Rosh Material #5 Flashcards by Alice Richards

type of eczema that mc occurs on arms and legs

nummular eczema (discoid eczema)

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nummular eczema rash is described as __ shaped, pruritic scaly lesions

coin

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tx for nummular (discoid) eczema

moisturizer
moderate to high dose topical steroids

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erythematous plaque surrounded by thick adherent scales

psoriasis

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what is this showing

non bullous impetigo
oozing and crusting rash

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what is this showing

nummular eczema

round, oozing, crusting erosions
dry macules w. a fine scaly pattern

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what is this showing

pityriasis rosea

small oval, thick scaling plaques

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what is this showing

tinea corporis

thin scaly lesions w. central clearing

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mc cause of waterborne and foodborne diarrhea

girardia

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first line pharm for giraridia

less than 12 months old: metronidazole
1-3 yo: nitazoxanide
3 yo and older: tinidazole

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2 places girardia is commonly contracted

camping/backpacking
daycare

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what food should be temporarily avoided after giardiasis due to temporary intolerance

lactose

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is the diarrhea associated w. girardia bloody

nope!

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3 PE findings of IDA

koilonychia
atrophic glossitis
angular cheillosis

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what do howell-jolly bodies make you think of

SSA
asplenia

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what do schistocyes make you think of

hemolysis

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how elevated are pancreatic enzymes in acute pancreatitis

more than 3x UNL

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diminished S1 heart sound followed by holosystolic or mid to late systolic murmur heard best over the apex

mitral regurgitation

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aortic stenosis triad

exertional angina
dyspnea
presyncope

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murmur heard best in left lateral decubitus position

mitral stenosis

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acute mitral regurgitation murmur is heard best at the __
and radiates to the __ rather than the axilla

apex
base

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chronic mitral regurgitation murmur is heard best at the __
and radiates to the __

apex
axilla

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acute mitral regurgitation murmur is described as __
chronic mitral regurgitation murmur is described as __

acute: midsystolic
chronic: blowing holosystolic

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4 tx for acute mitral regurgitation

nitroprusside
dobutamine
intra-aortic balloon pump
emergency surgery

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inflammation of meibomian gland

chalazion

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which leukemia is mc associated w. previous hx of hematologic disorder, including myelodysplastic syndrome, aplastic anemia, polycythemia vera

AML

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rf for asthma

males in childhood
females in adulthood
atopy
allergen exposure
urban dwellers
pollution
respiratory infxns
smoking
obesity
occupation

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strongest predisoposing rf for asthma

atopy

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3 components of asthma pathology

obstruction to airflow
bronchial hyper-reactivity
airway inflammation

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FEV1 of asthma stages

intermittent: > 80%
mild persistent: 80% or higher
moderate: 60-80%
severe persistent: < 60%

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initial test for cholecystitis:
gs test for cholecystitis:

initial: US
gs: HIDA

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diagnostic criteria for DM need to be repeated for confirmation unless

2 or more criteria are met

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screening recs for T2DM

annually in pt > 35 yo
or in pt < 35 yo w. rf

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what is this showing

seborrheic keratosis

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velvety, waxy lesions with “stuck on appearance”

seborrheic keratosis

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tx for seborrheic keratosis

reassurance

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rf for seborrheic keratosis

advanced age
“barnacles of aging”

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leser-trelat sign

rapid appearance of multiple SK lesions associated w. GI malignancy

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at what age do kids usually start to cooperate w. PFTs

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rf for emphysema

smoking
alpha 1 antitrypsin deficiency
environmental exposures

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3 PE findings of emphysema

pursed lip breathing
barrel chest
hyperresonance to percussion

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2 PFT findings of emphysema

decreased FEV1:FVC
increased TLC

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emphysema in young, non smoker

alpha-1-antitrypsin deficiency

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immunizations to avoid in severely immunocompromised pt

rotavirus
MMR
varicella
zoster

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3 vaccinations contraindicated in pregnancy

MMR
varicella
zoster

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ASA and salicylate containing meds can cause what syndrome in peds

reye

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what type of contraception may worsen symptoms of menorrhagia, dysmenorrhea, or endometriosis-related pain

copper IUD

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viral conjunctivitis is mc caused by

adenovirus

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mc cause of achilles tendinitis

increased activity

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heel and foot pain when first stepping out of bed or after period of inactivity
improves w. walking or stretching calf

plantar fasciitis

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where is pain w. plantar fasciitis felt

over sole of foot near calcaneus

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2 tx for plantar fasciitis

stretching
heel inserts

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mc cause of infertility

PCOS

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rotterdam criteria for PCOS

2/3:
oligo or anovulation or both
clinical or biochemical signs of hyperandorgenism or both
polycystic ovaries by US

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4 PE findings of PCOS

hirsutism
menstrual irregularities
acanthosis nigrans
obesity
acne

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5 comorbidities associated w. PCOS

glucose intolerance
metabolic syndrome
OSA
fatty liver
endometrial hyperplasia

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labs for PCOS

high LH to FSH
elevated testosterone

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mc cause of PCOS

insulin resistance

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tx for PCOS

OCP
lifestyle
metformin

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LAD in mono is mc located

posterior cervical chain

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mono triad

fever
tonsillar pharyngitis
posterior cervical chain LAD

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mono rash

generalied maculopapular
uticarial
petechial

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dx for mono

heterophile abs test

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anterior cervical chain LAD is associated w. (3)

CMV
toxoplasmosis
head/neck infxns

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mono pt’s need to avoid contact sports for __ weeks

4 weeks

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According to USPSTF:
mammography screenings should start at age __
and continue q __ years
until age __

50
2
75

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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

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chronic eczematous dz of the nipple and areola w. an underlying carcinoma of the breast

paget’s dz

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mc site of FB obstruction

C6 -> at the level of cricopharyngeus

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most FB can have obs x __

24 hr

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3 indications for emergent removal of FB

battery
sharp object
signs of obstruction

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pH in vaginal candidiasis

normal (<4.5)

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valve condition associated w.: jugular venous A wave
and left parasternal lift

pulmonary stenosis

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valvular disorder associated w. TOF

pulmonary stenosis

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what murmur produces a fluttering sensation in the neck, fatigue, cold extremities

tricuspid stenosis

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what causes dysmenorrhea

increased PGF2alpha -> uterine contractions

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inability of eye to abduct

lateral rectus CN VI palsy

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lateral rectus CN VI palsy is concerning for

CVA

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tx for noninflammatory comedome acne

topial retinoid
azelaic acid/salicylic acid

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tx for mild papulopustular and mixed acne

topical benzoyl peroxide and topical abx
+/- topical retinoid

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tx for moderate papulopustular and mixed acne

topical retinoid
AND
oral abx
AND
topical benzoyl peroxide
OR
oral isotretinoin monotherapy

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3 tx for acne during pregnancy

oral or topical erythromycin
topical clinda
topical azelaic acid

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oral abx for acne

doxycycline/minocycline

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what acne med is pregnancy class X and pt must be on 2 forms of birth control to take it

isotretinoin

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ixodes scapularis

lyme disease

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how long does a tick need to be attached to transmit lyme dz

48 hr

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what rash is pathognmonic for lyme dz

erythema migrans

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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

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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

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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

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who should be assessed for ASCVD risk

all adults 40-75 yo

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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

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indication for high intensity statin in 40-75 yo

LDL 190 or higher
ASCVD risk 20% or higher

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indication for moderate intensity statin in pt 40-75 yo

DM
ASCVD risk 7.5% or higher

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labs for Crohn’s

ASCA: positive
pANCA: negative

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pain with eye movement
opththalmoplegia
proptosis

orbital cellulitis

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the mantoux TB test is a type __ hypersensitivity

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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

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5 or more induration for TB test is positive for (6)

HIV
recent TB contact
CXR changes
organ transplant
TNF a inhibitors
chronic steroids

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leading cause of fatal anaphylaxis

PCN

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colicky postprandial pain
fever/erythema/tender gland

sialadenitis

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etiology of sialadenitis:
viral:
bacterial:
AI:

viral: mumps, HIV
bacterial: staph/strep
AI: Sjorgens

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mc encountered infxn of neck space

ludwig’s angina

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cellulitis of sublingual and submandibular spaces
often infxn of mandibular dentition
edema and erythema
tongue displaced upward

ludwig’s angina

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tx for sialadenitis

hydration
warm compress
gland massage
sialogogues
dicloxacillin

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9 common teratogenic drugs

isotretinoin
phenytoin
diethylstillbestrol (DES)
tetracycline
lithium
warfarin
valproate/carbamazepine
ACEI
vit A

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first line tx for trigeminal neuralgia

carbamazepine (antiepileptic)

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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

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life threatening complication of hypothyroidism

myxedema coma

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hashimoto is a rf for what malignancy

non-hodgkin lymphoma

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how long can it take for levothyroxine to be effective

6 weeks

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acquired hypertriglyceridemia is associated w. what conditions

obesity
T2DM
renal dz
hypothyroidism
pregnancy
etoh
diet
meds

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hereditary hypertriglyceridemia is associated with what conditions

chylomicronemia
familial combined hyperlipidemia
familial dysbetailpoproteinemia (wtf?!)

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blood in anterior chamber

hyphema

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hyphema commonly occurs dt

blunt or penetrating injury

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2 pt’s at risk for vision threatening hyphema

anticoagulated
dyscrasias

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5 tx for pt not at risk of vision loss from hyphema

eye shield
bed rest
head of bed elevation
pain control
cycloplegia

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5 PE findings of hyphema

decreased vision
photophobia
pain
absence of red reflex
unequal pupils

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avoid __ in hyphema

antiplatelets/anticoagulatns

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tx for adhesive capsulitis that affects ADLs

intra-articular steroid injxn

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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

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what drugs can cause SJS

sulfonamides
antiepileptics
allopurinol
NSAIDs

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what infxn is associated w. SJS

mycoplasma PNA

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sx of SJS

flu like prodrome
cutaneous lesions
mucosal lesions
uerthritis

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coalescing erythematous macules with purpuric centers

SJS

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how to differentiate toxic epidermal necrolysis from SJS

they are identical, but toxic epidermal necrolysis lesions cover > 30% of the body

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most significant comorbid rf in SJS

HIV

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in acute bronchitis, the cough lasts > __ days

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when should antitussive be given in acute bronchitis

only when it interferes with sleep

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tx for acute bronchitis

supportive

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PID is mc caused by

chlamydia

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first line med for pt w. hx MI or ACS

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all pt w. acute lbp and no red flags should be told to

remain active and limit bed rest

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what DM med increases risk for vaginal candidiasis

empagliflozin

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which DM med will show glucosuria on UA and urine dipstick

empagliflozin

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injury and inflammation to wrist extensors

lateral epicondylitis

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lateral epicondylitis is aka

tennis elbow

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order of tx for lateral epicondylitis

imaging
conservative tx
reimaging to r.o missed injury
steroid injxn
surgical referral

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golfers elbow

medial epicondylitis

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average age for perimenopause

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what lab is elevated in perimenopause

FSH

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unopposed estrogen therapy increases the risk of

endometrial ca

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best PE test for appendicitis

mcburney point

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RLQ pain elicited by flexion of the knee and hip with internal rotation of the right hip

obturator sign -> low sensitivity

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RLQ pain elicited by passive right hip extension

psoas sign -> poor sensitivity

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pain that begins as periumbilical and then moves to RLQ

appendicitis

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RLQ pain when LLQ is palpated

rovsing

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mc cause of appendicitis

fecolith

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what test is recommended for women as long-term follow up after hodgkin lymphoma has been treated to remission

annual mammography

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aortic stenosis triad

chest pain
dyspnea
syncope

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3 PE findings of aortic stenosis

delayed/diminished carotid pulses
paradoxically split S2
S4 gallop
narrow pulse pressure

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2 heart sounds associated w. aortic stenosis

paradoxically split S2
S4 gallop

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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

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

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

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

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

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

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