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
2
Q
how to differentiate ganglion cyst vs tumor
A
ganglion cyst will transilluminate
3
Q
order of management for ganglion cyst
A
- obs and reassurance
- needle aspiration (high recurrence rate)
- surgical removal
4
Q
mc soft tissue tumor of the hand
A
ganglion cyst
5
Q
what do you think of when you see Terry-thomas sign on an X-ray of the wrist
A
scapholunate dissociation
6
Q
herniation of the posterior bladder wall into the anterior wall of the vagina
A
cystocele
7
Q
order of tx for a cystocele
A
- conservative measures
- pessary → if symptomatic
- surgery → if ulceration or tissue destruction
8
Q
two vaccines that prevent PNA for immunocompetent adults > 65 yo
A
PCV 15
PCV 20
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
10
Q
PNA vaccination used for Peds
A
PCV 13
11
Q
which type of PNA presents with extra pulmonary symptoms (myalgia, sore throat, HA, nausea)
A
atypical → mycoplasma, chlamoydophila, legionella
12
Q
vaccination schedule for PCV 13
A
2, 4, 6, 12 months
13
Q
which abx is used for pneumocystis jirovecci infxn
A
bactrim
14
Q
what assessment tool is used to determine high risk PNA patients
A
CURB-65 →
confusion, urea nitrogen, RR, bp, 65 or older
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
16
Q
which organisms make up the HACEK group of organism
A
haemophilus
actinobacillus
cardiobacterium
eikenella
kingella
17
Q
for dx of GAD, pt must have symptoms > __
A
6 months
18
Q
3 conditions commonly associated w. GAD
A
social phobia
specific phobia
panic disorder
19
Q
what screening tool is used in primary care to screen for GAD
A
GAD seven-item scale (GAD-7)
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
21
Q
2 mc somatic sx associated w. GAD
A
HA
cervical, shoulder, back pain
22
Q
what do you think when you see: corrigan pulse, wide pulse pressure, de musset sign, and quincke sign
A
aortic regurgitation
23
Q
head bobbing with each heartbeat
A
de musset sign
24
Q
pulsating nail beds
A
quincke sign
25
which valve disorder do you think of when you see jugular venous dissension and left parasternal lift
pulmonary stenosis
26
which valvular d.o do you think of when you see Austin flint murmur
aortic regurgitation
27
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
28
common drugs that cause torsades de point
antiarrhythmics
antidepressants
droperidol
phenothiazines
erythromycin
fluoroquinolones
methadone
29
how do you differentiate btw sustained and non sustained vtach
sustained has duration 30 seconds or more
30
what do you think when you see: rhythm \> 180, and frequent QRS variation axis and morphology
torsades de pointes
31
what hypercoagulable disorder is associated with warfarin-induced skin necrosis
protein C deficiency
32
what hypercoaguable disorder is associated with neonatal purpura fulminans
protein C deficiency
33
mc hypercoagulable disorder
factor V leiden
34
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
35
normal FEV1
\>80%
36
which hereditary d.o should patients with suspected COPD be evaluated for
alpha-1 antitrypsin deficiency
37
what do you think of when you see: excessive O2 → decreased respiratory drive
COPD
emphysema
38
management of COPD/emphysema
bronchodilators
anticholinergics
steroids
NIPPV
smoking cessation
39
what type of bacteria causes bacterial meningitis with symptoms of petechiae and purpura fulminans
gram negative diplococci →
Neisseria meningitidis
**meningococcemia**
40
what bacteria is mc responsible for meningitis in infants and children \< 23 mo old
e. coli
41
mc cause of bacterial meningitis in older adults
strep pneumo
42
what type of bacteria is strep pneumo
gram positive lancet shaped diplococci
43
listeria monocytogenes bacterial meningitis is mc seen in
neonates
immunocompromised patients
older adults
44
what type of bacteria is listeria monocytogenes
gram positive motile coccobacili
45
4 CSF findings of meningitis
elevated opening pressure
decreased glucose
elevated protein
elevated WBC → neutrophils predominate
46
empiric abx tx for meningitis for non immunocompromised
vanco
PLUS
ceftriaxone or cefotaxime
PLUS
dexamethasone
47
tx for immunocompromised pt's w. meningitis
vanco
PLUS
ceftriaxone
PLUS
ampicillin
PLUS
dexamethasone
48
vaccinations are available for which 2 types of meningitis
strep pneumo
Neisseria meningitidis
49
prophylaxis tx for close contacts of meningitis
rifampin
OR
cipro
OR
ceftriaxone
50
4 unique sx of Neisseria meningitidis
septicemia
rapidly spreading ecchymosis
gangrene of extremities
DIC
51
tx for Neisseria meningitidis
ceftriaxone ASAP!
52
at what age should the quadrivalent meningococcal conjugate vaccine be administered
11-12 yo
booster at 16
53
exercise induced asthma has connection with what 2 other conditions
atopic dermatitis
allergic rhinitis
54
first line tx for exercise induced asthma
SABA before exercise
55
t/f: montelukast is effective in treating exercise induced asthma
t!
56
mc cause of lateral hip pain in adults
greater trochanteric pain syndrome
57
radiograph findings of greater trochanteric pain syndrome
normal
58
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
59
tx for greater trochanteric pain syndrome
self limiting
heating pad
NSAIDs
PT
glucocorticoid injxn if persistent
60
what do you think when you see: immunocompromised pt with e.o external wound or puncture wound near painful hip
microbial trochanteric bursitis
61
what do you think when you see: osteophytes, joint space narrowing, subchondral sclerosis
OA
62
which orthopedic test detects tightness of the IT band, tensor fascia late, and gluteus Maximus
ober
63
more than half of FB obstructions occur in the __ lung
right
64
sx of FB ingestion
cough
stridor
monophonic wheezing
diminished lung sounds
hyper resonance to percussion over the affected area
65
CXR findings of FB ingestion
hyperinflated lung
atelectasis
mediastinal shift
PNA
radiopaque object
66
management of FB ingestion
supportive
immediate removal
rigid or flexible bronchoscopy
67
what does segmental hyperresonance make you think of
FB obstruction
68
t/f: bronchodilators may aid in the removal of an aspirated FB
f!
69
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
70
tx for labyrinthitis (4)
benign, self limiting
corticosteroids
symptomatic tx
vestibular rehab
71
vestibular neuritis + unilateral hearing loss =
labyrinthitis
72
mc symptom of TB
fever
73
2 CXR findings of TB
normal
hilar adenopathy → mc
74
what do you think when you see “ghon complex”
TB
75
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
76
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
77
what do you think when you see: loss of central vision
macular degeneration
78
classification of macular degeneration
dry → atrophic
wet → neovascular/exudative
79
3 rf for macular degeneration
advanced age
smoking
family hx
80
what do drusen spots make you think of
macular degeneration
81
possible supportive care to slow down macular degeneration progression
combo of:
vitamin C
vitamin E
lutein
zinc
copper
82
class of meds that might treat wet macular degeneration
anti vascular endothelial growth factors →
bevacizumab
ranibizumab
83
mc type of macular degeneration
dry → nonexudative
84
4 sx of dry macular degeneration
drusen spots
gradual loss of vision
macular thinning
not total blindness
85
5 sx of wet (exudative) macular degeneration
neovascularization
sudden loss of vision
bleeding, leaking of fluid
not total blindness
more severe central vision loss
86
what do you think when you see: clouding of the visual field
cataracts
87
tx for cataracts
surgical replacement of lens
88
what do you think when you see: peripheral vision loss
glaucoma
89
distortion of straight lines, such as perceiving doors or blinds as curved
can be seen with wet macular degeneration
metamorphosia
90
mc cause of blindness in older pops
macular degeneration
91
anterior wall of rectum herniates through posterior wall of vagina
weakening of pelvic floor muscles
rectocele
92
tx for rectocele
conservative measures
pessary if concern for ulceration or if symptomatic
surgery
93
bacteria commonly associated w. food poisoning
staph aureus
bacillus cereus
clostridium perfingens
e.coli
94
which diarrhea is associated w. farm animal exposure
salmonella
95
which pathogen causes travelers diarrhea
giardia
96
community acquired dysentery is caused by what 3 pathogens
shigella
campylobacter
salmonella
97
indications for further testing with diarrhea
high risk
cardiac dz
IBD
high fever
abd pain
passage of \> 6 unformed stools x 24 hr
hypovolemia
98
empiric abx tx for invasive gastroenteritis
azithromycin
OR
fluoroquinolone
99
which abx is used in treatment of diarrhea dt c.diff
oral Vanco
*only indication for oral vanco*
100
mc cause of SBO
adhesions
101
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
102
free air noted in the abdomen indicates
bowel perforation → immediate surgery
103
what do you think when a patient presents with: bilious vomiting and high pitched bowel sounds
SBO
104
what do “stack of coins,” and “string of pearls” on xray make you think of
SBO
105
tx for SBO
NGT
surgery
106
mortality rate for SBO and ischemic bowel if left untreated
100%
107
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
108
characteristics of malignant pulmonary nodule
\>2.5 cm
spiculated
upper lobe
multiple pulmonary nodules 1 cm or greater in diameter
\>30yo
109
ddx for pulmonary nodule
infectious granuloma
bronchogenic carcinoma
hamartoma
malignancy
bronchial adenoma
110
clinical characteristics of HOCM
left ventricular hypertrophy
thickened septum
left ventricular hyper contractility
left atrial enlargement
diastolic dysfunction
111
what heart sound is associated with HOCM
S4 gallop
112
what action decreases HOCM murmur
actions that increase preload:
squatting
hand-grip
113
PE findings of HOCM
pulses bisferiens (biphasic pulses)
triple apical impulse
prominent a wave
S4 gallop
114
what actions increase HOCM murmur
actions that decrease preload →
standing
valsalva
115
mainstay of tx for HOCM
beta blocker
OR
CCB
116
meds to avoid with HOCM
meds that decrease preload:
nitrates
diuretics
ACEI
ARBS
117
ECG findings of HOCM
large amplitude QRS
deep narrow Q waves in lateral or inferior leads
tall R waves
118
which gallop heard on cardiac auscultation can be a normal finding in pt \< 30 yo
S3
119
3 common PE findings associated w. B12 deficiency anemia
gait ataxia
parasthesia
glossitis
120
peripheral blood smear for B12 deficiency
hyperhsegmented neutrophils
121
what does low B12 with elevated methylmalonic acid and homocysteine suggest
B12 deficiency
122
what does low B12 with nl methylmalonic acid and homocysteine suggest
folate deficiency
123
pale green discoloration of skin seen with severe IDA
chlorosis
124
spoon shaped nails (koilonychia) are seen with
IDA
125
oral ulcers may be seen with which type of anemia
folate deficiency
126
what antibody is associated w. pernicious anemia
autoantibodies to intrinsic factor
127
what drug is associated with B12 deficiency
metformin
128
OA pain is worse with \_\_
and alleviated with \_\_,
and morning stiffness lasts \_\_
activity, evening
rest
\<30 min
129
RA pain is worse with \_\_
relieved by \_\_,
and morning stiffness lasts \_\_
rest
activity
60 min
130
OA commonly affects what joints
weight bearing joints
knees
shoulders
hips
proximal PIP (Bouchard nodes)
DIP (heberden)
131
OA is __ lateral
RA is __ lateral
OA: unilateral
RA: bilateral
132
RA commonly affects which joints
PIP
metacarpophalangeal joints
*never DIP*
133
lab findings of RA
elevated CRP/ESR
positive RF. anti CCP, citrullinated peptide
134
first line tx for OA
**naproxen**
others: topical capsaicin, duloxetine, steroid injxns
135
which orthopedic condition is associated w, ulnar deviations, swan neck deformity, and boutonniere deformity
RA
136
ankylosing spondylitis is associated w. which HLA
B27
137
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
138
hallmark of ankylosing spondylitis that occurs early in the disease
bilateral sacroillitis
*earliest radiographic finding*
139
conditions associated w. ankylosing spondylitis
**uveitis**
**aortitis**
IBD
psoriasis
pulmonary fibrosis
140
radiograph findings of ankylosing spondylitis
syndesmophytes bridging across multiple vertebrae → bamboo spine
141
first line tx for ankylosing spondylitis
**NSAIDs**
if unresponsive: TNF inhibitors (ex. adalimumab)
142
tx to avoid in ankylosing spondylitis
steroids
143
HLA of RA
DR4
144
what endocrine disorder is strongly associated with HLA DR3 and HLA DR4
T1DM
145
diseases associated with HLA B27
**PAIR:**
psoriatic arthritis
ankylosing spondylitis
IBD
reactive arthritis
146
mc cause of upper GI bleeding
**PUD**
* also:*
* gastritis*
* duodenitis*
* esophageal varices*
* portal HTN gastropathy*
* mallory weiss tear*
* GI malignancy*
* AV malformation*
147
upper GI bleeding includes bleeding from the \_\_
to the \_\_
oropharynx
ligament of treitz
148
describe the blood in upper GI bleeding
coffee grounds stools
149
describe the bleeding in lower GI stools
bright red hematochezia
150
transfusion protocol for esophageal varies
1 unit fresh frozen plasma
PLUS
1 unit of platelets
q 4 hours
151
acute management of esophageal varices bleeding
hemodynamic resuscitation
otreotide
banding/sclerotherapy
prophylactic abx
152
chronic management of esophageal varices
beta blockers
endoscopic variceal ligation
153
classic presentation of diverticulitis
painless hematochezia
154
dx for esophageal varices
upper GI endoscopy
155
what do you think when you see endoscopy findings of: dilated submucosal esophageal or gastric veins
esophageal varices
156
prophylactic abx for esophageal varices
cefttriaxone
157
endoscopic tx of bleeding esophageal varices
ligation (banding)
158
samter triad
asthma
ASA sensitivity
nasal polyps
159
3 PE findings of asthma
obstructive pattern
expiratory wheezing
improvement of FEV1 \>12% after bronchodilator
160
pale, boggy, edematous masses of hypertrophied nasal mucosa
nasal polyps
161
nasal polyps are associated w.
chronic allergic rhinitis
162
dermatitis
diarrhea
dementia
pellagra (B3 deficiency)
163
what is the mainstay of therapy for salicylate poisoning
alkalization w. sodium bicarbonate
164
contents of abdominal cavity protrude upward thru the esophageal hiatus of the diaphragm
hiatal hernia
165
gastroesophageal junction is displaced above the diaphragm
sliding hiatal hernia
166
fundus is displaced above the diaphragm
paraesophageal hiatal hernia
167
which type of hernia is associated w. trauma, congenital malformation, and iatrogenic factors
sliding hiatal hernias
168
which type of hernia is associated with surgical procedures - ex. anti reflux procedures, esophagomyotomy, and partial gastrectomy
paraesophageal hiatal hernia
169
which type of hiatal hernia is mc asymptomatic
sliding hiatal hernia
170
which type of hiatal hernia mc presents with epigastria pain, postprandial fullness, n/v
paraesophageal hiatal hernia
171
what do you think when you see “retro cardiac air-fluid level” on upright xray, CT, or MRI
hiatal hernia
172
sliding hiatal hernias are typically asymptomatic, but may present w.
GERD
173
dx for hiatal hernia
upper endoscopy
barium swallow → most sensitive
174
management of sliding hiatal hernia
conservative
manage GERD if present
175
management of paraesophageal hernia
asymptomatic: conservative
symptomatic: surgery
176
what do you think when you see n/v, diarrhea, abd cramps, and fever 8-72 hr following exposure to undercooked chicken
salmonellosis
177
what is the mc performed surgical procedure to correct a hiatal hernia
nissen fundoplication
178
atypical sx of GERD
asthma
chronic cough
chronic laryngitis
sore throat
chest pain
sleep disturbance
179
mc dx for GERD
8 week trial of bid H2 receptor antagonist
OR
8 week trial of once daily PPI
180
name 3 H2 receptor antagonists
cimetidine
famotidine
ranitidine
181
name 3 PPIs
omeprazole
esomeprazole
pantoprazole
182
gs for dx of GERD
esophageal pH testing
183
complications of longterm PPI tx
infectious gastroenteritis
IDA
B12 deficiency
hypomagnesemia
PNA
hip fx
184
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
185
what surgical procedure is recommended in pt who is morbidly obese and has sx of GERD
bariatric surgery
186
first step in management of a pt who has expressed intimate partner violence
express empathy, acknowledge struggle, thank patient for their trust
187
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
188
t/f: the PHQ9 is helpful to identify pt's who have been victims of intimate partner violence
f!
189
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
190
mc cause of cancer death in US
lung ca
191
Horner syndrome
ptosis
miosis
anhidrosis
192
4 types of lung ca
small cell
non small cell
squamous cell
adenocarcinoma
193
4 mc presenting sx of lung ca
cough
hemoptysis
chest pain
dyspnea
194
2 syndromes related to lung ca
pancoast syndrome
superior vena cava syndrome
paraneoplastic
195
pan coast syndrome is commonly related to which type of lung ca
non small cell
196
sx of pancoast tumor syndrome
dermatomal sx stemming from C8-T1 and T2 → muscle atrophy, weakness, pain
Horner syndrome
197
4 common metastasis sites of lung ca
liver
bones
adrenal glands
brain
198
3 signs of aggressive/metastatic lung ca
back pain
HA
focal neuro sx
199
3 dx studies for lung ca
CXR
chest CT w. contrast
PET
lung bx
200
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
201
what is this showing
pancoast tumor
202
what do you think when you see: pain related to brachial plexus dermatomes
Horner syndrome
weakness/atrophy of hand muscles
pancoast syndrome
203
what is the location of a pancoast tumor
superior sulcus of lung
204
dilated milk ducts found in lactating women
galactocele
205
tender breast node with fever, malaise, enlarged ipsilateral axillary nodes, and skin erythema
breast abscess
206
breast node that occurs in setting of previous breast trauma or injection
fat necrosis
207
breast node that occurs in premenopausal women
discrete, widespread, tender
fibrocystic breast changes
208
gs clinical intervention for women \< 30 yo w. palpable, nontender, breast lesion that is firm and semi mobile
breast US
209
t/f: mammogram in pt \< 30 yo does not have high yield
t!
*dt breast density*
210
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
211
gs clinical intervention for woman of any age w. suspicious breast mass
diagnostic mammogram and US
212
what is the best next dx step in a pt w. mammographically proven suspicious breast lesion
breast bx
213
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
214
what 2 infixes is reactive arthritis associated w.
GI
GU
215
common GI infxns that cause reactive arthritis
shigellosis
salmonellosis
yersiniosis
campylobacteriosis
216
2 STIs associated w. reactive arthritis
**chlamydia trachomatis**
ureaplasma urealyticum
217
can't pee
can't see
can't climb a tree
reactive arthritis
218
mc affected joints w. reactive arthritis
knee
ankle
219
synovial fluid findings of reactive arthritis
leukocytosis w. neutrophil predominance
220
management of reactive arthritis
abx
supportive tx for n/v
NSAIDs
glucocorticoids if unresponsive to NSAIDs
221
what does bilateral flank ecchymosis make you think of
grey turner sign → retroperitoneal hemorrhage or pancreatitis
222
what does periumbilical ecchymosis make you think of
Cullen sign → pancreatitis
223
what does supraclavicular LAD make you think of
virchow node → GI malignancy
224
what is troisier sign
enlarged, hard Virchow node
225
what does strawberry red tongue, fever, LAD, rash, conjunctivitis, erythema make you think of
kawasaki dz
226
what is keratoderma blenorrhagicum
lesions on palms and soles → reactive arthritis
227
only FDA approved drug to treat fibrocystic breast changes
danazol
228
supplements that may help w. fibrocystic breast changes
gamolenic acid
vitamin E
primrose oil
229
mc breast tumor in young women
fibroadenoma
230
painless, solitary, smooth, firm, mobile, rubberlike, well defined breast mass
fibroadenoma
231
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
232
mc cause of fibrocystic breast changes
fluctuating hormone levels during menstrual cycles
233
sudden-onset epigastric pain that radiates to the back, made worse by walking and lying supine, improved by sitting and leaning forward
pancreatitis
234
4 causes of pancreatitis
gallstones \>
etoh \>
hypertriglyceridemia \>
drugs
235
in pancreatitis, amylase and lipase are elevated __ x the normal
3 x
236
lab findings of pancreatitis
elevated amylase/lipase
leukocytosis
elevated BUN
hyperglycemia
hypocalcemia
237
gs dx for pancreatitis
CT
238
what do you think when you see “sentinel loop” or segment of air-filled small intestine
pancreatitis
239
what criteria is used to assess severity of pancreatitis
ranson
240
management of pancreatitis
bowel rest
fluids
pain control
241
treatment for gallstone related pancreatitis
ERCP → endoscopic retrograde cholangiopancreatography
242
most specific laboratory marker for pancreatitis
elevated lipase
243
fever + RUQ pain after eating
cholecystitis
244
what GI disorder is AI pancreatitis typically associated w.
celiac
245
mc cause of pancreatitis
gallstones
246
definitive tx for chronic coronary artery dz w. single vessel involvement
revascularization → percutaneous transluminal coronary angioplasty (PTCA)
247
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
248
gs test for diagnosis of CAD
coronary angiography
249
tx for ischemic heart dz
ASA
nitrates
clopidogrel
heparin
bb
250
tx for ischemic heart dz
ASA
nitrates
clopidogrel
heparin
bb
251
w. Cushing dz, a high ACTH level suggests
pituitary or other ectopic ACTH secreting tumor
252
w. Cushing, low ACTH level indicates
adrenal tumor
(glucocorticoid tumor is suppressing the HPA axis)
253
steps of screening for Cushing
1. 8 am dex serum cortisol test
2. 24 hr urinary free cortisol test
3. midnight salivary cortisol levels test
254
in Cushing dz, what are the results of CRH stimulation test
ACTH AND cortisol are elevated
255
results of dexamethasone suppression test in Cushing pt's
glucocorticoid suppression
256
what drugs increase the metabolism of dexamethasone leading to impaired cortisol suppression
anti seizure drugs → phenytoin, phenobarbital
rifampin
257
mc cause of Cushing
iatrogenic → long term steroid use
258
mc non iatrogenic cause of Cushing
ACTH secreting pituitary adenoma
259
if cause of Cushing is pituitary tumor, then it is called
Cushing disease
260
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
261
tx for gonorrhea
ceftriaxone 500 mg IM x 1 dose
doxy 100 mg bid x 7 days
262
gonorrhea can affect which parts of the body
urethra
cervix
rectum
pharynx
conjunctiva
263
mc affected parts of the body with gonorrhea
men → urethritis
women → cervix
264
disseminated gonorrhea affects the
joints
hearts
meninges
265
what do you think when you see cervix that is friable on exam
gonorrhea
266
gs dx test for gonorrhea
NAAT
267
what do you think when you see gram stain of intracellular gram negative diplococci with polymorphonuclear leukocytes
gonorrhea
268
gonorrhea often occurs in conjunction w.
chlamydia
269
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)
270
mc pathogen related to folliculitis
staph
271
pathogen associated w. hot tub folliculitis
pseudomonas
272
folliculitis dt chronic rubbing, friction, occlusion, and perspiration
nonbacterial folliculitis
273
tx for pseudomonas folliculitis
ciprofloxacin
274
tx for non pseudomonas folliculitis
clindamycin
cephalexin
275
meds for nonbacterial folliculitis
steroids
antihistamines
276
what is this showing
folliculitis → papular/pustular inflammation of hair follicles
277
what is this showing
furuncle → painful, firm, or fluctuant abscess originating from a hair follicle
278
what is this showing
carbuncle → network of furuncles connected by sinus tracts
279
in what pt pop would you suspect eosinophilic folliculitis
HIV
280
folliculitis caused by shaving
pseudofolliculitis
*hair follicles located to one side of hair follicle, not in them*
281
where does pseudomonas folliculitis commonly occur
trunk → 8-48 hr after exposure to dirty water
282
what is a complication of folliculitis that causes chronic lesions to the head and neck that are refractory to tx
sycosis
283
order of tx for folliculitis
1. topical abx
2. oral abx
284
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
285
ex of macrovascular transient ischemic attack
carotid artery stenosis
286
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*
287
pt of moderate risk of stroke using the ABCD2 scale should receive what intervention
daily ASA
PLUS
clopdigrel
288
pt of high risk using ABCD2 scale for transient ischemic attack should receive what therapy
ASA
PLUS
clopdigrel
PLUS
anti platelet therapy
289
pt low risk on the ABCD2 scale for transient ischemic attack should receive what intervention
daily ASA 325 mg
290
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
291
what is the MOA of clopidogrel
irreversible blockage of ADP receptors on platelet surface → inhibits platelet aggregation
292
what do you think when you see lesions that typically appear on extensor surfaces, scalp, palms, and soles
psoriasis
293
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
294
psoriasis plaque formation on site of prior trauma
Koebner phenomenon
295
punctuate bleeding spots that are seen when psoriasis scales are scraped off
auspitz sign
296
tx for psoriasis that affects \< 10% of body surface area
high potency topical steroid cream/ointment
297
supplemental tx for psoriasis
vitamin D analogs
tar shampoo
salicylic acid gel
flucoinolone acetonide
tracolimus ointment
primecrolimus cream
298
psoriatic flare ups should NEVER be treated with
systemic steroids
299
tx of psoriasis for pt who has multiple small lesions and in those who have 10-30% affected body surface area
UV phototherapy
300
psoriasis tx for pt who has \> 30% body surface area involvement
op narrowband UV B (NB-UVB) tx
301
lifestyle change that can improve psoriasis
wt loss
302
what 4 conditions is psoriasis associated w.
CVD
T2DM
metabolic syndrome
lymphoma
303
pregnancy loss before 20 weeks
spontaneous abortion
304
abd pain or bleeding in the first 20 weeks of gestation
cervical os closed
threatened abortion
305
abd pain or bleeding in the first 20 weeks of gestation
cervical os open
inevitable abortion
306
abd pain or bleeding in the first 20 weeks of gestation
cervical os open
some products of conception passed
incomplete abortion
307
abd pain or bleeding in the first 20 weeks of gestation
cervical os closed
complete passage of fetal parts and placenta
complete abortion
308
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
309
infxn of uterus during miscarriage
f/c
cervical os open w. purulent d.c
uterine tenderness
no products of conception passed
septic abortion
310
what pathogen is usually responsible for septic abortions
staph aureus
311
retained products of conception have not been fully expelled
endometritis develops
septic abortion
312
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)
313
rf for frozen shoulder/adhesive capsulitis
DM
thyroid dz
prolonged immobilization
stroke
AI dz
314
management of frozen shoulder/adhesive capsulitis
gentle ROM exercise
PT
corticosteroids → oral and injxn
315
when is surgery indicated for frozen shoulder
sx lasting \> 10-12 mo
unresponsive to other tx
sx severely affect adl
316
2 surgeries for frozen shoulder/adhesive capsulitis
manipulation under anesthesia
arthroscopic release
317
what MSK disorder would you prescribe a night splint for
CTS
318
what n passes thru the quadrangular space of the shoulder
axillary
319
5 meds associated w. delirium
sedatives
anticholinergics
opioids
benzos
antihistamines
320
hallmark feature distinguishing delirium from dementia
inattention w. delirium
321
t/f: most cases of delirium are reversible
t!
322
screening tool for delirium
confusion assessment method
323
mc form of dementia
alzheimer's
324
strongly held bizarre or non bizarre beliefs that are not a part of the patient's culture or religion
delusions
325
psychosis includes (4)
delusions
hallucinations
thought disorganization
agitation or aggression
326
behavioral deterioration in the evening hours
sundowning
327
sundowning is mc in what pt population
institutionalized pt's w. dementia
328
t/f: visual, auditory, or somatosensory hallucinations may accompany delirium
t!
329
transverse nasal crease from pushing on the nose
allergic salute
330
allergic rinitis tx
1. intranasal corticosteroid sprays
2. second gen antihistamines (loratidine, fexofenadine, cetirizine)
331
allergic rhinitis is __ mediated
IgE
332
which generation of antihistamines is recommended for allergic rhinitis
2nd gen → less anticholinergic/sedative effects
333
what are the 1st gen antihistamines
brompheniramine
diphenhydramine
hydroxyzine
→ more sedative/anticholinergic effects
334
what are the 2nd gen antihistamines
loratidine
fexofenadine
cetirizine
→ preferred due to less sedative/anticholinergic effects
335
what might you see in the hx of a pt with allergic rhinitis
asthma
atopic dermatitis
sinusitis
336
vasomotor rhinitis, a common cause of clear rhinorrhea in older patients, is associated w. an increased sensitivity of which nerve
vidian nerve
337
which leukemia is associated with a reciprocal translocation on the long arms of chromosomes 9 and 22
CML
*philadelphia chromosome*
338
3 phases of CML
chronic
accelerated
plastic
339
sx of chronic phase of CML
splenomegaly
fever
night sweats
wt loss
340
accelerated phase of CML is associated w.
greater organomegaly
blast cells
341
plastic phase of CML includes
acute sx → fever, night sweats, wt loss, bone pain
**\>30% blasts in the peripheral blood smear**
+/- anemia, thrombocytopenia, thrombocytosis
342
tx for CML
allogenic hematopoietic cell transplantation → *not recommended for older pt's*
tyrosine kinase inhibitors
cytotoxic agents
343
mc childhood leukemia
ALL
344
which type of leukemia is associated with auer rods and is mc in adults
AML
345
mc adult chronic leukemia
associated w. smudge cells
worst prognosis
CLL
346
mostly seen in adults
philadelphia chromosome
basophilia on smear
CML
347
what are B symptoms
group of symptoms caused by active leukemia →
fever, weight loss, night sweats
348
flu sx
**abrupt onset:**
fever
malaise
myalgia
HA
respiratory tract illness sx
349
most sensitive dx test for influenza
reverse transcriptase polymerase chain reaction (RT-PCR)
350
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
351
what patients are at high risk of complications from influenza
\>65 yo
pregnant or postpartum
LTC facilities
chronic medical conditions
immunocompromised
352
mc antiinfluenza therapy
oseltamivir
353
t/f: oseltamivir is effective against A and B influenza
T!
354
what is the mc complication of influenza
PNA
355
classifications of asthma severity
mild intermittent
mild persistent
moderate persistent
severe persistent
356
mc chronic dz in Peds
asthma
357
daily asthma sx twice a week, nightly sx twice a month or less and lungs are asymptomatic btw attacks
mild intermittent
358
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
359
daily asthma sx, nightly sx more than once a week
sx interfere w. daily activities
moderate persistent
360
asthma sx throughout the day, nightly sx often more than 7x/week
sx that have extremely limited ADLs
severe persistent
361
what condition presents w. an expiratory monophonic wheeze best heard over large airways
tracheomalacia
362
vaccines recommended for HIV pt's w. CD4 200 or higher
influenza
tdap
pneumococcal
menigococcal
hep B series
HPV series
MMR
varicella
363
vaccination schedule for HIV pt's w. CD4 could 200 or less
influenza
tdap
pneumococcal
meningococcal
hep B series
HPV series
364
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*
365
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
366
agents that cause pneumoconiosis and affect the lower lungs
**hard metal** → diamonds, cobalt
**asbestos** → insulation, brakes, ships, construction
367
what do you think when you see: SOB, dry cough, cutaneous nodules on fingers and forearms, hilar LAD and diffuse parenchymal infiltrates
berylliosis pneumoconiosis
368
monday fever
increased bronchovascular markings, cardiomegaly, hyperinflation
byssiniosis
369
eggshell calcifications of hilar nodes on CXR
increased risk of TB
silicosis
370
does pneumoconiosis typically present w. an obstructive or restrictive pattern on PFT
restrictive
371
what CD4 count for HIV pt is pneumocystis jiroveci vaccination recommended
\<200
