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EOR: Family Med > Rosh Material #4 > Flashcards

Rosh Material #4 Flashcards

1
Q

mucopurulent unilateral eye discharge with erythema Pruritis rare

A

bacterial conjunctivitis

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2
Q

unilateral watery discharge with erythema

+/- Pruritis

A

viral conjunctivitis

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3
Q

unilateral eye erythema with cobblestoning and pruritis

A

allergic conjunctivitis

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4
Q

eye condition commonly seen in contact lens wearers

A

infectious keratitis

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5
Q

when do chlamydial and gonococcal neonatal conjunctivitis generally occur

A

chlamydial: btw 5-14 days of life days of life
gonococcal: btw 2-5 days of life

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6
Q

mc bacteria that cause bacterial conjunctivitis

A

staph aureus

strep pneumo

h. flu

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7
Q

conditions that are associated w. fibromyalgia

A

RA

hypothyroidism

anxiety

dpn

insomnia

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8
Q

widespread, achy MSK pain and stiffness

multiple tender points

fatigue, sleep disorders, subjective numbness

IBS

A

fibromyalgia

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9
Q

when are sx of fibromyalgia most severe

what aggravates them

A

AM

minor exertion

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10
Q

dx for fibromyalgia

A

3 conditions must be present:

widespread pain index > 7 and symptoms severity scale > 5

sx present x at least 3 months

absence of other d.o to explain sx

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11
Q

common sites of point tenderness in fibromyalgia

A

neck

jaw

shoulder girdle

upper and lower arms

chest

abdomen

upper and lower back

hips

upper and lower legs

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12
Q

tx for fibromyalgia

A

CBT

pt education

sleep hygiene

low impact aerobic exercise

amitryptiline

fluoxetine

duloxetine

pregabalin/gabapentin

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13
Q

3 pharm that are ineffective for fibromyalgia

A

NSAIDs

steroids

opioids

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14
Q

what does distal to proximal progression of muscle weakness make you think of

A

guillain-barre

esp w. PMH recent infxn

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15
Q

what recent infxn is associated w. Guillain barre

A

campylobacter jejuni

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16
Q

what does proximal extremity weakness that improves throughout the day make you think of

A

Lambert-eaton syndrome

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17
Q

what malignancy is Lambert eaton syndrome associated w.

A

small cell lung cancer

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18
Q

3 FDA approved meds for fibromyalgia

A

duloxetine

pregabalin

milnacipran

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19
Q

what virus causes verrucous papules (warts)

A

HPV

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20
Q

vaccine schedule for HPV

A

patients < 15 yo: 2 doses

patients 14 and older: 3 doses

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21
Q

tx for warts

A

spontaneous resolution (mc in kids)

liquid nitrogen cryotherapy

40% salicylic acid plaster after paring

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22
Q

condyloma acuminata

A

genital warts

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23
Q

tx for condyloma acuminata

A

liquid nitrogen cryotherapy

podophyllum resin

imiquimod 5% cream

electrocautery

laser therapy

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24
Q

what is this showing

A

plantar wart → verruca plantera

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25
Q

what is this showing

A

common wart → verruca vulgarisms

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26
Q

what is this showing

A

flat wart → verruca plana

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27
Q

medical usefulness of clostridium toxin (botox)

A

cervical dystonia

hyperhidrosis

overactive bladder

amblyopia

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28
Q

bleomycin is contraindicated for warts located where

A

fingers

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29
Q

which 2 hav types are mc associated w. condyloma acuminata

A

6

11

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30
Q

mc location for warts

A

hands

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31
Q

95% of testicular tumors are

A

germ cell tumors

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32
Q

2 types of testicular germ cell tumors

A

nonseminomas

seminomas

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33
Q

2 mc sx of testicular ca

A

enlargement of testis

sensation of heaviness

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34
Q

PE finding of testicular ca

A

contender, discrete mass

OR

diffuse testicular enlargement

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35
Q

3 signs of metastatic spread of testicular ca

A

LE edema → vena cava obstruction

back pain → retroperitoneal metastasis

cough → pulmonary

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36
Q

3 lab findings of testicular ca

A

elevated:

human chorionic gonadotropin

alpha fetoprotein

LDH

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37
Q

definitive dx for testicular ca

A

inguinal orchiectomy

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38
Q

preferred dx for testicular ca

A

scrotal US

CT scan

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39
Q

localized tenderness w. swelling of posterior right testis

A

epididymitis

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40
Q

2 mc causes of epididymitis in men < 35 yo

A

Neisseria gonorrhoeae

chlamydia trachomatis

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41
Q

2 mc causes of epididymitis in men > 35 yo

A

e.coli

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42
Q

what is prehn sign and what does it make you think of

A

pain relief w. elevation of painful testicle

eididymitis

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43
Q

is cryptochordism more likely to occur on the right or left side

A

right

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44
Q

rf for teesticular ca

A

cryptochordism

15-35 yo

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45
Q

tx for metastatic testicular ca

A

platinum based chemo

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46
Q

t/f: an elevated LDL is not considered a criterion of metabolic syndromeT

A

t!

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47
Q

mc age of onset for Parkinson’s

A

45-65 yo

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48
Q

resting or pill rolling tremor

cogwheel/lead pipe rigidity

bradykinesia

postural instability

masked facies

A

parkinson’s

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49
Q

loss of ability to perform rapid movements

A

dysdiadochokinesia → think Parkinson’s

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50
Q

what 2 things must be present for Parkinson’s dx

A

bradykinesia

PLUS

rigidity OR tremor

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51
Q

Parkinson’s tx for pt’s < 65 yo

A

dopamine agonists →

pramipexole

ropinirole

bromocriptine

goal is to delay levodopa

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52
Q

mainstay tx for Parkinson’s in pt > 65 yo

A

levodopa

PLUS

carbidopa

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53
Q

common s.e of levodopa

A

n/v

hypotension

dyskinesias

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54
Q

what medication is associated w. the on-off phenomenon

A

levodopa →

transient, abrupt fluctuations in motor sx in response to falling blood levels

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55
Q

second line drugs for parkinson’s

A

amantadine

rasagline

tolcapone/entacapone

benztropine

antipsychotics

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56
Q

etiology of Parkinson’s

A

loss of Substantia Nigra → depletion of dopamine

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57
Q

chorea (dance like movements) makes you think of

A

huntington dz

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58
Q

CAG trinucleotide repetition

autosomal dominant dz

A

huntington dz

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59
Q

huntington sx worsen with

A

trial of levodopa

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60
Q

tx for huntington

A

tetrabenazine

dopamine depleting drug

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61
Q

multisystem atrophy

progressive neuro condition

constipation, incontinence, postural hypotn, anhidrosis, lower motor neuron signs

parkinsonism

A

shy-drager syndrome

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62
Q

low ceruloplasmin

increased copper deposition

chronic hepatitis

dx before 20 yo

A

wilson dz

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63
Q

what are kayser-fleischer rings

what are they pathognomonic for

A

dark rings encircling the iris

wilson dz

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64
Q

what sign seen in Parkinson dz is characterized by sustained blink response to repetitive tapping over the bridge of the nose

A

myerson sign

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65
Q

3 mc pops that have bowel hypermobility

A

infants

young children

IBS pt’s

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66
Q

presentation of bowel hypermobility

A

chronic diarrhea

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67
Q

nonabsorbable solutes in the intestinal lumen

A

osmotic/diet induced diarrhea

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68
Q

what type of diarrhea does ingestion of polyethylene glycol 3350 induce

A

osmotic

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69
Q

mc diagnostic tool for PE

A

CTA

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70
Q

what is Virchow’s triad

A

venous stasis

endothelial injury

hypercoagulability

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71
Q

what do westermark sign and Hampton hump make you think of

A

PE

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72
Q

mc findings of PE on ECG

A

sinus tachycardia

nonspecific ST and T wave changes

S1Q3T3

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73
Q

tx for stable pt w. PE

A

heparin bridge

NOAC OR warfarin

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74
Q

tx for unstable pt w. PE

A

thrombolytic therapy → altepase streptokinase

embolectomy

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75
Q

tx for PE if pt has contraindication to anticoagulation, high risk for DVT, or recurrent thromboembolism

A

IVC filter

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76
Q

what is the mcginn-white sign

A

S1Q3T3 pattern on ECG in pt w. acute right heart strain

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77
Q

6 PE findings of CHF

A

bibasilar rales

laterally displaced PMI

S3 gallop

peripheral edema

JVD

hepatojugular reflex

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78
Q

what is the hepatojugular reflex and what does it make you think of

A

jugular venous dissension increases w. liver palpation

hepatic congestion → CHF

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79
Q

vessel cephalization

Kerley lines

batwing pattern in hilar area

pulmonary edema

A

CHF

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80
Q

med to avoid in CHF

A

bb

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81
Q

meds for CHF

A

diuretics

nitrates

O2

digoxin

dobutamine

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82
Q

fixed split S2 sound

A

RBBB

OR

atrial septal defect

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83
Q

2 mc heart sounds associated w. CHF

A

S3 → systolic HF

S4 → diastolic HF

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84
Q

leg pain, cramping, muscle fatigue, stasis dermatitis

medial malleolus ulcer

A

venous insufficiency

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85
Q

JVD

muffled heart sounds

hypotension

A

cardiac tamponade

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86
Q

common hx findings for cardiac tamponade

A

pericarditis

malignancy

chest xrt

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87
Q

what IV nutritional supplement has been shown to improve functional outcomes in pt w. CHF

A

Iron

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88
Q

tx for CHF PLUS hypotension with no signs of shock

A

doputamine

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89
Q

s.e of dobutamine

A

may worsen hypotension

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90
Q

tx for CHF PLUS hypotension with signs of shock

A

NE

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91
Q

bone condition that typically presents in kids

result of subchondral bone necrosis

affects medial femoral condyle in the knee

A

osteochondritis dessicans

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92
Q

dx for osteochondritis dessicans

A

MRI

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93
Q

CT disorder

presents w. multiple low trauma fx in peds

A

osteogenesis imperfecta

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94
Q

blue sclera, short stature, ligamentous laxity, easy bruising

A

osteogenesis imperfecta

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95
Q

what class of meds used for the tx of osteoporosis has been associated w. osteonecrosis of the jaw

A

bisphosphonates

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96
Q

screening recs for smokers to screen for abdominal aneurysm

A

abd US btw 65-75 yo

one time test

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97
Q

mc type of lung ca

A

non small cell

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98
Q

what genetic mutation causes pt’s to need an annual colonoscopy dt 100% risk of colon ca

A

FAP → familial adenomatous polyposis

autosomal dominant

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99
Q

those at risk for familial adenomatous polyposis

A

first degree relatives of pt w. FAP

>10 cumulative colorectal adenomas

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100
Q

at what age does pt w.FAP need to start getting colonoscopy

A

12 yo

continues annually until colectomy is performed

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101
Q

2 tx options for FAP

A

proctocolectomy w. ieorectal and anal anatomosis

total colectomy w, ileorectal anastomosis

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102
Q

3 conditions associated w. increased risk for colorectal ca

A

Lynch syndrome

familial adenomatous polyposis

hamartomatous polyposis syndrome

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103
Q

EBCAM (B) gene mutation

A

Lynch syndrome

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104
Q

mc cause of inherited colorectal ca

A

Lynch syndrome

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105
Q

other cancers associated w. Lynch syndrome (besides colorectal)

A

gastric

SI

endometrial

ovarian

urinary tract

skin

pancreatic

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106
Q

MLH1 (C)

MSH2

MSH6

PMS (D(

mismatch gene mutations

A

Lynch syndrome

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107
Q

what guidelines are used in pt’s w. Lynch syndrome associated colorectal ca to determine the need for tumor testing for microsatellite instability

A

revised Bethesda

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108
Q

3-2-1 criteria for Lynch syndrome

A

3 family members w. Lynch syndrome associated ca

2 associated cancers involving 2 generations

1 ca diagnosed before 50 yo

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109
Q

at what age do colonoscopies begin for pt w. Lynch syndrome

A

25

also endometrial and ovarian screening/surgical resection/chemo

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110
Q

multiple non caveating granulomas throughout the body

affects many organ systems

20-40 yo

chemical exposure

A

sarcoidosis

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111
Q

2 mc organs affected by sarcoidosis

A

lungs

skin

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112
Q

most common sx of sarcoidosis (3)

A

SOB

pulmonary effusion

PTX

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113
Q

3 skin manifestation of sarcoidosis

A

warm, erythematous painful patches and nodules on shins, arms, buttocks

erythema nodosum

lupus pernio

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114
Q

erythema nodosum

uveitis

bilateral hilar adenopathy on CXR

A

common PE findings of sarcoidosis

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115
Q

gallium uptake is increased around the hilar nodes and trachea

A

lambda sign → sarcoidosis

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116
Q

gallium uptake is increased around the lacrimal and parotid glands of the face

A

panda sign → sarcoidosis

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117
Q

tx for sarcoidosis

A
  1. steroids → prednisone for up to 6 mo to taper
  2. MTX
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118
Q

tx for cutaneous sarcoidosis

A

hydroxychloroquine

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119
Q

fever, fatigue, weight loss, polyarthritis

bilateral hilar LAD

A

sarcoidosis

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120
Q

sarcoidosis lab elevations (3)

A

ACE

hypercalcemia

hypercalciuria

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121
Q

indications for lung transplant for sarcoidosis

A

failed pharm tx

severe end stage dz → parenchymal infiltrates, fibrosis, honeycombing, hilar retractions, bulbous cysts

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122
Q

t/f: sarcoidosis often spontaneously resolves

A

t!

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123
Q

why isn’t sputum culture useful for sarcoidosis

A

not an infectious process

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124
Q

chronic, violaceous, raised plaques and nodules commonly found on chest, cheeks, nose, and around the eyes

A

lupus pernio

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125
Q

what is lupus pernio pathognomonic for

A

sarcoidosis

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126
Q
A
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127
Q

what does Loefgren syndrome make you think of

A

sarcoidosis

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128
Q

which of the radiographic stages used to classify lung involvement in sarcoidosis is associated w. the least favorable prognosis

A

stage 3

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129
Q

what test is used to evaluate for glaucoma

A

tonometry

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130
Q

IOP > __ is considered increased

A

21

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131
Q

first line tx for chronic glaucoma

A

PG analog → latanoprost

+/- topical bb → timolol

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132
Q

standard procedure for chronic open angle glaucoma

A

trabeculectomy

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133
Q

initial tx for acute angle closure glaucoma

A

IV acetazolamide

topical timolol

topical pilocarpine

topical apraclonidine

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134
Q

what surgical procedure is used as definitive tx for angle-closure glaucoma

A

peripheral iridotomy

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135
Q

2 factors that may reduce breast ca risk

A

breastfeeding

regular PA

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136
Q

GOLD criteria for COPD classification/tx

A
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137
Q

what abx for COPD exacerbation has been shown to have anti inflammatory properties in the lungs

A

azithromycin

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138
Q

greatest rf for PID

A

multiple sex partners

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139
Q

how long should op oral abx be continued when treating PID

A

14 days

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140
Q

1st line drug therapy specifically targeted to lowering TG

A

fenofibrate

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141
Q

tx for pt w. severely elevated TG

A

statin

PLUS

fenofibrate

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142
Q

what lipid lowering medication is contraindicated w. statin

A

gemfibrozil

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143
Q

t/f: adult pt’s should be screened for hypertriglyceridemia

A

f!

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144
Q

xanthomas, tendinous xanthomas, corneal arcus

A

hypertriglyceridemia

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145
Q

tx for hypertriglyceridemia (4)

A

fibrates

omega 3

niacin

etoh abstinence

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146
Q

preferred dx test for nephrolithiasis

A

non contrast CT of abdomen/pelvis

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147
Q

5 rf for nephrolithiasis

A

hyperparathyroidism

HTN

DM

dehydration

gout

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148
Q

mc type of kidney stones

A

calcium oxalate

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149
Q

all types of kidney stones

A

calcium oxalate

calcium phosphate

uric acid

struvite

cysteine

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150
Q

proteus and klebsiella are associated w. what type of kidney stone

A

struvite

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151
Q

imaging for pregnant pt w. nephrolithiasis

A

US

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152
Q

stones > __ will not pass spontaneously

A

5 mm

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153
Q

what med helps w. stone passage

A

tamsulosin

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154
Q

mc location for kidney stones

A

ureterovesicular junction (UVJ)

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155
Q

management of kidney stones

A

analgesics

fluids

tamsulosin

renal/urology consult

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156
Q

what type of stone is associated w. the development of staghorn calculi

A

struvite

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157
Q

what type of kidney stone is radiolucent on xray

A

uric acid

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158
Q

what type of kidney stone is found in kids w. metabolic dz

A

cysteine

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159
Q

stones > __ should get medical expulsive therapy (tamsulosin)

A

5 mm

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160
Q

management of stone > 10 mm

A

urology consult

shock wave therapy

uteroscopy

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161
Q

what do you think when you see: swelling of the superior posterior aspect of the scrotum

A

epididymitis

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162
Q

mc pathogen associated w. epididymitis in pt’s < 35 yo

A

chlamydia trachomatis

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163
Q

mc cause of scrotal pain

A

epididymitis

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164
Q

what does a positive prehn sign suggest

A

epididymitis

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165
Q

alleviation of pain w. elevation of the scrotum

A

prehn sign

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166
Q

tx for epididymitis in pt < 35 yo (STI)

A

ceftriaxone/doxy

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167
Q

tx for epididymitis for pt > 35 yo (non STI)

A

levofloxacin

OR

Bactrim (if quinolone contraindication)

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168
Q

pathogen associated w. pelvic infxns in women w. IUD

A

actinomyces israelii

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169
Q

what dx is the blue dot sign associated w.

A

torsion of the appendix and testicle

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170
Q

gradual onset unilateral scrotal pain

A

epididymitis

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171
Q

US findings of epididymitis

A

increased color flow

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172
Q

mc cause of dementia

A

alzheimer’s

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173
Q

definitive dx for alzheimers

A

brain bx

174
Q

amyloid plaques

hyperphosphorylated tau protein

neurofibrilary tangles

A

alzheimers

175
Q

screening tools for Alzheimers

A

mini mental status exam

montreal cognitive assessment

176
Q

meds for alzheimers

A

cholinesterase inhibitors:

donepezil

galantamine

rivastigmine

NMDA agonist:

memantine

antioxidants

selegiline

177
Q

what is finger agnosia

A

loss of the ability to recognize one’s own fingers, the fingers of others, and any drawing or representation of the fingers

178
Q

short term memory loss

confusion about location of familiar places

difficulty completing daily tasks

poor judgment

changes in mood/personality

A

Alzheimer’s

179
Q

mc type of HA

A

tension

180
Q

tension HA’s are __lateral

A

bi

181
Q

describe the pain in a tension HA

A

moderate

non throbbing

182
Q

regions of the head mc affected by tension HA

A

band like distribution:

frontal

occipital

183
Q

what do you think when you see a HA that is associated w. tenderness of pericranial myofascial tissues (muscle tenderness)

and

increased myofascial trigger points

A

tension HA

184
Q

dx for tension HA

A

at least 15 episodes of HA per month lasting 30 minutes to 7 days x 3 months

185
Q

t/f: tension HA are aggravated by PA

A

f!

186
Q

first line tx for tension HA

A

NSAIDs

ASA

also APAP

187
Q

first line tx for prophylaxis of tension HA

A

amitriptyline

188
Q

what type of HA is aggravated by PA

A

migraine

189
Q

triggers for tension HA

A

stress

fatigue

glare

noise

190
Q

first line tx for cluster HA

A

100% O2

191
Q

what is included in metabolic syndrome

A

3 or more of the following:

waist circumference:

m: > 102 cm
w: > 88 cm

TG > 150

HDL < 40

SBP > 130 OR DBP > 85

FBG > 100

192
Q

what dietary supplement acts like a low intensity statin

A

red yeast rice

193
Q

PE findings of hypertriglyceridemia

A

skin xanthomas

tendinous xanthomas

corneal arcus

194
Q

TG __ or higher indicates increased risk for CVD

A

150

195
Q

TG __ or higher increases risk for pancreatitis

A

500-1000

196
Q

med for severely elevated TG

A

Fibrates

197
Q

mc pathogen associated w. atypical PNA

A

mycoplasma pneumoniae

198
Q

what do you think when you see: insidious onset of dry cough with no sputum production, sore throat, HA, myalgia, fever

A

atypical PNA

199
Q

PE findings of atypical PNA

A

pulse-temperature dissociation (normal pulse in setting of high fever)

wheezing

ronchi

crackles

200
Q

CXR findings of atypical PNA

A

reticulonodular or interstitial infiltrates

absent/minimal consolidation

201
Q

3 abx for atypical PNA

A

macrolides

doxy

fluoroquinolone

202
Q

PNA that is associated w. smokers and aerosol producing devices (whirlpool spas, grocery shop mist machines, air travel, watersheds)

A

legionella

203
Q

legionella PNA presents with nonproductive cough and __ symptoms

A

GI

204
Q

what type of PNA can present with a positive urinary antigen test even weeks after tx has started

A

legionella

205
Q

which atypical organism is associated w. exposure to livestock and transaminitis

A

coxiella burnetti

206
Q

mc ECG finding for anorexia

A

sinus Brady

207
Q

soft/fine hair

common finding with anorexia

A

lanugo

208
Q

cardiac complications of anorexia

A

mitral valve prolapse

myocardial fibrosis

209
Q

ECG findings of hypokalemia

A

flattened/inverted T waves

QT prolongation

U waves

209
Q

ECG findings of hypokalemia

A

flattened/inverted T waves

QT prolongation

U waves

210
Q

antidepressant to avoid in pt w. eating disorder

A

bupropion → lowers sz threshold

211
Q

what pathogen causes acute suppurative parotitis

A

s. aureus

212
Q

rf for suppurative parotitis

A

dehydration

poor oral hygiene

intubation

213
Q

classic pt that develops supportive parotitis

A

older post op

214
Q

abrupt onset of erythematous, firm, painful swelling from the periauricular area to the angle of the mandible

A

acute bacterial parotitis

215
Q

which duct might suppurative parotitis affect

A

stenson’s

216
Q

treatment for bacterial suppurative parotitis

A

IV abx

nafcillin PLUS metronidazole OR clinda

OR

Unasyn (Amp/Sulbactam)

217
Q

2tx for hospital acquired suppurative parotitis

or

immunocompromised pt

A

Vanco OR linezolid

PLUS

cefepime, metronidazole, Zosyn

218
Q

surgical incision/drainage should be performed fur suppurative parotitis if pt has not improved w.in

A

2 days

219
Q

what pathogen can cause unilateral or bilateral non purulent parotitis

and systemic symptoms like fever, HA, myalgia

A

mumps

220
Q

complications of mumps

A

orchitis

oophoritis

meningitis

encephalitis

deafness

221
Q

rf for MRSA

A

IVDU

LTC facility

recent hospital admit

hemodialysis

222
Q

bipolar 1 is characterized by

A

manic episodes

hypomanic episodes

major depressive episodes

223
Q

bipolar II is characterized by

A

depressive episodes

at least one hypomanic episodes

no manic episodes

224
Q

difference btw mania and hypomania

A

mania lasts at least one week

225
Q

first line tx for bipolar major depression

A

quetiapine

OR

lurasidone

226
Q

difference btw bipolar I and bipolar II

A

bipolar II does not include manic episodes

227
Q

tx for acute mania, mixed mood episodes, and maintenance therapy of bipolar

A

lithium

228
Q

t/f: lithium is FDA approved for bipolar

A

f!

229
Q

first line tx for bipolar in pregnant pt

A

lamotrigine

230
Q

main organ responsible for conversion of T4 to T3

A

liver

231
Q

what disorder is Zollinger Ellison syndrome closely associated w.

A

multiple endocrine neoplasia type I

232
Q

gnawing epigastric pain

A

PUD

233
Q

ulcer pain is alleviated by ingesting food

A

duodenal

“dud give me food”

234
Q

ulcer pain is exacerbated by ingesting food

A

gastric ulcer

235
Q

infection that mc occurs at the olecranon, pre patellar, and infrpatellar bursa

A

septic bursitis

236
Q

rf for septic bursitis

A

trauma

gout

loss of skin integrity

recent joint aspiration

immunosupression

237
Q

mc pathogen associated w. septic bursitis

A

s. aureus

238
Q

acute onset of tenderness, pain, edema, erythema, and warmth at bursa

A

septic bursitis

239
Q

you should consider septic arthritis instead of septic bursitis if you see what PE finding

A

limitation of joint movement

240
Q

gs for dx of septic bursitis

A

bursa fluid culture

241
Q

indications for surgical drainage of septic bursitis

A

severely swollen

persistent sx after 36-48 hr after abx

242
Q

who is at risk for MRSA infxn with septic bursitis

A

prior hx MRSA

inability to tolerate oral abx

bursitis overlying prosthetic joint or graft

243
Q

tx for MRSA associated septic bursitis

A

IV Vanco PLUS cefazolin

244
Q

oral tx for MRSA associated bursitis without systemic infxn/immunocompromised

A

bactrim

245
Q

abx for MSSA or strep associated septic bursitis

A

cephalexin

OR

diclozacillin

246
Q

t/f: aseptic bursitis can be caused by gout

A

t!

247
Q

where in the body is FSH synthesized

A

gonadotrophin cells of the anterior pituitary

248
Q

red flags of back pain

A

night pain and wt loss → tumor

f/c, sweats → bone/disk infxn

acute bony tenderness → fx

morning stiffness > 30 min in young adult → seronegative spondyloarthropathy

urinary/bowel retention/saddle anesthesia → cauda equina

recent spinal instrumentation → spinal epidural abscess/hematoma

immunodeficiency → bone/disk infxn

extremes of age

coagulopathy → spinal epidural hematoma

249
Q

most back pain resolves within __

A

6 weeks

250
Q

what response with plantar stimulation is a positive Babinski sign in adults characterized

A

dorsal extension and fanning of the toes

251
Q

what do you think when you see a pt who presents with hemolysis following an oxidative stressor, ex recent administration of a drug

A

G6PD deficiency

252
Q

G6PD is an __ linked

__ enzyme disorder

A

X

RBC

253
Q

3 meds associated w. G6PD deficiency

A

dapsone

antimalarial drugs

nitrofurantoin

254
Q

what disorder are fava beans associated with

A

G6PD deficiency

255
Q

4 sx of hemolysis

A

jaundice

pallor

abd pain

dark urine

256
Q

sign of G6PD deficiency in neonates

A

kernicterus

257
Q

labs for G6PD deficiency

A

decreased hgb

increased reticulocytes

increased bilirubin

decreased haptoglobin

increased ldh

258
Q

what does peripheral smear show for hemolysis

A

heinz bodies

bite cells

259
Q

is Coombs test negative or positive for G6PD deficiency

A

negative → non immune

260
Q

what do you think when you see: inclusion w.in the RBC composed of denatured hgb that is formed as a result of oxidative damage

A

heinz body → results in bite cell

261
Q

what does the G6PD deficiency protect against

A

malaria

262
Q

what do you think when you see the following triad:

rash, fever, eosinophilia

in the setting of antibiotic therapy

A

allergic interstitial nephritis

263
Q

what do you think when you see: PIGA gene mutation on the X chromosome that results in episodic hemolytic anemia and hemoglobinuria at night time and early morning

A

paroxysmal nocturnal hemoglobinuria

264
Q

what supplement should be initiated in patients with chronic hemolysis

A

folic acid

265
Q

what do you think when you see: acute non painful, unilateral complete vision loss, and a pale retina with cherry-red spot in the macula

A

acute retinal artery occlusion

266
Q

pathology behind acute retinal artery occlusion

A

embolism occludes blood flow to the retina → retinal ischemia, vision loss

267
Q

mc cause of acute rental artery occlusion

A

carotid artery atherosclerotic lesion

268
Q

what test can aid in the dx of acute retinal artery occlusion

A

fluorescein angiography

269
Q

how do you r.o giant cell arteritis when working up central retinal artery occlusion

A

ESR or CRP → will be elevated with giant cell arteritis

270
Q

management of acute retinal artery occlusion

A

immediate ophthalmology consult

try:

orbital massage

intra-arterial thrombolytic therapy

IOP reduction → acetazolamide, mannitol

vasodilators

anterior chamber paracentesis

271
Q

what do you think when you see: blood and thunder appearance on fundoscopic exam

A

central retinal vein occlusion

272
Q

all patients > __ yo with acute monocular vision loss should have ESR done to r/o

A

giant cell arteritis

273
Q

tx for giant cell arteritis

A

high dose steroids asap

274
Q

what are the possible sequelae of retinal artery occlusion

A

vision loss

vitreous hemorrhage

neovascular glaucoma

275
Q

boxcar look or cherry red spot on fundoycopic exam

A

acute retinal artery occlusion

276
Q

2 types of hemorrhoids

A

internal

external

277
Q

hemorrhoids that originate above the dentate line

A

internal

278
Q

hemorrhoids that originate below the dentate line

A

external

279
Q

what do you think when you see: painless rectal bleeding with bowel movements, not colon ca

A

hemorrhoids

280
Q

what does rectal pain and a palpable lump with hemorrhoids indicate

A

thrombosed external hemorrhoid

281
Q

1st line management of hemorrhoids

A

lifestyle mods →

increase fluids/fiber, PA

avoid sitting

attempt BM after meals

282
Q

second line tx for hemorrhoids if lifestyle mods do not work

A

sitz baths

local anesthetics

topical steroids

vasoactive substances → nitroglycerin, phenylephrine

zinc oxide

283
Q

procedures for persistent hemorrhoids

A

rubber band ligation

sclerotherapy

excision

284
Q

who is a candidate for rubber band ligation for hemorrhoids

A

healthy patients with grade I, II, or III internal hemorrhoids

285
Q

who is a candidate for sclerotherapy with hemorrhoids

A

pt on anticoagulants/antiplatelets

immunocompromised

portal HTN

286
Q

when should excision be used for hemorrhoids

A

acutely thromboses external hemorrhoids

287
Q

when should you not attempt office-based procedures for hemorrhoids

A

grade IV internal hemorrhoids

288
Q

hemorrhoid that does not protrude through the anus

A

grade I

289
Q

hemorrhoid that protrudes through the anus and then reduces spontaneously

A

grade II

290
Q

hemorrhoid that must be manually reduced

A

grade III

291
Q

__ can not be used on external hemorrhoids due to pain

A

rubber band ligation

292
Q

what is the recommended procedural treatment for patients with refractory grade II internal hemorrhoids who are on anticoagulants

A

sclerotherapy → low risk of bleeding

293
Q

men < 65 yo who consume __ drinks are at risk for alcohol-related health risks

A

4 or more/day

14 or more/week

294
Q

definition of standard drink

A

12 ounce beer

5 ounce glass of wine

1.5 ounce of 80-proof liquor

295
Q

women and adults 65 yo and older who consume __ drinks are at higher risk of alcohol related health risk

A

7 or more/week

3 or more on any day

296
Q

what is the definition of binge drinking

A

drinking enough that the blood alcohol concentration level reaches 0.08 g/dL within 2 hr

297
Q

self limited, benign condition in which the costochondral or chondosternal joints become inflamed and causes reproducible chest wall tenderness

A

costochondritis

298
Q

describe the location of pain in costochondritis

A

reproducible chest wall tenderness over the costal cartilages along the sternal border

299
Q

mc cause of chest pain in children - often caused by carrying a backpack on one shoulder

A

costochondritis

300
Q

work up for pt > 35 yo with cp along the sternal border

A

EKG

Xray

301
Q

inflammatory disorder that presents with costochondral tenderness and is likely to be preceded by infectious, rheumatologic, or neoplastic process

A

tietze syndrome

302
Q

how do you differentiate costochondritis from tietze syndrome

A

costochondritis is:

more common

usually affects > 40 yo

involves > 1 area of reproducible tenderness

does not include reproducible swelling

303
Q

management of costochondritis

A

PT/stretching

heat or cold therapy

APAP or NSAIDs

topical analgesic or anti-inflammatory

steroids for refractory

304
Q

what do you think when you see: pain along the sternal border, recent viral infxn, and localized swelling

A

tietze syndrome

305
Q

which ribs attach directly to the sternum via their costal cartilage

A

the first 7

306
Q

2 largest rf for dementia

A

advanced age

cerebrovascular dz

307
Q

2 treatable causes of dementia to r.o during work up

A

B12 deficiency

hypothyroidism

308
Q

2 main drug classes in dementia tx

A

cholinesterase inhibitors

N-methyl-D aspartate antagonists

309
Q

preferred imaging for evaluation of cognitive decline

A

MRI

although not required for dx

310
Q

t/f: MMS or MOCA is required for dx of dementia

A

f!

311
Q

what is mild cognitive impairment

A

a decline in memory or cognition that is noticeable to the patient or family members but does not significantly interfere with ADL

312
Q

a D dimer < __ has a high negative predictive value for PE

A

500

313
Q

small PTX < __ % of the hemithorax will resolve spontaneously

A

15

314
Q

what do you think when you see: temporary let ventricular systolic dysfunction that mimics a MI and EKG findings of ST segment elevation and elevated troponin

A

takotsubo cardiomyopathy

315
Q

how do you differentiate btw an NSTEMI and takotsubo cardiomyopathy

A

with takotsubo cardiomyopathy there is an absence of obstructive coronary disease or acute plaque rupture

316
Q

nitroglycerin is contraindicated in what type of MI

A

right ventricular MI

317
Q

2 essential criteria for dx of PTSD

A

symptoms must affect ADL

symptoms must be present 1 month or more

318
Q

if symptoms of PTSD last < 1 month, what is the diagnosis

A

acute stress disorder

319
Q

tx for PTSD

A

CBT

SSRI

320
Q

what are the two SSRIs that are FDA approved for PTSD

A

sertraline

paroxetine

321
Q

med to add to PTSD tx if pt also has insomnia if pt has PTSD AND insomnia

A

trazodone

322
Q

what is the appropriate tx for a patient with acute stress disorder

A

CBT

323
Q

2 mc modes of transmission for Hep B

A

sexual transmission

IVDU

324
Q

sx of Hep B

A

fatigue

malaise

anorexia

nausea

RUQ pain

+/- low grade fever

+/- jaundice

325
Q

labs indicative of Hep B

A

ALT and AST elevations, often 1,000-2,000 units/L

326
Q

is ALT or AST higher in Hep B

A

ALT

327
Q

indication of chronic Hep B

A

persistent ALT elevation for > 6 months

328
Q

what lab value is used to screen for, detect, and diagnose acute and chronic Hep B

A

HbsAG

329
Q

what lab value is the earliest routine indicator of acute HBV and can identify infected people before symptoms occur

A

HBsAG

330
Q

what lab value can indicate previous exposure to HBV OR successful vaccination

indicates immunity to HBV

A

anti-HBs

331
Q

first antibody produced after HBV infection

A

IgM

332
Q

antibody produced later in HBV infection

A

IgG

333
Q

what lab value is used to indicate acute HBV infection and to monitor effectiveness of treatment

A

HBeAG

334
Q

management of HBV

A

supportive

335
Q

when are antivirals indicated for HBV infection

A

acute liver failure

336
Q

indications of severe liver failure in HBV infection

A

encephalopathy

severe coagulopathy

337
Q

risks associated w. chronic HBV

A

cirrhosis

hepatocellular carcinoma

338
Q

vaccination schedule for HBV

A

initial dose at birth

subsequent doses at 1 month and 6 months

339
Q

which of the 5 hepatotoxic viruses is only seen in combo with hep B

A

hep D

340
Q

infxn of the soft tissues around the fingernail that usually veins as superficial cellulitis and can progress to an abscess

A

paronychia

341
Q

mc pathogen associated w. paronychia

A

staph

342
Q

tx for paronychia without fluctuance

A

topical abx → mupirocin or triple abx ointment

warm compress

antiseptic soak

343
Q

tx for paronychia with extensive cellulitis or underlying conditions

A

oral abx → dicloxacillin OR cephalexin

344
Q

tx for paronychia if MRSA is suspected

A

bactrim

clinda

doxy

345
Q

tx for paronychia with abscess formation

A

immediate incision and drainage

abx usually not required

346
Q

paronychia affects what area of the nail

A

lateral and proximal nail folds

347
Q

infection of the nail bed below the nail

A

eponychia

348
Q

complications of acute paronychia in immunocompromised patients

A

eponychia

tenosynovitis

osteomyelitis

felon formation

349
Q

what 2 CCB are recommended for first line tx of HTN

A

dihydropyridine CCB →

amlodipine

nifedipine

350
Q

fist line drugs for HTN

A

HCTZ

dihydropyridine CCB

ACEI OR ARB

351
Q

mc cause of aortic regurgitation

A

endocarditis

352
Q

what do you think when you see a pt w.: exertion dyspnea, signs of HF, hx of angina, and a hyperdynamic apical pulse

A

aortic regurgitation

353
Q

describe the pulse in aortic regurgitation

A

bounding peripheral pulse

wide pulse pressure

354
Q

describe the murmur in aortic regurgitation

A

acute: low pitched early diastolic murmur
chronic: holodiastolic, high pitched murmur

355
Q

where is the murmur of aortic regurgitation best heard

A

left upper sternal border

356
Q

aortic regurgitation murmur __ with valsalva

A

decreases

357
Q

swift upstroke and rapid fall of radial pulse with wrist elevation

A

water-hammer pulse

358
Q

head bobbing pulse

A

de Musset sign

359
Q

visible pulsations of uvula

A

mueller sign

360
Q

fingernail bed pulsations with light compression

A

quincke pulse

361
Q

what do de Musset sign, Mueller sign, water-hammer pulse, and Quincke pulse make you think of

A

aortic regurgitation

362
Q

definitive diagnostic test for aortic regurgitation

A

cardiac catheterization

363
Q

definitive tx for aortic regurgitation

A

surgical repair or valve replacement

364
Q

indications for surgery with aortic regurgitation

A

symptomatic

ejection fraction < 55%

365
Q

management of mild/asymptomatic aortic regurgitation

A

ACEI

CCB

digoxin

salt restriction

cardiac rehab

366
Q

3 causes of acute aortic regurgitation

A

endocarditis

aortic dissection

trauma

367
Q

what early diastolic murmur is heard best in the lateral decubitus position

A

mitral stenosis

368
Q

what murmur presents with a blowing, holosystolic murmur that is heard best at the apex

A

mitral regurgitation

369
Q

what does an Austin flint murmur suggest

A

severe aortic regurgitation → late diastolic murmur heard best at the apex

370
Q

what is duroziez sign and what does it make you think of

A

systolic or diastolic thrill or murmur heard over the femoral arteries

aortic regurgitation (insufficiency)

371
Q

mc chronić dysrhythmia

A

afib

372
Q

4 types of afib

A

paroxysmal

persistent

long standing persistent

permanent

373
Q

triggers for afib

A

thyroid disorders

pericarditis

trauma to the chest

OSA

cardiac surgery

pulmonary disorders

meds

374
Q

condition to r.o for afib

A

thyroid disorders

375
Q

mc consequence of afib

A

thrombus formation

376
Q

how do you determine if a pt w. afib needs to be anticoagulated

A

CHA2DS2-VASc:

CHF → 1

HTN → 1

age 75 or older → 2

DM → 1

stroke → 2

vascular disease → 1

age 65-74 → 1

2 or higher for males = NOAC

3 or higher for females = NOAC

sex category (female) → 1

377
Q

what are the 4 NOACS

A

dabigitran

rivaoxaban

apixaban

edoxaban

378
Q

what med MUST be given to afib pt before cardioverting them

A

anticoagulant

379
Q

what meds are used for rate control in afib

A

bb

ccb

digoxin

380
Q

the which clotting factor do the NOACs inhibit

A

Xa

381
Q

which clotting factors does Warfarin inhibit

A

II

VII

IX

X

proteins C and S

382
Q

t/f: ASA is useful for the prevention of stroke dt afib

A

f!

383
Q

2 strains of HPV associated w. cervical ca

A

16

18

384
Q

HPV infections lasting > __ increase risk for precancerous/cancerous lesions

A

12 months

385
Q

rf for cervical ca

A

HPV 16 and 18

early age of sexual activity

multiple partners

hx of STI

hx of vulvar or vaginal squamous neoplasia or ca

low socioeconomic status

immunosuppression

386
Q

2 major types of cervical ca

A

squamous cell carcinoma

adenocarcinoma

387
Q

mc type of cervical ca

A

squamous cell carcinoma

388
Q

sx of cervical ca

A

irregular/heavy vaginal bleeding

postcoital bleeding

changes in vaginal discharge

389
Q

cervical ca screening should begin at what age __

and should continue q __ years if no abnormalities are found

A

21

3

390
Q

cervical ca screening for women 30-65 should be q __ years

A

5

391
Q

t/f: the cervix is removed during a total hysterectomy

A

t!

392
Q

do patients who have had a total hysterectomy need to continue to have cervical ca screening

A

no

393
Q

vaccination schedule for HPV

A

11 or 12 years old

women up to 26 yo if they were not previously vaccinated

394
Q

what HPV vaccination is used in the US

A

9vHPV

395
Q

what is the recommended approach for women 25 and older with low grade squamous intraepithelial lesions and a positive HPV test

A

colposcopy

396
Q

what is the effect of low serum estradiol and progesterone levels on gonadotropin releasing hormone, FSH, and LH at the beginning of the menstrual cycle

A

increased gonadotropin releasing hormone

increased FSH

increased LH

397
Q

2 phases of the menstrual cycle

A

follicular

luteal

398
Q

in the beginning of the follicular phase, estradiol and progesterone levels are __

which causes increased release of __

from the __

A

low

GnRH

hypothalamus

399
Q

GnRH acts on the __

to secrete __ (2)

which causes follicle release

A

anterior pituitary

FSH and LH

400
Q

what hormone causes thickening of the uterine endometrium and an increase in cervical mucosa

A

estradiol

401
Q

when during the menstrual cycle do estradiol levels peak

A

day 1 before ovulation

402
Q

what stimulates ovulation

A

LH surge

403
Q

during the menstrual cycle, in the absence of fertilization, the dominant follicle becomes the __

A

corpus luteum

404
Q

what hormone maintains the corpus luteum

A

chorionic gondatotropin

405
Q

what marks the transition of the luteal phase back to the follicular phase

A

onset of menses

406
Q

what amount of blood lost during a menstrual cycle defines heavy menstrual bleeding

A

>80 mL

407
Q

what is the appropriate screening guideline for an abdominal aortic aneurysm according to the USPTF

A

screen all men age 65-75 old who have ever smoked with a one-time US

408
Q

2 mc rf associated with abdominal aneurysm

A

smoking

advanced age

409
Q

t/f: abdominal aortic aneurysm screening is recommended for women, regardless of smoking status

A

f!

it is not recommended for women

410
Q

what are the 2 greatest interventions to reduce the risk of developing an abdominal aortic aneurysm

A

smoking cessation

blood pressure control

411
Q

what will PE show for an abdominal aortic aneurysm

A

pulsatile abdominal mass

412
Q

indication of ruptured abdominal aortic aneurysm

A

hypotension

413
Q

diagnostic tool for abdominal aortic aneurysm

A

US

414
Q

monitoring for abdominal aortic aneurysm 4.0-4.9 cm

A

annually

415
Q

monitoring for abdominal aortic aneurysm 5.0-5.4 cm

A

q 6 mo

can use CT or MRI in addition to US

416
Q

what size abdominal aortic aneurysm is indicative of surgery

A

>5.5 cm with rapid expansion rate

417
Q

mc acute leukemia in adults

A

acute myeloid leukemia (AML)

418
Q

rf for AML

A

age

radiation

tobacco

trisomy 21

419
Q

sx of AML

A

anemia

neutropenia

thrombocytopenia

fatigue

easy bruising

pallor

SOB

fever

420
Q

2 sx not associated w. AML in adults

A

bone pain

organomegaly

421
Q

anemia associated w. AML

A

normocytic

normochromic

422
Q

what do Auer rods make you think of

A

AML → circulating myeloblasts

423
Q

dx for AML is done using __

which must have what finding

A

bone marrow bx

greater than 20% blast cells

424
Q

first line tx for AML

A

combo chemo: 7+3 regimen

425
Q

procedure to consider for select AML patients

A

allogenic hematopoietic stem cell transplantation

426
Q

complications of AML

A

tumor lysis syndrome

febrile neutropenia

427
Q

which leukemia that is common in kids presents with fever, LAD, organomegaly

A

ALL

428
Q

3 phases of CML

A

chronic

accelerated

blast

429
Q

gene associated w. CML

A

ABL1 → results in Philadelphia chromosome

430
Q

if you see leukemia in an kid, you can rule out

A

AML

EOR: Family Med (7 decks)

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