botulism, wound botulism
Typical initial presentation for infantile botulism?
Typical initial presentation in infants is constipation and poor feeding, followed by hypotonia and weakness.
Pathophysiology of infantile botulism?
The toxin acts on presynaptic nerve terminals to block the release of acetylcholine by impairing the exocytosis process.
Most common atypical presenting complaint in older patients diagnosed with acute coronary syndrome?
Dyspnea
Target-shaped skin lesions. The most common known causes?
Reactivated herpes simplex, Mycoplasma pneumonia, and upper respiratory tract infections.
Drugs causing erythema Multiforme?
Drugs: sulfa, oral hypoglycemics, anticonvulsants, penicillin, NSAIDs (SOAPS)
Ataxia, dysarthria, vision and hearing loss, cardiomyopathy, and diabetes. Dx?
Friedreich ataxia
Dementia, choreiform movements, and psychiatric manifestations. Dx?
Huntington disease
Premenstrual disorders treatment?
Selective serotonin reuptake inhibitors (SSRIs) (e.g. escitalopram) are first-line. If patients do not wish to take SSRIs, have failed SSRIs or wish to have contraception as an added benefit, oral contraceptive pills can be used instead.
Pyoderma gangrenosum is a rare disorder typically associated with an underlying?
Systemic disease (e.g., inflammatory bowel disease, hematologic malignancy, arthritis)
Most common cause of postpartum hemorrhage?
Uterine atony
DDx: uterine atony, lacerations, retained placenta, abnormally adherent placenta, coagulopathy
Classic manifestations of idiopathic pulmonary fibrosis?
Gradual onset of dyspnea on exertion with nonproductive cough.
Slows disease progression in patients with idiopathic pulmonary fibrosis. Medications?
Prognosis is poor, but two medications, pirfenidone and nintedanib, seem to slow the course of disease
What test best confirms the initial diagnosis of ankylosing spondylitis?
Pelvic X-ray of the sacroiliac joint.
HCOM murmur?
Harsh mid-systolic crescendo-decrescendo murmur.
Increase with valsalva and standing up
Dercrease with squatting and trendelenburg,
What is the initial medication of choice in symptomatic patients with hypertrophic cardiomyopathy to prevent chest pain and sudden cardiac death?
Beta-blockers
COPD groups type?
0-1 moderate exacerbation (Group A and B)
>= 2 moderate exacerbation (Group E)
COPD treatment based on group?
Group A: Bronchodilator (long acting preferred than short)
Group B: LABA + LAMA
Group C: LABA + LAMA+ ICS if blood eosinophils >300
Postbronchodilator FEV1/FVC < 0.7 on spirometry. DX?
COPD
How does laryngotracheitis manifest on a posterior-anterior chest radiograph?
Subglottic narrowing is typically seen, commonly called the “steeple sign.”
Adhesive capsulitis can be differentiated from subacromial pathology?
Subacromial condition have a limited active range of motion, but passive range of motion is preserved.
Most common cause of cor pulmonale?
COPD
What complication of HSV-1 is a major cause of blindness?
HSV keratitis.
Medications for HSV infection ?
Acyclovir, valacyclovir, and famciclovir.
Acute hepatitis B infection. Which of the markers will be detectable in serum first?
HBsAg
What lab value is diagnostic of chronic hepatitis B infection?
Persistence of elevated hepatitis B surface antigen (HBsAg) for more than six months.
Serologic markers for Hepatitis B?
Acute hepatitis B: HBsAg, Anti-HBc IgM, HBeAg,+ HBV DNA
Resolved infection: Anti-HBs, Anti-HBc IgG, +/− HBeAb
Vaccinated: Anti-HBs
Benign cysts characteristics?
Thin-walled, unilocular, anechoic, and less than 10 cm in size with smooth, regular borders are considered to be benign cysts
What radiographic or endoscopic findings are highly suggestive of a C. difficile infection?
Pseudomembranous colitis (severe inflammation of the inner lining of the bowel).
Treatment of C. diff?
Nonsevere or severe: oral vancomycin or oral fidaxomicin
Fulminant: oral vancomycin with parenteral metronidazole
Indications for chronic PPI?
Such indications include Barrett esophagus,
Severe erosive esophagitis,
Eosinophilic esophagitis,
and high risk for upper gastrointestinal (GI) bleeding.
Risk factors for GI bleeding include prior ulcer,
Age >65,
High-dose NSAID therapy,
Concurrent use of aspirin, corticosteroids, or anticoagulants.
Such patients should be advised to use PPIs indefinitely.
Treatment of Diarrhea that develops in patients with ileal Crohn’s disease or following ileal resection?
It is usually due to increased amounts of bile acid remaining in the stool.
Bile acid sequestrant such as cholestyramine
To prevent neural tube defects in newborns, the U.S. Preventive Services Task Force recommends?
Folic acid, 0.4–0.8 mg daily
Which one of the following is the most accurate and appropriate maneuver to detect an anterior cruciate ligament tear?
The Lachman test is the most accurate test for an anterior cruciate ligament (ACL) tear
The other two commonly used tests are the anterior drawer test, which has a sensitivity of 38% and a specificity of 81%, and the pivot shift test, which is more technically difficult than the other two tests and has a sensitivity ranging from 24% to 85%. The pivot shift test is effective if done correctly but should not be used alone to diagnose an ACL tear
What treatments has been shown to improve the quality of life for a patient with tinnitus?
Treatments to reduce awareness of tinnitus and tinnitus-related distress include cognitive-behavioral
therapy, acoustic stimulation, and educational counseling. No medications, supplements, or herbal
remedies have been shown to substantially reduce the severity of tinnitus.
Treatment of PCOS?
Treatment should be based on the patient’s goals and modified
based on her desire for fertility.
In a patient who is not interested in near-term fertility and whose goal is
to control menstrual irregularities, a levonorgestrel IUD is most likely to reduce the frequency, duration,
and volume of bleeding.
Metformin is used to treat insulin resistance,
dietary modifications are used to
treat obesity,
spironolactone can be used to treat hirsutism or acne, and
Clomiphene is used to induce
ovulation and fertility.
Donepezil side effect in elderly?
The 2015 American Geriatrics Society Beers Criteria for potentially inappropriate medication use in older adults >65 years of age states that donepezil use should be avoided in patients with syncope, due to an increased risk of bradycardia.
It is Cholinesterase inhibitor. Due to their cholinergic effect, these medications have a vagotonic effect on the sinoatrial and atrioventricular nodes.
What is the most common cause of secondary hyperparathyroidism?
Decreased levels of 1,25-dihydroxyvitamin D, hyperphosphatemia, and hypocalcemia in the setting of chronic kidney disease.
Severe mitral regurgitation murmur sound?
A high-pitched holosystolic murmur
High-frequency blowing diastolic murmur?
Aortic regurgitation.
Mid-diastolic rumble murmur?
Mitral stenosis.
Harsh late systolic murmur?
Aortic stenosis.
What inherited condition is Zollinger-Ellison syndrome often associated with?
Multiple endocrine neoplasia, type 1 (MEN 1).
What is the most common cause of hypercalcemia?
Primary hyperparathyroidism.
Which of the following laboratory tests is most helpful for confirmation of the diagnosis of Poststreptococcal glomerulonephritis?
Antistreptolysin O (ASO) antibody can be used to confirm recent invasive streptococcal infection.
Diagnosis of poststreptococcal ASO antibody does not provide a definitive diagnosis, so other tests, including anti-hyaluronidase, anti-deoxyribonuclease B, and anti-streptokinase antibodies, may be needed for confirmation.
Which medications should be discontinued 4–6 weeks prior to obtaining a plasma aldosterone/renin activity ratio?
An aldosterone antagonist, such as spironolactone or eplerenone,
can increase renin and aldosterone levels and should be discontinued 4–6 weeks before obtaining a ratio.
Angiotensin receptor blockers and ACE inhibitors can increase renin levels.
Mild concussion without loss of consciousness. Tx?
Initial complete cognitive and physical rest followed by an individualized graded return to activity
A school nurse discovers head lice on a fourth-grade student. When should the student be
permitted to return to class?
Immediately
Transmission generally requires head-to-head contact, as lice
cannot survive when separated from their host for more than 24 hours and do not fly or hop. Visible nits
are generally present at the time of diagnosis, confirming that the infestation has been present for some
time, so immediate isolation from other children would not be expected to change the natural course of
events. The American Academy of Pediatrics (AAP) recommends that children found to be infested with
lice remain in class but be discouraged from close contact with others until treated appropriately with a
pediculicide.
The first step in the evaluation of nonmassive hemoptysis?
Chest radiograph
High risk of malignancy (patient age 40 years or older with at least a 30-pack year smoking
history), chest CT should be ordered.
In North America, the most common conditions associated with uveitis are ?
Seronegative
spondyloarthropathies, sarcoidosis, syphilis, rheumatoid arthritis, and reactive arthritis.
Significant risk factor for esophageal adenocarcinoma?
Esophageal adenocarcinoma has become the predominant type of esophageal cancer in North America and
Europe, and gastroesophageal reflux and obesity are the main risk factors.
Initial approach to constipation in children?
Oral osmotics such as polyethylene glycol–based solutions are recommended as an appropriate initial approach to constipation in children because they are effective, easy to administer, noninvasive, and well tolerated
ASD murmur?
Grade 2 or 3 systolic ejection murmur best heard at the upper left sternal border with a wide split fixed S2.
Ventricular septal defect murmur?
Loud holosystolic murmur
Patent ductus arteriosus murmur?
Continuous crescendo-decrescendo murmur
What would suggest a diagnosis of prostate cancer rather than benign prostatic hypertrophy?
Asymmetric areas of induration on digital rectal exam.
Elevated serum PSA (B) and the presence of hematuria on urinalysis (C) may be seen in both prostate cancer and benign prostatic hypertrophy (BPH).
Typical radiographic findings include flowing linear calcification and ossification along the anterolateral aspects of the vertebral bodies, which continue across the discs. Dx?
Diffuse idiopathic skeletal hyperostosis
Which type of X-ray can detect most cases of diffuse idiopathic skeletal hyperostosis?
Chest X-ray
Calcaneal stress fracture VS Plantar Fasciitis?
Calcaneal stress fracture typically results from trauma, such as from a fall.
Plantar fasciitis refers to pain in the plantar region of the foot that is worse when walking, and it is one of the most common causes of heel pain in adults. Physical examination of the affected heel typically produces pain and point tenderness when palpating the heel during dorsiflexion of the toes.
What are some risk factors associated with the development of plantar fasciitis?
Obesity, prolonged standing, flat feet, and reduced ankle dorsiflexion.
PVCs treatment?
Treatment is only recommended for symptomatic patients because suppression of premature ventricular complexes has not been shown to improve mortality.
In the absence of underlying heart disease, offering reassurance and recommended avoidance of triggers is sufficient.
If the patient is experiencing frequent premature ventricular complexes that are symptomatic, then treatment with a beta-blocker, such as metoprolol, or a calcium channel blocker is recommended.
Diagnosis of type 2 diabetes can be confirmed by two hemoglobin A1c values at or above a threshold of ?
The diagnostic cutoff point for type 2 diabetes is a fasting plasma glucose level 126 mg/dL or a hemoglobin A1c >6.5%. The diagnosis requires confirmation by repeat testing or by obtaining both a fasting glucose level and hemoglobin A1c.
In sarcoidosis, which one of the following organ systems should be examined yearly to detect extrapulmonary manifestations of the disease?
Ocular
Indicated in the routine evaluation of patients with
syncope?
Orthostatic blood pressure measurement and an EKG
In patients with normocytic or microcytic anemia. Order?
A serum ferritin level should be ordered.
An examination reveals a nodular appearance at the site of insertion of the Achilles tendon to the calcaneus, and local tenderness of the distal tendon.
Typical symptoms and findings of Achilles tendinopathy.
Improve antidepressant-related sexual arousal dysfunction. Treatment?
Bupropion
Indicated for dyspareunia related to vulvar
and vaginal atrophy due to menopause.?
Ospemifene
Treatment postmenopausal women with low sexual desire?
3- to 6-month course of testosterone specifically for
postmenopausal women with low sexual desire.
Blepharitis treatment?
Initial treatment of blepharitis consists of lid hygiene using warm compresses to remove dried
secretions and debris.
Mild shampoo can help in this process and aid in keeping the bacterial colonization
load down.
In severe or recalcitrant cases a topical antibiotic ointment may be applied to the lids.
Oral antibiotics can be considered for more severe cases.
Depression screening starting at what age?
Depression in adolescents and adults starting at age 12
HIV screening, what age?
HIV screening is recommended in adolescents and adults 15–65 years of age
Dermatitis herpetiformis related to?
Secondary to cutaneous IgA and immune complex deposition related to gluten sensitivity, as in celiac disease.
The diagnosis is supported by elevated IgA tissue transglutaminase (tTG) antibodies, which is the serology of choice for diagnosing celiac disease.
The rash frequently responds well to a gluten-free diet and is classically treated with dapsone.
Treatment of human papillomavirus causes cutaneous warts?
First-line treatment includes topical salicylic acid or cryotherapy
Neonatal myasthenia gravis vs Botulism?
Almost always present within the first 3 days of life.
In addition, the weakness of myasthenia gravis is typically fatigable, meaning it becomes more prominent with repetitive motions.
What other autoimmune conditions are associated with celiac disease?
Dermatitis herpetiformis, type 1 diabetes mellitus, and autoimmune thyroiditis.
ECG shows right bundle branch block and persistent ST segment elevation in the right precordial leads. Diagnosis?
Brugada syndrome
HTN medication for CKD with proteinuria?
Patients with CKD and proteinuria the combination of an ACE inhibitor or an ARB with a diuretic or calcium channel blocker is most effective for lowering morbidity and mortality.
Antihypertensive therapy and antianginal therapy medications?
β-Blockers are first-line therapy for antihypertensive therapy and antianginal therapy, whereas calcium channel blockers are second-line agents in patients who are unable to tolerate β-blockers.
Calcium channel blockers may also be added as additional therapy when hypertension and angina symptoms are not controlled with β-blockers alone.
Medications that can also be used relieving pain from vertebral fractures.?
Subcutaneous calcitonin can also be useful for relieving pain from vertebral fractures.
DM medication that increase the risk of bone fractures with long-term use.
Thiazolidinediones (pioglitazone and rosiglitazone)
Diabetes medications is most associated with hypoglycemia?
Sulfonylureas, such as glipizide, glyburide, and glimepiride
Vitamin D supplementation should be started within?
Vitamin D supplementation should be started within the first 2 months of life.
Vitamin D supplementation in formula-fed infants?
Infants who consume less than 1 liter of formula per day need supplementation with 400 IU of vitamin D daily.
Three major risk factors for curve progression of idiopathic scoliosis?
The magnitude of the curve at presentation, the potential for future growth, and female sex.
Of these factors, curve progression has the most impact on the need for referral versus observation.
What is first-line treatment for androgenetic alopecia?
Topical minoxidil 2%.
Patches of smooth, nonscarring hair loss with patches of smaller hairs called exclamation hairs. Dx and treatment?
Alopecia Areata
Treatment is intralesional corticosteroids
Scabies treatment?
Tx: permethrin 5% (infants > 2 months old) or oral ivermectin (ivermectin not first line in pregnancy or in children < 15 kg)
Most immunocompetent adults diagnosed with pneumonia who have no comorbidities or recent antibiotic use. Tx?
Oral macrolide such as azithromycin or clarithromycin for five days
Pneumonia treatments?
No comorbidities: Amoxicillin or Doxycycline or macrolide
Comorbidities: Augmentin or Cephalosporin and Macrolide or Fluoroquinolone as monotherapy.
Modified Centor criteria
The best predictors of group A streptococcal pharyngitis are included in the modified Centor criteria for patients with symptoms ≤ 3 days:
3 to 14 years of age,
absence of cough,
tender anterior cervical adenopathy,
tonsillar exudates, and
fever.
One point is given for each criterion, with those over 45 years of age given a score of −1.
A rapid antigen detection test should be ordered in patients with a modified Centor score ≥ 2
First-line treatment includes a 10-day course of penicillin or amoxicillin.
When titrating the dosage of opioids, the CDC recommends that you should also consider prescribing naloxone when the opioid dosage reaches what morphine milligram equivalent (MME) per day threshold?
The evidence shows that the risk of an opioid overdose increases at the threshold of 50 MME/day.
Which of the following is the most aggressive type of thyroid cancer?
Anaplastic
Spinal dysraphism (tethered cord). Parameters?
While the exact parameters of what is considered
large (>0.5 cm diameter) and
close (within 2.5 cm of the anal verge)
Ultrasonography can
accurately and safely detect spinal dysraphism in these cases.
Obese patients
with peripheral neuropathy, which ultimately leads to foot deformities (the classic rocker-bottom foot) and
resultant ulcerations and infections. Dx?
Acute Charcot neuroarthropathy
Immobilization is typically required for at least 3–4 months but in some cases may be needed for
up to 12 months.
Total contact casting, which
increases the total surface area of contact to the entire lower extremity, distributing pressure away from
the foot.
Most appropriate initial pharmacotherapy for a temporomandibular disorder?
The initial first-line pharmacologic therapy for temporomandibular disorders is naproxen.
Cyclobenzaprine may also be added if there is evidence of muscle spasm.
If this is unsuccessful, other options include a trial of amitriptyline or gabapentin.
Management of asymptomatic peripheral artery disease (PAD)?
Management of asymptomatic peripheral artery disease (PAD) should initially be conservative and should
include a walking program, smoking cessation, and a healthy diet. Statins should be started for
all patients with PAD regardless of their LDL-cholesterol levels.
A single antiplatelet agent is recommended for patients with PAD. Both aspirin and
clopidogrel are effective in the reduction of stroke, but the combination of the two is recommended only
after revascularization surgery.
Effective interventions for weight loss in nursing home patients?
Effective interventions for weight loss in nursing home patients include providing meals in a pleasant,
home-like environment.
Avoiding dietary restrictions has low quality evidence of effectiveness.
According to the most recent American College of Cardiology/American Heart Association guidelines, hypertension is defined as a blood pressure reading greater than
130/80 mm Hg
A blood pressure of 130–139/80–89 mm Hg is classified as stage 1 hypertension and a systolic
pressure >140 mm Hg or a diastolic pressure >90 mm Hg is classified as stage 2 hypertension.
Fasting blood glucose level in gestational diabetes?
The goal fasting blood glucose level in patients with gestational diabetes is <95 mg/dL.
The goal 2-hour
postprandial glucose level is <120 mg/dL and the goal 1-hour postprandial glucose level is <140 mg/dL.
Functional gastrointestinal disorder. Symptoms?
Symptoms such as recurrent abdominal pain related to defecation, pain related to a change in the frequency of defecation, abdominal bloating and distension, and loose and watery or lumpy and hard stools are used to diagnose functional bowel disorders.
Strongest indication for formal allergy testing?
Recurrent or persistent upper respiratory symptoms
Which one of the following is the recommended first-line agent to prevent steroid-induced osteoporosis?
Alendronate (Fosamax)
Long-term
glucocorticoid therapy definition?
Long-term
glucocorticoid therapy, defined as >2.5 mg of prednisone for a duration of 3 months or longer.
Osteoporosis treatment?
Oral bisphosphonates are recommended as first-line agents for preventing glucocorticoid-induced
osteoporotic fractures, although intravenous bisphosphonates can be used if patients are unable to use the
oral forms.
Supplementation of calcium (800–1000 mg) and vitamin D (400–800 IU) is also recommended.
Criteria for the treatment of patients receiving glucocorticoids?
The
American College of Rheumatology recommends pharmacologic treatment for these patients, as well as
for patients receiving glucocorticoids who have a bone mineral density T-score –2.5 at either the spine
or the femoral neck and are either male and 50 years of age or female and postmenopausal.
Fall on an outstretched hand and findings of anatomic snuffbox tenderness. DX and TX?
Scaphoid fracture.
When there is a high clinical suspicion for a scaphoid fracture but radiographs are negative, it is reasonable to immobilize in a thumb spica splint and
reevaluate in 2 weeks.
Acute anterior wall myocardial infarction with possible incipient
cardiogenic shock. Tx?
Along with initiating the hospital’s protocol for myocardial infarction, immediate
treatment should include dual antiplatelet therapy with a 325-mg dose of nonenteric aspirin, a P2Y12
inhibitor (clopidogrel, prasugrel, or ticagrelor), and an anticoagulant (unfractionated heparin or
bivalirudin).
Alcohol use disorder. Types?
Mild alcohol use disorder is defined by the presence of 2–3 of the 11 symptoms documented in the DSM-5,
whereas 3–5 symptoms indicate moderate alcohol use disorder and 6 or more symptoms indicate severe
alcohol use disorder.
First-line medication for a patient newly diagnosed with ADHD?
Methylphenidate.
What is the first-line therapy for those who can’t take stimulant medication due to a personal or family history of drug abuse?
Atomoxetine.
Framingham criteria?
The Framingham criteria can reliably diagnose heart failure if two major or one major and two minor criteria are present.
What conditions should be tested for in patients before starting treatment with immunosuppressive biologic agents for rheumatoid arthritis?
Hepatitis B, hepatitis C, and tuberculosis.
Hookworm treatment?
Treatment consists of anthelmintic therapy which includes albendazole, mebendazole, or pyrantel pamoate.
the most sensitive and specific test for genital herpes?
When genital herpes occurs during pregnancy, the best method of diagnosis is either a tissue culture or a
polymerase chain reaction (PCR) test, which is more sensitive
Nephrogenic diabetes insipidus?
Polyuria occurs in 20%–70% of patients on long-term lithium therapy, even when plasma lithium levels
are in the therapeutic range. This is a result of impaired renal concentrating ability that is resistant to
vasopressin (nephrogenic diabetes insipidus).
Dyspepsia (fullness, bloating, nausea). Tx?
dyspepsia (fullness, bloating, nausea), which can be associated with GERD, testing for and
treating H. pylori is expected to be beneficial.
AMS (mountain sickness) treatment and prevention?
Treatment: Dexamethasone
Prevention: Acetazolamide
how long should this patient continue dual antiplatelet therapy, who recently underwent angioplasty with placement of a drug-eluting stent for the treatment of left main coronary artery disease and acute coronary syndrome.?
Dual antiplatelet therapy should extend beyond 1 year for patients with acute coronary syndrome who are not considered at high risk of bleeding, especially those with risk factors associated with high ischemic risk such as diabetes mellitus, peripheral artery disease, left main stenting, or a history of a cardiovascular event.
For dual antiplatelet therapy that continues beyond a year, either ticagrelor, 60 mg twice daily, or clopidogrel, 75 mg daily, is recommended in addition to aspirin.
The patient’s bleeding and ischemic risk should be reevaluated at least annually.
Dual antiplatelet therapy should continue for at least 1 year in patients who are considered at high risk of bleeding.
For patients who are at very high risk of bleeding or who experience significant bleeding while on dual antiplatelet therapy, a duration of less than 1 year is recommended.
Most appropriate management of stress-induced (Takotsubo) cardiomyopathy after discharge?
A diuretic + ACE or ARB inhibitor + β-blocker until his symptoms and the abnormalities seen on the echocardiogram resolve
Treatment for toxic multinodular goiter?
Radioactive
iodine ablation and thyroidectomy with subsequent thyroid hormone replacement are both appropriate
treatments for toxic multinodular goiter,
Groups that have the highest prevalence of syphilis?
The risk
for syphilis infection is highest among men who have sex with men and among persons who are
HIV-positive.
Diabetes insipidus?
Diabetes insipidus (DI) results from insufficient antidiuretic hormone (ADH) production by the hypothalamus (central diabetes insipidus) or from impaired ADH action in the kidney (nephrogenic diabetes insipidus). ADH deficiency results in large amounts of dilute urine.
Current guideline for target hemoglobin in CKD?
Current guidelines recommend a target hemoglobin of 11 to 12 g/dL.
Treatment with erythropoiesis-stimulating agents should only be initiated when the hemoglobin falls below 10 g/dL
Which test for steatorrhea is sufficient to confirm the diagnosis of chronic pancreatitis?
72-hour fecal fat determination
Whereas normal fecal fat excretion is less than 6 grams per day, more than 6 grams per day is considered pathological, and patients with steatorrhea typically excrete more than 20 grams per day.
What is a common direct pancreatic function test used for the diagnosis of chronic pancreatitis, including early pancreatic insufficiency?
Secretin pancreatic function testing.
Research Statistics: Summarizing Data
Number needed to treat (NNT) = 1 / absolute risk reduction
Odds ratio (OR) = odds of the outcome in the exposed group / odds of the outcome in the nonexposed group
Relative risk (RR) = event rate in intervention group / event rate in control group
Absolute risk reduction = event rate in control group − event rate in intervention group
RR reduction = 1 − RR, or absolute risk reduction / event rate in control group
Attributable risk = incidence risk among exposed group − incidence risk among nonexposed group
Number needed to harm = 1 / attributable risk
Imaging needed for tinnitus?
Pulsatile tinnitus, unilateral tinnitus, or tinnitus associated with asymmetric hearing loss is more likely to be associated with a pathologic cause.
MRI head
What tests performed at the time of admission can best predict the severity of pancreatitis?
Hematocrit,
BUN, and creatinine levels are the most useful predictors of the severity of pancreatitis, reflecting the
degree of intravascular volume depletion.
Monitoring glucose control in
patients with diabetes and hemoglobinopathies?
Serum Fructosamine correlates well with
hemoglobin A1c levels and is recommended instead of hemoglobin A1c for monitoring glucose control in
patients with diabetes and hemoglobinopathies.
What test is done to confirm proteinuria in the nephrotic range?
A spot urine protein/creatinine ratio is now suggested instead
of a 24-hour collection of urine.
FDA for the treatment of New York Heart Association class II–IV heart failure with reduced ejection fraction regardless of the presence of diabetes mellitus.
Dapagliflozin
What is needed to qualify for palliative care?
Serious illness
Kidney stone passage?
< 5 mm: likely to pass spontaneously
> 8 mm: unlikely to pass
Numbness and tingling, ataxia, glossitis, and weakness, fatigue, easy bruising. Dx?
vitamin B12 (cobalamin) deficiency
Which of the following findings on pleural fluid analysis of a pleural effusion indicates a diagnosis of cerebrospinal fluid leakage into the pleural space?
Detection of beta-2 transferrin
Higher levels of which sex hormone are associated with increased risk of AVNRT?
Progesterone.
SVT vs Sinus tachycardia?
P wave buried in QRS in SVT
How does the timing of symptoms differ between rheumatoid arthritis and osteoarthritis?
Morning stiffness occurs in rheumatoid arthritis, whereas osteoarthritis symptoms are often worse later in the day after overuse.
Serology tests is most specific for rheumatoid arthritis?
Anti-citrullinated peptide antibodies
What antibiotic is routinely recommended for dog bite wounds?
Amoxicillin-clavulanic acid.
Exposure to be rabies should be considered in those patients who have made contact with an infected animal’s ?
Saliva, central nervous system tissue, or cerebrospinal fluid.
Chorioretinitis, hydrocephalus, and intracranial calcifications. Dx?
classic triad of congenital toxoplasmosis
Congenital toxoplasmosis medication for preventing transmission in infected mother?
spiramycin (< 18 weeks GA)
pyrimethamine plus sulfadiazine (≥ 18 weeks GA)
Clindamycin contraindicated in pregnancy
Treatment of toxoplasmosis?
Tx: pyrimethamine + sulfadiazine or clindamycin, PLUS leucovorin to prevent myelosuppression
Clindamycin contraindicated in pregnancy
The classic facial dysmorphologies?
Smooth philtrum,
shortened palpebral fissures, and a thin vermilion border of the upper lip.
Premature adrenarche workup?
Laboratory studies and radiography warrant consideration if the
patient develops secondary sex characteristics before the age of 8, or if her height velocity increases
rapidly during the surveillance period.
headache, palpitations, and sweating. Dx?
pheochromocytomas
Preadolescent children with
hypertension should be evaluated for possible ?
Secondary causes and renal ultrasonography should be the
first choice of imaging in this age group.
Medications that causes higher risk for kidney stone formation?
Topiramate (Topamax)
fifth metatarsal fracture treatment?
Compressive dressings
such as an Aircast or Ace bandage, with weight bearing and range-of-motion exercises as tolerated.
Minimally displaced (<3 mm) avulsion fractures of the fifth metatarsal tuberosity can be treated with a
short leg walking boot.
If the displacement is >3 mm, an orthopedic referral is warranted.
DDH screening?
The American Academy of Pediatrics, however, recommends routine screening of all newborns
with physical examination maneuvers, and targeted screening ultrasonography for infants who were breech
in the third trimester, have a family history of DDH, or have a personal history of instability.
Diagnosis of orthostatic hypotension?
Decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within 5 minutes of standing from a supine position
What is the first-line prescription medication recommended for treatment of orthostatic hypotension?
1st line: Fludrocortisone (expands intravascular volume)
Midodrine and droxidopa (Northera) act to increase peripheral vascular resistance
Menopausal treatment?
Menopausal hormone therapy (estrogen alone or combine with progestin) is the treatment of choice in healthy, symptomatic women who are within 10 years of menopause or younger than age 60 years and who do not have contraindications including a history of breast cancer, coronary heart disease, a previous venous thromboembolic event or stroke, or active liver disease.
Women with moderate to severe hot flashes who are not candidates for hormone therapy can use nonhormonal agents?
Nonhormonal agents such as selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors for symptom management.
The only two nonhormonal drugs that are FDA-approved for the treatment of vasomotor symptoms associated with menopause are paroxetine and fezolinetant, a neurokinin B receptor antagonist.
Paroxetine can inhibit the conversion of tamoxifen to its active metabolite, so women who are on tamoxifen therapy should consider a different therapy for the management of hot flashes.
Since acute cervical lymphadenopathy secondary to viral or bacterial etiologies is common, how long should lymphadenopathy be monitored for resolution before further diagnostic workup is warranted?
4 to 6 weeks.
What diabetic agent is recommended for patients with contraindications to metformin who have heart failure?
SGLT2 inhibitor such as empagliflozin.
Appetite stimulant hormones?
Ghrelin and somatostatin
Best testing method for making the diagnosis of acute localized pulmonary histoplasmosis?
Serology by complement fixation and immunodiffusion tests
Reversible or treatable causes of delirium?
Uncontrolled pain, constipation, urinary retention, infections (e.g., urinary tract infections), and medication side effects.
Which medications for the treatment of type 2 diabetes has been associated with ketoacidosis?
Dapagliflozin (Farxiga)
Risk factor for committing intimate partner violence?
Young age
Unvaccinated flu age range?
Previously unvaccinated patients ages 6 months to 8 years should receive
two doses of either trivalent or quadrivalent vaccine separated by 1 month.
(FABER) test positive. Dx?
sacroiliac joint dysfunction.
Positive FABER test,
and pain in the groin area. Dx?
Femoroacetabular impingement
+ log roll test. Dx?
Piriformis syndrome
Recommended duration of anticoagulation therapy in provoked VTE?
3 months
First-line treatment for primary focal hyperhidrosis ?
topical 20% aluminum chloride.
Cancers of what has the highest risk of developing venous thromboembolism (VTE) and should receive pharmacologic VTE prophylaxis during hospitalizations?
Cancers of the pancreas and stomach have the highest risk of developing venous thromboembolism (VTE) and should receive pharmacologic VTE prophylaxis during hospitalizations.
Acquired hypercoagulable factors?
Such risk factors include obesity, pregnancy, prolonged immobility, recent surgical procedure, trauma, certain medications including hormone therapy and combined oral contraceptives, malignancy, and liver disease.
Antiphospholipid syndrome (Beta-2 glycoprotein and cardiolipin, assay of lupus anticoagulant)
Inherited hypercoagulable factors?
There are five main inherited conditions that predispose patients to venous thromboembolism: protein C deficiency, protein S deficiency, antithrombin deficiency, prothrombin gene mutation, and factor V Leiden mutation.
Which tests for inherited coagulation disorders cannot be accurately tested during an acute venous thromboembolism?
Antithrombin, protein C, and protein S deficiencies.
Most common infectious etiology of diarrhea in patients with AIDS?
Cryptosporidium
HIV infections based on CD 4 counts?
Chronic watery diarrhea: Cryptosporidium
White cottage-cheese lesions: Candida
Irremovable white lesions on lateral tongue: hairy leukoplakia (EBV)
Pneumonia, CD4 < 200/mm3: PCP
TB: CD4 < 200/mm3, may have negative CXR or PPD
Ring-enhancing intracranial lesions + focal neurologic deficits: Toxoplasma gondii
Ring-enhancing intracranial lesions + AMS: primary CNS lymphoma
Meningitis, CD4 < 100/mm3: Cryptococcus
Focal neurologic deficits, nonenhancing white matter lesions, CD4 < 200/mm3: PML (JC virus)
Retinitis, cotton-wool spots: CMV
Dark purple skin or mouth nodules: Kaposi sarcoma
Cutaneous: HSV, zoster reactivation
Febrile seizure?
Febrile seizures are most common between the ages of 6 months and 5 years and most commonly occur during the initial spike in temperature.
There are two types of febrile seizures: simple and complex.
Simple febrile seizures last < 15 minutes, occur once during a single illness, and are nonfocal.
Complex febrile seizures are prolonged, recurrent (with more than one seizure during an acute illness), or focal in nature.
The primary event in aortic dissection is a tear in the ?
The primary event in aortic dissection is a tear in the aortic intima.
Skin Cancer comparisons?
SCC vs BCC?
BCC: “pearly border” and telangiectatic vessels.
SCC: Erythematous or flesh-colored papules or nodules with hyperkeratosis and central erosions or ulcerations.
What topical treatment is recommended for mild to moderate papulopustular rosacea?
Topical metronidazole, azelaic acid, or ivermectin is recommended with sodium sulfacetamide as an alternative topical therapy.
Somatic conversion disorder, also known as functional neurological symptom disorder. Tx?
SSRI
normocytic
anemia and evidence of renal insufficiency, which can indicate ?
normocytic
anemia and evidence of renal insufficiency, which can indicate MM.
Breast cancer survivors should undergo a history and physical examination ?
Breast cancer survivors should undergo a history and physical examination every 3–6 months for the first
3 years after treatment, then every 6–12 months for the next 2 years, and then annually thereafter
beta-thalassemia minor lab values?
beta-thalassemia minor almost always have a hematocrit > 30%, a mean corpuscular volume < 75 fL, and a normal red cell distribution width since cells are hypochromic and microcytic.
Major side effects of amiodarone ?
Major side effects of amiodarone are as follows: pulmonary toxicity (most commonly interstitial disease, including pulmonary fibrosis),
nephrotoxicity (causing or worsening chronic kidney disease),
ocular abnormalities (including optic neuropathy and blindness),
cardiac toxicity (ventricular dysrhythmias and bradycardia),
hepatotoxicity (hepatitis),
metabolic dysfunction (including hyper- or hypothyroidism and lipid abnormalities),
neurologic abnormalities (tremor, ataxia, neuropathy), and
disturbances of the integumentary system.
Ocular adverse reactions are the most common adverse effect of amiodarone use, as the drug can cause corneal microdeposits in up to 98% of patients.
However, these do not often result in vision changes, and only a small fraction of patients report ocular symptoms with amiodarone therapy.
For this reason, ophthalmological surveillance is not required for patients taking amiodarone without ocular symptoms, although all patients should have a baseline eye exam at the start of therapy.
Organ systems most commonly affected by long-term amiodarone use but does not require annual surveillance while on amiodarone therapy?
Ocular
What are the complications of cryptorchidism?
Testicular carcinoma, subfertility and testicular torsion.
What virus is associated with Hodgkin lymphoma?
Epstein-Barr virus is thought to play a role in the pathogenesis of Hodgkin lymphoma and can be detected in Reed-Sternberg cells.
high-risk wild animal for rabies?
high-risk wild animal (e.g., bat, raccoon, skunk, bobcat, fox, woodchuck, and coyote) that is not available for testing.
CT finding of IPF (pul fibrosis)?
High-resolution CT to establish the diagnosis shows peripheral, bibasilar reticular opacities associated with architectural distortion, including honeycomb changes and traction bronchiectasis. Honeycombing refers to clusters of cystic airspaces approximately 3 to 10 mm in diameter, usually in a subpleural location.
What high-resolution CT image is associated with asbestosis?
Pleural plaques, especially with linear bands of calcification.
Most common surgical emergency in pregnant patients?
Appendicitis
When does acute fatty liver of pregnancy typically occur?
During the third trimester.
Pityriasis rosea rash characteristic?
The eruption typically begins with a “herald” patch manifesting as a single round or oval, sharply demarcated, pink or salmon-colored lesion on the neck, chest, or back. It is typically 2 to 5 cm in diameter and becomes scaly and begins to clear centrally, leaving the free edge of the cigarette paper-like scale directed inwards toward the center (“collarette”).
1st: Round to oval patch
2nd: Scaly and clear centrally
What treatments may be useful for patients with severe presentations of pityriasis rosea?
Acyclovir and ultraviolet light therapy.
Furosemide mechanism of action?
Inhibits reabsorption of sodium, potassium, and chloride ions in the loop of Henle
Simple vs Complex febrile seizure?
Simple
Number of seizures: 1
Duration: < 15 mins
Type: generalized
Complex
Number of seizures: > 1 in 24 hrs
Duration: > 15 mins
Type: focal or generalized
Acetazolamide. MOA?
Carbonic anhydrase inhibitors
Thiazide MOA?
Inhibiting reabsorption of sodium and chloride ions in the distal convoluted tubule
Aldosterone antagonists. MOA?
Inhibiting the sodium-potassium transporter in the proximal convoluted renal tubule
What are common electrolyte abnormalities seen with loop diuretic use?
Hyponatremia, hypokalemia, and hypomagnesemia. Elevated blood urea nitrogen and creatinine are also common.
Dermatophyte vs candida infection. Tx?
Topical antifungal agents, such as azoles (econazole cream), allylamines, butenafine, ciclopirox, and tolnaftate, which is administered once or twice per day for one to three weeks. For patients with recalcitrant disease or extensive involvement, systemic treatment with terbinafine, itraconazole, griseofulvin, or fluconazole is recommended.
Nystatin ointment should not be used in the treatment of dermatophyte infections as it is not effective. It is used in the treatment of cutaneous and mucocutaneous fungal infections caused by Candida albicans and other susceptible Candida species.
What are the three primary characteristics of eosinophilic granulomatosis with polyangiitis (Churg-Strauss)?
Chronic rhinosinusitis, asthma, and peripheral blood eosinophilia.
GDM 3 hour OGTT criteria?
Diagnostic criteria
ADA: 3-hour 100 g OGTT results
> 95 mg/dL fasting,
> 180 mg/dL at 1 hour,
> 155 mg/dL at 2 hours, or
> 140 mg/dL at 3 hours
AOM treatment?
amoxicillin,
consider amoxicillin-clavulanate in otitis-conjunctivitis syndrome
What are the primary differences in side effect profiles between first- and second-generation antipsychotics?
First-generation antipsychotics often cause extrapyramidal symptoms such as tardive dyskinesia, while second-generation antipsychotics are known for weight gain and metabolic disorders.
Schizophreniform disorder?
at least 1 month and < 6 months
Schizoaffective disorder?
psychosis + mania or depression
Schizophrenia?
At least 6 months of a combination of active/prodromal/residual symptoms
Brief psychotic disorder?
< 1 month
Antihistamine VS intranasal corticosteroid?
All antihistamines effectively reduce sneezing, rhinorrhea and pruritus but they are less effective at treating ocular symptoms and nasal congestion.
Whereas intranasal corticosteroid helps with ocular symptoms.
Which second generation antihistamine causes more sedation compared to others?
Cetirizine.
What are some common negative symptoms seen in schizophrenia?
Flat affect, lack of energy, inexpressive facial expressions, poverty of speech, and monotone speech.
FDA for PrEP HIV?
The medications approved by the US Food and Drug Administration for use in HIV PrEP include oral emtricitabine-tenofovir disoproxil fumarate.
What is the treatment for prevention of coronary artery aneurysm development in patients with Kawasaki disease?
Early intervention with intravenous immune globulin and aspirin therapy has dramatically decreased the frequency of coronary artery aneurysm development.
Kawasaki symptoms?
CRASH and burn: conjunctivitis, rash, adenopathy, strawberry tongue, hand or foot edema, uncontrolled high fever
Which two findings on urinalysis are associated with a diagnosis of acute cystitis in women?
Positive nitrites and trace leukocytes.
What type of immune reaction is seen in systemic lupus erythematosus?
Immune complex-mediated reaction (type III hypersensitivity)
SLE symptoms and tests?
Diagnosis of SLE is based on meeting at least 4 of the 11 criteria
malar rash, discoid rash, photosensitivity, oral ulcers, nonerosive arthritis, serositis, kidney disorder, neurologic disorder, hematologic disorder, immunologic disorder, positive antinuclear antibody.
The antinuclear antibody (ANA) test is positive in nearly all patients with SLE but is positive in up to 50% of patients who do not have SLE.
Therefore, a negative ANA test virtually rules out the diagnosis.
A positive test should prompt further evaluation with more specific antibodies, such as anti-dsDNA and anti-Sm antibodies.
A ventricular septal defect involving which of the following segments requires periodic surveillance for sinus node dysfunction and tricuspid regurgitation?
Atrioventricular septum
(Gerbode defect)
Pneumocystis jirovecii pneumonia treatment?
oral trimethoprim-sulfamethoxazole for 21 days.
Additionally, patients with Pneumocystis jirovecii pneumonia should start, antiretroviral therapy within two weeks of Pneumocystis treatment.
Hydrofluoric acid treatment?
After exposed clothes are removed, copious water irrigation and calcium are the mainstays of treatment of hydrofluoric acid burns. Applying calcium gluconate gel to the burned area will prevent further toxicity.
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a survey is for?
Patient satisfaction
Levothyroxine dose in pregnancy?
It is therefore recommended that women who take levothyroxine daily increase their dose to nine weekly doses (one extra dose on two days of the week). This should be done as soon as the pregnancy is confirmed.
Episodes of flushing, diarrhea, and bronchospasm. Dx?
Carcinoid syndrome
Carcinoid syndrome. test?
Measurement of the 24-hour urinary excretion of the serotonin byproduct 5-hydroxyindoleacetic acid (5-HIAA)
In which type of dementia do patients develop Parkinsonian movement disorders?
Lewy body dementia.
Polymyositis associated with?
Associated with an increased risk of malignancy
Most common risk factor for the development of oral leukoplakia?
Smokeless tobacco products
Arterial vs Venous insufficiency?
Lateral aspect of the ankle are more likely due to arterial insufficiency
Medial aspect of the ankle are more likely due to venous insufficiency
Treatment for venous insufficiency?
Treatment of venous insufficiency involves gradient compression stockings that provide 30–40 or 40–50 mm Hg of compression at the ankle, with decreasing levels of compression proximally. Leg elevation augments venous return to the heart
Painless gross hematuria, constitutional symptoms (e.g., weight loss, fatigue, anorexia), suprapubic tenderness, and enlarged para-aortic lymph nodes are suggestive of?
bladder cancer.
Which of the following signs or symptoms is typical of Morton neuroma?
Examination may reveal paresthesia or pain when the first and fifth metatarsal heads are squeezed together. If an audible click is heard, it is called Mulder sign, representing a fibrotic neuroma.
When Morton neuroma lesions are seen on ultrasound, what size is considered clinically important?
Lesions over 5 mm in diameter.
Which scaphoid fracture needs referral to orthopedic?
proximal, medial and displaced fractures require an urgent orthopedic referral.
Treatment for scaphoid fracture?
If these imaging tests are not available, then X-rays may be repeated in 10 to 14 days while the area is kept immobilized. Nondisplaced distal fractures generally heal well with a thumb spica cast
Criteria for SLE as an obligatory entry?
The newer 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus has a higher sensitivity than the previous criteria and includes a positive ANA with a titer ≥ 1:80 at least once as an obligatory entry criterion.
Treatment for SLE?
Hydroxychloroquine reduces disease flares and is the mainstay of treatment. Low-dose glucocorticoids are used to treat most manifestations of lupus.
Most common cause of drug-resistant hypertension?
Primary hyperaldosteronism
What is the treatment for individuals with erysipelas who have systemic manifestations?
Parenteral cefazolin, ceftriaxone, or flucloxacillin. Patients with mild infection may be treated with oral penicillin or amoxicillin, or cephalexin or clindamycin in those with a beta-lactam allergy.
The recommended treatment for oppositional defiant disorder is ?
The recommended treatment for oppositional defiant disorder is psychotherapy, particularly therapy for the parents as well as the child.
Negatively vs Positive birefringent?
Calcium pyrophosphate deposition synovitis: Positive
Gout: Negative
What medication was approved by the US Food and Drug Administration in 2017 for adults with moderate to severe atopic dermatitis not adequately controlled with topical therapies?
Dupilumab, an interleukin (IL)-4 receptor alpha antagonist.
Symptoms more common with right-sided colorectal cancers than with cancers located elsewhere in the bowel?
Iron deficiency anemia
Pediatric Enuresis treatment?
In children 6 years of age and older who have failed behavioral interventions, desmopressin is recommended as first-line pharmacotherapy.
Peritoneal empiric therapy?
Intraperitoneal empiric therapy covering both gram-positive and gram-negative organisms should be started in patients using peritoneal dialysis with suspected peritonitis. Gram-positive organisms may be covered by vancomycin or a first-generation cephalosporin, such as cefazolin. Gram-negative organisms may be covered by a third-generation cephalosporin or an aminoglycoside.
PPI medication without regard to meal timing?
Dexlansoprazole
Endoscopy to screen for Barrett esophagus?
Endoscopy to screen for Barrett esophagus is not routinely recommended, but may be considered in white men 50 years of age or older who have had GERD symptoms for at least 5 years
Nighttime reflux medication?
Patients with significant nighttime reflux symptoms may benefit from omeprazole and sodium bicarbonate because of its effectiveness in controlling nighttime pH.
What metabolic disorders are linked to slipped capital femoral epiphysis?
Hypothyroidism and growth hormone deficiency.
Samter Triad?
Samter Triad
Classic Features:
- Asthma
- Aspirin sensitivity (e.g., bronchospasm with aspirin use)
- Nasal polyps
Tx: avoid aspirin and NSAIDs, treat asthma, and manage nasal polyps (e.g., surgery or intranasal steroids)
Contraindication for OCP’s?
Research formulas?
Hyponatremia correction?
Acute/symptomatic: small increase in sodium often sufficient to resolve symptoms (ex. 2 mEq/L/hour for the first 2–3 hours or 4–6 mEq/L over 6 hours); monitor sodium closely
Chronic: correct by 4–6 mEq/L in 24 hours
peripheral smear of different disease?
laboratory results support the diagnosis of iron deficiency anemia?
Decreased serum ferritin, decreased transferrin saturation, increased total iron binding capacity
Juvenile idiopathic arthritis?
Jersey vs Mallet injury?
Mallet is injury to the extensor tendon. Splint for 6 weeks. Orthopedic referral for avulsion fracture.
Lung cancer test based on their location (Central and Peripheral).
TIMI risk score
All patients with non-ST elevation acute coronary syndrome should undergo early risk stratification as soon as possible after the diagnosis is made.
A higher TIMI risk score correlates with an increased number of events such as all-cause mortality, new or recurrent myocardial infarction, or severe recurrent ischemia requiring revascularization at 14 days.
Treatment for Prelabor rupture of membranes ?
Patients between 34 and 0/7 – 36 and 6/7 weeks should be administered antibiotics for group B streptococcus prophylaxis and preparations for delivery should be made.
EKG finding in Brugada syndrome?
ECG is the recommended initial test, looking for characteristic changes in the ST-segment to include either downsloping ST-segment elevation in leads V1–V2 or a “saddle-back” ST-segment in leads V1–V2.
