Rosh Material #5 Flashcards
type of eczema that mc occurs on arms and legs
nummular eczema (discoid eczema)
nummular eczema rash is described as __ shaped, pruritic scaly lesions
coin
tx for nummular (discoid) eczema
moisturizer
moderate to high dose topical steroids
erythematous plaque surrounded by thick adherent scales
psoriasis
what is this showing
non bullous impetigo
oozing and crusting rash
what is this showing
nummular eczema
round, oozing, crusting erosions
dry macules w. a fine scaly pattern
what is this showing
pityriasis rosea
small oval, thick scaling plaques
what is this showing
tinea corporis
thin scaly lesions w. central clearing
mc cause of waterborne and foodborne diarrhea
girardia
first line pharm for giraridia
less than 12 months old: metronidazole
1-3 yo: nitazoxanide
3 yo and older: tinidazole
2 places girardia is commonly contracted
camping/backpacking
daycare
what food should be temporarily avoided after giardiasis due to temporary intolerance
lactose
is the diarrhea associated w. girardia bloody
nope!
3 PE findings of IDA
koilonychia
atrophic glossitis
angular cheillosis
what do howell-jolly bodies make you think of
SSA
asplenia
what do schistocyes make you think of
hemolysis
how elevated are pancreatic enzymes in acute pancreatitis
more than 3x UNL
diminished S1 heart sound followed by holosystolic or mid to late systolic murmur heard best over the apex
mitral regurgitation
aortic stenosis triad
exertional angina
dyspnea
presyncope
murmur heard best in left lateral decubitus position
mitral stenosis
acute mitral regurgitation murmur is heard best at the __
and radiates to the __ rather than the axilla
apex
base
chronic mitral regurgitation murmur is heard best at the __
and radiates to the __
apex
axilla
acute mitral regurgitation murmur is described as __
chronic mitral regurgitation murmur is described as __
acute: midsystolic
chronic: blowing holosystolic
4 tx for acute mitral regurgitation
nitroprusside
dobutamine
intra-aortic balloon pump
emergency surgery
inflammation of meibomian gland
chalazion
which leukemia is mc associated w. previous hx of hematologic disorder, including myelodysplastic syndrome, aplastic anemia, polycythemia vera
AML
rf for asthma
males in childhood
females in adulthood
atopy
allergen exposure
urban dwellers
pollution
respiratory infxns
smoking
obesity
occupation
strongest predisoposing rf for asthma
atopy
3 components of asthma pathology
obstruction to airflow
bronchial hyper-reactivity
airway inflammation
FEV1 of asthma stages
intermittent: > 80%
mild persistent: 80% or higher
moderate: 60-80%
severe persistent: < 60%
initial test for cholecystitis:
gs test for cholecystitis:
initial: US
gs: HIDA
diagnostic criteria for DM need to be repeated for confirmation unless
2 or more criteria are met
screening recs for T2DM
annually in pt > 35 yo
or in pt < 35 yo w. rf
what is this showing
seborrheic keratosis
velvety, waxy lesions with “stuck on appearance”
seborrheic keratosis
tx for seborrheic keratosis
reassurance
rf for seborrheic keratosis
advanced age
“barnacles of aging”
leser-trelat sign
rapid appearance of multiple SK lesions associated w. GI malignancy
at what age do kids usually start to cooperate w. PFTs
5
rf for emphysema
smoking
alpha 1 antitrypsin deficiency
environmental exposures
3 PE findings of emphysema
pursed lip breathing
barrel chest
hyperresonance to percussion
2 PFT findings of emphysema
decreased FEV1:FVC
increased TLC
emphysema in young, non smoker
alpha-1-antitrypsin deficiency
immunizations to avoid in severely immunocompromised pt
rotavirus
MMR
varicella
zoster
3 vaccinations contraindicated in pregnancy
MMR
varicella
zoster
ASA and salicylate containing meds can cause what syndrome in peds
reye
what type of contraception may worsen symptoms of menorrhagia, dysmenorrhea, or endometriosis-related pain
copper IUD
viral conjunctivitis is mc caused by
adenovirus
mc cause of achilles tendinitis
increased activity
heel and foot pain when first stepping out of bed or after period of inactivity
improves w. walking or stretching calf
plantar fasciitis
where is pain w. plantar fasciitis felt
over sole of foot near calcaneus
2 tx for plantar fasciitis
stretching
heel inserts
mc cause of infertility
PCOS
rotterdam criteria for PCOS
2/3:
oligo or anovulation or both
clinical or biochemical signs of hyperandorgenism or both
polycystic ovaries by US
4 PE findings of PCOS
hirsutism
menstrual irregularities
acanthosis nigrans
obesity
acne
5 comorbidities associated w. PCOS
glucose intolerance
metabolic syndrome
OSA
fatty liver
endometrial hyperplasia
labs for PCOS
high LH to FSH
elevated testosterone
mc cause of PCOS
insulin resistance
tx for PCOS
OCP
lifestyle
metformin
LAD in mono is mc located
posterior cervical chain
mono triad
fever
tonsillar pharyngitis
posterior cervical chain LAD
mono rash
generalied maculopapular
uticarial
petechial
dx for mono
heterophile abs test
anterior cervical chain LAD is associated w. (3)
CMV
toxoplasmosis
head/neck infxns
mono pt’s need to avoid contact sports for __ weeks
4 weeks
According to USPSTF:
mammography screenings should start at age __
and continue q __ years
until age __
50
2
75
According to ACS:
mammorgraphy screenings are recommended annually for women aged __
mammography screenings are recommended q 2 years for women aged __
and continue until __
45-54
55 and older
woman is in good health and expected to live at least 10 more years
chronic eczematous dz of the nipple and areola w. an underlying carcinoma of the breast
paget’s dz
mc site of FB obstruction
C6 -> at the level of cricopharyngeus
most FB can have obs x __
24 hr
3 indications for emergent removal of FB
battery
sharp object
signs of obstruction
pH in vaginal candidiasis
normal (<4.5)
valve condition associated w.: jugular venous A wave
and left parasternal lift
pulmonary stenosis
valvular disorder associated w. TOF
pulmonary stenosis
what murmur produces a fluttering sensation in the neck, fatigue, cold extremities
tricuspid stenosis
what causes dysmenorrhea
increased PGF2alpha -> uterine contractions
inability of eye to abduct
lateral rectus CN VI palsy
lateral rectus CN VI palsy is concerning for
CVA
tx for noninflammatory comedome acne
topial retinoid
azelaic acid/salicylic acid
tx for mild papulopustular and mixed acne
topical benzoyl peroxide and topical abx
+/- topical retinoid
tx for moderate papulopustular and mixed acne
topical retinoid
AND
oral abx
AND
topical benzoyl peroxide
OR
oral isotretinoin monotherapy
3 tx for acne during pregnancy
oral or topical erythromycin
topical clinda
topical azelaic acid
oral abx for acne
doxycycline/minocycline
what acne med is pregnancy class X and pt must be on 2 forms of birth control to take it
isotretinoin
ixodes scapularis
lyme disease
how long does a tick need to be attached to transmit lyme dz
48 hr
what rash is pathognmonic for lyme dz
erythema migrans
sx of lyme dz:
stage 1:
stage 2:
stage 3:
stage 1: erythema migrans, flu like
stage 2: myocarditis, bilateral bells palsy
stage 3: chronic arthritis, chronic encephelpathy
factors that increase risk for adverse cardiovascular event
age > 40
male
AA
current smoker
total cholesterol > 200
HDL < 40
SBP > 130
current tx for HTN and DM
what fam hx increases risk for CVD
first degree male relative w. CVD before 55 yo
first degree female relative with CVD before 65 yo
who should be assessed for ASCVD risk
all adults 40-75 yo
primary prevention w. statin by age
0-19: familial hypercholesteremia
20-39: LDL 160 or higher, FH CVD
40-75: LDL 190 or higher, DM
indication for high intensity statin in 40-75 yo
LDL 190 or higher
ASCVD risk 20% or higher
indication for moderate intensity statin in pt 40-75 yo
DM
ASCVD risk 7.5% or higher
labs for Crohn’s
ASCA: positive
pANCA: negative
pain with eye movement
opththalmoplegia
proptosis
orbital cellulitis
the mantoux TB test is a type __ hypersensitivity
IV
10 or more induration for TB test is positive for (5)
immigrants > 5 years ago
IVDU
homeless shelters/LTC/prison/hospital
children < 4 yo
exposure to adults in high risk categories
5 or more induration for TB test is positive for (6)
HIV
recent TB contact
CXR changes
organ transplant
TNF a inhibitors
chronic steroids
leading cause of fatal anaphylaxis
PCN
colicky postprandial pain
fever/erythema/tender gland
sialadenitis
etiology of sialadenitis:
viral:
bacterial:
AI:
viral: mumps, HIV
bacterial: staph/strep
AI: Sjorgens
mc encountered infxn of neck space
ludwig’s angina
cellulitis of sublingual and submandibular spaces
often infxn of mandibular dentition
edema and erythema
tongue displaced upward
ludwig’s angina
tx for sialadenitis
hydration
warm compress
gland massage
sialogogues
dicloxacillin
9 common teratogenic drugs
isotretinoin
phenytoin
diethylstillbestrol (DES)
tetracycline
lithium
warfarin
valproate/carbamazepine
ACEI
vit A
first line tx for trigeminal neuralgia
carbamazepine (antiepileptic)
FDA pregnancy categories
A: no risk in human studies
B: no risk in animal studies
C: small risk in animal studies
D: strong e.o risk
X: very high risk
life threatening complication of hypothyroidism
myxedema coma
hashimoto is a rf for what malignancy
non-hodgkin lymphoma
how long can it take for levothyroxine to be effective
6 weeks
acquired hypertriglyceridemia is associated w. what conditions
obesity
T2DM
renal dz
hypothyroidism
pregnancy
etoh
diet
meds
hereditary hypertriglyceridemia is associated with what conditions
chylomicronemia
familial combined hyperlipidemia
familial dysbetailpoproteinemia (wtf?!)
blood in anterior chamber
hyphema
hyphema commonly occurs dt
blunt or penetrating injury
2 pt’s at risk for vision threatening hyphema
anticoagulated
dyscrasias
5 tx for pt not at risk of vision loss from hyphema
eye shield
bed rest
head of bed elevation
pain control
cycloplegia
5 PE findings of hyphema
decreased vision
photophobia
pain
absence of red reflex
unequal pupils
avoid __ in hyphema
antiplatelets/anticoagulatns
tx for adhesive capsulitis that affects ADLs
intra-articular steroid injxn
PE findings of COPD
increased A/P chest diameter
prolonged expiratory phase
splitting of second heart sound
wheezes
pursed lip breathing
decreased heart and lung sounds dt hyperinflation
what drugs can cause SJS
sulfonamides
antiepileptics
allopurinol
NSAIDs
what infxn is associated w. SJS
mycoplasma PNA
sx of SJS
flu like prodrome
cutaneous lesions
mucosal lesions
uerthritis
coalescing erythematous macules with purpuric centers
SJS
how to differentiate toxic epidermal necrolysis from SJS
they are identical, but toxic epidermal necrolysis lesions cover > 30% of the body
most significant comorbid rf in SJS
HIV
in acute bronchitis, the cough lasts > __ days
5
when should antitussive be given in acute bronchitis
only when it interferes with sleep
tx for acute bronchitis
supportive
PID is mc caused by
chlamydia
first line med for pt w. hx MI or ACS
bb
all pt w. acute lbp and no red flags should be told to
remain active and limit bed rest
what DM med increases risk for vaginal candidiasis
empagliflozin
which DM med will show glucosuria on UA and urine dipstick
empagliflozin
injury and inflammation to wrist extensors
lateral epicondylitis
lateral epicondylitis is aka
tennis elbow
order of tx for lateral epicondylitis
- imaging
- conservative tx
- reimaging to r.o missed injury
- steroid injxn
- surgical referral
golfers elbow
medial epicondylitis
average age for perimenopause
47
what lab is elevated in perimenopause
FSH
unopposed estrogen therapy increases the risk of
endometrial ca
best PE test for appendicitis
mcburney point
RLQ pain elicited by flexion of the knee and hip with internal rotation of the right hip
obturator sign -> low sensitivity
RLQ pain elicited by passive right hip extension
psoas sign -> poor sensitivity
pain that begins as periumbilical and then moves to RLQ
appendicitis
RLQ pain when LLQ is palpated
rovsing
mc cause of appendicitis
fecolith
what test is recommended for women as long-term follow up after hodgkin lymphoma has been treated to remission
annual mammography
aortic stenosis triad
chest pain
dyspnea
syncope
3 PE findings of aortic stenosis
delayed/diminished carotid pulses
paradoxically split S2
S4 gallop
narrow pulse pressure
2 heart sounds associated w. aortic stenosis
paradoxically split S2
S4 gallop
aortic stenosis murmur radiates to the
carotids
hernia that bulges through the internal inguinal ring to the scrotum
indirect
hernia that protrudes medial to the inferior epigastric vessels
direct inguinal
least common type of hernia that protrude thru femoral canal
femoral hernia
hernia that arises from medical condition that increase abd pressure (ascites, pregnancy, obesity)
umbilical
which type of hernia is a medical emergency dt incarceration or strangulation
femoral
which type of hernia protrudes through hesselbach triangle
direct inguinal
which inguinal hernia has higher risk for strangulation
indirect
what do you think when you see salmonellosis plus osteomyelitis
SSA
what causes parotid gland swelling in pt w. bulimia nervosa
noninflammatory stimulation of the salivary glands
russell sign
callouses, abrasions, scarring on knuckles of bulimia pt
eye condition associated w. sunlight exposure, windy, sandy, and dusty environments
pterygium
soft, flat, pink triangular growth extending toward and involving a small portion of the cornea bilaterally
pterygium
tx for pterytium
artificial tears
surgical excision
similar to pterygium but confined to conjunctiva without corneal involvement
pinguecula
pterygium is located:
pinguecula is located:
pterygium: medial
pinguecula: lateral
prolonged PR interval with no dropped beats
P wave for every QRS
first degree AV block
tx not needed
progressive increase in PR interval with eventual dropped beat
+/- symptomatic
Mobitz type 1 2nd degree AV block
PR intervals always the same duration
dropped beats
Mobitz type 2 2nd degree AV block
what meds can cause or exacerbate AV blocks
bb
ccb
digoxin
complete dissociation of P waves w. QRS complexes
bradycardia
third degree AV block
tx for second degree heart block type II
immediate transcutaneous pacing
predisposing factors for endocarditis that count as minor criteria
IVDU
prosthetic heart valve
glomerulonephritis
positive RF
colon ca screening recs for pt w. fam hx colon ca
40 yo
OR
10 years before first degree relative was diagnosed
whichever comes first
management of afib:
stable:
unstable:
stable: rate control -> metropolol, diltiazem
unstable: synchronized cardioversion
how long to anticoagulate pt before cardioversion
21 days
when to cardiovert afib pt
sx > 48 hr
when is orchiectomy PLUS chemo recommended for testicular ca pt
stage II
TB med known for causing GI sx and arthralgia
pyrazinamide
TB med that is hepatotoxic and causes GI s.e
rifampin
TB dz of vertebrae that manifests as osteomyelitis and arthritis
Pott dz
platelet morphology in immune thrombocytopenia of childhood
normal
3 main predictors for future OP fx
age
low bone mineral density
hx previous fx
cause of primary type 1 OP
postmenopausal loss of estrogen
causes of primary type II OP
> 75 yo
loss of zinc
lack of calcium intake
anything besides postmenopausal estrogen loss
causes of secondary OP
chronic dz
meds
2 ways pt can be diagnosed w. OP
T score -2.5 or lower on DXA
fragility fx
what is N-methylnicotinamide deficiency associated w.
pellagra
mc type of mental health disorder
phobic disorders
when are meds used for phobic disorders
when CBT is not available
time constraint (ex upcoming blood draw)
med for phobic disorder if CBT is not available
lorazepam 30 min before exposure to stimulus
2 indications for haldol
schizophrenia
aggressive behavior related to psychosis
indication for dialectical behavior therapy
borderline personality disordr
specific phobia can only be dx if sx last for __
6 months
what lifestyle factor worsens fibrocystic breast changes
frequent etoh consumption
bilateral parotitis in a ped
mumps
2 mc organ systems affected by SLE
MSK
skin
hand deformity seen w. SLE
swan neck deformity
rash associated w. SLE
malar (butterfly)
the malar rash spares the
nasolabial folds
heliotrope rash
dermatomyositis
telangiectasia rash
rosacea
sx of SLE
photosensitivity
fatigue
fever
wt loss
arthritis
pleuritis
pericarditis
neuropsych sx
most sensitive test for SLE:
most specific test for SLE:
sensitive: ANA
specific: anti-dsDNA, anti-SMITH
tx for SLE
NSAIDs
steroids
hydroxychloroquine
immunosuppresants
what lab value correlates w. SLE severity
anti-dsDNA
what lab value is seen in SLE flare ups
low complement
what drugs cause SLE
HIPPS:
hydralazine
INH
procainimide
phenytoin
sulfonamides
2 birth controls recommended for SLE
levonorgestrel IUD
progestin-only
2 first line HTN meds for AA
thiazides
CCB
when to refer HTN pt to specialist
> 3 drugs needed
what 2 bb do not carry risk of impaired glucose tolerance or DM
carvedilol
nebivolol
bp goal for < 60 yo or those w. DM
140/90
bp goal for > 60 yo
150/90
HTN med for CKD with or w.o DM
ACEI
OR
ARB
2 common causes of tinnitus
NSAIDs/ASA
excessive etoh
consider NSAIDs as cause of tinnitus in what pt pop
young pt w. arthritis (taking lots of NSAIDs)
facial paralysis
zoster lesions
tinnitus
ramsay hunt syndrome
5 ototoxic agents
salicylates
NSAIDs
quinine
abx
chemo
3 ototoxic abx
aminoglycosides
erythromycin
vancomycin
first line pharm for panic disorder
citalopram
which lung ca starts peripherally
adenocarcinoma -> mc type
which 2 types of lung ca starts centrally
small cell
squamous cell
which type of lung ca is associated w. hypercalcemia
squamous cell
3 types of non small cell lung ca
adenocarcinoma
squamous cell
large cell
which type of lung ca is associated w. paraneoplastic syndromes
small cell
individual hairs on head are easily dislodged
positive pull test -> alopecia areata
immune mediated, recurrent, non-scarring hair loss
alopecia areata
exclamation mark hairs
alopecia areata
from thin proximal shaft
androgenic alopecia is aka
male pattern or female pattern baldness
diffuse hair loss that occurs two to three months after inciting event (childbirth, stress, dietary changes, meds)
teolgen effluvium
areas of hair loss w. pruritis and scarring
tinea capitis
mc cause of alopecia areata
AI
tx for alopecia areata
intralesional corticosteroids
Ken Tuc Ky heart sound
S3 -> systolic HF
can be normal
Te Nuh See heart sound
S4 gallop -> diastolic HF
always pathologic
as preload increases, cardiac stroke volume also increases until at a certain point it plateaus, then declines
frank-starling principle
FDA approved meds for delirium
none!
med absolutely contraindicated in delirium except w. substance withdrawal
benzos
med to consider for delirium
atypical antipsychotics
CHESS criteria for high risk syncope
CHF
hematocrit > 30%
ECG abnormal
SOB
systolic BP > 90
test for every pt w. syncope
ECG
symmetrically distributed, coalescent, hyperpigmented macules in exposed areas of the face
melasma
hyperpigmented coalescent macules in sun exposed areas of the body
begin as solitary lesion
solar lentingines
tx for solar lentigines
fluocinolone
trichloracetic acid
hydroquinone
tretinoin
bleaching agents
chemical peels
laser therapy
melasma during pregnancy
cholasma
lab value to monitor for pt on allopurinol long term
Cr
management of acute gout
- NSAIDs, ice
- prednisone
- triamcinolone injxn
- arthrocentesis
- chochicine
what gout med reduces formation of uric acid crystals in the joint but has a narrow therapeutic window
colchicine
what gout med causes vomiting and diarrhea
chochicine
med for chronic management of gout
allopurinol -> lowers urate
2 meds contraindicated in gout
ASA
loop and thiazide diuretics
treat to target level of uric acid in gout pt
< 6
what is podagra
acute onset of pain in first MTP -> gout
needle shaped crystal with negative birefringence
gout
what med class can induce mania in bipolar I or II
SSRI
what does DIG FAST stand for
distractibility
impulsivity
grandiosity
flight of ideas
activities
sleep - decreased
talkative
mania sx
accumulation of bile in the liver as a result of decreased secretion of bile by hepatocytes or obstruction of bile ducts
cholestasis
causes of cholestatic jaundice in older kids and adults
drug induced
viral hepatitis
progressive familial syndromes
causes of obstructive cholestasis
cholelithiasis
cholangitis
tumors
patients with cholestatic jaundice have __ total bile salt pool size
decreased
4 extrahepatic causes of cholestasis
choledocholithiasis
tumor
biliary atresia
ascending cholangitis
4 intrahepatic causes of cholestasis
hepatitis
etoh liver dz
primary sclerosing cholangitis
primary biliary cirrhosis
3 acne meds contraindicated in pregnancy
doxycycine
isotretinoin
tretinoin
topical abx for papulopustular and mixed acne
erythromycin
clindamycin
oral abx for papulopustular and mixed acne
doxycycline
bactrim
which type of lesion is the hallmark of acne vulgaris
comedome
completely disorganized EKG
irregular chaotic pattern w.o p waves or qrs
incompatible w. life
vfib
mc cause of vfib
ischemic heart dz
tx for vfib
CPR
IV access
defbrillator -> 200 joules
1 mg IV epi
lower core body temp to 32-36 degrees
tx for CAP PNA in healthy adult (3)
high dose amoxicillin
OR
doxycycine
OR
macrolide
tx for CAP PNA: comorbidities
augmento or cephalosporin
PLUS
doxycycine PLUS macrolide
OR
fluoroquinolone
pt pops at risk for klebsiella PNA
DM
etoh abuse
single erythematous patch with overlying warmth
cellulitis
purple, pruritic, polygonal, papular plaques
ankles, wrists, genital/oral mucosa
lichen planus
derm condition associated w. hep C
lichen planus
raised, pruritic, target-like lesions with two zones of color change
SJS
TEN
bright red plaque w. raised and sharply demarcated borders
erysipelas
cellulitis is mc caused by (3)
GAS
strep pyogenes
s. aureus
immediate tx of htn emergency
sodium nitroprusside
markedly elevated bp w.o e.o end organ damage
hypertensive urgency
hypertensive emergency definition
sbp > 180
dbp > 120
end organ damage
tx for aortic dissection
esmolol
tx for eclampsia
hydralazine
sx of bells palsy
no forehead wrinkling
lip droop
drooling
hyperacusis
retroauricular pain
ipsilateral tongue numbness
loss of taste
pink/salmon-colored herald patch with a collarette of scale
pityriasis rosea
papulosquamous eruption along lines of cleavage of skin
inflammatory, oval in proximal areas of extremities and trunk
mc in fall/spring
pityriasis rosea
tx for pityriasis rosea
spontaneously resolves
symptomatic
antihistamines/corticosteroids
christmas tree rash on the back
pityriasis rosea
2 types of abnormal uterine bleeding
heavy menstrual bleeding
intermenstrual bleeding
structural causes of AUB
PALM:
polyp
adenomyosis
leiomyoma
malignancy
nonstructural causes of AUB
COEIN:
coagulopathy
ovulatory dysfxn
endometrial
iatrogenic
not yet classified
bleeding disorders to r.o for AUB
von willebrand
factor VIII
women w. SLE need to avoid pregnancy for __ months after active dz
6 mo
antihistone antibody
SLE
major complications of cirrhosis
portal htn
hepatic encephalopathy
hepatocellular carcinoma
portal vein thrombosis
complications of portal hypertension
esophageal varices
ascites
spontaneous bacterial peritonitis
hepatorenal syndrome
management of esophageal varices
endoscopy
TIPS
variceal ligation
med for esophageal varies
bb -> nadolol, propranolol
mc complication of cirrhosis
ascites
management of ascites
diuretis
salt restriction
paracentesis
infxn of ascitic fluid
typically in end stage liver dz
spontaneous bacterial peritonitis
management of SBP
d.c bb and ppi
diuretics
abx
abx for sbp
bactrim
OR
cipro
management for hepatorenal syndrome
TIPS
terlipressin with albumin
sx of hepatic encephalopathy
asterix
hyperactive DTR
insomnia
decerebrate posturing
meds for hepatic encephalopathy
- lactulose to produce 2 soft stools/day
- rifamixin
med that prevents recurrent hepatic encephalopathy and improves qol/reduces morbidity/mortality when given with lactulose
rifamixin
hepatocellular carcinoma lab finding
elevated serum alpha fetoprotein
management of portal vein thrombosis
screen for esophageal varices
anticoagulation
ankle inversion sprain causes damage to the __ ligament
calcaneofibular
eversion ankle sprain causes damage to the __ ligament
deltoid
high ankle sprain is associated w. __ tear
syndesmotic
palpation of LLQ causes pain in RLQ
rovsing sign
mc inherited disorder of bilirubin glucoronidation
gilbert syndrome
UGT1A1 gene mutation
gilbert syndrome
what enzyme is responsible for transforming unconjugated bilirubin to water soluble conjugated bilirubin for excretion
glucuronosyltransferase
conjugated bilirubin is broken down into __ for excretion in the feces
and into __ for excretion in the urine
feces: urobilinogen
urine: urobilin
3 causes of unconjugated hyperbilirubinemia
hemolysis
gilbert syndrome
drug rxns
7 causes of conjugated hyperbilirubinemia
intraphepatic cholestasis
hepatitis
cirrhosis
sepsis
biliary obstruction -> choledocholithiasis, sclerosing angitis, pancreatitis
dubin johnson
rotor
benign autosomal recessive condition characterized by reduced production of uridine 5’diphospho-glucuronosyltransferase that results in elevated unconjugated or indirect bilirubin levels
gilbert syndrome
definitive dx for gilbert syndrome
genetic testing
intermittent jaundice… otherwise asymptomatic
gilbert syndrome
retention of bile in the liver
cholestasis
reduced excretory fxn of hepatocytes -> increased conjugated bilirubin
dubin-johnson syndrome
inability to visualize liver on cholecystography
black liver
dubin-johnson syndrome
reduced hepatic uptake of bilirubin conjugates
can visualize liver
no black liver
rotor syndrome
what serum level of bilirubin is associated w. jaundice
3 or higher
3 ways to maximize bone mass
nutrition -> Ca/vit D
PA
avoid smoking and etoh
score that compares bone mass w. a healthy 30 yo of the same sex
t score
score that compares bone density to average person of same age and sex
z score
preferred iron supplement for IDA
oral ferrous sulfate 325 mg
for dx of mdd, pt must have at least __ symptoms x __ months
5 symptoms x 6 months
factors that increase risk for mdd
childhood trauma
early-onset anxiety
low self esteem
substance abuse
parental loss
low parental warmth
marital issues
low education
is fam hx of mdd a risk factor for developing it
no!
but it is for bipolar
a post bronchodilator FEV1:FVC < __ i used to establish presence of airflow limitation in COPD
70%
__ diffusing capacity for carbon dioxide is a good measurement of amt of emphysematous destruction in the lungs
low
4 CXR findings of COPD
flat diaphragm
increased retrosternal lung space
rapidly tapering vasculature
bullae
unexpected panic attacks followed by a month or more of persistent worry about additional panic attacks or significant maladaptive behaviors
panic disorder
sx of panic disorder
sweating
shaking
feeling of choking/smothering
chest pain/pressure
nausea
dizzy
chills
heat sensation
impending doom
tx for panic d.o
CBT
SSRI
t/f: panic attacks occur in response to a particular stimulus
f!
tiny, weeping vesicles and crusted lesions in a linear distribution on both arms bilaterally
erythematous maculopapular lesions extending outward from vesicular lesions
poison ivy
poison ivy is an example of __ dermatitis
allergic contact
excessive exposure to soaps, detergents, or organic solvents that causes physical, chemical, or mechanical irritation to the skin
irritant contact dermatitis
allergic contact dermatitis is a type __ hypersensitivity rxn, mediated by __ cells
IV
T cells
5 common causes of allergic contact dermatitis
nickel (metal fasteners of pants/belts)
poison ivy (urushiol)
soaps
neomycin
cobalt
potassium dichromate
difference btw irritant and allergic contact dermatitis
irritant: limited to sites of direct contact w. irritant
allergic: occurs beyond sites of direct contact
lesions typical of irritant contact dermatitis
erythematous
burning
scaly
lesions typical of allergic contact dermatitis
intensely pruritic macules
papules
weeping vesicles
crusted lesions
bullae in severe cases
tx for poison ivy
washing w. soap and water w.in 30 minutes of contact
topical steroids
systemic steroids
calamine lotion
zinc oxide paste
how to r.o infxn like cellulitis and impetigo w. contact dermatitis
gram stain and culture
what type of hypersensitivity rxn is a transfusion rxn due to ABO incompatibility
II
dx for allergic contact dermatitis
patch test
“Id” rxn
generalized cutaneous rxn in areas not exposed to allergen (allergic contact dermatitis)
5 common causes of irritant contact dermatitis
water
detergents
solvents
acids
alkali
tx for irritant contact dermatitis
emollients
topica steroids
painless progressive visual field defect
curtain moving across the eye
increase in floaters
retinal detachment
tx for retinal detachment
stat surgical referral for:
laser
cryoretinopexy
fluid behind retina
vitreous detachment
retinal detachment
cobweb appearance
photopsia
visual field defect
retinal detachment
protrusion of uveal content
tear drop pupil
eccentric pupil
open globe injury -> trauma
hazy/gray retina with white folds
retinal detachment
most sensitive imaging for acute ischemic stroke
MRI
3 urgent diagnostic tests for acute stroke
noncontrast CT
finger stick BG
O2 sat
5 emergent diagnostic tests for acute stroke
ECG
CBC
troponin
PT, PTT/INR
escarin clotting time
4 factors in initial eval of suspected syncope
comprehensive hx
PE
ECG
transthoracic ECHO
placental tissue covers the internal cervical ox by 2 cm
placenta previa
painless vaginal bleeding in a woman beyond 20 weeks gestation
placenta previa
5 rf for plaenta previa
previous placenta previa
previous cesarean
multiple gestation
multiple induced abortions
advanced age
dx for placenta previa
transvaginal > transabdominal
exam to avoid in placenta previa
digital vaginal exam
med to give in deliveries before 37 weeks gestation to help with lung development
antenatal steroids
med to give for deliveries btw 24-32 weeks gestation for neuroprotection
magnesium sulfate
management of asymptomatic placenta previa
obs
monitor w. US
avoid sexual activity/exercise
avoid long periods of standing
goal of placenta previa management
get pt to 34 weeks before cesarean
you can exclude placenta previa if pt is not in the __ trimester
third
what pt pop can try H2 receptor for GERD before PPI
mild and intermittent -> sx less than twice weekly
no esophagitis or Barett
pt w. mild/intermittent GERD sx who starts w. H2 receptor antagonist should be switched to PPI if sx have not improved w.in __ of daily dose
2 weeks
if pt w. mild/intermittent GERD sx has improvement w. 2 weeks of daily H2 receptor, what is the next step
switch H2 receptor antagonist to PRN
