U world Missed #2 Flashcards
MRI for back pain is only recommended when
there is severe neurologic deficits or high risk features that suggest a potentially serious cause (malignancy or infection)
recommended first like treatment for noncomplicated lumbosacral radiculopathy
NSAIds and acetaminophen
clinical signs and symptoms of lumbosacral radiculopathy (nerve root compression)
pain in the low back radiating down to the posterior leg or foot
positive straight leg raise or crossed straight leg raise test
dermatomal sensory loss or myotomal weakness
evaluation of lumbosacral radiculopathy
usually diagnosed clinically
MRI recommended if there is bladder/bladder dysfunction. saddle anesthesia, epidural access etc.
treatment go lumbosacral radiculopathy
activity modification (NOT bedrest)
NSAIDS first 2 weeks
PT or glucocorticoids after 2 weeks
MRI or surgery after 6 weeks
what is irritant contact diaper dermatitis ?
the most common dermatitis in infants that results from a breakdown in the skin due to moisture and friction in the diaper
classically it looks red in the genital area region that is only in the diaper region
painless papule or confluent erythema
treatment of irritant contact diaper dermatitis
frequent diaper changes, diaper free periods, gentle cleansing soap and application of an ointment like petroleum.
refractory cases can use low potency topical corticosteroids
what is candida dermatitis
dermatitis that is a yeast superinfection on top of irritant contact dermatitis (skin fold involvement)
there are beefy red confluent plaques that involve the skin folds and satellite lesions
treat with anti fungal therapy
what its the colon cancer screening recommendations for patients with average risk?
start at age 45
colonoscopy every 10 years
gFOBT or FIT every year
FIT-DNA every 1-3 years
CT colonogrpahy every 5 years
Flexible sigmoidoscopy every 5 years or every 10 years with annual fit
what is the colon cancer screening recommendations for patients with a first degree relative with colorectal cancer history or a high risk adenomatous polyp?
colonoscopy at age 40 or 10 years prior to age of diagnosis in FDR which ever comes first
repeat every 5 years (every 10 if the FDR diagnosed after age 60)
what is the colon cancer recommendation screening for a patient with an adenomatous polyp
start screening 8-10 years after diagnosis
colonoscopy every 1-3 years
what is considered an advanced adenomatous polyp?
greater than 10mm, high grade dysplasia, villous elements
buckle fracture
a fracture common in young children that have porous bone. This results in a stable incomplete radial or ulnar fracture.
presents as pain and tenderness over the fracture , ROM can be limited and there is no swelling
need an x-ray to diagnose: a cortical bulge is visualized
treatment of a buckle fracture
pain control and prevention of reinjury (heal within a few weeks)
avascular bone necrosis in children presents with?
chronic joint pain and decreased Rom typically in the hip
X-ray shows bony fragmentation and sclerosis
volume and duration of menses is dependent upon?
surface area of the endometrial cavity, platelet aggregation and thrombi formation, uterine spiral arteriole constriction
how is tranexamic acid used in the treatment of uterine fibroids
it stops heavy menstrual cladding and reduces blood loss by stabalizing the cloths and preventing plasmin formation
it is safe in pregnancy
uterine fibroids cause heavy menstrual bleeding by?
enlarging the uterus and decreasing the response to vasoactive factors that limit spinal artery vasoconstriction
contraindication to OCP
migraine with aura (increased risk for stroke)
developmental milestones at age 2 months
gross:
fine:
language:
social and cognitive:
gross: lifts head with lying on tummy
fine: opens hands briefly
language: reacts to loud noises, makes noises
social and cognitive: social smile, clams when spoken to, tracks past midline
developmental milestones for a 4 months old
gross:
fine:
language:
social and cognitive:
gross: holds head steady and pushes up on forearms
fine: brings hands to midline/mouth and holds toy if put in hand
language: coos and turns to voice
social and cognitive:seeks attention and enjoys looking at hands
developmental milestones of a 6 months old
gross:
fine:
language:
social and cognitive:
gross: rolls over and leans hands to support seated position
fine: reaches for toy and puts things in mouth
language:blows raspberries and squeals
social and cognitive: laughs and recognizes familiar faces
developmental milestones in a 9 month year old
gross: gets to sitting unassisted and sits without support
fine: transfers objects between hands , raking grasp
language:babbles (mamma), turns to name
social and cognitive: stranger anxiety and separation anxiety
developmental milestones for a 12 month old
gross: pulls to stand, cruises
fine:pincer grasp
language: mama and dada, understands no
social and cognitive: plays pat-a-cake, looks for hidden object
every well child examination should include
an assessment of developmental milestones
when do primitive reflexes disappear
by 6 months
what is the only primitive reflex that may persist up to 2 years old but can disappear by age 12 months
babinksi reflex
(stroking of the sole of the foot causes the big toe to up turn)
the initial evaluation of hypertension focuses on?
identifying complications or comorbid conditions that might change management
screen for major atherosclerotic risk factors, lipid panels, and serum glucose or hemoglobin A1C
what is adjustment disorder
distress or functional impairment within 3 months of an identifiable stressor
emotional or behavioral symptoms that are excessive for a normal stress response
management of adjustment disorder
psychotherapy
short term pharmacotherapy with a anxiolytic or sleep aid
autosomal polycystic kidney disease
most patient are asymptomatic until 30-40 years old they will have flank pain, hematuria, hypertension, a palpable abdominal mass and CKD
low gravity urine
extra renal features of polycystic kidney disease
cerebral aneurysms
hepatic and pancreatic cysts
Mitral valve prolapse, and aortic regurigitation, colonic diverticulosis, ventral and inguinal hernias
imaging for autosomal dominant polycystic kidney disease
US showing multiple renal cysts
treatment of autosomal dominant polycystic kidney disease
control CKD, ACE inhibitors, hemodialysis and renal transplant if in end stage renal disease
vasopressin-2 receptor antagonists (stop the growth of the cysts)
what is secondary spontaneous pneumothorax?
acute onset of SOB with hypoxia and unilaterally decreased breath sounds in a patient with a preexisting lung disease like cystic fibrosis of COPD.
chest pain and hyper resonance on percussion are also possible
_ markedly increases the risk of a pneumothorax
smoking
chronic destruction of alveolar sacs can lead to?
alveolar blebs (air pockets) which can rupture and leak air into the pleural space
diagnosis of a pneumothorax is made by?
chest X-Ray which will demonstrate a visceral pleural line with no pulmonary markings
tracheal deviation
bullous impetigo
bull with yellow fluid and crusting overlying sites of ruptured bullae
a superficial bacterial infection of the epidermis caused by bacterial invasion through a break in the skin barrier
caused by staph aureus
leaves a collarete scale with overlying crusting, yellow fluid within bullae
treatment of bullous impetigo
oral antibiotics
what is nonbullous impetigo?
papules and pustules with a honey crusted lesion caused by staph aureus OR group A streptococcus
it is treated with topical antibiotics first then oral antibiotics
what is erythema nodosum
2-3 cm tender erythematous or violaceous nodules that usually occurs on the shins but can develop anywhere.
It is a hypersensitivity reaction to various antigens.
what are common triggers for erythema nodosum
infections like strep
inflammatory bowel disease
sarcoidosis
and malignancy
medications (sulfonamides, penicillins)
biopsy of erythema nodosum shows
septal panniculitis without vasculitis
what is a testicular varicocele
a tortuous dilation of the pampinoform plexus that surrounds the testis
it is a soft irregular mass that increases with valsalva and does NOT transilluminate
more common on the left side
bag of worms texture
can present with sub fertility or testicular atrophy
treatment of a varicocele
gonadal vein ligation
scroptal support and NSAIDS
ultrasound findings of a
- varicocele
- spermatocele
- hydrocele
- varicocele - retrograde venous flow, tortuous tubules, dilation of pampiniform plexus
- Hydrocele- translumination
- spermatocele- on the head of the epididymis, fluid filled cyst that transilluminates with a painless pass at the superior pole of the testis (does not change in size)
post partum thyroiditis
occurs within the first 6 months, with a brief hyperthyroid phase that quickly changes to a hypothyroid phase with fatigue, weight gain, constipation. There will be a nontender goiter , bradycardia, diastolic hypertension, and edema. TSH will be elevated and free T3 will be low
*hypercholesterolemia and hyponatremia can also be a side effect
has elevated titers of anti-thyroid peroxidase autoantibodies
return to euthyroid state in a few months
post partum thyroiditis is similar to
painless (silent) thyroiditis
routine health maintenance in diabetes mellitus included monitoring for?
microvascular complications
-annual urine albumin/creatinine ration, annual dilated eye exam, periodic foot examination to test sensation and vibration
the earliest sign of diabetic neprhopathy is ?
albuminuria
in diabetes when should an ACE or ARB be added?
if there is hypertension or microalbuminemia
the most common cause of travelers diarrhea is?
enterotoxigenic EColi
enterotoxin causes diarrhea 1-3 days after ingestion and abdominal pain
usually self resolves, can cause dehydration which can predispose people to decreased urinary output and hypernatremia
symptoms of a zenker diverticulum
pharyngoesophageal
dysphagia, halitosis, history of regurgitating food-undigested, progressive dysphagia
abnormal spasm or diminished relaxation cricopharyngeal muscles during swallowing with increased pressure and herniation of the mucosa resulting in pushing and a psuedofiverticulum
aspiration of regurgitated food may lead to ?
recurrent aspiration pneumonia
Zenker diverticulum occurs where
a zone of weakness between the inferior pharyngeal constrictor
chlamydia and gonorrhea in women risk factors
manifestations
age less than 25
high risk sexual behaviors
asymptomatic, cervitis, urethritis, perihepatitis
test for chlamydia and gonorrhea
annual NAAT in patients we have high and low sexual behaviors
the measles mumps rubella vaccination is recommended at what ages
age 1 and again at age 4
what is vaccine strain
a fever and maculopapular rash that can present 1-3 weeks after an MMR vaccine that is self limited
people with this rash should avoid immunocompromised individuals until the rash resolves
treat with reassurance
the onset of backpain upon walking is known as
neurogenic claudication
relieved by leaning forward
lumbar stenosis- MRI of the spine
lumbar stenosis better with-
lumbar herniation better with
flexion
extension
what are the main causes of vitamin D deficiency ?
inadequate intake (vegan diet)
malabsorption (chrons, celiac)
inadequate sunlight exposure
metabolic disorders (CKD and chronic liver disease)
increased catabolism (anticonvulsants like carbamazepine)
Subgaleal hemorrhage
a potentially fatal neonatal injury that is caused by scalp traction during delivery, the veins will shear and there will be an accumulation of blood between the periosteum and the galea aponeurotica , soft swelling
common in vacuum assisted deliveries , presents as scalp swelling across the suture lines that moves with movement.
diagnosis is critical because it can lead to hypovolemic shock, DIC or death
cephalohematoma
bleeding between the skill and periosteum due to subperiosteal vessel rupture
firm non fluctuant swelling that does not cross the suture lines
