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UWorld Family Medicine > Week 2-3 > Flashcards

Week 2-3 Flashcards

1
Q

what are the three scenarios where foot and ankle x ray is required?

A

pain at malleolus, pain at midfoot, inability to bear weight for 4 steps

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2
Q

name four findings of diabetic retinopathy on eye exam

A

cotton wool spots, retinal edema, microaneurysms, hemorrhages, and new vessels

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3
Q

what is a1c goal with t2dm?

A

7.0

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4
Q

what three labs/exams should be done yearly for patients with diabetes?

A

retinopathy exam, neuropathy exam, and albumin/creatinine ratio

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5
Q

what can be used if patient with diabetes has elevated (>30) albumin?

A

ACE inhibitors

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6
Q

who gets spinal cord compression? where?

A

cervical…usually elderly who have cervical spondylosis (spinal narrowing)

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7
Q

what are the upper extremity symptoms of spinal cord compression?

A

neck pain and lower motor neuron signs in the upper extremities

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8
Q

what are the lower extremity symptoms of spinal cord compression?

A

gait unste`adiness, and upper motor neuron signs

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9
Q

what is dupuytren contracture?

A

fibrosis of the palmar fascia near the distal palmar crease

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10
Q

what is rx for IBS that can be started?

A

fiber

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11
Q

if patient has myopathy from a statin, what can you do to help with lipids?

A

try another statin or use moderate dosing

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12
Q

if a rash that sounds like varicella goes away and patient has pain for long time after rash, what is likely cause?

A

postherpetic neurlgia…herpes zoster

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13
Q

what is rx of postherpetic neuralgia?

A

tricyclic antidepressants or gabapentin

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14
Q

what is first line rx of nummular eczema?

A

topical corticosteroids

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15
Q

what is rx for chronic prostatitis? how long

A

fluoroquinolones for 6 weeks

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16
Q

what are some sx of chronic prostatitis?

A

recurrent UTI, with UTI sx and pain with ejaculation

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17
Q

what movement is decreased in SCFE?

A

internal rotation

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18
Q

when do you screen for abdominal aortic aneurysms?

A

ages 65-75

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19
Q

who gets screened for AAA?

A

male smokers ages 65-75

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20
Q

what is the screening for AAA?

A

one time ultrasound

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21
Q

when do cluster headaches occur?

A

at night

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22
Q

what is associated with cluster headaches

A

horner syndrome

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23
Q

two rx for cluster headaches?

A

100% o2 and sumitriptan

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24
Q

aside from a mass, what are presenting sx of testicular cancer?

A

back pain and dyspnea 2/2 metastasis

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25
Q

what is a common complication of femoral herniaS?

A

incarceration and SBO

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26
Q

what type of arthritis do you get from lyme disease?

A

monoarthritis

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27
Q

what are the two types of arthritis you can get with disseminated gonoccocal infection?

A

purulent monoarthritis
and
migrating arthralgia with tenosynovitis and rash

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28
Q

what will joint culture and aspirate show with disseminated gonoccocal infection/

A

no growth and less than 50K white cells

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29
Q

what four labs should be ordered for patient suggesting alzheimer disease to rule out other causes?

A

CBC, B12, CMP and TSH

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30
Q

what is test used to screen for diabetic nephropathy?

A

urine albumin to creatinine

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31
Q

what is first line topical rx for psoriasis?

A

high dose roids

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32
Q

what is firts line systemic rx for psoriasis?

A

methotrexate

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33
Q

what are some co-occurring sx with psoriasis?

A

uveitis, conjunctivitis, nail pitting, arthritis

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34
Q

3 rx options for pityriasis versicolor?

A

ketoconazole, selenium sulfide or terbinafine

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35
Q

what vaccines should patients with HIV get?

A

all of them they need/dont show immunity to

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36
Q

patient with hypothyroidism is thinking about pregnancy, what should you do?

A

give extra levothyroxine

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37
Q

what is another name for greater trochanteric pain syndrome?

A

trochanteric bursitis

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38
Q

what are sx of trochanteric bursitis ?

A

chronic lateral hip pain that is worse when laying on side and with flexion

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39
Q

3 rx options for trochanteric bursitis ?

A

NSAIDs
corticosterois injxn
PT

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40
Q

what is found on exam with trochanteric bursitis ?

A

focal tenderness over greater trochanter during flexion

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41
Q

what skin cancer often causes neurologic sx like numbness and paraesthesisa?

A

squamous cell carcinoma

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42
Q

how do squamous cell carcinomas of skin appear?

A

often are elevated bump with crusting/bleeding

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43
Q

how does basal cell carcinoma appear?

A

pearly pink/fleshy colored papule with telangiectasia

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44
Q

what age gets low dose CT to screen for lung cancer?

A

50-80

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45
Q

who gets low does CT to screen for lung cancer?

A

current smokers or 20 pack year former smokers

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46
Q

what are the four criteria to consider testing for strep?

A

fever
tonsillar exudates
tender anterior cervical lymph
absence of cough

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47
Q

3 rx options for moderate acne

A

topical retinoids, abx or benzoyl peroxide

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48
Q

rx option for severe acne?

A

oral abx

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49
Q

rx option for treatment resistant acne>

A

oral isoretinoin

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50
Q

if pain in heel is worse when pressing laterally and medially on the heel, what should you think about?

A

calcaneal stress fracture

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51
Q

what is rx for acute prostatitis?

A

6wks of fluoroquinolone or bactrim

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52
Q

does smoking contribute to HTN?

A

nah not really

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53
Q

what is best way to help HTN without meds?

A

DASH diet

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54
Q

all patients older than 40 with T2DM should be on what?

A

a statin

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55
Q

what are sx of hep a infxn?

A

fever, malaise, RUQ pain, hepatomegaly

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56
Q

what is rx of hep a?

A

nothing supportive care

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57
Q

what CD4 count means you cannot get live vaccines with HIV?

A

less than 200

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58
Q

what is another name for sciatica?

A

lumbosacral radiculopathy

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59
Q

what is most common cause of sciatica?

A

disc herniation

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60
Q

what is sign on exam for sciatica?

A

pain with straight leg raise

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61
Q

where do patients hurt with sciatica?

A

low back radiating down to lower leg

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62
Q

what imaging do you need to diagnose sciatica?

A

none

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63
Q

what is rx of sciatica?

A

NSAIDs and activity management

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64
Q

what are signs of osteonecrosis of the jaw?

A

chronic mild pain and swelling with exposed bone

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65
Q

what is risk for osteonecrosis of the jaw?

A

bisphosphonate therapy

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66
Q

what is the appearance of skin squamous cell carcinoma?

A

scaly plaques/patches

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67
Q

5 nonmodifiable risk factors for OA

A

advanced age, female, prior trauma, family history and abnormal joint alignment

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68
Q

what chronic medical condition can contribute to OA?

A

diabetes

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69
Q

what is rx and prognosis of osteoid osteoma?

A

NSAIDs and resolution on its own

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70
Q

pain with defecation and chronic anal discharge are signs of what

A

anorectal fistula

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71
Q

what is MC cause of anorectal fistula?

A

ruptured perianal abscess

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72
Q

what is rx of anorectal fistula?

A

surgical management

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73
Q

is scabies itchy?

A

YES

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74
Q

how does scabies spread?

A

direct contact with infected person

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75
Q

what is rx of scabies?

A

topical permethrin

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76
Q

where does scabies like to go?

A

interdigital web spaces, axillae, umbilicus and genitals

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77
Q

what does scabies rash look like?

A

small erythematous papules

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78
Q

what are some signs of TMJ disorder?

A

facial pain, headache, and jaw dysfxn

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79
Q

what is a physical exam sign of TMJ disorder?

A

pain with palpation of joint and muscles

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80
Q

when are the 5 dtaps given?

A

2, 4, 6, 15 mos and 4 years

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81
Q

two contraindications to DTAP

A

encephalopathy after vaccine, anaphylaxis

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82
Q

5 tests to do with new diagnosis of HTN

A

CMP, ECG, TSH, Lipid profile, A1C

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83
Q

what is difference in eye discharge between viral and bacterial conjunctivitis?

A

viral is watery and bacterial is purulent

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84
Q

how to treat viral conjunctivitis?

A

warm compresses

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85
Q

what is MC cause of viral conjunctivitis?

A

adenovirus

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86
Q

what is rx for bacterial conjunctivitis?

A

topical abx`

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87
Q

what two murmurs get louder with valsalva?

A

HCM and MVP

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88
Q

what two murmurs get softer with squatting?

A

HCM and MVP

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89
Q

what is the MoA of ACE inhibitors?

A

blocks the angiotensin constriction of efferent arteriole so lowers hydrostatic pressure in kidney

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90
Q

what is a buckle fracture?

A

when bone bends but does not actually break

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91
Q

who gets buckle fractures? what are sx?

A

kids…often just tender over fracture and may have minimal loss of rom

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92
Q

what are the symptoms of SIBO?

A

bloating, watery diarrhea, crampy abdominal pain

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93
Q

what is the test to diagnose SIBO?

A

carbohydrate breath test

94
Q

what is sibo?

A

small intestine bacterial overgrowth

95
Q

what are a couple risk factors for SIBO?

A

chronic diabetes, chronic opiate use (both slow the bowels)

96
Q

what is rx for SIBO?

A

oral abx like rifamixin

97
Q

two risk factors for hidradenitis supporativa

A

smoking and metabolic syndrome (obesity, diabetes)

98
Q

what is rx for mild to moderate hidradenitis supporativa?

A

topical abx then oral tetracycline

99
Q

what is rx for severe hidradenitis supporativa?

A

adalimumab and surgery

100
Q

can patients with lactational mastitis continue to breastfeed?

A

you bet…it helps cure the infection

101
Q

what percent stenosis is considered severe in carotids

A

above 70

102
Q

if patient is symtpomatic with severe stenosis of carotid, what should they receive?

A

carotid endarterectomy

103
Q

what are signs of a gastric outlet obstruction?

A

early satiety, weight loss, intractable vomiting and nausea, and succossion splash

104
Q

what is the most common cause of a gastric outlet obstruction?

A

malignancy

105
Q

what nerve is affected in tarsal tunnel syndrom?

A

posterior tibial nerve

106
Q

where is nerve running in tarsal tunnel syndrome?

A

posterior to medial malleolus

107
Q

what motions make tarsal tunnel syndrome worse?

A

dorsiflexion-eversion and plantarflexion-inversion

108
Q

what is rx for tarsal tunnel syndrome?

A

NSAIDs rest and steroid injxn

109
Q

what are pyogenic granulomas?

A

small abnormal capillary and grnaulation tissue beds

110
Q

what happens with pyogenic granulomas?

A

surgical or laser removal

111
Q

who gets pyogenic granulomas?

A

young adults, common in prgnancy

112
Q

3 drug classes that improve life expectancy with left ventricular heart failure

A

ACE/ARBs, beta blockers, and mineralocorticoid receptor antagonists (spiranolactone)

113
Q

clear unilateral rhinorhhea should make you suspicious of what?

A

maybe CSF leak

114
Q

what are signs of CSF leak from nose?

A

if it increases when bending over or pooping and if it is clear and unilateral

115
Q

what are the heme findings in SLE?

A

anemia, thrombocytopenia and leukopenia

116
Q

what is the test for SLE?

A

ANA

117
Q

what are kidney and heart manifestations of SLE?

A

HTN and murmur/pericarditis

118
Q

two rx options for dyshidrotic eczema?

A

topical emollients or strong topical steroids

119
Q

where does dyshidrotic eczema mainly effect?

A

hands and feet

120
Q

cause of vitiligo

/

A

AI destruction of melanocytes

121
Q

rx of vitiligo

A

topical steroids then oral steroids or calcineurin inhibitors

122
Q

what ASCVD risk indicates starting a statin?

A

7.5-10 and above

123
Q

3 GI changes that are normal in pregnancy

A

constipation, GERD< biliary stasis

124
Q

classic appearance of basal cell carcinoma

A

slow growing, ulcerated pearly nodule with rolled borders

125
Q

what is a sign on physical exam for epididymitis?

A

pain relieved with elevation of testicle

126
Q

what is cause of epididymitis in ppl under 35?

A

STIs

127
Q

what is cause of epididymitis in ppl over 35?

A

bladder outlet obstruction

128
Q

what abx used for rx of epididymitis?

A

ceftriaxone and doxy

129
Q

what is pain like in epididymitis?

A

chronic dull pain

130
Q

what are PE signs of NAFLD?

A

hepatomegaly

131
Q

what labs are elevated in NAFLD?

A

liver enzymes, can have alk phos elevation too

132
Q

what often co-occurs with NAFLD?

A

metabolic syndrome and obesity

133
Q

which of gono or chlamydia causes early onset conjunctivitis in newborns

A

gono first, chlamydia second

134
Q

what is considered early onset conjunctivitis in newborn?

A

2-5 days

135
Q

what is rx for chalmydia conjunctivitis in newborn

A

oral erythromycin

136
Q

what is rx for gonorrhea conjunctivitis in newborn

A

IM cephalosporin

137
Q

what are two sx of vestibular schwannoma?

A

hearing loss and loss of sensation on affected side of face

138
Q

what type of hearing loss in vestibular schwannoma?

A

unilateral sensorineural

139
Q

why do people with vestibular schwannoma lose facial sensation?

A

schwannoma can get big enough that it impinges CNv

140
Q

when blood sugar gets really low…what is bodies response?

A

release catecholamines to increase the sugar

141
Q

if patients have chronically low blood sugar, what happens to response to low blood sugars? what does this put them at risk for?

A

decrease the catecholamine response to low sugars ad puts them at risk for developing low sugar episodes

142
Q

how does HCTZ affect blood sugar?

A

increase

143
Q

how does ACE/ARBs affect blood sugar

A

decrease

144
Q

how does statin affect blood sugar?

A

increase

145
Q

3 locations you can have lichen planus

A

genitals, oral mucosa, and ankles/wrists

146
Q

what is rx for lichen planus?

A

topical high potency corticosteroids

147
Q

what disease is lichen planus associated with?

A

hep C

148
Q

two main sx of sjogren syndrome?

A

dry eyes and mouth

149
Q

what abs are positive in sjogrens?

A

ro and la

150
Q

what are associated symptoms with sjogren aside from dry eyes and mouth

A

vasculitis, raynauds, dry skin

151
Q

three complications associated with sjogrens

A

non hodkin lymphoma, dental caries and corneal damage

152
Q

how does giardia cause diarrhea?

A

epthelial tight junctions get messed up and cause malabsroption

153
Q

what is rx of giardia?

A

tinidazole

154
Q

patients with hx of aortic aneurysm should not be given what abx?

A

fluorquinolones

155
Q

why cant patients with aortic aneurysm have fluoroquinolones?

A

bc can lead to collagen degradation

156
Q

aside from HA, HTN and blurry vision, what else can happen in pheochomocytoma?

A

high sugar

157
Q

four signs of eustachian tube dysfunction

A

ringing, popping in ears, hearing loss, fullness/discomfort

158
Q

how does tympanic membrane look in eustachian tube dysfunction?

A

retracted

159
Q

what part of prostate does cancer and BPH affect?

A

BPH is central, cancer is peripheral

160
Q

how does prostate feel in BPH?

A

symmetric and smooth

161
Q

how does prostate feel in cancer?

A

irregular and nodular

162
Q

what test should be ordered if you think patient had BPH? why?

A

urinalysis,,,to rule out nephrolithiasis and bladder cancer

163
Q

what is triad of sx with zenker diverticulum?

A

halitosis, regurgitation of undigested food, dysphagia

164
Q

what is cause of zenker diverticulum?

A

cricopharyngeal motor dysfunction

165
Q

what bug causes non purulent cellulitis?

A

strep pyo

166
Q

what bug causes purulent cellulitis

A

staph

167
Q

what shoulder issue leads to decrease in passive and active range of motion?

A

adhesive capsulitis

168
Q

what is the progression/duration of urticaria?

A

each wheal lasts less than 24 hours, but the urticaria will last up to 6 weeks

169
Q

what two movements make lateral epicondylitis worse?

A

passive wrist flexion, active wrist extension

170
Q

if carpal tunnel is suspected, but not confirmed with tinel or phalen tests, then how do you diagnose it?

A

nerve conduction study will show decreased median nerve

171
Q

where is pes anserine bursitis located?

A

anteromedial aspect of knee

172
Q

what causes pes anserine bursitis?

A

repeated movement

173
Q

what happens in pes anserine bursitis?

A

swelling and knee pain

174
Q

what is rx for pes anserine bursitis?

A

stretches and NSAIDs and rest

175
Q

what is a morton neuroma?

A

mechanically induced neuropathic degeneration of interdigital nerves in the foot

176
Q

who gets morton neuromas

A

runners

177
Q

what are the sx of morton neuromas?

A

pain/numbness between 3rd and 4th metatarsals that is worse with walking/running

178
Q

what is rx for morton neuroma?

A

bar or pad to support the foot

179
Q

what is epidermolysis bullosa?

A

inherited disorder of skin that leads to easy blistering with minimal friction to skin

180
Q

can epidermolysis bullosa occur in the mouth?

A

yes

181
Q

are hyperplastic polyps concerning on colonoscopy?

A

no…continue usual screening

182
Q

when do you screen for colon cancer every 5 years instead of ten?

A

if high family history

183
Q

if murmur disappears with standing, is it concerning or reassuring?

A

reassuring

184
Q

how does chemo interrupt hair growth?

A

interrupts follicular keratinocyte proliferation

185
Q

what are issues in early disseminated lyme disease

A

CN palsy
meningitis
carditis
migratory arthralgia

186
Q

what are late issues in lyme disease

A

arthritis encephalitis and peripheral neuropathy

187
Q

what is rule for FEV/FVC for determining if restrictive versus obstructive lung disease?

A

if less than 70% the obstructive, if more than 70% it is restrictive

188
Q

name some lung diseases with low DLCO

A

emphysema, fibrosis, sarcoid and asbestosis

189
Q

name some lung diseases with normal DLCO

A

asthma, chronic bronchitis

190
Q

name the restrictive lung diseases

A

fibrosis, asbestosis, sarcoidosis, obesity

191
Q

name the obstructive lung diseases

A

chronic bronchitis, emphysema, asthma

192
Q

what does acanthosis nigricans look like?

A

hyperpigmented areas in intertriginous regions of skin

193
Q

what is acanthosis nigrican associated with?

A

T2DM

194
Q

what is a common surgery that increases risk for infective endocarditis?

A

dental procedures

195
Q

what bug commonly causes infective endocarditis following dental procedure?

A

strep viridan

196
Q

what are the 5 signs of infective endocarditis?

A 
fever
heart murmur
splinter hemorrhages
janeway lesion or osler nodes
heart failure
197
Q

what should be done first in patient with potential infective endocarditis?

A

3 venipuncture cultures

198
Q

what is second step in management of patient with infective endocarditis after you draw for cultures?

A

start empiric abx and evaluate heart

199
Q

two arteries mainly affected in fibromuscular dysplasia

A

renal and carotid

200
Q

how to diagnose fibromuscular dysplasia?

A

imaging…usually US

201
Q

how to treat fibromuscular dysplasia?

A

ACEs first line then do a PTA (percutaneous transluminal angioplasty)

202
Q

what are some sx of fibromuscular dysplasia?

A

secondary hypertension, recurrent headaches, TIAs, strokes, tinnitus

203
Q

what are the four main sx of aortic stenosis

A

exertional angina
exercise intolerance
exercise dyspnea
presyncope

204
Q

what is murmur of AS?

A

crescendo decrescendo at RUSB

205
Q

what is rx of AS?

A

valve replacement

206
Q

what imaging is used to eval AS?

A

transthoracic echo

207
Q

if patient on combined OCP and has HTN, what is first step in management of the HTN?

A

change the OCP

208
Q

what is cause of adhesive capsulitis?

A

glenohumeral capsule contracture

209
Q

what is the main sx of adhesive capsulitis?

A

poorly localized pain and stiffness of the shoulder

210
Q

what are the effects of adhesive capsulitis on arm movement?

A

reduced active and passive range of motion

211
Q

what is rx for adhesive capsulitis?

A

range of motion exercises and NSAIDs

212
Q

do you have to have positive TTG IgA to have celiacs?

A

NOOO

213
Q

what is seen on biopsy in celiacs?

A

villous atrophy

214
Q

when to start colorectal cancer screening for average risk?

A

45

215
Q

when to start colorectal cancer screening for high risk?

A

40

216
Q

high risk patients should be screened for colon cancer every how many years?

A

every 5

217
Q

patients with UC should be screened when for colon cancer?

A

8-10 years after diagnosis..every 1-3 yrs

218
Q

how does pain associated with avascular necrosis of the hip progress?

A

starts with exercise…progresses to being present at rest

219
Q

new iron deficiency anemia in elderly patients should be considered what until proven otherwise?

A

GI blood loss

220
Q

what is patellofemoral pain syndrome?

A

pain of knee with flexion of the knee, not certain what causes it

221
Q

who gets patellofemoral pain syndrome?

A

young women

222
Q

what movements cause pain patellofemoral pain syndrome?

A

anything that causes flexion of the knee usually

223
Q

what is therapy for patellofemoral pain syndrome?

A

stretching strengthening and NSAIDs

224
Q

if bacterial sinusitis is left untreated, what can develop?

A

brain abscess

225
Q

what are signs of a brain abscess?

A

elevated ICP signs…like early morning vomiting, specific pain in specific location

226
Q

what is initial work up of suspected brain abscess?

A

CT of head

227
Q

what is pseudofollicular barbae?

A

bumps form shaving

228
Q

what is rx for pseudofollicular barbea?

A

stop shaving..

229
Q

what DM meds help with weight loss?

A

GLP-1 inhibitors (liraglutide)

230
Q

what is rx of lactational mastitis?

A

dicloxacillin and continue feeding

231
Q

what movement makes patellofemoral pain syndrome hurt?

A

knee flexion with quad contractions

232
Q

which STI does not grow in culturee or gram stain?

A

chlamydia

UWorld Family Medicine (3 decks)

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