Rosh Material #4 Flashcards
1
Q
mucopurulent unilateral eye discharge with erythema Pruritis rare
A
bacterial conjunctivitis
2
Q
unilateral watery discharge with erythema
+/- Pruritis
A
viral conjunctivitis
3
Q
unilateral eye erythema with cobblestoning and pruritis
A
allergic conjunctivitis
4
Q
eye condition commonly seen in contact lens wearers
A
infectious keratitis
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
6
Q
mc bacteria that cause bacterial conjunctivitis
A
staph aureus
strep pneumo
h. flu
7
Q
conditions that are associated w. fibromyalgia
A
RA
hypothyroidism
anxiety
dpn
insomnia
8
Q
widespread, achy MSK pain and stiffness
multiple tender points
fatigue, sleep disorders, subjective numbness
IBS
A
fibromyalgia
9
Q
when are sx of fibromyalgia most severe
what aggravates them
A
AM
minor exertion
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
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
12
Q
tx for fibromyalgia
A
CBT
pt education
sleep hygiene
low impact aerobic exercise
amitryptiline
fluoxetine
duloxetine
pregabalin/gabapentin
13
Q
3 pharm that are ineffective for fibromyalgia
A
NSAIDs
steroids
opioids
14
Q
what does distal to proximal progression of muscle weakness make you think of
A
guillain-barre
esp w. PMH recent infxn
15
Q
what recent infxn is associated w. Guillain barre
A
campylobacter jejuni
16
Q
what does proximal extremity weakness that improves throughout the day make you think of
A
Lambert-eaton syndrome
17
Q
what malignancy is Lambert eaton syndrome associated w.
A
small cell lung cancer
18
Q
3 FDA approved meds for fibromyalgia
A
duloxetine
pregabalin
milnacipran
19
Q
what virus causes verrucous papules (warts)
A
HPV
20
Q
vaccine schedule for HPV
A
patients < 15 yo: 2 doses
patients 14 and older: 3 doses
21
Q
tx for warts
A
spontaneous resolution (mc in kids)
liquid nitrogen cryotherapy
40% salicylic acid plaster after paring
22
Q
condyloma acuminata
A
genital warts
23
Q
tx for condyloma acuminata
A
liquid nitrogen cryotherapy
podophyllum resin
imiquimod 5% cream
electrocautery
laser therapy
24
Q
what is this showing
A
plantar wart → verruca plantera
25
what is this showing
common wart → verruca vulgarisms
26
what is this showing
flat wart → verruca plana
27
medical usefulness of clostridium toxin (botox)
cervical dystonia
hyperhidrosis
overactive bladder
amblyopia
28
bleomycin is contraindicated for warts located where
fingers
29
which 2 hav types are mc associated w. condyloma acuminata
6
11
30
mc location for warts
hands
31
95% of testicular tumors are
germ cell tumors
32
2 types of testicular germ cell tumors
nonseminomas
seminomas
33
2 mc sx of testicular ca
enlargement of testis
sensation of heaviness
34
PE finding of testicular ca
contender, discrete mass
OR
diffuse testicular enlargement
35
3 signs of metastatic spread of testicular ca
**LE edema** → vena cava obstruction
**back pain** → retroperitoneal metastasis
**cough** → pulmonary
36
3 lab findings of testicular ca
elevated:
human chorionic gonadotropin
alpha fetoprotein
LDH
37
definitive dx for testicular ca
**inguinal orchiectomy**
38
preferred dx for testicular ca
scrotal US
CT scan
39
localized tenderness w. swelling of posterior right testis
epididymitis
40
2 mc causes of epididymitis in men \< 35 yo
Neisseria gonorrhoeae
chlamydia trachomatis
41
2 mc causes of epididymitis in men \> 35 yo
e.coli
42
what is prehn sign and what does it make you think of
pain relief w. elevation of painful testicle
eididymitis
43
is cryptochordism more likely to occur on the right or left side
right
44
rf for teesticular ca
cryptochordism
15-35 yo
45
tx for metastatic testicular ca
platinum based chemo
46
t/f: an elevated LDL is not considered a criterion of metabolic syndromeT
t!
47
mc age of onset for Parkinson's
45-65 yo
48
resting or pill rolling tremor
cogwheel/lead pipe rigidity
bradykinesia
postural instability
masked facies
parkinson's
49
loss of ability to perform rapid movements
dysdiadochokinesia → think Parkinson's
50
what 2 things must be present for Parkinson's dx
bradykinesia
PLUS
rigidity OR tremor
51
Parkinson's tx for pt's \< 65 yo
dopamine agonists →
pramipexole
ropinirole
bromocriptine
*goal is to delay levodopa*
52
mainstay tx for Parkinson's in pt \> 65 yo
levodopa
PLUS
carbidopa
53
common s.e of levodopa
n/v
hypotension
dyskinesias
54
what medication is associated w. the on-off phenomenon
levodopa →
transient, abrupt fluctuations in motor sx in response to falling blood levels
55
second line drugs for parkinson's
amantadine
rasagline
tolcapone/entacapone
benztropine
antipsychotics
56
etiology of Parkinson's
loss of Substantia Nigra → depletion of dopamine
57
chorea (dance like movements) makes you think of
huntington dz
58
CAG trinucleotide repetition
autosomal dominant dz
huntington dz
59
huntington sx worsen with
trial of levodopa
60
tx for huntington
tetrabenazine
*dopamine depleting drug*
61
multisystem atrophy
progressive neuro condition
constipation, incontinence, postural hypotn, anhidrosis, lower motor neuron signs
parkinsonism
shy-drager syndrome
62
low ceruloplasmin
increased copper deposition
chronic hepatitis
dx before 20 yo
wilson dz
63
what are kayser-fleischer rings
what are they pathognomonic for
dark rings encircling the iris
wilson dz
64
what sign seen in Parkinson dz is characterized by sustained blink response to repetitive tapping over the bridge of the nose
myerson sign
65
3 mc pops that have bowel hypermobility
infants
young children
IBS pt's
66
presentation of bowel hypermobility
chronic diarrhea
67
nonabsorbable solutes in the intestinal lumen
osmotic/diet induced diarrhea
68
what type of diarrhea does ingestion of polyethylene glycol 3350 induce
osmotic
69
mc diagnostic tool for PE
CTA
70
what is Virchow's triad
venous stasis
endothelial injury
hypercoagulability
71
what do westermark sign and Hampton hump make you think of
PE
72
mc findings of PE on ECG
**sinus tachycardia**
**nonspecific ST and T wave changes**
S1Q3T3
73
tx for stable pt w. PE
heparin bridge
NOAC OR warfarin
74
tx for unstable pt w. PE
thrombolytic therapy → altepase streptokinase
embolectomy
75
tx for PE if pt has contraindication to anticoagulation, high risk for DVT, or recurrent thromboembolism
IVC filter
76
what is the mcginn-white sign
S1Q3T3 pattern on ECG in pt w. acute right heart strain
77
6 PE findings of CHF
bibasilar rales
laterally displaced PMI
S3 gallop
peripheral edema
JVD
hepatojugular reflex
78
what is the hepatojugular reflex and what does it make you think of
jugular venous dissension increases w. liver palpation
hepatic congestion → CHF
79
vessel cephalization
Kerley lines
batwing pattern in hilar area
pulmonary edema
CHF
80
med to avoid in CHF
bb
81
meds for CHF
diuretics
nitrates
O2
digoxin
dobutamine
82
fixed split S2 sound
RBBB
OR
atrial septal defect
83
2 mc heart sounds associated w. CHF
S3 → systolic HF
S4 → diastolic HF
84
leg pain, cramping, muscle fatigue, stasis dermatitis
medial malleolus ulcer
venous insufficiency
85
JVD
muffled heart sounds
hypotension
cardiac tamponade
86
common hx findings for cardiac tamponade
pericarditis
malignancy
chest xrt
87
what IV nutritional supplement has been shown to improve functional outcomes in pt w. CHF
Iron
88
tx for CHF PLUS hypotension with no signs of shock
doputamine
89
s.e of dobutamine
may worsen hypotension
90
tx for CHF PLUS hypotension with signs of shock
NE
91
bone condition that typically presents in kids
result of subchondral bone necrosis
affects medial femoral condyle in the knee
osteochondritis dessicans
92
dx for osteochondritis dessicans
MRI
93
CT disorder
presents w. multiple low trauma fx in peds
osteogenesis imperfecta
94
blue sclera, short stature, ligamentous laxity, easy bruising
osteogenesis imperfecta
95
what class of meds used for the tx of osteoporosis has been associated w. osteonecrosis of the jaw
bisphosphonates
96
screening recs for smokers to screen for abdominal aneurysm
abd US btw 65-75 yo
*one time test*
97
mc type of lung ca
non small cell
98
what genetic mutation causes pt's to need an annual colonoscopy dt 100% risk of colon ca
FAP → familial adenomatous polyposis
*autosomal dominant*
99
those at risk for familial adenomatous polyposis
first degree relatives of pt w. FAP
\>10 cumulative colorectal adenomas
100
at what age does pt w.FAP need to start getting colonoscopy
12 yo
continues annually until colectomy is performed
101
2 tx options for FAP
proctocolectomy w. ieorectal and anal anatomosis
total colectomy w, ileorectal anastomosis
102
3 conditions associated w. increased risk for colorectal ca
Lynch syndrome
familial adenomatous polyposis
hamartomatous polyposis syndrome
103
EBCAM (B) gene mutation
Lynch syndrome
104
mc cause of inherited colorectal ca
Lynch syndrome
105
other cancers associated w. Lynch syndrome (besides colorectal)
gastric
SI
endometrial
ovarian
urinary tract
skin
pancreatic
106
MLH1 (C)
MSH2
MSH6
PMS (D(
mismatch gene mutations
Lynch syndrome
107
what guidelines are used in pt's w. Lynch syndrome associated colorectal ca to determine the need for tumor testing for microsatellite instability
revised Bethesda
108
3-2-1 criteria for Lynch syndrome
3 family members w. Lynch syndrome associated ca
2 associated cancers involving 2 generations
1 ca diagnosed before 50 yo
109
at what age do colonoscopies begin for pt w. Lynch syndrome
25
*also endometrial and ovarian screening/surgical resection/chemo*
110
multiple non caveating granulomas throughout the body
affects many organ systems
20-40 yo
chemical exposure
sarcoidosis
111
2 mc organs affected by sarcoidosis
lungs
skin
112
most common sx of sarcoidosis (3)
SOB
pulmonary effusion
PTX
113
3 skin manifestation of sarcoidosis
warm, erythematous painful patches and nodules on shins, arms, buttocks
erythema nodosum
lupus pernio
114
erythema nodosum
uveitis
bilateral hilar adenopathy on CXR
common PE findings of sarcoidosis
115
gallium uptake is increased around the hilar nodes and trachea
lambda sign → sarcoidosis
116
gallium uptake is increased around the lacrimal and parotid glands of the face
panda sign → sarcoidosis
117
tx for sarcoidosis
1. steroids → prednisone for up to 6 mo to taper
2. MTX
118
tx for cutaneous sarcoidosis
hydroxychloroquine
119
fever, fatigue, weight loss, polyarthritis
bilateral hilar LAD
sarcoidosis
120
sarcoidosis lab elevations (3)
ACE
hypercalcemia
hypercalciuria
121
indications for lung transplant for sarcoidosis
failed pharm tx
severe end stage dz → parenchymal infiltrates, fibrosis, honeycombing, hilar retractions, bulbous cysts
122
t/f: sarcoidosis often spontaneously resolves
t!
123
why isn't sputum culture useful for sarcoidosis
not an infectious process
124
chronic, violaceous, raised plaques and nodules commonly found on chest, cheeks, nose, and around the eyes
lupus pernio
125
what is lupus pernio pathognomonic for
sarcoidosis
126
127
what does Loefgren syndrome make you think of
sarcoidosis
128
which of the radiographic stages used to classify lung involvement in sarcoidosis is associated w. the least favorable prognosis
stage 3
129
what test is used to evaluate for glaucoma
tonometry
130
IOP \> __ is considered increased
21
131
first line tx for chronic glaucoma
PG analog → latanoprost
+/- topical bb → timolol
132
standard procedure for chronic open angle glaucoma
trabeculectomy
133
initial tx for acute angle closure glaucoma
IV acetazolamide
topical timolol
topical pilocarpine
topical apraclonidine
134
what surgical procedure is used as definitive tx for angle-closure glaucoma
peripheral iridotomy
135
2 factors that may reduce breast ca risk
breastfeeding
regular PA
136
GOLD criteria for COPD classification/tx
137
what abx for COPD exacerbation has been shown to have anti inflammatory properties in the lungs
azithromycin
138
greatest rf for PID
multiple sex partners
139
how long should op oral abx be continued when treating PID
14 days
140
1st line drug therapy specifically targeted to lowering TG
fenofibrate
141
tx for pt w. severely elevated TG
statin
PLUS
fenofibrate
142
what lipid lowering medication is contraindicated w. statin
gemfibrozil
143
t/f: adult pt's should be screened for hypertriglyceridemia
f!
144
xanthomas, tendinous xanthomas, corneal arcus
hypertriglyceridemia
145
tx for hypertriglyceridemia (4)
fibrates
omega 3
niacin
etoh abstinence
146
preferred dx test for nephrolithiasis
non contrast CT of abdomen/pelvis
147
5 rf for nephrolithiasis
**hyperparathyroidism**
HTN
DM
dehydration
gout
148
mc type of kidney stones
calcium oxalate
149
all types of kidney stones
calcium oxalate
calcium phosphate
uric acid
struvite
cysteine
150
proteus and klebsiella are associated w. what type of kidney stone
struvite
151
imaging for pregnant pt w. nephrolithiasis
US
152
stones \> __ will not pass spontaneously
5 mm
153
what med helps w. stone passage
tamsulosin
154
mc location for kidney stones
ureterovesicular junction (UVJ)
155
management of kidney stones
analgesics
fluids
tamsulosin
renal/urology consult
156
what type of stone is associated w. the development of staghorn calculi
struvite
157
what type of kidney stone is radiolucent on xray
uric acid
158
what type of kidney stone is found in kids w. metabolic dz
cysteine
159
stones \> __ should get medical expulsive therapy (tamsulosin)
5 mm
160
management of stone \> 10 mm
urology consult
shock wave therapy
uteroscopy
161
what do you think when you see: swelling of the superior posterior aspect of the scrotum
epididymitis
162
mc pathogen associated w. epididymitis in pt's \< 35 yo
chlamydia trachomatis
163
mc cause of scrotal pain
epididymitis
164
what does a positive prehn sign suggest
epididymitis
165
alleviation of pain w. elevation of the scrotum
prehn sign
166
tx for epididymitis in pt \< 35 yo (STI)
ceftriaxone/doxy
167
tx for epididymitis for pt \> 35 yo (non STI)
**levofloxacin**
OR
Bactrim (if quinolone contraindication)
168
pathogen associated w. pelvic infxns in women w. IUD
actinomyces israelii
169
what dx is the blue dot sign associated w.
torsion of the appendix and testicle
170
gradual onset unilateral scrotal pain
epididymitis
171
US findings of epididymitis
increased color flow
172
mc cause of dementia
alzheimer's
173
definitive dx for alzheimers
brain bx
174
amyloid plaques
hyperphosphorylated tau protein
neurofibrilary tangles
alzheimers
175
screening tools for Alzheimers
mini mental status exam
montreal cognitive assessment
176
meds for alzheimers
**cholinesterase inhibitors:**
donepezil
galantamine
rivastigmine
**NMDA agonist:**
memantine
**antioxidants**
**selegiline**
177
what is finger agnosia
loss of the ability to recognize one's own fingers, the fingers of others, and any drawing or representation of the fingers
178
short term memory loss
confusion about location of familiar places
difficulty completing daily tasks
poor judgment
changes in mood/personality
Alzheimer's
179
mc type of HA
tension
180
tension HA's are \_\_lateral
bi
181
describe the pain in a tension HA
moderate
non throbbing
182
regions of the head mc affected by tension HA
**band like distribution:**
frontal
occipital
183
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
tension HA
184
dx for tension HA
at least 15 episodes of HA per month lasting 30 minutes to 7 days x 3 months
185
t/f: tension HA are aggravated by PA
f!
186
first line tx for tension HA
**NSAIDs**
**ASA**
also APAP
187
first line tx for prophylaxis of tension HA
amitriptyline
188
what type of HA is aggravated by PA
migraine
189
triggers for tension HA
stress
fatigue
glare
noise
190
first line tx for cluster HA
100% O2
191
what is included in metabolic syndrome
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
what dietary supplement acts like a low intensity statin
red yeast rice
193
PE findings of hypertriglyceridemia
skin xanthomas
tendinous xanthomas
corneal arcus
194
TG __ or higher indicates increased risk for CVD
150
195
TG __ or higher increases risk for pancreatitis
500-1000
196
med for severely elevated TG
Fibrates
197
mc pathogen associated w. atypical PNA
mycoplasma pneumoniae
198
what do you think when you see: **insidious onset of dry cough** with no sputum production, sore throat, HA, myalgia, fever
atypical PNA
199
PE findings of atypical PNA
pulse-temperature dissociation (normal pulse in setting of high fever)
wheezing
ronchi
crackles
200
CXR findings of atypical PNA
reticulonodular or interstitial infiltrates
absent/minimal consolidation
201
3 abx for atypical PNA
macrolides
doxy
fluoroquinolone
202
PNA that is associated w. smokers and aerosol producing devices (whirlpool spas, grocery shop mist machines, air travel, watersheds)
legionella
203
legionella PNA presents with nonproductive cough and __ symptoms
GI
204
what type of PNA can present with a positive urinary antigen test even weeks after tx has started
legionella
205
which atypical organism is associated w. exposure to livestock and transaminitis
coxiella burnetti
206
mc ECG finding for anorexia
sinus Brady
207
soft/fine hair
common finding with anorexia
lanugo
208
cardiac complications of anorexia
mitral valve prolapse
myocardial fibrosis
209
ECG findings of hypokalemia
flattened/inverted T waves
QT prolongation
U waves
209
ECG findings of hypokalemia
flattened/inverted T waves
QT prolongation
U waves
210
antidepressant to avoid in pt w. eating disorder
bupropion → lowers sz threshold
211
what pathogen causes acute suppurative parotitis
s. aureus
212
rf for suppurative parotitis
dehydration
poor oral hygiene
intubation
213
classic pt that develops supportive parotitis
older post op
214
abrupt onset of erythematous, firm, painful swelling from the periauricular area to the angle of the mandible
acute bacterial parotitis
215
which duct might suppurative parotitis affect
stenson's
216
treatment for bacterial suppurative parotitis
**IV abx**
nafcillin PLUS metronidazole OR clinda
OR
Unasyn (Amp/Sulbactam)
217
2tx for hospital acquired suppurative parotitis
or
immunocompromised pt
Vanco OR linezolid
PLUS
cefepime, metronidazole, Zosyn
218
surgical incision/drainage should be performed fur suppurative parotitis if pt has not improved w.in
2 days
219
what pathogen can cause unilateral or bilateral **non purulent** parotitis
and systemic symptoms like fever, HA, myalgia
mumps
220
complications of mumps
orchitis
oophoritis
meningitis
encephalitis
deafness
221
rf for MRSA
IVDU
LTC facility
recent hospital admit
hemodialysis
222
bipolar 1 is characterized by
manic episodes
hypomanic episodes
major depressive episodes
223
bipolar II is characterized by
depressive episodes
at least one hypomanic episodes
***no manic episodes***
224
difference btw mania and hypomania
mania lasts at least one week
225
first line tx for bipolar major depression
quetiapine
OR
lurasidone
226
difference btw bipolar I and bipolar II
bipolar II does not include manic episodes
227
tx for acute mania, mixed mood episodes, and maintenance therapy of bipolar
lithium
228
t/f: lithium is FDA approved for bipolar
f!
229
first line tx for bipolar in pregnant pt
lamotrigine
230
main organ responsible for conversion of T4 to T3
liver
231
what disorder is Zollinger Ellison syndrome closely associated w.
multiple endocrine neoplasia type I
232
gnawing epigastric pain
PUD
233
ulcer pain is alleviated by ingesting food
duodenal
***“dud give me food”***
234
ulcer pain is exacerbated by ingesting food
gastric ulcer
235
infection that mc occurs at the olecranon, pre patellar, and infrpatellar bursa
septic bursitis
236
rf for septic bursitis
trauma
gout
loss of skin integrity
recent joint aspiration
immunosupression
237
mc pathogen associated w. septic bursitis
s. aureus
238
acute onset of tenderness, pain, edema, erythema, and warmth at bursa
septic bursitis
239
you should consider septic arthritis instead of septic bursitis if you see what PE finding
limitation of joint movement
240
gs for dx of septic bursitis
bursa fluid culture
241
indications for surgical drainage of septic bursitis
severely swollen
persistent sx after 36-48 hr after abx
242
who is at risk for MRSA infxn with septic bursitis
prior hx MRSA
inability to tolerate oral abx
**bursitis overlying prosthetic joint or graft**
243
tx for MRSA associated septic bursitis
IV Vanco PLUS cefazolin
244
oral tx for MRSA associated bursitis without systemic infxn/immunocompromised
bactrim
245
abx for MSSA or strep associated septic bursitis
cephalexin
OR
diclozacillin
246
t/f: aseptic bursitis can be caused by gout
t!
247
where in the body is FSH synthesized
gonadotrophin cells of the anterior pituitary
248
red flags of back pain
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
most back pain resolves within \_\_
6 weeks
250
what response with plantar stimulation is a positive Babinski sign in adults characterized
dorsal extension and fanning of the toes
251
what do you think when you see a pt who presents with hemolysis following an oxidative stressor, ex recent administration of a drug
G6PD deficiency
252
G6PD is an __ linked
\_\_ enzyme disorder
X
RBC
253
3 meds associated w. G6PD deficiency
dapsone
antimalarial drugs
nitrofurantoin
254
what disorder are fava beans associated with
G6PD deficiency
255
4 sx of hemolysis
jaundice
pallor
abd pain
dark urine
256
sign of G6PD deficiency in neonates
kernicterus
257
labs for G6PD deficiency
decreased hgb
increased reticulocytes
increased bilirubin
decreased haptoglobin
increased ldh
258
what does peripheral smear show for hemolysis
heinz bodies
bite cells
259
is Coombs test negative or positive for G6PD deficiency
negative → non immune
260
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
heinz body → results in bite cell
261
what does the G6PD deficiency protect against
malaria
262
what do you think when you see the following triad:
rash, fever, eosinophilia
in the setting of antibiotic therapy
allergic interstitial nephritis
263
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
paroxysmal nocturnal hemoglobinuria
264
what supplement should be initiated in patients with chronic hemolysis
folic acid
265
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
acute retinal artery occlusion
266
pathology behind acute retinal artery occlusion
embolism occludes blood flow to the retina → retinal ischemia, vision loss
267
mc cause of acute rental artery occlusion
carotid artery atherosclerotic lesion
268
what test can aid in the dx of acute retinal artery occlusion
fluorescein angiography
269
how do you r.o giant cell arteritis when working up central retinal artery occlusion
ESR or CRP → will be elevated with giant cell arteritis
270
management of acute retinal artery occlusion
immediate ophthalmology consult
try:
orbital massage
intra-arterial thrombolytic therapy
IOP reduction → acetazolamide, mannitol
vasodilators
anterior chamber paracentesis
271
what do you think when you see: blood and thunder appearance on fundoscopic exam
central retinal vein occlusion
272
all patients \> __ yo with acute monocular vision loss should have ESR done to r/o
giant cell arteritis
273
tx for giant cell arteritis
high dose steroids asap
274
what are the possible sequelae of retinal artery occlusion
vision loss
vitreous hemorrhage
neovascular glaucoma
275
boxcar look or cherry red spot on fundoycopic exam
acute retinal artery occlusion
276
2 types of hemorrhoids
internal
external
277
hemorrhoids that originate above the dentate line
internal
278
hemorrhoids that originate below the dentate line
external
279
what do you think when you see: painless rectal bleeding with bowel movements, not colon ca
hemorrhoids
280
what does rectal pain and a palpable lump with hemorrhoids indicate
thrombosed external hemorrhoid
281
1st line management of hemorrhoids
**lifestyle mods →**
increase fluids/fiber, PA
avoid sitting
attempt BM after meals
282
second line tx for hemorrhoids if lifestyle mods do not work
sitz baths
local anesthetics
topical steroids
vasoactive substances → nitroglycerin, phenylephrine
zinc oxide
283
procedures for persistent hemorrhoids
rubber band ligation
sclerotherapy
excision
284
who is a candidate for rubber band ligation for hemorrhoids
healthy patients with grade I, II, or III internal hemorrhoids
285
who is a candidate for sclerotherapy with hemorrhoids
pt on anticoagulants/antiplatelets
immunocompromised
portal HTN
286
when should excision be used for hemorrhoids
acutely thromboses external hemorrhoids
287
when should you not attempt office-based procedures for hemorrhoids
grade IV internal hemorrhoids
288
hemorrhoid that does not protrude through the anus
grade I
289
hemorrhoid that protrudes through the anus and then reduces spontaneously
grade II
290
hemorrhoid that must be manually reduced
grade III
291
\_\_ can not be used on external hemorrhoids due to pain
rubber band ligation
292
what is the recommended procedural treatment for patients with refractory grade II internal hemorrhoids who are on anticoagulants
sclerotherapy → low risk of bleeding
293
men \< 65 yo who consume __ drinks are at risk for alcohol-related health risks
4 or more/day
14 or more/week
294
definition of standard drink
12 ounce beer
5 ounce glass of wine
1.5 ounce of 80-proof liquor
295
women and adults 65 yo and older who consume __ drinks are at higher risk of alcohol related health risk
7 or more/week
3 or more on any day
296
what is the definition of binge drinking
drinking enough that the blood alcohol concentration level reaches 0.08 g/dL within 2 hr
297
self limited, benign condition in which the costochondral or chondosternal joints become inflamed and causes reproducible chest wall tenderness
costochondritis
298
describe the location of pain in costochondritis
reproducible chest wall tenderness over the costal cartilages along the sternal border
299
mc cause of chest pain in children - often caused by carrying a backpack on one shoulder
costochondritis
300
work up for pt \> 35 yo with cp along the sternal border
EKG
Xray
301
inflammatory disorder that presents with costochondral tenderness and is likely to be preceded by infectious, rheumatologic, or neoplastic process
tietze syndrome
302
how do you differentiate costochondritis from tietze syndrome
costochondritis is:
more common
usually affects \> 40 yo
**involves \> 1 area of reproducible tenderness**
does not include reproducible swelling
303
management of costochondritis
PT/stretching
heat or cold therapy
APAP or NSAIDs
topical analgesic or anti-inflammatory
steroids for refractory
304
what do you think when you see: pain along the sternal border, recent viral infxn, and localized swelling
tietze syndrome
305
which ribs attach directly to the sternum via their costal cartilage
the first 7
306
2 largest rf for dementia
advanced age
cerebrovascular dz
307
2 treatable causes of dementia to r.o during work up
B12 deficiency
hypothyroidism
308
2 main drug classes in dementia tx
cholinesterase inhibitors
N-methyl-D aspartate antagonists
309
preferred imaging for evaluation of cognitive decline
MRI
*although not required for dx*
310
t/f: MMS or MOCA is required for dx of dementia
f!
311
what is mild cognitive impairment
a decline in memory or cognition that is noticeable to the patient or family members but does not significantly interfere with ADL
312
a D dimer \< __ has a high negative predictive value for PE
500
313
small PTX \< __ % of the hemithorax will resolve spontaneously
15
314
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
takotsubo cardiomyopathy
315
how do you differentiate btw an NSTEMI and takotsubo cardiomyopathy
with takotsubo cardiomyopathy there is an absence of obstructive coronary disease or acute plaque rupture
316
nitroglycerin is contraindicated in what type of MI
right ventricular MI
317
2 essential criteria for dx of PTSD
symptoms must affect ADL
symptoms must be present 1 month or more
318
if symptoms of PTSD last \< 1 month, what is the diagnosis
acute stress disorder
319
tx for PTSD
CBT
SSRI
320
what are the two SSRIs that are FDA approved for PTSD
sertraline
paroxetine
321
med to add to PTSD tx if pt also has insomnia if pt has PTSD AND insomnia
trazodone
322
what is the appropriate tx for a patient with acute stress disorder
CBT
323
2 mc modes of transmission for Hep B
sexual transmission
IVDU
324
sx of Hep B
fatigue
malaise
anorexia
nausea
RUQ pain
+/- low grade fever
+/- jaundice
325
labs indicative of Hep B
ALT and AST elevations, often 1,000-2,000 units/L
326
is ALT or AST higher in Hep B
ALT
327
indication of chronic Hep B
persistent ALT elevation for \> 6 months
328
what lab value is used to screen for, detect, and diagnose acute and chronic Hep B
HbsAG
329
what lab value is the earliest routine indicator of acute HBV and can identify infected people before symptoms occur
HBsAG
330
what lab value can indicate previous exposure to HBV OR successful vaccination
indicates immunity to HBV
anti-HBs
331
first antibody produced after HBV infection
IgM
332
antibody produced later in HBV infection
IgG
333
what lab value is used to indicate acute HBV infection and to monitor effectiveness of treatment
HBeAG
334
management of HBV
supportive
335
when are antivirals indicated for HBV infection
acute liver failure
336
indications of severe liver failure in HBV infection
encephalopathy
severe coagulopathy
337
risks associated w. chronic HBV
cirrhosis
hepatocellular carcinoma
338
vaccination schedule for HBV
initial dose at **birth**
subsequent doses at **1 month and 6 months**
339
which of the 5 hepatotoxic viruses is only seen in combo with hep B
hep D
340
infxn of the soft tissues around the fingernail that usually veins as superficial cellulitis and can progress to an abscess
paronychia
341
mc pathogen associated w. paronychia
staph
342
tx for paronychia without fluctuance
topical abx → mupirocin or triple abx ointment
warm compress
antiseptic soak
343
tx for paronychia with extensive cellulitis or underlying conditions
oral abx → dicloxacillin OR cephalexin
344
tx for paronychia if MRSA is suspected
bactrim
clinda
doxy
345
tx for paronychia with abscess formation
immediate incision and drainage
abx usually not required
346
paronychia affects what area of the nail
lateral and proximal nail folds
347
infection of the nail bed below the nail
eponychia
348
complications of acute paronychia in immunocompromised patients
eponychia
tenosynovitis
osteomyelitis
felon formation
349
what 2 CCB are recommended for first line tx of HTN
dihydropyridine CCB →
amlodipine
nifedipine
350
fist line drugs for HTN
HCTZ
dihydropyridine CCB
ACEI OR ARB
351
mc cause of aortic regurgitation
endocarditis
352
what do you think when you see a pt w.: exertion dyspnea, signs of HF, hx of angina, and a hyperdynamic apical pulse
aortic regurgitation
353
describe the pulse in aortic regurgitation
bounding peripheral pulse
wide pulse pressure
354
describe the murmur in aortic regurgitation
acute: low pitched early diastolic murmur
chronic: holodiastolic, high pitched murmur
355
where is the murmur of aortic regurgitation best heard
left upper sternal border
356
aortic regurgitation murmur __ with valsalva
decreases
357
swift upstroke and rapid fall of radial pulse with wrist elevation
water-hammer pulse
358
head bobbing pulse
de Musset sign
359
visible pulsations of uvula
mueller sign
360
fingernail bed pulsations with light compression
quincke pulse
361
what do de Musset sign, Mueller sign, water-hammer pulse, and Quincke pulse make you think of
aortic regurgitation
362
definitive diagnostic test for aortic regurgitation
cardiac catheterization
363
definitive tx for aortic regurgitation
surgical repair or valve replacement
364
indications for surgery with aortic regurgitation
symptomatic
ejection fraction \< 55%
365
management of mild/asymptomatic aortic regurgitation
ACEI
CCB
digoxin
salt restriction
cardiac rehab
366
3 causes of acute aortic regurgitation
endocarditis
aortic dissection
trauma
367
what early diastolic murmur is heard best in the lateral decubitus position
mitral stenosis
368
what murmur presents with a blowing, holosystolic murmur that is heard best at the apex
mitral regurgitation
369
what does an Austin flint murmur suggest
severe aortic regurgitation → late diastolic murmur heard best at the apex
370
what is duroziez sign and what does it make you think of
systolic or diastolic thrill or murmur heard over the femoral arteries
aortic regurgitation (insufficiency)
371
mc chronić dysrhythmia
afib
372
4 types of afib
paroxysmal
persistent
long standing persistent
permanent
373
triggers for afib
thyroid disorders
pericarditis
trauma to the chest
OSA
cardiac surgery
pulmonary disorders
meds
374
condition to r.o for afib
thyroid disorders
375
mc consequence of afib
thrombus formation
376
how do you determine if a pt w. afib needs to be anticoagulated
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
what are the 4 NOACS
dabigitran
rivaoxaban
apixaban
edoxaban
378
what med MUST be given to afib pt before cardioverting them
anticoagulant
379
what meds are used for rate control in afib
bb
ccb
digoxin
380
the which clotting factor do the NOACs inhibit
Xa
381
which clotting factors does Warfarin inhibit
II
VII
IX
X
proteins C and S
382
t/f: ASA is useful for the prevention of stroke dt afib
f!
383
2 strains of HPV associated w. cervical ca
16
18
384
HPV infections lasting \> __ increase risk for precancerous/cancerous lesions
12 months
385
rf for cervical ca
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
2 major types of cervical ca
squamous cell carcinoma
adenocarcinoma
387
mc type of cervical ca
squamous cell carcinoma
388
sx of cervical ca
irregular/heavy vaginal bleeding
postcoital bleeding
changes in vaginal discharge
389
cervical ca screening should begin at what age \_\_
and should continue q __ years if no abnormalities are found
21
3
390
cervical ca screening for women 30-65 should be q __ years
5
391
t/f: the cervix is removed during a total hysterectomy
t!
392
do patients who have had a total hysterectomy need to continue to have cervical ca screening
no
393
vaccination schedule for HPV
11 or 12 years old
women up to 26 yo if they were not previously vaccinated
394
what HPV vaccination is used in the US
9vHPV
395
what is the recommended approach for women 25 and older with low grade squamous intraepithelial lesions and a positive HPV test
colposcopy
396
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
increased gonadotropin releasing hormone
increased FSH
increased LH
397
2 phases of the menstrual cycle
follicular
luteal
398
in the beginning of the follicular phase, estradiol and progesterone levels are \_\_
which causes increased release of \_\_
from the \_\_
low
GnRH
hypothalamus
399
GnRH acts on the \_\_
to secrete __ (2)
which causes follicle release
anterior pituitary
FSH and LH
400
what hormone causes thickening of the uterine endometrium and an increase in cervical mucosa
estradiol
401
when during the menstrual cycle do estradiol levels peak
day 1 before ovulation
402
what stimulates ovulation
LH surge
403
during the menstrual cycle, in the absence of fertilization, the dominant follicle becomes the \_\_
corpus luteum
404
what hormone maintains the corpus luteum
chorionic gondatotropin
405
what marks the transition of the luteal phase back to the follicular phase
onset of menses
406
what amount of blood lost during a menstrual cycle defines heavy menstrual bleeding
\>80 mL
407
what is the appropriate screening guideline for an abdominal aortic aneurysm according to the USPTF
screen all men age 65-75 old who have ever smoked with a one-time US
408
2 mc rf associated with abdominal aneurysm
smoking
advanced age
409
t/f: abdominal aortic aneurysm screening is recommended for women, regardless of smoking status
f!
it is not recommended for women
410
what are the 2 greatest interventions to reduce the risk of developing an abdominal aortic aneurysm
smoking cessation
blood pressure control
411
what will PE show for an abdominal aortic aneurysm
pulsatile abdominal mass
412
indication of ruptured abdominal aortic aneurysm
hypotension
413
diagnostic tool for abdominal aortic aneurysm
US
414
monitoring for abdominal aortic aneurysm 4.0-4.9 cm
annually
415
monitoring for abdominal aortic aneurysm 5.0-5.4 cm
q 6 mo
can use CT or MRI in addition to US
416
what size abdominal aortic aneurysm is indicative of surgery
\>5.5 cm with rapid expansion rate
417
mc acute leukemia in adults
acute myeloid leukemia (AML)
418
rf for AML
age
radiation
tobacco
trisomy 21
419
sx of AML
anemia
neutropenia
thrombocytopenia
fatigue
easy bruising
pallor
SOB
fever
420
2 sx not associated w. AML in adults
bone pain
organomegaly
421
anemia associated w. AML
normocytic
normochromic
422
what do Auer rods make you think of
AML → circulating myeloblasts
423
dx for AML is done using \_\_
which must have what finding
bone marrow bx
greater than 20% blast cells
424
first line tx for AML
combo chemo: 7+3 regimen
425
procedure to consider for select AML patients
allogenic hematopoietic stem cell transplantation
426
complications of AML
tumor lysis syndrome
febrile neutropenia
427
which leukemia that is common in kids presents with fever, LAD, organomegaly
ALL
428
3 phases of CML
chronic
accelerated
blast
429
gene associated w. CML
ABL1 → results in Philadelphia chromosome
430
if you see leukemia in an kid, you can rule out
AML
