Week 2-3 Flashcards
what are the three scenarios where foot and ankle x ray is required?
pain at malleolus, pain at midfoot, inability to bear weight for 4 steps
name four findings of diabetic retinopathy on eye exam
cotton wool spots, retinal edema, microaneurysms, hemorrhages, and new vessels
what is a1c goal with t2dm?
7.0
what three labs/exams should be done yearly for patients with diabetes?
retinopathy exam, neuropathy exam, and albumin/creatinine ratio
what can be used if patient with diabetes has elevated (>30) albumin?
ACE inhibitors
who gets spinal cord compression? where?
cervical…usually elderly who have cervical spondylosis (spinal narrowing)
what are the upper extremity symptoms of spinal cord compression?
neck pain and lower motor neuron signs in the upper extremities
what are the lower extremity symptoms of spinal cord compression?
gait unste`adiness, and upper motor neuron signs
what is dupuytren contracture?
fibrosis of the palmar fascia near the distal palmar crease
what is rx for IBS that can be started?
fiber
if patient has myopathy from a statin, what can you do to help with lipids?
try another statin or use moderate dosing
if a rash that sounds like varicella goes away and patient has pain for long time after rash, what is likely cause?
postherpetic neurlgia…herpes zoster
what is rx of postherpetic neuralgia?
tricyclic antidepressants or gabapentin
what is first line rx of nummular eczema?
topical corticosteroids
what is rx for chronic prostatitis? how long
fluoroquinolones for 6 weeks
what are some sx of chronic prostatitis?
recurrent UTI, with UTI sx and pain with ejaculation
what movement is decreased in SCFE?
internal rotation
when do you screen for abdominal aortic aneurysms?
ages 65-75
who gets screened for AAA?
male smokers ages 65-75
what is the screening for AAA?
one time ultrasound
when do cluster headaches occur?
at night
what is associated with cluster headaches
horner syndrome
two rx for cluster headaches?
100% o2 and sumitriptan
aside from a mass, what are presenting sx of testicular cancer?
back pain and dyspnea 2/2 metastasis
what is a common complication of femoral herniaS?
incarceration and SBO
what type of arthritis do you get from lyme disease?
monoarthritis
what are the two types of arthritis you can get with disseminated gonoccocal infection?
purulent monoarthritis
and
migrating arthralgia with tenosynovitis and rash
what will joint culture and aspirate show with disseminated gonoccocal infection/
no growth and less than 50K white cells
what four labs should be ordered for patient suggesting alzheimer disease to rule out other causes?
CBC, B12, CMP and TSH
what is test used to screen for diabetic nephropathy?
urine albumin to creatinine
what is first line topical rx for psoriasis?
high dose roids
what is firts line systemic rx for psoriasis?
methotrexate
what are some co-occurring sx with psoriasis?
uveitis, conjunctivitis, nail pitting, arthritis
3 rx options for pityriasis versicolor?
ketoconazole, selenium sulfide or terbinafine
what vaccines should patients with HIV get?
all of them they need/dont show immunity to
patient with hypothyroidism is thinking about pregnancy, what should you do?
give extra levothyroxine
what is another name for greater trochanteric pain syndrome?
trochanteric bursitis
what are sx of trochanteric bursitis ?
chronic lateral hip pain that is worse when laying on side and with flexion
3 rx options for trochanteric bursitis ?
NSAIDs
corticosterois injxn
PT
what is found on exam with trochanteric bursitis ?
focal tenderness over greater trochanter during flexion
what skin cancer often causes neurologic sx like numbness and paraesthesisa?
squamous cell carcinoma
how do squamous cell carcinomas of skin appear?
often are elevated bump with crusting/bleeding
how does basal cell carcinoma appear?
pearly pink/fleshy colored papule with telangiectasia
what age gets low dose CT to screen for lung cancer?
50-80
who gets low does CT to screen for lung cancer?
current smokers or 20 pack year former smokers
what are the four criteria to consider testing for strep?
fever
tonsillar exudates
tender anterior cervical lymph
absence of cough
3 rx options for moderate acne
topical retinoids, abx or benzoyl peroxide
rx option for severe acne?
oral abx
rx option for treatment resistant acne>
oral isoretinoin
if pain in heel is worse when pressing laterally and medially on the heel, what should you think about?
calcaneal stress fracture
what is rx for acute prostatitis?
6wks of fluoroquinolone or bactrim
does smoking contribute to HTN?
nah not really
what is best way to help HTN without meds?
DASH diet
all patients older than 40 with T2DM should be on what?
a statin
what are sx of hep a infxn?
fever, malaise, RUQ pain, hepatomegaly
what is rx of hep a?
nothing supportive care
what CD4 count means you cannot get live vaccines with HIV?
less than 200
what is another name for sciatica?
lumbosacral radiculopathy
what is most common cause of sciatica?
disc herniation
what is sign on exam for sciatica?
pain with straight leg raise
where do patients hurt with sciatica?
low back radiating down to lower leg
what imaging do you need to diagnose sciatica?
none
what is rx of sciatica?
NSAIDs and activity management
what are signs of osteonecrosis of the jaw?
chronic mild pain and swelling with exposed bone
what is risk for osteonecrosis of the jaw?
bisphosphonate therapy
what is the appearance of skin squamous cell carcinoma?
scaly plaques/patches
5 nonmodifiable risk factors for OA
advanced age, female, prior trauma, family history and abnormal joint alignment
what chronic medical condition can contribute to OA?
diabetes
what is rx and prognosis of osteoid osteoma?
NSAIDs and resolution on its own
pain with defecation and chronic anal discharge are signs of what
anorectal fistula
what is MC cause of anorectal fistula?
ruptured perianal abscess
what is rx of anorectal fistula?
surgical management
is scabies itchy?
YES
how does scabies spread?
direct contact with infected person
what is rx of scabies?
topical permethrin
where does scabies like to go?
interdigital web spaces, axillae, umbilicus and genitals
what does scabies rash look like?
small erythematous papules
what are some signs of TMJ disorder?
facial pain, headache, and jaw dysfxn
what is a physical exam sign of TMJ disorder?
pain with palpation of joint and muscles
when are the 5 dtaps given?
2, 4, 6, 15 mos and 4 years
two contraindications to DTAP
encephalopathy after vaccine, anaphylaxis
5 tests to do with new diagnosis of HTN
CMP, ECG, TSH, Lipid profile, A1C
what is difference in eye discharge between viral and bacterial conjunctivitis?
viral is watery and bacterial is purulent
how to treat viral conjunctivitis?
warm compresses
what is MC cause of viral conjunctivitis?
adenovirus
what is rx for bacterial conjunctivitis?
topical abx`
what two murmurs get louder with valsalva?
HCM and MVP
what two murmurs get softer with squatting?
HCM and MVP
what is the MoA of ACE inhibitors?
blocks the angiotensin constriction of efferent arteriole so lowers hydrostatic pressure in kidney
what is a buckle fracture?
when bone bends but does not actually break
who gets buckle fractures? what are sx?
kids…often just tender over fracture and may have minimal loss of rom
what are the symptoms of SIBO?
bloating, watery diarrhea, crampy abdominal pain
what is the test to diagnose SIBO?
carbohydrate breath test
what is sibo?
small intestine bacterial overgrowth
what are a couple risk factors for SIBO?
chronic diabetes, chronic opiate use (both slow the bowels)
what is rx for SIBO?
oral abx like rifamixin
two risk factors for hidradenitis supporativa
smoking and metabolic syndrome (obesity, diabetes)
what is rx for mild to moderate hidradenitis supporativa?
topical abx then oral tetracycline
what is rx for severe hidradenitis supporativa?
adalimumab and surgery
can patients with lactational mastitis continue to breastfeed?
you bet…it helps cure the infection
what percent stenosis is considered severe in carotids
above 70
if patient is symtpomatic with severe stenosis of carotid, what should they receive?
carotid endarterectomy
what are signs of a gastric outlet obstruction?
early satiety, weight loss, intractable vomiting and nausea, and succossion splash
what is the most common cause of a gastric outlet obstruction?
malignancy
what nerve is affected in tarsal tunnel syndrom?
posterior tibial nerve
where is nerve running in tarsal tunnel syndrome?
posterior to medial malleolus
what motions make tarsal tunnel syndrome worse?
dorsiflexion-eversion and plantarflexion-inversion
what is rx for tarsal tunnel syndrome?
NSAIDs rest and steroid injxn
what are pyogenic granulomas?
small abnormal capillary and grnaulation tissue beds
what happens with pyogenic granulomas?
surgical or laser removal
who gets pyogenic granulomas?
young adults, common in prgnancy
3 drug classes that improve life expectancy with left ventricular heart failure
ACE/ARBs, beta blockers, and mineralocorticoid receptor antagonists (spiranolactone)
clear unilateral rhinorhhea should make you suspicious of what?
maybe CSF leak
what are signs of CSF leak from nose?
if it increases when bending over or pooping and if it is clear and unilateral
what are the heme findings in SLE?
anemia, thrombocytopenia and leukopenia
what is the test for SLE?
ANA
what are kidney and heart manifestations of SLE?
HTN and murmur/pericarditis
two rx options for dyshidrotic eczema?
topical emollients or strong topical steroids
where does dyshidrotic eczema mainly effect?
hands and feet
cause of vitiligo
/
AI destruction of melanocytes
rx of vitiligo
topical steroids then oral steroids or calcineurin inhibitors
what ASCVD risk indicates starting a statin?
7.5-10 and above
3 GI changes that are normal in pregnancy
constipation, GERD< biliary stasis
classic appearance of basal cell carcinoma
slow growing, ulcerated pearly nodule with rolled borders
what is a sign on physical exam for epididymitis?
pain relieved with elevation of testicle
what is cause of epididymitis in ppl under 35?
STIs
what is cause of epididymitis in ppl over 35?
bladder outlet obstruction
what abx used for rx of epididymitis?
ceftriaxone and doxy
what is pain like in epididymitis?
chronic dull pain
what are PE signs of NAFLD?
hepatomegaly
what labs are elevated in NAFLD?
liver enzymes, can have alk phos elevation too
what often co-occurs with NAFLD?
metabolic syndrome and obesity
which of gono or chlamydia causes early onset conjunctivitis in newborns
gono first, chlamydia second
what is considered early onset conjunctivitis in newborn?
2-5 days
what is rx for chalmydia conjunctivitis in newborn
oral erythromycin
what is rx for gonorrhea conjunctivitis in newborn
IM cephalosporin
what are two sx of vestibular schwannoma?
hearing loss and loss of sensation on affected side of face
what type of hearing loss in vestibular schwannoma?
unilateral sensorineural
why do people with vestibular schwannoma lose facial sensation?
schwannoma can get big enough that it impinges CNv
when blood sugar gets really low…what is bodies response?
release catecholamines to increase the sugar
if patients have chronically low blood sugar, what happens to response to low blood sugars? what does this put them at risk for?
decrease the catecholamine response to low sugars ad puts them at risk for developing low sugar episodes
how does HCTZ affect blood sugar?
increase
how does ACE/ARBs affect blood sugar
decrease
how does statin affect blood sugar?
increase
3 locations you can have lichen planus
genitals, oral mucosa, and ankles/wrists
what is rx for lichen planus?
topical high potency corticosteroids
what disease is lichen planus associated with?
hep C
two main sx of sjogren syndrome?
dry eyes and mouth
what abs are positive in sjogrens?
ro and la
what are associated symptoms with sjogren aside from dry eyes and mouth
vasculitis, raynauds, dry skin
three complications associated with sjogrens
non hodkin lymphoma, dental caries and corneal damage
how does giardia cause diarrhea?
epthelial tight junctions get messed up and cause malabsroption
what is rx of giardia?
tinidazole
patients with hx of aortic aneurysm should not be given what abx?
fluorquinolones
why cant patients with aortic aneurysm have fluoroquinolones?
bc can lead to collagen degradation
aside from HA, HTN and blurry vision, what else can happen in pheochomocytoma?
high sugar
four signs of eustachian tube dysfunction
ringing, popping in ears, hearing loss, fullness/discomfort
how does tympanic membrane look in eustachian tube dysfunction?
retracted
what part of prostate does cancer and BPH affect?
BPH is central, cancer is peripheral
how does prostate feel in BPH?
symmetric and smooth
how does prostate feel in cancer?
irregular and nodular
what test should be ordered if you think patient had BPH? why?
urinalysis,,,to rule out nephrolithiasis and bladder cancer
what is triad of sx with zenker diverticulum?
halitosis, regurgitation of undigested food, dysphagia
what is cause of zenker diverticulum?
cricopharyngeal motor dysfunction
what bug causes non purulent cellulitis?
strep pyo
what bug causes purulent cellulitis
staph
what shoulder issue leads to decrease in passive and active range of motion?
adhesive capsulitis
what is the progression/duration of urticaria?
each wheal lasts less than 24 hours, but the urticaria will last up to 6 weeks
what two movements make lateral epicondylitis worse?
passive wrist flexion, active wrist extension
if carpal tunnel is suspected, but not confirmed with tinel or phalen tests, then how do you diagnose it?
nerve conduction study will show decreased median nerve
where is pes anserine bursitis located?
anteromedial aspect of knee
what causes pes anserine bursitis?
repeated movement
what happens in pes anserine bursitis?
swelling and knee pain
what is rx for pes anserine bursitis?
stretches and NSAIDs and rest
what is a morton neuroma?
mechanically induced neuropathic degeneration of interdigital nerves in the foot
who gets morton neuromas
runners
what are the sx of morton neuromas?
pain/numbness between 3rd and 4th metatarsals that is worse with walking/running
what is rx for morton neuroma?
bar or pad to support the foot
what is epidermolysis bullosa?
inherited disorder of skin that leads to easy blistering with minimal friction to skin
can epidermolysis bullosa occur in the mouth?
yes
are hyperplastic polyps concerning on colonoscopy?
no…continue usual screening
when do you screen for colon cancer every 5 years instead of ten?
if high family history
if murmur disappears with standing, is it concerning or reassuring?
reassuring
how does chemo interrupt hair growth?
interrupts follicular keratinocyte proliferation
what are issues in early disseminated lyme disease
CN palsy
meningitis
carditis
migratory arthralgia
what are late issues in lyme disease
arthritis encephalitis and peripheral neuropathy
what is rule for FEV/FVC for determining if restrictive versus obstructive lung disease?
if less than 70% the obstructive, if more than 70% it is restrictive
name some lung diseases with low DLCO
emphysema, fibrosis, sarcoid and asbestosis
name some lung diseases with normal DLCO
asthma, chronic bronchitis
name the restrictive lung diseases
fibrosis, asbestosis, sarcoidosis, obesity
name the obstructive lung diseases
chronic bronchitis, emphysema, asthma
what does acanthosis nigricans look like?
hyperpigmented areas in intertriginous regions of skin
what is acanthosis nigrican associated with?
T2DM
what is a common surgery that increases risk for infective endocarditis?
dental procedures
what bug commonly causes infective endocarditis following dental procedure?
strep viridan
what are the 5 signs of infective endocarditis?
fever heart murmur splinter hemorrhages janeway lesion or osler nodes heart failure
what should be done first in patient with potential infective endocarditis?
3 venipuncture cultures
what is second step in management of patient with infective endocarditis after you draw for cultures?
start empiric abx and evaluate heart
two arteries mainly affected in fibromuscular dysplasia
renal and carotid
how to diagnose fibromuscular dysplasia?
imaging…usually US
how to treat fibromuscular dysplasia?
ACEs first line then do a PTA (percutaneous transluminal angioplasty)
what are some sx of fibromuscular dysplasia?
secondary hypertension, recurrent headaches, TIAs, strokes, tinnitus
what are the four main sx of aortic stenosis
exertional angina
exercise intolerance
exercise dyspnea
presyncope
what is murmur of AS?
crescendo decrescendo at RUSB
what is rx of AS?
valve replacement
what imaging is used to eval AS?
transthoracic echo
if patient on combined OCP and has HTN, what is first step in management of the HTN?
change the OCP
what is cause of adhesive capsulitis?
glenohumeral capsule contracture
what is the main sx of adhesive capsulitis?
poorly localized pain and stiffness of the shoulder
what are the effects of adhesive capsulitis on arm movement?
reduced active and passive range of motion
what is rx for adhesive capsulitis?
range of motion exercises and NSAIDs
do you have to have positive TTG IgA to have celiacs?
NOOO
what is seen on biopsy in celiacs?
villous atrophy
when to start colorectal cancer screening for average risk?
45
when to start colorectal cancer screening for high risk?
40
high risk patients should be screened for colon cancer every how many years?
every 5
patients with UC should be screened when for colon cancer?
8-10 years after diagnosis..every 1-3 yrs
how does pain associated with avascular necrosis of the hip progress?
starts with exercise…progresses to being present at rest
new iron deficiency anemia in elderly patients should be considered what until proven otherwise?
GI blood loss
what is patellofemoral pain syndrome?
pain of knee with flexion of the knee, not certain what causes it
who gets patellofemoral pain syndrome?
young women
what movements cause pain patellofemoral pain syndrome?
anything that causes flexion of the knee usually
what is therapy for patellofemoral pain syndrome?
stretching strengthening and NSAIDs
if bacterial sinusitis is left untreated, what can develop?
brain abscess
what are signs of a brain abscess?
elevated ICP signs…like early morning vomiting, specific pain in specific location
what is initial work up of suspected brain abscess?
CT of head
what is pseudofollicular barbae?
bumps form shaving
what is rx for pseudofollicular barbea?
stop shaving..
what DM meds help with weight loss?
GLP-1 inhibitors (liraglutide)
what is rx of lactational mastitis?
dicloxacillin and continue feeding
what movement makes patellofemoral pain syndrome hurt?
knee flexion with quad contractions
which STI does not grow in culturee or gram stain?
chlamydia
