UWORLD FM Flashcards
1
Q
Uterine Sarcoma RF
A
- RF: Post menopausal, Tamoxifen, radiation
2
Q
Compartment syndrome clinical features
A
POOP, Inc pain with stretch, paraesthesia, rapidly increasing swelling and tense
3
Q
IUD contraindications
A
- Progestin + Copper (unexplained vag bleeding, endometrial/cervical ca, preg/gestational trophoblastic Dx, distorted uterus, active PID)
- Progestin (liver Dz, br ca)
- Copper (wilson)
4
Q
Traveller’s Diarrhea Tx
A
- Adults: Quinolones
- Kids: Azithromycin
5
Q
Gold standard for assessing dehydration
A
weight loss
6
Q
Incontinence Treatment
A
- Stress (pee with inc abd pressure): pelvic Sx or exercises, pessary
- Urgency (bladder training, anti-muscaranics)
- Overflow (trouble emptying bladder and dribbling): cholinergic agonists, self cath
7
Q
Benign vs harsh murmurs
A
- Benign: Mid systolic/early, Grade 1-2, decrease with standing/valsalva
- Path: Diastolic/holosystolic, >Grade 3, persist with valsalva/standing
8
Q
Prolonged QT syndrome
A
- Etiology: Congenital, electrolytes (hypo-ca/mag/kalemia), Drugs (quinolones, macrolides, opioids like oxy, zofran, antipsychotics)
9
Q
Pneumonia in children- criteria for admission
A
Hypoxia <90, mod-severe distress, failed OP Tx, dehydration, complicated (effusion)
10
Q
Causes of vertigo
A
- BPPV
- Migraine (associated with h/a)
- vestibular neuritis (after URI, lasts days)
- Cerebellar stroke (persistent, >50 with RFs, non-suppresable nystagmus)
- Meniere’s
11
Q
Treatment of PAD
A
- First: Smoking, HTN, DM, ASA+Statin
- First: Exercise program
- Second: Cilastazole
- Third: Surgery (Angio with stent or bypass)
12
Q
Factors concerning for thyroid malignancy
A
- > 1cm
- Microcalcification, inc vascularity, hypoechoic, elevated/normal TSH
- Relatives, radiation, rapid growth, cervical LNpathy
13
Q
Prophylaxis for Lyme disease Criteria (must meet all)
A
- Attached tick adult
- Attached >36 hours
- PPx within 72 hours of tick bite
- No C/I to doxy
- Borrelia infection rate >20% (new england)
14
Q
Etiology for IE
A
- S. Aureus (IVDU, prosthetic valves, catheters, implantable devices)
- S. epi (same as staph Aureus but no IVDU)
- Candida (long Abx, immunosup)
- Enterococci (UTIs)
- Strept (Respiratory or dental)
- S. Gallalyticus (Colon Ca, IBD)
15
Q
Treatment for Lichen Sclerosis
A
High potency steroids.
16
Q
Treatment for severe opioid induced constipation.
A
methylnatrexone
17
Q
When should tamoxifen be stopped before surgery?
A
2-4 weeks as it can cause thrombosis.
18
Q
Post partum urinary retention
A
Pudendal nerve injury. Self resolves in a week.
19
Q
Pregnancy Rhinitis
A
- Nasal congestion and often epistasix
- Treat with saline sprays and exercise. Flonase only helps if they had underlying seasonal allergies
20
Q
Absolute C/I to OCPs
A
Migraine, >15 cigs + >35y, heart disease, clots, pregnancy, diabetes, liver disease, immobilization, Hx of stroke, APL syndrome
21
Q
Tourrett’s syndrome Tx
A
Behavioral is first line. Pharm is antipsychotics
22
Q
HOCM
A
- Presents with CP, dyspnea, syncope
- Sys ejection murmur
- EKG: depo (Q waves) and repol (T wave inversions) and Echo (LVH)
- Tx: BB/CCBs, avoid dehydration and vaso, ICD maybe, ablation/transplant
23
Q
Lactose intolerance test of diagnosis
A
Lactose hydrogen breath test
24
Q
Common causes of esophagitis in HIV pts
A
- Candida (pseudohyphae on Bx)
- HSV (Multinuclei on Bx)
- CMX (intracytoplasmic/nucleic inclusions)
25
Ankylosing spondylitis
- <40 years, low back pain, hip/butt pain IMPROVES with exercise. Uveitis. Limited lumbar spine and chest expansion. Sacroilitis on imaging
26
Congenital Toxoplasmosis
- Through undercooked meat, vegetables, cat feces
- Chorioretinitis, seizures, intellectual disability, hearing issues, hydrocephalus
- Tx Spiramycin
27
Lung abscess
- Fever, night sweats, weight loss, putrid sputum
- Ampicillin-sulbactam alt- clinda
- Cultures are not helpful
- Air-fluid level on imaging
28
SJS and TEN
- BSA: <10 (SJS), 10-30 (overlap) and >30 TEN
- 4-28D after exposure, erythema/vesicles/macules, necrolysis and epidermal sloughing
- Causes (Abx- sulfa, phenytoin, carbamezapine, allopurinol, NSAIDs)
29
Eating Disorder treatments
- Anorexia: CBT, NT and OLANZAPINE
- Bulimia: CBT, NT and SSRI (Fluoxetine)
- Binge-eating: SSRI, Lisdexamphetamine
30
Cutaneous Larva Migrans
- usually from caribean, south Asia
- Cutaneous serpengious rash on feet
- "Hook worm"
- Ivermectin> albendazole
31
Internal hemorrhoids
- <40 without red flags: Anoscopy, 40-49 without red flags: sigmoidoscopy, >50 with red flags: Colonoscopy
32
ECT Indications and risk
- For dep with psychosis, resistant depression, wont eat/drink, suicide risk
- Risk: recent MI/stroke, unstable aneurysm
33
Burns in children
- Intentional: will not splash marks, will be uniform with sharp borders, spares creasing
- 2nd/third degree burns- transfer out
34
Rhinitis medicamentosa
Recurrent rhinitis after using decongestant >5 days. usually treat with flonase.
35
Screening for Diabetes
- BG levels (more accurate that A1c): Fasting >126. Repeat on 2 different occasions. >200 PP
- A1c: >6.5
- OGTT: Most sensitive
36
Antiplatelet therapy after stent placement
- Should continue DAPT for at least 6-12 months in DES/metal stent. Ideally 30 months.
- If elective, postpone until minimum requirement met (6 months for DES and 1 mo for metal)
- usually continue ASA indefinatley
- Continue plavix unless high bleeding procedure (brain surgery)
37
Macular degeneration
Most common cause of vision loss in elderly. Can be wet (unilateral, exudative) or dry (atrophic). First sign is way/bendy lines)
38
lactose malabsorption
- Can handle some dairy. Should be given calcium and vitamin D supplementation
39
Statin side effects
Can increase risk for diabetes due to increase in BG levels. A rare side effect is rhabdo, more common in simvastatin.
40
post-partum sadness
- PP Blues <10 days: self-limiting
- PP dep: >2 weeks
41
Vaginal bleeding DDx
- Placenta Abruptio: Bleeding BEFORE delivery, uterine tenderness, painful contractions
- Uterine rupture: Painful bleeding, uterine tenderness, NO contractions
- Placenta accreta: Hard to remove placenta AFTER delivery
42
Recognizing adrenal insufficiency
- Hyperkalemia, hyponatremia, eosinophilia, azotemia,
43
T.bili for phototherapy in newborns
>9 at 12 hours or 10-12 at 24 hours
44
FHR etiologies
- Fetal tachy: Infection (prolonged labor), terbutaline, hypothyroidism
- Decels: placenta abruptio, umbilical cord prolapse, uterine rupture
- Brady: Mag sulfate
45
Evaluation of adrenal incidentaloma
- Always do hormonal work up (Cushing- DST, Pheochroma- catecholamines, Primary hyperaldo- renin-aldo ratio)
- >4 cm or suggestive of Ca: FNA, if not, conservative follow up
- If hormones are elevated: Adrenalectomy
46
Side effects of Carbidopa/Levodopa
Hallucinations, headaches, agitation and dyskinesis/dystonia 5-10 years after treatment.
47
Sickle cell prophylaxis
Antibiotics from 2 months to 5 years.
Needs pneumococcal, meningococcal and flu vaccines
48
Infertility tests
- Male: Semen analysis
- Ovarian reserve: Clomifene challenge or day 3 measurement of FSH and estradiol
- Ovulatory function: 21 day progesterone challenge
- Uterine evaluation: sonohysterogram
- Fallopian evaluation: Hysterosalphingogram
49
PNA management in kids
- Pre-school (S.Pneumo): Amox
- Older kids (Mycoplasma): Azithro
50
Neurocystericosis
T.Solium. Calcified nodules in brain. Can cause headache and new-onset seizures. Albendazole +/- Steroids.
Toxo causes ring enhancing lesions
51
Wound management
- Close with primary closure (suture, adhesive tape or staples) within up to 18 hours and up to 24 for face. If late, immunocomp, crush injuries or bites- secondary closure
51
Systemic Sclerosis
2 types: limited cutaneous (hands, feet, neck, face) and diffuse (abdomen, chest)
Limited: better prognosis. CREST syndrome. More prone for pulm HTN as opposed to renal failure/heart which is more common in diffuse.
51
Asthma exacerbation in kids management
- Mild: neb albuterol (3 doses in an hour) and PO steroids
- Mod: neb albuterol + ipratropium and PO/IV steroids
- Severe: above + mag and IV steroids
51
ADHD
Symptoms
Rule of 6. More than 6 symptoms of inattention and/or hyperness for >6 months. Presents mostly before 12. Present in 2 settings. Functional impairment.
52
Vulvar masses
Bartholin cysts are usually benign but if appear nodular or irregular in an especially post menopausal woman, it needs biopsied.
53
Intussception
- RF: viral illness, rotavirus, HSP, celiac
- Presents with episodic crampy abdominal pain, current jelly stools
- Crescent sign on Xray and target sign on USG
- Tx: Enema vs sx
54
Anti-depressant with-drawl syndrome
usually due to abrupt stoppage of drug causing irritability, fatigue, anxiousness, GI upset and flu symptoms. Re-start old and taper before starting new.
55
Indications for TRUS prostate Bx
- Do it before MRI which can be used for staging
- Indications: Nodule, irregularity, asymmetry on DRE, PSA 1st check >7 and >2 in 2nd check.
56
Tocolytics options and C/I
- <32wks: Indomethacin, <34: Nifidepine/Terbutaline
- ONLY to delay pre-term delivery
- C/I: Fetal death, fetal anomaly, pre-eclampsia, HD instability, pelvic infection
57
Whitlow finger
- Caused by HSV
- Tx: supportive in immunocompetent and acyclovir for immunosuppressed.
58
Infectious tenosynovitis
- Kanavel signs: Sausage finger, pain with extension, tenderness along the tendon sheath
- Incision and drainage with Abx.
59
Acute Paronychia
Swelling, erythema, tenderness in medial part of finger. Localized bacterial infection. Treat with warm soaks and topical Abx.
60
Chronic SDH
Presents with fluctuating/insidious symptoms like confusion, irritability. Present after a fall. Older people. Neuroimaging necessary. Tx: Watch if <10mm and surgery (>10mm, herniation, midline shift)
60
Metabolic Alkalosis
(What happens to Cl)
- If urine Cl is low: Body trying to save Cl in hypovolemic states (Dehydration)
- IF urine Cl is high: It represents renal wasting. I.e. Barter and Gitleman syndrome (hypovolemic) and Cushing, hyperaldo (hypervol)
60
Meningitis in USA
- Most commonly caused by S.Pneumo, N.men, H.influenza, Listeria
- Only add dexa to Abx if S.pneumo
60
Traumatic Hyphema
- Usually eye injury with blunt trauma.
- Presents with photophobia, eye pain, blood in ant chamber, unequal pupils
- Tx: Bed rest or limit activity, eye shield, monitor IOP, steroid/cyclopegic eyes drops
- Complications: Permanent vision loss, glauma, rebleeding
61
RSV prevention
Nervisemab for all infants <8 months.
62
Disseminated gonococcal infection
- Triad of tenosynovitis, migratory polyathralgia and pustular skin lesions. Treat chlamydia too.
63
Blunt chest trauma
1. Bones (Clavicle, sternum, ribs, scapula)
2. Flail chest >3 adjacent ribs, each fractures in 2 places
3. Internal injury
- Aortic: Widened mediastinum
- Pulm contusion: opacity on pulm parenchyma
- Pneumothorax
64
Parvovirus in pregnant women
- Can cause fetal demise <20 weeks and >20 week need to be monitored with USG for hydrops fetalis
65
Pediatric sepsis
- <28D (GBS, E.coli, Listeria). Treat with Ampi+Genta
- >28D (S.Pneumo, N.men). Treat with Vanc + Rocephin
66
RA risks
- Cardiovascular mortality has been shown to be increased.
- DRUGS SIDE EFFECTS
1. Methotrexate (hepatotoxicity, stomatitis, cytopenias)
2. Leflumide (Hepato, cytopenia)
3. Hydroxychloroquine (retinopathy)
4. TNF inhibitors (infxn, ca, CHF)
5. Sulfasalzine (Hepato, hemolytic anemia stomatitis)
67
Coxsackie Myocarditis
Most common. It is post URI. Can lead to dilated cardiomyopathy and lead to heart failure.
68
MMR vaccine
- Infants at 12 months and then 4 years
- If they are travelling internationally, then can receive before 12 months but will have poor immune response so 2 dose needs to be administered.
69
Conduct and Anti-social disorder
Conduct is <18 years and anti-social >18 years
70
Polycythemia Vera
Myleproliferative disorder which causes erythropoietin derived increased erythrocytes. Presents with transient vision loss, burning face, hepato-splenomegaly. Low erythropoeitin. <60 years can be treated with ASA and phlebotomy. >60y need hydroxyurea.
71
Strept throat treatment
Penicillin.
If mild allergy, cephalosporin
If anaphylaxis, azithromycin or clindamycin
72
Polymorphic eruptions of pregnancy
Urticarial rashes on abdomen and spare the peri-umbilical region. Steroid is treatment.
73
Classic congenital adrenal hyperplasia
- 21-hydroxylase deficiency- Elevated 17-Hydroxyprogesterone
- Causes hyperkalemia, hyponatremia and hypoglycemia
- Treat with mineralocorticoid and glucocorticoid
74
Pemphigus Vulgaris
- Erythematous bullae that begin in mouth and then to the body
- +ve Nikolsy sign (burst on contact)
- Dx: Desmoglein Ab and skin bx
- Tx: Systemic steroids
75
ADHD medication titration
Increased weekly as long as not getting side effects
76
Sudden onset heavy proteinuria and hypoalbuminemia in adults
- MCD: Nothing on UA. After URI. Need renal Bx. Treat with steroids
- Focal segmental glomerulonephrosis: Crescent formation
77
ABI interpretation
<0.9: Diagnosis of PAD
>1.3: Calcified can falsely elevate ABI
78
Most accurate way to determine exact due date
USG in 1 month, calculate crown rump length
79
Smoking cessation
1. Varenicline- BEST. Can cause abnormal dreams
2. Nicotine gum and patch- Reduces craving and safe
3. Bupropion- Reduces weight gain post cessation.
80
TSH ranges in pregnancy for Hypothyroidism
1st trimester: 0.1-2.5, 2nd: 0.2-3 and 3rd: 0.3-3.
Increase dose by 30% and repeat labs every 4 weeks.
81
Vision changes in diabetic patients
1. Nuclear Cataracts: Loss of distant vision BEFORE hazy lens formation
2. Diabetic Retinopathy: Slow blurry vision, spots and flashy lights
82
Varicella Zoster in exposed newborns
IF mother has symptoms 5 days before or 2 days after delivery and newborn is asymptomatic, then isolate. give immunoglobulin and monitor for 21 days
If newborn has symptoms then treat with Acyclovir.
83
Ascites
- SAAG: Serum albumin - Fluid albumin
- >1.1 indicated portal HTN (Cirrhosis, heart failure)
- <1.1: TB, Ca, nephrotic
84
Capnography
Earliest sign of ROSC is sudden rise in ECO2
85
Reactive Arthritis causes and treatment
- Shigella, Salmonella, Yersinia, Chlamydia
- NSAIDs first line. 2nd line: DMARDs, Steroids. Abx just in chlamydia
86
Preventative care for SCD patients.
Transcranial doppler (2-16 years): If there is high flow, they would need chronic erythrocyte transfusion.
87
Acute Otitis Externa Tx
- Mild: Acidifying solution like acetic acid
- Moderate: Topical antibiotics and wick if canal occluded
- Severe: Broad spectrum Abx (Cipro) and +/= debridement
88
When to reduce testosterone dosage
When Hgb is >16 or Hct >54%
89
Bloody diarrhea causing organisms
Shigella, E.coli and campylobacter
90
Elderly cognition
- Normal Aging: Losing fluid intelligence (learning new concepts)
- Mild Cog impairment: Sometimes memory affected and still able to function independently
- Dementia: Cannot function independently.
91
Improper positioning of ET tube.
1. If in lungs: Capnography will be normal. Will hear unequal lung sounds. retract ET tube
2. If in esophagus: abnormal capnography. Take it out and re-insert.
92
What defines Pre-term labor?
Before term gestation with frequent contracts and ONE of the following (Cervical dilation >3 cm or Length shorter than 20 mm)
93
DMD
- Usually presents with motor weakness, scoliosis, gowers sign, calf pseudohypertrophy
- Measure CPK and gene study
- Complications include restrictive lung disease and dilated cardiomyopathy (need serial ECGs, Echos and PFTs)
- Treat with steroids
94
Bluish tinge vision is seen in which condition?
PDE-5 inhibitor use
95
When do you see dot blot hemorrhages and microaneurysms?
Diabetic retinopathy
96
Generalized pustular psoriasis
Generalised spread of sterile pustules. Usually in pregnant patients or when withdrawn from steroids. Treat with high potency retinoids or immunosuppressive therapy
97
RA associated cervical myelopathy
- Symptoms (neck pain, spastic paresis, resp depression, hand and feet sensory deficits)
- Signs (Protruding atlas, scoliosis, spastic paresis, babinski, hoffman sign)
98
Juvenile myoclonic epilepsy
- Symptoms (Myoclonic, gen tonic-clonic seizures, absence)
- EEG: Bilateral polyspike and slow wave
- Tx: Valproic acid
99
Side effect of Lasix
OTOTOXICITY
100
AAA mangement
- ASA and statin, stop smoking
- Need surgery if large >5.5cm or increasing in size rapidly (>0.5 in 6 months) or associated with PAD/aneurysm
101
Patellar dislocation
Lateral displacement of patella. In flexion. Urgent closed reduction and brace after care.
102
FHR
Late Decels: FGR and placental insufficiency
Variable Decels: Umbilical cord compression
Early Decels: Head compressions
103
Charcot's Arthropathy
Repeat joint trauma. With DM
Acute: Erythema, pain, swelling. Xrays usually negative. Treat with cast and non-weight bearing
Chronic: Stress fractures, ulcers, cellulitis. Treat with Abx, orthotic foot wear and surgery for alignment
104
Recurrent Aphthous ulcers
- Present as small vesicles. First line treatment is topic steroids. Conditions that cause it are HIV, behcets.
105
Difference between JIA and Transient synovitis
JIA is in toddler girls with large joints except hip involved. Inflammatory markers elevated.
TS Boys, normal inflammatory markers. More in boys.
106
GBS Prophylaxis indications
- Infection during pregnancy despite treatment
- Previous infant with GBS infection
- Unknown GBS AND one of the following (<37 weeks, intra partum fever, ROM >18 hours )
107
Precautions
AIRBONE: TB, Virus (measles, varicella)
DROPLET: Nisseria, Mycoplasma, H.influenza, Influenza
CONTACT: RSV, E.coli, VRE, MRSA, C. Diff, scabies
108
Syphilis testing
Non-trepenomal (VDRL, RPR) tell us past or active infection. Detect earlier
Trepenomal (FTA-ABS): May remain positive even after treatment. Cant differentiate.
109
Migraine treatment
Abortive: NSAIDs, ergotamine, triptans, anti-emetics
PPx: BB, Topamax, TCA (Amytriptiline), Venlafaxine, Menstrual (Frovatriptan), Kids (Riboflavin, cyproheptadine)
110
Most common thrombophilia
Factor 5 Leiden Mutation (Protein C resistance)
111
Prolonged Labor
>20 hours in nulliparous and >14 hours in multi
112
GDM diagnosis and treatment
If 2/4 values are elevated (95, 180-155-140)
-Tx: 1st lifestyle modification and then metformin or inuslin
113
Difference between inflammatory and non-inflammatory diarrhea
Non-inflammatory usually watery large volume and inflammatory is small volume and may not contain mucus/blood.
114
Exercise induced urticaria
usually triggered by exercise. Skin is flushed and with rashes. Can progress to anaphylaxis. Treat with H2 blockers like loratidine.
115
Common peroneal neuropathy
usually supplies dorsal foot and shin
Superficial helps with foot eversion
Deep helps foot dorsiflexion and toe extension
116
Aortic Stenosis
Mild: gradient <20. Echo 3-5 years
Mod: gradient 21-39. Echo 1-2 years
Severe: gradient >40. Asx (6 months) and sx (AVR)
117
Lights Criteria
- It is for Exudative
- Pleural protein/Serum protein >0.5, Pleural LDH/Serum LDH >0.6 or LDH 2/3 upper limit
- Exudative (Infection, Ca, pancreatitis, PE) and transudative ( Nephrotic, cirrhosis, heart failure)
118
When do Abx needed in addition to I&D for abscess
- >2cm, surrounding cellulitis, systemic symptoms, multiple abscesses, neutropenia, extreme of ages.
119
Non-hogkins lymphoma complications
usually radiated. Increases risk of other malignancy especially breast cancer. So annual mammos 8 years later and no later than 40.
120
Strabismus treatment
Cover unaffected eye, put corrective lens on affect eye.
121
BB toxicity
Hypotension, hypoglycemia, bradycardia
122
Treatment of Gout
PPx is with allopurinol (Start with 100 and then titrate slowly and in patients with renal disease)
123
Evaluate hirsutism
Serum testosterone
124
Centor criteria
- Fever, tender cervical LNpathy, tonsillar exudates and absence of fever
- If 2 or more: get the test
125
Factors associated with increased mortality in patients with MVP
Degree of MR and EF <50%
126
Eclampsia management
If <37 weeks then there is benefit to delay delivery. If at 37 or more, then deliver. Anti-hypertensives and Mag is given for stroke prevention when BP is over160/110
127
Treatment of osteo in patients with severe GI symptoms
IV zalendronic acid infusion yearly.
128
PPROM Management
- If <34 weeks and uncomplicated then steroids and Abx with expectant management and if complicated then steroids, Abx, mag <32 wks plus deliver
- 34-<37: GBS Ppx and deliver
129
Evaluation of head trauma
- GCS <14, AMS: HCT w/o con
- GCS 15, abnormal behavior, hematoma, severe injury (>3 feet): Observe +/- HCT
- GCS 15, No issues: Send home
130
Recurrent HSV management in couples
Abstinence during outbreaks even with condoms. Daily suppressive therapy with Valacyclovir due to Asx viral shedding
131
What are causes of hypercalcemia
- PTH related: Primary hyperparathyroidism (Urine Ca>250), tertiary in renal failure, FHH
- PrPTH: Malignancy, hyperthyroidism, adrenal insufficiency, sarcoidosis, immobilization, Vitamin D excess, medications
132
Indications for hospitalization in Anorexia
- Bradycardia, hypotension, hypothermia, BMI <15, Organ damage, electrolyte abnormalities
133
Treatment of ITP
- Kids: If cutaneous, just observe. Otherwise steroids, IVIG
- Adults: If cutaneous and >30K, observe. Then steroids and IVIG.
134
Skin cancers
Basal cell Ca: More common, face, nodular lesion with rolled margin
Squamous cell: Less common, usually arises from a precursor lesion
135
Juvenile Dermatomyositis
Gottron's papules, calcinosis, heliotropic rash, proximal muscle weakness. Elevated CK. Tx: Steroids +/- MTX
136
Diagnosis of gastroparesis
Upper endoscopy to rule out obstruction and gastric emptying study.
137
Amiodarone induced hypothyroidism
Continue Amio and start levothyroxine
138
ITP co testing
Hep C and HIV. >60y then bone marrow aspiration to rule out myodysplastic syndrome
139
Type 1 diabetes honeymoon phase
After initiating insulin, BG levels normalize and body starts to produce insulin. Requirement decreases for a brief period and starts to rise again.
140
Transtumumab side effect
Cardiotoxicity. Echo before starting.
141
Colonoscopy screening in UC
8-10 years after diagnosis and 1-3 years after that
142
Emergency contraceptives in order of efficacy
Copper IUD, Prog IUD, Urlipristat (not in obese women), Progestin pills, OCPs
143
How to treat craddle cap?
Brush hair after applying emollient
144
Fragile X syndrome features
Long face, small chin, protruding ears, enlarged testicles
145
Warning signs for IBS
Nocturnal diarrhea, bleeding, anemia, weight loss
146
Impetigo treatment
Non-bullous: Localized can be treated with topical mucoporin and spreaded treat with Keflex.
Bullous keflex
147
MYOPATHIES
1. Steroid induced: LE weakness, normal CK/ESR
2. PMR: Pain in proximal muscles. High ESR. Asso with GCA
3. Polymyositis/Dermatositis: Weakness and elevated CK/ESR
4. Statin induced: Pain, elevated CK
5. Hypothyroid: weakness and pain. Elevated CK
148
Pressure ulcer stages and management
1: Intact skin with local redness
2: Shallow ulcer
3: Full skin gone with subq fat visible
4: Tendon and bone visible
5. Full thickness, base is visible and may have eschar
- Debridement only needed when there is infection as it can cause osteomyelitis
149
C.dig toxic megacolon treatment
PO Vanc and IV Flagyl and urgent surgical intervention
150
Common cause of acute scrotal pain
Epidydimis, scrotal abscess, testicular torsion or infarction
151
Subclinical hyperthyroidism
Can get overt. Should be screened for heart failure, A.fib, osteoporosis. Treatment should be given if TSH <0.1 or >65 years
152
Diagnosing COPD
Symptomatic need spirometry. Asymptomatic COPD patients dont.
153
Roseola Infantum
Caused by HH-6. Maculopapular rash appears after resolution of high grade fever. Treat with supportive cares.
154
Etiologies of tinnitus
Can be pulsatile (vascular) and non-pulsatile (usually has SNHL). Non-pulsatile needs audiometry.
U/L: Cerumen impaction, vestibular schwannoma
B/L: Presbycusis, otosclerosis, ototoxicity, vascular, Meniere's, hypertension
155
Pancoast tumor features
- Shoulder pain (most common symptom)
- Horner syndrome
- Neuro (Weak hand muscles, 4/5th finger paresthesia)
- Supraclavicular LNpathy
- Weight loss
156
Most likely cause of mortality in pregnant patients with Marfan syndrome
Most common is aortic disease which presents as dilation that can result in dilation and dissection.
157
What helps with prognosis of MM
B-microglobulin and serum albumin
158
Amiodarone side effects
- Thyroid, pulmonary, bradycardia/QT prolongation, hepatitis, blue-grey skin discoloration, optic neuritis
159
SIADH diagnosis
- Patient should be euvolemic and not had diuretics in the last 24-48 hours
- Serum osmolality low and urine osmolality is high
160
Varicocele
"bag of worms" which improves lying down and prominent when standing. USG shows dilated pampiniform plexus and retrograde venous flow. Treatment gonadal vein ligation in kids and supportive in old men.
161
Cancer pain
- Mild is with non-opioid
- Moderate: Short acting opioid (Oxy, morphine)
- Severe: Long acting (Morphine ER, Fentanyl patch)
162
Bug bites
- Bug bites: Linear pruritic pattern
- Spider: papule>pustule>wheal
163
Treatment of inflammatory acne
- There is papules and pustules <5 mm with redness
1st: Benzoyl peroxide and topical retinoid
2nd: Add topical Abx (clinda, erythromycin)
3rd: Add Oral Abx
- Nodular cystic acne: Nodules that appear cystic > 5mm and scarring. treat with benzoyl peroxide + topical retinoid + topical Abx, if severe add oral Abx and if unresponsive then oral isotret
164
Non-inflammatory acne
Comedonal acne. may progress to inflammatory. treat with topical salicylic or azelaic acid.
165
Small intestinal overgrowth syndrome
- Related to motility disorders (DM, scleroderma), structural (surgery, stricture), chronic pancreatitis, PPI use, Ig A deficiency
- Presents as bloating, flactulence, abdominal pain, fatty diarrhea
- Treat with Amox or rifaximin
166
AK
Presents as scaly erythematous macules or papules in sun exposed areas. Can progress to SCC. Treat with cryo or 5FU/imiquod.
167
TIA
Use ABCD (Age>60, high BP, clinical presentation, duration>60 min and DM). if >3 points, then admission to hospital. Should present within 72 hours.
168
PPH treatment
initially start Pitocin and bimanual massage.
Can use Methygorvine (C/I in HTN) or Carbaprost (C/I in asthmatics)
Tranexamic can be used if all fails
169
Atypical Endometrial hyperplasia management
- If women want fertility- treat with progestin and repeat biopsy in 3 months
- If not, then hysterectomy
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DRESS syndrome
- Presents 2-8 weeks after drug exposure (Sulfa, Anti-convulsants)
- Presents as fever, generalised LNpathy, facial edema, erythmatous rash, organ involvement (kidney, liver, pulm) and eosinophilia.
171
Pityriasis Rosea
pruritic plaques around trunk, neck and upper extremities. Supportive therapy but can give topical steroid and anti-histamines for itching or phototherapy if really bad.
172
Cholesterol embolism
- Would have co-morbid conditions and after a cath
- S/S: Skin (livedo reticularis, blue toe syndrome), Acute/subacute kidney injury, GI symptoms. Can cause stroke
- Diagnosis: Clinic or biopsy (Perivascular inflammation with eosinophils)
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Pediatric hypertension
Elevated in 3 separate visits. Initial work up is BMP, UA, CBC, echo. if suspecting secondary, then plasma renin and aldosterone, renal ultrasound, plasma/urine catecholamines
174
Hyperaldosteronism
- Primary: Increased aldo but low renin. Adrenals are the problem. Thiazides can exacerbate it
- Secondary: Increased aldo and renin. Caused by diuretics, renovascular, malignant
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Nipple trauma
Cracked nipples are common during breast feeding. observe
176
Chronic Paronychia
>6 weeks. Treat with topical steroids. If acute, then keflex.
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Starting children on stimulant medications for ADHD
Obtain family cardiac history, if complex refer to ped cardiologist.
178
Uterine Endometritis
Fever >24 hours. Uterine fundal tenderness. Purulent lochia. Treat with clinda and genta.
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Post MI pericarditis treatment
Only with HD ASA. Avoid NSAIDs and steroids.
180
Tinea Capitis
Erythematous, scaly patch. May even develop kerion. Treatment oral Griseofulvin (kids preferred) or terbinafine. SS shampoo only asymptomatic
181
Pink eye
Viral conjunctivitis. No treatment is necessary just supportive. Bacterial will have unremitting discharge and more pain
182
Long term effects of Weed
Infertility, low testosterone, psychosis, cyclic vomiting syndrome, lung/bladder cancer, Amotivational syndrome
183
Dermatosytosis
Have 5 fold increased risk of malignancy and should undergo age appropriate screening. Treated with high dose steroids
184
Erythema Multiforme
Non-painful target lesions that appear with infections like HSV. Doesn't have central clearing
185
Myasthenia Gravis
Ocular and bulbar weakness as the day progresses. CPK is normal. CT chest to rule out thymoma.
186
Abnormal AST/ALT evaluation
Think of alcohol, fatty liver, hepatitis, drugs, hemochromatosis. Then consider,
Hepatic: AI, a-1 trypsin def, wilsons
Non-hepatic: Muscle, thyroid, celiac, adrenal insufficiency
187
Pathological vs pubertal gynecomastia in males
Physiological is usually around tanner stage 3-4 around 14 and pathological usually tanner stage 5
188
Alopecia Areata
Patches of hairloss. Can be associated with autoimmune conditions like thyroiditis. Treat with intralesional steroids.
189
Which factor does not CV factor does not change in healthy older adults?
Resting LVEF. Resting HR decreases.
190
OA treatment
Weight loss and exercise
NSAID AS NEEDED and topical NSAID
Consider duloxetine, topical capsacin
Surgery
191
Difference between Ecthyma gangrenosum and pyoderma
Ecthyma is pseudomonas
PG is the AI condition.
192
Mullerian Agenesis
External genetalia and ovaries are unaffected. karyotype is normal. Uterus is missing and there is a bling vaginal pouch. Renal USG should be performed.
193
Car seats
Usually rear-facing till 2-4 (have to grow out of it. Kids <13 sit in the back seat
194
Antihypertensives that blood glucose levels
Thiazides but they reduce CV outcomes
BB too but not the cardio-selective
195
Glucose challenge test in high risk patients
Done in first trimester
196
Ectopic pregnancy management
HCG <5000: MTX
>5000: Surgery
197
Acute closure glaucoma
Open angle Glaucoma
Acute: Presents with sudden eye pain, redness, mid-dilated pupil, decreased vision (Halos)
Open: Gradual peripheral vision loss with inc IOP
198
Chalazion
Basically a painless stye
199
Episcleritis
Sudden onset of irritation, redness and watering but NO vision issues or pain
200
Keratitis
Fluroscein stain will be positive. Fb sensation. Pain, eyelid swelling, redness
201
Anterior Iritis (Uveitis)
May have hypopyon. In younger patients. usually presents as UL painful and red eye.
Redness around eye
202
Retinal Detachment
RF: >50, Fam Hx, cataract Sx, Myopia
Presents with sudden, progressive vision loss with floaters and flashing lights
203
Amaurasis Fugax
Sudden "curtain" over eyes. Usually associated with CAD
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