Rosh Material #2 Flashcards
what do you think when you see: flesh colored, smooth, firm, well circumscribed fluid filled mass overlying a joint or tendon (mc wrist over scapholunate joint)
ganglion cyst
how to differentiate ganglion cyst vs tumor
ganglion cyst will transilluminate
order of management for ganglion cyst
- obs and reassurance
- needle aspiration (high recurrence rate)
- surgical removal
mc soft tissue tumor of the hand
ganglion cyst
what do you think of when you see Terry-thomas sign on an X-ray of the wrist
scapholunate dissociation
herniation of the posterior bladder wall into the anterior wall of the vagina
cystocele
order of tx for a cystocele
- conservative measures
- pessary → if symptomatic
- surgery → if ulceration or tissue destruction
two vaccines that prevent PNA for immunocompetent adults > 65 yo
PCV 15
PCV 20
vaccination schedule for pneumococcal vaccines
no previously received PCV or status unknown: one dose of PCV 20 OR PCV 15
if PCV 15 is given: give PPSV 23 1 year later
if received PCV13 but not PPSV23: give PPSV23 at least 1 year after PCV 13
PNA vaccination used for Peds
PCV 13
which type of PNA presents with extra pulmonary symptoms (myalgia, sore throat, HA, nausea)
atypical → mycoplasma, chlamoydophila, legionella
vaccination schedule for PCV 13
2, 4, 6, 12 months
which abx is used for pneumocystis jirovecci infxn
bactrim
what assessment tool is used to determine high risk PNA patients
CURB-65 →
confusion, urea nitrogen, RR, bp, 65 or older
which pathogen is associated with prosthetic valve associated endocarditis
<2 months after implantation: staph aureus
2-12 mo after implantation: staph epidermidis
>12 months after implantation: streptococci and staph aureus
which organisms make up the HACEK group of organism
haemophilus
actinobacillus
cardiobacterium
eikenella
kingella
for dx of GAD, pt must have symptoms > __
6 months
3 conditions commonly associated w. GAD
social phobia
specific phobia
panic disorder
what screening tool is used in primary care to screen for GAD
GAD seven-item scale (GAD-7)
when is GAD-7 indicated
pt can not control worry
worry is associated w. restlessness, easy fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
2 mc somatic sx associated w. GAD
HA
cervical, shoulder, back pain
what do you think when you see: corrigan pulse, wide pulse pressure, de musset sign, and quincke sign
aortic regurgitation
head bobbing with each heartbeat
de musset sign
pulsating nail beds
quincke sign
which valve disorder do you think of when you see jugular venous dissension and left parasternal lift
pulmonary stenosis
which valvular d.o do you think of when you see Austin flint murmur
aortic regurgitation
which valve disorder do you think of when you see: palpitations, dyspnea, nonexertional CP, and fatigue
AND
mid systolic click and late systolic murmur
mitral valve prolapse
common drugs that cause torsades de point
antiarrhythmics
antidepressants
droperidol
phenothiazines
erythromycin
fluoroquinolones
methadone
how do you differentiate btw sustained and non sustained vtach
sustained has duration 30 seconds or more
what do you think when you see: rhythm > 180, and frequent QRS variation axis and morphology
torsades de pointes
what hypercoagulable disorder is associated with warfarin-induced skin necrosis
protein C deficiency
what hypercoaguable disorder is associated with neonatal purpura fulminans
protein C deficiency
mc hypercoagulable disorder
factor V leiden
causes of reduced levels of protein C, besides protein C deficiency
liver dz
chronic infxn
uremia
malignancy
chemo
DIC
use of vitamin K agonists
vitamin K deficiency
normal FEV1
>80%
which hereditary d.o should patients with suspected COPD be evaluated for
alpha-1 antitrypsin deficiency
what do you think of when you see: excessive O2 → decreased respiratory drive
COPD
emphysema
management of COPD/emphysema
bronchodilators
anticholinergics
steroids
NIPPV
smoking cessation
what type of bacteria causes bacterial meningitis with symptoms of petechiae and purpura fulminans
gram negative diplococci →
Neisseria meningitidis
meningococcemia
what bacteria is mc responsible for meningitis in infants and children < 23 mo old
e. coli
mc cause of bacterial meningitis in older adults
strep pneumo
what type of bacteria is strep pneumo
gram positive lancet shaped diplococci
listeria monocytogenes bacterial meningitis is mc seen in
neonates
immunocompromised patients
older adults
what type of bacteria is listeria monocytogenes
gram positive motile coccobacili
4 CSF findings of meningitis
elevated opening pressure
decreased glucose
elevated protein
elevated WBC → neutrophils predominate
empiric abx tx for meningitis for non immunocompromised
vanco
PLUS
ceftriaxone or cefotaxime
PLUS
dexamethasone
tx for immunocompromised pt’s w. meningitis
vanco
PLUS
ceftriaxone
PLUS
ampicillin
PLUS
dexamethasone
vaccinations are available for which 2 types of meningitis
strep pneumo
Neisseria meningitidis
prophylaxis tx for close contacts of meningitis
rifampin
OR
cipro
OR
ceftriaxone
4 unique sx of Neisseria meningitidis
septicemia
rapidly spreading ecchymosis
gangrene of extremities
DIC
tx for Neisseria meningitidis
ceftriaxone ASAP!
at what age should the quadrivalent meningococcal conjugate vaccine be administered
11-12 yo
booster at 16
exercise induced asthma has connection with what 2 other conditions
atopic dermatitis
allergic rhinitis
first line tx for exercise induced asthma
SABA before exercise
t/f: montelukast is effective in treating exercise induced asthma
t!
mc cause of lateral hip pain in adults
greater trochanteric pain syndrome
radiograph findings of greater trochanteric pain syndrome
normal
what do you think of when you see: lateral hip pain, pain when lying on affected side, local top of greater trochanter
greater trochanteric pain syndrome
tx for greater trochanteric pain syndrome
self limiting
heating pad
NSAIDs
PT
glucocorticoid injxn if persistent
what do you think when you see: immunocompromised pt with e.o external wound or puncture wound near painful hip
microbial trochanteric bursitis
what do you think when you see: osteophytes, joint space narrowing, subchondral sclerosis
OA
which orthopedic test detects tightness of the IT band, tensor fascia late, and gluteus Maximus
ober
more than half of FB obstructions occur in the __ lung
right
sx of FB ingestion
cough
stridor
monophonic wheezing
diminished lung sounds
hyper resonance to percussion over the affected area
CXR findings of FB ingestion
hyperinflated lung
atelectasis
mediastinal shift
PNA
radiopaque object
management of FB ingestion
supportive
immediate removal
rigid or flexible bronchoscopy
what does segmental hyperresonance make you think of
FB obstruction
t/f: bronchodilators may aid in the removal of an aspirated FB
f!
what do you think when you see: acute onset of persistent vertigo, n/v, hearing loss, tinnitus, horizontal nystagmus, hx of recent URI
labyrinthitis l
tx for labyrinthitis (4)
benign, self limiting
corticosteroids
symptomatic tx
vestibular rehab
vestibular neuritis + unilateral hearing loss =
labyrinthitis
mc symptom of TB
fever
2 CXR findings of TB
normal
hilar adenopathy → mc
what do you think when you see “ghon complex”
TB
common name of pulmonary aneurysm found in TB that begins in the infected cavity and spreads to the bronchial arteries causing massive hemoptysis upon rupture
Rasmussen aneurysm
absolute contraindications to administering altepase in the tx of an acute ischemic stroke
intracranial hemorrhage on CT
neurosurgery
head trauma
stroke within past 3 mo
uncontrolled HTN >185/110
hx of intracranial hemorrhage
known arteriovenous malformation
aneurysm
neoplasm
suspected or confirmed endocarditis
known bleeding diathesis
BG < 50
what do you think when you see: loss of central vision
macular degeneration
classification of macular degeneration
dry → atrophic
wet → neovascular/exudative
3 rf for macular degeneration
advanced age
smoking
family hx
what do drusen spots make you think of
macular degeneration
possible supportive care to slow down macular degeneration progression
combo of:
vitamin C
vitamin E
lutein
zinc
copper
class of meds that might treat wet macular degeneration
anti vascular endothelial growth factors →
bevacizumab
ranibizumab
mc type of macular degeneration
dry → nonexudative
4 sx of dry macular degeneration
drusen spots
gradual loss of vision
macular thinning
not total blindness
5 sx of wet (exudative) macular degeneration
neovascularization
sudden loss of vision
bleeding, leaking of fluid
not total blindness
more severe central vision loss
what do you think when you see: clouding of the visual field
cataracts
tx for cataracts
surgical replacement of lens
what do you think when you see: peripheral vision loss
glaucoma
distortion of straight lines, such as perceiving doors or blinds as curved
can be seen with wet macular degeneration
metamorphosia
mc cause of blindness in older pops
macular degeneration
anterior wall of rectum herniates through posterior wall of vagina
weakening of pelvic floor muscles
rectocele
tx for rectocele
conservative measures
pessary if concern for ulceration or if symptomatic
surgery
bacteria commonly associated w. food poisoning
staph aureus
bacillus cereus
clostridium perfingens
e.coli
which diarrhea is associated w. farm animal exposure
salmonella
which pathogen causes travelers diarrhea
giardia
community acquired dysentery is caused by what 3 pathogens
shigella
campylobacter
salmonella
indications for further testing with diarrhea
high risk
cardiac dz
IBD
high fever
abd pain
passage of > 6 unformed stools x 24 hr
hypovolemia
empiric abx tx for invasive gastroenteritis
azithromycin
OR
fluoroquinolone
which abx is used in treatment of diarrhea dt c.diff
oral Vanco
only indication for oral vanco
mc cause of SBO
adhesions
what do you think when you see: loops of distended bowel, air-fluid levels within bowel lumen, string of pearls appearance, or and proximal bowel dilation
SBO
free air noted in the abdomen indicates
bowel perforation → immediate surgery
what do you think when a patient presents with: bilious vomiting and high pitched bowel sounds
SBO
what do “stack of coins,” and “string of pearls” on xray make you think of
SBO
tx for SBO
NGT
surgery
mortality rate for SBO and ischemic bowel if left untreated
100%
characteristics of benign pulmonary nodule
very fast or no growth on repeat imaging 2 years apart
popcorn calcification pattern
multiple pulmonary nodules < 5 mm in diameter
<30 yo
nonsmoker
characteristics of malignant pulmonary nodule
>2.5 cm
spiculated
upper lobe
multiple pulmonary nodules 1 cm or greater in diameter
>30yo
ddx for pulmonary nodule
infectious granuloma
bronchogenic carcinoma
hamartoma
malignancy
bronchial adenoma
clinical characteristics of HOCM
left ventricular hypertrophy
thickened septum
left ventricular hyper contractility
left atrial enlargement
diastolic dysfunction
what heart sound is associated with HOCM
S4 gallop
what action decreases HOCM murmur
actions that increase preload:
squatting
hand-grip
PE findings of HOCM
pulses bisferiens (biphasic pulses)
triple apical impulse
prominent a wave
S4 gallop
what actions increase HOCM murmur
actions that decrease preload →
standing
valsalva
mainstay of tx for HOCM
beta blocker
OR
CCB
meds to avoid with HOCM
meds that decrease preload:
nitrates
diuretics
ACEI
ARBS
ECG findings of HOCM
large amplitude QRS
deep narrow Q waves in lateral or inferior leads
tall R waves
which gallop heard on cardiac auscultation can be a normal finding in pt < 30 yo
S3
3 common PE findings associated w. B12 deficiency anemia
gait ataxia
parasthesia
glossitis
peripheral blood smear for B12 deficiency
hyperhsegmented neutrophils
what does low B12 with elevated methylmalonic acid and homocysteine suggest
B12 deficiency
what does low B12 with nl methylmalonic acid and homocysteine suggest
folate deficiency
pale green discoloration of skin seen with severe IDA
chlorosis
spoon shaped nails (koilonychia) are seen with
IDA
oral ulcers may be seen with which type of anemia
folate deficiency
what antibody is associated w. pernicious anemia
autoantibodies to intrinsic factor
what drug is associated with B12 deficiency
metformin
OA pain is worse with __
and alleviated with __,
and morning stiffness lasts __
activity, evening
rest
<30 min
RA pain is worse with __
relieved by __,
and morning stiffness lasts __
rest
activity
60 min
OA commonly affects what joints
weight bearing joints
knees
shoulders
hips
proximal PIP (Bouchard nodes)
DIP (heberden)
OA is __ lateral
RA is __ lateral
OA: unilateral
RA: bilateral
RA commonly affects which joints
PIP
metacarpophalangeal joints
never DIP
lab findings of RA
elevated CRP/ESR
positive RF. anti CCP, citrullinated peptide
first line tx for OA
naproxen
others: topical capsaicin, duloxetine, steroid injxns
which orthopedic condition is associated w, ulnar deviations, swan neck deformity, and boutonniere deformity
RA
ankylosing spondylitis is associated w. which HLA
B27
what do you think when you see: man, gradually worsening shoulder/back/hip pain
relieved with mild activity, does not improve with rest
ankylosing spondylitis
hallmark of ankylosing spondylitis that occurs early in the disease
bilateral sacroillitis
earliest radiographic finding
conditions associated w. ankylosing spondylitis
uveitis
aortitis
IBD
psoriasis
pulmonary fibrosis
radiograph findings of ankylosing spondylitis
syndesmophytes bridging across multiple vertebrae → bamboo spine
first line tx for ankylosing spondylitis
NSAIDs
if unresponsive: TNF inhibitors (ex. adalimumab)
tx to avoid in ankylosing spondylitis
steroids
HLA of RA
DR4
what endocrine disorder is strongly associated with HLA DR3 and HLA DR4
T1DM
diseases associated with HLA B27
PAIR:
psoriatic arthritis
ankylosing spondylitis
IBD
reactive arthritis
mc cause of upper GI bleeding
PUD
- also:*
- gastritis*
- duodenitis*
- esophageal varices*
- portal HTN gastropathy*
- mallory weiss tear*
- GI malignancy*
- AV malformation*
upper GI bleeding includes bleeding from the __
to the __
oropharynx
ligament of treitz
describe the blood in upper GI bleeding
coffee grounds stools
describe the bleeding in lower GI stools
bright red hematochezia
transfusion protocol for esophageal varies
1 unit fresh frozen plasma
PLUS
1 unit of platelets
q 4 hours
acute management of esophageal varices bleeding
hemodynamic resuscitation
otreotide
banding/sclerotherapy
prophylactic abx
chronic management of esophageal varices
beta blockers
endoscopic variceal ligation
classic presentation of diverticulitis
painless hematochezia
dx for esophageal varices
upper GI endoscopy
what do you think when you see endoscopy findings of: dilated submucosal esophageal or gastric veins
esophageal varices
prophylactic abx for esophageal varices
cefttriaxone
endoscopic tx of bleeding esophageal varices
ligation (banding)
samter triad
asthma
ASA sensitivity
nasal polyps
3 PE findings of asthma
obstructive pattern
expiratory wheezing
improvement of FEV1 >12% after bronchodilator
pale, boggy, edematous masses of hypertrophied nasal mucosa
nasal polyps
nasal polyps are associated w.
chronic allergic rhinitis
dermatitis
diarrhea
dementia
pellagra (B3 deficiency)
what is the mainstay of therapy for salicylate poisoning
alkalization w. sodium bicarbonate
contents of abdominal cavity protrude upward thru the esophageal hiatus of the diaphragm
hiatal hernia
gastroesophageal junction is displaced above the diaphragm
sliding hiatal hernia
fundus is displaced above the diaphragm
paraesophageal hiatal hernia
which type of hernia is associated w. trauma, congenital malformation, and iatrogenic factors
sliding hiatal hernias
which type of hernia is associated with surgical procedures - ex. anti reflux procedures, esophagomyotomy, and partial gastrectomy
paraesophageal hiatal hernia
which type of hiatal hernia is mc asymptomatic
sliding hiatal hernia
which type of hiatal hernia mc presents with epigastria pain, postprandial fullness, n/v
paraesophageal hiatal hernia
what do you think when you see “retro cardiac air-fluid level” on upright xray, CT, or MRI
hiatal hernia
sliding hiatal hernias are typically asymptomatic, but may present w.
GERD
dx for hiatal hernia
upper endoscopy
barium swallow → most sensitive
management of sliding hiatal hernia
conservative
manage GERD if present
management of paraesophageal hernia
asymptomatic: conservative
symptomatic: surgery
what do you think when you see n/v, diarrhea, abd cramps, and fever 8-72 hr following exposure to undercooked chicken
salmonellosis
what is the mc performed surgical procedure to correct a hiatal hernia
nissen fundoplication
atypical sx of GERD
asthma
chronic cough
chronic laryngitis
sore throat
chest pain
sleep disturbance
mc dx for GERD
8 week trial of bid H2 receptor antagonist
OR
8 week trial of once daily PPI
name 3 H2 receptor antagonists
cimetidine
famotidine
ranitidine
name 3 PPIs
omeprazole
esomeprazole
pantoprazole
gs for dx of GERD
esophageal pH testing
complications of longterm PPI tx
infectious gastroenteritis
IDA
B12 deficiency
hypomagnesemia
PNA
hip fx
with GERD dx protocol, if recurrent sx occur 3 months or more after d/c of PPI or H2 antagonist what is the next step
perform upper endoscopy to r/o other dx/GERD complications
what surgical procedure is recommended in pt who is morbidly obese and has sx of GERD
bariatric surgery
first step in management of a pt who has expressed intimate partner violence
express empathy, acknowledge struggle, thank patient for their trust
6 indications to ask pt about intimate partner violence
women w. injuries
women w. chronic unexplained abd pain
women w. chronic unexplained HA
women w. STI
older adults w. e.o neglect
older adults w. injuries
t/f: the PHQ9 is helpful to identify pt’s who have been victims of intimate partner violence
f!
what is an important consideration when giving pt who have reported intimate partner violence written summaries of their visit
do not include any written material or resources regarding intimate partner violence
mc cause of cancer death in US
lung ca
Horner syndrome
ptosis
miosis
anhidrosis
4 types of lung ca
small cell
non small cell
squamous cell
adenocarcinoma
4 mc presenting sx of lung ca
cough
hemoptysis
chest pain
dyspnea
2 syndromes related to lung ca
pancoast syndrome
superior vena cava syndrome
paraneoplastic
pan coast syndrome is commonly related to which type of lung ca
non small cell
sx of pancoast tumor syndrome
dermatomal sx stemming from C8-T1 and T2 → muscle atrophy, weakness, pain
Horner syndrome
4 common metastasis sites of lung ca
liver
bones
adrenal glands
brain
3 signs of aggressive/metastatic lung ca
back pain
HA
focal neuro sx
3 dx studies for lung ca
CXR
chest CT w. contrast
PET
lung bx
who should get CT scan of chest for lung ca screening
50-80 yo w. 20 pack-year smoking hx or have quit in last 15 years
what is this showing
pancoast tumor
what do you think when you see: pain related to brachial plexus dermatomes
Horner syndrome
weakness/atrophy of hand muscles
pancoast syndrome
what is the location of a pancoast tumor
superior sulcus of lung
dilated milk ducts found in lactating women
galactocele
tender breast node with fever, malaise, enlarged ipsilateral axillary nodes, and skin erythema
breast abscess
breast node that occurs in setting of previous breast trauma or injection
fat necrosis
breast node that occurs in premenopausal women
discrete, widespread, tender
fibrocystic breast changes
gs clinical intervention for women < 30 yo w. palpable, nontender, breast lesion that is firm and semi mobile
breast US
t/f: mammogram in pt < 30 yo does not have high yield
t!
dt breast density
gs clinical intervention for women > 30 yo w. palpable, nontender, breast lesion that is firm and semi mobile
diagnostic mammogram w. or w.o directed US
gs clinical intervention for woman of any age w. suspicious breast mass
diagnostic mammogram and US
what is the best next dx step in a pt w. mammographically proven suspicious breast lesion
breast bx
what do you think when you see: asymmetric oligoarthritis of LE, urethritis, and bilateral injected conjunctiva/uveitis 1-2 weeks following an infxn
reactive arthritis
what 2 infixes is reactive arthritis associated w.
GI
GU
common GI infxns that cause reactive arthritis
shigellosis
salmonellosis
yersiniosis
campylobacteriosis
2 STIs associated w. reactive arthritis
chlamydia trachomatis
ureaplasma urealyticum
can’t pee
can’t see
can’t climb a tree
reactive arthritis
mc affected joints w. reactive arthritis
knee
ankle
synovial fluid findings of reactive arthritis
leukocytosis w. neutrophil predominance
management of reactive arthritis
abx
supportive tx for n/v
NSAIDs
glucocorticoids if unresponsive to NSAIDs
what does bilateral flank ecchymosis make you think of
grey turner sign → retroperitoneal hemorrhage or pancreatitis
what does periumbilical ecchymosis make you think of
Cullen sign → pancreatitis
what does supraclavicular LAD make you think of
virchow node → GI malignancy
what is troisier sign
enlarged, hard Virchow node
what does strawberry red tongue, fever, LAD, rash, conjunctivitis, erythema make you think of
kawasaki dz
what is keratoderma blenorrhagicum
lesions on palms and soles → reactive arthritis
only FDA approved drug to treat fibrocystic breast changes
danazol
supplements that may help w. fibrocystic breast changes
gamolenic acid
vitamin E
primrose oil
mc breast tumor in young women
fibroadenoma
painless, solitary, smooth, firm, mobile, rubberlike, well defined breast mass
fibroadenoma
what is the name of the fibroadenoma-like tumor with cellular storm that grows rapidly and has a leaf like pattern on histology
phyllodes tumor
mc cause of fibrocystic breast changes
fluctuating hormone levels during menstrual cycles
sudden-onset epigastric pain that radiates to the back, made worse by walking and lying supine, improved by sitting and leaning forward
pancreatitis
4 causes of pancreatitis
gallstones >
etoh >
hypertriglyceridemia >
drugs
in pancreatitis, amylase and lipase are elevated __ x the normal
3 x
lab findings of pancreatitis
elevated amylase/lipase
leukocytosis
elevated BUN
hyperglycemia
hypocalcemia
gs dx for pancreatitis
CT
what do you think when you see “sentinel loop” or segment of air-filled small intestine
pancreatitis
what criteria is used to assess severity of pancreatitis
ranson
management of pancreatitis
bowel rest
fluids
pain control
treatment for gallstone related pancreatitis
ERCP → endoscopic retrograde cholangiopancreatography
most specific laboratory marker for pancreatitis
elevated lipase
fever + RUQ pain after eating
cholecystitis
what GI disorder is AI pancreatitis typically associated w.
celiac
mc cause of pancreatitis
gallstones
definitive tx for chronic coronary artery dz w. single vessel involvement
revascularization → percutaneous transluminal coronary angioplasty (PTCA)
when is CABG indicated (2)
pt w. left main coronary artery involvement w. > 50% stenosis, > 70% stenosis 3 vessel dz, or decreased LVEF < 40%
diabetics w. multi vessel dz
gs test for diagnosis of CAD
coronary angiography
tx for ischemic heart dz
ASA
nitrates
clopidogrel
heparin
bb
tx for ischemic heart dz
ASA
nitrates
clopidogrel
heparin
bb
w. Cushing dz, a high ACTH level suggests
pituitary or other ectopic ACTH secreting tumor
w. Cushing, low ACTH level indicates
adrenal tumor
(glucocorticoid tumor is suppressing the HPA axis)
steps of screening for Cushing
- 8 am dex serum cortisol test
- 24 hr urinary free cortisol test
- midnight salivary cortisol levels test
in Cushing dz, what are the results of CRH stimulation test
ACTH AND cortisol are elevated
results of dexamethasone suppression test in Cushing pt’s
glucocorticoid suppression
what drugs increase the metabolism of dexamethasone leading to impaired cortisol suppression
anti seizure drugs → phenytoin, phenobarbital
rifampin
mc cause of Cushing
iatrogenic → long term steroid use
mc non iatrogenic cause of Cushing
ACTH secreting pituitary adenoma
if cause of Cushing is pituitary tumor, then it is called
Cushing disease
what do you think when you see a M w. new sexual partner who c/o itching/burning w. urination
milking of urethra produces mucopurulent d.c
gonorrhea
tx for gonorrhea
ceftriaxone 500 mg IM x 1 dose
doxy 100 mg bid x 7 days
gonorrhea can affect which parts of the body
urethra
cervix
rectum
pharynx
conjunctiva
mc affected parts of the body with gonorrhea
men → urethritis
women → cervix
disseminated gonorrhea affects the
joints
hearts
meninges
what do you think when you see cervix that is friable on exam
gonorrhea
gs dx test for gonorrhea
NAAT
what do you think when you see gram stain of intracellular gram negative diplococci with polymorphonuclear leukocytes
gonorrhea
gonorrhea often occurs in conjunction w.
chlamydia
what inflammatory syndrome involving glisson capsule can occur in pt’s w. PID 2/2 to chlamydia trachomatis and Neisseria gonorrhoeae
fitz hugh curtis (perihepatitis)
mc pathogen related to folliculitis
staph
pathogen associated w. hot tub folliculitis
pseudomonas
folliculitis dt chronic rubbing, friction, occlusion, and perspiration
nonbacterial folliculitis
tx for pseudomonas folliculitis
ciprofloxacin
tx for non pseudomonas folliculitis
clindamycin
cephalexin
meds for nonbacterial folliculitis
steroids
antihistamines
what is this showing
folliculitis → papular/pustular inflammation of hair follicles
what is this showing
furuncle → painful, firm, or fluctuant abscess originating from a hair follicle
what is this showing
carbuncle → network of furuncles connected by sinus tracts
in what pt pop would you suspect eosinophilic folliculitis
HIV
folliculitis caused by shaving
pseudofolliculitis
hair follicles located to one side of hair follicle, not in them
where does pseudomonas folliculitis commonly occur
trunk → 8-48 hr after exposure to dirty water
what is a complication of folliculitis that causes chronic lesions to the head and neck that are refractory to tx
sycosis
order of tx for folliculitis
- topical abx
- oral abx
acute episode of neurologic compromise, including speech, vision deficit, or extremity weakness that resolves on its own w.o causing tissue damage
transient ischemic attack
ex of macrovascular transient ischemic attack
carotid artery stenosis
what does ABCD2 stand for in risk stratification for transient ischemic attack
age → >60 (1 pt)
bp → SBP 140 or higher (1 pt)
clinical features → speech deficits (1 pt), unilateral weakness (2 pt)
duration → 60 minutes or more (2 pt), 10-50 min (1 pt)
- score of 6-7 = high 2 day risk of stroke*
- score of 2-5 = moderate risk of stroke*
- score of 0-1 = low risk of stroke*
pt of moderate risk of stroke using the ABCD2 scale should receive what intervention
daily ASA
PLUS
clopdigrel
pt of high risk using ABCD2 scale for transient ischemic attack should receive what therapy
ASA
PLUS
clopdigrel
PLUS
anti platelet therapy
pt low risk on the ABCD2 scale for transient ischemic attack should receive what intervention
daily ASA 325 mg
med for pt with transient ischemic attack caused by a fib, intracardiac thrombus, acute coronary artery syndrome, prosthetic heart valve, or venous thromboembolism
anticoagulant →
rivaroxaban OR warfarin
what is the MOA of clopidogrel
irreversible blockage of ADP receptors on platelet surface → inhibits platelet aggregation
what do you think when you see lesions that typically appear on extensor surfaces, scalp, palms, and soles
psoriasis
what do you think when you see: well-demarcated plaques that are bright red and covered w. silvery scales
plaque on an erythematous base w. sharp margins
psoriasis
psoriasis plaque formation on site of prior trauma
Koebner phenomenon
punctuate bleeding spots that are seen when psoriasis scales are scraped off
auspitz sign
tx for psoriasis that affects < 10% of body surface area
high potency topical steroid cream/ointment
supplemental tx for psoriasis
vitamin D analogs
tar shampoo
salicylic acid gel
flucoinolone acetonide
tracolimus ointment
primecrolimus cream
psoriatic flare ups should NEVER be treated with
systemic steroids
tx of psoriasis for pt who has multiple small lesions and in those who have 10-30% affected body surface area
UV phototherapy
psoriasis tx for pt who has > 30% body surface area involvement
op narrowband UV B (NB-UVB) tx
lifestyle change that can improve psoriasis
wt loss
what 4 conditions is psoriasis associated w.
CVD
T2DM
metabolic syndrome
lymphoma
pregnancy loss before 20 weeks
spontaneous abortion
abd pain or bleeding in the first 20 weeks of gestation
cervical os closed
threatened abortion
abd pain or bleeding in the first 20 weeks of gestation
cervical os open
inevitable abortion
abd pain or bleeding in the first 20 weeks of gestation
cervical os open
some products of conception passed
incomplete abortion
abd pain or bleeding in the first 20 weeks of gestation
cervical os closed
complete passage of fetal parts and placenta
complete abortion
in utero death of the embryo or fetus prior to 20 weeks gestation w. retention of pregnancy
cervical os closed
no products passed
missed abortion
infxn of uterus during miscarriage
f/c
cervical os open w. purulent d.c
uterine tenderness
no products of conception passed
septic abortion
what pathogen is usually responsible for septic abortions
staph aureus
retained products of conception have not been fully expelled
endometritis develops
septic abortion
what do you think when you see shoulder pain that is worse at night, increasing stiffness x 2-9 mo, and decreased ROM
adhesive capsulitis (frozen shoulder)
rf for frozen shoulder/adhesive capsulitis
DM
thyroid dz
prolonged immobilization
stroke
AI dz
management of frozen shoulder/adhesive capsulitis
gentle ROM exercise
PT
corticosteroids → oral and injxn
when is surgery indicated for frozen shoulder
sx lasting > 10-12 mo
unresponsive to other tx
sx severely affect adl
2 surgeries for frozen shoulder/adhesive capsulitis
manipulation under anesthesia
arthroscopic release
what MSK disorder would you prescribe a night splint for
CTS
what n passes thru the quadrangular space of the shoulder
axillary
5 meds associated w. delirium
sedatives
anticholinergics
opioids
benzos
antihistamines
hallmark feature distinguishing delirium from dementia
inattention w. delirium
t/f: most cases of delirium are reversible
t!
screening tool for delirium
confusion assessment method
mc form of dementia
alzheimer’s
strongly held bizarre or non bizarre beliefs that are not a part of the patient’s culture or religion
delusions
psychosis includes (4)
delusions
hallucinations
thought disorganization
agitation or aggression
behavioral deterioration in the evening hours
sundowning
sundowning is mc in what pt population
institutionalized pt’s w. dementia
t/f: visual, auditory, or somatosensory hallucinations may accompany delirium
t!
transverse nasal crease from pushing on the nose
allergic salute
allergic rinitis tx
- intranasal corticosteroid sprays
- second gen antihistamines (loratidine, fexofenadine, cetirizine)
allergic rhinitis is __ mediated
IgE
which generation of antihistamines is recommended for allergic rhinitis
2nd gen → less anticholinergic/sedative effects
what are the 1st gen antihistamines
brompheniramine
diphenhydramine
hydroxyzine
→ more sedative/anticholinergic effects
what are the 2nd gen antihistamines
loratidine
fexofenadine
cetirizine
→ preferred due to less sedative/anticholinergic effects
what might you see in the hx of a pt with allergic rhinitis
asthma
atopic dermatitis
sinusitis
vasomotor rhinitis, a common cause of clear rhinorrhea in older patients, is associated w. an increased sensitivity of which nerve
vidian nerve
which leukemia is associated with a reciprocal translocation on the long arms of chromosomes 9 and 22
CML
philadelphia chromosome
3 phases of CML
chronic
accelerated
plastic
sx of chronic phase of CML
splenomegaly
fever
night sweats
wt loss
accelerated phase of CML is associated w.
greater organomegaly
blast cells
plastic phase of CML includes
acute sx → fever, night sweats, wt loss, bone pain
>30% blasts in the peripheral blood smear
+/- anemia, thrombocytopenia, thrombocytosis
tx for CML
allogenic hematopoietic cell transplantation → not recommended for older pt’s
tyrosine kinase inhibitors
cytotoxic agents
mc childhood leukemia
ALL
which type of leukemia is associated with auer rods and is mc in adults
AML
mc adult chronic leukemia
associated w. smudge cells
worst prognosis
CLL
mostly seen in adults
philadelphia chromosome
basophilia on smear
CML
what are B symptoms
group of symptoms caused by active leukemia →
fever, weight loss, night sweats
flu sx
abrupt onset:
fever
malaise
myalgia
HA
respiratory tract illness sx
most sensitive dx test for influenza
reverse transcriptase polymerase chain reaction (RT-PCR)
consider influenza antiviral therapy in what pt pops
severe dz
high risk of complications
not high risk but present w.in 48 hr of onset
what patients are at high risk of complications from influenza
>65 yo
pregnant or postpartum
LTC facilities
chronic medical conditions
immunocompromised
mc antiinfluenza therapy
oseltamivir
t/f: oseltamivir is effective against A and B influenza
T!
what is the mc complication of influenza
PNA
classifications of asthma severity
mild intermittent
mild persistent
moderate persistent
severe persistent
mc chronic dz in Peds
asthma
daily asthma sx twice a week, nightly sx twice a month or less and lungs are asymptomatic btw attacks
mild intermittent
daily sx more than 2 days a week but less than daily, 3-4 nocturnal awakenings/month but not more than once weekly
sx begin to interfere w. daily activities
mild persistent asthma
daily asthma sx, nightly sx more than once a week
sx interfere w. daily activities
moderate persistent
asthma sx throughout the day, nightly sx often more than 7x/week
sx that have extremely limited ADLs
severe persistent
what condition presents w. an expiratory monophonic wheeze best heard over large airways
tracheomalacia
vaccines recommended for HIV pt’s w. CD4 200 or higher
influenza
tdap
pneumococcal
menigococcal
hep B series
HPV series
MMR
varicella
vaccination schedule for HIV pt’s w. CD4 could 200 or less
influenza
tdap
pneumococcal
meningococcal
hep B series
HPV series
t/f: the bacillus calmette-guerin vaccine should be administered to pt’s w. HIV who are at increased risk of contracting TB
f!
may cause disseminated dz
agents that cause pneumoconiosis and affect the upper lung
coal dust
beryllium → fluorescent lights, dental, computer, aerospace
talc → ceramics, plastics, rubbers, cosmetics
silica → mining, quarrying, drilling, sand
agents that cause pneumoconiosis and affect the lower lungs
hard metal → diamonds, cobalt
asbestos → insulation, brakes, ships, construction
what do you think when you see: SOB, dry cough, cutaneous nodules on fingers and forearms, hilar LAD and diffuse parenchymal infiltrates
berylliosis pneumoconiosis
monday fever
increased bronchovascular markings, cardiomegaly, hyperinflation
byssiniosis
eggshell calcifications of hilar nodes on CXR
increased risk of TB
silicosis
does pneumoconiosis typically present w. an obstructive or restrictive pattern on PFT
restrictive
what CD4 count for HIV pt is pneumocystis jiroveci vaccination recommended
<200
