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Family Medicine > UWorld FM > Flashcards

UWorld FM Flashcards

1
Q

initial evaluation of HTN

A

Chemistry panels =
- electrolytes
- creatinine
- Hgb
- Hct

Urinalysis =
- hematuria
- proteinuria

ECG =
- LVH (Leftward deviation) = Lead 1 & Lead 2 + aVF all are negative = HTN
- prior MI (U wave/decrease R wave amp - scar tissue or inverted T (MI hours/days ago)

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2
Q

Lochia

A

vaginal discharge after giving birth

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3
Q

Birthcontrol

<1 month postpartum & breastfeeding
HTN

A

Nonhormonal birthcontrol = copper IUD

subdermal progestin-releasing implant or the progestin-releasing IUD

Copper IUD (C/I): heavy bleeding

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4
Q

Opacification of the lens = a clouding of your eye’s lens capsule
Chronic loss of visual acuity

A

Cataracts

Glares & halos
loss of red reflex

Tx: surgical removal of the lens w/implantation of a prosthetic lens

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5
Q

Anal foul-smelling discharge
pruritus
pain w/ defecation
perianal skin inflammed
Pustule-like lesions

A

Anorectal fistula

Tx: surgical evaluation

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6
Q

Polio sx vs GBS

A

Polio = weakness asymmetric

GBS = symmetric & begins w/ LE

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7
Q

Anorexia nervosa vs Bulimia nervosa vs Binge-eating

A
  • Anorexia: <18.5 tx: Olanzapine
  • Bulimia: inappropriate compensatory behavior tx: SSRI
  • Binge-eating: only lacks control tx: SSRI or Lisdexamfetamine
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8
Q

Glycemic control = A1c goal

A

Younger, otherwise healthy: ≤7%

Elderly/comorbidities: ≤8%

Tight control only prevents microvasuclar issues = nephro/retinopathy

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9
Q

Nephropathy Screening

A

Annual random
albumin/crt - <30 mg/g

Periodically
Serum crt

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10
Q

Retinopathy Screening

A

Dilated eye exam 1-2 years
Annual slit-lamp exam

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11
Q

Neuropathy Screening

A

Annually
* Comprehensive foot exam

Every visit
* Visual inspection

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12
Q

CV risk reduction

A

Rx statin
annual lipid
BP screening

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13
Q

Elderly
Wt loss
epigastric pain/tenderness
PMH: Smoking

A

Malignancy affecting the Upper GI tract
- Liver
- GB
- Pancreas

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14
Q

Hinged knee brace application

A

transfer load from Medial → Lateral joint compartment = Unicompartmental OA associated Varus deformity

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15
Q

Arthroscopic meniscectomy

A

tears of the meniscus → increase risk of OA

NOT a tx for pts w/ OA

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16
Q

OA management

A
  1. exercise + wt loss
  2. NSAIDs/Topical NSAIDs (diclofenac) + dulozetine + topical capsaicin
  3. Chronic pain management = GC injectable or hyaluronic acid
  4. Surgery = Total knee arthroplasty (replace articular surface of the knee w/ prostetic components)
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17
Q

What can reduce hypoglycemia awareness?

A

long-standing DM → blunted autonomic response

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18
Q

U/L watery rhinorrhea

A

Cerebrospinal fluid → Meningitis

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19
Q

Lhermitte sign

A

electric shock–like sensation down the spine with forward flexion of the neck

Associated w/ Spinal Cord Compression = myelopathy

Seen in MS

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20
Q

Neck pain
LMN in UE
Unsteady gain
UMN in LE

A

Cervical spondylotic myelopathy

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21
Q

TB workup

A
  1. Tb skin test (TBT) or Interferon gamma release assay (IGRA)
  2. Chest x-ray
  3. Sputum cultures
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22
Q

HIV prophylaxis

A

TMP-SMX
- Pneumocystitis = CD4 <200
- Toxoplasma = CD4 <100

Azithromycin
- Mycobacterium avium comple (MAC) = CD4 <50 + NO ART

Azole
- Fluconazole - Coccidiomyosis (CD4<250 - US west)
- Itraconazole - Histoplasmosis (CD4<150)

Vax
- MMR/Varicella = CD4 >200

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23
Q

Fever
lymphadenopathy
bone pain

A

ALL = 2-5 yo (MC) or 60+ yo

BM biopsy = >25% blast = +TdT
Tx:
- Vinceristin
- roids
- Asparginase

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24
Q

Cancer in 65+

Pancytopenia
DIC - association

A

AML
Dx:
- Auer rods
- +myeloperoxidase
- >25% blast

Dauorubicin + Cytaraabine

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25
Q

Antiphospholipid Syndrome Dx

A

1 Clinical + 1 Lab

Clinical
- thrombosis
- prego = 3+ miscarriages + pre-eclampsia + fetal demise
Lab
- Lupus anticoagulant = dilute ressull venom viper test
- Anti-cardiolipin (ELISA IgM/IgG)
- Anti-b2 glycoprotein (ELISA IgM/IgG)

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26
Q

Skin lesion

Pearly
waxy
Peripheral telangiectasia
Bleeding ulceration
Scaly (dried) plaque (raised)

A

Basal Cell Carcinoma

Dx: shave, punch, excisional biopsy

Tx:
Excision
Topicial: 5-FU or Imiquimod

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27
Q

systemic sclerosis = scleroderm
Limited vs Diffused

A

Limited
* C = Calcinosis -fingers
* R = Raynaud syndrome
* E = Esphogeal dysfunction
* S = Sclerodactyly
* T = Telangiectasia

Diffused = Organ involvement
- GI = Esophgeal/Dysphagia/pepsisa
- Pulm = Interstitial fibrosis (decrease vol.) + Pulmonary HTN (pulm artery narrowing)
- CV = Myocardial fibrosis + pericarditis (rub)
- Renal = HTN + renal crisis (hemolytic anemia + oliguria + ↓ platelet)

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28
Q

RA management

A
  1. DMARD - Methotrexate
  2. NSAID or roid
  3. DMARD + Biologic

Flares = roids

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29
Q

HTN 1st line

A

Wt ↓ > Diet > Exercise > ↓ Salt > ↓ EtoH

ACEi/ARB
thiazides
CCB

> 140/90
130/80 - high risk pts

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30
Q

AAA Screening

A

65+ & smoker

Ab US
* Small aneurysms (3.0–3.9 cm) - every 3 yrs
* 4.0–4.9 cm - annually
* Aneurysms 5.0–5.4 cm - every 6 months

Aneurysms 5.5+ cm + rapidly growing should be evaluated for surgery

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31
Q

what determines severity of COPD

A

FEV1

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32
Q

Joint fluid values

A

Normal: <200

OA: <2,000

crystals +RA: <100,000

Septic: 500,000+

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33
Q

When should revascularization w/ carotid endarterectomy occur?

A

50%-99% - in men
70-99% - in women

Antiplatelet (ASA) + Stain + BP control should be started

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34
Q

Elderly F

High-pitched bowel sounds
distended loops of bowel w/ air-fluid levels

Fullness + tenderness w/n right groin

A

Small bowel Obstruction → femoral hernia (MC in elderly female)

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35
Q

Incarcerated vs Strangulation

A

Incarceration = hernia trapped w/m sac → small bowel obstruction

Stranulation = reduced venous outflow → ischemia + necrosis

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36
Q

Sensorineural hearing loss

A

Lateralization to oppose side
Air conduction B/L or to affected side

Etiology

  • Meniere’s = asymmetric + vertigo
  • Schwannoma = facial numbness + U/L hearing loss
  • Congenital
  • Presbycusis = Aging + B/L
  • Noise-induced hearing loss = Corti (sterocilia damage due to loud noises) → rupture tympanic membrane
  • Ototoxic rx = aminoglycosides
  • MS = young f w/ UMN sx
  • CVA
  • CNS infection = meningitis + neurosyphilis
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37
Q

Pelvic Organ Prolapse management

A

Asx = anterior bulge w/o urinary retention or hydronephrosis - reassurance + observation

Sx =
- Kegel exercises
- Pessary placement = nonsurgical correction of cystocele

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38
Q

Ear pain/fullness
Retraction of the tympanic membrane

A

Chronic otitis media → conductive hearing loss

could also show fluid in the middle ear

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39
Q

Night sweats
Wt loss
nonproductive cough
Cavity - CXR

A

Reactivated TB

Endemic > Smoking

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40
Q

Conductive hearing loss

A

Both Lateral & Bone on same side

Etiology
- Otitis media = pain/fullness + retaction TM + fluid
- Cholesteatoma = keratin debris
- Otosclerosis = young prego + normal ear exam = stiff stapes
- Tympanic membrane perforation
- Eustachian tube dysfunction = Asymmetric hearing loss + popping/pain + middle ear effusion

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41
Q

Excessive fundal pressure + traction of umbilical cord → postpartum hemorrhage + vaginal mass + fundus no longer palpable

A

Uterine inversion

Tx: manual replacement of uterus

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42
Q

Child

Fever
Rash
Conjunctivia = sclera injected
extremity edema

A

Kawasaki disease = Ig + ASA

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43
Q

Postvoid residual = Obstructive uropathy

A

> 50mL

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44
Q

DM + kidney

A

Microangiopathy = nephrotic syndrome

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45
Q

TM-SMX & prego

A

SAFE in 2nd trimester
give fosfomycin in 1st trimester

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46
Q

CAP vs Atypical Pneumo

A

CAP
* Dx: ↑ sputum + fever + rhonchi
* Tx: Amoxicillin-clavulante + doxycycline

Atypical
* Dx: nonproductive cough + fever + rhonichi
* Tx: Azithromycin + doxycycline

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47
Q

Scabies dx

A

Microscopic prep

Tx: 5% permethin & oral Ivermectin

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48
Q

Middle age F

Facial redness
Telangietasias
Burning/stinging
Edema
dryness

A

Rosecea

Tx: Topical Brimonidine = α2-adrenergic receptors agonist

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49
Q

onychomycosis

A

Fungal infection of toe nail
Dx: KOH microscopy scrapings + PAS stain + cultures of clippings

Tx:
Oral terbinafine or itraconazole
Topical = ciclopirox or efinaconazole

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50
Q

Saph scalded skin syndrome vs Toxic Shock Syndrome

A

Scalded skin = bullae w/ sloughing
tx: fluids + Nafcillin + vancomycin

Toxic Shock = Fever + ↓ BP + Rash + desquamation
tx: vancomycin + clindamycin

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51
Q

Tinea corporis management

A

Topical azoles or Terbinafine

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52
Q

Chlamydia Screening

A

all sexually active women 24 years or younger

women 25+ who are at increased risk for infection

dx: NAAT

Tx:
Azithromycin or Doxycycline + Ceftriaxone (for Gonorrhea co-infection)

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53
Q

Syphillis

A

Screen
treponemal test
- FTS-Ab = Fluorescent treponemal antibody absorption test
- TP EIA = syphilis enzyme immunoassay

nontrepnemal
- RPR = Rapid plasma reagin testor
- VDRL =
Venereal disease research lab test

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54
Q

Giant cell arthritis vs TMJ

A

Age
Giant cell arthritis = old 50+
TMJ = younger <50

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55
Q

Fibromuscular dysplasia vs Pheochromocytoma

A

HTN
Headache
Fibromuscular dysplasia = sub-auricular carotid bruit (systolic) + tinnitus + TIA/stroke

Phenochromocytoma = episodic sx including sweating + ↑HR

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56
Q

Kleihauer-Betke testing

A

Rh-neg /vag bleeding

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57
Q

Irregular vaginal bleeding - postcoital (after intercourse)
Cervical mass
Cervical friability = bleeding w/ manipulation

A

invasive cervical cancer = raised, exophytic mass
Prego →↑ vascularity →↑bleeding

Cervical biopsy

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58
Q

Braces are used when

A

Ligamentous injuries occur

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59
Q

Immobilizes are used

A

W/ fractures

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60
Q

Young F

Anterior Knee pain
Sensation that the knee will “give way”
Compressing patella → trochlear groove reproduces the pain

A

Patellofemoral pain syndrome (PFPS) aka runners knee aka Chondromalacia Patellae

Managment:
-activity modification = reduce intensity of exercise
- NSAIDs
- Stretching & strengthening of quads/hip abductors

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61
Q

Round well-circumscribe mass dorsal wrist
Transilluminate

A

Ganglion cyst = tissue outpouching - tendon sheath + joint capsule + bursae

Observe = spontaneous resolve
Needle aspiration = pain + paresthesia
Surgical excision

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62
Q

Diffuse cutatnous scaling (dry)
rough
fish-like scales
trunk + extremities
Hyperlinear palms = increased linear creases on palms
worsen during winter

A

Ichthyosis vulgaris = FLG → defective keratinocyte desquamation

Tx
- long baths = removes scales + moisturizers (keratolytics - a hydroxy acid = lactic acid + urea+ salicyclic acid)

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63
Q

Pustular rash
Migrating arthralgia = multiple joints
tenosynovitis = clear synovial fluid + leukocytosis (G- organism)

A

Disseminated gonococcal infection

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64
Q

Prego
Friable
dome-shape nodule
Small abnormal capillaries & granulation tissue
bleed w/ minor trauma

A

Pyogenic granuloma

regress postpartum

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65
Q

Bacillary angiomatosis =
- multiple small reddish/purple papules
- friable nodules
- fever
- malaise
- night sweat

A

Bartonella infection

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66
Q

Contraception → UTI

A

Spermicide (nonoxynol-9) = alters vaginal microbiome

Diaphragm → urinary stasis by applying pressure on the anterior vaginal wall = increases bacterial replication

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67
Q

Midline trachea
COPD/Cystic fibrosis
fremitus decrease U/L
breath sound decrease U/L

A

Rupture of an apical alveolar bleb → leak air into the pleural space = pneumothorax

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68
Q

Oxybutynin vs Desmopressin

A

Oxybutynin = night/daytime incontinence - urinary retention = anticholinergic

Desmopression = nocturnal enuresis 1st line = ADH agonist

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69
Q

Prego
New onset oligohydramnios

A

Spontaneous rupture of membranes

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70
Q

Pleural effusion vs Atelectasis

A
  • decrease breath sounds
  • decrease percussion = dullness
  • decrease fremitus

Atelectasis = trachea towards
Pleural effusion = trachea away

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71
Q

diffuse enlargement of the breasts w/o
- pain
- tenderness
- nodules
- skin dimpling

High BMI

A

Pseudogynecomastia = excessive depo of fat due to wt gain

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72
Q

Aphthous stomatitis (canker sores) vs
Lichen planus

A

Aphthous = acutely painful + episodes only last a few days

Lichen planus = white papules/plaques = Wickham striae + B/L + symmetric + lines of minor trauma =Köbner phenomenon

Lichen planus = CD8+ T cells → tx GC

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73
Q

Right-sided band-like area of hyperesthesia
4+ months of persistent pain

A

Postherpetic Neuralgia (PHN)

Tx: Gabapentin + TCA

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74
Q

Meningitis in young infants is commonly caused by

A

Group B Streptococcus - <3 months

Listeria monocytogenes - <1 month

Neisseria meningitidis - young children & young adults (18-month-old+)

Tx: C (ceftrixone) V (vancomycin) S (steroid)

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75
Q

Endometrial evaluation for Post-Menopausal Bleeding

A
  1. transvaginal US
  2. endometrial biopsy
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76
Q

Lipid abnormailities workup
Including the following sx
- wt gain
- HTN
- fatigue

A
  1. TSH levels = hypothyroidism → ↓LDL receptors
  2. Statin
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77
Q

Wt loss bariatric surgery

A

BMI 40+
BMI 35+ w/ comorbidity

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78
Q

Associated conditions w/ pseudogout

A

Hemachromatosis
Gitelman syndrome

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79
Q

funduscopy

Yellow extracellular material
B/L central vision loss

A

Age-related macular degeneration

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80
Q

med: bisphosphate
tooth extraction
jaw pain

A

Bisphosphonate-related osteonecrosis of the jaw

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81
Q

Well-defined erythematous (red) plaques (raise 1+cm) w/ scaling (dry)
Scraping → bleeding

A

Psoriasis

Tx: Topical betamethasone or emollients
refractory cases: Methotrexate + Cyclosporine + TNFai or ILi

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82
Q

B/L pruritius
mild leg pain
Scaling = dry
weeping (fluid leaking from your legs)/Edema
red/brown discoloration

A

Chronic stasis dermatitis result of venous insufficiency

Workup = venous doppler US

Tx: compression stockings, exercise + leg elevation

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83
Q

Viral arthritis vs RA

A

Viral (anti-parovirus B19 IgM) = < 30 mins of morning stiffness +flu-like sx + symmetric joints tenderness

RA = < 60 mins of morning stiffness

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84
Q

Anti-cyclic citrullinated peptide Ab

A

RA

also associated w/ Rheumatoid factor

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85
Q

ANA = antinuclear Ab
anti-DNA Ab

A

SLE

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86
Q

Female
recurrent/self-limiting rectal pain (cramping)

A

Proctalgia fugax

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87
Q

U/L white patch on the tongue that cannot be removed w/ scraping
Painless

A

Oral Leukoplakia

Risk factors = tocbacco + EtOH use

Management: biopsy - associated w/ cancer

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88
Q

Giardia vs ETEC (Enterotoxigenic E. coli) vs Norovirus

A

Giardia = Bloating + foul-smelling + hiking/travel
tx: metronidazole

ETEC = Traveler’s diarrhea + rice-water resembling cholera
Tx: ciprofloxacin

Norovirus = Pediatric + Outbreaks (healthcare + restaurants + schools + military) watery
Tx: supportive (self-limiting)

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89
Q

Associated conditions w/ S4

A

Acute MI
Concentric LVH = long-standing HTN
Restrictive cardiomyopathy
Diastolic Heart failure

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90
Q

Ischemic cardiomyopathy

A

Damage to heart tissue (CAD) → heart failure w/ reduced EF (Systolic heart failure)

Eccentric heart changes
ABCDs

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91
Q

Associated conditions w/ S3

A

AR
HF w/ reduced EF = Ischemic or dilated cardiomyopathy
High-output HF (AV fistula + thyrotoxicosis)
MR
Systolic heart failure

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92
Q

Romes Dx

A

3+ days for 3+ months
2+ sx
- Change in form of stool
- Change in frequency of stool
- Sx improve w/ BM

Dx IBS

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93
Q

Recurrent facial edema + ab pain

A

Heredirary angioedema secondary to C1 esterase inhibitor definency

Decrease C4

Tx:
- C1-INH concentrate
- Fresh Frozen Plasma (FFP)

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94
Q

ACEi C/I

A

Pts w/ C1-INH defiency = ↑ bradykinin → angioedema

Prego pts

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95
Q

BPH vs Urethral stricture (narrowing)

A

-incomplete voiding
- weak stream
- elevated Postvoid residual (PVR)
- dribbling urine

BPH = 40+
Urethral stricture = < 40

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96
Q

When should you image pts w/ back pain

A
  • Neurologic deficits (severe)
  • Cancer PMH
  • Osteoporosis
  • IV drug us
  • Constitutional sx = fever + ↓ wt + lymphadenopathy
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97
Q

How to workup back pain

A

Acute = < 4 weeks (NSAIDs) + refractory (baclofen = Muscle relaxants)
Subacute (4+ weeks) = imaging
- XR (non-specific sx)
- CT/MRI (radiculopathy + Spinal stenosis)
Red flags = Imaging

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98
Q

Compartment Syndrome

A

6 P’s
- Paresthesias
- Pallor
- Poikilothermia
- Pulselessness
- Paralysis

Delta pressure 20-30

Tx: fasciotomy

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99
Q

Mediastinal fullness & scattered reticular opacities in upper lobe

Hypercalcemia

A

Hilar lymphadenopathy

↑ Vit D conversion by lung macrophages

Sarcoidosis = restrictive lung disease + fibrosis (DLCO decrease)

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100
Q

Interdigital (Morton) neuroma vs Charcot arthropathy

A

Morton neuroma = numbness/pain 3rd/4th toes

Charcot arthropathy = claw toe deformity (dorsiflexion MTPs) ← Diabetic peripheral neuropathy

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101
Q

Occult GI bleeding post ICU due to septic shock

A

Stress-induced ulcer due to mucosal injury
- splanchnic hypoperfusion
- reflux of bile salts
- accumulation of uremic toxins

Prophylatic acid suppressive agents

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102
Q

Chondrocalcinosis w/ moderate effusion - knee
hepatomegaly

A

Pseudogoat (Ca++ pyrophosphate dihydrate crystal deposition) - which is associated w/ Hereditary hemochromatosis

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102
Q

Hereditary hemochromatosis workup

A
  1. iron studies (elevated serum irion + ferritin + transferrin saturation)
  2. LFTs
  3. Biopsy = if LFTs are really bad

Tx: Phlebotomy

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103
Q

Tx pts receiving chemo + neutropenic fever

A

IV vancomycin

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104
Q

Patiromer vs hemodialysis vs Ca++ Carbonate/gluconate

A

Patiromer = K+ chelator w/n the colon & excreted in feces used to tx outpt hyperkalemia (<6.5)

Hemodialysis = severe hyperkalemia >6.5

Ca++ Carbonate = hyperkalemic + rapdily stabilzation of muscle membrane (given IV)

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105
Q

Meniere disease risk factors

A

salt intake
Caffeine
EtOH
Allergies

Tx: diuretics + vasodilators
vestibular suppressants = benzo + antiemetics (promethazine)

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106
Q

increased Central Venous pressure

A

Cardiogenic shock = ↑ Pulmonary wedge pressure

Obstructive shock = ↓ Pulmonary wedge pressure

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107
Q

Bone metastases w/ progressive pain

A

< 4/10 = non-opioid analgesics (tylenol + NSAIDs)

> 4/10 = Short-acting opioids (oxycodone + morphine)

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108
Q

When is topical capsaicin useful

A

mild-moderate neuropathic pain

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109
Q

PMH: Uveitis
SOB
Presyncope episodes
AV block
LBBB

A

Sarcoidosis → cardiac noncaseating granulomas

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110
Q

MC mononeruopathy in hemodialysis pts

A

Carpal tunnel syndrome (CTS)

dialysis-related amyloidosis → ↑beta2 microglobulin

111
Q

Postexposure HIV prophylaxis = PEP

A

3 drug antiretroviral therapy for 4 weeks a combination
* nucleoside/nucleotide reverse transcriptase inhibitor (tenofovir-emtricitabine)
* an integrase inhibitor(dolutegravir + raltegravir) w/n the 1st few hrs

112
Q

in NSTEMI which tx proven to reduce all-cause mortality

A

BB & Aspirin

113
Q

indication for Ambulatory BP monitoring

A

signs of hypertensive disease (left-axis)
normal BP in office

114
Q

Elderly pt

Exertional syncope

A

age-related decreased baroreceptor sensitivity = vasodilation + fixed SV

115
Q

Gestational DM screening

A

24-28 weeks
1. 1 hr 50g Glucose Challenge Test
140+ = abnormal

  1. 3 hr 100g Glucose Challenge Test
    - fasting = 95+
    - 1hr = 180+
    - 2hr = 155+
    - 3hr = 140+

Tx: Diet > Insulin > Metformin

116
Q

Venous thrombosis vs Arterial thrombosis vs Arterial emboli

A

Venous = dull/achy pain + swelling + warm

Arterial thrombosis = claudication + decrease pulse in unaffected limbs

Arterial emboli = pulseless + cool + weak + numb

117
Q

Resistant HTN
PMH = CAD
Claudication = leg pain w/ activity & resolves w/ rest
Ab bruit = periumbilical area

A

Renovascular disease = Renal Artery stenosis

118
Q

Young F
Smokes
recurrent chest discomfort = rest/during sleep
transient ST elevations

A

Hyperactive intimal smooth muscle = Vasospastic angina

  • CCB (preventive)
  • Nitro (abortive)

Risk factors = CAD (HTN + DM) & SMOKING

During sleep = diaphoresis + Nausea + palpitations + SOB

119
Q

Cardioprotective antidiabetic agents

A

GLP-1 agonist = -tide
SGLT-2i = -flozin

120
Q

Adverse effect of implantable pacemakers or cardioverter-defibrillator

A

Tricuspid regurgitation (TR) = sx of right-sided HF
- JVD
- B/L edema
- Holosystolic murmur LLSB
- hepatomegaly

121
Q

Breast Cancer workup

A
  1. Breast imaging = mammography
  2. Fine-needle aspiration

Cancer =
- eccentric (off center) to nipple
- well-defined or spiculated margins
- calcifications

122
Q

Lipid management

A
  1. High-intensity Statin
  2. Moderate-intensity statin
  3. Ezetimibe
123
Q

HTN workup in Young F (w/ evidence of OCP)

A
  1. Obtain more BP readings
  2. Stop combined OCP
  3. Start 1 of 1st line drugs
124
Q

Screening tool for lung cancer

A

Annual low-dose CT
- 50-80 yo
- 20+ pack-year smoking history
- Currently smoking or stopped in the past 15 years

125
Q

Screening tool for colon cancer

A

Colonoscopy
starts at 45 & repeat every 10 yrs

FH (1st degree relatives) - every 5 yrs
- 40 yo
- 10 years before the earliest age at dx

FAP - annual
- 10-12 yo

Lynch syndrome - 1-2yrs
- 20-25

IBD (Crohn/UC) - 1-2 yrs
- 8yrs post dx

Alternative = FIT for Hgb

126
Q

empiric therapy for tx of human bite wounds

A

amoxicillin-clavulanate

127
Q

which T2DM Rx cannot be given to pts w/ kidney issues

A

Metformin = b/c it is excreted 100% by kidneys

128
Q

Celiac testing

A
  1. Ab (anti-tissue transglutaminase) or quantitative fecal fat testing or IgA endomysial antibody
  2. DEXA = dual-energy x-ray absorptiometry scan - malabsorption of Ca++/Vit. D = bone issues
129
Q

Villous adenomas and colorectal cancer (CRC) risk factors

A

T2DM
Obesity
Smoking
EtOH
Red meats

130
Q

Duke criteria

A

Major:
* + cultures
* TEE = mass on valve

Minor:
* fever
* Drug use
* Vascular = Janeway lesions
* Immunologic = kidney issues + RF + Osler nodes + Roth spots
* microbiologic

bacterial endocarditis

Tx: Vancomycin
Prophylaxis = Amoxicillin

131
Q

Aortic Dissection Dx

A

CTA = stable
TEE = unstable + CKD pts
CP/Back pain = tearing sensation

132
Q

HOCM Dx

A

Harsh systolic murmur (crescendo-decrescendo) increases w/ valsalva + standing & decreases w/ squatting
1. Echo
2. CXR = mitral regurgitation

132
Q

HOCM features

A

Harsh Systolic murmur that ↑ w/ ↓ preload = Valsalva + standing

Young pt
sudden collapse

133
Q

Pericarditis Dx

A

ECG = diffused ST elevation
CXR = pericardial effusion

134
Q

Pericarditis sx

A

Chest pain that worsens in supine position + inspiration

135
Q

Increase risk for CVD

A

FH
1st degree males (father + brother) = MI before age 55

1st degree females (mother + sister) = MI before age 65

136
Q

The MC causses of death in pts w/ CKD or DM

A

Cardiovascular disease = approximately 50% of deaths in this population

137
Q

T2DM dx

A
  • A1c measurement 6.5%+
  • 2 fasting glucose at separate times = 126+ mg/dl

every change in 30 mg/dl in serum glucose = 1 point Δ in A1c

138
Q
  • “blowing” early diastolic murmur that is best heard at the left sternal border
  • a wide pulse pressure
  • hyperdynamic pulses
A

Aortic regurgitation

Head bobbing

139
Q

58 M

Annual health maintenance examination
- screening colonoscopy at age 51
- low-dose CT scan of the chest 6 months ago
- PMH: 40 yr pack
- FH: bladder cancer in the patient’s grandfather
- VS & PE: normal

Which of the following screening procedures is most appropriate for this patient at this time?

A

NOTHING
Colonoscopy - every 10 years
Lung cancer - every year
Bladder cancer & Prostate = not screened

140
Q

15 cigarettes (3/4 pack) a day for 1 year =

20 cigarettes (1 pack) a day for 1 year =

40 cigarettes (2 packs) a day for 1 year =

A

15 cigarettes (3/4 pack) a day for 1 year = ¾ pack-year

20 cigarettes (1 pack) a day for 1 year = 1 pack-year

40 cigarettes (2 packs) a day for 1 year = 2 pack-years

141
Q

Strongest risk factors for chronic pancreatitis vs pancreatitic cancer

A

Chronic pancreatitis = steatorrhea due to excess EtOH

Pancreatic cancer = pancreatitis sx + wt loss due to SMOKING

142
Q

Rx & Supplements that can cause HTN

A

Antidepressants
- Fluoxetine
- Monoamine oxidase inhibitors
- Tricyclic antidepressants
- Venlafaxine

Biologic therapies
- Bevacizumab
- Imatinib

Decongestants
- Phenylephrine
- Pseudoephedrine

Herbal supplements
- Ephedra
- Ginseng
- Licorice
- St. John’s wort

Hormonal birth control
- Combination OCPs

Immunosuppressants
- Cyclosporine
- Tacrolimus

Illicit drugs
- Amphetamines
- Anabolic steroids
- Cocaine

Pain medications
- Indomethacin
- Naproxen

Stimulants
- Caffeine
- Methylphenidate

143
Q

Young M

Runner presents
U/L LE pain w/ ambulation = signs of claudication
PE: palpable pedal pulses
Duplex US = elevated velocities in the popliteal artery w/o other abnormalities

A

Claudication = Popliteal artery entrapment

Medial head of the gastrocnemius muscle

144
Q

Initial management of peripheral arterial occlusive disease w/ palpable pulses is to

A
  1. modify risk factors (tobacco cessation + regular exercise to promote collateral flow)
  2. Tx T2DM - A1c < 7%
  3. initiating statin + antiplatelet therapy (ASA)
  4. In refractory cases= phosphodiesterase inhibitor, cilostazol, can be used to improve walking distance
145
Q

Activities of daily living include

A
  • transferring (bed to chair)
  • toileting
  • continence
  • feeding
  • dressing
  • bathing
146
Q

Which BP med causes
- wt gain
- ↑ blood glucose
- worsened dyslipidemia

A

Beta blockers

Metoprolol = metabolic ADR

147
Q

Greater trochanteric pain syndrome vs IT band syndrome

A

Lateral thigh pain
Greater trochanteric = butt pain (gluteus medius/minimus tendons on greater trocanter)
IT band = knee pain

148
Q

Dyspareunia = pain w/ exercise + sex
U/L homogeneous low level echoes (blood)
Chronic pelvic pain

A

Endometriosis = endometriamas (chocolate cyst)

149
Q

Focal headache or face pain
Fever
Vomiting - early morning
Sx of sinus infection = oropharynx erythema + purlent discharge + nasal drainage (green) U/L

10+ days of URI = cough + congestion + sore throat

A

Acute bacterial rhinosinusitis

Get CT scan = ring-enhancing lesion

tx: Amoxicillin-Clavulante or Doxycycline

150
Q

Gonococcal proctitis vs Anorecal fistula secondary to Anal abscess

A

Anal discharge + pruritus + pain w/ BM

Gonococcal = white discharge + normal perianal exam

Anorecal fistula = foul-smelling discharge + indurated pustule-like lesion near anal verge

151
Q

SCFE risk factors

A

obesity = due to increased mechanical strain on the physis

tall, thin adolescents during a growth spurt

Tx = immediate stabilization of the physis w/ surgical fixation to avoid the risk of avascular necrosis

152
Q

H. pylori

A
  1. PPI + amoxicillin (5 -7 days) followed by a
  2. PPI + fluoroquinolone + nitroimidazole (5-7days)
  3. LOAD therapy = levofloxacin + omeprazole + nitazoxanide [Alinia] + doxycycline (7-10 days)
153
Q

Viral Conjunctivitis vs Allergic Conjunctivitis Vs Bacteria

A

VC = viral sx (rhinorrhea + nasal congestion + sinus tenderness + cough) + mild injection and a granular appearance of the tarsal conjunctiva
tx: Warm compress

AC = Conjunctival edema
tx: Olopatadine eye drops (mast cell stabilizer)

BC = dry + purlent discharge
tx: fluoroquinolones

154
Q

Monoarticular arthritis = U/L joint pain
Achilles tendon pain
Oral ulcers
vesiculo-pustular rash (soles + palms)
polymorphonuclear leukocytes w/o organisms on Gram stain

A

Reactive Arthritis w/ Chlamydia trahomatis infection

155
Q

Primary Adrenal Insufficiency = Addision disease dx

A

1o tumors = lung + breast + kidney can metastasize to the adrenal glands
Constitutional sx: fatigue + anorexia + wt loss
GI sx: nausea + ab pain

↓BP + ↓Glucose + ↓Na+ + ↑K+

Dx: cosyntropin stimulation testing = synthetic ACTH which should ↑ cortisol production

  • if it doesnt increase = 1 PAI
  • if it does increase = 2/3 PAI
156
Q

Organisms associated w/ osteomyelitis

fever + ↑HR + leukocytosis
localized pain
skin changes = erythema + warmth + edema

A

Staph aureus
Pseudomonas aeruginosa

157
Q

Nystatin ointment vs Clotrimazole

A

Nystatin = Candida species

Clotrimazole = Dermatophytes (Trichophyton)

158
Q

Summer months
In the grass
pruritic + erythematous papules on the LE

A

Trombiculosis = chigger bites

self-limited

Management = sx control w/ topical application of vinegar, hot showers, and/or calamine lotion

159
Q

Meniere disease vs Perilymphatic fistula

A

Sensorineural hearing loss
episodic vertigo

Meniere = longer vertigo episodes

Perilymphatic fistula = trauma + brief vertigo episodes + valsalva meneuver stimiluating

160
Q

Cognitive impairment workup

A
  1. Labs (CBC + B12 + TSH + CMP)
  2. Imaging (CT or MRI)

Atypical
- Labs → get CSF
- Imaging → EEG

161
Q

Xerosis

A

dry skin seen in elderly pts when in a dry environment

162
Q

Anovulation vs Endometrial polyp

A

Anovulation = abnormal uterine bleeding

Endometrial polyp = bleeding betw regular + monthly menstr

163
Q

Tx of Chlamydia + Gonorrhea

A

Empiric (pending test results): ceftriaxone + doxycycline*

Confirmed chlamydia: doxycycline*

Confirmed gonorrhea: ceftriaxone

164
Q

Murmurs that get soft w/ squatting

A

MVP
HCOM

get louder w/ valslva + standing

165
Q

Murmurs that get soft w/ handgrip

A

HCOM
AS

166
Q

achieving strict glycemic control improves

A

Microvascular complications
- Retinopathy
- Nephropathy

167
Q

Emotional & behavioral sx w/n 3 months w/ identifiable stressor

A

Adjustment disorder

168
Q

What should you consider about Live-Attenuated vax among travelers

A

Live-attenuated vax can cause dissemenate disease in immunocomp - so don’t give

  • MMR
  • Varicella
  • Oral typhiod
  • Intranasal Influenza
169
Q

Mammography Screening

A

Women aged 50 to 74 year
Every 2 years

170
Q

Cholesterol screening

A

begins at 40
3-5 yrs interval

171
Q

Cutaneous horn

A

Keratinaceous projection from skin = conical or elongated
associated w/ seborrheic keratosis + SCC

172
Q

Dermatofibroma vs Basal Cell Carcinoma vs Molluscum contagiosum vs Keratocanthoma

A

Dermatofibroma = small + firm + hyperpigmented nodule +/- dimpling in the center w/ keratin plug & ulcerated

MC = Large umbilicated nodules w/o keratin plug

BCC = ulcerated + sun exposed skin + slow growing

Keratocanthoma = ulcerated + keratin plug + resolves spontaneously

173
Q

Rapidly growing nodule
ulcerated
keratin plug
resolve spontaneously
Sun exposed areas (face + forearm)

A

Keratocanthoma

174
Q

Shin splints vs Stress fracture

A

Shin splints = diffuse pain

Stress fracture = point tenderness

175
Q

Preseptal vs Orbital cellulitis

A

Eyelid edema + erythema
Fever
Leukocytosis

Preseptal = inital after trauma

Orbital = Opthalmoplegia (eye muscle movements + paralysis) + painful extraocular movements + proptosis + visual changes

176
Q

Finkelstein/Eichhoff test = flexing thumb + ulnar deviation positive

Hand + wrist pain
- radial styloid pain

A

de Quervain tendinopathy

Tx:
- NSAIDs
- thumb spica splinting

177
Q

Abx should be avoided in elderly pts w/ CAD + HTN + AAA + PMH: smoking

A

Fluoroquinolones (-floxacin)
↑ collagen degradation →
- Achilles tendon rupture
- Retinal detachement
- Aortic aneurysm rupture

178
Q

Doxycycline ADR

A

Children = yellow teeth

Adult =
- skin photosensitivity
- Rx-induced esophagitis

179
Q

Ligamentous sprain vs Inflammation at ligamentous insertions

A

Ligamentous sprain = traced to a specific event action + more pain w/ movement

Inflammation at insertions = worse w/ rest but improves w/ movement + <40 yo + gradual-onset pain

180
Q

Irregular soft mass
increase in size during valsalva maneuver
No transilluminate
Scrotal heaviness

A

Varicocele = dilation of the pampiniform plexus

Dx: retrograde venous flow (US) + anechoic tubules adjacent to testis
Tx: Ligation + NSAIDs

180
Q

Post Injection

Joint
- ↑pain after injection
- swelling + erythema + warm
- Fever + chills + myalgias

A

Septic bursitis
1. image-guided aspiration
2. Abx - Staph/Strep

181
Q

↓ fetal movement

A

<10 movements in 2 hrs
1. Nonstress Test (NST)

182
Q

Nonstress test

A

monitors an unborn baby’s heart rate for 20-30 min to see if it changes as the fetus moves and during contractions

183
Q

Adolescent boys
pain worse at night
NSAIDs make feel better

Small round lucency

A

Osteoid osteoma = benign bone-forming tumor

184
Q

Cough 5+ days +/- sputum
absent fever + chills
wheezing/rhonchi
chest wall tenderness

yellow/purulent sputum → Blood sputum

A

Acute bronchitis

Self-limiting

185
Q

Ground-glass appearance = B/L alveolar infiltrates

A

Pulmonary Edema seen in ARDS

V/Q Mismatch = high A-a gradient

Associated w/
- Mitral Stenosis/MR & papillary muscle rupture = Left-sided HF
- Pre-eclampsia
- Malaria
- Leukemias - AML/ALL
- HTN
- Nephritic syndrome

186
Q

Syncope dx testing

A

ECG = arrhythmias
Holter monitors = arrhythmias
Echo = Structural
Stress test. = ischemia
CT = SAH
EEG = seizures
BP = hypovolemic (autonomic)
Glucose = hypoglycemia
Tilt-table testing = neural mediated syncope

187
Q

MVP management

A

Reassurance

188
Q

Orthostatic Hypotension Management

A

NonRx:
- salt tablets
- avoid large carbohydrate-rich meals (to prevent postprandial hypotension)
- limit alcohol intake
- adequate hydration

Rx:
Fludrocortisone = synthetic mineralocorticoid (1st-line therapy)
Midodrine = peripheral selective alpha-1-adrenergic agonist
Pyridostigmine = cholinesterase inhibitor

189
Q

Postural Orthostatic Tachycardia Syndrome Management

A

NonRx:
high fluid intake
graded exercise programs
support hosiery
care with posture will improve symptoms.

Rx:
aim to increase blood volume and red blood cell mass (fludrocortisone, desmopressin, erythropoietin)
vasoconstrict (midodrine, methylphenidate, octreotide)
reduce heart rate (beta blockers)
modify central neurovascular control (SSRI, SNRI, clonidine)
facilitate neural transmission (pyridostigmine)

190
Q

Thyroid Nodule Diagnostic Testing

A

High/normal TSH → US
>2 cm or >1cm w/ calcification + irregular → FNA

Low TSH = Radioactive iodine = hyperthyroidism

191
Q

Young M
Nonproductive cough
Pulmonary nodules
Retroperitoreal lymphadenopathy = lymphatic spread - possibly neoplastic + mostly

A

Testicular = US & tumor markers - most likely the dx

Other options
Lung cancer = cough + SOB, CT
Liver cancer = Ab pain + mostly seen in F, US

192
Q

Contact dermatitis vs psoriasis of the hand

A

CD = dorsum of hand
Psoriasis = palms + dorsum

193
Q

↑indirect bilirubin
Mild jaundice = scleral icterus
Stress = illness + fasting + dehydration + menstruation + exercise + surgery

A

Gilbert =↓ UDP enzyme →↓ conjugated bili

194
Q

Ear pain
Facial weakness = difficulty closing eye + U/L facial droop
Vesicular rash in external auditory canal

A

VZV reactivation → Ramsay hunt syndrome

affects CN7 (facial) & CN8 (vestibulocochlear)

195
Q

Annular/ target-like lesions
Painful erosions & bullae
Symmetrical
Extensor surface + palms + soles
Recent cold sores or other viral infection sx

A

Erythema multiforme = all-mediated immune response to viral or other Ag

196
Q

Esophageal stricture vs esophageal adenocarcinoma vs achalasia

A

ES = symmetric concentric narrowing - Associated w/ GERD + issues w/ solids ONLY
EA = asymmetric irregular narrowing associated w/ Barrett esophagus - complication of GERD
Achalasia = issues w/ solids & liquids (mechanical) + dilated above LES = birds beak

197
Q

Epicondylitis management

A
  1. Brace
  2. Short-term NSAIDs > roids
  3. Surgery
198
Q

Common Rx that cause pancreatitis

A

AntiHTN
Statins
Fibrates
T2DM = metformin + GLP-1 + DPP-4

199
Q

chronic diarrhea +/- malabsorptive sx
Lymphocytes + eosinophils w/n lamina propria

A

Tropical Sprue

200
Q

Osteopenia vs osteoporosis vs osteomalacia

A

DEXA scan
Osteopenia = > -2.5
Osteoporosis = < -2.5
Osteomalacia = > -2.5 w/ radio lucena bands = history of fractures

201
Q

Renal Stones
Abx use post UTI

A

struvite (Mg++ ammonium phosphate) stone = ↑ urine ammonia production

Staghorn

202
Q

Acne:
Papules + pustules + nodules

A

Inflammatory
Topical: retinoids + tazarotene
Abx: Topical benzoyl peroxide > Topical clindamycin > Oral Doxycycline

203
Q

Comedone:
- white = closed
- black = opened

A

Topical:
- Retinoids
- Salicylic
- Azelaic
- Glycolic Acid

204
Q

Osteoporosis Screening

A

DEXA scan

postmenopausal women < 65 yo who are at increased risk of osteoporosis (previous fractures)

65+

205
Q

Pneumonia management

A

Outpt = Macrolide (-mycin) or Doxycycline

Inpt = Bactam (Ceftriaxone) + macrolide (Azithromycin) or Flurorquinolone (Levo or Moxifloxacin)

MRSA = Vancomycin or Linezolid

Pseudomonas = Piperacillin-Tazobactam + Cefepime + Meropenem

206
Q
  • osmotic diarrhea
  • crampy ab pain
  • bloating
  • flatulence
A

Lactose intolerance = lacks brush-border enzyme
Dx: Hydrogen levels 20+ ppm

|other test =
- High stool osmotic gap
- ↓ stool pH

207
Q

Colonoscopy Screening

  • hyperplastic polyps
  • hamartomatous polyps
  • submucosal polyps
A

does not warrant enhanced screening

208
Q

anal fissure management

A
  1. fiber, sitz baths, stool softeners, topical analgesics, and a topical vasodilator (nifedipine or nitroglycerin)
  2. botulinum toxin injections or surgical intervention (lateral sphincterotomy)
209
Q

tinea versicolor management

A

Fungus → hypopigmentation
usually seen when its hot outside

Tx:
Topical agents
- selenium sulfide
- sodium sulfacetamide
- ciclopiroxolamine
- azole
- allylamine antifungals

Oral antifungal tx may be considered in cases that are not responsive to topical therapy

210
Q

brown tumors w/ Plain film radiograph

A

osteopenia w/ multiple cysts (blood + fibrous tissue + osteoclasts) = Osteitis fibrosa cystica = hyperparathyroidism

Associcated w/ hypercalcemia

211
Q

PCKD vs Rhabdomyolysis

A
  • Blood on UA
  • Gross blood in urine
    PCKD= RBCs on microscopy + FH
    Rhabdo = no RBCs on microscopy
212
Q

Morton neuroma vs Tarsal tunnel syndrome

A

Morton neuroma = squeezing metatarsal joints (clicking + numbness + pain btw 3rd & 4th metatarsals)

Tarsal tunnel = compression ankle (tibial nerve) causes burning + numbness + aching distal plantar surface of the foot/toes

213
Q

A 13-year-old girl presented with a painless bump on her left medial knee that had been present for about two weeks. She did not report any trauma or injury, and the bump was not interfering with her daily activities. Her personal and family histories were unremarkable.

Physical examination revealed no ecchymosis or knee joint effusion. On palpation, there was a nontender bony prominence in the medial distal left femur. There was no palpable inguinal lymphadenopathy, and her knee range of motion was normal.

Plain radiography was performed

A

Osteochondroma

214
Q

Scars (especially burn scars) + chronic wounds are at ↑risk of developing squamous cell carcinoma

A

Marjolin ulcer =
- chronic inflammation
- continuous re-epithelization
- local damage to immune functions of the skin
- toxins from local cell damage

chronic inflammation and local toxin production = neoplastic changes and development of a malignancy

215
Q

Cutaneous injury
Enlarged lymph nodes

A

Lymphagitis = skin injury → pathogen invasion of lymphatics in deep dermis

Strep pyogenes + MSSA

Tx: cephalexin

215
Q

Candida species vs Dermatophytes

A

Candida = w/n skin folds - tx: Nystatin

Dermatophytes = pruritic rash + raised border + central clearing - tx: Terbinafine cream + miconazole & oral (fluconazole + griseofulvin)

216
Q

Fever + headache + malaise = non-specific viral prodrome
erythematous annular lesion - trunk
pruritic
Obliqely along the lines of tension = Christmas tree pattern

A

Pityriasis rosea

Self-limiting
pruitus sx = antihistamines + topical roids

217
Q

How does pregnancy affect doses of Levothyroxine?

A

Pregnancy → estrogen ↑serum thyroxine-binding globulin = ↓ TH

Need to increase Levothyroxine (T4)

Total T4 = ↑
Free T4 = normal
TSH = ↓

218
Q

Dysmenorrhea
Symmetrically (Globular) enlarged uterus
Heavy menstrual bleeding

A

Adenomyosis

219
Q

Pap test shows abundant clue cells
clear discharge
no pelvic pain

A

Asx = do not require tx

Sx:
1. Wet mount microscopy + KOH whiff testing
2. Metronidazole + Clindamycin

220
Q

deQuervain tindinopathy
tendons

tender radial styloid

A

Abductor pollicis longus
Extensor Pollicis brevis
which passes under extensor retinaculum

221
Q

itchy eyes
gritty sensation in eyes
crusting of eyelashes

A

Blepharitis

Contributors
- seborrheic dermatitis
- rosacea
- allergic disorder
- bacterial infection
- viral infection
- Demodex mite infection

222
Q

Hordeolum

A

stye
focal inflammation of eyelash follicle or tear gland

tender
erythematous nodule at lid margin

223
Q

Blepharitis vs Dry eye disease

A

Blepharitis = erythema + swelling + scaling of lid margins

Dry eye disease = Sjogren →inadequate or poor tear production

224
Q

Atypical endometrial hyperplasia

A

Unopposed estrogen exposure (Obesity → ↑androgens) + chronic anovulation (PCOS)

  • intermenstrual spotting
  • Obesity
  • atypical glandular cells on Pap
225
Q

Carpal Tunnel workup

A
  1. Phalen & Tinel
  2. Nerve conduction study = slowed conduction velocities in median nerve
  3. US (swelling) MRI (suspected mass)

XR = for history of trauma

226
Q

Dx Parkinson

A

Clinically = TRAP
- Tremor = resting
- Rigidity = ↑ w/ passive movement
- Akinesia/bradykinesia = difficulty initiating movement
- Postural instability =

227
Q

Carpal tunnel in pregnant pts management

A
  1. Wrist splinting
  2. GC injections
    3.surgery
228
Q

Epidermis cysts

A

< 1 cm
Freely mobile nodules w/ central punctum (opening where cyst derived) - black dot in center
Palmer surface of digits

229
Q

Rheumatoid nodules

A

Firm fibrotic masses over pressure points
Olecranon
Dorsal forearm

230
Q

Skins of child abuse (RED FLAGS) in the presence of scald injuries

A
  • Symmetric distribution of burn
  • Uniformity of burn depths + Demarcation of wound margins = stocking or glove burn
  • Absence of splash marks
  • Sparing of flexural creases
231
Q

Chest Pain work up

A
  1. ECG (cardiac) PPIs (GI)
  2. Stress test (cardiac) EDG (GI)
  3. Cath (cardiac) Esophageal manometry (GI)
232
Q
  • microaneurysms
  • blot & dot hemorrhages
  • hard exudates
  • macular edema
A

Diabetic retinopathy

233
Q

Sudden U/L visual impairment = waking in the morning

A

Central retinal vein occlusion

234
Q

↑ Proteins w/ normal albumin levels (meaning Globulins are ↑)
↑ AST<ALT

A

Autoimmune hepatitis

235
Q

Dx delirium at bedside w/

A

Confusion Assessment Method (CAM) > Mini-Mental State Examination (MMSE)

236
Q

DDx for altered mental status

A

Electrolyte disturbance
Pain
Respiratory infection
Urinary retention
UTI

237
Q

Restless legs management

A
  1. Iron replacement
  2. Massage + heat + exercise
  3. avoid anti-dopaminergic agents + antihistamines

Pramipexole + Ropinirole = Dopamine agonist
Gabapentin

238
Q

Smoking Cessation

A

Varenicline = partial agoist of a4b2 (nicotinic Ach receptor) - sleep issues
Nicotine replacement = patch/gum
Bupriopion = Increase NE & Dopamine - seizure

239
Q

sildenafil

A

enhances the effect of nitric oxide (NO) by inhibiting phosphodiesterase type 5 (PDE5)

MI
Erection dys

240
Q

Thyroid Hormone replacement during prego

A

Methimazole = is preferred execpt during the 1st trimester (PTU)

241
Q

Fundoscopic exam finding

Hard exudates

Soft exudates

Drusen

Roth Spots

A

Hard exudates = w/n retina - yellow/creamy (DM)

Soft exudates = Cotton wool patches (HTN)

Drusen = yellow round spots beneath the retina (Macular degeneration)

Roth Spots = retinal hemorrhages (bacterial endocarditis)

242
Q

↓ visual acuity = painless peripheral vision loss
↑ cup-disc ratio
+/- ↑ IOP
Light sensitivity

A

Open-angle glaucoma = decreased aqueous humous in Anterior chamber

243
Q

↑ difficulty reading at close distance

A

Decreased lens elasticity

244
Q

Uveitis

A

Acute eye pain
Eye reddness

Inflammatory = Sarcoidosis + IBD + Spondyloarthritis
Viral = HSV/VZV
Paraasitic = Toxoplasmosis

245
Q

polycythemia
flank tenderness
Wt ↓

A

Renal Cell Carcinoma

Smoking history

Ab CT scan

246
Q

U/L reproducible chest pain
- palpation
- Upper body movement
- Deep breathing
- exertional activities

Fever
Cough

A

Costochondritis

247
Q

Concentric = Left Ventricular Heart Failure
Preserved EF
Restrictive Cardiomyopathy
Associated w/ DM + HTN + Obesity + Aging

A

Diastolic Heart Failure

248
Q

indications for statin tx

A
  1. LDL 190+
  2. Hx of ASCVD (e.g. MI, CAD, stroke, PAD)
    ■ ASCVD = atherosclerotic cardiovascular disease
  3. 40+ y.o. + diabetes mellitus + LDL >70
  4. 40+ y.o. + ASCVD risk > 7.5%
249
Q

Vasomotor sx = hot flashes + night sweats
Vaginal atrophy
Amenorrhea

A

Primary ovarian insufficiency =
- autoimmune disorder
- Turner Syndrome

250
Q

acute, poorly localized shoulder pain followed by
- increasing stiffness
- w/ ↓ active and passive ROM

A

Adhesive capsulitis = contracture of the glenohumeral joint capsule

Tx:
- ROM exercises
- NSAIDs
- Corticosteroid injections

251
Q

Tarsal tunnel syndrome vs Plantar fasciitis

A

PF = pain w/ dorsiflexion

TTS = burning pain (nerve issue)

252
Q

Kernig sign

A

is the inability or reluctance to allow full extension of the knee when the hip is flexed to 90 degrees

253
Q

Cushing Syndrome

A
  • HTN
  • ↑wt
  • Proximal muscle weakness + atrophy
  • ↓kalemia
  • Metabolic alkalosis

obtain urinary free cortisol level

254
Q

How many weeks?

5 cm above the umbilicus

A

25 weeks
20 weeks + 1cm/week after

255
Q

UTI in pregos

A

Avoid Nitrofurantoin in 1st trimester
Fosfomycin

TMP-SX - 1st trimester
Nitrofurantoin
Fosfomycin

256
Q

trigger by minor trauma
bullae erosions ulcers

found on palms & soles
oral blisters w/ bottle feeding

A

Epidermolysis Bullosa = Mutation of proteins involved in intraepidermal & dermoepidermal adhesin complexes in basement membrane zone

mutation of keratin gene

biopsy of fresh blisters for immunofluorescence microscopy
Tx: wound care + supportive measures

257
Q

Trichlooroacetic acid

A

HPV infection = verrucous growths in the anogenital region

258
Q

Conjunctival injection
Tarsal (or palpebral) inflammation
pale follicles
follicular conjunctivitis (white-yellow follicles on inflamed, upper tarsal conjunctivae

A

Trachoma = infection that causes blindness

Chlamydia trachomatis ABC

Dx: tarsal conjunctiva
Tx: Azithromycin

259
Q

CNS disease = Parkinson
Erythematous pruitic plaques w/ greasy scles
scalp + Central Face + Ears + Chest

A

Seborrheic dermaitis = Malassezia colonization

Tx:
- Topical Anti-fung = selenium sulfide + ketoconazole
- Topical GC

260
Q

Kid M

Hip pain
Viral illness predrome
Limp
well-appearing
afebrile
normal xr

A

Transient synovitis

Tx: NSAIDs + rest

261
Q

PAI vs Cushing Syndrome testing

A

PAI =
1. Early-morning cortisol level/Plasma ACTH
2. Cosynthropin

Cushing =
1. serum cortisol/late night salivary
2. 24 hr urine cortisol
3. Low dose dexamethasone suppression

262
Q

diet recommendation for alcohol cirrhosis

A

Limit
- EtOH
- Sodium
- unhealthy fats

263
Q

Diabetic neuropathy
Small vs Large

A

Small = Positive sx
- Pain/Tempature
- Burning/stabbing pain

Large = Negative sx
- Pressure
- Proprioception
- Poor balance
- numbness

264
Q

Which HY Rx increase risk of osteoporosis

A
  1. GC
  2. Heparin
  3. Phenytoin
  4. Cyclosporine
265
Q

Tender at dorsal aspect of the DIP joint
no active extension at the DIP

A

Mallet Finger = Extensor tendon injury at the DIP

Tx: splint for 6 weeks

266
Q

Otitis Media Prevention

A

Pneumo vax
Influenza vax
Breastfeeding
Xylitol

267
Q

EtOH addiction tx

A
  1. Naltrexone = Opioid receptor blocker
    - C/I Severe hepatitis = mild liver disease
  2. Acamprosate = Glutamate transmission modulator
    - C/I CKD
268
Q

What are the alarm sx that prompts us to get EDG

A
  • dysphagia
  • microcyctic anemia = chronic bleeding
  • wt ↓
269
Q

Measles vs Rubella

A

Measles = 4 C’s (cough + corynza (runny nose) + K(C)oplik spots (white mucosa) + Conjuctivitis)

Rubella = arthralgia (joint stiffness)

270
Q

Neuroblastoma dx

A
  • ab mass
  • ecchymosis = raccoon eyes
  • back pain
  • Horner Syndrome sx

Paraneoplastic = opsoclonus-myoclous

Dx:
1. Urine/serum catecholamines (VMA/HVA)
2. US
3. Biposy = small basophilic cells in rosettes

271
Q

BRCA Genetic Mutation - Underlying Mechanism

A

Tumor suppressor proteins = DNA damage/repair in double strand breaks
AD - incomplete penetrance
1/2 = Breast & Ovarian cancer
2 = Male breast cancer + Prostate

272
Q

HIV features

A

new psoriasis
Viral Sx = fever + sore throat + lymphadenopathy + headache + myalgias
PAINFUL mucocutaneous ulcers
Diarrhea

273
Q
A

Family Medicine (1 decks)

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