Family Medicine
"Atypical" pneumonia organisms include Mycoplasma, Legionella, Chlamydia, and viral, whose CXR presents with bilateral diffuse infiltrates
"Atypical" pneumonia organisms include _______________, whose CXR presents __________
"Barking cough" hoarseness, stridor common in 6 mo - 6 yo suggests croup. Commonly caused by Parainfluenza. Diagnosed with XR showing "steeple sign." Treatment is based on Westley croup score and includes corticosteroids and nebulized racemic epinephrine
"Barking cough" hoarseness, stridor common in 6 mo - 6 yo suggests __________. Commonly caused by _________. Diagnosed with _________. Treatment is _________
"Beaklike" upper GI with abdominal pain and bilious vomiting are suggestive of malrotation with volvulus
"Beaklike" upper GI with abdominal pain and bilious vomiting are suggestive of ______________
"Dew drops on a rose petal" suggest Varicella chickenpox
"Dew drops on a rose petal" suggest ___________
"Frothy" greenish-yellow, or gray, vaginal discharge suggests Trichomonas vaginalis. Women complain of soreness or dyspaerunia
"Frothy" greenish-yellow, or gray vaginal discharge suggests ____________. Women complain of ____________.
"Gold" milk is also called colustrum because it is antibody-rich
"Gold" milk is also called _________
"Ground-glass" infiltrates are suggestive of Pneumocystis jiroveci pneumonia, which is actually a fungus
"Ground-glass" infiltrates are suggestive of ___________ pneumonia, which is actually ______
"Hot" nodules are typically benign. "Cold" nodules are typically biopsied.
"Hot" nodules are typically _______. "Cold" nodules are typically _______.
how long can perimenopause last
- 2 to 8 years
after a c section when is follow up
- 2 weeks
healthy crying behavior
- 2 weeks of age: 2 hours/day - 6 weeks of age: 3 hrs/day - 3 months of age: 1 hr/day
how long is a recurrent episode of depression treated
- 2-3 years
fundal height
- 20 wks the top of the uterine fundus is at the level of the umbilicus - after 20 weeks it elevates 1 cm above the umbilicus for each week of pregnancy
gold standard for confirming diagnosis of GERD
- 24 hour pH probe -
when is rhogam given
- 28 weeks gestation AND if the baby is Rh+ (?) within 72 hours after delivery - also give if there are any episodes of vaginal or intrauterine bleeding
metabolic syndrome
- 3 of the following: -hypertriglyceridemia (>150) low HDL (<40 men, <50 women) elevated fasting blood glucose (>110) excessive waist circumference (>40in men, >35 in female) HTN (>130/85)
usually when does vision screening using a chart begin
- 3 yrs old
mild persistant asthma
- 3-4 days with symptoms/week (every other day) - treat with SABA PRN and low dose inhaled corticosteroids
preconception counceling
- 400-800 micrograms of folic acid - go over substance abuse -immunizations -control any chronic diseases
average age of menopause and how many months of no period leads is needed to dx menopause
- 51 - 12 months
when do you screen for obesity
- 6yo and older
how long can it take for milk production to begin
- 72 hours
gestational htn
- >140/90 - NO proteinuria -in a previoualy normotensive pregnant woman at or after 20 weeks of gestation -tends to recur in subsequent pregnancies and increases the risk of developing htn later in life -
HTN meds for general black population including those with diabetes
- CCB or thiazide
which tests are recommended for the early management of adults with ischemic stroke
- CT & MRI of the brain -renal function -electrolytes - ECG -markers for cardiac ischemia -CBC -PT/PTT -oxygen saturation - blood glucose
imaging for RLQ
- CT with contrast
therapy for moderate COPD
- FEV1 between 50% and 80% - maintenance therapy of inhaled anticholinergics alone or in combo with SABA
diagnosing COPD
- FEV1/FVC ratio <70% or less than the 5th percentile - spiromotry (pulmonary function test) is the gold standard
when would you use FOBT vs fecal immunochemical testing (FIT)
- FIT is more sensitive and specific than FOBT for detecting a lower GI bleed, not suitable for suspected bleeding above the ligament of treitz - multiple negative FOBTs or FITs do not excluse the presence of upper or lower GI blood loss
colorectal screening
- FOBT, flexible sigmoidoscopy or colonoscopy is recommended for patients 50-75
hyaluronic acid injections
- HA injections are less effective in the short term to steroid but equivalent in the intermediate term and superior in the long term
- HBsAG + anti HBsAG - HBeAg + anti HBcAG Resolved acute Hepatitis B infection
- HBsAG + anti HBsAG - HBeAg + anti HBcAG What does this patient have?
main RF for diastolic dysfuntion
- HTN
diagnosis of COPD gold standard
- PFT is the gold standard for Dx (also best screening test) - FEV1/FVC less than the 5th percentile or less than 70% confirms Dx -
normal weight gain in a newborn
1oz per day once the moms milk comes in (2-3 days after delivery)
What is the Duke Criteria
2 Major 1 Major and 3 minor 5 minor
Tx Trigger finger
2 injections only Surgical release if injections dont work
What is diagnostic for Hypertension
2 or more BP readings at 2 seperate visits over 140/90
What are the Major criteria of the Duke Criteria
2 positive blood cultures with typical organism 1 hr apart atleast Echo positive evidence vegitation or new valve regurgitation
What is the treatment for scabies
2 topical treatments separated by 1 week apart with prescription of Permethrin 5% Apply topical med neck down leave on over night rinse in AM
How long after starting therapy are pts not contagious
2 weeks
how long do postpartum blues last
2 weeks
Even after successful treatment for scabies how long can the itching last
2-4 weeks
How long after last drink do you get delerium tremons
2-7 days
how much of ones diet can be from saturated fats
25-35%
X-ray will show ________ Lisfranc fx
2nd metatarsal shifted laterally
How ong does the rash of Rubella last
3 days
what is Ventricular tachycardia
3 or more consecutive PVC at rate > 100bpm
Door to Fibrinolytics for MI in how many min
30min
when does group B screening occur
35-37 weeks gestation
usually when does hearing evaluation through audiometry begin
4
What age group is 5ths disease MC in
4-10 years old
How long do you treat Endocarditis
4-6 weeks
migraines can last
4-72 hours
What age do you start screening for high cholesterol in women
45
if no RF are present when should diabetes screening begin
45yo
5 A's of Smoking Cessation Ask Advise Assess Assist Arrange
5 A's of Smoking Cessation ___________
5 R's to motivate Smoking Cessation: Relevance Risks Rewards Roadblocls Repetition
5 R's to motivate Smoking Cessation
Unintened weight loss that exceeds ______% in 1 month or ______% in 6 months warrant evaluation
5% in 1 month 10% in 6 months
prediabetes
5.7-6.4
for vaginal delivery when is folow up
6 weeks
What is another name for Roseola
6th disease
For an exanthematous drug eruption what is the typical timeline for onset before the rash
7-10 days
How long can scabies survive off the body
72 hours
How long after starting a drug does SJS/TEN typically occur
8 weeks
chronic cough is a cough that lasts longer than ___ weeks
8 weeks
What is the typical age of onset and peask at what age for acne
8-12 and peaks around 15-18
optimal range for fasting blood glucose
80-120
how long is the first episode of depression treated
9-12 months
Door to PCI for MI in how many min
90 min
What is the treatment goal for BP for HTN
< 140/90
acute vs chronic diarrhea
< 3 weeks acute >3 weeks chronic
Roseola MC in what age group
< 5years old
BP goal for all ages with CKD or DM
<140/90
BP goal for general population <60yo
<140/90
BP goal for general population >60 yo
<150/90
optimal range for postprandial blood glucose between 1-2 hours after meal
<180
treatment for COPD
- SABA PRN - if symptoms are still inadequately controlled a daily dose of LABA should be added - choice between b-2, anticholinergic, theophylline or combo therapy depends on availability and individual response -
suicide severity scale
- SAD PERSONS - sex (male) - age (<19 or >45) - depression, diagnosis of - previous attempt -ethanol or other substance abuse -rational thinking impaired - social supports lacking -organized plan for suicide - no sig other -sickness - one point for each factor present - 4-6 = outpatient treatment is okay - 7-10 patient should be hospitalized
SE of PPIs and adverse events associated with non-judicious short and long term use of PPIs
- SE: headache, diarrhea, abdominal pain, nausea, constipation, bloating - adverse effects: community aquired pneumonia, c-diff diarrhea, osteoperotic fracture, anti-platelet agent inhibition, iron, Mg and B12 deficieny
red zone for asthma symptoms
- SOB when walking or talking -signs of cyanosis - peak flow reading <50%
if a woman cannot have HT replacement what can she use to control vasomotor symptoms
- SSRIs and SNRIs and clonidine and gabapentin - mind & body practices
EKG findings in LVH with strain
- ST depression with T wave inversions in the lateral precordial leads -large S wave in V3
after H pylori is r/o the following therapies have been proposed for functional dyspepsia
- TCA -insufficient evidence for psyhological therapies
causes of post partum hemorrhage
- Tone (uterine atony leading to continued bleeding) Trauma (perineal or cervical lacerations, uterine inversion) Tissue (retained or invasive placental tissue in the uterus) Thrombin (a bleeding disorder-much less common that the other three causes)
preferred method of imaging to evaluate the RUQ
- US
preferred method to study the RUQ
- US - US can accurately evaluate the gallbladder: preferred method of biliary colic/gallstones
TB skin test (PPD) what is positive for person recent immigrant from area known for TB, HIV negative drug user, Mycobacterio lab personnel, Resident/emplyoees of hig-risk congregate settings, Diabetes, Silicosis, Chronic renal failure, Children <4yo, Kids exposed to adults at high risk
> or equal to 10mm
TB skin test (PPD) what is positive for person with no risk factors
> or equal to 15mm
TB skin test (PPD) what is positive for person HIV positive, recent contact with active TB, person with evidence TB on CXR, or immunosupressed pt
> or equal to 5mm
Nephrotic range for proteinuria is
>3.5g/24 hours
What level BNP for HF
>500
first choice analgesic for short and long term treatment of OA pain
- acetominophen - max dose 4gm/day
what skin condition is topical 5-FU approved for
- actinic keratoses
merchants view
- evaluate patellofemoral joint - top view of the knee obtained with the knee bent at a 45 degree angle showing the patella in the groove of the femus
when is a thyroid US indicated
- evaluation of thyroid nodules and thyroid enlargement but not hyperthyroidism - guide fine needle aspiration
how often should children with new Dx of asthma be followed
- every 2-6 weeks until their asthma is stable and then in 1 to 6 month intervals depending on the level of control and severity
how often should TC and HDL levels be screen
- every 4-6 yrs in adults 20-79 w/0 ASCVD - men>35 and women>45 at risk for coronary heart disease - men 20-35 and women 20-45 if they are at increased risk of heart disease
whats signs are often associated with a herniated disc
- exacerbation when sitting or bending and relief when lying or standing - increased pain with coughing and sneezing - pain radiating dow the leg and sometimes the foot -parasthesias - muscle weakness such as foot drop
obturator sign
- examiner has patient supine with right hip flexed to 90 degress- takes patients right ankle in his right hand as he uses his left hadnto externally/internally rotate patients hip by moving the knee back and forth
which tests have an established role in the diagnosis of CAD
- exercise treadmill tesssting: initial diagnostic testas long as EKG is not interpretable -stress echocardiography -nuclear stress testing
gout/pseudogout
- extreme pain with any movement -painful to touch -athrocentesis with clear or slightly cloudy synovial fluid - negatively biefringent rods: gout
fetal development-week 27
- eyes will open -fetus will practice breathing - by 36 weeks the fetus will gain weight more quickly
AC joint separation
- fall on point of shoulder -pain in region of the AC joint on exam or pain with cross-chest adduction
RF for breast cancer
- family history in first degree relative menarche before 12 and menopause after 45 - advanced age at first pregnancy - genetic predisposition - advanced age - female sex - increased breast density and certain exposures (DES, hormone therapy, radiation, heavy smoking)
blood glucose levels for diabetes Dx
- fasting >126 confirmed on repeat testing - random blood glucose >200 with symptoms of hyperglycemia
in patients with BMI over 25 what labs should be drawn
- fasting blood glucose, serum creatinine and lipid profile
chronic fatigue syndrome
- fatigue for more than 6 months - unrelieved by rest and wosened with exertion - four of the following physical symptoms: impaired memory or concentration, post-exertional malaise, tender lymphadenopathy, sore throat, headache, myalgia, and arthralgia
which tests are the best for evaluating the eradication of H pylori
- fecal antigen and urea breath test - if either is positive the patient will require re-treatment for resistant infection - if the tets are negative and the patient continues to have symptoms then he should be referred to a GI for upper endoscopy. also consider US to evaluate for biliary disease
disequilibrium
- feeling off balance
iron deficiency treatment
- ferrous sulfate 325 mg three times daily - docusate sodium 100mg twice daily as needed for constipation
symptoms of seasonal influenza
- fever, cough, myalgia and sore throat
what must occur in order to treat DVT as an outpatient
- hemodynamically stable - good kidney function -low risk for bleeding
stain SE
- hepatic dysfunction + measure ALT prior to initiating statin therapy - myopahty + CK measure before stating - rare cases of rhabdomyolysis with acute renal failure secondary to myoglobinuria
pain with lumbar flexion is suggestive of
- herniation, osteoarthritis, muscle spasm
PAD
- history of claudication - *ankle brachial index <.9 is consistent with disease* - biggest RF: smoking
HEEADSSS interview
- home -education/emplyment -eating -activities -drugs -sexuality -suicide/depression -safety/ violence
4 yo milestones
- hop on one foot -copy a cross -mash their own food -brush their own teeth
when is fmhx of CHD a RF
- if a first degree relative has CHD male <55 and female <65
what are the indications for starting antivirals for influenza after 48 hours
- if the pt hs moderate to severe CAP with findings consistent with influenza - if the pt is clinically worsening at the time of the initial outpatient visit
if nipple discharge is present....
- imaging studies are needed: mammogram, US, ductogram, biopsy
what findings are diagnostic of asthma
- improvement FEV1 value by >12% or an increase in the percent predicted FEV1 value by 10% after a bronchodilator is given
when are inhaled steroids added to the asthma regimen
- in all patients with persistent asthma whether it is mild, moderate or severe
when do higher rates of relapse occur
- in men , younger age, fewer social supports, drank more prior to treatment and who have poor compliance with drug therapy
when is lung cancer screening recommended
- in patients 55-65 with a 30 pack history of smoking - low dose CT
when are NSAIDs contraindicated
- in patients on anticoagulanets
grade II sprain
- incomplete tear and moderate functional impairment - some loss of motor function - stretching of joint with a definite stopping point
COPD PE findings
- increased AP diameter - decreased diaphragmatic excursion - wheezing (often end-expiratory) - prolonged expiratory phase - decreased height of larynx
when are chances of breast cancer increased
- increased risk if a first degree relative has breast cancer
increased waist circumference and increased wait-to-hip ratio
- increased waist circumference (>40 inches in men, >35 inches in women) - increased wait-to-hip ratio (>.85 for women or >.9 for men)
cigarette smoking and cervical cancer
- increases the risk 4 X
left occiput nterior
- indictaes that the back (occiput) of the fetal head is anterior in the mothers pelvis and to the mothers left
when is a full work up for sepsis required
- infants under 2 mo of age with fever above 100.4 (38 c) - this includes blood culture, CSF and urine
long term effects of uncontrolled asthma
- inflammation, mucuous hypersecretion, airway smooth muscle hypertrophy, angiogenesis, subepithelial fibrosis, less reversibility of the airway obstruction
vaccine recommendations for diabetic patients
- influenza - pneumococcal polysaccharide vaccine: all diabetics over 2yo - one time revaccintion for patient over 64 is the vaccine was first reveived greater than 5 years ago. revaccination should also occur if the patient has nephrotic syndrome, chronic renal disease or immunocompromised - hep B
treatment for copd exacerbation
- inhaled bronchodilators (esp b2 agonists) and oral glucocorticosteroids
treatment for COPD exacerbation
- inhaled bronchodilators, oral glucocorticosteroids such as prednisone with or w/o antibiotics
treatment for chronic cough
- inhlared bronchidilator and maybe inhaled corticosteroid
what is focused on with initial asthma presentation vs asthma control and assessment
- initial: focus on assessment of severity - then focus on the control of asthma
moderate intensity statin should be used when
- initiated or conitnued for adults 40-75yo in patients with diabetes - patients <75 with ASCVD - patients 40-75 with estimate 10 year ASCVD risk <7.5%
wheezes
- inspiratory/expiratory spasms of the bronchioles -continuous - asthma: can be inspiratory or expiratory - chronic bronchitis: wheezes can clear with coughin
what does the anterior drawer test examine in the ankle
- integrity of the anteriotalofibular ligament
infants born to adolescent moms are at a greater risk for
- lower birth weight -STIs - poorer developmental outcome -increased risk of fetal death
three most common causes of back pain
- lumbar strain/sprain -age related degenerative joint changes -herniated disc
triple/quad screen
- markers in the mothers blood - AFP, hCG, unconjugated estriol and dimeric inhibin (in the quad screen) -perform at 15-21 weeks
cauda equina syndrome symptoms and management
- mass effect compresses the cauda equina causing pain radiating own the leg and numbness of the leg - emergency -decompression within 72 hours - higher on differential is patient has bowel or bladder problem - urinary incontinence or retention -saddle anesthesia-anap sphincter tone decreased or fecal incontinene - b/l lower extremity weakness of numbness -progressive neuro deficits
what is included in a prenatal follow up visit. pregnancy weight gain and fundal height
- maternal weight: expected to gain 25-35 lbs if normal weight, if overweight should gain 15-25 lbs and if obeses should gain 11-20 lbs -BP elevation - fetal heat tones: first head at 10-12 wka -fundal height: at 10 wks may be palpable at the pelvis brim. from 2o weeks and on the fundal height often correlates with the weeks of gestation
treatment for chronic sinusitis
- maxamize treatment for allergic rhinitis, including regular use of nasal corticosteroid and allergen immunotherapy -nasal saline irrigation is a useful adjunct - no use to suport the use of Ab in patients with chronic sinusitis
acute bacterial prostatitis
- may present with low back pain -general malaise, chills, hesitancy and pain on urination - fever - tenderness over the prostate on rectal exam
what does a US in the first trimester measure and how close should id be to naeugels rule
- measure the crown-rump length -within 1 week - gestational scan can be seen by 4-5 weeks - fetal pole is seen by 5-6 weeks
what are the imaging methods for dementia and when do you screen
- noncontrast CT or MRI - use to r/o other structural defects
babys can loose how much birth weight and when should they re-gain it?
- normal for babys to lose up to 10% of their birth weight in the first week - weight should be back to birth weight by 2 weeks of age
vestibular suppresant medications while breastfeeding
- occasional doses of meclizine are acceptable - short term use of promethazine is okay (with repeated dosea observe infant for excess sedation)
peroneal tendon tear
- often due to inversion injury and may occur w/ lateral ankle sprain - persistent pain posterior to lateral malleolus -
when is hep C screening recommended
- one time screening for HCV infections to adults born between 1945 and 1965
rotator cuff tendinopathy
- positive apleys scratch test - weakness and pain with empty can test - limited active ROM
popliteal (bakers) cyst
- posterior popliteal area - insidious onset of mild to moderate pain in popliteal area of the knee - most common synovial cyst of knee
what is the strongest lateral ankle ligament
- posterior talofibular ligmane ta
Ca recommendations for premenopausal and post menopasusal women
- pre: 1000 mg/day - post: 1500 mg/ day
stable angina
- predictable pattern of chest discomfort that usually occurs with exertion -relieved by rest or NG in less than 5-10min
radioactive iodine treatment precautions
- pregnancy test before starting treatment - cant be near pregnant women or kids for days after treatment bc iodine excreted in pee and poop - draw TSH evert 2-3 mo until stable - alertt patients to symptoms of hypothyroidism because this will occur at some point
AF with rapid ventricular response
- presence of vtach in the presence of AF - Tx: rate control and rhythm control
AC joint sprain
- present with swelling, brusing, point tenderness of the AC joint after a fall directly on the acromion with arm adducted Type I injuries involve injury of AC ligaments with no injury to the coracoclavicular (CC) ligaments. This causes a tender AC joint that often has mild swelling. This type usually heals within a few weeks.Type II injuries involve a complete tear of the AC ligaments and a sprain or partial tear of the coracoclavicular (CC) ligaments. This causes a tender AC joint, often with significant swelling.Type III injuries involve a complete tear of both the AC and CC ligaments. Significant swelling and tenderness of CC ligaments is present along with visible abnormality of the AC joint. Type III injuries can take several weeks to months to heal.Type IV, V, VI injuries are the most severe. Treatment often requires surgery.
preterm labor
- prior to 37 weeks
dosage of stain
- select a statin based on the patients ASCVD RF (rather than adjusting the dose to target a specific LDL goal)
acute bronchitis
- self limited inflammation of the large airways - cough - purulent sputum -often viral - coughing for more than 5 days - b2 agonist for those who are wheezing
severe preeclampsia criteria
- severe hypertension of at least 160 systolic or 110 diastolic, or - severe proteinuria of at least 5 grams in a 24 hour period or 3-4 + on dipstick, or signs of fetal compromise (intra-uterine growth restriction or fetal demise, or oligohydramnios), or persistent signs and symptoms of epigastric or right upper quadrant pain, or the HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets), or persistent neurologic signs and symptoms such as persistent and severe headache, scotoma (visual field defect), or seizures (eclampsia), or other evidence of end-organ damage such as oliguria (<500 cc in 24 hours), pulmonary edema - A patient with blood pressure in this range would need an anti-hypertensive in order to prevent sequelae of severe hypertension, such as myocardial infarction or stroke. It would be important, however, not to drop the blood pressure too far or too fast, in order to avoid decreased perfusion to the uterus (as well as the brain and other vital maternal organs).
COPD v Asthma
- significantly reversible is defined as an increase in FEV1> 12% after bronchodilator note: FVC is normal to decreased in COPD but always decreased in astham - macrophages and T killer cells play a role in COPD
chronis cinusitis
- similar symptoms to acute sinusitis but last at least 12 weeks - must have 2 of the following: + nasal obstruction/congestion +mucopurulent dranage +facial pain + pressure or fullness + decreased sense of smell
joint effusion seen with osteoarthritis or degenrative meniscal inuries
- simple joint effusion with clear, straw colored transudative fluid
when is zoster vaccine recommended
- single dose for adults 60+ - vaccine is given regardless of whether they report a prior episode of herpes zoster - CI: pregnancy, immunocompromised
causes of secondary HTN
- sleep apnea, chronic renal disease, renovascular disease, drugs, pheo, primary aldosteronism, chronic steroid use, cushings, thyroid disease, parathyroid disease, coarctation of aorta
main RF for DVT
- smoking & obesity
signs that help predict COPD
- smoking more than 40 pack years - self reported history of COPD -maximal laryngeal height of 4cm or less - age at least 45
venous insufficiency
- softer than chronic lymphedema - erythema, dermatitis, and hyperpigmentation along the distal aspect of the leg and skin - may see ulceration near the medial and lateral malleoli
who is the best persin to get a stress test
- someone with an intermediate pre-test probability
herbal remedies for hot flashed
- soy, black cohosh, flaxseed and st johns wart
what is the spatula and cytobrush used for in the pelvic exam?
- spatula is used for the exo-cervical sample -cytobrush is inserted into the endo-cervix
three most common causes of bleeding in early pregnancy
- spontaneous abortion -ectopic pregnancy -idiopathic bleeding in viable pregnancy
12 month milestones
- stands alpne -pincer grasp -mama dada (specific) plus another word or so - hands parent a book to read, points when wants something, imitates activites and plays ball with examiner
if there is high clinical supicion but nothing seen on xray what do you do
- start empiric treatment and repeat chest x ray in 24-48 hrs
2 month check up
- start some foods at * 4 months* - vit D 400 units/day unless drinking 32 ounces of formula or milk a day) - most babies sleep through the night by 4-6 months - place on back to go to sleep
naegeles rule
- start with the first day of the last normal menstrual period then: - add 1 year - subtract 3 months - add 1 week
GI problems due to obesity in peds
- steatosis and gallbladder disease - screen for steatosis at 10 if BMI greater than 95% or if greater than 84-94 but with RF and every 2 years therafter with AST and ALT - refer to GI for levels that are twice the upper limit of normal
acute cholecystitis
- stone lodged in the cystic duct - similar symptoms to biliary colic but lasts longer than 4-6 hours - fever, elevated WBC
managment of rotator cuff tendinopathy and impingement
- strengthen rotator cuff and scapular stabilizers to increase the subacromial space allowing the tendon to heal
cellulitis
- strep: small skin breaks - staph: larger wounds, ulcers - RF: diabetes, vascular disease
grade I sprain
- stretching or small tear of ligament - mild tenderness and swelling - slight to no functional loss
cremasteric reflex
- stroke or pinch the superior medial aspect of the thigh - ipsilateral testicular retraction should occur - absence of the cresmaster reflex may indicate testicular torsion - note: may be absent on PE in normal testes
rooting reflex
- stroking newborns cheek, which prompts the infant to turn her head towrad stimulus - disappears around 4 mo of age
evidence of active labor
- strong regular contraction every 3-5 minutes -cervical dilation of 4-5 cm+ in the setting of contractions -fetal heart tracing does not impact the diagnosis of active labor
disease processes with low radioiodine uptake
- subactute thyroiditis, silent thyroiditis, iodine induces, exogenous L-thyroxine, struma ovarii, amiodarone
ressiting internal rotation tests
- subscapularis muscle
paraoxysmal nocturnal dyspnea
- sudden, severe SOB at night that awakens a person from sleep, often with coughing and wheezing - often associated with CHF - occurs several hours after a person has fallen asleep - often relieved by sitting upright, but does not resolve as quickly as orthopnea
when is a breast MRI indicated
- surveillence of women with more than 30% lifetime risk May be used as a diagnostic tool to identify more completely the extent of disease in patients with a recent breast cancer diagnosis. Contrast-enhanced breast MRI may be indicated in the evaluation of patients with breast augmentation in whom mammography is difficult.
DVT
- swelling, pain, discoloration in the affected extremity - homans sign: pain on passive dorsiflexion of the foot - chronic venous infsifficiency may result from DVT or valvular incompetence - may have an accompanying inflammatory response which can cause low grade fever
influenza signs of complications
- symptoms last longer than 5-7 days without any relief -difficulty breathing w-orsening cough -diffculty maintaing hydration
major depressive disorder v bereavement
- symptoms must be present 2 full months after the loss for the Dx of MDD
bacterial pneumonia
- temp grater than 38 (100.4) - step pneumo most ofren - no prodromal symptoms (myalgia, rhinorrhea) -pleuritic chest pain, fever, chills, dyspnea, cough -pleural effusion common - crackles are a cardinal feature - often head crackles
A1c testing guidlines
- test at diagnosis and 2X/year in patients who are stable and A1c < 7 - test 4X/year when therapy is changing or goals are not met
selective screening for anemia
- test if: +at risk of iron deficiency because of special health needs -low iron diet -environmental factors
testicular torsion
- testical rotates around vascular supply -surgical emergency w/ a limited window of 4-12 hrs to save the testicle -swollen tender scrotom and the cremasteric reflex is absent - causes the testicle to have a "transverse lie" - one testicle may sit higher
placental abruption
- thrid trimester bleeding - abdominal pain, uterine contraction and non-reassuring fetal heart tracing - occurs when the placenta peels away from the inner wall of the uterus before delivery-either partially or comepletely - immediate medical attention
thyroid replacement therapy. when do you recheck TSH and once it is stable how long is it checked?
- thyroxine: 1.5 - 1.8/kg - increase dose slowly -recheck TSH in 6 weeks - when stable TSH is reached, check once or twice annually
most effective pharmacologic agent for the treatment of allergic rhinitis
- topical nasal steroids
torsion of the testicular appendages
- torsion of the testiular appendage - appendix testes is a small vestigal structure locate on the anterosuperior aspect of the testis - abrupt pain , less severe than testicular torsion -pain localized to the upper pole of the testis (region of the appendix testes) w/o any tenderness in the remaining areas of the testes - blue dot sign
primary pathophysiology of GERD
- transient LES relaxations
what is legal consent to treat adolescents w/o parental knowledge in all 50 states
- treatments for STIs
benefits and risk of hormone therapy replacement
- treats: hot flashes and vasomotor symptoms, strophic vaginits and dyspareunia, osteoperosis, -risks: breast CA, endometrial CA, after 60 increases CAD, stroke,
acute migraine treatment
- triptans -ergot alkaloids
diagnostic criteria for HTN
- two elevated mesurements - five minutes apart - one in each arm, should be made on 2+ visits
when is drawing TSH indicated
- type 1 diabetes (1/yr), newly diagnoses dyslipidemia, or women 50+
causes of secondary htn in children
- umbilical arterial or venous access during perinatal period can predispose to renal vascular disease - UTI: one of the leading cuases of htn and renal insufficiency later in life due to renal scarring following the infeection - catecholamine xs - family history of renal disease -coarctation of the aorta
BMI catagorizations
- underweight: below 18.5 - normal: 18.5 - 24.9 - overweight: 25 - 29.9 - obese: 30+
when does colic peak & definition
- unexplained paroxysmal bouts of crying that lasts at least *3 hrs a day, at least 3 times a week for longer than 3 weeks* - begins 2 weeks of like and peaks at 6 weeks of life - usually resolves by 12 weeks - Tx: stick with breast milk
influenza
- upper and lower respiratory tract symptoms accompanied by systemic symptoms -very abrupt - winter - high fever of 102-104 and chills, myalgia and headache - tx: zanamivir, oseltamivir, amantadine and rimantadine decrease duration by 1 day but should be given within first 48 hous of illness
some facts about HRT
- use of combined estrogen and progesterone beyond 3 years increases the risk of breast cancer - beginning HRT after 60 increases the risk of CAD - systemic estrogen is most effective for the treatment of vasomotor symptoms - increases endometrial cancer -good for osteoperosis
upper endoscopy and GERD
- useful for evaluating of complications of GERD
what are the thiazolidinediones useful for and what are some major SE
- useful for those who cannot tolerate GI SE of emtoformin - for those who have hypoglycemia with sulfonylureas - SE: increased risk of HF, edema, and bone fracture
physical exam findings of allergies
-allergic shiners -allergic salute: horizontal crease across the bridge of the nose -clubbing -dennie morgan lines: infraorbital creases
spondylolisthesis
-anterior displacement of a verteba or the verterbal column in renlation to the vertebra below -any age - causes aching back and posterior thigh discomfort that increases with activity or bending
patellofemoral syndrome
-anterior knee pain - overuse - worse after prolonged sitting
imporatn characeristics of dementia
-aquired, progressive, global, interfers with function
rhonchi
-expiratory/inspiratory continous low pitch sounds, sound like snothing -associated with larger bronchical secretions and airway narrowing -continuous - thought to be mucous secretions -clear after coughin
What are the 4 types of non small cell carcinoma
Adenocarcinoma Squamous cell Large cell (anaplastic) carcinoma Bronchoalveolar
presyncope
-feeling light headed for faint, as opposed to actually passing out -may feel worse when they stand up quickly
gestational dating and conceptional/developmental age
-gestational age: time elapsed since the first day of the LMP - conceptional/developmental age of the embryo is calculated from the date of fertalization or 2 weeks after the first date of the LMP
diabetic ulcer management
-grade 1/2: outpatient - grade 3: evaluate for possible osteomyelitis as well as PAD - grade 5: emergent hispitalization and surgical consultation
disease processes with high radioiodine uptake
-graves, multi-nodular goiter, toxic solitary nodule, TSH secreting pituitary tumor, HCG secreing tumor
complications of PUD
-hemorrhage or performation - gastric outlet obstruction syndrome
direct occiput anterior
-indicates that the occiput is directly posterior to the pubic symphysis (with the babys face towards the rectum)
tendinitis
-inflammatory etiology that occurs only in the first days after an *acute* tendon injury
gastritis
-inflmmation of stomahc lining and can cause epigastric pain that improves immediately following a meal -associated with alcohol and NSAID use
thrombolytic therapy is most effective when
-initiated within 90 minutes of onset - can be given within 3 hours of stroke onset
what does the inversion stress test examine in the ankle
-integrity of the calcaneofibular ligament
when is ECG w/o imaging indicated
-intermediate risk for CAD - chronic and stable nature of disease - able to excercise including patients with less than 1 mm ST-segment depression or complete RBBB on resting ECG
when can intra-arterial therapy be given for a TIA
-w/in 6 hours
Physical exam of community acquired pneumonia
Adentitious sounds (crackle) Dull to percussion Bronchial sounds over consolidation Increase fremitus + Egophany
Useful treatment for mild and intermittent allergic rhinitis is antihistamines
Best treatment for mild and intermittent allergic rhinitis is _________________
Migraine prophylaxis
Beta blockers CCB TCA Anticonvulsants
Treatment options for PSVT
Beta blockers, calcium channel blockers Radiofrequency ablation
Osteopenia is present with what T score
Between -1.0 and -2.5
Bilateral lower extremity edema is MC due to chronic venous insufficiency
Bilateral lower extremity edema is MC due to _____________
SS cauda equina syndrome
Bilateral lower extremity weakness saddle anesthesia sphincter dysfunction bowel and bladder dysfunction
What is the only class of lipid therapy safe in pregnancy
Bile Acid Sequestrants Cholestyramine
Biphosphonates should be taken with an empty stomach and full glass of water. Patient should stay upright for 30 minutes after taking pill
Biphosphonates should be taken with _______________
Bipolar disorder is treated with lithium, valproate, carbamazepine
Bipolar disorder is treated with ____________
Differential diagnosis for acute dyspnea
Bronchospasm PE pulmonary edema pneumothorax pneumonia MI Anxiety/panic attack anemia upper airway obstruction
What is characteristic of a brown recluse spider
Brown spider with a dark brown violin shaped marking on the belly
Buproprion is CI in: Eating disorders MAOi use within 2 weeks Seizures Typically started 1-2 weeks before quitting
Buproprion is CI in __________ Typically started __________
Buproprion is associated with risk of seizures and therefore contraindicated in hx of them.
Buproprion is associated with __________
Button batteries if ingested are concerning because electric conduction with esophageal wall may cause perforation
Button batteries if ingested are concerning because ____________
chronic diarrhea without apparent cause work-up should include
CBC, ESR, stool for ocult blood, ova and parasites, stool assay
Lab tests for jaundice
CBC, UA, Lifer function panel, alkaline phosphatase, albumin
DX studies and results for walking pneumonia
CBC- WBC usually normal or slight elevated CXR- segmental lower lung zone infilltrates
What is a good 1st line tx for AA people
CCB
Tx prinzmetals angina
CCB and nitro
What are the genes that make up the risk for familial melanoma
CDKN2A, CDK4, BRACA2
How do you determine if long term stroke prophylaxis is needed
CHA2DS2 VASc Score
CHD equivalents are: Peripheral Arterial Disease Cerebrovascular disease Abdominal Aortic Aneurysm DM
CHD equivalents are ___________
Differential diagnosis for chronic dyspnea
CHF COPD Asthma interstitial lung disease pulmonary hypertension pleural effusion obesity ascites kyphoscoliosis anemia anxiety lung mass
Causes of bilateral leg edema
CHF Pulmonary hypertension Venous insufficiency Cirrhosis Renal disease Hyopalbuminemia Chronic renal failure Glomerulonephritis Nephrotic syndrome Medications Myxedema (Hypothyroidism) Allergic reaction Idiopathic edema
What is the CHAD VAS 2 score
CHF +1 HTN +1 Age <65 +0 65-74 +1 >75 +2 Diabetes +1 Stroke/TIA/Thromoembolism hx +2 Vascular Dz +1 Sex Male +0 Female +1
neck vein distension, peripheral edema, and rales suggest
CHF or pulmonary hypertension
Lesions with low probability for malignancy can be watched how often
CT every 3 months for a year and if stable CT can be reduced to every 6 months for the next 2 years
What are some indications for hospitalization of a patient with pneumonia
CURB 65 Score Confusion BUN > 19 Respiratory rate > or equal to 30bpm Blood Pressure Systolic < 90 and Diastolic < 60 Age > 65
DX bronchitis
CXR
DX foreign body aspiration
CXR- only helpful if radiopeque PA/Lat xray of neck soft tissue Rigid Bronchoscopy
CXR for PE results
CXR- usually normal Hamptoms hump or Westermarks sign
DX studies and results for community acquired pneumonia
CXR: lobar or segmental infilltrates Sputum: gram stain CBC Procalcitonin: Increase if bacterial cause
What is a Ranke complex
Calcified primary focus and calcified hilar lymph node represent a healed primary infection
What is a Ghon complex
Calcified primary focus represent a healed primary infection
mcmurray test
Can assess the medial and lateral menisci, though it has low sensitivity and specificity for diagnosing meniscal tears The physician holds the patient's heel with one hand and grasps the knee over the medial and lateral joint lines with the other hand. The patient's knee is flexed as much as possible. The tibia is rotated either internally (tests lateral meniscus) or externally (tests medial meniscus) as the knee is extended to about 90 degrees. A varus stress (lateral meniscus) or valgus stress (medial meniscus) is applied across the knee joint while the knee is being extended. The test is positive if a clunk or click is felt, or if testing causes reproducible knee pain.
If a pregnant woman contracts 5ths disease what will happen to the fetus
Can cause hydrops fetalis
What is Kaposi Sarcoma
Cancer of connective tissue
What is prinzmetals angina
Caused by vasospasm usually wakes people early morning transient chest pain at rest
Inpatient tx community acquired pneumonia
Ceftriaxone and macrolide or Floroquinolone
Causes of unilateral leg edema
Cellulitis DVT Hematoma/ soft tissue injury Baker Cyst Venous insufficiency Lymphedema Extrinsic Compression Neoplasm Lymphoma
who should be screen for hyperlipidemia
Adults > 20 yrs should be screened for hyperlipidemia if at increased risk for CAD (i.e., diabetic, hypertensive, premature personal history of atherosclerosis or family history of CAD in males < 50 yrs or females < 60 yrs)
How and where does erysipelas appear
Affects lower extremities and face Pain, superficial redness, and plaque-like edema with sharp defined margin to normal tissue
After a laceration, first step is IRRIGATION, then consider Tetanus shot
After a laceration, first step is __________
If 3rd trimester bleeding present when can you do a speculum exam
After a transvaginal US is done to determine the location of the placenta and if no placenta previa or vasa previa then a speculum exam can be done.
After breast cyst aspiration, follow up in 4-6 weeks to check for recurrence
After breast cyst aspiration, follow up in _______________
After delivery, brown-colored lochia occurs for about a week. White-yellowish lochia occurs for about 3-6 weeks
After delivery, brown-colored lochia occurs for _____. White-yellowish lochia occurs for _________.
Age-related macular degeneration is characterized by loss of central vision
Age-related macular degeneration is characterized by loss of ____________
What is the MC chronic arrhythmia
Atrial fibrilation
Diagnosis of PCOS is based on: Hyperandrogenism Chronic anovulation Polycystic ovaries on ultrasound
Diagnosis of PCOS is based on _____________
DM Goals: HA1c < 7 BP 130/80 LDL < 100
DM Goals HA1c ____ BP _____ LDL _____
What is Aortic Regurgitation
Diastolic Murmur Back flow from aorta to left ventricle
What is Mitral Stenosis
Diastolic Murmur Flow obstruction of flow from left atrium to left ventricle causing increase left atrial pressure
What criteria is used to help diagnose Endocarditis
Duke Criteria
MC type of ulcer in gastric system
Duodenal MC than gastric
vertigo can be central or peripheral
Central: associated brainstem or other neurologic features Peripheral: isolated vertigo with or without hearing loss
antitussives can be centrally or peripherally acting list examples of each
Centrally: codine, dextromethorphan Peripherally: benzonatate
Chronic hepatitis C may lead to cirrhosis, hepatocellular carcinoma, hepatic decompensation
Chronic hepatitis C may lead to ____________
What is acne rosacea
Chronic inflammatory condition located at the "flush" areas of the face Papules and pustules superimposed on background of telangiectasias and general erythema
What are some clinical manifestations of pulmonary TB
Chronic, productive cough chest pain hemoptysis night sweats fever/chills anorexia and weight loss
Classic sign of a herniated disc is sciatica
Classic sign of a herniated disc is __________
DX MI
Clinical Hx EKG- ST segment elevation in 2 or more anatomically contiguous leads Cardiac enzymes ( CK and Troponin)
How do you dx seborrhic keratosis
Clinical or dermatoscope
How do you diagnose murmurs
Clinically and Echo
What doe pustular psoriasis look like
Clinically apparent pustules
What does acne start as______ and becomes ______
Clogged pores or comedones and gets debris stuck in pores which leads to inflammation of papules/pustules that have erythema and edema
Tx nocturnal monoclonus
Clonazepam
Close contacts of someone with menigococcal infection should be given Cipro or Rifampin prophylactically
Close contacts of someone with menigococcal infection should be given ___________
Closure of bite wounds should be limited to lacerations < 6 hours old
Closure of bite wounds should be limited to ___________
TX intertrigo
Clotrimazole cream or nystatin cream
What does cocaine withdrawl look like
Cocaine bugs depressed
What are pulmonary nodules known as
Coin lesions
DM treatment that is acceptable with renal insufficiency is Thiazolidinediones. These benefit DM by increasing insulin sensitivity in the adipose tissue, decreases triglycerides and increases HDL.
DM treatment that is acceptable with renal insufficiency is ____________. These benefit DM by _____________
Signs and symptoms of A-fib
Fatigue, Tachypnea, dyspnea, palpitation, lightheaded
Fecal occult blood tests recommended annually Sigmoidoscopy every 3-5 years Colonoscopy every 10 years
Fecal occult blood tests recommended ____ Sigmoidoscopy every _____ Colonoscopy every _____
What are risk factors for drug reactions
Female Prior history of drug reaction Recurrent drug exposure HLA type
Steidas fracture
Femoral avulsion fracture of MCL
Fetal heart tones are heard by 10 weeks
Fetal heart tones are heard by __________
What is Centor criteria and used to determine what
Fever > 100.4F Anterior cervical lymphadenopathy Lack of Cough Exudates on tonsis Indicates need for throat culture and Group A Strep
Fever over 104, Tachycardia, Metabolic acidosis, Rhabdomyolysis suggests Malignant hyperthermia
Fever over 104, Tachycardia, Metabolic acidosis, Rhabdomyolysis suggests ______________
Fever, cough, tachypnea, toxic-appearing suggests pneumonia
Fever, cough, tachypnea, toxic-appearing suggests ___________
What is the prodrome for Hand foot and mouth disease
Fever, sore throat, malaise for 2 days
Fever, sore throat, muffled voice, with child leaning forward with chin thrust forward suggests epiglottitis. Diagnosed with "thumbprint sign" on XR. Treatment is with airway management and antibiotics
Fever, sore throat, muffled voice, with child leaning forward with chin thrust forward suggests ________. Diagnosed with ________. Treatment is _____________
Signs and symptoms of Endocarditis
Fever, weight loss, EKG conduction abnormalities, Murmur, palor, splenomegaly, Splinter hemorrhage
What is the best drug to treat hypertriglyceridemia
Fibrates= Gemfibrozil and Fenofibrate
Special test DeQuervians
Finklestein
First line treatment for Tourette's is clonidine due to ability to control ADHD and OCD. Haloperidol and pimezole are more potent, but have worse side effects
First line treatment for Tourette's is __________ due to ___________. ___________ more potent, but have worse side effects
First line treatment for osteoporosis is Biphosphonates
First line treatment for osteoporosis is ____________
First line treatments for Parkinson's are levodopa for motor impairment, dopamine agonists (pramipexole, ropinirole) against to lower the risks of complications, and MAO inhibitors
First line treatments for Parkinson's are _____________
First-line treatments for CHF include: ACEIs low-dose BBs
First-line treatments for CHF include _____________
What do the later lesions of SJS/TEN look like
Flaaccid blisters that spread and break easy and leaving large areas of red exposed oozing dermis
SS ant shld dislocation
Flattened deltoid, fullness in anterior chest, prominence of acromion, guarding
FABER Test
Flexion, Abduction, and External Rotation The Faber test looks for pathology of the hip joint or sacrum (sacroiliac pain from sacroiliitis). The test is performed by flexing the hip and placing the foot of the tested leg on the opposite knee. Pressure is then placed on the tested knee while stabilizing the opposite hip. The test is positive if there is pain at the *hip or sacral joint or if the leg can not lower to the point of being parallel to the opposite leg* The FABER test should be done on all patients suspected of having sacroiliac pain, not just in the elderly patients. Sacroiliitis can occur in the young population as well.
Jersey Finger
Flexor tendon injury Pain and swelling at volar aspect of DIP jt Inability to flex at affected DIP jt
Signs and symptoms of left sided heart failure
Fluid on lungs Dyspnea Paroxsymal nocturnal dyspnea rales, ronchi chronic non productive cough Pink frothy sputum HTN S3 or S4
How do you treat Benzo intoxication
Flumazenil
diarrhea due to shigella should be treated with
Fluoroquinolone or if organism sensitive use trimethoprim sulfamethoxasole (bactrim)
Salmonella diarrhea tx with
Fluorquinolones
Hx of actinic keratosis and HPV increases the risk of squamous cell carcinoma
Hx of ______________ increases the risk of squamous cell carcinoma
Give example of thiazide Diuretics
Hydrochlorathiazide Chlorthalidone
Hypercalcemia results from: Increase in calcium resorption from bone Decreased renal excretion of calcium Increase in calcium absorption from GI
Hypercalcemia results from ___________
Physical exam emphysema
Hyperinflation Hyperresonance to percussion decrease/ abscent breath sounds decrease fremitus Barrel chest quite chest Pursed lip breathing
TX surgical and non surgical achilles rupture
Non: Cast and PT Surg: 2-3 months recover for ADL
Folic acid recommendations are: 400-800 micrograms/day (If Diabetic/Neuroleptic mom) 1 mg (If one child has neural tube defect) 4 mg
Folic acid recommendations are: 400-800 micrograms/day (If Diabetic/Neuroleptic mom) 1 mg (If one child has neural tube defect) 4 mg
Osmotic Laxatives examples and MOA
Nonabsorable solutes that draw fluid into the intestinal lumen Lactulose Milk of magnesia Magnesium citrate Sorbitol
Noncardiac causes of palpitations include: Anemia Electrolyte disturbance Thyroid disorder Hypoglycemia Hypovolemia Fever Pheochromocytoma
Noncardiac causes of palpitations include ________
Nonfunctioning thyroid nodules > 1 cm are examined with fine needle aspiration, which is highly sensitive and specific
Nonfunctioning thyroid nodules > __ are examined with __________, which is highly sensitive and specific
Stool specimen with < 3-4 WBC usually indicates
Noninflammatory
2 presentations of acute diarrhea
Noninflammatory or Inflammatory
If liver disease is suspected what labs should be ordered
Hepatitis A, B, C Antimitochondrial antibody screen for cirrhosis Serum iron, transferrin saturation and ferritin Urine copper levels
Hepatitis E is transmitted fecal-orally. Treatment is supportive
Hepatitis E is transmitted ______. Treatment is _________
Hepatitis B causes 80% of hepatocellular carcinoma
Hepatitis ___ causes 80% of hepatocellular carcinoma
Hepatitis B & C have the risk of becoming chronic. Risk is related inversely to age
Hepatitis ___ have the risk of becoming chronic. Risk is related _________
Hepatitis A is self-limited, but may turn into fulminant Hepatitis, if patient also has Chronic Hepatitis C
Hepatitis ___ is self-limited, but may turn into fulminant Hepatitis, if patient ________
Hepatitis e antigen usually replications and infectivity
Hepatitis e antigen usually __________
Tx Biceps tendon tear
Nonsurg: partial tears or elderly pts brace for 4 wks Surg: full tear in younger pts
what type of anemia would a man who was found to have incidental finding on CBC while in the hospital for alcohol abuse
Normal MMA and decreased serum folate level
Normal menstrual cycles are between 21-35 days
Normal menstrual cycles are between _________
MC cause of viral diarrhea in adults
Norwalk virus- cruise ships
What is Diastolic heart failure
Occurs due to muscles of heart unable to relax adequately and allow heart to fill appropriately
Pneumothorax
Occurs when potential space between the parietal and visceral pleura of the lungs fills with air and collapses the lung
Of the IBD, Ulcerative Colitis is a strong risk factor for colon cancer
Of the IBD, __________ is a strong risk factor for colon cancer
Only Orlistat is FDA approved for long-term treatment of obesity. Only Phentermine is FDA approved for short-term treatment of obesity
Only _________ is FDA approved for long-term treatment of obesity. Only _______ is FDA approved for short-term treatment of obesity
How do you treat moderate papular/ pustular and moderate nodular no scaring acne
Oral antibiotics, topical retnoid, topical benzoyl peroxide
What is the treatment for erysipelas
Oral antibiotics- bactrim, doxy, clinda
If topical antifungals dont treat tina corporis or cruris what can you use
Oral antifungal 7-14 days Terbinafine
Treatment of choice for Onychomycosis
Oral antifungals becuase topcial respond poorly ORAL: terbinafine 250mg daily 12 weeks
How do you treat severe nodular acne
Oral isotretinoin
30 year old male has both mild and persistent asthma and chronic environmental allergies. What medication is indicated for his management
Oral montelukast is indicated for both persistent asthma and chornic allergies
What class of drug should NEVER be used in psoriasis patients because it can severely flare the psoriasis upon discontinuation of drug
Oral steroids
TX for radiculopathy pain
Oral steroids NSAIDS Gabapentin Steroid injection PT
Joint pain that increases with use suggest what arthritis
Osteoarthritis
Osteoporosis is diagnosed with DEXA score of -2.5
Osteoporosis is diagnosed with __________
Complications of Measles
Otitis media and pneumonia
Direct damage to 8th cranial nerve results from
Ototoxic drugs or acoustic neuroma
Ottawa Ankle Rules apply to patients that are: Nonpregnant Normal mental status Do not have other injuries
Ottawa Ankle Rules apply to patients that are _________
What are some Physical exam findings of Pneumothorax
Hyperresonance percussion, tracheal deviation, decreased breath sounds, decreased tactile fremitis
Physical exam for pneumothroax
Hyperresonence decrease fremitus decrease breath sounds unequal respiration expansion Tachycardia tachypnea hypoxia hypotension
classes of obesity
I. BMI 30-34.9 II. 35-39.9 III. > 40
Snapping Hip
IT band snap over greater trochanter
IUD effective for 10 years is Paraguard T380. IUD effective for 5 years is Mirena
IUD effective for 10 years is ______. IUD effective for 5 years is _______.
If the use of an antidepressant triggers an episode of mania, suspect Bipolar disorder or drug abuse
If the use of an antidepressant triggers an episode of mania, suspect ____________
Initial studies for unstable angina include: CBC BUN Creatinine PT/INR PTT ECG CXR CK MB Troponin I and T
Initial studies for unstable angina include _____________
MC loctaion for Trigger finger
MP joint
Gold standard to Dx
MRI
Outpatient tx community acquired pneumonia
Macrolide (Azithromycin) or Doxycycline
Clinical Manifestations of Kaposi Sarcoma
Macular, papular, nodular plaque-like brown/pink/red or violaceous lesions
Torsades treatment
Magnesium
Majority of primary hyperparathyroidism is caused by adenoma of a parathyroid gland
Majority of primary hyperparathyroidism is caused by ____________
What is the MC valve affected by endocarditis and then the order MC to least common
Mitral-> Aortic-> Tricuspid-> Pulmonic
What do epidermal inclusion cysts look like
Mobile dermal nodule often with overlying punctum
Are people with latent TB contagious
NO
Tx for COPD inhaled corticosteroids should they be used as monotherapy
NO may be added to long acting bronchodilators Salmeterol + fluticasone
TX H.pylori
PPI, amoxicillin or flagly, clarithromycin, +/- PeptoBismaul
What is tinea versicolor (Pityriasis versicolor)
NOT A DERMATOPHYTE it is a colonization of malassezia a yeast
TX impingement
NSAIDS PT 6wks Steroid injection Arthoscopic repai
TX CAM impingement
NSAIDS and PT Surgical
Treatment for pericarditis
NSAIDS and steroids in severe cases
Best treatment for rheumatoid arthritis
NSAIDS initally, but due to progressive disease send to rheumatology for DMARDS (methotrexate)
Tx rotator cuff tear
NSAIDS, PT, possible steroid injection
Tx DeQuervians
NSAIDS, Thumb spica, Steroid injection
TX SCFE
NWB with crutches till surgery for pinning
What are the subtypes of basal cell carcinoma and which one is MC
Nodular- MC Ulcerated Pigmented Superficial Morphaform
Tx Non operative
Non op: wear figure 8 brace or sling
Chronic nausea and vomiting imaging recommended
Endoscopy or barium studies
What is a 2nd degree deep partial thickness burn
Epidermis + Deep dermis
What is a 3rd degree burn
Epidermis + Dermis + hypodermis
What is a 2nd degree superficial partial thickness burn
Epidermis + Superficial dermis
Treatment of Anaphylaxis
Epinephrine Beta Agonist: Albuterol Benadryl (H1 receptor blocker) tx cutaneous effects Cimetidine (H2 receptor blocker) tx rxn and urticaria Methylprednisolone 125mg IV 1x
what maneuver can be done to help treat Benign Positional Vertigo
Epley Maneuver
What is Leriche syndrome
Erectile dysfunction PAD in illiac artery Claudication
What is another name for 5ths disease
Erythema infectiosum Slapped cheek disease
Erythematous macular rash starting at the face and neck, moving to the trunk and extremities suggests Rubella or German measles
Erythematous macular rash starting at the face and neck, moving to the trunk and extremities suggests ______________
Erythematous macular rash starting at the forehead and moving down the body with Koplik spots suggests Rubeola or Measles
Erythematous macular rash starting at the forehead and moving down the body with Koplik spots suggests ____________
What is atinic keratosis
Erythematous papule or thin plaque with a rough or gritty scale appearance
What form of psoriasis is a Dermatologic Emergency
Erythrodermic posriasis
travelers diarrhea MC caused by
Escherichia Coli
Maisonneuves Fx
Eversion ankle stress deltoid, talus forced and distal syndismosis seperated and causes a rotational stress up fibula and causes proximal fibular fracture
MC bone to get a stress reaction
Tibia
Examples of anticholinergics
Tiotropium- spiriva Ipratropium- atrovent
What does Heroin intoxication look like
Track mars, euphoria, decrease consciousness and respiration
Vesicular enanthem on tongue on lips and mouth; maculovesicular rash on hands, feet, buttocks and groin suggests Hand, foot, and mouth disease by Coxsackie Virus
Vesicular enanthem on tongue on lips and mouth; maculovesicular rash on hands, feet, buttocks and groin suggests ____________ by _________
vertigo in association with viral illness is called ______ and when accompanied by hearing loss is called _____
Vestibular nerutisi Labyrinthitis
A young woman eats raw seafood and 2 days later develops fever, abdominal cramping, and watery diarrhea what is the most likely cause of her symptoms
Vibro
What does PCP withdrawl look like
Violence
MC cause of bronchitis
Viral (influenza A, B; parainfluenza; adenovirus)
Risk factors for Pulmonary emoblism
Virchows Triad: Hypercoag state, venous stasis, Vascular intimal injury
Treatments for venous insufficiency include: Compression stockings Leg elevation Low sodium diet, decreased fluid intake Weight loss Avoid aggravating medicines
Treatments for venous insufficiency include _______
What does ETOH withdrawl look like
Tremor (8-18 hrs), tachycardia, hypertension, agitation, seizure (48hrs) hallucinations
Trisomy can be screened at a prenatal visit during: Nuchal translucency at 1st trimester hCG and PAPP-A weeks 10-13 hCG, AFP, estriol at 2nd trimester hCG, AFP, estriol, inhibin weeks 16-18
Trisomy can be screened at a prenatal visit during ____________
What cardiac enzyme is most sensitive
Troponin
What cardiac enzymes are first to rise
Troponin
TX bronchial carcinoid tumors
Tumor excision
Best treatment for osteoarthritis
Tylenol and then NSAIDS nsaids have more side effects
Bupropion may be used on top of nicotine therapy for Smoking Cessation
__________ may be used on top of nicotine therapy for Smoking Cessation
Bupropion and Varenicline are "Pregnancy Category C" For Smoking Cessation
___________ are "Pregnancy Category C" For Smoking Cessation
Vaccinations CI during pregnancy include live MMR and live influenza
Vaccinations CI during pregnancy include ________
Vaccines available for HPV include Gardasil and Cerverix
Vaccines available for HPV include _____________
Vaccines contraindicated in HIV+ patients: Live MMR Live Varicella Live influenza
Vaccines contraindicated in HIV+ patients _______
TX SVT
Vagal maneuver Adenosine to medically convert Definitive radiofrequency ablation
Varenicline CI in: Psychiatric disorders Typically started 1 week before quitting
Varenicline CI in ___________ Typically started __________
Variable decelerations are due to umbilical cord compression during contractions
Variable decelerations are ___________
"Clock draw" and "three-item recall" are fairly reliable when assessing dementia
___________ are fairly reliable when assessing dementia
Tx 5th metatarsal fx zone 1
Walking boot
TX for stress fracture
Walking boot and NWB 2-12 weeks depending on extent
What is another name for atypical pneumonia
Walking pneumonia
Treatment for A-fib
Warfarin or a blood thinner of some type and possibly medication of control their rate
How do you treat bedding, clothing, and other items for scabies
Wash clothing and bedding HIGH HEAT Items bag for 3-7days then wash off
What is hamoptons hump
Wedge shape infarct on Cxr for PE
what are non drug treatments for HTN
Weight loss Dash diet- sodium restriction <2.4 g/ day smoking cessation Exercise >30min most days Limited alcohol comsumption
What does Tinea versicolor look like
Well demarcated tan, salmon, or hypopigmented patch
What are other treatments for lice
Wet combing treat contacts
Classic triad for foreign body aspiration symptoms
Wheezing Cough Deminished breath sounds
When a subarachnoid hemorrhage is suspected, but not proven by dry CT, perform a lumbar puncture
When a subarachnoid hemorrhage is suspected, but not proven by dry CT, perform a __________
When a women expresses postpartum depression, SSRIs are 1st line, pregnancy-safe and breastfeeding-safe
When a women expresses postpartum depression, ______ are 1st line, ___________
When an individual has an acute infection of Hepatitis, serology shows Antibody Hepatitis core antigen IgM
When an individual has an acute infection of Hepatitis, serology shows _____________
When an individual has been vaccinated for Hep B, serology shows Hepatitis B surface antibody
When an individual has been vaccinated for Hep B, serology shows ____________
When anterior shoulder does not readily pass through pubic symphysis, suspect shoulder dystocia. McRoberts maneuver or hyperflexion of the hips, episiotomy, rotation, or suprapubic pressure usually work
When anterior shoulder does not readily pass through pubic symphysis, suspect ____________. ___________ usually work
When bereavement lasts > 2 months, considered depression
When bereavement lasts ____, considered depression
When choking, perform Heimlich or back blows (in infants). If at the hospital, bronchoscopy
When choking, perform ____________. If at the hospital, __________
When dealing with a possible MI, workup includes: EKG CBC BUN Creatinine PT INR PTT CXR CKMB Troponins
When dealing with a possible MI, workup includes _______________
When following up with narcotic use, inquire about constipation
When following up with narcotic use, inquire about ____________
When hypoglycemia is observed, administer 50% dextrose
When hypoglycemia is observed, administer ____________
When managing possible depression, r/o: Hypothyroidism Anemia Toxic screen
When managing possible depression, r/o ____________
When performing physical exam on HTN patients, evaluate: Retinopathy Obstructive sleep apnea Palpate thyroid Bruits Peripheral pulses Organomegaly
When performing physical exam on HTN patients, evaluate _______
When suspected CVA seen, perform dry CT to r/o hemorrhage, tumor, or abscess. CBC, CMP, Lipid, ESR, ANA, Serology, A1c, EKG are indicated as well
When suspected CVA seen, perform __________
When suspecting hepatitis, inquire about: Medications IV drug use Blood transfusions Sexual histories Tattoos Travel and contaminated foods (Hep A)
When suspecting hepatitis, inquire about _________
What does heroin withdrawl look like
Yawning, sweating itching, pain, lacrimation
What does opiate withdrawl look like
Yawning, sweating, lacrimation, pain, itching
What is a pustule
a pus filled papule
What is a furuncle
a pus filled sac >1cm
eye emergencies that are sight threatening are:
acute close angle glaucoma iritis corneal ulceration
What is Steven Johnson Syndrome and Toxic Epidermal Necrolysis Syndrome
acute life threatening mucocutaneous reaction characterized by extensive necrosis and detachment of the epidermis and mucosal surfaced
What age should women get mammograms and how often
age 40 and then screen every 1-2 years pending results
SS compartment syndrome
Pain perasthesia pluslessness pallor paralysis shiny skin
Pain in the hip, thigh, or groin in an obese individual or athlete suggests slipped capital femoral epiphysis
Pain in the hip, thigh, or groin in an obese individual or athlete suggests _________________
Sings and symptoms Clavicle Fx
Pain to ant. clavicle, visible deformity, grinding with ROM, tenderness, crepitus
What does 2nd degree superficial partial thickness burn look like
Painful, blisters, blanch with pressure
What do 4th degree burns look like
Painless, black, dry
What does a 3rd degree burn look like
Painless, waxy/white, dry and leathery
Dupuytrens Contracture
Palm fibromatosis Nodular thickening and contraction palmar fascia
Pap smears are recommended annually. If three consecutive normal paps occur, may space out to every 3 years
Pap smears are recommended ________ . If ______ consecutive normal paps occur, may space out to _________
In Hypertensive Crisis what is an easy way to determine acute organ damage
Papilledema (Optic disc edema)
What does impetigo look like
Papules, plaques, bullae, or ulcerative areas with overlying honey-colored crust
What cases Measles
Paramyxovirus
How do you make definitive dx of TB
Positive ID of M. Tuberculosis from culture (6-8wks to grow) or DNA or RNA amplification technique (1-2days)
MC type of hip dislocation
Posterior
Postexposure risk to HIV involves treatment with: Immediate cleaning with PEP Antiretroviral therapy ...within 2 hours x 4 weeks
Postexposure risk to HIV involves treatment with __________
Postpartum fever, uterine tenderness, and foul-smelling lochia suggests endometritis
Postpartum fever, uterine tenderness, and foul-smelling lochia suggests ____________
What is the treatment for nummular eczema
Potent topical steroid ointment (Fluocinonide)
Tx vitiligo
Potent topical steroids Photo therapy
What cuases molluscum
Pox virus
stages of behavior change
Pre-contemplative - Not aware of need to change or not interested in changing behavior. Contemplative - Currently interested in changing behavior. Active - Currently making a behavior change. Relapse - Attempted behavior change but no longer making the change.
Minor criteria of Duke Criteria
Predisposing factors (abnormal valve, IVDU, Indwelling cath) Fever > 100.4F Vascular (Janeway lesions, pulmonary emobli) Immuno: (Osler nodes, Roth spots) Echo not meeting major criteria Positive blood culture not meeting major criteria
Risk factors Vericose veins
Pregnancy Obesity family history prolonged sitting or standing history of phlebitis
Pregnancy Category B: Not good in animals Ok in humans Ok in animals Not tested in humans
Pregnancy Category B _______
Pregnancy Category C Not good in animals Not tested in humans Not tested in animals or humans
Pregnancy Category C _________
Pregnancy Category D: Not good in humans
Pregnancy Category D ________
Prehepatic jaundice is typically from hemolysis of RBCs, causing unconjugated hyperbilirubinemia Hepatic jaundice may cause un/conjugated hyperbilirubinemia Posthepatic jaundice typically due to obstruction of the flow to the bile causing conjugated hyperbilirubinemia
Prehepatic jaundice is typically from ______, causing ___________ Hepatic jaundice may cause __________ Posthepatic jaundice typically due to ___________, causing ___________
What are PVC
Premature ventricular contractions
What is the gold standard for Dx PE
Pulmonary angiogram
Tx little league shoulder
Rest till sx subside and pain free ROM gradual return to throwing
TX foreign body aspiration
Rigid bronchoscopy
What is tinea corporis
Ringworm, sharply marginated erythematous annular plaque with central clearing
Tx for PAD
Risk factor modifications BB, ACEI, Statins Antiplatelet therapy with aspirin or clopidogrel Revascularization srugery
Risk factors of breast cancer: FMHx BRCA-1 BRCA-2 Early menarch, Late menopause
Risk factors of breast cancer ______
What is the number 1 risk factor for lung cancer
SMOKING
If patient presents with multiple erythematous papules on the trunk, extremities, and genitals, and burrows present in 2-3rd web spaces what is the likely diagnosis
Scabies
sandpaper like exanthems and Strawberry tongue can indicate
Scarlet Fever
What is the Koebner Phenomenon
Scratching causing the spread of skin infection
What is pancoast syndrome
Shoulder pain hroners syndrome (miosis, ptosis, anhydrosis) atrophy of hand/arm muscles
What degrees require surger
Sometime III Always 4, 5 and 6
If suspect PE what test is best to perform
Spiral CT or Ventilation/perfusion test
Spiral fracture of femur or humerus is suspicious of child abuse
Spiral fracture of ________ is suspicious of child abuse
Give example of potassium sparing diuretics
Spironalactone Amiloride
What are common agents used to treat hormonal acne
Spironolactone 50-100mg daily Oral contraceptives
Tx mallet finger
Spling 6-8 wks and surgery if splint fails
Which type of non small cell is typically associated with cavitary lesions
Squamous cell
Which type of non small cell is typically located centrally
Squamous cell
Substernal pressure for < 30 minutes, radiating to the arm, neck, jaw, with dyspnea; aggravated with exertion, improved with rest suggests Angina
Substernal pressure for < 30 minutes, radiating to the arm, neck, jaw, with dyspnea; aggravated with exertion, improved with rest suggests ____________
Substernal pressure for > 30 minutes, radiating to the arm, neck, jaw, with dyspnea; aggravated with exertion, improved with rest suggests MI
Substernal pressure for > 30 minutes, radiating to the arm, neck, jaw, with dyspnea; aggravated with exertion, improved with rest suggests ____
SS pneumothorax
Sudden onset chest pain Shortness of breath dyspnea cough +/- pain prominent in back and shoulders
SS hospital acquired pneumonia
Sudden onset fever productive cough tachycardia and tachypnea
Sudden onset of pleuritic pain, with tachycardia, tachypnea, and hypoxemia suggests pulmonary embolism
Sudden onset of pleuritic pain, with tachycardia, tachypnea, and hypoxemia suggests ______________
Sudden onset of tearing pain with radiation to the back suggests aortic dissection
Sudden onset of tearing pain with radiation to the back suggests _______________
Sulfonylureas benefit DM by stimulating pancreatic beta-cells to secrete insulin
Sulfonylureas benefit DM by _________
Treat melasma
Sun avoidance Daily sunscreen atleast SPF 30 Hydroquinone cream BID
What is folliculitis
Superficial bacterial infection of the hair follicle
What are the 4 types of Melanoma
Superficial spreading Lentigo Acral Lentiginous Nodular
What are the 2 MC forms of melanoma
Superficial spreading Nodular
Superficial spreading melanoma typically found in the elderly is the Lentigo Maligna. Most patients reside in Hawaii
Superficial spreading melanoma typically found in the elderly is the _____________. Most patients reside in _________
What is a 1st degree burn
Superficial, epidermis involved
Treatment Hand foot and mouth disease
Supportive Self limiting 10 days
Treatment Measles
Supportive anti-inflammatories Isolation 1week from onset rash
What is treatment for Rubella
Supportive and anti-inflammatories
TX amphetamine overdose
Supportive care
Tx walking pneumonia
Supportive care
TX for bronchitis
Supportive care Oral steroids or steroid inhaler Cough med: tylenol with codine or dextromethorphan Bronchodilators
Treatment 5ths disease
Supportive therapy Self limiting 5-10 days
Stage 1 of labor: (Latent) 1-3 cm cervix dilation (Active) 4 cm- complete dilation Stage 2: Complete dilation - delivery of baby Stage 3: Delivery of baby - delivery of placenta
Stage 1 of labor ________. Stage 2 ___________. Stage 3 ___________.
Treatment temporal arteritis
Steroids
If blood or WBC present in stool specimen then order
Stool culture
How do you treat Drug induced hypersensitivity syndrome
Stop all non-essential medications Consult Dermatology
Treatment of fixed drug eruption
Stop offending agent Lesions resolve days to weeks after drug stopped Tx with either topical steroid ointment or antimicrobial ointment
How do you treat an exanthematous drug reaction
Stop offending medication Resolves in a few days to a week Can use topical steroids, oral antihisamines, and reassurance
How do you treat minor burns
Stop the burning process Pain control- NSAIDS Wash area with soap and water Apply topical ointment
Special tests for radiulopathy
Straight leg raise pain recreated at less than 60 degrees of hip flexion
If a pt has rust colored sputum what is the MC causative agent
Strep Pneumonia
MC cause of community acquired pneumonia
Strep pneumoniae
Guttate psoriasis is often preceded by
Streptococcal pharyngitis
MC cause of Pneumonia in an HIV + patient
Streptococcous pneumonia or Pneumocystis Jiroveci if CD4 cound <200
Most common cause of community acquired pneumonia
Streptococcus pneumonia
What is little leagures shoulder
Stress fx of proximal humeral physis
Treatment for tension headaches
Stress reduction biofeedback NSAIDS 400-600 mg TID
Strokes that affect small branches of the main arteries of the brain are called lacunar infarcts
Strokes that affect small branches of the main arteries of the brain are called ____________
Strongest evidence supports the use of amitriptyline, propranolol, timolol, and divalproex sodium for migraine headache prevention
Strongest evidence supports the use of ____________ for migraine headache prevention
Treatment vericose veins
TED stockings Leg elevation regular exercise
What are Osler Nodes
TENDER nodes on pads of digits
If a pregnant woman gets Rubella it is considered what syndrome
TORCH
What are the types of diuretics
loop potassium sparing thiazide
Examples of ototoxic drugs
loop diuretics aminoglycoside abx
example of antimotility drugs
loperamide
What is skin erosinon
loss of part of or all of the epidermis
SS walking pneumonia
low grade fever dry nonproductive cough myalgia fatigue sore throat Head ache nausea/ vomiting/ diarrhea Red TM Bollous Myringitis- rare
What is the clinical presentation of Rubella
low grade fever, sore throat, cough, lymhadenopathy and pruritic pink to red macules begin on face and spread to trunk over 24 hours
SS for Drug induced hypersensitivity syndrome
macular exanthem, erythematous centrofacial swelling, fever, malaise, lymphandenopathy
Medications to treat labyrinthintis, vestibular neuritis, BVP include
meclizine, dimenhydrinate, antiemetics, and benzodiazepines
Night stick fracture
mid to distal ulnar fx
IBS affects- age range and M or W more?
middle age young adults 2:1 females over males
CXR for primary TB shows
middle or lower lobe consolidation
At 16 weeks gestation where should you feel the fundal height
midway between the pubis symphysis and the umbilicus
symptoms of tension headache
mild- moderate intensity bilateral bandlike pain
children should ride in a rear facing car seat until
more than 20 lbs and older than 1 year old
With nummular eczema will KOH be positive or negative
negative
vertigo
sensation of room spinning
What can Rubella cause to an unborn fetus
sensorineural deafness mental retardation eye abnormalities Congenital heart dz hip displasia
in 3rd trimester bleeding...Do not perform a digital or speculum vaginal examination until what is confirmed and why
normal placental position is confirmed by US, as disruption of the cervical-placental junction could precipitate catastrophic hemorrhage.
Symptoms of cluster headache
severe unilateral localized to periorbital/temporal area 1 of the following: lacrimation, rhinorrhea, ptosis, miosis, nasal congestion, eyelid edema
What does seborrhic keratosis look like
sharply marginated pigmented lesion that appears waxy and "stuck on"
Q waves on EKG=
old or recent MI
What other disease of the foot is tinea pedis associated with
onychomcosis- fungal infection toenail
When do you operate on Clavicle fx
open fx neurovascular injury associated tenting of skin multiple segments dominant arm of overhead athlete
Treatment of Uticaria
oral antihistamines Benadryl Avoid trigger in future
physical exam for dizziness/vertigo should include
orthostatic blood pressures ear exam neurologic exam hearing assessment
morning stiffness that lessens with movement and then prolonged standing or walking may worsen symptoms indicates what type of arthritis
osteoarthritis
Meniscal tear
pain and swelling joint line + thessalys and McMurrays
SS Cam impingement
pain in groin region sharp pain with turning or twisting catching and clicking
What is angioedema
painless, deeper form of uticaria affecting lips, tongue, eyelids, hands and feet
medical conditions associated with depression
parkinsons, hypothyroidism, dementia
What are the xray findings associated with rheumatoid arthritis
periarticular soft tissue swelling periarticular osteopenia uniform loss of joint space bony erosions
Diffuse ST elevation on EKG =
pericarditis
SS spondylolysis
persistant pain and risk of progression
2 forms of chronic diarreha
persistent or recurrent
What is the danger of Atinic Keratosis
premalignant lesions that have the potential to develop into skin cancer- SCC
What is Abruptio Placenta
premature separation of a normally implanted placenta from the uterine lining
primary vs secondary headaches
primary: no underlying cause: migraine, tension, cluster Secondary: result underlying cause mass, infection, CVA, drug withdrawl, metabolic disorders
Symptoms of bacterial Diarrhea
prodrome fever, headache, anorexia, fatigue, stools watery then become bloody
What is Secondary (reactivation) TB
reactivation of latent TB with waning immune defenses
SS foreign body aspiration
respiratory distress cyanosis altered mental status wheezing decrease air entry cough
How is Measles spread
respiratory droplets
How is Rubella spread
respiratory droplets
What is the pahtophys behind chronic bronchitis
productive cough 2-3months x 2 years consecutivley chronic airway inflammation causing increase airway resistance and mucous plugging
itching, watery (tearing) discharge from the eye indicates
allergic
SS of asthma
progressive SOB non-productive cough wheezing all lung fields chest tightness from decrease air flow
Compartment Syndrome
prolonged elevation of compartment pressure and decrease blood supply
If paitent younger than 40 with COPD you should suspect the cause to be
alpha 1 antitrypsin deificency
what could cause a false + on the skin TB test
pt had the BCG vaccination within 2-10 years
DO NOT use antidiarrheal meds when
pt with a fever or suspect infectious or inflammatory diarrhea
What is chronic (latent) TB
pts control initial primary infection via granuloma formation and become PPD + in 2-4 wks
WBC casts in urine indicate
pyleonephritis or interstitial nephritis
antibiotic use within 2 weeks and diarrhea suggests
alteration in bowel flora or Clostridium Defficile
What is pityriasis rosea
an acute exanthematos eruption that mainly occurs in young people pathogen not understood
What is a fixed drug eruption
an adverse drug reaction characterized by formation of a solitary erythematous patch or plaque that will recur at the same site with re-exposure to the drug
What is uticaria
an allergic reaction that results in hives or wheals
presence of bile in vomit suggests
an open pylorus
Colonoscopy indicated for constipation when:
anemia, weight loss, heme-positive stools, suspected malignancy
What is a herald patch
annular red 2-10cm patch anywhere on body with peripheral scaling and central clearing
Treatment of V tach Stable sustained
anti-arrhytimics ( amioderone, lidocaine)
Ventricular arrhythmias are treated with
antiarrhythmics and an implantable defibrilator
Treatment allergic conjunctivitis
antihistamines
How do you use the shampoo for tinea versicolor
apply to body let stand 10min then rinse repeat daily for 4 weeks
Clinical manifestations of bronchial carcinoid tumors
asymptomatic carcinoid syndrome (diarrhea, flushing, wheezing , hypotension)
crossed leg raise
asymptomatic leg is raised Test is positive if pain is increased in the contralateral leg; this correlates with the degree of disc herniation. Such results imply a large central herniation. Cross SLR test is much less sensitive (0.25) but is highly specific (about 0.90). Thus, a negative test is nonspecific, but a positive test is virtually diagnostic of disc herniation.
Osteoperosis is present with what T score
at or below -2.5
What is a common cause of peripheral vascular disease
atherosclerosis
What is Tinea pedis
athletes foot fungal infection
Small cell lung cancer tends to originate where and metz where
central bronci and metz to regional lymph nodes
Initial therapy fro lymphadenitis
cephalosporin, erythormycin, or dicloxacillin
What are some risk factors for placenta previa
cesarean delivery, multiple uterine surgeries, advanced maternal age, minority group status, cigarette smoking, and cocaine use.
if child is not getting better with pneumonia when they return to the office in 24 to 48 hours....
change Ab
What are clinical manifestations of lung cancer
changing cough hemoptysis pain anorexia wt. loss lymphadenopathy hepatomegaly clubbing of fingers Parneoplastic syndrome
Treatment viral conjunctivitis
rest, cool compresses, time
How can most spider bites be treated
rest, ice and elevation wound cleaning Tetanus shot if out of date
Symmetric polyarthritis is consistent with
rheumatoid arthritis
What is impetigo
common superficial bacterial infection of skin from Staph aureus
Staph aureus diarrhea from
custard filled pastries
What is rhinophyma and another name for it
dermal and sebaceous gland hyperplasia of the nose "whiskey nose"
most frequenct cause of new blindness among aduls
diabetes
Antispasmotics drugs example
dicyclomine
What are side effects of bisphosphonates that are used to treat osteoperosis
esophagitis, gastritis must take on an empty stomach with a full glass of water and stay upright 30min after taking
How often should you get a pap
every 3 years if normal
What is hyperlipidemia
excess lipids in blood
How do you treat basal cell carcinoma
excision with 3-4mm margins
What is stable angina
exertional pain lasting 5-15 min and relieved by rest or nitro, ischemia
S/S anterior hip dislocation
external rotaion shortened flattened lat hip Inability to ADD and IR
An infection of the glands Zeis of the eye causes
external-hordeolum
muscle atrophy and low back pain
f quadriceps and calf muscles; lack of atrophy, despite patient's complaints of long-term weakness, suggests malingering.
SS biceps tendon tear
felt a pop ecchymosis decrease AROM and MMT
What is a macule
flat spot less than 1cm
What is a vesicle
fluid filled papules that are <1cm
What is a bulla
fluid filled sac >1cm
What are common triggers for uticaria
food, medications, infections, insect bites, environmental
What is systolic HF
hearts inability to pump blood forward in ciruclating system "loss of squeeze"
What is CURB 65 score
help determine admit status of older pts with pneuo
painful nodules on or along the lid indicate
hordeola/ chalazion
What is the inital tx of choice for tinea pedis
hygine and topical antifungals
What will you see on a KOH prep for tina pedis
hyphae
When patients are prescribed Oral isotretinoin they must also sign what
iPLEDGE Females must enroll in FDA program and must use 2 forms of contraception and for 1 month after treatment has ended
cause of elevated conjugated bilirubin
impaired excretion of bilirubin from the liver
What does hyperinflation look like on PFT's
increase lung volume Increase RV, TLC, and FRC
obesity metabolic effects on the body
increases + insulin resistance +LDL +VLDL +TG decreases +HDL
What are individual risk factors for Melanoma
increasing age Fair skin Greater than 100 acquired nevi Atypical nevi Personal or family hx
What is seborrheic dermatitis
inflammatory reaction to to Malassezia yeast that thrives on oily skin
How do you get Salmonella
ingesting contaminated poultry or eggs
What is the treatment for stasis dermatitis
leg elevation, topical corticosteroids, compression therapy
What does Inverse/flexural psoriasis look like
lesions located in the skin folds
What level of ankel brachial index indicates PAD
less than or equal to 0.9
Oval fat bodies in urine indicate
lipiduria and nephrotic syndrome
What are risk factors for cellulitis
local trauma- bug bite, laceration Underlying skin infection edema and impaired lymphatics Preexisting skin infection
What is Dariers Sign
localized uticaria appearing where the skin is rubbed (Histamine induced)
how do the lesions of SJS/TEN initally start
located face, trunk, proximal extremities and spread erythematous irregularly shpaed dusky red to purpuric macules
what is the most commonly dislocated joint
shoulder
Where doe you get tina pedis from
showers, gyms,
Differential diagnosis for hematruia
sickle cell glomerulonephritis benign familial hematuria Renal vein/artery embolus TB pyleonephritis Polycystic kidney disease Interstitial nephritis tumor stones cystitis prostitis urethritis BPH
What is the secondary eruption of pityriasis rosea
similar salmon colored oval patches and plaques erupt symmetircally over trunk and proximal extremities (Christmas tree pattern)
How do you spread molluscum
skin to skin contact, fomite exposure, autoinoculation Associated with public water- pools hot tubs Wrestlers
CXR for miliary TB shows
small millet-seed like nodular lesions 2-4mm
what is the main cause of death in this country
smoking (lung cancer, ischemic heart disease, COPD)
What is a lipoma
solitary collection of fat under the skin
What is allergic contact dermatitis
source of vessicles that the main symptom is itching
What is Bowens disease
squamous cell carcinoma in situ and does not affect the dermis
What stage of sleep do sleep terrors occur
stage 3 and 4 (delta sleep)
What stage of sleep does sleepwalking occur
stage 3 and 4 of sleep in first 1/3 of the night & REM sleep later in the night
What is the common pathogen for folliculitis
staph aureus
How does pityriasis rosea initally appear
starts with a herald patch
Tx narcolepsy
stimulants- dextroamphetamine
diagnostic tests for acute diarrhea
stool specimen
Chronic nausea and vomiting usually caused by
structural lesions affecting the upper GI tract
new onset worst headache of my life
subarachnoid hemorrhage
nonblanching red "spot" painless without visual changes or discharge from eye indicates
subconjunctival hemorrhage
What is primary TB
the outcome of initial infection and usually self limited
What does crusted scabies look like
thick scaly white-grey plaques with minimal pruritis and localized to scalp, face, back, buttocks, and feet
What is Breslows depth
thickness of primary melanoma measured from the granular layer of epidermis to deepest part of tumor
AUDIT-C
three item alcohol screen that can help identify persons who are hazardous drinkers or have active alcohol use disorders
Pulmonary Embolism arise from
thrombi in system venous circulation or from the right side of the heart
treatment subconjunctival hemorrhage
time resolve over 7-14 days
What is Vasa Previa
umbilical vessels course in the amniotic membrane at the level of the cervical os, so that when the cervix begins to dilate in labor with membrane rupture, the blood vessels tear
Migraines require 2/4 characteristics to diagnosis migraine and associated with atleast 1 of the following 4 symptoms
unilateral location pulsatile quality moderate to sever intensity aggravation by movement photophobia, phonophobia, nausea, vomiting
Menieres disease
unkn etiology causes endolympatic hydrops and increased pressure in semicircular canals and damages the sensory hair cells
how long can a post infectious cough occur from a viral illness
up to 8 weeks
When do symptoms of Drug induced hypersensitivity syndrome usually occur
usually around 3rd week of new medication or new dose
Mechanism for posterior shoulder disslocation
usually seizure or electrical injury
What can cause abruptio placenta
uteroplacental insufficiency and fetal distress or demise or trauma
What underlying disease is stasis dermatitis often associated with
venous insufficiency
mode of examination for breasts
vertical strip pattern
What does dishydrotic eczema look like
vesiculopapules on palms and soles and sides of fingers "Tapioca pudding"
clear, mucoid discharge from the eye indicates
viral conjunctivitis
Labyrinthitis (vestibular neuronitis)
viral infection of the semicircular canals causing vestibular dysfunction and vertigo
treatment hordeolum or chilazion
warm compress may require abx ointment or drainage
How should clothing and bedding be treated for lice
washed and dryed HIGH HEAT
Noninflammatory diarrhea
watery
symptoms of a viral gastroentereitis
watery stool, low-grade fever, headache, nausea, vomiting, achiness
how to calculate BMI
weight in kg/ height in m^2
Tx sleep apnea
weight loss CPAP
When should you suspect secondary hyptertension
when hypertension is refractory to treatment with medication and diet
Who is usually affeced by Molluscum contagiosum
young kids sexually active adults Immunocompromised pts
when does a quad screen occur
- 15 to 20 weeks
amniocentesis
- 15 weeks - risk of spontaneous abortion - 1/300 to 1/500
Nodular melanoma grows how
Vertical and rapid
What is anaphylaxis
A lifethreatening allergic reaction
What type of non small cell is MC type in smokers, women, and nonsmokers
Adenocarcinoma
Which type of non small cell is typically located in the periphery
Adenocarcinoma
What is the MC cause of embolic stroke
Atrial Fibrilation
Lab test for constipation
CBC, BMP (electrolytes), TSH, Calcium
PE treatment
Heparin and warfarin started and bridge to warfarin
What is the true name for a brown recluse spider
Loxosceles Reclusa
Treatment of acute MI
MONA has HepB Morphine Oxygen Nitro Aspirin Heparin Beta Blocker
how do you diagnose temproal arteritis
Temporal artery biopsy
What are the cardinal features of Meniers
Vertigo, tinnitus, and hearing loss
high pitched bowel sounds are an early sign of
bowel obstruction
5th metatarsal Fx zone 2
"Jones fx" Fx extended 4/5 articulation
"Olive-shaped mass" suspect pyloric stenosis
"Olive-shaped mass" suspect ___________
5th metatarsal Fx zone 3
"Pseudo Jones Fx" Stress fx extend diaphysis for 1.5cm
categoriations of alcohol use
"Risky/hazardous drinking" means the patient's alcohol consumption exceeds the National Institute on Alcohol Abuse and Alcoholism per occasion threshold for men of 4 drinks per occasion. "Problem drinking" entails significant physical, social, or psychological harm from drinking. "Alcohol abuse" requires a maladaptive pattern of use with one or more of the following: Failure to fulfill work, school, or social obligations Recurrent substance use in physically hazardous situations Recurrent legal problems related to substance use Continued use despite alcohol-related social or interpersonal problems "Alcohol dependence" requires three or more of the following: Tolerance Withdrawal Substance taken in larger quantity than intended Persistent desire to cut down or control use Significant time spent obtaining, using, or recovering from alcohol use Social, occupational, or recreational tasks are sacrificed Use continues despite physical and psychological problems
"Rust-colored" sputum is suggestive of Strep pneumonia
"Rust-colored" sputum is suggestive of ___________
"Sausage-shaped mass" suspect intusussusception, commonly located at ileocecal junction
"Sausage-shaped mass" suspect ________________, commonly located at ________
"Slapped cheek" rash followed by a lacy, pruritic exanthem on the trunk suggests Parvovirus B19
"Slapped cheek" rash followed by a lacy, pruritic exanthem on the trunk suggests _____________
"Thinner" gray vaginal discharge, with a "fishy" order suggests bacterial vaginosis .Discharge has a pH of > 4.5
"Thinner" gray vaginal discharge, with a "fishy" order suggests _____________. Discharge has a pH of ____
"Tightness" sensation of chest, dyspnea, and tachycardia suggests anxiety
"Tightness" sensation of chest, dyspnea, and tachycardia suggests _____________
"Typical" pneumonia organisms are common in the very young or very old. "Atypical" pneumonia organisms are common in adolescents and young adults
"Typical" pneumonia organisms are common in ___________. "Atypical" pneumonia organisms are common in ___________
"Worst headache" suggests subarachnoid hemorrhage
"Worst headache" suggests ____________
What is the parkland formula
% burnd x Body weight in kg x 4 half of the formula needs to be replaced in 1st 8 hours The second half given over the next 16 hours
targeted HR calcuation
(220-age) X (.7-.8)
Special test achilles rupture
+ Thompson test
Tension pneumothorax
+ air pressure pushes lung, trachea and heat to opposite side
different quadrants of the abdomen
-
peds weight management recommendations
-
age of initiating diabetes screening in children
- *10 years of age or at onset of puberty, whicever is earlier - screen every 3 years*
intermittent asthma
- - < 2 days/week - treat with SABA PRN
when is LABA used in kids with asthma
- - used daily in kids with moderate persistent and severe asthma in addition to medium dose inhaled corticosteroids and SABA rescue meds -
moderate or severe persistent asthma
- -daily symptoms or symptoms throughout the day - SABA PRN w/ medium dose inhaled corticosteroids
MciSaac Decision Rule
- 1 pnt for each of the following: 1. fever more than 38 - absence of cough -tonsillar exudate -anterior cervical lymphadenopathy -age less than 15 - take one pnt away for age older than 45 - <1 = symptomatic treatment - 2 or 3: order strep test and treat with Ab dependent on results - >4: order throat culture and start empiric Ab
eclampsia
- 1+ convulsions in the presence of preeclampsia - highest risk in white, nulliparous women from lower socioeconomic backgrounds and women older than 25 and in teens and low twenties
how many episodes are needed to Dx tension, cluster and migraine headaches?
- 10 for tension - 5 for migraine and cluster
quadruple therapy
- 10-14 days (75-90% eradication rate) -PPI standard dose once or twice daily (OR ranitidine 150 mg twice daily) - metronidazole 250 mg four times daily - tetracycline 500mg four times daily - bismuth subsalicylate 525 mg four times daily
sensory foot testing in diabetes
- 10g monofillament + either vibration w/ 128hz fork, pinprick, ankle reflex or vibration perception threshold
how much vitamin D and Ca should women over 50 consume
- 1200mg of Ca and 600 IU vit D
preeclampsia
- >140/90 on at least 2 readings in a woman with previously normal BP and is over 20 weeks gestation WITH proteinuria of .3 grams in 24 hour urine sample or 1+ or 30mg/dL on dipstick on two occasions - most likley in women who develop gestational htn early in pregnancy - most common in african american women - r/o HELLP syndrome via evaluation of renal and liver function and CBC
age RF for HTN
- >55 men - >65 women
guidelines for glycemic control
- A1c <7% prevents microvascular disease
CMV follow up guidelines
- ABR or otoacoustic emissions until at least 12 mo- then age appropriate - recommended for patients when newborn then at 3, 6, 9, 12, 18, 24, 30, and 36 months then annually until school age - ophthamloscopy (vision function): test when patient is newborn, 12 months, 3 years and preschool - neuro exam/developmental asessment by primary care physician: perform at each check up until patient is school age - neuro: as indicated by clinical findings
ACA mammography guidelines vs USPTF guidelines
- ACA: every year starting at 40 - USPTF: every other year from 50-74
HTN medication for general non-black population including those with diabetes
- ACE-I -ARB -CCB - or thiazide ( JNC 8 recommends against using an ACE-I in black patients, even those with diabetes)
management of systolic HF
- ACE-I : reduced mortality and hospitalizations -ARBs: also reduce mortaity -digoxin: -loop diuretics -metoprolol - eplerenone
HTN meds for population with CKD
- ACE-I or ARB
when is hemarthrosis seen
- ACL tear - knee sprain -acute meiscal tear
x ray view to evaluate for OA
- AP, lateral and standing weight bearing views should be obtained
graves disease aka toxic diffuse goiter
- Ab that acts at the TSH receptor (thyrotropin receptor antibodies/thyroid stimulating immunoglobulins) - hypervascularity may result in bruit or thrill upon auscultation -exophthalmos & eyelid retraction is characteristic - corneal irritation due to eyelid retraction - increased radioactive iodine uptake - pretibila myxedema - thyroid peroxidase antibodies - treatment does not help the eye manifestations
pap smear recommendations
- At 21 years of age -- cervical cancer screening should begin. Between the ages of 21-29 years -- screening should be performed every three years. Between the ages of 30-65 years -- screening can be done every three years with cytology alone, or every five years if co-tested for HPV. Women older than 65 years who have had adequate screening within the last ten years may choose to stop cervical cancer screening. Adequate screening is three consecutive normal pap tests with cytology alone or two normal pap tests if combined with HPV testing.
anti-anginal medications
- B blockers: decreases myocardial oxygen consumption by slowing HR and decreases BP - CCB: dilate coronary arteries and increase coronary blood flow while also decreasing myocardial oxygen consumption -nitrates: dilate systemic and coronary arteries but are primary venodilators. the anti-ischemic effect of nitrates is due to systemic venodilation that leads to reduced preload and a decrease in myocardial oxygen demand
bariatric surgery
- BMI >40 or BMI >35 with associated health complications who have not succeeded in losing weight with other treatment methods -
BMI guidelines in periatrics
- BMI age and sex specific percentiles are used to interpret the BMI - the amount of body fat changes with age and the amount of body fat differs between girls and boys - Pediatrics: +healthy: 5th-85th percentile +overweight: 85th-95th percentile -obese: >95th %
when evaluation for BPH what should you check. flow rate? voided volume?
- DRE, urinalysis, PSA, BUN & creatinine -urine flow rate and post-void residual urine volume - flow rate greater than 15 basically excludes bladder outlet obstruction - voided volume should be more than 150ml
what tests are indicated in initial workup of essential HTN
- EKG, urynaliysis, blood glucose, Hct, serum K - creatinine/GFR, lipid profile, albumin excretion and albumin/creatinine ratio, serum Ca
what conditions are comorbid with asthma
- GERD, chronic sinusitis/uncontrolled allergic rhinitis, stress/depression, obstructive sleep apnea, overweight/obese
SE of NSAIDs
- GI upset - decreasing the effectiveness of htn meds -incresing the effect of sulfoylureas - chronic users have increased risk of ESRD - hepatotoxic - coagulopathy
INR goal for warfarin and time is takes to get there
- INR: 2-3 - half life of warfarin is 40 hours and it takes 5-7 days for the steady state to be stable
UTI treatment
- IV ceftriaxone
how long do you conitnue heparin with warfarin
- LMWH, UFH or fondaparinux be continued for atleast 5 days after beginning warfarin and until INR >2 for 24 hours
the definition of CAD
- MI, unatable angina, coronary artery procedures, myocardial ischemia - CAD equivalents include DM, symptomatic carotid artery disease, PAD, abdominal aortic aneurysm
theraoy for herniated disc
- NSAIDS and/or muscle relaxant -moist heat - MRI if not beter in 4-6 weeks
ACL sprain-
- noncontact deceleration frces - moderate to severe joint effusion -sweeling within 2 hours of pop
T2DM RF and screening
- RF BMI at or above 85%, increased fasting glucose of 100, and elevated faasting insulin - screening: *screen all children at 10 who have BMI >85 and RF for diabetes >95% without RF, rechecking every 2 years*
high cholesterol RF, screening and treatment
- RF: elevated BMI - screening: *fasting lipid profile on every child with BMI >85 percentile.* -total cholesterol should be 170 and LDL 130 - Tx: *drugs used when LDL >190 or LDL>160 with RF. only use drugs in kids over 10 who are either tanner 2 (male) or achieved menarche*
biliary colic
- RUQ pain, epigastric pain, or chest pain that is constant - pain lasts 4-6 hours or less and often radiates to the back (often the R shoulder blade) - nausea and vomiting - often follows a heavy and fatty meal - hall mark is that the stone is mobile and eventually moves away from the outlet allowing resumption of normal gallbladder function - new studies show that a cholecystectomy within the first 24 hours of diagnosis may be helpful
cholecystitis
- RUQ pain, nausea and vomiting and occurs following a fatty meal - causes by a stone that is NOT dislodged from the cystic duct outlet - symptoms persist -often associated with fever -elevated WBC - may require urgent cholecystectomy -
hepatitis clinical manifestations
- RUQ pain, nausea vomiting, malaise, anorexia, itching and icterus.jaundice, hepatomegaly
nonasthmatic eosinophilic bronchitis
- chronic cough >8 weeks -normal chest x ray - improve with corticosteroids - normal spirometry
peptic ulcer disease
- epigastric abdominal pain that improves with meals - episodic or recurrent epigastric aching or gwaning - relieved by meals
BPPV
- acute onset vertigo, cant be associated with nausea and vomiting and intact hearing - caused by Ca+ carbonate debris in the semicircular canals - often episodic rather than constant triggered by positional change - symptoms usually resolve several seconds to minutes following position change
when are short acting opiates indicated
- acute pain or breakthrough pain, when long acting agents are insufficient to control symptoms - for chronic pain when non-opiate therapties are not sufficient
acute v chronic bronchitis
- acute: productive cough lasting 1-3 weeks - chronic: productive cough for at least 3 months for the past 2 years
when should PPSV23 be administered early
- adults 19-64 with chronis heart disease, chronic lund disease, chronic liver disease, alcoholism, DM
high intensity statin should be used when
- adults 40-75 yo with diabetes with a >7/5% estimated 10yr ASCVD - patients >75 with clinical ASCVD - LDL >190
right middle cerebral infarct
- affects the right pariteal hemisphere - difficultues with spatial and perceptual abilities -left visual neglect - will not recognize their functional impairments -
what ethnic group has the highest rate of coronary heart disease
- african americans
when is it especially important to rest after an ankle injury
- after the first 72 hours
major traditional RF for CVD/ASCVD
- age>55, male, current smoking, dyspilidemia diabeetes, htn
who should be screened for htn
- all adults over 18
when does a child need an CXR
- all kids with a chronic cough (longer than 3 weeks)
who should be started on statins
- all patients >21yo (with or w/o diabetes) who have an LDL >190 shuld be started on statins
when is a statin indicated
- all patients over 21 with an LDL > 190
chlamydia screening recommendations
- all pregnant and non prego women 24 and younger - 25+ if at increased risk regardless of pregnancy status -RF: history of chlamydia or other STI, new or lots of sex partners, inconsitent condom use
dix-hallpike maneuver
- allows confirmation of BPPV - turn pnts head to 45 degress and then lay them supine with head just over the end of the exam table -then turn head to the side which should reproduce symptoms of dizziness and produce nystagmous - observe for 20-30 seconds - if present, the nystagmous will have the fast component in the direction of the pathology - next, sit the patient up and observe again for nystagmous
classic signs of pregnancy
- amenorrhea, fatigue, nausea/vomiting, breast changes -enlarged uterus
AB for 3mo to 5yr for pneumonia
- amoxicillin to cover strep pneumo
cardiac syndrome X
- angina like pain and have abnormal stress testing consistent with CAD - normal angiogram
what screening tests should be done for women with HNPCC
- annual screening for endometrial cancer with endometrial biopsy beginning at age 35
when is lung cancer screening recommended
- annual screening with los-dose CT for adults 55-80 who have a 30 pack year smoking history and currently smoke or have quit within the past 15 years
patients with inherited thrompiphilia
- anticoagulated indefinitely after an episode of thromboembolic disease
ottowa knee rules
- any of these criteria = knee xray - 55 and older -isolated tenderness of the patella - tenderness at the head of the fibula - inability to flex to 90 degrees - inability to bear weight both immediately and in the ER (4 steps; unable to transfer weight twice onto each lower limb regardless of limping)
impingement syndrome with bursitis
- apleys scratch test causes pain and/or limited range of motion - neer and hawkins kenedy tests used to r/o
SE of stimulant medication
- appetite suppresion -tic disorder -insomnia -decrease in growth velocity
weight loss drugs
- approved for BMI >30 (most also indicated for BMI >27 with at least one obesity related comorbidity)
complications of GERD
- esophagitis -peptic strictures: - barretts esophagus -> adenocarcinoma
what therapy is for prevention of noncardioembolic stroke
- aspiring or aspirin in combo with extended release dipydidamole -plavix - (anti platelet)
appropriate steps for managing high risk ASCVD
- asprin and moderate to high intensity statin
causes of wheezing
- asthma - COPD -CHF -foreign bosy aspiration - persistent bronchittis -upper airway cough syndrome -vocal cord dysfunction PE
atypical symptoms of GERD are what and are caused by what
- asthma, chronic cough, dental enamel loss, globus sensation, hoarseness, noncardiac chest pain, recurrent laryngitis, recurrent pharyngitis, subglottis stenosis - when severe reflux reaches the pharynx and mouth or is aspirated
indications for exercise stress test
- asymptomatic male over 45 with 1+ RF may obtain useful info from exercise testing
fetal development-2 trimester
- at 18 weeks the baby will have facial expression, early skeletal development and display perceptible movements - babys sex can be seen via US - baby will begin to have hair, fingerprints and footprint - lungs, liver and immune system will mature
chronic sinusitis diagnosis
- at least 12 weeks of at least 2 of the following: -nasal obstruction -mucopurulent drainage -facial pain - pressure or fullness -decrease sense of smell - inflammation must be deomonstrated by one of the following: + purulent mucus of edema in the middle meatus or ethmoid region + polyps in the nasal cavity of middle meatus area + inflammation of the sinuses on radiographic imaging
recommendations for frequncy and duration of excercise
- at least 30 minutes on most days of the moderate excercise - at least 20 minutes at least 3 days a week of vigorous activity - moderate intensity: can talk during activity but noy sing -target HR for moderate exertion is 50-70% of max HR (220-age)
when should you get a PFT for someone with COPD
- at least annually
carpal tunnel exam: tinnels sign and phalens test
- atrophy of the thenar eminence - tinnels: tap the median nerve at the wrist - phalens: flex wrists and place dorsal surface of hands together for 30-60s
endometrial hyperplasia
- atypical complex hyperplasia is a premalignant lesion that has a 25% probability of progressing to cancer
viral pneumonia
- atypical presentation - influenza, RSV, measles, aricella, adeno, rhino, para - 4 mo-5 years - often hear crackles
two most common complications of influenza
- bacterial pneumonia ( + bronchitis) & otitis media - could also have aseptci meningitis, guillain barre, febrile seizures - complications common in kids less than 5
secondary prevention of CAD
- beta blockers - if BB are CI use a CCB - stable angina with normal LV function should use ACE-I ( conflicting evidence that they reduce exercise induced angina)
when does nausea occur in most women
- between the 4 and 7 week and resolves by the 20
USPSTF mammography screening recommendations
- biennial screening mammography for women 50-74
where is monofillament testing done
- big toe & 1,3,5, metatarsal heads
increaed abdominal aortic size is...
- bigger than 2 cm
what does a US in the 2 trimester measure and how close should id be to naeugels rule
- biparietal diameter -head circumference -abdominal circumference -femus length -within 2 weeks
car seat safety
- children under 13 should not sit in the front seat - until age 2 children should face backward 2-4: forward facing car seat in back -4-8:booster seat in back (booster seat until you reach 4'9" - over 8: seat belt in back -13: seat belt in rear or front
when do you use antibiotics for otitis media
- children under 6 months get antibiotics - over 6 months with uncomplicated unilateral otitis media may be observed first -over 2 is treated with additional observation
what is treatment for alzheimers
- cholinesterase inhibitors, vitamin E, memantine, respite care, atypical antipsychotics for behavioral disturbances
pathophysiology of asthma
- biphasic inflammatory response - The first phase is referred to as the early asthmatic reaction and lasts for approximately an hour. After bronchial provocation with an allergen or environmental stimulus, mast cells and eosinophils release mediators such as prostaglandins and leukotrienes, leading to increased vascular permeability, mucus hypersecretion and a rapid bronchoconstriction. The second, or late, asthmatic reaction starts about 2-3 hours after the original exposure, reaches a maximum by about 4-8 hours and resolves in about 24 hours. This phase is due to neutrophil, eosinophil and lymphocyte infiltration into the bronchial epithelium which results in epithelial destruction, fibrotic remodeling and hyperplasia of the bronchial smooth muscle. This overall increase in airway hyperresponsiveness may persist for days to weeks after the late reaction appears to have resolved.
chronic htn in pregnancy
- blood pressure elevation first detected before the 20th week of pregnancy that persists beyond 12 weeks postpartum
1 mo milestones
- bring hands within range of their eyes and mouth and some of their jerky body movements smooth out - they will listen when you talk to them and focus on you when holding them - move head from side to side when lying on stomach - head will still flop if unsupported and their hands are in tight fists -preference for the human face, mature hearing, recognition for some sounds such as mother voice
estimating daily caloric reuirments
- caloric intake: Basal metabolic rate + additional calories for activity - basal metabolic rate : body weight in pound X 10 - additional calories: multiple the body weight in pounds by 1.3 if sedentary 1.5 for moderate activity 1.7 for heave 1.9 for intesne - to lose weight the caoloric intake should be less than the estimated caloric needs
post partum depression
- can be Dx up to 6 months after childbirtch -however formal criteria is depression during the peripartum period and up to 4 weeks following childbirtch - in practice onset may often be within the first year after delivery
bile acid sequestrants
- can cause an increase in TG - GI effects and cinstipation - SE: may exacerbate dyslipopproteinemia or hyperTG
neuroblastoma
- can regress at stage 4S -some cases are AD with low penetrance - most cases are due to somatic mutations
what should follow a positive stress test
- cardiac cath
non-pharm recommendations for management of knee OA
- cardiovascular and/or resitance land based excercise - aquatic excercise -lose weight
bronchioloitis
- caused by viruses such as RSV - seen in young children with the incidence peaking at 6 months of age - often start as a viral illness and progresses to wheezing, couh, dyspnea and cyanosis -
CCBS
- causes leg edema - CI: essential HTN & hypertensive urgencies
if a woman is GBS positive and allergic to PCN what should she receive
- cefazolin
tramadol
- centrally acting mu opioid receptor that stimulates release of serotonin and inhibits reuptake of NE - lower abuse potential than other opioids - SE: seizures, serotonin syndrome, respiratory depression, angioedema, bronchospasm, constipation, anusea, dizziness and pruritis
active labor
- cervical dilation >4cm in the presence of contractions -contractions are normally 3-5 minutes apart -fetus is not in distress
dependence
- characterized by maladaptive pattern of opiod use causing clinically significant imapirement or distress - manifested by at least 3 of the following: Tolerance, withdrawal, increasing doses, desire or inability to cut down, significant amount of time spent in search of drug, interference with social, occupational or recreational activities and continued use despite persistent/recurrent physical or psychological problems due to the drug.
when do you draw a lipid panel and how often is it drawn?
- check fasting lipids in all adults over 21 every 4-6 years - draw in fasting state with at least 8 hours after the last food intake
unstable angina
- chest pain that occurs at rest or with increasingly less exertion - also considered aunstable if it is new onset, worsening in severity, frequency, duration - acute coronary syndrome and requires emergency care
RF for complication on influenza
- children < 5, COPD, conditions that affect the ability to handle respiratory secretions/increased risk of aspiration, CHD, metabolic conditions, chronic renal disease, immunosuppression, long term aspirin therapy
symptoms and Dx of TB in a child
- children have very few symptoms - all lobar segments of the lung are at equal risk of initial infection - often involves hilar adenopathy, focal hyperinflation and then atelectasis with minimal evidence of the primary lung focus itself - in asymptomatic kids use a PPD (TST)+ positive testL >5mm in high risk children, >10mm in moderate risk children, >15 mm in low risk children - in symptomatic children culture the sputum or from a first morning gastric aspirate in young kids
JNC8 blood pressure medications for diabetics
- choose either an ACE, ARB, CCB, or thiazide - for blakcs: CCB or thiazide
new 23-valent pneumococcal vaccine recommendations
- chronic disease patients (including those with CAD) receive the pneumovax once prior to the age of 65 and then once more at 65 - patients with asplenia or immunocompromised may be given a booster vaccine 5 yrs after their initial pneumovax
ankylosing spondylitis
- chronic, inflammatory arthritis -- 15-40 yo - morning stiffness and achiness over SI joint and lumbar spine
relatives with colon cancer
- close relatives of someone diagnosed with cancer before age 60 should start screening when they are 40
central vertigo
- cns pathology - nystagmous: + purley horizontal, vertical, or rotational + does not less when the patient focuses gaze persists for a longer period + nystagmus changes direction with gaze
colon cancer screening options
- colonoscopy every 10 years - FOBT collected at home annually - flexible sigmoidoscopy every 5 years with FOBT every 3 years - double contrast enemas every 5 years - begin at 50 and continue until 75
diagnose testicular torsion w/ what?
- color dopper US & radionucline scintigraphy - radionuclide scintigraphy has 100% sensitivity but doppler is faster and more readily avalable
vestibular neuritis
- commonly associated with a recent URI -nystagmus will NOT change with direction gaze (because this a peripheral lesion) - inflammations of vestibular branch of the eighth cranial nerve
grade III sprain
- complete tear and loss of integrity of ligaments - inability to bear weight - stretching of the joint with stress, w/o a definite stopping endpoint
intraarticular coticosteroid injections
- consider if joint inflamed - no more than 3 injections/year - no more than 1 injection per month - triamcinolone prefered - 1 ml steroid + 3 ml local anesthetic - 24 hours of imobalization following the injection is helpful but prolonged rest should be avoided
guidelines is HbA1c > 8
- continue lifestyle change + metformin + sulfonylurea or glimepride or basal insulin or insulin detemir on intermediate acting insulin - if HbA1c is >8 on reassessment then add basal insulin or intensity of insulin regiming
PE findings for suspected HF
- crackles in the lung bases and dullness to percussion -JVD - PMI laterally displaced from the mid0clavicular line towards the axillary line - S3 from rapid ventricular filling or poor left ventricular functioning -enlarged liver, hepatojugular reflex and distension and shifting dullness indicating ascited - LE edema and check pulses -sacral edema
ASCVD statin benefit groups
- current ASCVD - LDL >190 - diabetes age 40-75 - estimated 10 year ASCVD risk >7.5%
symptomatix treatment of upper respiratory infection
- decongestant or saline nasal spray for congestion -acetaminophen for fever and pain
fish oil
- decrease TG and slightly increase HDL
pathophysiology of CHF
- decreased complaiance of the ventricles leads to increased filling pressures, which leads to congestion
pain with lumbar extension is suggestive of
- degenerative disease or spinal stenosis
tendinopathy
- degenerative pathology - chronic condition with lack of acute phase reactants and collagenous degeneration
when you suspect depression in an elderly person what else should be screened for and with what tool?
- dementia - mini-cog (more sensitive and specific than MMSE)
elderly abuse RF
- dementia - shared living situation of elder and abuser - caregiver substance abuse or mental illness - heavy dependence of caregiver on elder - social isolation of elder from people other than the abuser
primary dysmenorrhea RF
- depression, anxiety, smoking
what is often comorbid with dementia
- depression: may cause pseudo-dementia
diabetic opthalmology referrals
- dialated yearly exams - T1DM should have first yearly exam 5 yrs after diagnosis -T2DM should have first dilated exam when they are first diagnoses
what is the dialated exam sensitive for
- dialted exam is sensitive for detecting retinal thickening from macular edema and for neovascularization
therapeutic lifestyle changes to decrease risk of CHD and cholesterol treatment plan
- diet with saturated fat <7% of calories - cholesterol intake <200mg/day - increased soluble fiber intake -excerise and weight control
analgestic rebound headache
- diffuse, b/l - everyday: may prsent on first waking up in the morning - improves slightly with meds, but worstens when the medication wears off - more than 15 headaches/month -regular overuse of analgesic for more than 3 months -development or worstening of headache during med overuse (must use meds 15 times per month for 3 months)
peripheral vertigo treatment
- diretics: useful for menieres bc they decrease endolymphatic pressure - eply maneuver: treatment for BBPV - vestibular rehabilitation: unilateral peripheral vestibular dysfunction - vestibular suppressant meds:
what is the laryngeal height
- distance from the sternal notch to the top of the thyroid cartilage
asprin therapy in patients with diabetes
- does not reduce the likelihood of CVD in patients with diabetes w/o preexisting disease - consider patients with diabetes for aspirin therapy as any patient without diabetes would be treated -USPSTF: use apirin for med 45-79 yrs whne the potential beenfit for reduction in MI outweights the harm due to an increase in GI hemorrhage and in women 55 to 79
anemia screening
- done at 12 months and againt at preschool or kindergarden entry
MRI imaging for headaches
- dont do imaging for uncomplicated headaches - 1. pnt has migraine with atypical patterns or neuro signs -2. patient is high risk of significant abnormality -3. results of study would alter management of headache Symptoms that increase the odds of positive neuroimaging results include: Rapidly increasing frequency of headache Abrupt onset of severe headache Marked change in headache pattern A history of poor coordination, focal neurologic signs or symptoms, and a headache that awakens the patient from sleep. A headache that is worsened with use of Valsalva's maneuver Persistent headache following head trauma New onset of headache in a person age 35 or over History of cancer or HIV
what are the recommendations for screening asymptomatic diabetics for CHD
- dont do it
how is heparin dosed and titrated
- dosed based on body weight and titrated based on aPTT
b-hcg levels in normal pregnancy
- doubles every 48 hours for the first 6-7 weeks of gestations - pregnancy detected when b-hcg 1500-1800 - transvaginal US can detect pregnancy at b-hcg 1500-1800 - b-hcg is 5000 by the time an abdominal US can detect a pregnancy - in ectopic and spontaneous abortion hcg levels are lower than normal - molar and multiple gestations are associated with higher than normal hcg - note: intrauterine contents are not expected to be seen until the quantittive b-hcg >1500 - double every 2.2 days over the first few weeks and then doulbe more slowly every 3.5 days by 9 weeks - peak at 10-12 weeks and then decline rapidly until 22 weeks when levels rise until delivery
orthostatic hypotension
- drop in systolic BP of >20 mmHG OR - drop in diastolic BP of >10 + when changing position from supine to standing -accompanied by feelings of dizziness of light headedness
when are drug and surgery indicated in obese patients
- drugs: BMI of 30 or 37 +comorbidities - Sx: 40 or 35 with comorbidities
talar dome fracture
- due to acute injury - potential for interruption of the blood supply - may be missed by initial x ray
direct hernia
- due to weakness in the transversalis fascia area of the hesselbach triangle -triangle is defined inferiorly by the inguinal ligament, laterally by the inferior epigastric arteries and medially by the conjoint tendon
palpitation due to cardiac cause is more likley when what is present
- duration of palpations greater than 5 minutes - dscription of irregular heart beat -male - affects sleep or during work
when do refer to GI for endoscopy
- dysphagia - initial onset of upper GI symptoms after 50 - early satiety -hematemesis - hematochezia -iron deficiency anemia -odynophagia (painful swallowing) -recurrent vomiting -weight loss
orthopnea
- dyspnea when lying flat - person is forces to sleep on pillows or in a chair
when should B-blockers be used?
- effective in preventing a second MI in patients who have already had one, even if their blood pressure is normal
test of choice for carpal tunnel
- electrodiagnosis test (nerrve conduction velocity study)
what is elevated in colon cancer and what does it suggest
- elevation above 5ng/ml is associated with a worse prognosis at each stage and is helpful in determining prognosis
initial treatment for GERD, gastritis and PUD before a Dx is made
- empirit treatment with PPI or histamine-2 antagonist: this helps Dx GERD - stop anti-secretory therapy after successful 4-8 wk course or in a pulse dose manner - refer to endoscopy in setting of alarm setting or in cases that do not respond to empiritc treatment after 8 weeks
endocrinology and weight gain
- endocrine disease that cause weight gain usually limit growth and lead to short stature
transvaginal ultrasound and endometrial cancer
- endometrium <4 mm reassuring
stridor
- entirely inspiratory wheeze that is louder in the neck indicating partial obstruction of the airway - high pitched inspiratory noise that is the result of a partial obstruction of extrathoracic airways such as larynx/trachea - classic for coup, inhaled foreign body with partial obstruction and laryngomalacia
atypical pneumonia
-YOUNG ADULTS -mycoplasma, chlamydia - often hear crackles
mononeucleosis
- fever, pharyngitis, lymphadenopathy - posterior cervical lymphadenopathy - palatal petechiae on posterior oropharync (palatal petichiae can also be seen in GABHS) - suspicion with negative strep test in a patient who is ill for more than 7-10 days - monospot is not positive for atleast 7 days into illness -early in illness may have maculopapular generalized rash that is faint, rapidly disappears and is nonpruritic
how do you know when headache symptoms are under control
- fewer than 2 per week or 8 per month -relived with lifestyle modification and acute treatment medicine - controlled headaches do not require additional follow up unless the headaches change or get worse
fetal development first trimester
- first 12 weeks: heart, spine, arms, legs and other organs develop - neural tube closes by 4 weeks - 7-8 wees: heart begins to beat and the fetus will move
fibric acid derivatives
- first line therapy for reducing TG - hepato & renal toxic, myopathy (esp in combo with statins)
asthma exacerbation treatment
- first oxygen -then albuterol and ipratropium - then IV or oral corticosteroids
pharm guidelines in BPH
- first: alpha adrenergic antagonists - then you can try 5-alpha reductase inhibitors and then can try a combo of both - avoid decongestants and antihistamines
crackles
- fluid in the lungs - discontinious - can be heard at early, mid or end inspiration of expiration (typically inspiratory) - acute pnemonia: usually fine mid inspiration crackles -resolving pneumonia: couarse and late inspiratory crackles
prenatal visit recommendations
- folic acid 400-800 mcg (1mg in patients with diabetes or epilepsy and 4mg in patients who had a child with a previous NT defect) -carried screening -screening for infectious disease - environmental toxins
2 year milestones
- follow 2 step commands - listen to short stories -parallel play - hold a panecil, immature grip and imitates prencil strokes - remove pants and sock -need help to undess completely - throw a ball overhand
H pylori triple therapy
- for 10-14 days (70-85% eradication rate) - PPI atandard dose twice daily - amoxicillin 1 gram twice daily - clarithromycin 500 mg twice daily
SE of aspirin
- gastritis, PUD, bleeding (esp when used with clopidogrel)
osteoarthritis
- generalized or joint line tenderness - aggravated by weight bearing activity, relieved by rest - crepitus - joint stiffness
definition of atopy
- genetic predisposition for the development of an IgE mediated response to common allergens
steps to decrease maternal blood loss
- give oxytocin after baby is born to help the placenta detach quicker, pull the coord when the placenta appears to have detaches and massage the uterus - early clamping of the umbilical cord: delay 2 minutes to give baby the right amount of blood but not cause the mom too loose too mch
thyroiditis
- gland increases in size (viral/pregnancy) and xs hormone leaks out - there is LOW uptake of iodine
venous doppler
- good sensitivity and specificity for DVT
blue dot sign
- hard, tender nodule palpable in the upper pole of the testis - pathognomonic for appendiceal torsion when tenderness is also present
stoop test
- have patient go from standing to squatting - in patients with central spinal stenosis, squatting will reduce pain
crossed leg test
- have the patient cross their legs with the injured leg resting at the midcalf on the knee to detech high ankle sprains
diabetes diagnostic criteria
- hba1c > 6.5 OR - fasting (no caloric intake for at least 8 hours) plasma glucose >126 OR - 2 hour plasma glucose >200 during an oral glucose tolerane test following a glucose load of 75 g glucose OR - patent with symptoms of hyperglycemia, a random plasma glucose >200
common side effects of SSRI and SNRI
- headache -sleep disturbance - GI problems - SIADH - serotonin syndrome - increased risk of GI bleeding - may decreased bone density so worry about falls in elderly
symptoms of hyperthyroidism
- heat intolereance -tachycardia -fatigure -weight loss -tremor -increased sweating -exertional dyspnea - depression & hyperreflexia are less common -diarrhea and light periods can also occur
excercise ecg w/ imaging and excercise echo are indicated when?
- intermediate probability of cAD - can excercise and have either pre-excitation syndrome or more than 1 mm of ST-segment depression on resting ECG - pts with a history of previous revascularization procedures, those who take digoxin, LVH -
negative inversion test
- invert patients ankle. laxity indicates injury of the calcaneofibular ligament
syndesmotic sprain
- involves the interosseus membrane and the anterior inferior tibiofubular ligament - pain and disability are often out of proprtion to the injury - positive ankle squeeze test
most common cause of goiter worldwide
- iodine deficiency
most common cause of CHF
- ischemic cardiomyopathy - often the result of long term RF such as HTN, hyperlipidemia, diabetes
what does acitve and passive loss of motion suggest in an injury
- joint disease (while loss of only active ROM is more suggestive of a muscle disease)
radiographic features of OA
- joint space narrowing -subchondral sclerosis ( hardening of tissue beneath the cartilage. increased periarticular bone density) -ostephytes -subchondral cysts (fluid filled sacs in the bone marrow)
L5 and S1 distrubution to test in lower back pain
- l5: great toe -s1: lateral mallelous and posterolateral foot
clunk and o'brien test
- labral injury clunk: With the patient supine, the examiner rotates the patient's arm and loads (force applied) from extension through to forward flexion. The examiner is checking for a "clunk" sound or clicking sensation arising from the glenoid labrum that can indicate a labral tear even without instability. obrein: hands on hips with anterior force on the elbow
achilles tendon rupture
- landing on ball of foot -popping sound - pain in posterior ankle - unable to plantarflex
iliotibial band tendonitis
- lateral knee pain - overuse -worse with activity
most common ankle injury and damaged ligaments
- lateral sprain due to inversion and plantal flexion - injured: anterior talofibular, calcaneofibular, and posterior talofibular ligaments - anterior talofibular ligament is the most easily injured
salvage therapy for H pylori
- leofloxacin triple therapy is an option that may be considered for persistent H pylori - levofloxain triple therapy for 10 days: standard dose PPI twice daily, amoxicillin 1 gram twice daily, levofloxacin 500 mg one daily
blood pressure goal for patients with diabetes
- less than 140/90
lipid goals for peds
- less than 17o for TC and LDL less than 130 - children with a fmhz of high cholesterol or who are overweight or obese should have cholesterol checked
non germ cell tumors
- leydig and sertoli - rare; malignant in only 10% of cases
management of prehypertension in kids
- lifestyle change - BP rechecked in 6 months - no need for work up unless something concern based on fmhx,or PE exam
guidelines for when HbA1c > 6.5%
- lifestyle change + metformin
torn rotator cuff
- limited ROM with significant pain - in complete tear the patient will no be able to raise his arms over his head -significant weakness with strength testing
back pain due to malignancy
- localized to the affected bones - dull thrbbing progresses slowly - increases with recumbency or cough -patients over 50
realistic weight loss goals
- long term: 5% to 10% reduction in body weight - short term: lose half a pound to 1 pound a week
LMWH advantages over unfractionated heparin
- longer half life so can administer subQ once or twice daily - lab monitoring is not rquired -thrmobytopenia less likley -fixed dosing - can be used in outpatient setting
major risk factors for CHF
- low HDL - diabetes -current smoking
tobacco use during pregnancy is associated with...
- low birth weight in the fetus
echocardiogram
- measures the size of the chambers, thickness of the walls and size of cavity - evalutates the movement of heart structures - doppler assesses blood flow through the valves and chambers - the ratio of LV filling velocities (E/A) is a marker of diastolic dysfunction . This ratio is reduced when the diastolic dysfunction is present
3 hour glucose tolerance test
- measuring the patients glucose after fasting and then 1,2, and 3 hours after ingesting 100g glucose load -abnormal test = 2+ of the following values + fasting serum glucose >95 -one hour serum glucose >180 -2 hour serum glucose >155 - 3 hour serum glucse >140
management of primary htn in children
- medsications -diet changes (reduce sweets, fats, red meats and Na+) - weight loss -physical activity
in what groups are blood pressure rates the lowest
- mexican americans and native americans
when is migraine prophylaxis considered and important
- migrines more frequently than twice a week at at risk for medication overuse headache and migraine prophylaxis should be considered
GERD
- mild epigastric pain -symptoms commonly worsten after meals - burning pain -substernal -tends to worsen when gstric volume is increased, when gastric contents are located near the GE junction (reclining or bending). intra-abdomial pressure is increased
management of diastolic heart failure
- minimize fluid overload with diuretics -control BP - slow down HR - manage comorbid CHD - many physicians start with a B-blocker or non-dihydropyridine CCB in order to slow th heart rate, increase the ventricular filling time and decrease BP -excessive diresis and preload reduction can worsten diastolic failure
placenta previa
- more commin in women who have has a prior pregnancy, older than 35, smoke, have had twins, previous uterine Sx or C-section -more likley to resolve when detected earlier in pregnancy -marginal or incomplete previas are more likley to resolve than complete - bleeding most often occurs in the late 2 or 3 trimester - if it does not resolve, c-section is usually needed - often presents with painless vaginal bleeding -usually bright red -usually no abdominal pain
when would a transvaginal US be indicated
- more reliable for dating at 6 weeks gestation
when do reflexes disappear
- moro: 4 months - palmar grasp: 2-3 months - plantar grasp: 8 month -asymmetric tonic neck reflex: 6 months -babinski: normal in 1-2 years
distinguishing between viral URI and sinusitis
- mosre likley to be vial if the symptoms are less than 10 days and they are not worsening
cervical polyps
- most common in postpartum and perimenopausal women
germ cells tumor
- most common testicular tumors - further divided in seminomas and nonseminomas - nonseminomas: embryonal tumor, mixed GCT, teratoma, teratocarcinomas - *yolk sac tumors* aka endodermal sinus tumors are the most common prepubertal GCTs and are most often malignant . They have a good prognosis and require Sx and chemo. - choriocarcinoma is the most lethal but the least common NSGCT
nicotinic acid
- most effectice agent to increase HDL - exacerbates DM, group, PED, hepatotoxic
epididymitis
- most frequent cause of sudden scrotal pain in adults - slowly progressive over several days - patient may appear comfortable, except when examined -often high fevers are involved cremaster reflex is present, testis in normal location and position
intoeing
- most resolve by age 8 -if not resolved spontaneously by 4 years of age, refer to ortho
ethnicities more at risk for diabetes
- native americans, africans, asian americans, latin ameircans, pacific islanders
acute peancreatitis
- nausea, vomiting, epigastric pain - abdominal tenderness -grey turners sign: ecchymotic discoloration in the flank -cullens sign: ecchymotic discoloration in the periumbilial region
tolerance
- need for increasing doses of medication to achieve the initial effect of the drug
CAGE questionairre
- need to CUT down - felt ANNOYED by criticism - had GUILTY feelings - taken a morning EYE opener - 2+ positive answers = more intensive evaluation - consumption of more than 14 drinks per week or more than 4 drinks per occasion for men and more than 7 drinks per week or more than 3 drinks per occasion for women is a positive screen
how big should a non pregnant ladies uterus be
- no larger than 8 weeks in size (clenched fist) -
ace-i and arbs in african americans
- no recommended unless thy have ckd - 2-4 times more likley to develop angioedema
factor Xa inhibitors
- no weekly lab monitoring of INR - difficult to reverse anticoagulation in the face of a bleed
when is is acceptable to administer a t-pa
- onset of neurologic symptoms has been within three hours of the onset of symptoms, emergent CT scan does not show an intracranial bleed, an early acute infarct , or a brain mass
delerium treatment
- oral haloperidol -SE of haloperidol: sedation, constipation, tardive dyskinesia, QT prolongation (rare)
what corresponds best to pain vs disease progression with OA xray
- ostephytes: pain - joint space narrowing: disease progression
RF for diabetes in kids
- overweight (BMI >85th percentile) plus any two of the following: + fhx of t2dm in first or second degree relative + native american, african american, hispanic american, asian/south pacific islander + signs of insulin resistance or conditions associated with insulin resistance such as acanthosis nigricans + maternal history of diabtes or gestational diabetes during the childs gestation
what is suggestive of a mechanical cause of back pain
- pain worse with movement and sitting - lumbar strain/spain: spasm of the paraspinous muscle
lymphedema
- painless or chronic dull and heavy sensation -early on there is pitting - chronic: woody, indurated, fibrotic
inguinal hernia
- painless, becomes painful and tender when incarcerated
how does V tach usually present
- palpitations, lightheadedness and syncope
major deppression diagnostic criteria
- patient must have at east five of the following 9 criteria for a minimum of two weeks - SIG E CAPS - Sleep: insomia, hypersomina - Interest: loss of - Guilt - Energy: decreased -Concentration: decreased or crying -Appetite: increased or decreased - Psychomotor retardation - Suicidal ideation
absolute contraindications to digital cervical exam
- patient reports of vaginal bleeding with an undocumented placental location (or known previa ): b/c may worsten bleeding -leaking vaginal fluid with prematurity (or known PPROM): b/c may introduce bacteria into the uterus
primirive reflexes
- patients with advanced dementia or other neurodegenerative diseases may develop these with loss of frontal lobe control - reflexes seen in infants, including grasp, suck and glabellar tap
postpartum blues
- peak around 4th day and end around 10 days
most common site of mets for colorectal cancers
- pelvic lymph nodes -liver -lungs
first line treatment for strep pharyngitis
- penicillin V
diagnosing sinusitis in a child should be done when
- persistence of b/l nasal discharge of any quality or daytime cough or both lasting more than 10 days without significant improvement (unilateral symptoms suggest a nasal foreign body) OR - worsening after initial improvement OR - high fever and purulent nasal discharge for more than 3 days
indirect hernia
- persistent process vaginalis - begins at internal inguinal ring and courses along the inguinal liagament to the external ring located medial to the interior epigstric arteries -contents follow the tract of the testicle down into the scrotal sac
hyperemesis gravidum
- persistent vomiting, dehydration, ketosis, electrolyte disturbances and weight loss
prehn sign
- physical lifting of testes relieves pain caused by epiditymitis but not pain caused by torsion - + sign: pain relieved by lifting of the testicle
which of the following pain characteristics speak against the likelihood of angina
- pleuritic -pulsating -positional -reproduced by palpation - stabbing pain
peripheral vertigo
- problems with the inner ear or vestibular system - nystagmous: + unidirectional (usually horizontal and rotational) and does not change direction + inhibited by fixating on a point and intensifies when fixation is withdrawn - frenzel glasses prevent fixation and bring out the nystagmous
what birth control methods are okay to start immediately post partum
- progestin-only pills, injectable progestin, progestin implants - take the pill at the same time everyday - if exclusively breast feeding begin progestin only contraception after 6 weeks
suggestive of vertebral fracture
- prolonged use of corticosteoids - mild trauma over age 50 - age greater than 70 - history of osteoporosis - recent significant trauma at any age -previous vertebral fracture
PQRST for racing heart exam
- provocation/palliation (cold, stress, meals, sex) -quality - region/radiation
common rashes of pregnancy
- pruitic urticaial papules and plaques of pregnancy: papulovescicular lesions on the trunk and extremities - prurigo of pregnancy: excoriated areas on the trunk or limbs -pruritic folliculitis
when is a pharm stress test with myocardial perfusion imagine and dobutamine echo used
- pts with intermediate pretest for CAD & an electronically paced ventricular rhythm of LBBB
CHF PE findings
- pulmonary edema (evidenced by inspiratory crackles and/or dullness ro percussion) - S3 - PMI diffuse and laterally displaced - peripheral edema - increased JVD - hepatojugular reflux
diagnostic criteria for DM
- random glucose >200 + symptoms of hyperglycemia - fasting plasma glucose >126 - HbA1c >6.5
what do you do if the INR is elevated on warfarin
- rechck INR in 24 hours if INR is between 5-9 - if >9 : stop warfarin and give vitamin K
screening for group B strep
- rectovaginal swab at 35-37 weeks - Ab prophylaxis should begin at least 4 hours prior to delivery for optimal protection - if not screened prophylaxis is still given for those with RF such as delivery at less than 37 weeks gestation or prolonged rputure of the membranes greater than 18 hrs
arbs
- reduce microalbuminuria & macroalbuminuria -heart remodeling effects - avoid in pregos
orthostasis
- reduction of systolic or diastolic blood pressure of atleast 20 or 10 mmHg respectively, measured 3 mnutes after a patient who has accommodated to the supine position assumes a standing or sitting position -some also consider a + when the pulse rate remains increased by 20 beats/min (16 in elderly)
labral tear
- repetetive damage from glenohumeral joint instability or secondary to trauma - clunk and o briens test - often a dx of exclusion
progesterone levels and vaginal bleeding
- result >25 is associated with sustainable pregnancy - <5 suggets miscarriage or ectopic prgnancy - levels between 5-25 cant distinguish between intrauterine and ectopic pregnancy
RISE pneumonic for preventive visits
- risk factors - immunizations -screening tests -education
premature rupture of the membranes
- rupture of fetal membranes prior to onset of labor -can occur at any gestational age - large gush or steady trickle of clear vaginal fluid - preterm PROM is PROM prior to 37 weeks of gestation is the leading identifiable cause of premature birth
correct way to measure BP
- seated for 5 minutes with back supported - arm at heart level - length of the bladder of the cuff should be 80% of the arm and the width must be 40% of the arm circumference
cocaine and sitmulants during pregnancy
- vasocontriction _> placental insufficiency and low birth weight
symptoms of severe preeclampsia
- visual disturbances, severe headache, RUQ or epigastric pain nausea, vomiting, decreased urine output
when do most deaths due to PE occur
- w/in an hour or two
what therapy is for prevention of cardioembolic strokes
- warfarin (oral anticoagulant)
ACE-I
- watch K, Na and creatinine -renal protective -reduces microalbuminemia - first line in diabetes and renal disease -heart remodeling effects - increase 35% above baseline creatinine is acceptable after initiating use - SE: can cause cough & angioedema, renal dysfunction, hyperK - avoid in pregos
vocal cord dysfuntion
- wheezing -dont respond to astham meds - spirometry: flattening on inspiratory loop -abnromal vocal cords with laryngoscopy
when do you retest to see if Hpyloi was eradicated?
- when a patient has an Hpylori associated ulcer, persistent symptoms despite appropriate therapy, MALT lymphoma, history of resection for early gastric cancer and pts planning to resume chronic NSAID therapy
when does an MI in a family member increase the risk of CAD
- when it occurs in a first degree relative for a male <55 and female <65
with influenza when can u go back to school
- when most symptoms have improved and the child has been afebrile for 24 hours
when would TSH levels not reflect the level of circulation thyroid hormone?
- when there is a primary pituitary prblem )failure or the development of an adenoma that is not suppressed by excess thyroid)
when is a D -dimer used to diagnose a DVT
- when there is a very low pretest probability
when is risk of stroke greatest in patients with AF
- when they have had it for more than 48 hours or in those who have not been given 3 weeks of prior anticoagulant therapy
cotton wool spots
- white spots with fuzzy borders that indiate previous infarction -- seen in severe non proliferative retinopathy of diabetes
when is sling immobilization of the shoulder recommended
- with a shoulder dislocation or proximal humeral fracture
what does a US in the 3 trimester measure and how close should id be to naeugels rule
- within 3 weeks - fetal size cannot be accurately used to assess EGA or EDD and should not change a due date - do not use 3 trimester measurments for dating the EGA or EDD- - according to another case the US can be used to date when there is a discrepancy of more than 3 weeks in the 3 trimester - most accurate for dating when used before 20 weeks
when is a DEXA scan indicated for osteperosis screening
- women 65 yo - 0 to -1 is normal - osteopenia -1 to -2.5 - below -2.5 is osteoperosis - lifetiem risk of about 9.3 indicates screening as well
when can you stop doing pap smears
- women over 65 if they had had recent screening with normal paps
prostatitis
- young and middle aged men - pain (perineum, lower abdomen, testicles & penis, & w/ ejaculation), bladder irritation, bladder outlet obstruction and sometimes blood in semen
CVS
-10-13 WKS -sample of placental tissue - higher risk of spontaneous abortion and limb defects
triple therapy in patients allergic to pcn
-10-14 day regimine (70-85% eradication rate) - PPI standard dose twice daily - calrithromycin 500 mg twice daily -metronidazole 500 mg twice daily
when do you start screening for HTN
-18
when is US in pregnancy recommended
-18-20 weeks
screening for gestational diabetes
-24-28 wks with a 1 hour glucose tolerance test - use a fasting glucose and a one-hour glucose following a 50g glucose load - if fasting >126 OR one-hour glucose is greater than 130 then the patient is considered to have a positive result - if positive the pt should undergo a three-hour GTT with 100g glucose load
when to use aspirin
-45 to 79 in men to reduce MI risk -55-79 women for ischemic stroke - weight against GI hemorrhage -JNC 8 has no recommendation about aspirin and htn
postvoid residual volume
-50mL = normal -50-200 = equivocal - >200 = abnormal
what should an initial pregnancy evaluation include
-CBC, RPR, HIV, Rubella, blood type & Hep B -
therapy for severe COPD
-FEV1 <50% - inhaled glucocorticoids be added to bronchodilator treatment (LABA) -
late decelerations
-Late decelerations are decelerations in the fetal heart rate that begin after a contraction begins, with the nadir after the peak of the contraction. They can be an indication of utero-placental insufficiency, meaning that the baby may not be getting enough oxygen and late decelerations can be an early sign of hypoxemia during contractions.
NSAIDS and GERD
-NSAID can worsten GERD esp if taken on empty stomach
passive straight leg raise test
-The normal leg can be raised 80 degrees. If a patient only raises their leg <80 degrees, they have tight hamstrings or a sciatic nerve problem. To differentiate between tight hamstrings and a sciatic nerve problem, raise the leg to the point of pain, lower slightly, then dorsiflex the foot. If there is no pain with dorsiflexion, the patient's hamstrings are tight. The test is positive if pain radiates down the posterior/lateral thigh past the knee. This radiation indicates stretching of the nerve roots (specifically S1 or L5) over a herniated disc. This pain will most likely occur between 40 and 70 degrees. Pain earlier than 30 degrees is suggestive of malingering. Pain in the opposite leg during a straight leg raise is suggestive of root compression due to central disc herniation. When compared to MRI, the straight leg raise test has a sensitivity of 0.36 and specificity of 0.74 The ipsilateral straight leg raise test has a sensitivity of 0.80 and a specificity of about 0.40. Thus, a negative test makes a herniated disc unlikely, but a positive test is non-specific.
how do you treat patients with gout in which NSAIDs or colchicine is CI
-based on the number of joints - 1 or 2 joints are involved: artherocentesis with intra-articular glucocorticoid injections - polyarticular: oral glucocorticoids
first line treatment for HTN in a patient with a known CAD or previous MI
-beta blockers and ACE-I
chdwicks sign
-blue puriple tint of vaginal walls and cervix in pregnancy
systemic treatment for tinea capitus and tinea unguium
-capitis: griseofulvin - unguium: terbinafine, itraconazole in pulse therapy
main causes of palpitations
-cardiac arrhythmias -structural heart disease -psychosomatic disorder -systemic causes -effects of medical or recreational drugs
radiographic findings of CHF
-cardiomegaly: width of heart is more than half of the width of the throax - central vascular congestion and hilar fullness - pleural effusion -cephalization of pulmonary vasculature (esp in upper lung fields) - kerley B lines: small linear densiries 2-3 cm in length seen in the periphery of the lung fields on the PA view. repesent interstitial fluid in the lung tissue
acute pancreatitis
-causes severe abdominal pain, associated nausea and vomiting, ill appearance on exam, and clinical signs of dehydration such as tachycardia - epigastric area w/ radiation to the back and worstens with eating - may be caused by alcohol use -
tx for strep when pcn allergy present
-cephalosporin if pcn allergy is not an immediate type HS -macrolide for pts with pcn allergy
which bedside instrument is the best for diagnosing delerium
-confusion assessment method (CAM)
retinal hemorrhage
-dark blots with indistrinct borders that indicate partial obstruction and infarction -- seen in severe non proliferative retinopathy of diabetes
what is essential in the clinical staging of colorectal cancer
-depth on invasion of the bowel wall. cannot be determined until the cancer is surgically removed - endorectal US may help oncologist estimate the depth on invation -
MCC of ESRD
-diabetes
common childhood growth pattersn
-double birth weight by 4-5 months -triple birth weight by 1 year of age - double their birth length by 4 years
duodenal ulcer
-epigastric pain - relieved by food and antacids -
how often should you assess major ASCVD RF
-every 4-6 years in adults 20-79 yo who are free from ASCVD
vestibular migraine
-variant of migraine that can cause central vertigo - at time of vertigo may not present with headache
benefits from quitting smoking
-lung funtion decreased at twice the rate in patients who conitnued verses throse who quit -quitting smoking provded benefit whenever the person quit -contonuing smoking or relapsing worsened lung function - major benefits occured in the first year after smoking cessation
extragonadal testicular tumor
-lymphoma, leukemia and melanoma are the most common malignancy that met to the testis
hydrochlorothiazide
-may cause elders to become incontinent of urine - doses above 25 mg do not decrease BP further or further reduce morbidity and mortality - low dose has a better outcome on coronary heart disease than high dose - in elders dose should be below 25mg - CI in patients with CKD - avoid in patients with gout (increases uric acid) - watch for hyponatermia
what is the fundus photography exam sensitive for
-more sensitive for retinopathy
testicular cancer
-most common malignancy affecting males between 15-35 - most common among african americans - can present as a nodule or painless swelling - may present with dull ache or heavy sensation in the lower abdomen, perianal area, or scrotom
most effective meds for patients with allergic rhinits
-nasal corticosteroids
proliferative retinopathy
-neovascularization
what are the majority of dyspepsia cases due to
-non-ulcer dyspepsia (specific etiology for dyspepsia cannot be identified) in 50% of cases
in well controlled asthma how ofter should SABA be used
-not more than 2 times per week
atypical angina
-often diabetics, women and the elderly - may only present with weakness and SOB
referred scrotal pain in children and adolescents
-often due to a retrocecal appendicitis
abdominal aortic anuerysm screening
-one time US in men 65-75 who have any history of smoking
hemoarthosis with fat globules
-osteochondral fracture
post menopausal bleeding increases risk of
-ovarian cancer
conditions that contirbute to hyperglycemia
-overeating missing doses of medication, dehydration, infection, illness, stress
psoas sign
-passive extension of the patients thigh as he lies on his side with knees extended, or asking the patient to actively flex his thigh and hip causes abdominal pain
strongest RF fir delayed ulcer healing and amputation in diabetes patients
-pedal pulses
addiction
-persistent drug craving, loss of control over drug use, compulsive use, strong tendency to relapse after withdrawal
bisphosphanates
-potent inhibitors of bone resportion and resuce bone turnover
microaneurysms
-punctate dark lesions that indicate vascular dilation - seen in severe non proliferative retinopathy of diabetes
non specific white matter changes on MRI
-represent microvascular disease - generally irrelevant and very common
esophageal spasm
-sharp, stabbing substernal pain and can be triggered by temperatire extremes - often at night and after consumption o meal
compartment syndrome sign and treatment
-signs: pain, pallor, pulselessness, parasthesia, perishing cold, paralysis - Tx: fasciotomy
goodells sign
-softening of the cervix in pregnancy
hegars sign
-softening of the uterus in pregnancy
typical symptoms angina
-substernal chest iscomfort with a characteristic duration and features -exertional in nature -relief with rest or nitroglycerin
severe persistent asthma
-symptoms throughout the day - LABA is used here
b-2 agnost overuse symptoms
-tachycardia - exaggerated somatic tremor -hypokalemia
resisting external rotation
-tests infraspinatous and teres minor muscle
when is abortion legal
-up to 22 weeks of pregnancy
head thrust test
-used to demonstrate peripheral cause of vertigo - with a peripheral lesion: the vestibular ocular reflex will be disrupted. so when you ask a pt to stare at your nose and turn their head to the side, his eyes will more with the head and then saccade back to center when his head is moved in the direction of the lesion - a normal thrust test in the presence of vertigo means the peripheral vestibular system is intact and the lesion is central
symptoms and findings of atrophic vaginitis
-vaginal dryness, dyspareunia, urinary symptoms, vaginal pruritis
whenCAP is suspected when is an xray indicated
-when a kid is hypoxic or isnt responding to treatment
ectropion
-when the central part of the cervix appears red from the mucous producing endocervical epithelium protruding through the cervical os
What scores need stroke prophylaxis
0= Aspirin 1= Warfarin or Aspirin 2 or higher = Warfarin
What is a TIMI score and what is it used for
1 point for each item below and if score 3 or more increased risk of death from MI 65 or older 3+ risk factors for CAD Aspirin use in last 7 days Known CAD with stenosis > 90% 1 or more episodes resting angina last 24 hrs ST seg deviation 0.5mm Increase cardiac markers
stages of labor
1) - lacent stage: regular contractions have started, but the cervix is less than 4cm dilated - active phase: begins when 4cm dilated; ends when fully dilated 2) begins at full dilation, ends when the baby is delivered 3) begins with the birth of the baby; ends with delivery of the placenta
Symptoms of giardia diarrhea
greasy, foul smelling, bulky stolls
non REM has 4 stages
1,2,3,4
SS community acquired pneumonia
1-10 day hx increase cough sputum shortness of breath tachycardia pleuritic chest pain fever sweats/ rigors
How many days typically do lice survive away from the scalp and eggs
1-2 days lice 10 days eggs
Where are the murmurs best heard 1. Aortic Stenosis 2. Aortic Regurg 3. Mitral Stenosis 4. Mitral Regurg
1. 2nd Right intercostal space 2. 2nd-4th left intercostal space 3. Apex 4. Apex
long term management of asthma in children: a stepwise approach
1. Classify severity: Assign patient to most severe step in which any feature occurs (PEF is % of personal best; FEV1 is % predicted). 2. Gain control as quickly as possible, then step down to the least medication necessary to maintain control. 3. Minimize use of short-acting inhaled beta2-agonists. Over-reliance on short-acting inhaled beta2-agonists (e.g., use of approximately one canister a month even if not using it every day) indicates inadequate control of asthma and the need to initiate or intensify long-term-control therapy. 4. Asthma management is a multifaceted approach, including patient education on self-management and controlling environmental factors that make asthma worse (e.g., allergens and irritants). 5. Refer to an asthma specialist if there are difficulties controlling asthma or if step 4 care is required. Referral may be considered if Step 3 or greater care is required.
cardinal movements of labor
1. Engagement The presenting part of the fetus has entered the pelvic inlet. 2. Descent Described by the "station" on cervical exam. The fetus is at 0 station when the widest part of the presenting part is between the ischial spines. 3. Flexion When a fetus is in the occiput anterior position, the fetal head is flexed by the soft and bony tissues of the maternal pelvis, which facilitates passage through the birth canal. 4. Internal rotation The fetal head must rotate in order to further descend 5. Extension Occurs as the fetal head passes under the symphysis pubis, which occurs during crowning and delivery of the head 6. External rotation The head rotates to realign with the shoulders (also called restitution) 7. Expulsion Completing the delivery, with the anterior shoulder of the fetus being pushed out first, then the posterior shoulder and the rest of the body.
shoulder impingement testing
1. Neer & Hawkins-kennedy test
diabetes screening recommendations
1. Overweight or obese patients (body mass index 25 kg/m2) who have one or more of the following additional risk factors: Physical inactivity Race/ethnicity (e.g., Native American, Pacific Islander, Latino, African American, Asian American) First-degree relative with diabetes Previously diagnosed impaired fasting glucose (100-125 mg/dL) or impaired glucose tolerance (2-hour plasma glucose > 140 mg/dL following a 75 gram glucose load) Hypertension (Blood pressure > 140/90 mmHg) HDL cholesterol < 35 mg/dL and/or triglycerides > 250 mg/dL (2.83 mmol/L) History of gestational diabetes mellitus, or delivering a baby > 9 lbs. Polycystic ovarian syndrome History of cardiovascular disease A1C ≥5.7%, impaired glucose tolerance, or impaired fasting glucose on previous testing Other clinical conditions associated with insulin resistance (e.g., acanthosis nigricans, severe obesity) 2. In the absence of the above risk factors, screening should begin at 45 years of age. 3. If results are normal, testing should be repeated at least at three-year intervals, with consideration of more frequent testing depending on risk status and initial results.
wagner grading system of ulcers
1. diabetic ulcer (superficial) 2. ulcer extension) into ligaments and muscle but no bone involvement or abscess formation 3. deep ulcer with abscess or osteomyelitis 4. gangrene forefoot (partial) 5. extensice gangrene of foot
PHQ-2 for depression
1. have you been bothered by feeling down, depressed or hopeless? 2. have you often been bothered by little interest of pleasure in doing things? - yes to either question is a positive screen
treatment of graves
1. methimazole: suppress thyroid hormone production / SE include agranulocytosis. takes 3 mo to work. continue for several years. blood work needed as doses changed often2. PO radioactive Iodine:most commonly used in US. few SE. may need eventual thyroid replacment because much of the gland is destroyed
Where do the murmurs radiate 1. Aortic Stenosis 2. Aortic Regurg 3. Mitral Stenosis 4. Mitral Regurg
1. neck and left sternal border 2. apex and right sternal border 3. little or NONE may have opening snap 4. Left axilla
how do you test for H.pylori
1. rapid urease test- sample tissue from biopsy 2. histologic staining- 3. serologic tests 4. fecal antigen tests 5. Urea breath test
when should tPA therapy be delayed
1. there is clinical suspicion of a bleeding abnormality or thrombocytopneia 2. the pt has received heparin or warfarin 3. use of anticoagulants unknown
How long can Rhus dermatitis last for
10-21 days and initial episode longest up to 6 weeks
Treatment cluster headaches
100% oxygen at 7-10L/min for 10-15min Prednisone 60-80mg/day with 2-4 week taper help shorten duration of episodes and deminish frequency
What is the daily calcium and vitamin D intake recommended for osteoperosis
1200 mg Calcium 400-800 IU of vitamin D
Cluster headaches last
15-90min many times a day on and off for 4-6 weeks with 3-4 symptom free periods
What is the new treatment guide for BP control in patients over 60y/o
150/90
severe gestational htn/preeeclampsia is
160/110 - leads to increased complications of preterm delivery, SGA, placental abruption
if you just had a kid when is it okay to get pregnant again
18-23 mo
A high-potassium and high-calcium diet reduces blood pressure significantly
A __________ diet reduces blood pressure significantly
A child may use a booster seat when > 40 lbs
A child may use a booster seat when _______
A high fever of 3-5 days followed by a rash suggests Roseola, by Human Herpes Virus 6. Rash starts starts on the trunk and spreads to extremities, sparing the face
A high fever of 3-5 days followed by a rash suggests ______________. Rash starts __________
A rare cause of COPD is deficiency of alpha1-antitrypsin
A rare cause of COPD is _________
What is cellulitis
A spreading non-fluctuant tender plaque as a result of an infection of the dermis
What is erysipelas
A superficial cellulitis with marked dermal lymphatic involvement
USPSTF grading system
A: The USPSTF recommends this service. There is high certainty that the service improves health outcomes - net benefit is substantial. B: The USPSTF recommends this service. There is high certainty that the service improves health outcomes - net benefit is fair or fair certainty that the net benefit is moderate - substantial. C: The USPSTF recommends against routinely providing this service. There is moderate or high certainty that health outcomes are not improved - net benefit is small. However there may be occasions that warrant provision of this service in a patient. D: The USPSTF recommends against providing this service. There is moderate or high certainty that the service does not have any net benefits or harms outweigh benefits. I: There is insufficient evidence to recommend for or against the service.
MOA of anterior hip disolocation
ABD and ER of femur
Operative Tx AC joint sprain
AC joint fixation and coracoclavicular ligament fixation
TX for HF long term
ACE inhibitors Diuretics Diet and exercies
What is considered 1st line tx for HTN
ACE inhibitors or ARB's in non african american people
What injury do you have a high risk of having with a secgond fracture
ACL tear
X-ray views for SCFE
AP and frog leg
Imaging to Dx Shld disslocation
AP, Axillary, and Y views
What test do you run to help determine Post streptococcal glomerulonephritis
ASO titer (antistreptolysin)
What is a 3rd Degree block
AV dissassociation P waves not related to QRS more P's than QRS
Ab for uncomplicated pneumonia in child more than 5
AZITHROMYCIN
Mechanism of ant shoulder dislocation
Abduction and External rotation
What is Parasomnias
Abnormal behaviors during sleep: Sleep terrors nightmares sleepwalking enuresis
What is the pathophys behind Emphysema
Abnormal enlargement of terminal airspaces decrease gas exchange surface and loss of elastic recoil causing Air trapping (Pink Puffer)
Absence of red reflex may suggest congenital cataracts, glaucoma, or retinoblastoma
Absence of red reflex may suggest ______________
Acanthosis nigricans is a sign of insulin resistance
Acanthosis nigricans is a sign of ______________
Complication of anterior hip dislocation
Acetab Fx Ligamentum Teres Injury
Complication of Posterior hip dislocation
Acetabular fx Siatic nerve injury Rupture lig teres artery-> avascular necrosis femoral head
What type of melanoma is more common on darker skin individuals
Acral Lentiginous
What is the MC type of melanoma found in African Americans and Asians
Acral Lentiginous Melanoma
wells criteria dignosis for DVT
Active cancer (treatment ongoing or within previous 6 months or palliative) 1 Paralysis, paresis, or recent plaster immobilization of the legs 1 Recently bedridden for more than 3 days or major surgery within 4 weeks 1 Localized tenderness along the distribution of the deep venous system 1 Entire leg swollen 1 Calf swelling by more than 3 cm compared with the asymptomatic leg (measured 10 cm below the tibial tuberosity) 1 Pitting edema (greater in the symptomatic leg) 1 Collateral superficial veins (non-varicose) 1 Alternative diagnosis as likely or wider than that of deep vein thrombosis -2 Low probability 0 or less, moderate probability 1-2, high probability 3 or more.
Acute DVT is treated with low-molecular weight heparin, and possibly warfarin. INR is normal, discontinue heparin
Acute DVT is treated with ____________. If INR is normal, ____________
MC trigger for acute asthma
Acute URI
Pain, tearin, dilated pupil, shallow anterior chamber, halos around lights, and steamy cornea indicates
Acute angle- closure glaucoma
Acute onset of painless jaundice should prompt an examination for pancreatic cancer
Acute onset of painless jaundice should prompt an examination for ____________
What is the difference between acute bacterial and subacute bacterial endocarditis
Acute: infection in normal valves with Staph Aureus Subacute: indulent infection of abnormal valves with Strep Viridans
What are some triggers for rosacea
Alcohol, heat, hot beverages, spicy foods, sunlight
Differential diagnosis for weight loss
Alcohol/substance abuse anorexia CHF- end stage depression dementia Hepatitis Medications Ulcer disease Uremia Splenomegaly Bowel obstruction Gastric Bypass Pancreatic insufficiency Inflammatory bowel disease Celiac Sprue Cholestasis Diabetes uncontrolled Fistula Chronic infection (TB/ HIV) Malignancy Hyperthyroidism Poor dentition
All patients diagnosed with depression, should be questioned about the possibility of mania
All patients diagnosed with depression, should be questioned about the possibility of ________
pale boggy nasal mucosa and swollen turbinates indicate
Allergies
What are examples of fungicidal agents for tinea pedis second line
Allyamines: terbinafine, butenafine 4-6wks
Stimulant Agents examples and MOA
Alter mucosal permeability and stimulate the activity of intestinal smooth muscle Phenolphthalein- ExLax Bisacodly- Dulcolax
symptoms of IBS
Alternating Diarrhea/ constipation chronic recurring diarrhea abdominal pain relived by defecation fecal urgency bloating small amounts of mucus in stool
Amaurosis fugax is caused by a blockage of the opthalmic artery, which branches from the ICA
Amaurosis fugax is caused by ______________
What 4 features are related to the pathogenesis of acne vulgaris
Androgens in circulation- hormones Bacteria in hair follicle- p. acnes follicular plugging sebum secretion from increased hormone presence
What is unstable angina
Angina at rest lasting > 20 min
What are some differential Dx for Anaphylaxis
Angioedema uticaria asthma epiglottitis anxiety
Gold standard for dx PAD
Angiography
MC compartment affected in lower leg
Anterior compartment
MC shoulder dislocation
Anterior shoulder
What is the treatment of impetigo
Antibiotics Dicloxacillin Cephalexin Erythromycin Augmentin
TX PE in a hemodynamically stable pt
Anticoagulation IV- UFH or SQ- LMWH and PO warfarin 5-7 day bridge than warfarin for 6 months
TX DVT
Anticoagulation therapy Heparin or LMWH bridge to Warfarin and on if for 3-6months of IVC filter
What is a good first line treatment for tinea versicolor
Antifungal shampoo Selenium Sulfidine 2%, Ketaconazole shampoo
What are other areas TB can affect
Any organ Pott's Disease- spine involvement Scrofula- lymphnode involvement
Any patient with QT interval > 500 msec is at increased risk for dangerous dysrhythmias
Any patient with QT interval ______ is at increased risk for dangerous dysrhythmias
CXR for reactivation TB shows
Apical/ upper lobe fibrocavitary disease
What is vitiligo
Areas of well circumscribed depigmented macules and papules (michael Jackson)
What is an epidermal inclusion cyst
Arise from hair follices NOT OIL glands can be called sebacous cysts
When are compression stocking contraindicated
Arterial insufficiency
What are some clinical manifestations of HTN on fundoscopic exam
Arterial narrowing A-V Nicking Retinal hemorrhages, soft exudates papilledema
What is psoriatic arthritis
Arthritis in the presence of psoriasis
What and when prophylaxis therapy for endocarditis
Artificial valve, endocarditis, congenital defects Dental procedures adn Respiratory surgery Amoxicillin 2g 30-60 min prior
Asherman syndrome may cause decreased cyclic menstrual bleeding due to a decreased endometrial surface area
Asherman syndrome may cause decreased cyclic menstrual bleeding due to a _______________
valgus and varus stress test
Assess functioning of the medial and lateral collateral ligaments These test are performed with the patient's leg in full extension with the knee flexed to about 30 degrees. The physician places his/her hand on the lateral knee joint to apply a valgus stress to the distal tibia, or on the medial knee joint to apply a varus stress to the distal fibula. Excessive motion of the knee signifies instability of the corresponding ligament.
anterior and posterior drawer signs
Assess the anterior cruciate and posterior cruciate ligaments, respectively They are performed with the patient laying supine, knee bent to 90 degrees, and the foot stabilized, most easily done by the physician sitting on the foot. The physician's thumbs are placed on the tibial tubercle, while the fingers are placed on the posterior calf. The physician then attempts to displace the tibia, either anteriorly or posteriorly. Too much motion of the tibia, or lack of a clear end-point, especially as compared to the non-painful or non-affected side, constitutes an abnormal finding.
behavioral counseling
Assess the patient's dietary practices and related risk factors. Advise the patient to change dietary practices. Agree with the patient on goals. Assist the patient in changing dietary practices or addressing motivational barriers. Arrange follow-up, support, and/or referral for the patient.
lachmans test
Assesses the stability of the anterior cruciate ligament (and not the posterior cruciate ligament) This test is performed with the patient lying supine with the injured knee raised and slightly flexed to 30 degrees. The distal femur is stabilized by the physician with one hand, while the proximal tibia is held by the other hand. Force is applied to move the tibia anteriorly. The test is considered positive if there is excessive motion of the tibia.
Asymmetrical kidneys suggest renovascular disease
Asymmetrical kidneys suggest _______________
What are the ABCDE's of moles
Asymmetry Borders Color Diameter Evolution
Asymptomatic hematuria workup includes: R/O infection with urine culture R/O malignancy with imaging or Upper urinary tract, cytoscopy, and voided cytology
Asymptomatic hematuria workup includes _____________
Treatment for constipation
At least 64oz of water a day bran, fresh fruit, veggies, beans, and whole grains Dietary fiber 20-25g daily Scheduled toilet times
At the first suspicion of anaphylaxis, aqueous epinephrine 1:1000 in a dose of 0.2-0.5 mL injected subcu or IM with repeated injections every 15-30 minutes
At the first suspicion of anaphylaxis, ______________
Cause of acute MI
Atherosclerosis Arterial thrombosis
Athletes with these murmurs should be referred to cardiology: Systolic murmur III/VI Diastolic Holosystolic Continuous
Athletes with these murmurs should be referred to cardiology ________
If need abx for bronchitis because seems bacterial in cause what is a good 1st line agent
Augmentin
Antibiotics recommended for sinusitis bacterial
Augmentin, levaquin, or doxycycline
Chronic plaque psoriasis is typically symmetric and bilateral and can exhibit what sign and phenomenon
Auspitz sign Koebner phenomenon
What is Bullous pemphigoid
Autoantibodies to hemidesmosome resulting in DEEP TENSE bullae
What causes vitiligo
Autoimmune attack on melanocytes
What is westermarks sign
Avascular markings distal to embolus on CXr for PE
Primary tx migraine headache
Avoiding triggers NSAIDS Abortive therapy with Triptans
Secgond Fracture
Avulsion fracture of knee involves lateral aspect of knee and tibal plateau Due to IR and Varus stress
what is the ABX of choice for travelers diarrhea in children and pregnant women
Azithromycin
labs for vomiting
CBC, BMP possible BUN and pregnancy or drug levels of know meds like Digoxin
BMI is not accurate in: CHF patients Pregnant women Athletes Elderly Body builders Certain ethnic groups
BMI is not accurate in ____________
What labs should be ordered with burns
CBC, CMP, BUN, Cr, UA, CXR, EKG, ABG's
BRCA 1 and BRCA 2 gene associated with breast, ovarian, and colorectal cancer
BRCA 1 and BRCA 2 gene associated with _________ cancer
What are some topical ointments for minor burns
Bacitracin or Slivadine
Back pain relieved with sitting or stooping suggests spinal stenosis
Back pain relieved with sitting or stooping suggests __________
purulent discharge from eye indicates
Bacterial conjunctivitis
What is the tx of choice for pneumonia in pts with HIV
Bactrim
Complications of shoulder disslocation
Bankhart lesion Hillsachs lesion
Most common type of skin cancer
Basal cell carcinoma
What is the MC skin cancer
Basal cell carcinoma
Routine lab for edema
CBC, CMP, UA, CXR
When does the rash begin with 5ths disease
Begins with bright read cheeks and then a systemic red lacelike rash appears on trunk and extremities
Benefits of exercise: Decreases cardiovascular risk factors Increases insulin sensitivity Decreases metabolic syndrome
Benefits of exercise include ______________
Lesions that are calcified tend to be benign or malignant
Benign
Benign cause of unconjugated hyperbilirubinemia is Gilbert's syndrome. Jaundice appears with stress or illness
Benign cause of unconjugated hyperbilirubinemia is _____________. Jaundice appears with _________
TX of cocaine overdose
Benzodiazapine Calcium channel blocker
Treatment of ETOH withdrawl
Benzodiazepines
Tx sleep terror and sleepwalking
Benzodiazepines
What is Auspitz sign
Bleeding after removal of a scale
Side effects bulk forming agents
Bloating, impaction above strictures, fluid overload
Side effects Osmotic laxatives
Bloating, magnesium toxicity ( with renal failure)
Bloody nipple discharge shoule be evaluated with mammography, prolactin and thyroid levels measured and treated with surgical excision of terminal duct involved
Bloody nipple discharge shoule be evaluated with ___________ and treated with ____________
What are the major causes of 3rd trimester bleeding
Bloody show- labor Placenta Previa Abruptio placenta Vasa previa
What are koplic spots
Bluish white dots on the mucosal surface in the mouth
Where are bouchard and heberden nodes located and what disease are they associated with
Bouchard PIP joints of hands Heberden DIP joints of hands Osteoarthritis
What are risk factors for SCFE and common ages
Boys 11-16 Girls 10-14 African american Athletically inclined Obese kids
What is the single most important prognosis information for Melanoma
Breslow measurement- thickness of tumor
When and where does the rash appear
Bright pink macules and papules with red hals on skin and red erosions like ulcers in mouth
What is the treatment of choice for outpatient cellulitis
Broad spec abx: Augmentin if not purulent Broad spec abx if purulent: Clindamycin or doxy
Which of the 4 non small cell has best prognosis
Bronchoalveolar
How do you dx bronchial carcinoid tumors
Bronchoscopy that reveals pink to purple well vascularized central tumor
MOA for little league shoulder
Caused by rotational forces and stress on proximal hum. physis during throwing
MC cause of Left HF
CAD and HTN
Triptans contraindicated in
CAD or PVD
How do you Dx Orbital cellulits
CBC Head CT to determine extent of dz +/- Blood cultures
Causes of atrial flutter
COPD, HF, Atrial septal defects, CAD
what is the imaging study of choice for chronic sinusitis or orbital cellulitis
CT
How do you treat Molluscum Contagiosum
Cantharidin- topical best for kids Cryotherapy May resolve on own
Cardiac problems seen in Marfans: Mitral Valve Prolapse Aortic root dilation Aortic arch aneurysm
Cardiac problems seen in Marfans __________
Cardinal movements during labor include: Flexion Internal rotation Extension External rotation
Cardinal movements during labor include ________
Cardinal signs of Parksinson's: Resting tremor Rigidity Bradykinesia Postural instability Asymmetrical onset
Cardinal signs of Parksinson's _______________
TX atrial flutter
Cardioversion electrial 50 J Treat with anti coagulation and rate control prior to cardioversion
What is the histologic hallmark of TB
Caseating granulomas or necrotizing granulomas
Chantax and Buproprion are what pregnancy category for smoking cessation
Cat. C
Nicotine inhaler, nasal spray, and gum are what pregnancy category for smoking cessation
Cat. D
Characteristic rash of Lyme disease is erythema migrans, caused by Borrela burgdorferi by the Ixodes tick. Treatment is doxycycline
Characteristic rash of Lyme disease is ___________, caused by ________ by the _______. Treatment is ________
Tx of small cell carinoma
Chemotherapy with or without radiation
Chest pain reproducible with chest and back compression suggests costochondritis
Chest pain reproducible with chest and back compression suggests ______________
Tx lg pneumothorax
Chest tube
Chickenpox is commonly observed during seasons winter or early spring
Chickenpox is commonly observed during seasons _____________
Child should stay in a rear-facing seat until 20 lbs AND at least 1 year old
Child should stay in a rear-facing seat until ____________
TB screening guidelines
Children who should have annual Tuberculin Skin Test: Children infected with HIV Incarcerated adolescents Validated Questions for Determining Risk of Latent Tuberculosis Infection in Children in the United States: Has a family member or contact had tuberculosis disease? Has a family member had a positive tuberculin skin test? Was your child born in a high-risk country (countries other than the United States, Canada, Australia, New Zealand, or Western European countries)? Has your child traveled (had contact with resident populations) to a high-risk country for more than one week?
Chorionic villi sampling may be performed at week 10-12. Amniocentesis at week 15
Chorionic villi sampling may be performed at week _____. Amniocentesis at week ______
What is nickname for pityriasis rosea
Christmas tree disease
A 65 year old man with a history of rheumatoid arthritis is found to have microcytic anemia. He had a colonosocpy 1 year ago that was normal and stool guaiac was negative. What is the likely cause of his anemia
Chronic Disease
Chronic bronchitis is cough and sputum production on most days for at least 3 months for 2 consecutive years
Chronic bronchitis is cough and sputum production on most days for at least ____________
Colon cancer is the second cause of cancer deaths between men and women
Colon cancer is the _______ cause of cancer deaths between men and women
Tx for COPD- Bronchodilators
Combo therapy B2 agonist and anticholinergics show greater response
What are the 3 classifications of acne
Comedonal: open and closed comedones Inflammatory: papules and pustules Nodulocystic: nodules and cysts
Common causes of hypoglycemia are fasting, sulfonylurea abuse, exogenous insulin, autoimmunity
Common causes of hypoglycemia are _____________
Common causes of postpartum hemorrhage: "Four T's" Tone (Atony) Trauma Tissue (Retained placenta or membranes) Thrombin (Coagulopathies)
Common causes of postpartum hemorrhage ____________
which type of migraine MC
Common so no aura
Common treatment for diverticulitis is quinolone and metronidazole
Common treatment for diverticulitis is ________________
Common triggers of migraine headaches: Menses Fatigue Hunger Stress
Common triggers of migraine headaches ________
Complications of Strep infections include: Scarlet fever Rheumatic fever Acute post-strep glomerulonephritis
Complications of Strep infections include ___________.
What is Cauda Equina Syndrome
Compression of cauda L2-S1
If the patient presents with acute, PAINFUL vaginal bleeding or with acute abdominal/uterine pain consider what diagnosis
Consider placental abruption
What is a 1st degree Block
Constant prlonged PR interval > 0.20 sec
What is a 2nd Degree Mobitz Type 2
Constant prolonged PR interval till drop QRS
Constipation, diarrhea, alternating constipation, with diarrhea, and periods of normal bowel habits that alternate with constipation and/or diarrhea are suggestive of Irritable bowel syndrome. Abdominal pain is frequently in the LLQ
Constipation, diarrhea, alternating constipation, with diarrhea, and periods of normal bowel habits that alternate with constipation and/or diarrhea are suggestive of __________. Abdominal pain is frequently in the ____
Consumption of undercooked chicken may suggest Salmonella or Shigella. Undercooked hamburgers suggest E. coli. Mayonnaise suggests S. aureus or Salmonella. Raw seafood suggests Vibrio, Salmonella, Hepatitis A
Consumption of undercooked chicken may suggest _________. Undercooked hamburgers suggest _______. Mayonnaise suggests _______ Raw seafood suggests ___________.
management of late decelerations
Continuous fetal monitoring. Position the patient on her side to decrease pressure on her vena cava, and increase blood return to the heart, in order to maximize cardiac output and blood flow to the uterus. Monitor blood pressure. If her blood pressure is low, she may benefit from a fluid bolus to further increase blood flow to the uterus. Oxygen by face mask, to maximize placental oxygen delivery. Although there is no clear evidence to support this, it is unlikely to cause harm with short term use, other than minimal patient discomfort.
Contraindications to breastfeeding include: HIV + Acute Hep B infection Nipple transplant
Contraindications to breastfeeding include __________
Contraindications to vaccinations are previous anaphylactic reaction, but minor illnesses are NOT contraindicated
Contraindications to vaccinations are __________, but ___________ are NOT contraindicated
What is the causative agent of Hand foot and mouth disease
Coxsackie A16 virus
What does amphetamine withdrawl look like
Crash Depression Fatigue Headache Stomach cramps Profuse sweating
different vehicles for skin medication
Creams: The cream base is a mixture of several different organic chemicals (oils) and water, and usually contains a preservative. It can be used in nearly any area and therefore most often prescribed. It is cosmetically most acceptable. It has a drying effect with continuous use, therefore best for acute exudative inflammation. Ointments: The ointment base contains a limited number of organic compounds consisting primarily of grease such as petroleum jelly, with little or no water. Ointment is desirable for drier skin and has a greater penetration of medicine than a cream and therefore has enhanced potency. Lotions and gels: Lotions contain alcohol, which has drying effect on an oozing lesion. Lotions are most useful in the scalp area because they penetrate easily and leave little residue. Gels have a jelly-like consistency and are beneficial for exudative inflammation, such as poison ivy.
Crops of vesicles of different ages with an abnormal lung examination may suggests chickenpox Varicella complicated by pneumonitis
Crops of vesicles of different ages with an abnormal lung examination may suggests _______________
DDX for bronchitis
Croup, whooping cough, pneumonia, asthma exacerbation, COPD exacerbation, URI
Immue suppressed or neurologically impaired individuals are at increased risk of developing what type of scabies
Crusted scabies
Medications helpful in managine Meniers
Diuretics (acetazolamide or HCTZ) and salt restrictions
DSM IV Criteria for dementia include: Aphasia Apraxia Agnosia
DSM IV Criteria for dementia include __________
How do you tell the difference nits vs. Dandruff
Dandruff moves freely along hair shaft and nits do not
PCL tear
Dashboard Laxity and joint effusion + posterior drawer
MOA posterior hip dislocation
Dashboard injury Forced ER at knee with hip flexed to 90
Ddx for dementia include: Medications Stroke Thyroid disorder Syphilis Workup includes: TSH ESR CMP Anemia panel CT of head without contrast
Ddx for dementia include __________ Workup includes ________
Treatment for Hypertensive Crisis
Decrease BP by 10% in first hour and additional 15% over the next 2-3 hours using IV agents Lopressor, Carvadelol, Nitro, Hydralizine
What does obstruction look like on PFT's
Decrease FEV1 Decrease FVC Decrease FEV1/FVC <70%
Decreased Free T4, Elevated TSH suggests Primary hypothyroidism Decreased Free T4, decreased TSH suggests Secondary hypothyroidism.
Decreased Free T4, Elevated TSH suggests __________. Decreased Free T4, decreased TSH suggests ______________.
what type of anemia is suspected in a 67 year old man with dizziness and a positive stool guaiac
Decreased ferritin; decreased MCV; decreased serum iron level (Iron deficiency)
CXR emphysema
Decreased lung markings at apices flattened diaphragm hyperinflation small, thin appearing heart parenchymal bullae and blebs
Stool Softeners examples and MOA
Decreased surface tension and allows water and fat to mix in the stool Docusate sodium- Colace
What is a 4th degree burn
Deep tissue down to (muscle, tendon, bone)
What is a DVT
Deep vein thrombosis partial or complete occlusion of a vein and inflammatory changes
What is Spondylolysis
Defect in pars interarticularis lumbar vertebrae
What is a spondylolisthesis
Defect in pars interarticularis with forward translocation of one verebra on another
Treatment pulsless V tach
Defibrillation/ CPR
Tx Ventricular fibrillation
Defibrllation and CPR Defib x3 ( 200, 300, 360J) CPR Epi 1mg IV q 3-5min
Test for compartment syndrome
Delta Pressure (Diastolic BP- Comp Pressure) Delta pressure <30 needs FASCIOTOMY
Depression is considered major mood disorder for at least 2 weeks with 5/9 characteristics
Depression is considered major mood disorder for ____________
Risk factors for mI
Diabetes Age > 65 HTN Hyperlipidemia Family history Obesity Smoking
When do you see Hypertriglyceridemia
Diabetes ETOH Obesity Steroids Estrogen therapy
What does cocaine intoxication look like
Dilated pupils HTN crisis Psychosis Tachycardia
What does amphetamine intoxication look like
Dilated pupils fever- over heating Tachycardia Water intoxication
Clinical manifestations of vericose veins
Dilated, tortuous veins in lower extremities Distal edema skin ulceration
How does infection of scabies spread
Direct contact with infected individual
MC mechanism for AC joint seperation
Direct force
What is a SCFE
Displaced femoral head
Colles fracutre
Distal radius fracture with fragement tilted dorsally +/- involvement of articular surface radius +/- ulnar styloid fx
Smiths Fracture
Distal radius fracture with fragment tilted ventrally
determining the need for selective screening for lead toxicity
Does your child live in or regularly visit a house or child care facility built before 1950? Does your child live in or regularly visit a house or child care facility built before 1978 that is being or has recently been renovated or remodeled (within the last six months)? Does your child have a sibling or playmate who has or did have lead poisoning? test if any of these are (+)
Diagnostic studies for PAD
Doppler US Ankle brachial index Angoigraphy
Special tests
Drop Arm
What is andother name for Drug induced hypersensitivity syndrome
Drug Reaction with Eoxinophilia and Systemic Symptoms (DRESS)
What can cause a change in mental status
Drugs Polypharm ETOH intoxication Gases: carbonmonoxide, cyanide, ethylene glycol Withdrawl Infections- Sepsis Electrolyte imbalance Hyocarbia Hypoxia Hyper or Hypo- glycemia Wernikes encephalopathy Head injuries Psych Disorders Delerium Dementia
What does 2nd degree deep partial thickness burn look like
Dry, blister, +/- pain, no capillary refill
Lumbar radiculopathy
Dysfunction or irritation to nerve root causes pain, sensory impairment, weakness, decreased DTR
Clinical manifestations of emphysema
Dyspnea on exertion accessory muscle use prolonged expiration mild cough
Dyspnea on exertion, bilateral leg edema, pillow orthopnea, and pink forthy sputum suggest congestive heart failure
Dyspnea on exertion, bilateral leg edema, pillow orthopnea and pink, frothy sputum suggest ___________
Dysthmic disorder is 2 years of less acute depression
Dysthmic disorder is ____________
A 40 year old man travels to Mexico and develops diarrhea 1 day after coming back to the US. What is the most likely cause of his diarrhea
E. coli
How do you diagnose A-fib
EKG
What should be included in the work up for syncope
EKG BP and Orthostatics Then other options: Stress test, holter/even monitor, Echo, tilt table test
How do you dx Stable angina
EKG ST depression with exertion Stress test
2 diagnostic studies for new onset chest pain
EKG and CXR
Early deceleration are caused by compression of the fetal head.
Early deceleration are caused by _________________
How do you treat SJS/TEN
Early recognition Stop offending & all non-life threatening medications CONSULT DERM Treat like a burn patient if more than 25% BSA affected
Diagnose HF
Echo CXR BNP EKG
What are some differential dx for abdominal pain
Ectopic pregnancy Appendicitis AAA- rupture MI PID Biliary Dz Bowel obstruction Diverticulitis Mesinteric Ischemia Testicular or Ovarian torsion
What is the MC joint dislocated in Kids
Elbow
Who is usually affected by bullous pemphigoid
Elderly patients
if cant determine central vs peripheral what test do you order
Electronystagmography and audiometry and possible brain MRI
Elevated PTH, Elevated serum calcium levels suggest Primary hyperparathyroidism
Elevated PTH, Elevated serum calcium levels suggest __________
Elevated PTH, Low serum calcium levels suggest Secondary hyperparathyroidism
Elevated PTH, Low serum calcium levels suggest ________________
TX PE in a hemodynamically unstable pt where thrombolytics are contraindicated
Embolectomy
Causes of syncope
Emotional stress pain dehydration pooling blood in legs d/t sudden change body position Violent coughing spells cardiac problems metabolic disorders psych disorders pulmonary disorders
TX hospital acquired pneumonia
Emperic abx: Cefepime and FQ
What is the treatment for Endocarditis
Emperic therapy Gentamicin and Ceftriaxone or Gentamicin, Vanco and Cefepime
2 types of COPD
Emphysema Chronic Bronchitis
Special Tests for Impingement
Empty can Nears Speeds Hawkins Kennedy Scap liftoff
most frequent test ordered when evaluating symptoms of heartburn
Esophagogastroduodenoscogy (EGD)
Essential hypertension is rare in children, but when observed, may be from renal parenchymal disease. Perform UA, C&S, renography
Essential hypertension is rare in children, but when observed, may be from ___________. Perform __________
Antidote for methanol, ethylene glycol OD
EtOH, fomeprizole, dialysis
Evaluation of CHF includes: CBC CMP Cardiac Enzymes ECG Echo
Evaluation of CHF includes _______
Examples of 2nd generation antihistamines include: Fexofenadine Cetirizine Loratadine
Examples of 2nd generation antihistamines include ___________
A drug reaction that occurs after a medication that results in a widespread, symmetric, erythematous macules and papules on the truk or extremities indicates what reaction
Exanthematous drug reaction
Excessive daytime sleepiness and cognitive impairment suggests obstructive sleep apnea. Evaluation includes Comprehensive sleep evaluation, Epworth Sleepiness scale, polysomnography. Most effective therapy is Continuous positive airway pressure
Excessive daytime sleepiness and cognitive impairment suggests ______________. Evaluation includes ________. Most effective therapy is _________
What is hypersomnia
Excessive daytime sleepiness generally more a problem in patients with sleep apnea, narcolepsy, or nocturnal myoclonus
Achilles Tendon rupture MOA
Explosive force or rapid contraction
Exudative pharyngitis, fever, "sandpaper rash" and "Strawberry tongue" suggests Scarlet fever, a complication of group A Strep
Exudative pharyngitis, fever, "sandpaper rash" and "Strawberry tongue" suggests ______________
True or false it is ok to use topical antibiotics as a monotherapy for acne
FALSE
What is the Glasgow Comma Scale
Eye opening: Spontaneous 4, Verbal command 3, Pain 2, None 1 Verbal Response: A&O 5, confused yet coherent 4, Inappropriate words 3, Incomprehensible sound 2, none 1 Motor Response: Obeys commands 6, Localize to noxious stimuli 5, withdrawl noxious stimuli 4, Abnormal flexion (Decorticate) 3, Abnormal extension (Decerebrate) 2, No response 1
FDA-approved alcohol abuse treatments are Naltrexone, Disulfiram, and Acamprosate
FDA-approved alcohol abuse treatments are _______________
FDA-approved medications for osteoporosis include: Alendronate Risdedronate Ibandronate Zoledronic acid Calcitonin PTH (Teriparatide) Selective estrogen receptor modulate (Raloxifene)
FDA-approved medications for osteoporosis include __________
Scaphoid fracture MOA
FOOSH injury
Campylobacter diarrhea tx with
FQ or Bactrimerythormycin
E. Coli with bloody diarrhea tx with
FQ or bactrim
Factors diagnostic of DM: FBG > 125 RBG > 200 with classic symptoms BG > 200 after 75-g glucose delivered 2 hours prior HA1c > 6.5
Factors diagnostic of DM __________
What are risk factors for basal cell carcinoma
Fair skin Hx prolonged ultraviolet exposure Radiation exposure arsenic ingestion Immune supression
Frequent 1st line treatments for depression include SSRI, (such as Fluoxetine, Paroxetine, Sertraline, Citalopram, Escitalopram) or SNRI (such as Venlafaxine, Desvenlafaxine, Mirtazapine, Duloxetine)
Frequent 1st line treatments for depression include _____ (such as __________)
risks for vertical transmission of HIV
Frequent, unprotected sex during pregnancy (This increases the risk for chorioamnionitis, and chorioamnionitis and other sexually transmitted infections increase the risk of HIV transmission.) Advanced maternal HIV disease, which may indicate high viral load Membrane rupture greater than 4 hours prior to delivery if mother is not on antiretroviral therapy Vaginal delivery Breastfeeding Premature delivery (i.e., delivery before 37 weeks' gestation)
What are the first line antifungals for tinea pedis
Fungistatic's: Imidazoles Clotrimazole or miconazole 4-6wks
Give example of loop diuretics
Furosemide Bumetanide
Boxers fracture
Fx 5th metacarpal at MCP joint
GBS culture is obtained during gestational week 35-37
GBS culture is obtained during gestational week ________
GFR levels Stage I CKD: 90-120 Stage II CKD: 60-90 Stage III CKD: 30-60 Stage IV CKD 15-30 ESRD: < 15
GFR levels ___________
Side effects of Stimulant agents
Gastric or rectal irritation, degeneration of myoneural plexuses
What deos erythrodermic psoriasis look like
Generalized erythema covering nearly the entire body surface with varing degree of scales
Gestational diabetes is tested at week 26-28 with 1-hour 50-g glucose challenge test. If positive, perform 3-hour glucose tolerance test at fasting, 1-hour, 2-hour, and 3-hour
Gestational diabetes is tested at week ____ with ______. If positive, ______
MC cause of parasitic diarrhea
Giardia
Causes of jaundice
Gilbert Crigler-Najjar syndrome Hepatitis
What is a Bandhart lesion
Glenoid labrum avulsion anterior to inferior
Goals of treating parkinsons are slowing down progression and treating symptoms
Goals of treating parkinsons are ______________
Greenish exudates accompanied by sore throat and dysuria indicate what cause
Gonococcal pharyngitis
hemoptysis combined with hematuria is a symptom for what syndrome
Goodpastures
Gout exacerbations may occur from: Alcohol Trauma Large meal Surgery Thiazide diuretics Aspirin
Gout exacerbations may occur from ______
What are common organisms for orbital cellulitis
Group A beta hemolytic Strep Stre. Pneumoniae H. Influenza Staph Aureus
Scarlet fever is associated with what etiology
Group A beta heymolytic streptococci
What is the main pathogen of erysipelas
Group A strep
What is the most common pathogen of cellulitis
Group A strep and stachlococcus
What is a patch
Larger than 1cm and flat
TX for Kaposi Sarcoma
HAART therapy
HCM murmurs increase with Valsalva and decreases with squatting
HCM murmurs increase with __________ and decreases with __________
Kaposi Sarcoma MC in what patient population
HIV and Immunosupressed patients
HIV infects the helper T cells
HIV infects the _________
HIV is tested with ELISA, confirmed with Western blot
HIV is tested with _______, confirmed with _________
prenatal lab screening includes
HIV, rubella, hep B - blood type and Rh - urine drug screen
HIV/AIDS Stages I. CD4 cell count > 500 II. 200 - 499 III. (AIDS) < 200 IV. Lab parameters with AIDS-defining condition
HIV/AIDS Stages ___________
What is PSVT
HR > 100bpm and narrow complex
Worry about pneumonia if what symptoms are present
HR >100 Temp >100.4 RR >24 Age >64 Chest exam + consolidation findings
Causes of diastolic heart failure
HTN Infilltrative cardiomyopathy Diabetes left ventricular hypertrophy CAD Chronic heart valve stenosis
What is secondary hypertension
HTN due to an underlying Identafiable and often correctable cause
What is primary hypertension
HTN due to idiopathic etiology
What does benzo wtihdrawl look like
HTN, tachycardia, seizure, psychosis, anxiety
TX PCP overdose
Haldol Acidify the urine and increase urine excretion
What is the Rule of 9's
Head 9% Ant Trunk 18% Post Trunk 18% Each arm 9% Each leg 18% Genitalia 1%
what are the 3 different variants of lice
Head louse- pediculus capitus Body louse- pediculus corporis Pubic louse- Phthirus Pubis
Indications for neuroimaging
Headache recent onset <6months headache beginning after 50 yo worsening headaches headahce that does not fit primary pattern assocaited seizures focal neurologic sings/ symptoms personality changes severe headaches unresponsive to therapy history trauma new headache in a cancer patient
Headache with jaw pain or jaw claudication suggests temporal arteritis
Headache with jaw pain or jaw claudication suggests ________________
If you were to biopsy Molluscum contagiosum what would the histopathology show
Henderson-Paterson bodies
Hearing screening in newborns occurs with auditory brainstem response or evoked otoacoustic emission
Hearing screening in newborns occurs with ___________
What is a good initial test for PE
Helical CT scan
Glomerularniphritis usually presents with
Hematuria RBC casts mild-moderate hypertension Edema +/- proteinuria in smaller amounts
Differential Dx for Jaundice
Hemolytic anemia Thalassemia Gilbert Crigler Hepatocellular dysfunction Hepatitis Cirrhosis Drugs Sepsis Pancreatic cancer
What is Charcots triad and what does it indicate
High fever, RUQ pain, Jaundice cholangitis
Bulk forming agents examples and MOA
High in fiber Psyllium- metamucil Methylcellulose- citrucel Fibercon
If the psoriasis covers less than 5% body surface area what is the 1st line treatment
High potency topical steroids in combination with calcipotriene
SS of posterior hip dislocation
Hip IR and shortened, inability to ABD and ER
Femoralacetabular impingement (CAM)
Hip impingement between femoral head and acetabular pincer
List 3 methods to relocate an anterior disslocation
Hippocratic Stimson Hennipen
x-ray for lower back pain indicated when
History of trauma Strenuous lifting in patient with osteoporosis Prolonged steroid use Osteoporosis Age <20 and >70 History of cancer Fever/chills/weight loss Pain worse when supine or severe at night Spinal fracture, tumor, or infection
What is uticaria
Hives and a vascular reaction
If positive airway pressure is not improving symptoms, consider adding heated humidification
If positive airway pressure is not improving symptoms, consider __________________
What is Kaposi Sarcoma caused by
Human herpes 8 virus
What causes Roseola
Human herpes virus 6 and 7
If taking Coumadin, monitor PT, INR
If taking Coumadin, monitor _______
TX orbital cellulits
IV Abx- Vancomycin Surgical drainage if severe
How do you control rate for A-fib
IV- CCB (Diltiazem) or BB (Metropolol) HF present: digoxin and amiodarone NO HF: metropolol, Diltiazam, Verapamil
TX PE in hemodynamically stable pt where anticoagulation is contraindicated
IVC filter
Non operative Tx AC joint sprain
Ice, sling till pain decrease 7-10 days then start PT and no activity 3-4 weeks
Idiopathic gradual onset of hip, thigh, or knee pain and limping over few months suggests Legg-Calve-Perthes disease
Idiopathic gradual onset of hip, thigh, or knee pain and limping over few months suggests ___________
If < 3 hours from onset of CVA symptoms, administer thrombolytic therapy. If < 48 hours, administer aspirin
If < 3 hours from onset of CVA symptoms, administer ______________. If < 48 hours, administer ______
If CVA neurologic signs have resolved, MRI is preferred study to differentiate between TSI and TIA
If CVA neurologic signs have resolved, ____is preferred study to __________
If a DVT is suspected, order D-dimer (Sensitive, NOT specific) Doppler (confirms)
If a DVT is suspected, order ___________
If a breast cyst is observed, aspirate. If aspiration does not resolve cyst, is bloody, or if lesion recurs, further evaluation is warranted
If a breast cyst is observed, aspirate. If aspiration ___________ further evaluation is warranted
If bilirubin is present in UA, suggestive of conjugated hyperbilirubinemia
If bilirubin is present in UA, suggestive of ______________
When can you stop pap
If had a hysterectomy and the cervix is gone or between the age of 65-70
If pheochromocytoma is suspected, 24-hour urine collection for catecholamines and metanephrines is required
If pheochromocytoma is suspected, _____________
If taking Heparin, monitor PTT
If taking Heparin, monitor ______
If using OCP while breastfeeding, use minipill progestin only as combined hormones may interfere with breastfeeding. Other options include Depo Provera or IUD 6 weeks postpartum or lactation-induced contraception for about 6 months
If using OCP while breastfeeding, use ____________. Other options include ___________.
Immunization does not guarantee severity, but a less severe presentation of a disease
Immunization does not guarantee severity, but _______________
Immunizations indicated for 60 year olds include Herpes Zoster vaccine and 65 year olds includes Pneumo and Tdap
Immunizations indicated for 60 year olds include _______ and 65 year olds includes __________
What is a hillsachs lesion
Impression fracture to posterior lateral portion of humeral head
In COPD, the ratio of FEV1 and FVC are less than 0.7
In COPD, the ratio of FEV1 and FVC are _________________
In IBS, Constipation may be treated with: Fiber intake Lubiprostone Diarrhea may be treated with: Loperamide Alosetron
In IBS, Constipation may be treated with ________ Diarrhea may be treated with _________
In IBS, abdominal pain may be treated with: Antispasmodics (Dicyclomine) 1st line TCAs SSRIs Rifaximin Probiotics Peppermint
In IBS, abdominal pain may be treated with _______
In a CVA with Aphasia, contralateral hemiparesis, sensory loss, spatial neglect, and impaired conjugate gaze, suspect middle cerebral artery to be affected
In a CVA with Aphasia, contralateral hemiparesis, sensory loss, spatial neglect, and impaired conjugate gaze, suspect _________ to be affected
In a CVA with foot and leg deficits > arm deficits, suspect anterior cerebral artery to be affected
In a CVA with foot and leg deficits > arm deficits, suspect ____________ to be affected
In anaphylactic shock, administer: 0.3-0.5 mL of 1:1000 epinephrine (Repeat in 10-15 minutes PRN) Antihistamines Steroids (If severe) Bronchodilators
In anaphylactic shock, administer ___________
In bloodwork levels, conjugated bilirubin is direct bilirubin. Unconjugated is measured from subtracting "Direct" from "Total"
In blood work levels, conjugated bilirubin is _______. Unconjugated is measured from ___________.
In patients with a pleural effusion and pneumonia, consider empyema
In patients with a pleural effusion and pneumonia, consider ________
In patients with sickle cell disease, Parvovirus B19 infection can lead to aplastic crisis with anemia and leukopenia
In patients with sickle cell disease, ____________ infection can lead to aplastic crisis with anemia and leukopenia
In peptic ulcer disease, duodenal ulcers are more common overall and gastric ulcers are more common with NSAID use
In peptic ulcer disease, _______ ulcers are more common overall and ________ ulcers are more common with NSAID use
In women who are Rh negative, next step is assessing antibodies or indirect Coomb's test.
In women who are Rh negative, next step is ________.
In women who are not breastfeeding, menstrual periods return around 3 months postpartum
In women who are not breastfeeding, menstrual periods return around _____________
What is heart failure
Inability of the heart to pump sufficient blood to meet the metabolic demands of the body
Greenstick Fracture
Incomplete fx of tension side of cortex with buckling of compression side
Asthma
Increase inflammation of airways as well as bronchospasm of bronchial smooth muscle
CXR for chronic bronchitis
Increased interstitial markings at bases Diaphragms not flattened
Increased risk of cardiovascular outcomes in women taking estrogen or estrogen and progesterone combination
Increased risk of _________ in women taking estrogen or estrogen and progesterone combination
What is endocarditis
Infection of the endothelium/valves secondary to colonization of bacteria
Infertility in PCOS can be treated with clomiphene, aromatase inhibitors, or gonadotropins
Infertility in PCOS can be treated with ____________
What is bronchitis
Inflammation of large airways of lungs and usually self limited to a period of up to 3 weeks
What is intertrigo
Inflammation of large skin folds and can be complicated by candidia
DeQuervians Tenosynovitis
Inflammation of sheath surrounds ABD pollicus longus and extensor pollicus brevis
Initial management of asymptomatic diverticuli is high-fiber diet
Initial management of asymptomatic diverticuli is __________
prolonged morning stiffness and pain worse in the AM, improves with motion, and associated with systemic symptoms (fever)
Inflammatory arthritis
TB treatment for active TB
Initial 4 drug regime for 2 months, D/C Pyrazinamide after 2 months and continue rest for 4 more months Isoniazid Rifampin Pyrazinamide (Ethambutol or Streptomycin)
Initial workup of anemia includes CBC with RBC indices Peripheral blood smear Reticulocyte count
Initial workup of anemia includes ______________
Mallet Finger
Injury to tip of finger with avulsion of insertion of extensor tendon at distal finger
Signs and symptoms SCFE
Insidious onset Hip, thigh, KNEE pain Painful limp Loss of IR of hip
Insulin resistance in PCOS can be treated with metformin and thiazolidinediones
Insulin resistance in PCOS can be treated with ___________
Clinical manifestations of PAD
Intermittent claudication thigh or buttocks pain with walking Femoral and distal pulses weak numbness or tingling ischemic ulcerations
Bartons Fracture
Intra-articular fracture associated with subluxation of carpus of radius
Irregular shaped plaques or nodules with raised borders suggest squamous cell carcinomas
Irregular shaped plaques or nodules with raised borders suggest ________________
What is A-FIB
Irregularly irregular rhythm No p waves Atrial rate 350-600bpm
Causes of systolic heart failure
Ischemic heart disease s/p MI CAD HTN Fluid overload Valvular dz Cardiac dysrhythmia Renal Dz
What clinical changes occur in chronic venous insufficiency
Itching, dull pain with standing, ulceration above the ankle, shiny skin, thin skin, dark pigmentation changes to skin
What is an oral medication that can be prescribed for scabies
Ivermectin 200mcg/kg and repeat a dose 2 weeks later
JVD and lower extremity edema suggest cor pulmonale due to chronically elevated pressures in pulmonary circulation
JVD and lower extremity edema suggest ____________
What is becks triad and what does it indicate
JVD, Muffled heart sounds, and decreased blood pressure suggest cardiac tamponade
Jaundice is first observed in the sclera or under the tongue
Jaundice is first observed in _____________
What is tinea cruris
Jock itch- tinea in the groin area
Joint aspirate of gout appears as monosodium urate crystals with strong negative birefringence
Joint aspirate of gout appears as _____________
Joint aspirate of pseudogout appears as calcium pyrophosphate dehydrate crystals with rod-shaped, rhomboid, weakly positive birefringence
Joint aspirate of pseudogout appears as ___________________
Joint pain that is worse in the morning and improves as the day goes by suggests Rheumatoid Arthritis
Joint pain that is worse in the morning and improves as the day goes by suggests ______________
Joint pain worsened with activity and improved with rest suggests osteoarthritis
Joint pain worsened with activity and improved with rest suggests __________
Joint paint that awakens a child at night suggests malignancy
Joint paint that awakens a child at night suggests _______________
How do you diagnosis tinea pedis
KOH (potassium hydroxide) exam
How do you diagnose tinea versicolor
KOH prep and will see "spaghetti and meatball" pattern with hyphae and spores
DX intertrigo
KOH prep reveas pseudohyphae
Imaging used to check for bowel obstruction
KUB xray
In children under 5: fever, strawberry tongue, conjunctivitis, rash involving hands and feet that leads to desquamation of palms indicates
Kawasaki Disease
If you use dermatoscope on seborrhic keratosis what do you see
Keratin Pseudocysts- small white spots
Who should get pneumona vaccine
Kids 6wks-15months series of 4 kids 2-5 Over 65
diminished hip flexor strength suggests a lesions where
L2, L3 or L4
Innervation L3 L4 L5 S1
L3: hip flx; ant/med thigh; patellar reflex L4: knee ext; ant leg/ med foot; Patellar reflex L5: DF and gret toe ext; lat leg S1: PF; post leg/lat foot; Achilles reflex
difficulty with heel walk is associated with
L5 disc herniation - seen with L5 disc herniation there should be normal strenght of the knee flexion and ankle dorsiflexion - with L5 impingement a hypoactive ankle tendon reflex is also present
Laboratory studies recommended at first prenatal visit include: CBC HBsAg HIV RPR UA Rh Pap Ct and Ng
Laboratory studies recommended at first prenatal visit include _____________
Laboratory tests suggesting rheumatoid arthritis are Rheumatoid Factor and anti-CCP. Anti-CCP is more specific
Laboratory tests suggesting rheumatoid arthritis are __________. _______ is specific
A 58 year old woman comes in complaining of fatigue adn has also noticed burning sensation in her feet over the past 6 months. CBC shows anemia with an increased MCV. what is the most likely cause of anemia
Lack of intrinsic factor (B12 deficiency)
Which type of the 4 non small cell is very aggressive
Large cell
Late decelerations are manifests of uteroplacental insufficiency
Late decelerations are ______________
Lateral ligaments usually involved in an inversion injury include Anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament. ATFL is the MC injured ligament
Lateral ligaments usually involved in an inversion injury include ___________. ______ is the MC injured ligament
What are common causes of fixed drug eruptions
Laxatives Tetracyclines Metronidazole Sulfonamides Barbiturates NSAIDS Salicylates
ACL tear
Laxity and joint effusion + anterior drawer, lachmans, pivot shift
MC cause of Right HF
Left sided HF
Leiomyomatas or fibroids cause an increase in cyclic menstrual bleeding due to increasing endometrial surface area
Leiomyomatas or fibroids cause an increase in cyclic menstrual bleeding due to ______________
What is Koebner phenomenon
Lesion induced by trauma (Scratching)
What is the difference in itching between lice and scabies
Lice itch all the time Scabies mainly itch at night
Lower GI bleeding is defined as pathology below the ligament of Treitz
Lower GI bleeding is defined as pathology below the ____________
What is the treatment of choice for atinic keratosis
Liquid nitrogen cryotherapy or shave excision
What labs should be done before starting Terbinafine
Liver function because has risk to cause hepatotoxicity
What is important to do with electrical burns
Look for entrance and exit burns and get an EKG to look for cardiac arrhythmias
Low PTH, Elevated serum calcium suggests PTH-related peptide and malignancy until r/o!!!
Low PTH, Elevated serum calcium suggests _____________
Low back pain, incontinence, and saddle parasthesis suggests cauda equina. Treated with decompression
Low back pain, incontinence, and saddle parasthesis suggests _______. Treated with _________
What is the prodrome of 5ths disease
Low grade fever, malaise, headache, coryza, joint pain
What are other treatments for seborrheic dermatitis
Low potency topical steroid- Desonide 1-2wks Antidandruff shampoo for scalp and chest
What is the leading cause of cancer death in men and women
Lung cancer
MC antibiotics associated with pseudomembranous colitis or "C diff" are Clindamycin, Cephalosporins, Penicillins
MC antibiotics associated with pseudomembranous colitis or "C diff" are ______________
MC bacteria isolated in a human bite wound is Eikenella corrodens
MC bacteria isolated in a human bite wound is _________________
MC cause of lymphedema is secondary to malignancy (of prostate, ovary, lymphoma), surgery and radiation therapy
MC cause of lymphedema is secondary to ________________
MC cause of sudden cardiac death in adolescents is HCM
MC cause of sudden cardiac death in adolescents is _______
Patellar dislocation MOA
MC d/t twisting force
Patellar bursitis
MC from direct contact
What is the best class of drugs to reduce LDL
MHGcoA Reductase Inhibitors (Statins)
What are emergent causes of chest pain
MI, Aortic dissection, PE, Pneumothorax
What is 2nd line if lice resistant to permethrin
Malathion 0.5% to clean dry hair for 8-12 hours then rinse
Mammographies should begin at age 50 every 2 years
Mammographies should begin at age __ every __________
Management of uterine atony include oxytocin and bilateral uterine massage. If no improvement, Prostaglandin F2a (ci in asthma) or misoprostol.
Management of uterine atony includes __________. If no improvement, ___________.
Nephrotic syndrome usually presents with
Massive Proteinuria Hyperlipidemia lipiduria hypoalbuminemia Edema
Mastitis may be treated with Cephalexin and Dicloxacillin
Mastitis may be treated with _____________
Maternal benefits of breastfeeding include: Quicker return to normal body Quicker return of uterine tone Reduced incidence of breast and ovarian cancer
Maternal benefits of breastfeeding include _____________
MC cause of low back pain
Mechanical low back pain
Epicondylitis another name for Medical and Lateral
Medial= golfers elbow Lateral= Tennis elbow
Median survival in those with CHF is between 3-5 years
Median survival in those with CHF is ___________
Medications associated with edema include: NSAIDs CCBs OCPs
Medications associated with edema include __________
Medications that may cause galactorrhea include: TCAs SSRIs BBs CCBs H2 Blockers Opiates
Medications that may cause galactorrhea include _________
Melanoma typically invasive by the time of diagnosis is Nodular melanoma.
Melanoma typically invasive by the time of diagnosis is ____________.
Men should consume no more than 2 alcoholic drinks a night
Men should consume no more than _____ alcoholic drinks per night
Audiometry good for diagnosing ____
Menieres dz low frequency hearing loss
Metabolic Syndrome is: Waist Expanded (42" in men, 35" in women) Increased Glucose ( > 100) HTN HDL decreased Triglycerides elevated
Metabolic Syndrome is ____________
Metformin benefits DM by decreasing gluconeogenesis, increasing insulin sensitivity, and decreasing glucose reabsorption in the intestine
Metformin benefits DM by _____________
Metformin use is contraindicated with creatinine level > 1.4, hepatic insufficiency, chf
Metformin use is contraindicated with ___________
TX heroin addiction
Methadone
Tx for opiate abuse
Methadone
C. Diff and Giardia diarrhea tx with
Metronidazole- flagly
What is the preferred treatment for diarrhea caused by clostridium defficile toxin
Metronidazole/flagyl
Galiazzi fracture
Mid to distal radial fx Carpoulnar dislocation
Monteggia fracture
Mid to proximal ulnar fx Radial head dislocation
MC location to fx clavicle
Middle 1/3
Where are Brown recluse spiders found
Midwest and Southeast
18 year old male presents for follow up on his asthma. he has symptoms no more than 1 day per week adn 1 night per month. What level of asthma does he have and What treatment is appropriate for him
Mild intermittent asthma as needed inhaled albuterol inhaler
When you see dome shaped pearly, flesh colored to translucent and umbilicated papules what do you think of
Molluscum contagiosum
What test do you order for Mono
Mono spot test ( Heterophile antibody) Blood test
Monoarticular joint pain with associated systemic signs such as fever suggests septic arthritis
Monoarticular joint pain with associated systemic signs such as fever suggests ______________
Monoarticular swollen joint, hot-to-touch, with edema commonly to the great toe suggests gout. Exacerbations include EtOH, trauma, large meal, or thiazide diuretics. Aspiration shows negative bire-fringent monosodiumurate crystals
Monoarticular swollen joint, hot-to-touch, with edema commonly to the great toe suggests _____. Exacerbations include _________. Aspiration shows ________.
fever, posterior cervical adenopathy, general malaise and sore throat indicate
Mononucleosis caused by epstine barr virus
What is the treatment of pityriasis alba
Mositurization Sunscreen Consider low potency topical steroid
Most TIAs last for < 1 hour
Most TIAs last for ______
Clinical manifestations of hyperlipidemia
Most asymptomatic Xanthomas pancreatitis
Most common cause for false-positive serum screen is incorrect gestational age
Most common cause for false-positive serum screen is __________
Most common cause of bacterial community-acquired pneumonia is Strep. pneumo, others include H. flu and Moraxella
Most common cause of bacterial community-acquired pneumonia is ___________, others include ___________
Most common cause of chorea is Huntington's, inherited at autosomal dominant pattern, with an abnormality at chromosome 4
Most common cause of chorea is _________, inherited at __________, with an abnormality _________
Most common cause of pinkeye is adenovirus, usually lasts 2 weeks
Most common cause of pinkeye is ___________, usually lasts _______
Most common causes of postoperative fever: "5 W's" Wind (Pneumonia) Water (UTI) Wound (SSI) Walk (DVT) Wonder drugs (Drug fever)
Most common causes of postoperative fever _______
Most common melanoma found in African Americans and Asians is Acral Lentiginous Melanoma. Common sites include under the nails, soles of feet, palms of hands
Most common melanoma found in African Americans and Asians is ________________. Common sites include ______________
Most effective treatment and first-line therapy for long-term management of mild to moderate allergic rhinitis is ICS
Most effective treatment and first-line therapy for long-term management of mild to moderate allergic rhinitis is ____
Most effective treatment for depression is psychotherapy combined with pharmacotherapy
Most effective treatment for depression is _______________
Most patients with atrial fibrillation require warfarin
Most patients with atrial fibrillation require _________
Motor or sensory loss in all four limbs, cross signs, disconjugate gaze, nystagmus, dysarthria and dysphagia suggest vertebrobasilar artery to be affected
Motor or sensory loss in all four limbs, cross signs, disconjugate gaze, nystagmus, dysarthria and dysphagia suggest __________ to be affected
What are common areas affected by Fixed drug eruptions
Mouth Genitalia face acral areas
What is a topical treatment option for impetigo
Mupirocin ointment
What is the MC cause for walking pneumonia
Mycoplasma pneumoniae
Antidote for acetominophen OD
N-acetylcysteine
Tx bullous pemphigoid
NEVER POP and consult dermatology
TX for opiate overdose
Nalaxone
TX of heroin overdose
Nalaxone
S/S Bronchitis
Nasal congestion, rhinorrhea, pharyngitis, cough >5 days
TX for asthma acute attack
Nebulizer B2 agonist (Albuterol)
TX tension pneumothorax
Needle decompression (14G angio cath 2nd intercostal space MCL) followed by chest tube
What is the most aggressive form of Melanoma
Nodular melanoma
Work up for Hypertensive Crisis
Neuro exam- CT r/o stroke Cardiac exam- EKG, CXR, CK/Troponin Renal: UA, BUN, Cr Retinal Exam
Complications of Hypertensive Crisis
Neurologic: enecphalopathy, stroke Cardiac: Acute coronary syndrome, HF, Aortic dissection Renal: AKI, Protenuira, Hematruia
mri for lower back pain is indicated when
Neurological deficit Radiculopathy Progressive major motor weakness Cauda equina compression (sudden bowel/bladder disturbance) Suspected systemic disorder (metastatic or infectious disease) Failed six weeks of conservative care
symptoms suggestive of serious underlying cause for diarrhea
New onset >40yo Nocturnal symptoms aggressive course rectal fissures anemia Elevated ESR
Indication for EGD
New onset heartburn after 45yo evidence GI bleed early satiety and vomiting symptoms that persist after treatment
Nipple discharge may be tested for blood with fecal occult blood test card
Nipple discharge may be tested for blood with ___________
treatment bacterial conjunctivitis noncontact and contact lense wearers
No contacts: erythromycin or trimethoprim-polymixinB drops Contacts: cover for pseudomonas use FQ drops (cipro)
what is ventricular fibrillation
No effective pumpig action
What age do you start screening for osteoperosis with no other risk factors and with risk factors
No risk factors 65 Risk factors 60
Trigger finger
Nodular thickening of flexor tendon
OCPs may be reduced in efficacy with: Antibiotics Barbiturates Antifungals May prolong effects of : Theophyllines Benzodiazepines Caffeine
OCPs may be reduced in efficacy with _______, but may prolong affects of ____________
Mechanism for inferior shoulder disslocation
Overhead injury
Risk factors for spondylolysis
Overloading pars (trunk extension, hyperextension, Ext with rotaion)
Patellar tendonitis
Overuse injury "jumpers knee" Local pain and crepitus
What is the only medical therapy proven to decrease mortality in COPD pts
Oxygen therapy
What are Janeway lesions
PAINLESS red macules on palms and soles
PCOS is a syndrome of insulin resistance and androgen excess
PCOS is a syndrome of ____________
Parkinson's disease develops due to the degeneration of dopamine in the substantia nigra and proliferation of Lewy bodies
Parkinson's disease develops due to ______________
How do you determine fluid resuscitation for burns
Parkland formula
What is the MC cause of transient aplastic crisis in patients with sickle cell disease
Parovirus B-19
What is the cause of 5ths disease
Parovirus B-19
Patients treated for a first episode of depression must be on treatment for 6-9 months
Patients treated for a first episode of depression must ____________
Patients treating depression with MAOIs must be on a tyramine-restricted diet to prevent a hypertensive crisis
Patients treating depression with MAOIs must _____________
Patients with BMI over 40 without improvement from diet and exercise or 35 with comorbid conditions are potential candidates for surgical treatment of obesity
Patients with _____________ are potential candidates for surgical treatment of obesity
antibiotics for copd exacerbation should be given when
Patients with exacerbations of COPD with the following three cardinal symptoms: *increased dyspnea, increased sputum volume, and increased sputum purulence* Patients with exacerbations of COPD with two of the cardinal symptoms, if increased purulence of sputum is one of the two symptoms Patients with a severe exacerbation of COPD that requires mechanical ventilation (invasive or noninvasive).
Patients with ventricular tachycardia should be cardioverted and given amiodarone
Patients with ventricular tachycardia should be _____________
Pearly papules with central ulceration or multiple telangiectasias suggest basal cell carcinomas
Pearly papules with central ulceration or multiple telangiectasias suggest __________
What are some medications that can cause proteinuria
Penicillin Cephlosporins NSAIDS ACE inhibitors cyclosporins sulfonamides
What is the treatment of choice for strep pharyngitisq
Penicillin or Augmentin for 7-10 days
Pepto Bismol is CI in: HS to aspirin Pregnancy Methotrexate use Probenecid use Doxycycline use for malaria
Pepto Bismol is CI in ___________
TX stable angina
Percutaneous transluinal coronary angioplasty Percutaneous coronary intervention Nitro, BB or CCB and Aspirin
What is the 1st line over the counter and prescription lice treatment
Permethrin 1% to clean dry hair and leave 10min rinse off
What is forcheimer's sign
Petechial lesions on soft palate and uvula associated with Rubella
Pharmacologic options for Smoking Cessation: Nicotine gum or patch Bupropion Varenicline
Pharmacologic options for Smoking Cessation are ________
What are the 3 systemic treatment options for psoriasis
Phototherapy- UVB Oral Medications: Methotrexate Biologic agents: Alefacept, Infliximab, Etanercept, Adalumimab
Physiologic sinus tachycardia in response to stress, caffeine, fever, hyperthyroidism with an immediate onset and regular rhythym suggests PSVT
Physiologic sinus tachycardia in response to stress, caffeine, fever, hyperthyroidism with an immediate onset and regular rhythym suggests _______
What glands does acne affect
Pilosebaceous follicles
What does Bowens disease look like
Pink to red patch or thin plaque with scaly or rough surface
Signs and symptoms of right sided heart failure
Pitting edema distended neck veins hepatic congestion decrease appetite/nausea ascites cyanosis increase hepatojugular reflex
Psoriasis of the nail can occur with any type of psoriasis what are the nail changes seen
Pitting: punctate depression of nails Onycholysis: separation of nail plate from bed Subungual hyperkeratosis: abnormal keratinization of distal nail bed Trachyonychi: rough nails as if scraped with sandpaper
What are hypopigmented patches of the face in kids that have hx of atopy
Pityriasis alba
Complete placenta previa
Placenta completely covers the internal os
Partial placenta previa
Placenta partially covers the internal os
What is the MC type of psoriasis
Plaque
What are the 5 types of Psoriasis
Plaque Inverse/flexural Guttate Erythrodermic Pustular
Pneumonia after an influenza episode is suggestive of S. aureus
Pneumonia after an influenza episode is suggestive of _________
Pneumonia in an individual with underlying COPD suggests H. flu
Pneumonia in an individual with underlying COPD suggests _______
Pneumonia presented with diarrhea is suggestive of Legionella
Pneumonia presented with diarrhea is suggestive of ____________
What is considered rhus dermatitis
Poison ivy, oak, and sumack
Asthma history should include what questions
Previous episodes prior ED visits Need for prior intubation Hospitalization/ ICU admits Steroid use Inhaler use Medication compliance
How does superficial spreading melanoma usually grow
Primarily horizontal rather than down into the dermis
What is the clinical manifestations of Roseola
Prodrome HIGH fever 3-5 days after the fever gone a rose pink macules and papules surrounded by white halos begin on trunk and spread
Clinical manifestations Chronic bronchitis
Productive cough prolonged expiration
Progress of labor depends on Power (Uterine contractions) Passenger (Fetus) Pelvis (Shape and size)
Progress of labor depends on ________
What is a 2nd Degree Mobitz Type 1 (Wenckebach)
Progressive PR interval until drops QRS
Prophylaxis for HIV+ patients includes: Bactrim when CD4 < 200 against P. jirovecci Azithromycin when CD4 < 50 against MAC
Prophylaxis for HIV+ patients includes __________
positive birefringent crystals
Pseudogout
Signs and Symptoms of orbital cellulitis
Ptosis Eye lid edema Exopthalamos Purulent drainage Conjunctivitis Decrease vision Pain with occular movement Fever
What is the gold standard for Dx COPD
Pulmonary function testing/ Spirometry
Causes of A-fib (P3IRA2TES)
Pulmonary: COPD, PE Phenochrochromocytoma Pericarditis Ischemic heart Dz Rheumatic heart Dz Anemia Atrial myxoma Thyrotoxicosis Ethanol (holiday heart) Sepsis
Toys and non washable items treatment for lice
Put in sealed bag 3-7 days wash off after
projectile vomiting in children can suggest
Pyloric stenosis
Questionnaire for alcoholics is: "CAGE" Cut back Annoyed Guilty Eye opener
Questionnaire for alcoholics is ____________
What stage of sleep do nightmares occur
REM sleep
TX patellar tendonitis
REST patellar strap PT ICE
Rabies is typically caused by bats, skunks, dogs, foxes
Rabies is typically caused by _______________
What is nursemaid elbow
Radial head disslocation
Radiation exposure > 5 is associated with fetal harm
Radiation exposure > __ is associated with fetal harm
Radiographs with cystic changes in the joint and punched-out lesions and soft-tissue calcifications suggests gout
Radiographs with cystic changes in the joint and punched-out lesions and soft-tissue calcifications suggests __________
What is a plaque
Raised areas >1cm they cast a shadow with side lighting
Raised borders and brown lesions with pinks, whites, grays or blues, spreading superficially is the Superficial Melanoma. Men commonly affected on torso, Women to the legs.
Raised borders and brown lesions with pinks, whites, grays or blues, spreading superficially is the __________. Men commonly affected on _______, Women to the ______.
What is a papule
Raised lesions <1cm caused by proliferation of cells in epidermis or superficial dermis
Physical exam findings chronic bronchitis
Rales, crackles, ronchi wheezing Signs of cor pulmonale (peripheral edema, cyanosis)
Biceps tendon tear MOA
Rapid eccentric contraction of biceps=> distal tendon tear
What are the 2 states of sleep
Rapid eye movement (REM) and non REM
Rash that starts on wrists and ankles and spreads centrally to palms and soles suggests Rocky Mountain spotted fever. Treatment is doxycycline
Rash that starts on wrists and ankles and spreads centrally to palms and soles suggests _____________. Treatment is _________
Treat A-fib
Rate control over rhythm control
Recommendation for postmenopausal women includes 1200 mg calcium in divided doses and 800-1000 IU of vitamin D and perform regular weight bearing exercises.
Recommendation for postmenopausal women includes ____________.
Recommendations to reduce developing osteoporosis: 1200 mg Calcium supplement 400-800 IU Vitamin D supplement Weight-bearing exercise Avoid tobacco, EtOH
Recommendations to reduce developing osteoporosis ______________
Recommended prenatal visits are: Q 4 weeks until 28 weeks Q 2 weeks between 28-36 weeks Q week after 36 weeks
Recommended prenatal visits are _______
SS rotator cuff tear
Recurrent shoulder pain cant sleep on affect side Weakness, catching, grating when lifiting
What is the clinical presentation of a brown recluse spider bite
Red- peripheral erythema White- blanching Blue- Central violaceous area
Tx patellar dislocation
Reduction
How is 5ths disease transmitted
Respiratory droplets
What are some causes of secondary hypertension
Renal vascular cuases, Renal artery stenosis
Olecranon Bursitis MOA
Repeated trauma
Shoulder impingement syndrome
Repetivie microtrauma from old injures or from Abduction and External rotation
ABG lab for chronic bronchitis
Respiratory acidosis pH<7.35 PCo2 < 35
ABG labs for emphysema
Respiratory alkalosis pH > 7.45 and increase PCo2 > 45
What are roth spots
Retinal hemorrhage or petechi
Signs and symptoms of MI
Retrosternal chest pain Pain radiates to L arm, jaw, back or abdomen Pain at rest > 30 min Diaphoresis Dyspnea Nausea/ vomiting Weakness
Rheumatic fever is suggested by: Arthritis Carditis Subcutaneous nodules Erythema marginatum Sydenhams chorea
Rheumatic fever is suggested by ____________
If group A strep goes untreated what are 2 potential complications
Rheumatic fever leading to rheumatic heart disease Post streptococcal glomerulonephritis
What type of arthritis is associated with morning stiffness that lasts longer than 60min
Rheumatoid arthritis
RhoGam is given to Rh-negative mom during week 28 and if any instance of trauma
RhoGam is given to Rh-negative mom during week ___
What is the MC cause of allergic/contact dermatitis
Rhus dermatitis
Right bundle branch block with an elevated J point > 2 mm with flat or negative T waves in V1, V2, or V3 suggests Brugada syndrome, common in Asian males
Right bundle branch block with an elevated J point > 2 mm with flat or negative T waves in V1, V2, or V3 suggests _______, common in _______
MC location for foreign body aspiration objects to be located
Right main bronchus
Rome III diagnostic criteria for IBS includes symptoms for at least 3 days/month for the past 3 months
Rome III diagnostic criteria for IBS includes symptoms for at least ______
During the winter a daycare worker develops watery diarrhea. What is the most likely cause of her symptoms
Rotavirus
MC cause of acute diarrhea in kids
Rotovirus
What is another name for German Measles
Rubella
What is the other name for Measles
Rubeola
How do you estimate total body surface area burned
Rule of 9's
Spontaneous pneumothroax usually caused by
Ruptured bleb
difficulty with toe walk is associated with
S1 disc herniation
EKG results for PE
S1Q3T3 Wide deep S in lead 1 isolated Q wave in lead 3 Twave inversion in lead 3
SABAs are used PRN. Examples include: Albuterol Levalbuterol Pirbuterol
SABAs are used ______. Examples include ________.
What are medications that can induce SJS/TEN
SATAN Sulfa, Allopurinol, Tetracycline, Anticonvulsants, NSAIDS, Thiacetazone
When looking at elbow x-ray what sings are you looking for to help show fractures
Sail sing( Fat pad sign) = occult fracture
What are some examples of long acting beta agonists
Salmeterol/ Servent Formoterol Bambuterol/ AstraZeneca
What is Atrial Flutter
Saw tooth pattern no pwaves Rate 250-350 bpm Rate usually regular
Screenings for newborns involve: Pheynylketonuria Hypothyroidism Galactosemia Hemoglobinopathies
Screenings for newborns involve _________
56 year old man presents with symptoms consistent with allergic rhinitis. Past med history positive for BPH he works in a warehouse as a forklift drive. What medication would be best to treat his allergies
Second generation antihistamine Fexofenadine
What is a common cause of orbital cellulitis
Secondary infection to sinusitis
Treatment Roseola
Self limited
Treatment of pityriasis rosea
Self limiting 5-8 weeks Soothing anti itch lotions OTC
Self-limited inflammatory response hip pain often following a viral infection suggests transient synovitis
Self-limited inflammatory response hip pain often following a viral infection suggests ______________
What leads are and what artery innervates them Septal Anterior Lateral Inferior Posterior
Septal= V1 and V2, proximal Left anterior descending Anterior= V2, V3, V4, Left anterior descending Lateral= I, aVL, V5, V6, Circumflex Inferior= II, III, aVF, right coronary artery Posterior= ST depression V1 & V2, RCA and Circumflex
Cardiac enzymes are tested how
Serial 3 sets every 3-6 hours
What do bronchial carcinoid tumors secrete
Seritonin, ACTH, ADH, MSH
What is the prefered dx test for 5ths disease
Serum parovirus B-19 specific IgM antibody
Tx persisten asthma Step 5
Short acting beta agonist as needed + high dose inhaled corticosteroid + Long acting beta agonist + consider omalizumab if allergies too
Tx persistent asthma Step 3
Short acting beta agonist as needed + low dose inhaled corticosteroid + Long acting beta agonist
Tx persistent asthma Step 4
Short acting beta agonist as needed + medium dose inhaled corticosteroid + Long acting beta agonist
SPIKES system for delivering bad news
Setting up the interview: Arrange a private room where you can sit face to face with the patient. Encourage the patient to bring family members for support. Make eye contact during the interview. Perception: Use the rule, "before you tell, ask." Find out what is the patient's understanding of the situation before launching into an explanation. This allows you to dispel misinformation and identify denial. Invitation: Because a minority of patients do not want to learn about bad news, ask how the patient would like you to explain the information about the diagnosis. Give Knowledge and information to the patient: Expressing your own emotions about the bad news can lessen the shock of the news (e.g. "It makes me very sad to have to tell you that..."). Make sure to use non-technical words and avoid being overly blunt. Address the patient's Emotions with empathic responses: First, identify the emotion the patient is expressing and identify the reason for it (usually this is related to the bad news). Then let the patient know that you understand their emotion (e.g. "I can tell you weren't expecting to hear this." "I imagine this isn't what you wanted to hear."). Strategy and Summary: Laying out a plan for what will happen next, including how the patient can contact you and when you will see them again, can relieve anxiety and uncertainty for the patient. Summarizing the information and checking for understanding can prevent misunderstandings and avoid either an overly optimistic or pessimistic response by the patient.
SSRIs and pregnancy/lactation
Several of the selective serotonin reuptake inhibitors (SSRIs) are a Category B for breastfeeding. Concerns have been raised about infants' exposure to SSRIs during lactation and neurodevelopment, and the results of studies have been mixed. During pregnancy: There is no clear consensus about use of SSRIs in pregnancy except data which suggest that both untreated maternal depression and pregnancy with continual use of SSRIs are associated with a 20% preterm delivery incidence. Postpartum: There are significant risks associated with untreated postpartum depression, which might outweigh the risks associated with use of SSRIs during lactation.
Severe heart failure can results in hyponatremia
Severe heart failure can results in __________ (electrolyte imbalance)
How do you differentiate between Steven Johnson Syndrome and Toxic Epidermal Necrolysis Syndrome
Severity based on body surface area involved <10% BSA is Seven Johnson Syndrome 10-30% BSA is Combo SJS/TEN >30% BSA is Toxic Epidermal Necrolysis Syndrome
Sharp chest pain radiating to trapezius, worsened with respiration; improved with sitting forward suggests Pericarditis
Sharp chest pain radiating to trapezius, worsened with respiration; improved with sitting forward suggests _________
What is dermatographism
Sharply localized edema or wheal withing seconds to minutes after the skin is rubbed
bacterial diarhea causes
Shigella, Salmonella, Campylobacter
Tx intermittent asthma Step 1
Short acting beta agonist as needed
Tx persistent asthma Step 6
Short acting beta agonist as needed + High dose inhaled corticosteroid + Long acting beta agonist + Oral corticosteroids
Tx persistent asthma Step 2
Short acting beta agonist as needed + Low dose inhaled corticosteroid
When do you do surgery on rotator cuff tear
Significant symptoms Failed rehab >3-6month Traumatic
What exam findings will be present for TB
Signs of consolidation rales/ronchi near apices dullness
Signs of nephritic syndrome include: Coca-Cola urine (Hematuria) HTN Oliguria
Signs of nephritic syndrome include __________
Signs of nephrotic syndrome include: Peripheral edema Proteinuria Hyperlipidemia Hypoalbuminemia
Signs of nephrotic syndrome include _______
What happens in Drug Induced hypersensitivity syndrome
Skin eruption with systemic symptoms (Fever) and internal organ involvement
Side effect of stool softeners
Skin rash, hepatotoxicity
How do you confirm dx of scabies
Skin scraping with mineral oil preparation
Tx insomnia
Sleep hygine Medications: antihisamines or hypnotics (zolpidem)
DX sleep disorders
Sleep study ( Polysomnography) assesses EEG activity, HR, respiratory mvt, and O2 sats
What does ETOH intoxication look like
Slurred speech, blackout, ataxia, impaired judgement
Which type of bronchogenic cancer metz early
Small cell
What are the 2 categories of bronchogenic carcinomas
Small cell (oat cell) carcinoma Non small cell carcinoma
Small kidneys on imaging suggest irreversible damage
Small kidneys on imaging suggest _______________
What is a nodule
Small knot caused by proliferation of cells in mid-deep dermis
MC risk factor for COPD
Smoking or exposure smoke
Sneezing, nasal congestion, nasal itching, rhinorrhea, itchy eyes suggest allergic rhinitis
Sneezing, nasal congestion, nasal itching, rhinorrhea, itchy eyes suggest _________
Sodium should be restricted to 2-4 g/day in CHF patients
Sodium should be restricted to ____ in CHF patients
Stages of COPD and treatments include: 1: FEV1 > 80% Tx: SABA 2: FEV1 50-80% Tx: LABA 3: FEV1 30-50% Tx: ICS 4: FEV1 <30% Tx: O2 therapy
Stages of COPD and treatments include __________
several friends develop vomiting and diarrhea 6 hours after eating food at a private party. What is the most likely etiology of the symptoms
Staph auerus
What is the MC cause of hospital acquired pneumonia
Staph aureas or pseudomonias
Tx cardiac ischemia for NSTMI or Unstable angina
Start antithrombotic therapy Heparin
Tx acute MI
Start heparin, Nitro drip
When should paps begin
Starting at age 21 or within 3 years of becoming sexually active which ever is first
Where does the rash start
Starts in mouth and presents later on hands and feet
What is the morphology and spread of the rash for Measles
Starts on the face and spreads to the body the rash mobiliform brick red rash last 7 days
Tx for non small cell lung cancer
Surgery
Tx 5th metatarsal fx zone 3
Surgical consult for ORIF
Tx 5th metatarsal fx zone 2
Surgical consult possible ORIF
What is the treatment of choice for squamous cell carcinoma
Surgical excision
TX of epidermal inclusion cysts
Surgical excision and they may come back
Tx Jersey finger
Surgical repair and splint after
Treatment for Murmur
Surgical repair or valve replacement
What can cause foreign body aspiration
Swallowing a variety of objects
Symptomatic SVT can be treated with Vagal stimulation. If unsuccessful, adenosine
Symptomatic SVT can be treated with ______. If unsuccessful, ________
Treatment of V tach Unstable with pulse
Synchronized cardioversion 100-300J
What is Mitral Regurgitation
Systolic Murmur Backflow from left ventricle into left atria causeing left ventricular overload and decrease cardiac output
What is aortic stenosis
Systolic Murmur Left ventricular outflow obstruction leads to fixed cardiac output and increase afterload causeing Left ventricular hypertrophy
What BP indicates a Hypertensive Urgency
Systolic great or equal 220 Diastolic great or equal to 120 NO END ORGAN DAMAGE
What blood pressure indicates a Hypertensive Crisis/ Emergency
Systolic great or equal to 220 Diastolic greater or equal to 120
What is syncope
Temporary loss of consciousness caused by a fall in blood pressure, insufficient blood flow to the brain
Tachypnea, Toxic-appearing, fever, cough suggests pneumonia, diagnosed using Chest XR looking for infiltrates
Tachypnea, Toxic-appearing, fever, cough suggests ____________, diagnosed using _________
Tay-Sachs carrier state includes French-Canadian or Ashkenazi Jew. Sickle cell carriers include African Americans. Thalassemia carriers include Asians and Middle Eastern, Mediterranean. Cystic fibrosis carriers include Ashkenazi Jews and Caucasian
Tay-Sachs carrier state includes ___________ Sickle cell carriers include _________ Thalassemia carriers include _______ Cystic fibrosis carriers include _____
Deadly causes of chest pain
Tension pneumothorax aortic dissection PE Unstable angina Myocardial Infarct
3 main types of headaches
Tension, cluster, migraine
pelvic compression test
Test is performed by forcibly pressing together the hips A positive test elicits pain in the sacroiliac joint.
Test of choice in determining the source of lower GI bleeding is colonoscopy
Test of choice in determining the source of lower GI bleeding is __________
What are some examples or oral antibiotics that can be used to treat acne
Tetracycline, doxycycline, minocycline
statin recommendations in diabetic patients
The ACC/AHA guidelines for cholesterol management recommend that all patients with type 1 or 2 diabetes age 40-75 years old should be on either a moderate-intensity statin, or (if their estimated 10-year ASCVD risk >7.5%) a high-intensity statin.
breast cancer screening recommendations
The U.S. Preventive Services Task Force (USPSTF) recommends screening mammography, with or without clinical breast examination (CBE), every two years for women aged 50 to 74 years (Grade B recommendation). They recently updated their recommendation regarding mammography for women aged 40-49. Whereas they previously recommended routine mammography, they now recommend that patients and doctors should make individual decisions based on the patient's risks and health preferences (Grade C recommendation). Teaching self-breast examination (SBE) is not recommended (Grade D recommendation) as it has shown only to increase rates of biopsy without improving cancer detection or treatment. USPSTF also recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing (Grade B recommendation).
labor dystocia
The average speed of dilation is about 2 cm/hour for multiparous women and about 1 cm/hour for primiparous women, so the average length of the active phase of the first stage of labor is 2.4 hours for multiparous women and 4.6 hours for primiparous women. Failure to progress (or active phase arrest) occurs if there is no cervical change for two hours in the active phase of labor. - can also be diagnosed in the second stage of labor if the fetal presenting part does not descent significantly in the pelvis after 2 hours of pusghin (or 3 hours with an epidural0 - IN AN ACTIVE PHASE ARREST WE CAN GIVE IV OXYTOCIN AND/OR ARTIFICIAL RUPTURE OF THE MEMBRANES
The difference between a crystal-induced aspirate and a septic joint aspirate is: Crystal-induced has 2,000-6,000 WBC with < 90% neutrophils Septic joint has 100,000 WBC with > 90% neutrophils
The difference between a crystal-induced aspirate and a septic joint aspirate is _____________
The goal LDL level cholesterol in anyone with a history of CAD or DM is < 70 mg/dL
The goal LDL level cholesterol in anyone with a history of CAD or DM is ________
The inability to pinch fold of skin on the base of the 2nd toe is Kaposi-Stemmer sign, suggestive of lymphedema
The inability to pinch fold of skin on the base of the 2nd toe is ____________, suggestive of ___________
The type of anemia usually associated with alcoholics is folate deficiency anemia
The type of anemia usually associated with alcoholics is ___________
Tx PVC
Usually none needed
Thick, white, "curd-like" vaginal discharge that may be pruritic suggests a fungal infection. Discharge has a pH of 4-5
Thick, white, "curd-like" vaginal discharge that may be pruritic suggests _____________. Discharge has a pH of _____
Primary spontaneous pneumothroax usually occurs in what types of patients
Thin young men with a hx of tobacco use
Things to evaluate when a patient presents with dyspnea: Toxic appearance Accessory muscle use Pulse ox
Things to evaluate when a patient presents with dyspnea __________
subtypes of sponeateous aborption
Threatened abortion - bleeding before 20 weeks gestation. Threatened abortion is simply a pregnancy complicated by bleeding before 20 weeks gestation, and is - in some ways - a "catch-all" descriptive diagnosis. Inevitable abortion - dilated cervical os. Incomplete abortion - some but not all of the intrauterine contents (or products of conception) have been expelled. Missed abortion - fetal demise without cervical dilitation and/or uterine activity (often found incidentally on ultrasound without a presentation of bleeding). Septic abortion - with intrauterine infection (abdominal tenderness and fever usually present). Complete abortion - the products of conception have been completely expelled from the uterus.
What is the "gold standard" for diagnosing strep pharyngitis
Throat culture
TX PE in a hemodynamically unstable pt
Thrombolytic therapy Alteplast (tpA), Streptokinase, Urokinase
What is the cause of acute arterial occlusion
Thrombosis or embolism
Tx scaphoid fx
Thumb spica splint 10-14 days and re-xray if still negative splint still and refer to Ortho
PVC's and PAC's treatment
Usually nothing but can symptomatically treat with a beta blocker
To calculate estimated delivery date, use Naegele's rule (Subtract 3 months, Add 7 days)
To calculate estimated delivery date, use ____________
To confirm rupture of membranes: Visualizing amniotic fluids Pooling of amniotic fluid pH > 6.5 in vagina fluid with Nitrazine paper "Ferning" on fluid sample
To confirm rupture of membranes ___________
To diagnose a thyroid disorder, uptake of technetium 99 or iodine 123 is assessed. Hyperthyroidism presents with large uptake amount. Thyroiditis presents with patchy uptake.
To diagnose a thyroid disorder, uptake of _______ is assessed. Hyperthyroidism presents with ________. Thyroiditis presents with ________.
To enhance the levels of levodopa/carbidopa, add entacapone
To enhance the levels of levodopa/carbidopa, add ___________
To have Hepatitis D, you must have Hepatitis B. Treatment is Interferon
To have Hepatitis D, you must have _________. Treatment is ___________
To prevent embolic strokes, use anticoagulants. To prevent noncardioembolic ischemic strokes, use antiplatelets
To prevent embolic strokes, use ________. To prevent noncardioembolic ischemic strokes, use __________
To rule out secondary causes of osteoporosis, laboratories run should include: Alkaline phosphate Calcium 24 Hydroxy Vitamin D
To rule out secondary causes of osteoporosis, laboratories run should include _____________
To treat acute gout, use NSAIDs and Colchicine. Chronic gout is treated with Allopurinol or Probenecid
To treat acute gout, use __________. Chronic gout is treated with ____________
What cuases Rubella
Togavirus
Treatment of tinea corporis and cruris
Topical antifungals minimum 2 wks Clotrimazole or Miconazole
What is the 1st line tx seborrheic dermatitis
Topical ketoconazole 2x daily reduce yeast
Tx rhus dermatitis
Topical steroid and oral antihistamines If severe require oral steroids for 3 weeks
What is the treatment for rosacea
Topical- metronidazole or azelaic acid Oral Abx- Tetracycline Laser and light devices for erythema
MOA compartment syndrome
Trauma, premature cast, exercise
Trazadone may cause priapism and sedation
Trazadone may cause __________
Treatment for C dif is metronidazole or vancomycin
Treatment for C diff is ____________
Treatment for COPD exacerbation is similar to asthma; O2, bronchodilators, steroids
Treatment for COPD exacerbation is _________
Treatment for Huntington's is to target the signs and symptoms. There is no treatment to slow the progression. Chorea is treated with Tetrabenazine. Insomnia is treated with Benzodiazapene.
Treatment for Huntington's is ___________. Chorea is treated with _________. Insomnia is treated with ______
Treatment for Rheumatoid Arthritis includes NSAIDs, glucocorticoids, DMARDs (Sulfasalazine, Methotrexate) ,anticytokines (Infliximab, Etanercept), topical analgesics
Treatment for Rheumatoid Arthritis includes __________
Treatment for Traveler's diarrhea is Fluoroquinolones. Azithromycin (for children and pregnant women)
Treatment for Traveler's diarrhea is _____________
Treatment for acute bronchitis include bronchodilators, analgesics, antiussives
Treatment for acute bronchitis include _____________.
Treatment for acute hepatitis B is supportive. Chronic hepatitis is treated with antivirals
Treatment for acute hepatitis B is _______. Chronic hepatitis is treated with __________.
Treatment for cluster HA involves 100% O2, dihydroergotamines, and triptans
Treatment for cluster HA involves ______________
Treatment for dog or cat bite is Augmentin
Treatment for dog or cat bite is __________
Treatment for essential tremors is propranolol, primidone, gabapentin
Treatment for essential tremors is _______________
Treatment for hyperthyroidism includes Methimazole, Propylthiouracil, BBs. Definitive treatment is radioactive iodine or surgery (for pregnant patients)
Treatment for hyperthyroidism includes _______________. Definitive treatment is ______________
Treatment for opioid abuse is Naloxone
Treatment for opioid abuse is ___________
Treatment of choice for idiopathic edema is spironolactone
Treatment of choice for idiopathic edema is _________________
Treatment of choice in hyperprolactinemic disorders is dopamine agonists. Treatment of choice in hyperprolactin-induced anovulatory infertility is Bromocriptine
Treatment of choice in hyperprolactinemic disorders is ____________. Treatment of choice in hyperprolactin-induced anovulatory infertility is ___________
Treatments for dementia include: Donepezil Galantamine Rivastigmine Memantine
Treatments for dementia include ___________
Treatments for mastalgia include: Topical NSAIDs Soy protein Low-fat high-carb diet Chasteberry extract Danazol
Treatments for mastalgia include _________
Tx seborrhic keratosis
Usually nothing if irritating curettage, cryotherapy, shave removal
Types of colon neoplasms: Tubulous adenomas is the most benign Tubulovillous adenomas Villous adenomas is the least benign
Types of colon neoplasms __________
Types of emergency contraception include Mifepristone and Levonorgestrel
Types of emergency contraception include __________
What is Gamekeepers Thumb
UCL sprain at the 1st MCP joint
common causes of a cough
URI, irritants, allergies, asthma, COPD, cancer, GERD
What does the prodrome of Measles look like
URI: cough, coryza, conjunctivitis and Koplik spots
Best imaging study for the gallbladder and pancreas
US
to distinguish a solid mass from a cystic one in the breast
US
At 20 weeks gestation where should the fundal height be
Umbilicus
Clinical manifestations of DVT
Unilat swelling and leg edema Calf pain and tenderness + Homan's sign Phlebitis
Unilateral limb swelling is MC due to venous insufficiency, lymphedema, dvt
Unilateral limb swelling is MC due to _____________
Unilateral sharp, pleuritic pain of sudden onset suggests pneumothorax
Unilateral sharp, pleuritic pain of sudden onset suggests ___________
Bronchitis often follows what
Upper respiratory infection
Antidote for salicylates
Urine alkalization, dialysis, activated charcoal
When replacing fluids what do you need to monirto
Urine output via foley cath
S/S Anaphylaxis
Urticaria, erythema, pruritus Nasal congestion, sneezing, coryza, cough, tachypnea Sensation of throat tightness Tachycardia, Hypotension
Useful treatment for patients with both asthma and allergies are leukotriene inhibitors
Useful treatment for patients with both asthma and allergies are ____________
Rotator Cuff Tear
Usually age related degeneration or chronic impingement
What does squamous cell carcinoma look like
Various appearances papule, plaque, noudle, scale, pink/red/skin colored, may be a cutaneous horn
DX DVT
Venous duplex ultrasound D-dimer Venography
MC arrhythmia in cardiac arrest patients
Ventricular fibrillation
What are risk factor for DVT
Verchows Triad Venous stasis Endothelial damage Hypergoacuability
What does PCP intoxication look like
Vertical and horizontal nystagmus aggressive Impossible strength
What is a left bundle branch block
Wide QRS > .12 sec Broad, slurred R in V5 and V6 Deep S in V1 ST elevation V1-V3
What is a right bundle branch block
Wide QRS > .12 sec RSR in V1 and V2 Wide S wave in V6
What do PVC look like
Wide bizarre QRS occuring earlier than expected
With a red, swollen joint, ASPIRATE
With a red, swollen joint, _______________
With a shoulder injury: Hawkin's test and Empty can test rule in Supraspinatus External rotation test rule in Infraspinatus and Teres minor Internal rotation test rule in Subscapularis
With a shoulder injury _________
With an ankle injury: Anterior drawer test rule in ATFL Inversion test rule in CFL Squeeze test rule in Syndesmosis
With an ankle injury ___________
With an knee injury: Lachman test and Anterior drawer rule in ACL Valgus stress rule in MCL Varus stress rule in LCL McMurrays rule in Meniscal tears
With an knee injury __________
With extremity injuries, evaluate sensation, peripheral pulses, and capillary refill
With extremity injuries, evaluate _____________
With lymphedema, treatment is pneumatic compression, drainage, and possible surgery
With lymphedema, treatment is ___________
With pelvic pain, ALWAYS DO UA with Beta-HCG
With pelvic pain, ALWAYS ______________
With venous insufficiency, always consider a differential diagnosis of pulmonary hypertension
With venous insufficiency, always consider a differential diagnosis of _______________
A delta wave on an EKG suggests
Wolf Parkinson White syndrome
Wolf-Parkinson-White syndrome's classic finding is the delta wave
Wolf-Parkinson-White syndrome's classic finding is the _________
Women over 35 and smoking should not take OCP
Women _____________ not take OCP
Women of age 65 are recommended to screen for osteoporosis screening with DEXA scanning
Women of age 65 are recommended to screen for ___________ with ___________
Women with a new breast solid mass over 35 undergo triple assessment: Examination Mammography Core biopsy
Women with a new breast solid mass over 35 undergo triple assessment __________
How do you dx vitiligo
Woods light exam distinguishes hypopigmented from depigmented lesions DEPIGMENTED (bone white) = Vitiligo
Tx Dupuytrens Contracture
Xiaflex injection and manipulation next day
Are people with reactivation TB contagious
YES
Is impetigo contagious
YES
5th metatarsal Fx zone 1,2,3
Zone 1: avulasion fx peroneus brevis/peroneus longus "Dancers fracture"
High Triglyceride sare suggestive of hyperlipidemia from dietary choices. High cholesterol and normal triglyceride sare suggestive of hyperlipidemia from genetics
______ are suggestive of hyperlipidemia from dietary choices. ______ are suggestive of hyperlipidemia from genetics
Furosemide is the treatment of choice in CHF exacerbation with pulmonary edema due to diuretic effect and bronchial vasculature vasodilation
______ is the treatment of choice in CHF exacerbation with pulmonary edema due to __________
Elevated BNP > 500 and pro-BNP is a specific and sensitive lab marker for diagnosis of CHF
_______ is a specific and sensitive lab marker for diagnosis of CHF
Hepatitis C is the most common cause of Chronic liver disease. 60% of those with acute Hepatitis C infection will develop Chronic liver disease
_______ is the most common cause of Chronic liver disease. 60% of those with _______ infection will develop Chronic liver disease
Minipill is the most effective method of birth control for women postpartum desiring to breastfeed
_______ is the most effective method of birth control for women postpartum desiring to breastfeed
Kocher criteria is used to assess risk for septic arthritis
________ criteria is used to assess risk for septic arthritis
Lewy body dementia presents early with vivid hallucination, fluctuation in cognition, and parkonsinion extrapyramidal signs and postural instability
________ dementia presents early with vivid hallucination, fluctuation in cognition, and parkonsinion extrapyramidal signs and postural instability
Rotavirus is a common cause for watery diarrhea, especially in the winter
________ is a common cause for watery diarrhea, especially in the winter
Delirium is an acute change in mental status characterized by fluctuations in levels of consciousness. Usually caused by acute illness, medication use, or withdrawal
________ is an acute change in mental status characterized by fluctuations in levels of consciousness. Usually caused by ____________
ACEIs reduce short-term mortality when started within 24 hours of acute myocardial infarction
________ reduce short-term mortality when started within 24 hours of acute myocardial infarction
Vascular dementia is related to the amount and location of neuronal loss with sudden onset
_________ dementia is related to the amount and location of neuronal loss with sudden onset
Hypomagnesium may increase the incidence of Torsades, therefore magnesium sulfate should be given if low
_________ may increase the incidence of Torsades, therefore _________ should be given if low
S. aureus usually causes vomiting and diarrhea within 6 hours of eating contaminated food
_________ usually causes vomiting and diarrhea within 6 hours of eating contaminated food
E. coli is the most common cause for Traveler's diarrhea
__________ is the most common cause for Traveler's diarrhea
Ulcerative colitis causes continuous inflammation of the large bowel beginning at the rectum and extending proximally, may be pancolitic. Crohn's causes focal "skip lesions" anywhere between the mouth and rectum, may be transmural
___________ causes continuous inflammation of the large bowel beginning at the rectum and extending proximally, may be _______. ________ causes focal "skip lesions" anywhere between the mouth and rectum, may be ________
Conjunctival pallor is a reliable sign of anemia in the elderly
___________ is a reliable sign of anemia in the elderly
Echocardiography is the gold standard diagnosis for CHF
___________ is the gold standard diagnosis for CHF
Superficial melanoma is the MC melanoma in both sexes
____________ is the MC melanoma in both sexes
PTH, Calcitonin, and 1,25-dihydroxyvitamin D (Calcitriol) are responsible for regulating calcium levels
_____________ are responsible for regulating calcium levels
Elevated methylmalonic acid level can be used to confirm Vitamin B12 deficiency
_____________ level can be used to confirm Vitamin B12 deficiency
Elevated homocysteine level can be used to confirm folate deficiency
_____________ level can be used to confirm folate deficiency
Aspirin and heparin reduce the risk of subsequent MI and cardiac death in patients with unstable angina
_____________ reduce the risk of subsequent MI and cardiac death in patients with unstable angina
Polysomnography confirms diagnosis of OSA if: AHI or RDI > 15 or > 5 with symptoms. Severe is > 30
______________ confirms diagnosis of OSA if ______
Inflammatory bowel disease (crohns or collitis) symptoms- broad
abdominal pain bloody stools fever
Acute treatment for acute glaucoma
acetazolamide to lower intra occular pressure and then administer pilocarpine to constric pupils
Lisfrac fx
articulation btwn 3 cuniefiroms and base of 1st and 2nd metatarsals
What is the time frame for a positive mono test
as early as 5 days into infection and as long as 3 weeks
TX patellar bursitis
aspiration NSAIDS Surgical excision
MOA lisfranc Fx
axial loading in Plantar flexion/ hyper plantar flexion
Treatment for blepharitis
baby shampoo to eye lids warm wash cloths
Tx GERD
behavior modifications H2 blockers: cimetidine, famotidine, ranitidine PPI: omeprazole, esomeprazole, pantoprazole
What is another name for an Open comedone
black head
What are clinical manifestations of uticaria
blanchable, edematous pink papules, wheals, or plaques that may coalesce
Chronic lid margin erythema, scaling, loss of lashes indicates
blepharitis
Bidirectional or vertial nystagmus suggests
brainsem origin of vertigo
What are bronchial carcinoid tumors
bronchial gland tumor well differentiated neuroendocrine tumor
Buckle fracture
buckling of cortex
first line medication for quiting smoking
burproprion
what is COPD
chronic obstructive pulmonary disease It is progresive, largely irreversible airflow obstruction
palmar erythema, spider telangectasias, and ascites suggest
cirrhosis
What are the symptoms of Peripheral arterial disease
claudication, ischemia, and pain with exercise causing significant limitation of activity or disability
Treatment of folliculitis
cleansing the area with antibacterial soap and water 3x day oral or topical anti-staph agents may be used
How is lice spread
close physical contact and fomites
What is an ulcer
complete loss of the epidermis in addition to part of the dermis
buring, itching, discharge, lid edema indicate
conjunctivitis
Contact dermatitis occurs from what
contact to substance externally applied body doesnt like Nickle, detergents, soaps,
what iud is approved for use post partum
copper -can be placed immediately. higher expulsion rate than if you wait 4-6 weeks to place hormone releasing wait 4-6 weeks . more likley to perforate
pain, "foreign body" sensation in eye indicates
corneal abrasion/ foreign body
What is the tx for dishydrotic eczema
potent topical steroids
Treatment for Hypertensive Urgency
decrease BP by 25% in 24-48 hours using ORAL agents Atenolol, Metropolol
What does opiate intoxication look like
decrease consciousness and respiration Pin Point Pupils Euphoria
What does benzo intoxication look like
decrease consciousness and respiration coma
if think cough d/t ACE inhibitor tx?
discontinue ACE and cough should resolve within 4 weeks
Tx small pneumothorax
resolve on own monitor
What occurs in REM
dreaming
SS pulmonary emoblism
dyspnea tachypnea pleuritic chest pain hemoptysis +/- cough diaphoresis crackles Tachycardia
Causes of V tach
electrolyte imalance frequent complication acute MI Dilated cardiomyopathy Promonged QT Torsades
How do you treat vasa previa
emergency delivery
What is somatization
emotional or physiologic distress that is experienced and expressed as physical complaints in multiple organ systmes
How do you test for onychomycosis
fungal culture with KOH or fungal stain
What is onychomycosis
fungal infection of the nailbed
negative birefringent crystals
gout
S/S little league shoulder
gradual onset of pain usually 6-8 months Pain usually only with throwing
what is the MC presenting symptom of bladder Ca in people over 50
hematuria
acute labyrinthitis
infection affects both branches of the nerve resulting in tinnitus and/or hearing loss as well as vertigo
Most common causes of nausea and vomiting in primary care setting
infection, gastroenteritis, food poisoning, metabolic disorders, and medication side effects.
An infection of the meibomian gland of the eye causes
internal-hordeolum
chronic use of nitrofurantonin (Macrobid) can cause a cough secondary to ?
interstitial fibrosis
Pain, photophobia, papillary constriction, cloudy cornea, and anterior chamber of eye indicates
iritis
Classic symptom of intertrigo
it burns more than it itches
What type of fluids do you give burn patients
lactated ringers
What is chronic uticaria
last longer than 6 weeks and waxes and wanes Idiopathic in nature and often induced by stress
Direction of patellar dislocation
laterally
LCL tear
laxity and joint effusion + Varus stress test
MCL tear
laxity, joint effusion + valgus stress test
What is the nickname for melasma
mask of pregnancy
How do you treat abruptio placenta
maternal stabilization cardiotocographic monitoring to detect fetal distress emergency obstetric consultation Place two large-bore IVs; obtain a CBC, metabolic panel, coagulation panel, fibrin degradation product, and fibrinogen levels; and type and cross-match maternal blood. Administer RhoGAM® if the mother is Rh negative.
S/S lisfranc fx
max tenderness and swelling over tarsometatarsal Jt ecchymosis in arch Pain with rotation and translocation stress forefoot
What does nummular eczema present as
multiple coin shaped eczematous plaques on the extremities and trunk Very pruritic and can weep and crust
What does folliculitis usually look like
multiple follicular pustules surrounding erythem in areas of hair
What is the cause of TB
mycobacterium Tuberculosis
most common cause of walking pneumonia
mycoplasma pneumonia
Tx carpel tunnel
night splints NSAIDS surgical release
common migraines
no aura
What are the xray findings in osteoarthritis
nonuniform joint space narrowing changes in subchondral bone osteophytes
Diagnostic study for gastrophoresis
nuclear study, gastric emptying study
Who typically gets Obstructive sleep apnea
obese middle aged and older men hypertension
Elevated conjugated bilirubin and urine dipstick postive for bili indicates
obstruction: cholestasis or hepatocellular injury
Causes of PVC
occur increase frequency if myocardium irritated by ischemia or electrolyte imbalance, or benign
Definition of constipation
passing less than 3 stools a week
Definition of diarrhea
passing more than 3 abnormally loose stools per 24 hours
What is Melasma (Chloasma) characterized by
patchy light to dark brown hyperpigmentation of the face
Bites frequently occur when
patients are disturbing areas where spiders seek shelter (attics, clothing, shoes)
How is Basal cell carcinoma often described
pearly papule or nodule with rolled border and telangiectasias
If a pregnant women presents with painless bright-red vaginal bleeding in the 3rd trimester think
placenta previa
What is Placenta previa
placenta that extends near, partially over, or beyond the internal cervical os, caused by implantation lower in the uterus
Patients with HIV are at an increased risk to get pneumonia from
pneumocystis carinni
Medical conditions that can inhibit colonic motility
poor fluid and dietary intake, hypothyroidism, hypercalcemia, hypokalemia, scleroderma, diabests, multiple sclerosis, Parkinsons medications
Inflammatory diarrhea
presence of blood or WBC in stool
What does guttate psoriasis look like
presents with drop lesions, 1-10mm salmon-pink papules with fine scale
What does seborrheic dermatitis look like and where is it located
red scaling patches on the scalp, hariline, eyebrows, eyelids, central face, external auditory canals, central chest, and nasolabila folds
What is does stasis dermatitis look like
red, scale, pruritis, erosions, exudate and crust usually of the lower 1/3 of leg superior to medial malleolus
Carpel Tunnel
reduced size of or space of carpel tunnel and compression of median nerve
TX radial head diss
reduction. Bring into full supination and reduce then up into full flexion will feel clunk
What causes uticaria
release of hisamines, bradykinins, and other vasoactive substances from mast cells
Where does tinea pedis appear and look like
scaling and redness between toes and may have associated maceration
Where are characteristic locations for plaques to form
scalp, ears, elbows, knees, extensor surfaces, umbilicus, gluteal cleft, nails, recent trauma sites
What does plaque psoriasis look like
scaly, erythematous patches, papules, and plaques that are sometimes pruritic
What population is walking pneumonia common in
school aged, college, barracks
What is the atopic triad
seasonal allergic rhinitis Asthma Atopic dermatitis
causes of eleveated unconjugated bilirubin
secondary to overproduction hemolysis defects in bilirubin conjugation
What occurs in narcolepsy
sudden, brief sleep attacks, cataplexy, sleep paralysis and hypnagogic hallucinations
Squamous cell carcinoma most often occurs where on the body
sun exposed areas
What are vericose veins
superficial venous insufficiency and valvular incompetence
TX of lipoma
surgical excision if patient wants
SS radial head disslocation
swelling, pain, TTP
What are some medications that can trigger or exacerbate psoriasis
systemic corticosteroid withdrawal Beta blockers Lithium Interferons
2 blood tests that screen for celiacs disease
tTG: tissue tansglutimase antibody EMA: endymysial antibody
diseases for over production of bilirubin
thalassemia B12 deficiency
diagnosing ADHD
to be diagnosed with ADHD, individuals must meet specific criteria. In children, the diagnosis of ADHD is usually not made until a child is at least six years old. The symptoms must be more frequent or severe compared to other children the same age. In addition, the behaviors must be present in at least two settings, such as home and school and be *present for at least six months.*
How do you treat mild comedonal acne
topical retnoid (retinoic acid), +/- topical benzoyl peroxide
How do you treat mild papular/pustular acne
topical retnoid, topical antibiotics (erythromycin), topical benzoyl peroxide
vertigo defined as
true spinning, weaving or rocking and commonly associated with head movements
Marginal placenta previa
which reaches the internal os but does not cover it
What is another name for a closed comedone
white head
when is ortho consult of a rotator cuff injury warranted
with a complete tear
classic migraine
with aura
What stage of sleep does childhood enuresis typically occur
within 3-4 hours of bedtime
Hospital acquired pneumonia has to occur when
within 48 hours after admision and ICU pts at greatest risk
food poisoning usually occurs how many hours after eating
within 6 hours of the meal
What does a 1st degree burn look like
wound is red, painful and well demarcated
is the influenza vaccine recommended for pregnant women
yes
