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EOR: Family Med > Rosh Material #2 > Flashcards

Rosh Material #2 Flashcards

1
Q

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)

A

ganglion cyst

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2
Q

how to differentiate ganglion cyst vs tumor

A

ganglion cyst will transilluminate

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3
Q

order of management for ganglion cyst

A
  1. obs and reassurance
  2. needle aspiration (high recurrence rate)
  3. surgical removal
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4
Q

mc soft tissue tumor of the hand

A

ganglion cyst

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5
Q

what do you think of when you see Terry-thomas sign on an X-ray of the wrist

A

scapholunate dissociation

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6
Q

herniation of the posterior bladder wall into the anterior wall of the vagina

A

cystocele

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7
Q

order of tx for a cystocele

A
  1. conservative measures
  2. pessary → if symptomatic
  3. surgery → if ulceration or tissue destruction
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8
Q

two vaccines that prevent PNA for immunocompetent adults > 65 yo

A

PCV 15

PCV 20

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9
Q

vaccination schedule for pneumococcal vaccines

A

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

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10
Q

PNA vaccination used for Peds

A

PCV 13

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11
Q

which type of PNA presents with extra pulmonary symptoms (myalgia, sore throat, HA, nausea)

A

atypical → mycoplasma, chlamoydophila, legionella

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12
Q

vaccination schedule for PCV 13

A

2, 4, 6, 12 months

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13
Q

which abx is used for pneumocystis jirovecci infxn

A

bactrim

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14
Q

what assessment tool is used to determine high risk PNA patients

A

CURB-65 →

confusion, urea nitrogen, RR, bp, 65 or older

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15
Q

which pathogen is associated with prosthetic valve associated endocarditis

A

<2 months after implantation: staph aureus

2-12 mo after implantation: staph epidermidis

>12 months after implantation: streptococci and staph aureus

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16
Q

which organisms make up the HACEK group of organism

A

haemophilus

actinobacillus

cardiobacterium

eikenella

kingella

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17
Q

for dx of GAD, pt must have symptoms > __

A

6 months

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18
Q

3 conditions commonly associated w. GAD

A

social phobia

specific phobia

panic disorder

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19
Q

what screening tool is used in primary care to screen for GAD

A

GAD seven-item scale (GAD-7)

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20
Q

when is GAD-7 indicated

A

pt can not control worry

worry is associated w. restlessness, easy fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance

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21
Q

2 mc somatic sx associated w. GAD

A

HA

cervical, shoulder, back pain

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22
Q

what do you think when you see: corrigan pulse, wide pulse pressure, de musset sign, and quincke sign

A

aortic regurgitation

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23
Q

head bobbing with each heartbeat

A

de musset sign

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24
Q

pulsating nail beds

A

quincke sign

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25
Q

which valve disorder do you think of when you see jugular venous dissension and left parasternal lift

A

pulmonary stenosis

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26
Q

which valvular d.o do you think of when you see Austin flint murmur

A

aortic regurgitation

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27
Q

which valve disorder do you think of when you see: palpitations, dyspnea, nonexertional CP, and fatigue

AND

mid systolic click and late systolic murmur

A

mitral valve prolapse

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28
Q

common drugs that cause torsades de point

A

antiarrhythmics

antidepressants

droperidol

phenothiazines

erythromycin

fluoroquinolones

methadone

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29
Q

how do you differentiate btw sustained and non sustained vtach

A

sustained has duration 30 seconds or more

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30
Q

what do you think when you see: rhythm > 180, and frequent QRS variation axis and morphology

A

torsades de pointes

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31
Q

what hypercoagulable disorder is associated with warfarin-induced skin necrosis

A

protein C deficiency

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32
Q

what hypercoaguable disorder is associated with neonatal purpura fulminans

A

protein C deficiency

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33
Q

mc hypercoagulable disorder

A

factor V leiden

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34
Q

causes of reduced levels of protein C, besides protein C deficiency

A

liver dz

chronic infxn

uremia

malignancy

chemo

DIC

use of vitamin K agonists

vitamin K deficiency

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35
Q

normal FEV1

A

>80%

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36
Q

which hereditary d.o should patients with suspected COPD be evaluated for

A

alpha-1 antitrypsin deficiency

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37
Q

what do you think of when you see: excessive O2 → decreased respiratory drive

A

COPD

emphysema

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38
Q

management of COPD/emphysema

A

bronchodilators

anticholinergics

steroids

NIPPV

smoking cessation

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39
Q

what type of bacteria causes bacterial meningitis with symptoms of petechiae and purpura fulminans

A

gram negative diplococci →

Neisseria meningitidis

meningococcemia

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40
Q

what bacteria is mc responsible for meningitis in infants and children < 23 mo old

A

e. coli

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41
Q

mc cause of bacterial meningitis in older adults

A

strep pneumo

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42
Q

what type of bacteria is strep pneumo

A

gram positive lancet shaped diplococci

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43
Q

listeria monocytogenes bacterial meningitis is mc seen in

A

neonates

immunocompromised patients

older adults

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44
Q

what type of bacteria is listeria monocytogenes

A

gram positive motile coccobacili

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45
Q

4 CSF findings of meningitis

A

elevated opening pressure

decreased glucose

elevated protein

elevated WBC → neutrophils predominate

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46
Q

empiric abx tx for meningitis for non immunocompromised

A

vanco

PLUS

ceftriaxone or cefotaxime

PLUS

dexamethasone

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47
Q

tx for immunocompromised pt’s w. meningitis

A

vanco

PLUS

ceftriaxone

PLUS

ampicillin

PLUS

dexamethasone

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48
Q

vaccinations are available for which 2 types of meningitis

A

strep pneumo

Neisseria meningitidis

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49
Q

prophylaxis tx for close contacts of meningitis

A

rifampin

OR

cipro

OR

ceftriaxone

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50
Q

4 unique sx of Neisseria meningitidis

A

septicemia

rapidly spreading ecchymosis

gangrene of extremities

DIC

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51
Q

tx for Neisseria meningitidis

A

ceftriaxone ASAP!

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52
Q

at what age should the quadrivalent meningococcal conjugate vaccine be administered

A

11-12 yo

booster at 16

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53
Q

exercise induced asthma has connection with what 2 other conditions

A

atopic dermatitis

allergic rhinitis

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54
Q

first line tx for exercise induced asthma

A

SABA before exercise

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55
Q

t/f: montelukast is effective in treating exercise induced asthma

A

t!

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56
Q

mc cause of lateral hip pain in adults

A

greater trochanteric pain syndrome

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57
Q

radiograph findings of greater trochanteric pain syndrome

A

normal

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58
Q

what do you think of when you see: lateral hip pain, pain when lying on affected side, local top of greater trochanter

A

greater trochanteric pain syndrome

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59
Q

tx for greater trochanteric pain syndrome

A

self limiting

heating pad

NSAIDs

PT

glucocorticoid injxn if persistent

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60
Q

what do you think when you see: immunocompromised pt with e.o external wound or puncture wound near painful hip

A

microbial trochanteric bursitis

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61
Q

what do you think when you see: osteophytes, joint space narrowing, subchondral sclerosis

A

OA

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62
Q

which orthopedic test detects tightness of the IT band, tensor fascia late, and gluteus Maximus

A

ober

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63
Q

more than half of FB obstructions occur in the __ lung

A

right

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64
Q

sx of FB ingestion

A

cough

stridor

monophonic wheezing

diminished lung sounds

hyper resonance to percussion over the affected area

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65
Q

CXR findings of FB ingestion

A

hyperinflated lung

atelectasis

mediastinal shift

PNA

radiopaque object

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66
Q

management of FB ingestion

A

supportive

immediate removal

rigid or flexible bronchoscopy

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67
Q

what does segmental hyperresonance make you think of

A

FB obstruction

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68
Q

t/f: bronchodilators may aid in the removal of an aspirated FB

A

f!

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69
Q

what do you think when you see: acute onset of persistent vertigo, n/v, hearing loss, tinnitus, horizontal nystagmus, hx of recent URI

A

labyrinthitis l

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70
Q

tx for labyrinthitis (4)

A

benign, self limiting

corticosteroids

symptomatic tx

vestibular rehab

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71
Q

vestibular neuritis + unilateral hearing loss =

A

labyrinthitis

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72
Q

mc symptom of TB

A

fever

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73
Q

2 CXR findings of TB

A

normal

hilar adenopathy → mc

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74
Q

what do you think when you see “ghon complex”

A

TB

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75
Q

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

A

Rasmussen aneurysm

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76
Q

absolute contraindications to administering altepase in the tx of an acute ischemic stroke

A

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

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77
Q

what do you think when you see: loss of central vision

A

macular degeneration

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78
Q

classification of macular degeneration

A

dry → atrophic

wet → neovascular/exudative

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79
Q

3 rf for macular degeneration

A

advanced age

smoking

family hx

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80
Q

what do drusen spots make you think of

A

macular degeneration

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81
Q

possible supportive care to slow down macular degeneration progression

A

combo of:

vitamin C

vitamin E

lutein

zinc

copper

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82
Q

class of meds that might treat wet macular degeneration

A

anti vascular endothelial growth factors →

bevacizumab

ranibizumab

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83
Q

mc type of macular degeneration

A

dry → nonexudative

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84
Q

4 sx of dry macular degeneration

A

drusen spots

gradual loss of vision

macular thinning

not total blindness

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85
Q

5 sx of wet (exudative) macular degeneration

A

neovascularization

sudden loss of vision

bleeding, leaking of fluid

not total blindness

more severe central vision loss

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86
Q

what do you think when you see: clouding of the visual field

A

cataracts

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87
Q

tx for cataracts

A

surgical replacement of lens

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88
Q

what do you think when you see: peripheral vision loss

A

glaucoma

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89
Q

distortion of straight lines, such as perceiving doors or blinds as curved

can be seen with wet macular degeneration

A

metamorphosia

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90
Q

mc cause of blindness in older pops

A

macular degeneration

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91
Q

anterior wall of rectum herniates through posterior wall of vagina

weakening of pelvic floor muscles

A

rectocele

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92
Q

tx for rectocele

A

conservative measures

pessary if concern for ulceration or if symptomatic

surgery

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93
Q

bacteria commonly associated w. food poisoning

A

staph aureus

bacillus cereus

clostridium perfingens

e.coli

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94
Q

which diarrhea is associated w. farm animal exposure

A

salmonella

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95
Q

which pathogen causes travelers diarrhea

A

giardia

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96
Q

community acquired dysentery is caused by what 3 pathogens

A

shigella

campylobacter

salmonella

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97
Q

indications for further testing with diarrhea

A

high risk

cardiac dz

IBD

high fever

abd pain

passage of > 6 unformed stools x 24 hr

hypovolemia

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98
Q

empiric abx tx for invasive gastroenteritis

A

azithromycin

OR

fluoroquinolone

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99
Q

which abx is used in treatment of diarrhea dt c.diff

A

oral Vanco

only indication for oral vanco

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100
Q

mc cause of SBO

A

adhesions

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101
Q

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

A

SBO

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102
Q

free air noted in the abdomen indicates

A

bowel perforation → immediate surgery

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103
Q

what do you think when a patient presents with: bilious vomiting and high pitched bowel sounds

A

SBO

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104
Q

what do “stack of coins,” and “string of pearls” on xray make you think of

A

SBO

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105
Q

tx for SBO

A

NGT

surgery

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106
Q

mortality rate for SBO and ischemic bowel if left untreated

A

100%

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107
Q

characteristics of benign pulmonary nodule

A

very fast or no growth on repeat imaging 2 years apart

popcorn calcification pattern

multiple pulmonary nodules < 5 mm in diameter

<30 yo

nonsmoker

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108
Q

characteristics of malignant pulmonary nodule

A

>2.5 cm

spiculated

upper lobe

multiple pulmonary nodules 1 cm or greater in diameter

>30yo

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109
Q

ddx for pulmonary nodule

A

infectious granuloma

bronchogenic carcinoma

hamartoma

malignancy

bronchial adenoma

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110
Q

clinical characteristics of HOCM

A

left ventricular hypertrophy

thickened septum

left ventricular hyper contractility

left atrial enlargement

diastolic dysfunction

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111
Q

what heart sound is associated with HOCM

A

S4 gallop

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112
Q

what action decreases HOCM murmur

A

actions that increase preload:

squatting

hand-grip

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113
Q

PE findings of HOCM

A

pulses bisferiens (biphasic pulses)

triple apical impulse

prominent a wave

S4 gallop

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114
Q

what actions increase HOCM murmur

A

actions that decrease preload →

standing

valsalva

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115
Q

mainstay of tx for HOCM

A

beta blocker

OR

CCB

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116
Q

meds to avoid with HOCM

A

meds that decrease preload:

nitrates

diuretics

ACEI

ARBS

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117
Q

ECG findings of HOCM

A

large amplitude QRS

deep narrow Q waves in lateral or inferior leads

tall R waves

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118
Q

which gallop heard on cardiac auscultation can be a normal finding in pt < 30 yo

A

S3

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119
Q

3 common PE findings associated w. B12 deficiency anemia

A

gait ataxia

parasthesia

glossitis

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120
Q

peripheral blood smear for B12 deficiency

A

hyperhsegmented neutrophils

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121
Q

what does low B12 with elevated methylmalonic acid and homocysteine suggest

A

B12 deficiency

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122
Q

what does low B12 with nl methylmalonic acid and homocysteine suggest

A

folate deficiency

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123
Q

pale green discoloration of skin seen with severe IDA

A

chlorosis

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124
Q

spoon shaped nails (koilonychia) are seen with

A

IDA

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125
Q

oral ulcers may be seen with which type of anemia

A

folate deficiency

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126
Q

what antibody is associated w. pernicious anemia

A

autoantibodies to intrinsic factor

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127
Q

what drug is associated with B12 deficiency

A

metformin

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128
Q

OA pain is worse with __

and alleviated with __,

and morning stiffness lasts __

A

activity, evening

rest

<30 min

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129
Q

RA pain is worse with __

relieved by __,

and morning stiffness lasts __

A

rest

activity

60 min

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130
Q

OA commonly affects what joints

A

weight bearing joints

knees

shoulders

hips

proximal PIP (Bouchard nodes)

DIP (heberden)

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131
Q

OA is __ lateral

RA is __ lateral

A

OA: unilateral

RA: bilateral

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132
Q

RA commonly affects which joints

A

PIP

metacarpophalangeal joints

never DIP

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133
Q

lab findings of RA

A

elevated CRP/ESR

positive RF. anti CCP, citrullinated peptide

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134
Q

first line tx for OA

A

naproxen

others: topical capsaicin, duloxetine, steroid injxns

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135
Q

which orthopedic condition is associated w, ulnar deviations, swan neck deformity, and boutonniere deformity

A

RA

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136
Q

ankylosing spondylitis is associated w. which HLA

A

B27

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137
Q

what do you think when you see: man, gradually worsening shoulder/back/hip pain

relieved with mild activity, does not improve with rest

A

ankylosing spondylitis

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138
Q

hallmark of ankylosing spondylitis that occurs early in the disease

A

bilateral sacroillitis

earliest radiographic finding

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139
Q

conditions associated w. ankylosing spondylitis

A

uveitis

aortitis

IBD

psoriasis

pulmonary fibrosis

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140
Q

radiograph findings of ankylosing spondylitis

A

syndesmophytes bridging across multiple vertebrae → bamboo spine

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141
Q

first line tx for ankylosing spondylitis

A

NSAIDs

if unresponsive: TNF inhibitors (ex. adalimumab)

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142
Q

tx to avoid in ankylosing spondylitis

A

steroids

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143
Q

HLA of RA

A

DR4

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144
Q

what endocrine disorder is strongly associated with HLA DR3 and HLA DR4

A

T1DM

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145
Q

diseases associated with HLA B27

A

PAIR:

psoriatic arthritis

ankylosing spondylitis

IBD

reactive arthritis

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146
Q

mc cause of upper GI bleeding

A

PUD

  • also:*
  • gastritis*
  • duodenitis*
  • esophageal varices*
  • portal HTN gastropathy*
  • mallory weiss tear*
  • GI malignancy*
  • AV malformation*
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147
Q

upper GI bleeding includes bleeding from the __

to the __

A

oropharynx

ligament of treitz

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148
Q

describe the blood in upper GI bleeding

A

coffee grounds stools

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149
Q

describe the bleeding in lower GI stools

A

bright red hematochezia

150
Q

transfusion protocol for esophageal varies

A

1 unit fresh frozen plasma

PLUS

1 unit of platelets

q 4 hours

151
Q

acute management of esophageal varices bleeding

A

hemodynamic resuscitation

otreotide

banding/sclerotherapy

prophylactic abx

152
Q

chronic management of esophageal varices

A

beta blockers

endoscopic variceal ligation

153
Q

classic presentation of diverticulitis

A

painless hematochezia

154
Q

dx for esophageal varices

A

upper GI endoscopy

155
Q

what do you think when you see endoscopy findings of: dilated submucosal esophageal or gastric veins

A

esophageal varices

156
Q

prophylactic abx for esophageal varices

A

cefttriaxone

157
Q

endoscopic tx of bleeding esophageal varices

A

ligation (banding)

158
Q

samter triad

A

asthma

ASA sensitivity

nasal polyps

159
Q

3 PE findings of asthma

A

obstructive pattern

expiratory wheezing

improvement of FEV1 >12% after bronchodilator

160
Q

pale, boggy, edematous masses of hypertrophied nasal mucosa

A

nasal polyps

161
Q

nasal polyps are associated w.

A

chronic allergic rhinitis

162
Q

dermatitis

diarrhea

dementia

A

pellagra (B3 deficiency)

163
Q

what is the mainstay of therapy for salicylate poisoning

A

alkalization w. sodium bicarbonate

164
Q

contents of abdominal cavity protrude upward thru the esophageal hiatus of the diaphragm

A

hiatal hernia

165
Q

gastroesophageal junction is displaced above the diaphragm

A

sliding hiatal hernia

166
Q

fundus is displaced above the diaphragm

A

paraesophageal hiatal hernia

167
Q

which type of hernia is associated w. trauma, congenital malformation, and iatrogenic factors

A

sliding hiatal hernias

168
Q

which type of hernia is associated with surgical procedures - ex. anti reflux procedures, esophagomyotomy, and partial gastrectomy

A

paraesophageal hiatal hernia

169
Q

which type of hiatal hernia is mc asymptomatic

A

sliding hiatal hernia

170
Q

which type of hiatal hernia mc presents with epigastria pain, postprandial fullness, n/v

A

paraesophageal hiatal hernia

171
Q

what do you think when you see “retro cardiac air-fluid level” on upright xray, CT, or MRI

A

hiatal hernia

172
Q

sliding hiatal hernias are typically asymptomatic, but may present w.

A

GERD

173
Q

dx for hiatal hernia

A

upper endoscopy

barium swallow → most sensitive

174
Q

management of sliding hiatal hernia

A

conservative

manage GERD if present

175
Q

management of paraesophageal hernia

A

asymptomatic: conservative
symptomatic: surgery

176
Q

what do you think when you see n/v, diarrhea, abd cramps, and fever 8-72 hr following exposure to undercooked chicken

A

salmonellosis

177
Q

what is the mc performed surgical procedure to correct a hiatal hernia

A

nissen fundoplication

178
Q

atypical sx of GERD

A

asthma

chronic cough

chronic laryngitis

sore throat

chest pain

sleep disturbance

179
Q

mc dx for GERD

A

8 week trial of bid H2 receptor antagonist

OR

8 week trial of once daily PPI

180
Q

name 3 H2 receptor antagonists

A

cimetidine

famotidine

ranitidine

181
Q

name 3 PPIs

A

omeprazole

esomeprazole

pantoprazole

182
Q

gs for dx of GERD

A

esophageal pH testing

183
Q

complications of longterm PPI tx

A

infectious gastroenteritis

IDA

B12 deficiency

hypomagnesemia

PNA

hip fx

184
Q

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

A

perform upper endoscopy to r/o other dx/GERD complications

185
Q

what surgical procedure is recommended in pt who is morbidly obese and has sx of GERD

A

bariatric surgery

186
Q

first step in management of a pt who has expressed intimate partner violence

A

express empathy, acknowledge struggle, thank patient for their trust

187
Q

6 indications to ask pt about intimate partner violence

A

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

188
Q

t/f: the PHQ9 is helpful to identify pt’s who have been victims of intimate partner violence

A

f!

189
Q

what is an important consideration when giving pt who have reported intimate partner violence written summaries of their visit

A

do not include any written material or resources regarding intimate partner violence

190
Q

mc cause of cancer death in US

A

lung ca

191
Q

Horner syndrome

A

ptosis

miosis

anhidrosis

192
Q

4 types of lung ca

A

small cell

non small cell

squamous cell

adenocarcinoma

193
Q

4 mc presenting sx of lung ca

A

cough

hemoptysis

chest pain

dyspnea

194
Q

2 syndromes related to lung ca

A

pancoast syndrome

superior vena cava syndrome

paraneoplastic

195
Q

pan coast syndrome is commonly related to which type of lung ca

A

non small cell

196
Q

sx of pancoast tumor syndrome

A

dermatomal sx stemming from C8-T1 and T2 → muscle atrophy, weakness, pain

Horner syndrome

197
Q

4 common metastasis sites of lung ca

A

liver

bones

adrenal glands

brain

198
Q

3 signs of aggressive/metastatic lung ca

A

back pain

HA

focal neuro sx

199
Q

3 dx studies for lung ca

A

CXR

chest CT w. contrast

PET

lung bx

200
Q

who should get CT scan of chest for lung ca screening

A

50-80 yo w. 20 pack-year smoking hx or have quit in last 15 years

201
Q

what is this showing

A

pancoast tumor

202
Q

what do you think when you see: pain related to brachial plexus dermatomes

Horner syndrome

weakness/atrophy of hand muscles

A

pancoast syndrome

203
Q

what is the location of a pancoast tumor

A

superior sulcus of lung

204
Q

dilated milk ducts found in lactating women

A

galactocele

205
Q

tender breast node with fever, malaise, enlarged ipsilateral axillary nodes, and skin erythema

A

breast abscess

206
Q

breast node that occurs in setting of previous breast trauma or injection

A

fat necrosis

207
Q

breast node that occurs in premenopausal women

discrete, widespread, tender

A

fibrocystic breast changes

208
Q

gs clinical intervention for women < 30 yo w. palpable, nontender, breast lesion that is firm and semi mobile

A

breast US

209
Q

t/f: mammogram in pt < 30 yo does not have high yield

A

t!

dt breast density

210
Q

gs clinical intervention for women > 30 yo w. palpable, nontender, breast lesion that is firm and semi mobile

A

diagnostic mammogram w. or w.o directed US

211
Q

gs clinical intervention for woman of any age w. suspicious breast mass

A

diagnostic mammogram and US

212
Q

what is the best next dx step in a pt w. mammographically proven suspicious breast lesion

A

breast bx

213
Q

what do you think when you see: asymmetric oligoarthritis of LE, urethritis, and bilateral injected conjunctiva/uveitis 1-2 weeks following an infxn

A

reactive arthritis

214
Q

what 2 infixes is reactive arthritis associated w.

A

GI

GU

215
Q

common GI infxns that cause reactive arthritis

A

shigellosis

salmonellosis

yersiniosis

campylobacteriosis

216
Q

2 STIs associated w. reactive arthritis

A

chlamydia trachomatis

ureaplasma urealyticum

217
Q

can’t pee

can’t see

can’t climb a tree

A

reactive arthritis

218
Q

mc affected joints w. reactive arthritis

A

knee

ankle

219
Q

synovial fluid findings of reactive arthritis

A

leukocytosis w. neutrophil predominance

220
Q

management of reactive arthritis

A

abx

supportive tx for n/v

NSAIDs

glucocorticoids if unresponsive to NSAIDs

221
Q

what does bilateral flank ecchymosis make you think of

A

grey turner sign → retroperitoneal hemorrhage or pancreatitis

222
Q

what does periumbilical ecchymosis make you think of

A

Cullen sign → pancreatitis

223
Q

what does supraclavicular LAD make you think of

A

virchow node → GI malignancy

224
Q

what is troisier sign

A

enlarged, hard Virchow node

225
Q

what does strawberry red tongue, fever, LAD, rash, conjunctivitis, erythema make you think of

A

kawasaki dz

226
Q

what is keratoderma blenorrhagicum

A

lesions on palms and soles → reactive arthritis

227
Q

only FDA approved drug to treat fibrocystic breast changes

A

danazol

228
Q

supplements that may help w. fibrocystic breast changes

A

gamolenic acid

vitamin E

primrose oil

229
Q

mc breast tumor in young women

A

fibroadenoma

230
Q

painless, solitary, smooth, firm, mobile, rubberlike, well defined breast mass

A

fibroadenoma

231
Q

what is the name of the fibroadenoma-like tumor with cellular storm that grows rapidly and has a leaf like pattern on histology

A

phyllodes tumor

232
Q

mc cause of fibrocystic breast changes

A

fluctuating hormone levels during menstrual cycles

233
Q

sudden-onset epigastric pain that radiates to the back, made worse by walking and lying supine, improved by sitting and leaning forward

A

pancreatitis

234
Q

4 causes of pancreatitis

A

gallstones >

etoh >

hypertriglyceridemia >

drugs

235
Q

in pancreatitis, amylase and lipase are elevated __ x the normal

A

3 x

236
Q

lab findings of pancreatitis

A

elevated amylase/lipase

leukocytosis

elevated BUN

hyperglycemia

hypocalcemia

237
Q

gs dx for pancreatitis

A

CT

238
Q

what do you think when you see “sentinel loop” or segment of air-filled small intestine

A

pancreatitis

239
Q

what criteria is used to assess severity of pancreatitis

A

ranson

240
Q

management of pancreatitis

A

bowel rest

fluids

pain control

241
Q

treatment for gallstone related pancreatitis

A

ERCP → endoscopic retrograde cholangiopancreatography

242
Q

most specific laboratory marker for pancreatitis

A

elevated lipase

243
Q

fever + RUQ pain after eating

A

cholecystitis

244
Q

what GI disorder is AI pancreatitis typically associated w.

A

celiac

245
Q

mc cause of pancreatitis

A

gallstones

246
Q

definitive tx for chronic coronary artery dz w. single vessel involvement

A

revascularization → percutaneous transluminal coronary angioplasty (PTCA)

247
Q

when is CABG indicated (2)

A

pt w. left main coronary artery involvement w. > 50% stenosis, > 70% stenosis 3 vessel dz, or decreased LVEF < 40%

diabetics w. multi vessel dz

248
Q

gs test for diagnosis of CAD

A

coronary angiography

249
Q

tx for ischemic heart dz

A

ASA

nitrates

clopidogrel

heparin

bb

250
Q

tx for ischemic heart dz

A

ASA

nitrates

clopidogrel

heparin

bb

251
Q

w. Cushing dz, a high ACTH level suggests

A

pituitary or other ectopic ACTH secreting tumor

252
Q

w. Cushing, low ACTH level indicates

A

adrenal tumor

(glucocorticoid tumor is suppressing the HPA axis)

253
Q

steps of screening for Cushing

A
  1. 8 am dex serum cortisol test
  2. 24 hr urinary free cortisol test
  3. midnight salivary cortisol levels test
254
Q

in Cushing dz, what are the results of CRH stimulation test

A

ACTH AND cortisol are elevated

255
Q

results of dexamethasone suppression test in Cushing pt’s

A

glucocorticoid suppression

256
Q

what drugs increase the metabolism of dexamethasone leading to impaired cortisol suppression

A

anti seizure drugs → phenytoin, phenobarbital

rifampin

257
Q

mc cause of Cushing

A

iatrogenic → long term steroid use

258
Q

mc non iatrogenic cause of Cushing

A

ACTH secreting pituitary adenoma

259
Q

if cause of Cushing is pituitary tumor, then it is called

A

Cushing disease

260
Q

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

A

gonorrhea

261
Q

tx for gonorrhea

A

ceftriaxone 500 mg IM x 1 dose

doxy 100 mg bid x 7 days

262
Q

gonorrhea can affect which parts of the body

A

urethra

cervix

rectum

pharynx

conjunctiva

263
Q

mc affected parts of the body with gonorrhea

A

men → urethritis

women → cervix

264
Q

disseminated gonorrhea affects the

A

joints

hearts

meninges

265
Q

what do you think when you see cervix that is friable on exam

A

gonorrhea

266
Q

gs dx test for gonorrhea

A

NAAT

267
Q

what do you think when you see gram stain of intracellular gram negative diplococci with polymorphonuclear leukocytes

A

gonorrhea

268
Q

gonorrhea often occurs in conjunction w.

A

chlamydia

269
Q

what inflammatory syndrome involving glisson capsule can occur in pt’s w. PID 2/2 to chlamydia trachomatis and Neisseria gonorrhoeae

A

fitz hugh curtis (perihepatitis)

270
Q

mc pathogen related to folliculitis

A

staph

271
Q

pathogen associated w. hot tub folliculitis

A

pseudomonas

272
Q

folliculitis dt chronic rubbing, friction, occlusion, and perspiration

A

nonbacterial folliculitis

273
Q

tx for pseudomonas folliculitis

A

ciprofloxacin

274
Q

tx for non pseudomonas folliculitis

A

clindamycin

cephalexin

275
Q

meds for nonbacterial folliculitis

A

steroids

antihistamines

276
Q

what is this showing

A

folliculitis → papular/pustular inflammation of hair follicles

277
Q

what is this showing

A

furuncle → painful, firm, or fluctuant abscess originating from a hair follicle

278
Q

what is this showing

A

carbuncle → network of furuncles connected by sinus tracts

279
Q

in what pt pop would you suspect eosinophilic folliculitis

A

HIV

280
Q

folliculitis caused by shaving

A

pseudofolliculitis

hair follicles located to one side of hair follicle, not in them

281
Q

where does pseudomonas folliculitis commonly occur

A

trunk → 8-48 hr after exposure to dirty water

282
Q

what is a complication of folliculitis that causes chronic lesions to the head and neck that are refractory to tx

A

sycosis

283
Q

order of tx for folliculitis

A
  1. topical abx
  2. oral abx
284
Q

acute episode of neurologic compromise, including speech, vision deficit, or extremity weakness that resolves on its own w.o causing tissue damage

A

transient ischemic attack

285
Q

ex of macrovascular transient ischemic attack

A

carotid artery stenosis

286
Q

what does ABCD2 stand for in risk stratification for transient ischemic attack

A

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*
287
Q

pt of moderate risk of stroke using the ABCD2 scale should receive what intervention

A

daily ASA

PLUS

clopdigrel

288
Q

pt of high risk using ABCD2 scale for transient ischemic attack should receive what therapy

A

ASA

PLUS

clopdigrel

PLUS

anti platelet therapy

289
Q

pt low risk on the ABCD2 scale for transient ischemic attack should receive what intervention

A

daily ASA 325 mg

290
Q

med for pt with transient ischemic attack caused by a fib, intracardiac thrombus, acute coronary artery syndrome, prosthetic heart valve, or venous thromboembolism

A

anticoagulant →

rivaroxaban OR warfarin

291
Q

what is the MOA of clopidogrel

A

irreversible blockage of ADP receptors on platelet surface → inhibits platelet aggregation

292
Q

what do you think when you see lesions that typically appear on extensor surfaces, scalp, palms, and soles

A

psoriasis

293
Q

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

A

psoriasis

294
Q

psoriasis plaque formation on site of prior trauma

A

Koebner phenomenon

295
Q

punctuate bleeding spots that are seen when psoriasis scales are scraped off

A

auspitz sign

296
Q

tx for psoriasis that affects < 10% of body surface area

A

high potency topical steroid cream/ointment

297
Q

supplemental tx for psoriasis

A

vitamin D analogs

tar shampoo

salicylic acid gel

flucoinolone acetonide

tracolimus ointment

primecrolimus cream

298
Q

psoriatic flare ups should NEVER be treated with

A

systemic steroids

299
Q

tx of psoriasis for pt who has multiple small lesions and in those who have 10-30% affected body surface area

A

UV phototherapy

300
Q

psoriasis tx for pt who has > 30% body surface area involvement

A

op narrowband UV B (NB-UVB) tx

301
Q

lifestyle change that can improve psoriasis

A

wt loss

302
Q

what 4 conditions is psoriasis associated w.

A

CVD

T2DM

metabolic syndrome

lymphoma

303
Q

pregnancy loss before 20 weeks

A

spontaneous abortion

304
Q

abd pain or bleeding in the first 20 weeks of gestation

cervical os closed

A

threatened abortion

305
Q

abd pain or bleeding in the first 20 weeks of gestation

cervical os open

A

inevitable abortion

306
Q

abd pain or bleeding in the first 20 weeks of gestation

cervical os open

some products of conception passed

A

incomplete abortion

307
Q

abd pain or bleeding in the first 20 weeks of gestation

cervical os closed

complete passage of fetal parts and placenta

A

complete abortion

308
Q

in utero death of the embryo or fetus prior to 20 weeks gestation w. retention of pregnancy

cervical os closed

no products passed

A

missed abortion

309
Q

infxn of uterus during miscarriage

f/c

cervical os open w. purulent d.c

uterine tenderness

no products of conception passed

A

septic abortion

310
Q

what pathogen is usually responsible for septic abortions

A

staph aureus

311
Q

retained products of conception have not been fully expelled

endometritis develops

A

septic abortion

312
Q

what do you think when you see shoulder pain that is worse at night, increasing stiffness x 2-9 mo, and decreased ROM

A

adhesive capsulitis (frozen shoulder)

313
Q

rf for frozen shoulder/adhesive capsulitis

A

DM

thyroid dz

prolonged immobilization

stroke

AI dz

314
Q

management of frozen shoulder/adhesive capsulitis

A

gentle ROM exercise

PT

corticosteroids → oral and injxn

315
Q

when is surgery indicated for frozen shoulder

A

sx lasting > 10-12 mo

unresponsive to other tx

sx severely affect adl

316
Q

2 surgeries for frozen shoulder/adhesive capsulitis

A

manipulation under anesthesia

arthroscopic release

317
Q

what MSK disorder would you prescribe a night splint for

A

CTS

318
Q

what n passes thru the quadrangular space of the shoulder

A

axillary

319
Q

5 meds associated w. delirium

A

sedatives

anticholinergics

opioids

benzos

antihistamines

320
Q

hallmark feature distinguishing delirium from dementia

A

inattention w. delirium

321
Q

t/f: most cases of delirium are reversible

A

t!

322
Q

screening tool for delirium

A

confusion assessment method

323
Q

mc form of dementia

A

alzheimer’s

324
Q

strongly held bizarre or non bizarre beliefs that are not a part of the patient’s culture or religion

A

delusions

325
Q

psychosis includes (4)

A

delusions

hallucinations

thought disorganization

agitation or aggression

326
Q

behavioral deterioration in the evening hours

A

sundowning

327
Q

sundowning is mc in what pt population

A

institutionalized pt’s w. dementia

328
Q

t/f: visual, auditory, or somatosensory hallucinations may accompany delirium

A

t!

329
Q

transverse nasal crease from pushing on the nose

A

allergic salute

330
Q

allergic rinitis tx

A
  1. intranasal corticosteroid sprays
  2. second gen antihistamines (loratidine, fexofenadine, cetirizine)
331
Q

allergic rhinitis is __ mediated

A

IgE

332
Q

which generation of antihistamines is recommended for allergic rhinitis

A

2nd gen → less anticholinergic/sedative effects

333
Q

what are the 1st gen antihistamines

A

brompheniramine

diphenhydramine

hydroxyzine

→ more sedative/anticholinergic effects

334
Q

what are the 2nd gen antihistamines

A

loratidine

fexofenadine

cetirizine

→ preferred due to less sedative/anticholinergic effects

335
Q

what might you see in the hx of a pt with allergic rhinitis

A

asthma

atopic dermatitis

sinusitis

336
Q

vasomotor rhinitis, a common cause of clear rhinorrhea in older patients, is associated w. an increased sensitivity of which nerve

A

vidian nerve

337
Q

which leukemia is associated with a reciprocal translocation on the long arms of chromosomes 9 and 22

A

CML

philadelphia chromosome

338
Q

3 phases of CML

A

chronic

accelerated

plastic

339
Q

sx of chronic phase of CML

A

splenomegaly

fever

night sweats

wt loss

340
Q

accelerated phase of CML is associated w.

A

greater organomegaly

blast cells

341
Q

plastic phase of CML includes

A

acute sx → fever, night sweats, wt loss, bone pain

>30% blasts in the peripheral blood smear

+/- anemia, thrombocytopenia, thrombocytosis

342
Q

tx for CML

A

allogenic hematopoietic cell transplantation → not recommended for older pt’s

tyrosine kinase inhibitors

cytotoxic agents

343
Q

mc childhood leukemia

A

ALL

344
Q

which type of leukemia is associated with auer rods and is mc in adults

A

AML

345
Q

mc adult chronic leukemia

associated w. smudge cells

worst prognosis

A

CLL

346
Q

mostly seen in adults

philadelphia chromosome

basophilia on smear

A

CML

347
Q

what are B symptoms

A

group of symptoms caused by active leukemia →

fever, weight loss, night sweats

348
Q

flu sx

A

abrupt onset:

fever

malaise

myalgia

HA

respiratory tract illness sx

349
Q

most sensitive dx test for influenza

A

reverse transcriptase polymerase chain reaction (RT-PCR)

350
Q

consider influenza antiviral therapy in what pt pops

A

severe dz

high risk of complications

not high risk but present w.in 48 hr of onset

351
Q

what patients are at high risk of complications from influenza

A

>65 yo

pregnant or postpartum

LTC facilities

chronic medical conditions

immunocompromised

352
Q

mc antiinfluenza therapy

A

oseltamivir

353
Q

t/f: oseltamivir is effective against A and B influenza

A

T!

354
Q

what is the mc complication of influenza

A

PNA

355
Q

classifications of asthma severity

A

mild intermittent

mild persistent

moderate persistent

severe persistent

356
Q

mc chronic dz in Peds

A

asthma

357
Q

daily asthma sx twice a week, nightly sx twice a month or less and lungs are asymptomatic btw attacks

A

mild intermittent

358
Q

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

A

mild persistent asthma

359
Q

daily asthma sx, nightly sx more than once a week

sx interfere w. daily activities

A

moderate persistent

360
Q

asthma sx throughout the day, nightly sx often more than 7x/week

sx that have extremely limited ADLs

A

severe persistent

361
Q

what condition presents w. an expiratory monophonic wheeze best heard over large airways

A

tracheomalacia

362
Q

vaccines recommended for HIV pt’s w. CD4 200 or higher

A

influenza

tdap

pneumococcal

menigococcal

hep B series

HPV series

MMR

varicella

363
Q

vaccination schedule for HIV pt’s w. CD4 could 200 or less

A

influenza

tdap

pneumococcal

meningococcal

hep B series

HPV series

364
Q

t/f: the bacillus calmette-guerin vaccine should be administered to pt’s w. HIV who are at increased risk of contracting TB

A

f!

may cause disseminated dz

365
Q

agents that cause pneumoconiosis and affect the upper lung

A

coal dust

beryllium → fluorescent lights, dental, computer, aerospace

talc → ceramics, plastics, rubbers, cosmetics

silica → mining, quarrying, drilling, sand

366
Q

agents that cause pneumoconiosis and affect the lower lungs

A

hard metal → diamonds, cobalt

asbestos → insulation, brakes, ships, construction

367
Q

what do you think when you see: SOB, dry cough, cutaneous nodules on fingers and forearms, hilar LAD and diffuse parenchymal infiltrates

A

berylliosis pneumoconiosis

368
Q

monday fever

increased bronchovascular markings, cardiomegaly, hyperinflation

A

byssiniosis

369
Q

eggshell calcifications of hilar nodes on CXR

increased risk of TB

A

silicosis

370
Q

does pneumoconiosis typically present w. an obstructive or restrictive pattern on PFT

A

restrictive

371
Q

what CD4 count for HIV pt is pneumocystis jiroveci vaccination recommended

A

<200

EOR: Family Med (7 decks)

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