Rosh Material #1 Flashcards
mc cause of action tremor in adults
essential tremor
essential tremor is triggered by (2)
voluntary movement
fixed posture against gravity
t/f: essential tremor is typically bilateral
t!
essential tremor classically affects the (2)
hands
arms
tx for essential tremor (6)
propranolol
primidone
gabapentin
tpiramate
etoh
botulinum
what do you think when you see “stroking of the skin that results in localized hives”
urticaria
tx for urticaria
avoid triggers
antihistamines
glucocorticoids (if associated w. angioedema)
3 common causes of urticaria
food
meds
infections
circumscribed, raised, erythematous papules and plaques on the face lips, extremities, or genitals
urticaria
t/f: individual urticaria lesions last < 24 hr
t!
what do you think when you see “lateral pressure in the initial lesion causes separation of the epidermis”
nikolsly sign
2 conditions associated w. nikolsky sign
staphylococcal scalded skin syndrome
pemphigus vulgaris
lesions that last longer than 24 hr that burn or sting
urticarial vasculitis
mimics urticaria
what do you think when you see “lesions with an initial central puncture”
insect bite → papular urticaria
what do you think when you see “opacity with penlight exam taht takes up fluorescein stain”
corneal ulcers
corneal ulcers are commonly caused by
infectious bacterial keratitis
what pathogen is associated w. infectious bacterial keratitis
pseudomonas aeruginosa
mc risk factor associated w. bacterial keratitis
contact lenses
also trauma and prior eye surgery
corneal ulcers that are round and central
infectious keratitis
corneal ulcers that are smaller and located more on the periphery of the cornea
contact lens induced ulcers
tx for infectious bacterial keratitis ulcers
topical moxifloxacin
tx for non infectious causes of corneal ulcers
topical steroids
clinical sx of bacterial keratitis induced corneal ulcers
foreign body sensation
trouble keeping eye open
conjunctivitis
photophobia
tx for acute bacterial conjunctivitis in non contact lens wearer
erythromycin ointment
tx for glaucoma
latanoprost drops
glaucoma leads to reduced __ vision
peripheral
mc cause of infectious ulcers in non contact lens wearer
staph
t/f: bacterial keratitis ulcers are a medical emergency
t!
what do you think when you see “cobblestoning of the intestinal mucosa”
Crohn disease
Crohn disease mc affects which part of the intestines
terminal ileum → RLQ
what do you think when you see “patchy, transmural inflammation of the intestines” and “skip lesions”
Crohn disease
t/f: diarrhea associated w. Crohn’s is typically non bloody
t!
definitive dx test for Crohn’s
colonoscopy with intubation of the ileum
mainstay tx for Crohn’s
5-aminosalicylic acid derivatives →
corticosteroids
immunomodulators
6 intestinal sx of Crohn’s
chronic diarrhea
crampy abdominal pain
fever
wt loss
strictures
fistulas
7 extra intestinal manifestations of Crohn’s
pyoderma grangrenosum
erythema nodosum
ankylosing spondylitis or sacroilitis
arthritis
uveitis
liver dz
nephrolithiasis
t/f: IBS is typically associated with wt loss
f!
colonoscopy findings of IBS
normal
t/f: UC is associated with bloody diarrhea
t!
what do you think when you see, “continuous mucosa inflammation confined to the colon and rectum”
UC
is Crohn’s or UC associated with pseudo polyps
UC
what do you think when you see:
aphthous ulcers, anal fissures, perirectal abscesses anorectal fistulas
Crohn’s
t/f: surgery is curative for Crohn’s
f!
t/f: COPD patients show improvement in PFTs after bronchodilator tx
f!
step 1 tx for asthma
PRN ICS → formoteral
OR
PRN ICS + PRN SABA
step 2 tx for asthma
daily low dose ICS (formoterol)
OR
OR PRN low dose ICS (formoterol)
step 3 tx for asthma
low dose ICS PLUS LABA
step 4 tx for asthma
medium dose ICS
PLUS
LABA
step 5 tx for asthma
high dose ICS
PLUS
LABA
all asthma patients should have __ for acute relief
PRN ICS → formoterol
OR
PRN SABA
what do you think when you see “no change in FEV or FVC after bronchodilator therapy”
COPD
what class of drug is montelukast
leukotriene inhibitor
ABI < __ is considered critical limb ischemia
- 4
* pain at rest*
gs for dx of PAD
contrast arteriography
order of tx for PAD
- lifestyle mods → f/u in 3 mo
- trial of cliostazol → f/u in 3 mo
- advanced vascular imaging
- angioplasty/stenting
t/f: PAD is mc asymptomatic
t!
define intermittent claudication
pain related to activity
what do you think when you see “cool extremity w. absent/diminished pulses
PAD
mc cause of PAD
atherosclerotic dz
what pt population do you think of when you see acanthuses nigricans
DM
CTS involves compression of the __ nerve
median
3 rf for CTS
female
pregnant
DM
2 PE tests for CTS
phalen
tinel
2 dx tests for CTS
electromyography
nerve conduction studies
1st line tx for CTS
night splints
also NSAIDs, PT, corticosteroid injxns
definitive tx for CTS
surgical decompression
hypothenar atrophy is associated with damage to the __ nerve
ulnar
cubital tunnel syndrome is associated with damage to the __ nerve
ulnar
positive adon test is indicative of __ syndrome
thoracic outlet
classic signs of infective endocarditis
FROM JANE:
fever
roth spots
osler nodes
murmur
laneway lesions
anemia
nail bed hemorrhages
emboli
how many cultures should be drawn for endocarditis
3
gs dx for endocarditis
transthoracic ECG
duke criteria
2 major
OR
1 major and 3 minor
OR
5 minor
major duke criteria (2)
positive cultures
ECG findings
which valve is mc affected by infective endocarditis in IVDU
tricuspid
mc cause of vaginitis
BV
rf for BV
WSW
douching
multiple sex partners
not using condoms
smoking
describe the discharge with BV
think
milky gray-white
fishy odor
what do you think when you see KOH findings of “epithelial cells covered w. bacteria”
BV
what do you think when you see “clue cells”
BV
tx for BV
metronidazole 500 mg bid x 7 days
t/f: pregnant women with BV can take metronidazole 500 mg bid x 7 days
t!
tx for vulvovaginal candidiasis
fluconazole 200 mg bid x 7 days
discharge in vulvovaginal candidiasis
thick
white
curd like
tx for trichomonas vaginitis
metronidazole 2 g PO one dose
discharge in trichomonas vaginalis
frothy
yellow-green
PE finding consistent with trichomonas vaginalis
cervical petechiae
BV involves pH > __
and __ cells
4.5
clue
mc bacteria associated with BV
gardnerella vaginalis
mc pathogen associated w. CAP
strep pneumo
also h.flu, klebsiella, staph
2 atypical pathogens associated w. CAP
legionella
mycoplasma
op tx for CAP
macrolide
OR
doxy
inpt or high risk tx for CAP (significant PMH)
fluoroquinolone
OR
fluoroquinolone PLUS macrolide or doxy
2 causes of hyperresonance to percussion of lungs
PTX
obstructive lung dz
3 PE findings associated with pleural effusion
dullness to percussion
decreased tactile remits
decreased breath sounds
what do you think when you see ECG with “brief 3 Hz spike and wave discharges”
absence sz
what do you think when you see ECG with “focal or lateralized sharp spikes and slow waves”
complex partial sz
4 tx for focal sz
phenytoin
valproic acid
phenobarbital
lamotrigine
2 tx for absence sz
ethosuximide
valproic acid
4 tx for tonic clonic sz
carbamazepine
phenobarbital
levetiracetam
phenytoin
tx for status epilepticus
airway management
IV dex
IV benzo followed by IV phenytoin or fosphenytoin
3 phases of tonic clonic sz
tonic
clonic
postictal
usually occurs in infancy and involves sudden flexion or extension of muscles
epileptic spasm
single sz > 5 min
OR
2 or more sz w.in a 5 min periods w.o recovery between
status epilepticus
brief period of unilateral paralysis following a sz
Todd paralysis
what is this showing
orbital cellulitis
orbital cellulitis involves infection of the (2)
fat
ocular muscles
not the globe
how do you distinguish orbital cellulitis from preseptal cellulitis (3)
orbital cellulitis involves:
ophthalmoplegia
pain w. eye movement
proptosis
CT findings of orbital cellulitis
inflammation of extra ocular muscles
fat stranding
anterior displacement of globe
initial tx for orbital cellulitis
vanco
PLUS
ceftriaxone
mc cause of orbital cellulitis
bacterial rhonosinusitis
also ophthalmologic surgery, orbital trauma, dacrocystitis
t/f: preseptal cellulitis involves vision impairment
f!
2 mc pathogens associated w. orbital cellulitis
staph
strep
definitions of neck strain from acute-chronic
acute: < 6 weeks
subacute: 6-12 weeks
chronic: > 12 weeks
lateral contraction of the neck, causing the head to tilt to one side with the chin rotated in the opposite direction
torticollis
management of specific phobias
- CBT
- benzos
- SSRIs
what type of therapy helps improve the ability to relate to others in an interpersonal way
psychodynamic psychotherapy
condition where the glans penis becomes inflamed
balanitis
inflammation of the distal foreskin
balanoposthisis
balanitis is mc in
uncircumcised pt’s
mc cause of balanitis
candidal infxn
which balanitis is associated w. reactive arthritis and presents with shallow ulcers on the glans
circinate balanitis
balanitis can result in what complication
phimosis or paraphimosis
constricted foreskin can not be retracted over the glans
phimosis
constricted foreskin is retracted over the glans and can not be reduced
paraphimosis
3 tx for candidal balanitis
topical imidazole
nystatin cream
oral fluconazole
tx for bacterial balanitis
topical metronidazole
oral augmenting
topical clinda
what do you think when you see a pt with a painful pruritic glans penis, with small erythematous lesions and thick foul-smelling d.c
balanitis
what do you think when you see a pt with a painful pruritic glans penis, with small erythematous lesions and thick foul-smelling d.c
balanitis
penile deformity 2/2 to fibrosis of the tunica albuginea that causes abnormal penile curvature and pain during erection
peyronie dz
reactive arthritis triad
conjunctivitis
urethritis
arthritis
can’t see, can’t pee, can’t climb a tree
inflammation of the glans penis AND the foreskin
balanoposthisis
what lung condition do you think of when you see asbestos exposure: insulation, flooring, paint cement
mesothelioma
what do you think when you see: pleural opacities in the lower lungs in a multi nodular pattern
mesothelioma
mc type of malignant mesothelioma
pleural mesothelioma
4 clinical signs of mesothelioma
age > 60
present decades after exposure
gradually worsening, nonspecific sx
pleural effusion
environmental lung disorder common in workers exposed to silica
silicosis
mainstay of BPH tx
alpha 1 adrenergic antagonists→ the -osins
ex tamsulosin, doxazosin
which class of BPH drug reduces the size of the prostate and improves symptoms
5 alpha reductase inhibitors → -sterides
ex finasteride, dutasteride
4 types of drugs used to treat BPH
alpha-1 adrenergic antagonists → zosin
5 alpha reductase inhibitors → steride
anticholinergics → ex oxybutinin
phosphodiesterase-5 inhibitors → ex tadalafil
common s.e of tadalafil
HA
abd pain
muscle pain
stuffy nose
flushing
what do you think when you see PE findings of “smooth, firm, mobile prostate without any nodules or indurations.”
BPH
BPH is mc in which zone
transitional
surgery for BPH
TURP
which bacterial diarrhea is associated with dysentery
shiga toxin
first line tx for shigella
azithromycin
ciprofloxacin
tx for girardia
metronidazole
tx for entamoeba histolytica
metronidazole
which shigella species is associated with reactive arthritis
shigella flexneri
presentation of shigellosis
fever
bloody mucoid diarrhea
seizures (kids)
labs for shigellosis will show (2)
RBCs
WBCs
complications of shigellosis
HUS
reactive arthritis
mc symptom of menopause
hot flashes
definition of menopause
no menstrual cycle x 12 consecutive months w.o any pathologic cause
menopause is characterized by decreased __
and increased __
estrogen
FSH
dx to consider for women experiencing sx of menopause who are younger than the average age of onset
hyperprolactinemia
t/f: weight gain is typically associated w. menopause
f!
2 mc pathogens associated w. otitis media
h. flu
strep pneumo
tx for acute otitis media in Peds < 24 mo
amoxicillin
when can you consider obs as tx for acute otitis media
kids 24 mo or older
unilateral AOM w. mild symptoms < 48 hr duration
no fever or otorrhea
when is augmentin considered first line tx for AOM
pt has had beta lactam abx in the last 30 days
recurrent AOM
concomitant purulent conjunctivitis
abx tx for AOM if pt has anaphylactic reaction to amoxicillin
azithromycin
OR
clindamycin
3 mc identifiable causes of interstitial lung dz
occupational and environmental agents
drug induced
radiation induced
med notorious for causing interstitial lung dz
amiodarone
2 PE findings of interstitial lung dz
crackles
clubbing
PFT findings of interstitial lung dz
restrictive pattern →
reduced FVC and total lung capacity
normal or increased FEV1/FVC ratio
gs test for interstitial lung dz
CT
CT findings of interstitial lung dz
ground glass opacities
honeycombing
reticular opacities
reticulonodular opacities
what does bilateral hilar adenopathy make you think of
sarcoidosis
what do pleural plaques make you think of
asbestos related pulmonary dz
what type of ventilatory pattern is seen with asthma
obstructive
recommended dose of APAP in kids
10-15 mg/kg/dose
max dose of APAP in kids
90 mg/kg/day
emergent care should be administered if APAP dose exceeds
200 mg/kg
OR
10 g total
x 24 hr
tx protocol for peds APAP overdose
- activated charcoal at 1 g/kg
- serum APAP level at least 4 hr after ingestion and then q 1-2 hr
- N-acetylcysteine if probable toxicity
when might endoscopy or surgery be indicated in a toxic ingestion
heavy metals
pharmacobezoar
illicit drug
2 most effective drugs for smoking cessation
- varenicline
- bupropion
contraindication for bupropion
sz disorder
3 first line tx for smoking cessation
NRT (nicotine replacement therapy)
bupropion
varenicine
second line tx for smoking cessation
nortriptyline
combo bupropion PLUS NRT
clonidine
contraindication for verenicline for smoking cessation
pmanic dpn
schizophrenia
etoh abuse
when do nicotine withdrawal sx peak
3 days
2 tx for hyperthyroidism
methimazole
propylthiouracil
which drug for hyperthyroidism is contraindicated in the first trimester of pregnancy
methimazole
tx for hyperthyroidism in first trimester of pregnancy
PTU
p for pregnant
pathogens commonly associated w. pyelonephritis
e coli
pseudo
enterobacter
proteus
klebsiella
op tx for pyelonephritis
fluoroquinolone
bactrim
parenteral tx for pyelonephritis
ceftriaxone
fluoroquinolone
parenteral tx for severe pyelonephritis
cefepime
zosyn
meropenem
what type of bacteria is the mc cause of acute prostatitis
gram negative
mc e.coli
2 high intensity statins
atorvastatin 40-80mg
rosuvastatin 20-40mg
moderate intensity statins
lovastatin 40-80mg
pravastatin 40-80mg
simvastatin 20-40mg
atorvastatin 10-20mg
rosuvastatin 5-10mg
low intensity statins
pravastatin 10-20 mg
lovastatin 20 mg
fluvastatin 20-40 mg
simvastatin 10 mg
3 common s.e of statins
myopathy, rhabdo
hepatic dysfunction
kidney dysfunction
what is Levine sign and what does it make you think of
clenched fist over midchest
stable angina
stable angina sx last <
15 min
angina > __ is suggestive of MI
15 min
ECG in asymptomatic angina pt
normal
ECG findings of symptomatic angina
horizontal or down sloping ST segment depression
T wave flattening or inversion
only antianginal med shown to improve mortality in pt’s with CAD
beta blockers
first line tx for pt’s with chronic stable angina
beta blockers
all tx for stable angina
nitro
long acting nitrates (isosorbide, dinitrate)
beta blockers
ranolazine
2 meds used to alleviate angina
beta blockers
ranolazine
tx for CAD
daily ASA
high intensity statin
chest discomfort precipitated by activity
sx abate after activity
stable angina
ischemic sx suggestive for ACS
+/- ECG changes indicative of ischemia
unstable angina
troponin elevation
subendocardial ischemia
ST depressions
NSTEMI
troponin elevation
transmural ischemia
ST elevation
STEMI
coronary artery vasospasms
nonexertional symptomatic myocardial ischemia
transient ST elevation that resolves w.sx
inverted U waves
normal cardiac enzymes
absence of CAD
prinzmetal angina
primary rf for prinzmetal angina
smoking
when do prinzmetal sx typically occur
AM
which reflex originates in the cardiac sensory receptors and promotes PSNS activity resulting in bradycardia, vasodilation, hypotn
bezold-jarisch reflex
pathogen that causes TB
tuberculosis myobacterium
test if pt is at high risk for TB exposure
PPD
followed by chest XR based on induration measurement
primary TB usually causes consolidation in which lung lobe
middle or lower
reactivated TB shows cavitary lesions in which lung field
apices
blood test for TB
IGRA → interferon gamma release assay
t/f: IgA test for TB can differentiate between latent and active infxn
f!
gs for active TB infxn
culture of acid fast bacilli bacteria from respiratory secretions
tx for active TB
RIPE →
rifampin
isoniazid
pyrazinamide
ethambutol
latent TB tx
isoniazid PLUS pyridoxine x 9 mo
rifampin x 4 mo
which RIPE drug is associated w. higher rates of hepatitis
isoniazid
colon ca screening rec for pt with fam hx of colon ca
10 yers before the age at which first-degree relative was diagnosed with colon ca
who should be screened earlier than 45 yo for colon ca (3)
personal or strong fam hx
adenomatous polyps
fam hx of hereditary syndrome
colon ca recs for pt 45-75 yo
annual fecal occult blood test OR sigmoidoscopy q 3-5 years
OR
colonoscopy q 10 years
pt’s should not be screened for colon ca past __ yo
85
which criteria are used to identify pt’s who are at increased risk for Lynch syndrome
Amsterdam
which 2 pathogens cause most cases of fungal external otitis
aspergillus
candida
mc cause of fungal otitis externa
abx tx for bacterial otitis externa
what do you think when you see: deep seeded itching, discomfort, otorrhea, foreign body sensation
fungal otitis externa
what is this showing
otomycosis →
mass of epithelial cells containing hyphae
what do you think when you see fine coal dust or wet newspaper like material on otoscopic exam
aspergilus infxn
what do you think when you see: white sebaceous-like pseudomembrane lining the ear canal
candidal infxn
tx for otomycosis
topical clotrimazole 1% bid x 10-14 days
what class of medication used to treat otitis externa should be avoided in the presence of TM perforation
aminoglycosides
risk factor for otomycosis
humid climate
ear wax
ear surgery
topical steroids
oral abx
3 pathogens commonly associated w. PID
chlamydia trachoma’s
Neisseria gonorrhoaea
trichomonas
major criteria for PID
lower and pain in pops w. rf
PLUS
uterine tenderness
OR
adnexal tenderness
OR
cervical motion tenderness
minor criteria for PID
fever > 38
abnormal vaginal d.c
positive culture for gonorrhea or trich
elevated CRP or ESR
op tx for PID
ceftriaxone 500 mg IM
PLUS
doxy 100 mg po bid x 14 days
PLUS
metronidazole 500 mg po bid x 14 days
inpatient tx for PID
cefotetan 2 gm IV q 12 hr x 14 days
PLUS
doxy 100 mg po/iv q 12 hr
tx for PID in pregnant pt
IV ceftriaxone
PLUS
azithromycin instead of doxy
mc cause of PID
chlamydia trachomatis
perihepatitis
PLUS
PID
fitz hugh curtis syndrome
2 mc psychiatric disorders associated w. bulimia
unipolar dpn
specific phobia
management of bulimia (3)
nutritional rehab
CBT
fluoxetine
what emetic is often misused by pt w. bulimia
syrup of ipecac
DSM5 for bulimia
recurrent binge eating followed by inappropriate compensatory behavior at least once a week x 3 months
triad of bulimia
caloric restriction
binge eating
self induced vomiting
HTN guidelines
normal: <120/80
elevated: 120-129 AND <80
stage 1: 130-139 OR 80-90
stage 2: 140 or higher OR 90 or higher
HTN crisis: 180 or higher OR 120 or higher
which CCB is the only one with established safety in pt w. severe heart failure
amlodipine
2 forms of diabetic retinopathy
proliferative
nonproliferative
variable display of nerve fiber layer infarcts (cotton wool spots)
intraretinal hemorrhages
hard exudates
microvascular abnormalities primarily in macula and posterior retina
absence of abnormal new bv emanating from the retina
nonproliferative retinopathy
neovascularization arising from the disc or retinal vessels
pre retinal and vitreous hemorrhage
fibrosis
retinal detachment
proliferative retinopathy
bp goals for pt with concurrent DM and HTN
<140/<90
classification of dysmenorrhea
primary
secondary
membranous
causes of secondary dysmenorrhea
endometriosis
PID
IUD
passage of endometrial cast through the cervix
membranous dysmenorrhea
rf for primary dysmenorrhea (no organic cause)
age < 30 yo
menarche before 12 yo
tobacco use
low BMI
longer or irregular menstrual cycles
hx of sexual assault
triad of endometriosis
dysmenorrhea
dyschezia
dyspareunia
t/f: pain with endometriosis occurs outside of menstrual cycle
t!
t/f: leiomyoma is not typically associated w. pain
t!
it is associated with heavy menstrual bleeding
first line tx for primary dysmenorrhea
NSAIDs
hormonal therapy for primary dysmenorrhea
estrogen-progestin contraceptives
innocent murmurs occur in kids ages
2-7
mc type of innocent murmur
still
what do you think when you see: soft, high pitched crescendo-decrescendo murmur during mid systole along the left sternal border in a kid aged 2-7
still murmur
qualities of innocent murmurs
no radiation
vibratory/musical
quiet precordium
normal S1
no additional heart sounds
PE technique to identify innocent murmurs
standing maneuver
for an innocent murmur, the standing maneuver results in
decrease in both aortic stenosis murmur
AND
decrease in innocent murmur
characteristics of pathologic murmurs
grade 3 or higher
holosystolic
max intensity at left upper sternal border
harsh or blowing quality
systolic click
abnormal heart sounds
diastolic
increased intensity with upright position
gallops
friction rub
handgrip test can identify which type of murmur
mitral regurgitation
the squatting maneuver affects __
and increases which murmur
preload
aortic stenosis
4 causes of mid systolic murmurs
innocent murmurs of childhood
HOCM
aortic stenosis
pulmonic stenosis
patients who recently had a stent placed should be prescribed what 2 meds
dual anti platelet therapy for NSTEMI →
ASA
P2Y inhibitor → tricagrelor OR clopidogrel
what are macrophages called after ingesting LDL at the site of a fatty acid streak
foam cells
what do you think when you see: sudden onset of hematuria, proteinuria, and blood cell casts
glomerulonephritis
nephritic syndromes
post streptococcal glomerulonephritis
IgA nephropathy
Alport syndrome
membranoproliferative glomerulonephritis
rapidly progressive glomerulonephritis
presentation of post streptococcal glomerulonephritis
HTN
periorbital edema
peripheral edema
oliguria
dx for post streptococcal glomerulonephritis
antistreptolysin O titers OR evidence of a recent GAS skin or pharyngeal infxn
low serum complement
azotemia
hematuria, RBC, proteinuria
tx for post streptococcal glomerulonephritis
penicillin OR erythromycin if active strep infxn
supportive care: loop diuretics, nifedipine/nicardipine
dialysis if severe
post streptococcal glomerulonephritis occurs __ after pharyngitis infxn
and __ after skin infxn
pharyngitis: 1-2 weeks
skin: 3-6 weeks
what do you think when you see: asymptomatic, persistent microscopic hematuria, bilateral sensorineural hearing loss, ocular defects
alport syndrome
mc cause of acute glomerulonephritis worldwide
IgA nephropathy
what do you think when you see: gross hematuria, flank pain, rash, arthralgia, abdominal pain in young adult within 2 days of a respiratory or GI infxn
IgA nephropathy
which cytoplasmic abs are associated with polyangitis
perinuclear antineutrophil cytoplasmic (pANCA)
granulomatosis with polyangitis affects the small and medium sized vessels of the
ear
nose
throat
lungs
kidneys
which drug is used to for tx and prevention of vertebral fx in osteoporosis pt
SERM → raloxifene
which 2 drugs can be used to treat vertebral AND non vertebral fx in osteoporosis pt’s
parathyroid hormone → teriparatide
human monoclonal abs → denosumab
4 antiresorptive drugs for OP
bisphosphanates → “dronates” and zoledronic acid
calcitonin
SERMs → raloxifene
monoclonal abs → denosumab
bone forming drug used in OP
parathyroid hormone → teriparatide
first line drug for OP if pt can not tolerate bisphosphonate
raloxifene
dx for OP is done using __
DEXA
T scores for OP
osteopenia: -1.0 to -2.5
osteoporosis: -2.5 or less
mc OP fx
vertebral body compression fx
common PE findings of PAD
diminished/absent pulses
bruits
skin and nail changes
ulcers at tips of toes, between digits
pt’s w. PAD may have pallor with __
followed by rumor with __
LE elevation
lowering extremity
mc site of intermittent claudication/pain in PAD patient
calf
what confirmatory test is recommended after a pt has had a positive TB screen
IGRA
when should a pt get a CXR for TB screening
if skin and blood tests are positive
when is 5 or higher considered positive for a skin TB test
HIV (+)
recent contact
CXR changes
organ transplant
immunosuppressed
when is > 10 considered positive for TB skin test
recent antivirals
IVDU
myobacteriology lab workers
high congregate settings
comorbidities
<90% IBW
Peds < 5 yo
high risk infants, kids, adolescents
TB skin test results for pt with no known rf
15 or higher
the __ maneuver diagnoses BPPV
the __ maneuver treats BPPV
diagnose: dix-hallpike
treat: epley
which type of nystagmus is bad and suggestive of a central issue
vertical
what do you think when you see: sudden onset of sensation of room spinning that is triggered by positional changes of the head lasting seconds to minutes
BPPV
pathogen associated w. IVDU endocarditis
valve associated w. IVDU endocarditis
staph
tricuspid
pathogen associated with non IVDU endocarditis
valve associated w. non IVDU endocarditis
staph, strep viridians
mitral
contraindications for contraceptives containing estrogen
increased risk for thromboembolitic events:
>35 yo
smokers
recent leg trauma
sedentary lifestyle
2 types of progesterone only contraception
norethindrone
levonorgestrel
risk of what 2 types of cancers are reduced by using OCP
ovarian
endometrial
what lifestyle change leads to the greatest reduction in bp
weight loss
which 2 patient pops with HTN should not increase dietary potassium to lower bp
those taking K+ sparing diuretics
those with CKD
4 types of melanoma
superficial spreading
nodular
lentigo maligna
acral lentiginous
mc subtype of melanoma
superficial spreading
what do you think when you see: flat macule or slightly raised discolored plaque with irregular borders
superficial spreading melanoma
superficial melanoma is mc found on the __ in women
and on the __ in men
women: legs
men: trunk
subtype of melanoma that mc affects AA pops
acral lentiginous
subtype of melanoma that mc affects chronically sum damaged areas in older pops
lentigo maligna
type of melanoma that has a uniform color, symmetric border, and small diameter
nodular
second mc subtype of melanoma
nodular
enteric coated ASA
aluminum hydroxide gel
sucralfate
psyllium gel
cholestyramine
