U world Missed #1 Flashcards
Ottawa Ankle Rules
X ray is required if there is pain at the malleolar zone and one of the following
- tenderness at the posterior margin of the medial malleolus
- tenderness at the posterior margin of the lateral malleolus
- inability to bear weight for 4 steps
Ottawa Foot Rule
X-ray is required if there is pain at the mid foot along with one of the following
- tenderness at the navicular
- tenderness at the base of the 5th metatarsal
- unable to bear weight 4 steps
What is a cluster headache
a headache that has a predilection for males that typically has an onset during sleep. The pain is localized behind one eye and it is sharp. It lasts about 15-90 minutes and can be associated with autonomic manifestations (sweating, flushing, nasal congestion, lacrimation, pupillary changes)
-100% oxygen can help in acute cases
What is a migraine
a headache that has a predilection for females and a family history can be present. Onset is variable and it is unilateral. It is a pulsating/throbbing pain that lasts for about 4-72 hours. It is associated with aura, photophobia, nausea, and phonophobia.
What is a tension headache
a headache that has a predilection for females that is common under stress it has a band like pattern of distribution and is dull, tight and persistent. It lasts for about 30 minutes to 7 days and can be associated with muscle tenderness in the shoulder, neck , and head.
Tinea Corporis
slowly expanding, pruritic rash that has a raised border and central clearing caused by trichophyton rubrum (a fungus)
transmitted from contact with skin, animal or fomites
How is Tinea Corporis Diagnosed?
typically general inspection but potassium hydroxide on a skin scraping can confirm the diagnosis
Tinea Corporis Treatment
With topical Antifungals (terbinafine or miconazole)
What are lifestyle risk factors for colon cancer
frequency consumption of red/processed meat
tobacco or alcohol use
what are medical risk factors that increase risk for colon cancer
family history of adenomatous polyps or colon cancer
inherited colon cancer syndromes
ulcerative colitis, diabetes, obesity, radiation
how are obesity and type 2 diabetes associated with an increased risk of colorectal cancer
hyperinsulnemia leads to increased levels of insulin like growth factor 1 which inhibits colorectal epithelial cell apoptosis and promotes neoplastic progression
obesityL increased inflammatory cytokines
protective factors against colorectal cancer
high fiber diet, aspirin/NSAID use, high coffee and tea intake
what is gonococcal proctitis
Neisseria gonorrhoeae a gram negative diplococci bacterium is a STD that can have direct speed from the vagina or from anal intercourse.
Symptoms of tenesmus, mucopurulent discharge, rectal pain and itchiness, constipation
diagnosis of gonococcal proctitis
Nucleic Acid Amplification test of rectal swab
treatment of gonococcal proctitis
ceftriaxone + doxycycline
what is the difference between primary and secondary nocturnal enuresis
primary is when there is nighttime incontinence at the age of 5 or greater without a prolonged period of continence
secondary is when there is nighttime incontinence a the age of 5 or greater with prolonged period of continence before hand >6 months
what is the cause of primary nocturnal enuresis
brain maturation delay and or genetics
what is the cause of secondary nocturnal enuresis
an underlying medical condition like diabetes/UTI or psychological stressors
what is the initial evaluation of nocturnal enuresis ?
urinalysis
what is the management of nocturnal enuresis primary vs. secondary
primary: reassurance, behavioral modifications, bed wetting alarm
secondary: treat the underlying condition, behavioral modification
*behavioral modifications can include: evening fluid restriction
what medications can lower blood pressure and minimize left ventricular hypertrophy
Ace inhibitors, Angiotensins Receptor Blockers, Calcium Channel blockers and thiazide diureteics
what medication that is used for hypertension can raise uric acid and precipitate gout?
thiazide diuretics
what is the preferred medication for antihypertensive patients with gout
Angiotensin II receptor Blockers (ARBs)
Enuresis medical causes
Constipation, UTI, bladder dysfunction, CKD, diabetes, OSA
Chronic Kidney Disease in children are most commonly due to?
a posterior urethral valve which blocks the outflow or urine from the bladder
causes symptoms of urinanary incontience day and night ; damages the kidneys and causes recurrent UTIs and proteinuria
Enuresis due to CKD should have what type of workup
evaluate the serum creatinine level
renal ultrsound, voiding cysteaurethrogram
what type of vaccine is the diphtheria-tetanus-acellular pertussis vaccine?
combined vaccine containing acellular pertussis antigen with diphtheria and tetanus toxoids
safe and effective
what is the DTaP immunization scheduling
5 does of inactivated DTap vaccine at 2 months, 4 months, 6 months, 15-18 months and 4-6 years
adverse reaction to the DTap?
generally low minor symptoms like erythema at the injection site
seizures caused by the pertussis vaccine is RARE
Is a family history of seizures or personal history of seizures a contraindication to the DTaP vaccine?
No
benefits outweigh the risks
what is the DTap vaccine contraindicated in?
anaphylaxis, unstable neurological disorders like infantile spasms, and encephalopathy
thin walled ovarian cyst with pelvic free fluid is?
a ruptured ovarian cyst
a ruptured ovarian cyst that is hemodynamically stable is managed how?
observation and reassurance
if they are hemodynamically unstable then surgery is required
what is mittelschmerz
recurrent unilateral mid cycle pain prior to ovulation that lasts hours
Pelvic inflammatory disease symptoms and ultrasound findings
fever/chills, vaginal discharge, lower abdominal pain and cervical motion tenderness
imaging: tuboovarian access
ovarian torsion symptoms and ultrasound findings
ovarian torsion: uniltateral sudden lower abdominal pain with N/C
unilateral tender adnexal mass on examination
enlarged ovary with decreased or absent blood flow
Nonalcoholic fatty liver disease
liver steatosis on imaging that is common in people with metabolic syndrome, an AST/ALT less than 1 and hyper echoic texture on US
mostly asymptomatic until liver cirrhosis occurs
management of nonalcoholic hepatic steatosis
weight management and control of metabolic risk factors
what is the prognosis of nonalcoholic fatty liver disease
increased risk of hepatic fibrosis, cirrhosis and liver related death
autoimmune hepatitis
marked elevation in AST and ALT and bilirubin with arthranglia, anorexia, and fatigue
common causes of mechanical obstruction in patients with GERD
esophageal stricture
esophageal adenocarcinoma
what is a esophageal stricture
reflux of gastric acid contents cause mucosal damage and collagen deposition in the esophagus
they are no malignant and imaging will show a symmetric concentric narrowing of the distal esophagus
what is esophageal adenocarcinoma
barretts esophagus can scause this from intestinal metaplasia of the distal esophagus
imaging will show an asymmetrical and irregular narrowing of the distal esophagus
treatment of an esophageal stricture
endoscopic dilation
achalasia
a esophageal motility disorder with dysphagia to solids and liquids at onset
peristalsis and dilation of the esophagus proximal to the LES with a bird beak appearance
vascular rings
uncommon congenital anomalies in which the aortic arch vessels compress the trachea or esophagus at the level of the aortic arch (by rib 2)
