FM EOR
How does asthma present clinically
dyspnea, wheezing, cough, prolonged expiration
How does fulminant hepatitis present clinically
encephalopathy (vomiting, coma, AMS, seizures, asterixis, increased ammonia, hyperreflexia, cerebral edema, increased ICP, coagulopathy, hepatomegaly, jaundice
How is hepatitis E transmitted
fEco-oral route (waterborne outbreaks)
What clotting factor deficiency is associated with hemophilia A
factor 8
What clotting factor deficiency is associated with hemophilia B
factor 9
How does cirrhosis present clinically
fatigue, weakness, wt loss, muscle cramps, Hepatic Encephalopathy (confusion lethargy), Esophageal varices, Spontaneous bacterial peritonitis
How do you manage a fistula
fistulotomy
How does acute sinusitis present clinically
headache radiating to upper teeth fever, facial pain, purulent rhinorrhea
How do you prevent acute hepatitis B
hep b vaccine given at 0, 1, 6 months
How does invasive diarrhea present clinically
high fever, blood, fecal leukocytes, not voluminous, mucus
How does meniscus tear present clinically
joint line pain, effusion, locking after twist injury + feeling of knee giving away + pain walking up or down stairs + pain with squatting
What is the recommended modality to evaluate for microcalcification and spiculated breast masses
mammogram
How do you manage C. diff
metronidazole 1st line, Vancomycin PO 2nd line (1st line if severe)
How do you manage an aorta 3-4 cm
monitor by ultrasound annually
How do you manage an aorta 4-4.5 cm
monitor by ultrasound every 6 months
How does gastritis present clinically
most asymptomatic, if symptomatic there will be epigastric pain, possible signs of upper GI bleed (hematemesis, melena), N/V
How do you manage an aorta <3cm
no testing needed
How does Crigler-Najjar Syndrome Type II present clinically
often asymptomatic
How does Gilbert's syndrome present clinically
often asymptomatic but can have episodes of jaundice during periods of stress, fasting, alcohol intake or illness
How does prepatellar bursitis present clinically
pain with direct pressure on the knee (kneeling), swelling over the patella
How does osteoarthritis present clinically
pain worse with activities, swelling, stiffness, sticking, grinding palpable crepitus
How do you manage stage 4 non-small cell bronchogenic carcinoma
palliative
How do you manage Crigler-Najjar syndrome type I
phototherapy is mainstay, plasmapheresis in acute crisis, liver transplant for definitive
Patient is a 19-year-old male transported to the ED following a car crash. Upon arrival, he is alert and anxious and appears to be in respiratory distress. A quick assessment reveals that he sustained trauma to his face, neck, and chest. His left hemithorax appears to be expanding more than the right. He is receiving oxygen via nonrebreathing mask. His vital signs are: respiratory rate 36 and labored. SpO2 is 85%. On physical exam, you notice decreased tactile fremitus, deviated trachea, hyperresonance, and diminished breath sounds. What does this patient likely have
pneumothorax
How does ACL tear present clinically
pop and swelling, instability, giving out, hemarthrosis after a quick plant and twist injury
How does encephalitis present clinically
profound lethargy, abnormal cerebral functions, seizures
What is primary dysmenorrhea associated with
prostaglandins
How do you manage an aorta >4.5 cm
refer to vascular surgeon
How does TTP present clinically
remember FAT RN: Fever, Anemia, Thrombocytopenia, Renal failure, Neurological symptoms
How do you manage hepatitis E
self-limiting
How do you manage Hepatitis A
self-limiting within weeks, post exposure prophylaxis for close contacts with HAV immune globulin
How does adhesive capsulitis present clinically
shoulder pain and stiffness that comes in cycles with decreased passive range of motion
How does rotator cuff tendinopathy/tear present clinically
shoulder pain with overhead activity, at night lying on arm or weakness and immobility after acute injury, passive motion > active range of motion
How do you diagnosis autoimmune hemolytic anemia
+ Direct coombs test, retic count >2, elevated LDH, low hemoglobin, increased indirect bilirubin
How does pneumonia present on physical exam
+ egophony, increased tactile fremitus, dullness to percussion
How do you diagnose Hereditary spherocytosis
+ osmotic fragility test
How do you diagnose sickle cell disease
+HgbS on hemoglobin electrophoresis, Howell jolly bodies
How do you diagnosis testicular carcinoma
+bHCG, + alpha fetoprotein, scrotal ultrasound
How do you manage acute hepatitis B
supportive
How does patellar tendinitis present clinically
swelling over the tendon and tenderness at the inferior border of the patella
What dose epinephrine should be used in acute anaphylaxis
0.2-0.5 mg of 1:1000 IM every 5-15 minutes
What is the folic acid supplementation for women prior to conception
0.4-08 mg and 4 mg for secondary prevention
What is the lifetime incidence for breast carcinoma development in women
1 in 8
What are the indications for percutaneous transluminal coronary angioplasty
1 or 2 vessel disease not involving the left main coronary artery in whom ventricular function is normal
When does ITP often present
1-2 weeks after a viral infection
How does Bell palsy present clinically
unilateral facial paralysis, ipsilateral hyerpacusis (ear pain), taste disturbance (anterior 2/3)
What factors compromise the common pathway
10 and 5
How long does the copper IUD last
10 years
How do you manage cluster headaches
100% (6-10 L), can use SQ sumatriptan or Ergotamines
How does bullous pemphigoid present clinically
urticarial plaques that progress to tense bullae
What is normal serum sodium
135-145
What factors are deficient in von Willebrand deficiency
vWF and factor 8
What is the daily maintenance fluid requirement for adults
1500-2500 mL
What are the 5 levels of Clark classification system of microstaging melanoma
1: confined to epidermis (in situ), 2: invasion into the papillary dermis, 3: penetration to the papillary-reticular interface, 4: invasion into the reticular dermis, 5: penetration into subcutaneous fat
Define Naegele's rule
1st day of LMP + 7 days - 3 months + 1 year
What are risk factors for breast cancer
1st degree relative with breast cancer history, obesity/alcohol use, >65, late >17 or early <12 menarche, early menopause, increased estrogen exposure, BRCA1 and BRCA2
How do you treat impetigo if extensive disease or systemic sx (fever)
1st gen cephalosporin (Keflex)
How do you treat acute exacerbations of chronic bronchitis in which bacterial causes are more likely
1st line empiric: 2nd generation cephalosporin, 2nd line: 2nd generation macrolide or Bactrim
How do you diagnose endocarditis
2 major criteria or 1 major and 3 minor or 5 minor
Due to isotretinoin teratogenicity how often must women receive pregnancy test with therapy
2 serum pregnancy test prior to starting and monthly thereafter
What is a normal bleeding time range
2-8 minutes
How does noninvasive diarrhea present clinically
vomiting, watery, voluminous, no fecal WBCs or blood
At what bilirubin level does jaundice begin to occur
2.5 mg/dL
How long should you irrigate chemical burns with water
20 minutes
What amount of variation in pulse between right and left arm is indicative of aortic dissection
20 mmHg
When should you initiate screening for cervical cancer
21-year-old
In patients with STEMI it's important to get an immediate coronary angiography but how long can you wait in patients with NSTEMI
24-48 hours
How do you diagnose pheochromocytoma
24-hour catecholamines + CT or MRI of abdomen
What is the GOLD STANDARD for diagnosing GERD
24h ambulatory pH monitoring
How long does the progestin only IUD Mirena last
3-5 years
At what angle should the knee be bent in order to test for MCL laxity
30 degrees
How do you calculate rough estimate of fluid intake requirement for 24-hour period
30 x patient's weight in kg
What is the incubation period of mono and how is it transmitted
30-50 days and transmitted via salvia
what age group is duodenal ulcers more common
30-55 yo
How much weight is lost with banding procedures in first few years
35-45%
How many weeks is considered a term pregnancy
37-42 weeks
How do you treat osteomyelitis in sickle cell patients
3rd generation cephalosporin: fluoroquinolone: cipro or levofloxacin
How do you classify clavicle fractures
3rds, medial/middle/lateral third
What is considered normal peak expiratory flow rate
400-600
What is are positive results on a polysomnography test
5 or more predominantly obstructive respiratory events per hour of sleep in patients with symptoms/comorbidities or 15 or more in patients regardless of symptoms/comorbidities
What is the average age of menopause
51.5
How long must a diaphragm remain in place after intercourse
6-24 hours
How you manage patella fractures
6-8 weeks immobilization and may partially weight bear if nondisplaced, ORIF if displaced fracture
How do you manage a tibial plateau fracture
6-8 weeks in cast if nondisplaced, ORIF if displaced
When should you discontinue cervical cancer screening
65 years old
What factor does PT pathway include
7
What is a normal CD4 count
700-1500
How much weight is loss in the first 2 years with gastric bypass
75-85% of excess body weight
Foreign body aspirations most commonly occur where
80% in mainstem or lobar bronchus, right > left
How does Osgood Schlatter present clinically
9-14-year-old athletic male complaining of tenderness and swelling over tibial tubercle
Describe full can test
90-degree abduction, 30-degree flexion, rotate externally, apply downward pressure, positive test is weakness or pain
Describe empty can test
90-degree abduction, 30-degree flexion, rotate internally, apply downward pressure, positive test is weakness or pain
How fast should serum sodium be corrected
< or = 10 mEq/L over 24 hours
What TBSA in adults is consider a minor burn
<10%
What percent body area is considered to be SJS
<10%
What percent full thickness burn is considered a minor burn
<2%
At how many weeks of gestation is fetal loss considered an abortion
<20 weeks
What potassium level is considered decreased
<3.5
How do you manage nephrolithiasis
<5 mm pass spontaneously, >5 - 10 mm may require lithotripsy, stones >10 mm urethral stent or percutaneous nephrostomy
What TBSA in young/old is consider a minor burn
<5%
What mm of induration is considered positive in healthcare workers
> or = 10 mm
What mm of indurations is considered positive in those without risk factors
> or = 15 mm
What Ranson's criteria score is suggestive of severe pancreatitis
> or = 3
In patients with history of HIV, immunocompromised, close contacts of patient with active TB or chest x-ray consistent with old/healed TB, what mm of induration is considered positive
> or = 5 mm
At what age should everyone receive annual influenza vaccination
> or = 6 months
What is considered a normal forced expiratory volume in one second to forced vital capacity ratio
> or = 80%
What percent full thickness burn is considered a major burn
>10%
What level anion gap is considered elevated
>16
What TBSA in young/old is considered a major burn
>20%
What TBSA in adults is considered a major burn
>25%
What size aorta is considered aneurismal
>3 cm
What potassium level is considered elevated
>5-5.5
What percent stenosis is seen with stable angina
>70%
What can be used for elective medical abortion in the first 7-9 weeks
? Mifepristone and misoprostol
What does ABCDE stand for when describing skin lesions
A = asymmetry, B = border, C = color (varied), D = diameter (increasing or > 6 mm), E = elevation (raised)
What are the 3 strains of influenza
A, B, and C
What is used to estimate stroke after TIA
ABCD2 score: Age, blood pressure, clinical features, duration of symptoms/diabetes mellitus
How do you manage burns
ABCs, fluid replacement, topical antibiotic (silver sulfadiazine/aloe vera or bacitracin for superficial burns)
What should your workup of arterial/venous ulcer disease include
ABI: <0.9 indicates arterial insufficiency, evaluation for diabetes, ask about history of DVT, workup for thrombophilia, biopsy if vasculitis suspected, duplex sonography, tissue culture, bone scan (osteomyelitis)
Patient is a 37-year-old right-hand dominant male fell off his bicycle four days ago and injured his left non-dominant shoulder. There is an abnormal contour of the left shoulder with an elevation of the clavicle, AC joint tenderness, and pain with cross chest testing. What does this patient have
AC joint separation
What blood pressure medication is contraindicated in renal vascular disease
ACE inhibitors
What drug class decreases comorbidity and mortality in patients with CHF
ACE inhibitors
How do you treat systolic left heart failure
ACE inhibitors + beta blockers + loop diuretic
How do you treat diastolic heart failure
ACE inhibitors + beta blockers or calcium channel blockers
What drugs can cause aplastic anemia
ACE inhibitors, sulfonamides, phenytoin, chloramphenicol, chemotherapy, radiation
Fungal pneumonias are common in patients with what risk factors
AIDS, steroid use, organ transplant
How does severe asthma or status asthmaticus present
AMS, pulsus paradoxus (inspiratory drop in SBP by 10), silent chest, tripoding, inability to speak in full sentences, PEFR <40%
What radiographic views should be ordered for clavicle fracture
AP and clavicle
What views should you order for a possible shoulder dislocation
AP, axillary lateral, scapular Y-view
What imaging should you order in a suspected tibial plateau fracture
AP, lateral and oblique radiographs
What imaging can should be ordered in patellar tendinitis
AP, lateral and skyline views of the knee
What radiographs should be ordered for suspected LCL tear
AP, lateral and varus stress
What lab value is positive in patients with Crohn disease
ASCA
What is the diagnostic test of choice for acute pancreatitis
Abdominal CT
Patient is a >60-year-old male complaining of severe abdominal pain radiating to the back. EMS states that he had a syncopal episode. Pulse is 110, BP 90/50 O2 93% RR 14. On physical exam you appreciate a pulsatile abdominal mass. What is this patient likely experiencing
Abdominal aortic aneurysm
How do you diagnose small bowel obstruction
Abdominal x-ray will show air fluid levels in step ladder pattern, dilated loops of bowel, can use an UGI series
How do you diagnose chronic pancreatitis
Abdominal x-ray will show calcified pancreas
Define secondary amenorrhea
Absence of menses for 3 months in a woman with previously normal menstruation or 6 months in a woman with a history of irregular cycles
How does adhesive capsulitis present on MR arthrogram
Absence of normal axillary recess
Patient is a 13-year-old obese male who is being seen for his routine physical. His skin examination reveals velvety, hyperpigmented, papillomatous lesions of the neck and axillae. The remainder of the examination is unremarkable. The patient has a strong family history of diabetes. Laboratory analysis reveals a Hgb A1C - 5.9 (high), Insulin level - 18 (normal); lipids, CMP, T4, TSH, and cortisol are all normal. What does this patient have
Acanthosis nigricans
What is considered first line treatment for mild to moderate osteoarthritis pain and no evidence of inflammation
Acetaminophen
What is the most common cause of fulminant hepatitis
Acetaminophen, along with drug reactions, viral hepatitis and Reye syndrome
Hormone that directly stimulates parietal cells to secrete HCl acid via parasympathetic activation of the vagus nerve
Acetylcholine
What hormone is known as the rest and digest hormone
Acetylcholine, increase GI activity
40 yo Pt presents with dysphagia of solids & liquids, wt loss, dehydration, regurgitation of undigested food, CP and cough. What does this pt have
Achalasia
What is the role of bicarbonate
Acid buffer from the chyme entering the duodenum from the stomach
How do you manage gastritis if H. pylori comes back negative
Acid suppression: PPI, H2 blocker, antacids, sucralfate
How do you manage gastritis if h. pylori negative
Acid suppression: PPI, H2 blocker, antacids, sucralfate
Vertigo associated with ataxia and neurofibromatosis type 2
Acoustic neuroma
Patient is a 69-year-old man with male-patterned baldness is concerned because the skin on his scalp is no longer smooth. He describes it as feeling rough, like "sandpaper." While he is now retired, he was a gardener and often spent hours working under the sun. Physical exam reveals discrete yellow-brown, scaly patches on sun-exposed areas of the face, scalp, ears, forearms, and the dorsum of the hands. What does this patient have
Actinic keratosis
Patient is a 23-year-old-female with a one-week history of cough productive of whitish sputum. This was preceded one week prior by an URI. She denies chills, night sweats, shortness of breath or wheeze. Temperature is 99.9°F (37.7°C). What does this patient have
Acute bronchitis
Patient is a 47-year-old male presenting with fever/chills, jaundice, and RUQ pain. What does this patient have
Acute cholangitis, patient is presenting with Charcot's triad
Patient is a 40-year-old, fertile female who mildly obese c/o of RUQ pain. Pt states that she has experienced nausea and note that her symptoms started after eating a juicy burger and fries. What does this patient most likely have
Acute cholecystitis
Patient is a 3-7 y/o child with lymphadenopathy, bone pain, bleeding, and fever. Bone marrow demonstrates > 20% lymphoblasts. What does this patient have
Acute lymphocytic leukemia (ALL)
Patient is a 62-year-old male with a history of atrial fibrillation, CAD and hyperlipidemia complaining of abdominal pain. Upon physical exam you note his pain to be out of proportion to your physical findings. What does this patient likely have
Acute mesenteric ischemia
Patient is a 52-year-old male who reports that he has been feeling very tired lately and his wife thinks that he looks pale. You order a complete blood count, which shows: Hgb 8.5 g/dL (normal 13.5-17.5); WBC 1,200/microliter (normal 4,500 - 11,000); platelets 70,000/microliter (normal 150,000 - 400,000). The patient is referred for bone marrow biopsy, which shows myeloblasts with Auer rods. What does this patient have
Acute myelogenous leukemia (AML)
Patient is a 47-year-old white male with a history of alcohol abuse complaining of constant epigastric pain that radiates to his back. Patient is tachycardiac on physical exam and states that his pain is better with sitting forward but worse with laying back. What does this patient have
Acute pancreatitis
What are some complications of choledocholithiasis
Acute pancreatitis and acute cholangitis
Patient is a 34-year-old previously healthy male with complaints of facial pressure and rhinorrhea for the past 3 weeks. The patient reports that several weeks prior, he had a "common cold" which resolved. However, he has since developed worsening facial pressure, especially over his cheeks and forehead. He reports over 1 week of green-tinged rhinorrhea. His temperature is 100.1 deg F (37.8 deg C), Nasal exam reveals edematous turbinates and purulent discharge. The patient has facial tenderness with palpation over the involved sinus. What does this patient have
Acute sinusitis
What is the most common type of gastric carcinoma worldwide
Adenocarcinoma
What type of lung cancer presents as a non-smoker, with an incidental finding and a small peripheral lesion
Adenocarcinoma
What are the 3 type of non-small cell lung cancer
Adenocarcinoma (35-40%), squamous cell (25-35%), large cell (5%/Anaplastic)
What is the most common type of esophageal cancer I the united states
Adenocarcinoma, occurs in lower 1/3 esophagus
What are causes of secondary dysmenorrhea
Adenomyosis, endometriosis, fibroid, PID, IUD
Patient is a 58-year-old female presenting with a rapidly enlarging painful breast mass. Her overlying skin exhibits edema, warmth and erythema. You note swollen/enlarged lymph nodes on the ipsilateral side. What does this patient have
Adenopathy
What is the are 2 most common causes of small bowel obstruction
Adhesions and incarcerated hernias
Patient is a 50-year-old female complaining of right shoulder pain and stiffness that has been ongoing for a little over a year. Patient denies any previous injuries to her shoulder but states she has history of diabetes and hypothyroidism. On physical exam you note decreased external rotation and resisted passive range of motion. What does this patient have
Adhesive capsulitis (frozen shoulder)
What are common complications of shoulder fractures
Adhesive capsulitis or rotator cuff tear
30% of spontaneous pneumothoraxes recur how do you manage, a recurrence
Administer noxious agent to obliterate the pleural space or partial pleurectomy or abrasion of the pleural space
Patient is a 69-year-old female found to have an incidental 6.2 × 4.0 × 3.8 cm left adrenal mass on non-contrast CT scan of the abdomen obtained for abdominal pain. The patient has a recent history of new-onset hypertension, 25-lb weight loss and complaints of fatigue, muscle weakness, poor appetite, emotional lability, and insomnia. She has no significant family history of endocrine disease and no prior history of malignancy. What does this patient likely have
Adrenal carcinoma
How do you treat pheochromocytoma
Adrenalectomy
How do you manage adrenal carcinoma
Adrenalectomy or systemic chemotherapy and external-beam radiation if >90% resection not possible
What test is used in suspected thoracic outlet syndrome
Adson: loss of radial pulse with head extended and rotated to affected side, then armed pulled back
What is the PERC criteria for ruling out PE in low suspicion patients
Age <50, Pulse <100, O2 >95%, no prior: PE, trauma, surgery, hemoptysis, estrogen use, unilateral leg swelling
What are the 3 main triggers of asthma
Airway hyperactivity: allergen (extrinsic - increased IgE) vs infection or pharmacological use (intrinsic), Bronchoconstriction: obstruction, inflammation
Give 2 examples of SABAs
Albuterol or levalbuterol
What are the 2 most common causes of chronic pancreatitis
Alcohol abuse and idiopathic
What are the most common causes of cirrhosis
Alcohol, hepatitis (B, C, D), nonalcoholic fatty liver disease, hemochromatosis
Patient is a 4-year-old female with spots of hair loss that has been progressively worsening. According to the patient's mom, her daughter lost all the hair on her head, including eyelashes and eyebrows, 2 years ago. Her hair grew back and now new spots of hair loss are appearing. What does this patient have
Alopecia
Oval shaped well-demarcated hair loss, autoimmune - attack against hair follicles. Onset usually prior to 30 years of age; men and women are equally affected. Well-documented genetic predisposition. What is this called
Alopecia areata
What genetic disease is linked to COPD in patient <40 years old
Alpha 1 antitrypsin deficiency
What agents should you preoperatively in someone with pheochromocytoma
Alpha blockade with phenoxybenzamine or phentolamine x 7-14 days (don't use Beta blockade)
What are causes of secondary polycythemia
Altitude related, COPD, OSA, bloodletting, neoplasms
How do you treat influenza A
Amantadine or Rimantadine
Monocular vision loss - temporary lampshade down on one eye is called
Amaurosis Fugax
How do you manage bronchiectasis
Ambulatory oxygen, aggressive antibiotics, chest physiotherapy and eventually lung transplant
What protozoan infection presents with GI colitis, dysentery, stool ova and parasites
Amebiasis
How do you manage inflammatory bowel disease
Aminosalicylates: Sulfasalazine with folic acid, mesalamine + Corticosteroids for acute flares: prednisone, methylprednisolone + immune modifying agents: 6-mercaptopurine, azathioprine, methotrexate or anti-TNF agents: Adalimumab, infliximab, certolizumab
What is the treatment of choice in children <8 years old or pregnant patients who have early Lyme disease
Amoxicillin or Cefuroxime
What type of antibiotics can be used in mild exacerbation of chronic bronchitis
Amoxicillin, doxycycline, Bactrim
How do you treat cryptococcus
Amphotericin B
How do you treat histoplasma capsulatum
Amphotericin B
How do you manage acute cholangitis
Ampicillin/sulbactam (Unasyn) / Piperacillin/tazobactam (Zosyn) vs Ceftriaxone + Metronidazole or Fluoroquinolone + Metronidazole or Ampicillin + Gentamicin. All of that + ERCP due provide decompression and stone extraction
Bacterial pneumonia associated with poor dental hygiene
Anaerobes
Patient is a 35-year-old male with a history of IBS-D. Patient states that he noticed bright red blood after wiping. Patient states that along with the blood he has had severe pain and is now fearful of passing a bowel movement. Upon inspection of the perianal area you note a linear crack in the posterior midline. What does this patient have
Anal fissure
How do you treat sickle cell crisis
Analgesics, oxygen, hydration, hydroxyurea to decrease frequency of crises
Typical male pattern baldness
Androgenic alopecia
Patient is a 62-year-old male with a history of chronic kidney disease complains of weight loss, fatigue, and weakness. Iron studies reveal decreased serum iron, increased ferritin, and decreased TIBC. Peripheral blood smear shows normochromic RBCs. What does this patient have
Anemia of chronic disease
How does AML present
Anemia, nosebleeds, bruising, neutropenia, thrombocytopenia, bone pain, splenomegaly
How do you definitively diagnose acute mesenteric ischemia
Angiogram
What is the gold standard for diagnosing peripheral arterial disease
Angiography
What is the gold standard for evaluation of AAA
Angiography
What is the gold standard for diagnosing arterial embolism/thrombosis
Angiography, also order EKG and echocardiogram
Patient is a 47-year-old man with severe rectal pain when he defecates. He has a fever of 102.2 F (39 C). On exam there is perianal swelling, redness and tenderness. A palpable mass is felt at the anal verge. What does this patient have
Anorectal abscess
What is the 2nd stage in managing GERD
Antacids & OTC H2 receptor antagonists as needed
What is the most common type of shoulder dislocation
Anterior
Patient is a 24-year-old male with severe pain in the right knee. He is a professional football player and a few hours prior to presentation, an opposing player hit his leg from his left side. Afterward, he felt a "popping" sound that was followed by severe knee pain and a sensation of knee instability. On physical exam, there is an anterior translation of the proximal tibia when pulled as the patient has the knee flexed at 90° and supine. What does this patient have
Anterior Cruciate Ligament Tear
What type of stroke is associated with hemispheric signs and symptoms such as aphasia, apraxia, hemiparesis, visual field defects
Anterior circulation involvement
Describe Lachman test for ACL tear
Anterior pulling of the proximal tibia while stabilizing distal femur
Patient is an 80-year-old woman arrives at the emergency room with severe right shoulder pain and immobility. She fell down the steps outside her house and landed on her right side two hours prior to presentation. On exam, her right arm is abducted and externally rotated. She has decreased sensation to touch over the lateral aspect of her right shoulder. What does this patient have
Anterior shoulder dislocation
How do you diagnose hepatitis C virus
Anti HCV + in 6 weeks
What drug class should you not give with invasive diarrhea
Anti-motility agents
How do you treat hospital acquired pneumonia
Anti-pseudomonal beta lactam: piperacillin/tazobactam or cefepime + anti-pseudomonal aminoglycoside: Amikacin, gentamicin or fluoroquinolone: levofloxacin or moxifloxacin
How do you treat acute osteomyelitis
Antibiotics 4-6 weeks
How do you treat arterial embolism/thrombosis
Anticoagulated with IV heparin, surgical embolectomy within 4 to 6 hours, bypass for embolectomy failure
What drugs should not be used in a patient with shigella
Antidiarrheals: diphenoxylate or loperamide
What should you expect in a young woman with malar rash, arthritis, photosensitivity, renal/cardiac symptoms, fever, malaise, recurrent pregnancy loss and increased PTT
Antiphospholipid syndrome
How do you treat unstable angina
Antiplatelet drugs, beta blockers, nitroglycerin, calcium channel blockers, ACE inhibitors, statins, revascularization
What is the differential diagnosis for palpitations
Anxiety, electrolyte abnormalities (hypokalemia, hypomagnesemia), exercise, hyperthyroidism, ischemic heart disease, ingestion of stimulant, pheochromocytoma, hypoglycemia in DM type 1, MVP, atrial fibrillation, wolf-Parkinson-white syndrome, sick sinus syndrome
Patient is a 73-year-old female with a history of hypertension, diabetes, and coronary artery disease presents to the emergency department with severe, tearing, knife-like back pain. She states that the pain started approximately 30 minutes ago, and she has felt lightheaded and dizzy ever since its onset. On exam, her vitals are given: T: 98.6 F, HR: 115 bpm, BP: 95/53, RR: 14, SaO2: 97% on room air. What is this patient experiencing
Aortic dissection
Patient is a 25-year-old male recently started on phenytoin for seizure disorder is complaining of a low-grade fever, fatigue, and weakness. Physical exam reveals a temperature of 99.2°F, purpura, pallor, and gingival bleeding. There is no hepatosplenomegaly. His blood tests show WBC 1100/μL, platelets 35,000/μL, Hb of 4.0 g/dL; MCV 90 fl; and 1% reticulocyte count. A bone marrow biopsy is obtained, showing hypocellularity and increased adipose tissue. What does this patient have
Aplastic anemia
How do you test for adhesive capsulitis
Apley scratch test
How do you diagnose onychomycosis
Appearance, wet mount, culture, PCR
When does CK/CK-MB first appear, peak and how long does it last
Appears in 4-6 hours, peas at 12-24 hours, last for 3-4 days
When does troponin first appear, peak and how long does it last
Appears in 4-8 hours, peaks at 12-24 hours, last for 7-10 days
How do you manage appendicitis
Appendectomy
Patient is a 25-year-old female complaining of RLQ pain. Patient states that her pain started in the periumbilical/epigastric region but has now moved to her lower right quadrant. She reports nausea, vomiting, and loss of appetite. What does this patient have
Appendicitis
What is the characteristic finding of colorectal cancer on barium enema
Apple core lesion
How often is the NuvaRing applied
Applied every 3 weeks and off for 1 week
How do you manage osteoarthritis
Aquatic exercises, stretching, Acetaminophen 1 g PO QID vs tramadol or opioids vs topical or oral NSAIDs for refractory pain or intraarticular injections (corticosteroids, sodium hyaluronate) or glucosamine & chondroitin vs total joint replacement for unresponsiveness to conservative therapy
Describe drop arm test
Arm passively abducted and actively adducted slowly, positive test when arm drops quickly at 30 degrees
How do you manage a clavicle fracture
Arm sling or figure of 8 sling in children for 4-6 weeks, ortho consult if proximal 1/3
What neoadjuvant endocrine therapy is helpful in women that are postmenopausal ER positive patients with breast cancer
Aromatase inhibitors: Letrozole, Anastrozole
What is your differential for dyspnea on exertion
Arrythmia (Afib, sinus tach, sick sinus syndrome), Myocardial (cardiomyopathies, coronary ischemia), Restrictive (Constrictive pericarditis, pericardial effusion/tamponade), Valvular (Aortic insufficiency/stenosis, congenital heart disease, mitral valve insufficiency/stenosis
What should the differential of syncope include
Arrythmia, seizure, stroke, TIA, vasovagal, orthostatic hypotension, hypovolemia, medications, exercise
A 64-year-old patient with known history of type 1 diabetes mellitus for 50 years has developed pain radiating from the right buttock to the calf. Patient states that the pain is made worse with walking and climbing stairs. Based upon this history which of the following would be the most appropriate test to order
Arterial duplex scanning
Patient is A 56-year-old man is seen in the ED for onset of severe pain and numbness in his left leg that began 30 min ago. He has a past medical history significant for hypertension, diabetes, and hyperlipidemia. Physical exam reveals a temperature of 98.3 °F, blood pressure of 134/74 mmHg, pulse of 89/min, and respiratory rate of 16/min. Heart is irregularly irregular with no murmurs appreciated. On extremity exam, there is absent pulses in the left femoral, popliteal, and pedal arteries. On the right, all pulses are 2+. The left foot is cool to touch as compared to the right. Sensation to pinprick is decreased on the left dorsum of the foot compared to the right. What is this patient experiencing
Arterial embolism/thrombosis
Patient is a 62-year-old male with a 3.5 mm ulcerated area of the right medial malleolus. The wound is inflamed with associated edema. PMH is significant for varicosities. What does this patient likely have
Arterial/venous ulcer disease
What are the common causes of intracerebral hemorrhage
Arteriovenous malformation
What are some non-GI symptoms that can be seen with ulcerative colitis and Crohn disease
Arthritis, uveitis, episcleritis, fever, sweats, fatigue, erythema nodosum, pyoderma gangrenosum
How do you definitively diagnose septic arthritis
Arthrocentesis: WBC > 50,000 primarily PMNs; gram stain & culture, crystals
What are the 2 different types of meningitis
Aseptic or bacterial
What 2 syndromes can cause secondary amenorrhea
Asherman's: endometrial atrophy/scarring post pregnancy termination or Sheehan's: pituitary dysfunction due to hemorrhage
How do you treat stable angina
Aspirin, nitrates, beta blockers, calcium channel blockers, ACE inhibitors, statins, coronary angioplasty or coronary artery bypass graft
How do you manage an anal fissure
Assure patient that 80% resolve spontaneously, recommend supportive care: Sitz baths, analgesics, high fiber diet, stool softeners
What type of findings will you see on PE in a patient with cirrhosis
Asterixis (flapping tremor), ascites (abdominal distention), caput medusa, hepatosplenomegaly, jaundice, dupuytren's contractures, spider angioma
Patient is a 5-year-old boy who is brought to the emergency department by his parents for a cough and shortness of breath. He has a past medical history of eczema and seasonal rhinitis. On physical exam, you note a young boy in respiratory distress taking deep slow breaths to try and catch his breath. He has diminished breath sounds in all lung fields with prolonged, expiratory wheezes. What does this patient have
Asthma
What are causes of secondary pneumothorax
Asthma, COPD, cystic fibrosis, interstitial lung disease
What is Samter's triad
Asthma, nasal polyps, ASA/NSAID allergy
What are some clinical manifestations of bronchial carcinoid tumors
Asymptomatic, recurrent pneumonia, SIADH, carcinoid syndrome: (diarrhea due to elevated serotonin), flushing, tachycardia, bronchoconstriction
How often should you recommend clinical breast exams
At least every 3 years if 20-39 and annually if >40
Name 3 examples of protease inhibitors (PI)
Atazanavir (Reyataz), Darunavir (Prezista), Lopinavir & Ritonavir (Kaletra)
What is the most common cause of peripheral arterial disease
Atherosclerosis
What is the most common risk factor for developing AAA
Atherosclerosis, followed by smoking, Caucasian, hyperlipidemia, connective tissue disorder, hypertension
What is the most common cause of embolus from the heart
Atrial fibrillation
What are the most common causes of thrombus formation
Atrial fibrillation and mitral stenosis
Vaginitis that presents with dyspareunia, irritation, dryness, recurrent UTI despite treatment, thin/pale mucosa on vaginal exam
Atrophic vaginitis
What laboratory finding supports a diagnosis of mononucleosis
Atypical lymphocytosis on WBC differential
What type of bacterial pneumonia is associated with an indolent course
Atypical pneumonia most commonly mycoplasma
Achalasia is the loss of what plexus which leads to increased LES pressure
Auerbach's - contains ganglion cells that produce Nitric Oxide which causes relaxation of LES
How do you manage dog bite
Augmentin or clinda + cipro or Bactrim
How do you manage human bite
Augmentin or clinda + moxifloxacin or Bactrim
How do you manage cat bite (Pasteurella multocida)
Augmentin or doxy if PCN allergic
How do you treat cat bite (Pasteurella multocida)
Augmentin or doxy if penicillin allergic
Bleeding when scale is picked is called
Auspitz sign
Patient is a 59-year-old male with complaints of fatigue, shortness of breath with physical exertion, and a sense of abdominal fullness. His wife accompanies him to his appointment and expresses concerns about his skin color, commenting that he has an "orange hue" to his skin. On physical exam the patient is noticeably jaundice with palpable splenomegaly. A peripheral smear comes back with spherocytes as well a smudge cells. His direct Coombs test is positive with anti-C3 and anti-IgG antibodies. What does this patient have
Autoimmune hemolytic anemia
Patient is a 49-year-old female with progressive left hip pain and limp which has become progressively worse over 13 months. Her past medical history is significant for heterozygous sickle cell anemia and she has been under hydroxyurea treatment for about 20+ years. She is on no other medication and denies alcohol or tobacco use. The pain is localized to the groin, lateral hip, and buttocks. What does this patient have
Avascular necrosis of hip
How do you treat G6PD deficiency
Avoid triggers (antimalarials, sulfa drugs, ASA, fava beans)
Where is adenopathy most commonly seen in patients with breast cancer
Axilla
What can be a complication of shoulder dislocation
Axillary nerve injury (transient neurapraxia), always check for sensation over the deltoid
What is the 1st line treatment for MAC
Azithromycin or Clarithromycin, 2nd line is Rifabutin
How do you prophylactically manage migraines
BBs, CCBs, TCAs, anitconvulsants (valproate, topiramate)
What are the indications for bariatric surgery
BMI of >40 kg/m2, a BMI >35 kg/m2 with a comorbid condition, or a BMI of >30 kg/m2 with dysmetabolic syndrome or difficult-to-control type 2 diabetes mellitus, failed other non-surgical weight loss programs
How do you diagnose orthostatic hypotension
BP measured with patient supine for 5 minutes, 1 minute in seated position and 3 minutes in standing. Can use tile table testing
Vaginitis that presents as fishy, grey, scant, sticky discharge, pH >4.5, clue cells on wet prep, + whiff test with KOH
Bacterial vaginosis
Does bacterial or fungal vaginal infection present with foul smelling vaginal discharge, that is grayish in color and pH >4.5
Bacterial, fungal has white curd-like discharge and pH <4.5
How do you treat pneumocystis jiroveci
Bactrim and steroids (Bactrim is also used as prophylaxis)
What is the 1st line treatment for Toxoplasmosis
Bactrim, 2nd includes Dapsone + Pyrimethamine + Folinic acid
What is the 1st line treatment for PCP
Bactrim, 2nd line includes dapsone or atovaquone
How do you manage shigella diarrhea if severe
Bactrim, always fluids if not severe
How do you treat methicillin-resistant staph aureus cellulitis
Bactrim, clindamycin, doxycycline vs IV vancomycin or linezolid
What type of cyst can be formed due to knee osteoarthritis
Baker's cyst
What surgeries are considered restrictive bariatric procedures
Banding and sleeve gastrectomy
What associated conditions should you consider in a patient with shoulder dislocation
Bankart or Hill-Sachs lesion, axillary nerve injury, rotator cuff tear, labral tear
What diagnostic test is contraindicated in acute diverticulitis
Barium enema
How do you diagnose esophageal webs & rings
Barium esophagram
What is the name of alpha thalassemia that has the A trait
Bart's (hydrops fetalis)
Patient is a 45-year-old fair-skinned woman who is concerned about a "pink mole" on her cheek. On physical examination you note a 7 mm pearly papular lesion on the right cheek with surface telangiectasias, rolled border and central erosion. What does this patient likely have
Basal cell carcinoma
How does lead poison diagnosed
Basophilic stippling
Tenderness to palpation at distal pole of the patella in full extension and no tenderness to palpation at distal pole of the patella in full flexion is called
Basset's sign
What are some examples of long-term medication for chronic asthma
Beclomethasone or triamcinolone (ICS), Salmeterol (LABA), Cromolyn (mast cell modifiers), montelukast (LTRA), theophylline
How do you treat obstructive sleep apnea
Behavior modification: weight loss/exercise, avoid alcohol/sedatives, sleep in nonsupine position; + positive airway pressure therapy/oral appliance if mild to moderate vs continuous positive airway pressure if severe
Idiopathic unilateral hemifacial weakness/paralysis due to inflammation/compression of CN VII is called
Bell palsy
What is the first-line treatment of ulcers
Below-knee compression stockings, surgical debridement with xylocaine gel, 30 min of brisk walking 5 times per week, elevation, refer nonhealing ulcers to wound care
How do you manage Osgood Schlatter disease
Benign and self-limiting, NSAIDs, ice, physical therapy: quad stretching vs surgical ossicle excision or resection for refractory cases
Vertigo characterized by changes in position but no hearing loss, tinnitus or ataxia
Benign positional vertigo
How do you manage stage 3 acne vulgaris
Benzoyl peroxide + systemic antibiotic
How do you manage stage 4 acne vulgaris
Benzoyl peroxide + systemic antibiotic or isotretinoin
How do you manage stage 2 acne vulgaris
Benzoyl peroxide +/- topical antibiotic +/- keratinolytic agent
What is the most common cause of SAH
Berry aneurysm rupture (anterior communicating artery)
What blood pressure medication is used to decrease expansion and rupture risk of AAA
Beta blockers
How do you manage NSTEMI in long-term
Beta blockers + nitroglycerin + aspirin + heparin
What drug is contraindicated in isolated peripheral arterial disease and why
Beta blockers because they can worsen claudication
How do you treat hyperthyroidism
Beta blockers for cardiac symptoms (atenolol) + antithyroid drugs (methimazole or PTU) vs radioactive iodine or thyroidectomy
What drug class is contraindicated in patients with Prinzmetal angina
Beta blockers such as propranolol
How do you treat inpatient community acquired pneumonia
Beta lactam: ceftriaxone + macrolide or doxycycline vs broad spectrum fluoroquinolone
Patient is a 33-year-old man who complains of left anterior shoulder pain for 4 weeks. The pain is made worse with overhead activities. On examination, you note maximal pain in the shoulder with palpation between the greater and lesser tubercle. Pain in the shoulder is exacerbated when the arm is held at the side, elbow flexed to 90 degrees, and the patient is asked to supinate and flex the forearm against your resistance. What does this patient have
Biceps Tendonitis
Explain speed test for biceps tendonitis
Bicipital groove pain with resisted forward flexion while arm is supinated (can be positive with SLAP lesions)
How does essential tremor present
Bilateral intention tremor that doesn't occur at rest, autosomal dominant, better with alcohol
Patient is a 40-year-old obese Caucasian female complaining of RUQ/epigastric pain. She states that the pain comes in episodes, lasting for 30 minutes and is made worse by eating. She also notes that she is currently taking OCPs. What does this patient have
Biliary colic
What is acute cholangitis
Biliary tract infection secondary to obstruction
What bariatric surgeries are considered malabsorptive
Biliopancreatic diversion and biliopancreatic diversion with duodenal switch
How do you diagnose Kaposi sarcoma
Biopsy
How do you diagnose squamous cell carcinoma
Biopsy
What are the causes of Histoplasma capsulatum
Bird or bat droppings, associated with Mississippi or Ohio river valley
What is the common appearance of Achalasia on esophagram
Bird's Beak
What three specific beta-1 selective drugs reduce mortality from heart failure
Bisoprolol, carvedilol, metoprolol succinate
How do you treat osteoporosis caused by hyperparathyroidism
Bisphosphonates
Spider bite that causes neurologic manifestations
Black widow
How do you diagnose Dubin-Johnson Syndrome
Black-liver on biopsy and isolated conjugated hyperbilirubinemia between 2-5 mg/dL
Patient is a 60-year-old male with painless hematuria. He first noticed the color of his urine darkening several weeks ago, and it has recently worsened. He denies any pain. Vital signs are stable. Physical examination is within normal limits. Past medical history is significant for a 25 pack/year history of smoking. He has no costovertebral angle tenderness. Urinalysis is positive for heme with with >100 RBC/HPF and urine culture is negative. What does this patient have
Bladder carcinoma
How would you describe urticaria
Blanchable, edematous pink papules, wheals or plaques
What is a common cause of spontaneous pneumothorax
Bleb rupture
What are some complications of PUD
Bleeding, perforation, penetration, obstruction
What is the MOA of PPIs
Blocks H/K ATP-ase (proton pump) of parietal cells, reducing acid secretion
How do you treat vascular disease dementia
Blood pressure control
What is another name for someone with chronic bronchitis
Blue bloater due to obese and cyanotic appearance
Pt presents with retrosternal CP made worse with deep breathing/swallowing and hematemesis. On auscultation of chest you hear CREPITUS. What does this pt have
Boerhaave syndrome
What is the gold standard for diagnosing osteomyelitis
Bone aspiration
How do you confirm diagnosis of polycythemia
Bone marrow biopsy
How do you definitively manage alpha thalassemia
Bone marrow transplant
How do you diagnose ALL
Bone marrow with >20% blasts
What is the cause of Lyme disease
Borrelia burgdorferi via Ixodes/deer tick
Swelling of the proximal interphalangeal joint is called
Bouchard node
How do you manage toxic megacolon
Bowel decompression (NG tube), bowel rest, broad-spectrum antibiotics, electrolyte repletion vs colostomy for refractory cases
What is the most common nerve compressed in thoracic outlet syndrome
Brachial plexus followed by subclavian vein and subclavian artery
How do you conservatively manage MCL tear
Bracing and physical therapy vs surgery for chronic instability
Patient is a 32-year-old lactating female with breast pain, swelling, fever, chills and a fluctuant mass of her left breast. The area directly above the lesion is warm, erythematous and tender to touch. What does this patient likely have
Breast abscess
How do you definitively diagnosis breast carcinoma
Breast biopsy
Patient is a 33-year-old woman who arrives at your outpatient clinic for the evaluation of a painless breast mass that has been slowly enlarging over the past 3 months. Her past medical history is unremarkable. She has no prior history of breast complaints or trauma. The findings from the physical examination are unremarkable except for the breast examination. A hard, nontender 3-cm mass is noted in the upper outer quadrant of her left breast. The left axilla is without abnormalities. Examination of the right breast reveals no dominant mass or axillary adenopathy. What does this patient likely have
Breast carcinoma
How do you manage AC joint separation
Brief sling immobilization, analgesia, ice, ortho follow up, type III may need surgery
Rare neuroendocrine (enterochromaffin cell) tumors characterized by slow growth, low METs are called
Bronchial carcinoid tumors
Patient is a 25-year-old cystic fibrosis patient complaining of chronic, frequent coughing productive of yellow and green sputum. She recently recovered from a Pseudomonas spp. Pneumonia requiring hospitalization. On physical examination you notice foul breath, purulent sputum and hemoptysis along with a CXR demonstrating dilated and thickened airways with "plate-like" atelectasis (scarring). What does this patient have
Bronchiectasis
The subtype of adenocarcinoma bronchogenic carcinoma which is characterized by voluminous sputum and interstitial lung pattern on CXR is known as
Bronchioalveolar
How do you diagnose pneumocystis Jiroveci
Bronchoalveolar lavage (PCR)
How are central lesions diagnosed
Bronchoscopy
How do you treat foreign body aspiration
Bronchoscopy (rigid is preferred in children)
How do you diagnose bronchial carcinoid tumors
Bronchoscopy: pink to purple well-vascularized central tumor
Spider bite that causes central necrosis
Brown recluse
Within regard to acute cholecystitis, referred pain to the right shoulder/subscapular area is known as
Bsoas sign
How does a cystocele present
Bulge in the vagina, pelvic pressure, urinary dysfunction
What is the above called
Bullous pemphigoid
How does Lyme disease present in early localized stage
Bullseye rash, otherwise known as erythema migrans, viral-like syndrome, headaches, fever, malaise, lymphadenopathy
How do you treat SJS
Burn unit admission and IV immunoglobulin
How do you treat TENs
Burn unit admission, cyclosporine or plasma exchange if severe
How do you manage a subdural hematoma
Burr hole trephination, craniotomy or craniectomy
What labs should you order in workup of osteoarthritis
C-reactive protein and erythrocyte sedimentation rate which will be normal
What dermatomes are located over the shoulder and deltoid
C4 shoulder, C5 deltoid
What is the innervation of the SITS muscles
C5 and C6
How do you manage gastritis if H. pylori comes back positive
CAP (clarithromycin + Amoxicillin + PPI) - metro if PCN allergic
How do you manage PUD if H. pylori present
CAP (clarithromycin + Amoxicillin + PPI) or metro if PCN allergic vs quadruple therapy (PPI + Bismuth subsalicylate + tetracycline + metro)
How do you manage gastritis if h. pylori positive
CAP = clarithromycin, amoxicillin and PPI (metronidazole if PCN allergic)
How is shigella diarrhea diagnosed
CBC shows leukemoid reaction (WBC >50,000), sigmoidoscopy shows punctate areas of ulceration
What labs should you order for hematochezia/melena
CBC, chemistries, LFTs, Coags
What CD4 count is indicative of HIV
CD4 < 200 cells/uL
What tumor marker can be used to diagnose and monitor colorectal cancer
CEA
What are causes of hypervolemic hyponatremia
CHF, nephrotic syndrome, renal failure, cirrhosis
How do you diagnose epidural hematoma
CT
What is the gold standard in diagnosing bronchiectasis
CT
What is the study of choice for evaluating acute head injuries such as concussions
CT
What is the study of choice for pancreatic pseudocyst
CT
What is the initial test of choice for pancreatic carcinoma
CT but ERCP is most sensitive
What imaging studies are used in suspected adrenal carcinoma
CT scan
What is the diagnostic test of choice for diverticulosis/diverticulitis
CT scan
What is the test of choice for thoracic aneurysm and for further evaluation of patients with known abdominal aortic aneurysm
CT scan
What is the test of choice for evaluating aortic dissection
CT scan with contrast
How do you diagnose appendicitis
CT scan, can see leukocytosis, can conduct US initially
What is the initial test of choice in suspected TIA
CT without contrast
What drugs interact with emergency contraception
CYP3A4 inducers such as carbamazepine, topiramate, st. john's wort
What is the triad of chronic pancreatitis
Calcification, steatorrhea, diabetes mellitus
What does the mnemonic CHOBBS for Ranson's criteria within 48 hours stand for
Calcium <8.0 mg/dL, Hematocrit fall >10%, Oxygen PO2 <60 mmHg, BUN >5 mg/dL p IV fluids, Base deficit >4 mEq/L, Sequestration of fluid >6L
How do you treat hyperphosphatemia
Calcium carbonate and restrict potassium
What are the 4 types of kidney stones
Calcium oxalate (radiopaque), uric acid (radiolucent), cystine, struvite (seen with chronic UTI, treat with antibiotics)
What is Homan's sign
Calf pain with dorsiflexion of foot while leg extended indicated possible DVT or thrombophlebitis
What is the most common cause of bacterial enteritis in US and most common antecedent event in post-infectious GBS
Campylobacter jejuni
Incidence of GBS is associated with
Campylobacter jejuni or antecedent respiratory or GI infection
What are the common invasive diarrhea causes
Campylobacter, shigella, salmonella, Yersinia, enterohemorrhagic E coli
What causes paronychia
Candida if chronic and staph if acute
Vaginitis that presents with clumpy or cheesy vaginal discharge, pruritis, dysuria, pH <4.5 and branching hyphae on KOH
Candida vaginitis
What should you do if > 70% stenosis of internal or common carotid artery
Carotid endarterectomy
What is the first line revascularization option for patients with carotid disease
Carotid endarterectomy (CEA) vs carotid artery stenting if unable to tolerate CEA
How do you treat dysfunctional uterine bleeding
Cause cycle bleeding for protection of endometrium via progesterone therapy, OCPs, GnRh agonists, hysteroscopy, endometrial curettage or ablation, NSAIDs
How does TB present on x-ray
Cavitary lesions, infiltrates, ghon complexes in apex of lungs (calcified lymph + lesions), caseating granulomas
What antibiotics are used in treatment of gram-negative cocci or gonococcus suspected
Ceftriaxone
How do you manage bacterial meningitis caused by S. pneumo or N. meningitidis
Ceftriaxone + Vancomycin
What is the empiric treatment of meningitis
Ceftriaxone + Vancomycin in adults or Ampicillin + Cefotaxime in infants
What type of antibiotics can be used in moderate and severe cases of chronic bronchitis
Cefuroxime, Augmentin, Bactrim, levofloxacin, ciprofloxacin
Patient is a 64-year-old female with a 4 cm × 7 cm edematous, red, hot tender area on the left thigh. The lesion has gotten larger over the past 6 hours. She tells you she has also had a low-grade fever and some chills. On physical exam, there is a poorly demarcated 12 cm red and tender plaque on her right calf. Some parts resemble an orange peel. There is a superficial cut in the middle of the plaque. What does this patient have
Cellulitis
What does the above image show
Cellulitis
How do you manage cellulitis if not worried about MRSA
Cephalexin or dicloxacillin
How do you treat mild cellulitis (MSSA)
Cephalexin or dicloxacillin, clindamycin or macrolide if penicillin allergic
What can rapid correction of hypernatremia cause
Cerebral edema and pontine herniation
Patient is a 45-year-old female with post coital bleeding and painful intercourse. On exam you notice a friable, bleeding cervical lesion. The cytological evaluation shows a high-grade squamous intraepithelial lesion (HSIL/CIN2/3). She is referred for colposcopy and directed biopsies. What does this patient have
Cervical cancer
Define menopause
Cessation of menses for at least 12 months
What is another name for cervical motion tenderness
Chandelier sign
What is Reynold's pentad
Charcot's triad + AMS and Shock: hypotension
How do you treat Kaposi sarcoma
Chemotherapeutic agents
How do you stage 4-5 melanoma
Chemotherapy
How do you manage small cell bronchogenic carcinoma
Chemotherapy +/- radiotherapy
How do you manage stage 3 non-small cell bronchogenic carcinoma
Chemotherapy then surgery
What is the recommended adjunctive therapy post lumpectomy/mastectomy for women with stage II-IV breast cancer or inoperable breast cancer
Chemotherapy: Doxorubicin, Cyclophosphamide, Fluorouracil, Docetaxol
How do you manage spontaneous pneumothorax if larger and severe
Chest tube placement (thoracostomy)
How do you diagnose viral pneumonia
Chest x-ray shows bilateral interstitial infiltrates, rapid antigen test for flu, RSV nasal swab, cold agglutinin titer is negative
How do you diagnose bronchiectasis
Chest x-ray shows linear lung markings (tram track), atelectasis, plate-like atelectasis
How do you diagnose emphysema
Chest x-ray shows loss of lung markings, hyperinflation, parenchymal bullae and blebs, decreased FEV1/FVC ratio
How do you diagnose pneumonia
Chest x-ray shows patchy, segmental lobar or multilobar consolidation + blood cultures x 2 and sputum gram stain
What should your workup of foreign body aspiration include
Chest x-ray with expiratory view and ABG to access ventilation
What should your workup of CHF include
Chest x-ray, ECG, BNP
How do you diagnose lung cancer
Chest x-ray, bronchoscopy + biopsy for central lesions or FNA
How do you diagnose bronchogenic carcinoma
Chest x-ray, sputum cytology (squamous/small cell), bronchoscopy (central lesions), transthoracic needle biopsy (peripheral)
What are common causes of cystoceles in women
Childbirth, constipation, violent coughing, heavy lifting
How does ALL present
Children 3-7 years old + lymphadenopathy + bone pain + bleeding + fever
Tibial plateau fractures are commonly seen in what patient population
Children in MVA
What is the difference in calculating burns in children as compared to adults
Children's head is 18% total, legs are 14% total
Bacterial pneumonia associated with college kids, sore throat, long prodrome
Chlamydia pneumonia
How do you manage cholelithiasis
Cholecystectomy or if asymptomatic: observation/Ursodeoxycholic to dissolve stone
What hormone aids in the breakdown of fats & proteins via stimulation of pancreatic release of trypsin, amylase and lipase
Cholecystokinin (CCK)
Patient is a 45-year-old female presenting with a complaint of RUQ pain that has been ongoing for the past 2 days. Patient states that she has noticed her eyes have started to turn yellow. She notes that she has felt feverish and in office temperature is 38.2 C. What does this patient likely have
Choledocholithiasis
Gallstones in the gallbladder without inflammation is called
Cholelithiasis
How do you manage pruritus caused by cirrhosis
Cholestyramine (Questran which is a bile acid sequestrant)
How do you manage Alzheimer disease
Cholinesterase inhibitors such as Donepezil or tacrine
What is the most common cause of spontaneous abortion
Chromosomal abnormalities
Patient is a 60-year-old female with shortness of breath of recent onset. She has a six-year history of Rhonchi are continuous low pitched, rattling lung sounds that often resemble snoring. Obstruction or secretions in larger airways are frequent causes of rhonchi and is on oxygen at home. Physical assessment reveals the following: respiratory rate 32, slightly labored, temperature 98.9F. Her SpO2 is 90% while receiving oxygen via nasal cannula at 2 Lpm. What does this patient have
Chronic bronchitis: COPD
Hyperphosphatemia is associated with what disease
Chronic kidney disease
What is the most common secondary cause of hyperparathyroidism
Chronic kidney disease
Patient is a 60-year-old male complains of fatigue, blood tests demonstrate severe anemia, decreased neutrophil count, and small, abnormal B lymphocytes in the bone marrow (>30%) with levels at 90,000 per cubic millimeter. Has painless cervical lymphadenopathy and hepatosplenomegaly. What does this patient have
Chronic lymphocytic leukemia
Patient is a 49-year-old healthy male complains of no symptoms, but on a routine complete blood count (CBC) has a markedly increased white blood cell count of 40,000 per uL (normal 4500 - 11,000). A peripheral blood smear demonstrates leukocytosis with myeloid cells present at various stages of differentiation, with more mature cells present at a greater percentage than less mature cells. The cytogenetic analysis is positive for the Philadelphia chromosome. What does this patient have
Chronic myelogenous leukemia (CML)
What is the most important risk factor for the development of COPD
Cigarette smoking/exposure
How do you treat septic arthritis in IV drug abusers due to pseudomonas
Cipro or Levaquin
How do you prophylactically treat patients exposed to someone with meningitis
Ciprofloxacin 500 mg PO x 1 dose or Rifampin
What is post exposure prophylactic treatment for meningitis
Ciprofloxacin or Rifampin
How do you treat osteomyelitis due to puncture wounds
Ciprofloxacin or levofloxacin
How do you treat puncture wounds if through the shoe
Ciprofloxacin to cover for pseudomonas
Irreversible liver fibrosis with nodular regeneration secondary to chronic liver disease is called
Cirrhosis
Describes the 4 classes of NYHA functional classification of heart failure
Class 1: no limitations, Class 2: Comfortable at rest, slight limitation of physical activity, Class 3: comfortable at rest, marked limitation of physical activity, Class 4: discomfort at rest
Patient is a 65-year-old male presenting with a 5-month history of progressively worsening right calf pain upon walking. He describes the pain as a tightening or cramping, and it comes on after walking two blocks. The pain forces him to stop walking and is relieved after he sits down for 10 min. He can then resume walking again. What is this patient experiencing
Claudication
Patient is a 23-year-old woman arrives at the emergency room after a biking accident. She reports acute pain after falling on her shoulder. On physical exam, there is swelling, erythema, and tenderness on the anterior aspect of her right shoulder. No tenting of the skin is noted. Distal pulses are intact, and there is no motor or sensory deficits. What does this patient have
Clavicle fracture
How do you manage diverticulitis
Clear liquid diet, Ciprofloxacin or Bactrim + Metronidazole
How do you treat hand-foot-mouth disease
Clear ups within 10 days, recommend good hygiene
How do you treat MSSA osteomyelitis in patients >4 months old in patients allergic to penicillin
Clindamycin or Vancomycin
How do you diagnose varicose veins
Clinical but can use duplex ultrasonography
How do you diagnose Parkinson's disease
Clinical impression, neuropathologic exam is gold standard, can test response to dopamine
What is the Well's criteria for PE
Clinical signs of DVT, PE is number 1 diagnosis, heart rate >100, immobilization > 3 days or surgery in previous 4 weeks, history of DVT/PE, hemoptysis, history of malignancy within past 6 months
What is the drug of choice for hypertensive urgency
Clonidine
What is type of diarrhea is usually due to iatrogenic factors, especially by taking clindamycin
Clostridium Difficile
What type of headache more commonly presents in middle age males with unilateral periorbital/temporal sharp, lancinating temporal pain lasting <2 hours
Cluster
Bacterial pneumonia associated with valley fever, common in dry states
Coccidioides
What fungal pneumonia presents as a patient with non-remitting cough/bronchitis non-responsive to conventional treatments
Coccidioides (valley fever)
A CD4 count of < or = 250 suggest what opportunistic infection
Coccidioidomycosis
How do you manage concussion syndrome
Cognitive and physical rest
What is the diagnostic test of choice for suspected colorectal cancer
Colonoscopy
What test should you order for hematochezia
Colonoscopy
What is the USPSTF colorectal screening guidelines for those who had a first degree > or = 60 with colorectal cancer
Colonoscopy every 10 years starting at age 40
What is the USPSTF colorectal screening guidelines for those who had a 1st degree relative <60 with colorectal cancer
Colonoscopy every 5 years starting at age 40 or 10 years before the age the relative was diagnosed
Patient is a 54-year-old African American male presenting with a complaint of rectal bleeding and inability to pass stools for the past 3 days. Patient notes that his eats a lot of steak and burgers. You order a CBC and note iron deficiency anemia. What does this patient likely have
Colorectal cancer
How do you diagnose cervical cancer
Colposcopy with biopsy
How do you treat AML
Combination chemotherapy vs bone marrow transplant
How do you treat Hodgkin's lymphoma
Combination chemotherapy, radiation (low risk patients)
How do you treat ALL
Combination chemotherapy, stem cell transplant if relapse
Describe stage I acne vulgaris
Comedones +/- papules and pustules
What is the common etiology of hepatocellular carcinoma
Commonly metastatic from lung or breast malignancies
Lobar consolidation is seen in what type of pneumonia
Community acquired
How do you diagnose compartment syndrome
Compartment pressure > 30-45 mmHg, elevated CK and myoglobin
Patient is a 33-year-old man who has undergone ORIF of the left tibia. Fifteen hours postoperatively, the patient complains of increased pain and swelling of his left leg. His pain is unrelieved by medication, he is experiencing numbness, tingling, and loss of function in the extremity. Physical examination demonstrates decreased sensation and painful paralysis of his toes along with diminished pedal pulses on the affected side and coolness with a loss of color in the area. What does this patient have
Compartment syndrome
What should you watch for postoperatively after reperfusion of a limb
Compartment syndrome, hyperkalemia, renal failure from myoglobinuria, MI
EEG shows interictal spikes with slow waves in the temporal area plus aura plus consciousness impaired, what type of seizure is this
Complex partial
How do you manage prepatellar bursitis
Compressive wraps + NSAIDs +/- aspiration and immobilization for 1 week, +/- corticosteroid injection
Patient is a 40-year-old married promiscuous male patient who admits to having recent intercourse with a male prostitute during a recent trip to Las Vegas. On physical exam you note several raised, cauliflower-like lesions in clusters on the shaft of his penis. What does this patient have
Condyloma acuminatum: genital warts
A primigravida (women who is pregnant for the 1st time) patient with bilateral painful breast engorgement most likely has
Congestive mastitis
How do you treat avascular necrosis of hip
Conservative treatment, joint replacement, bisphosphonates
How do you manage LCL tear
Conservatively with bracing and therapy vs surgery if grade III injury
What is the common cause of salmonella typhi (enteric fever)
Consumption of fecally contaminated food or water
How do you definitively diagnose Boerhaave syndrome
Contrast esophagram preferably with Gastrografin looking for leakage
What non-hormonal therapies can you recommend to menopausal women
Cool temps, heat avoidance, avoid: spicy foods, beverages, avoid ETOH, soy
What is the most effective emergency contraception that also provides long lasting contraception
Copper IUD
What is the appearance of Diffuse Esophageal Spasm on esophagram
Corkscrew
What is the gold standard/definitive in diagnosing angina
Coronary angiography
What is the gold standard for diagnosing Prinzmetal angina
Coronary angiography with injection of provocative agents into the coronary artery
What causes the transient ST-segment elevation seen with prinzmetal angina
Coronary artery vasospasms
What can you use in a patient with mono that develops airway obstruction due to lymphadenopathy, hemolytic anemia or severe thrombocytopenia
Corticosteroids
How does acute bronchitis present
Cough that persists > 5 days.
What is the cause of hand-foot-mouth disease
Coxsackievirus type A
Hereditary unconjugated hyperbilirubinemia characterized by either no glucuronosyltransferase (UGT) activity - Type I or little UGT activity (< or = 10% of normal) - type II, is called
Crigler-Najjar Syndrome
Patient is a newborn presenting with a complaint of jaundice which has seem to be worse during the 2nd week. You note signs of kernicterus (bilirubin induced encephalopathy: hypotonia, deafness, lethargy, oculomotor palsy). What does this newborn likely have
Crigler-Najjar Syndrome Type I
Patient is a 25-year-old while female complaining of RLQ pain and weight loss. What does this patient likely have
Crohn disease
How do you test for AC joint separation
Cross chest test
How is shigella commonly spread
Crowded conditions such as day cares
How do you manage DIC
Cryoprecipitate, fresh frozen plasma, platelet transfusion if <30K, heparin
How do you treat verrucae
Cryotherapy or salicylic acid
Which fungal pneumonia is found in soil and can disseminate causing meningitis
Cryptococcus
What is the most common cause of chronic diarrhea in patients with AIDs
Cryptosporidium Superficial inflammation/irritation of the stomach mucosa with mucosal injury is called? Gastritis
Within regard to acute pancreatitis, what is periumbilical ecchymosis called
Cullen's sign
How do you diagnose cellulitis
Culture if purulent and follow up in 48 hours
How do you diagnosis salmonella
Culture: blood, stool, urine; will see elevated WBC and low platelets
What is the most common cause of bronchiectasis
Cystic fibrosis
Patient is a 45-year-old female complaining of pressure in the pelvis and vagina along with discomfort when straining. She also feels that her bladder hasn't fully emptied after urinating. What does this patient have
Cystocele: bladder hernia
What is the gold standard for diagnosing bladder cancer
Cystoscopy with biopsy
What is the recommendation for cervical cancer screening in women ages 21-29 years old
Cytology alone every 3 years
What test can be used to rule out a negative D-dimer in low risk patients
D-dimer
How do you manage von Willebrand disease
DDAVP: desmopressin vs transfusion of blood clotting factors containing vWF if excessive bleeding
Abnormal activation of the coagulation cascade leading to the formation of microthrombi leading to simultaneous bleeding and thrombosis
DIC
Patient is a 78-year-old female complaining of generalized pain and edema in her left leg. She denies chest pain, shortness of breath, and hemoptysis. She takes 2.5 mg warfarin daily for atrial fibrillation and her INR is 2.6. On physical examination the patient experience calf pain with dorsiflexion of the left foot. What does this patient likely have
DVT
Localized urticaria appearing where the skin is rubbed is called
Darier's sign
How do you manage stage 3-4 pressure ulcer
Debridement of necrotic tissue (scalpel if dry, mechanical if wet), if wet use absorptive dressings (calcium alginates, foams, hydrofibers), if dry use occlusive dressing (hydrocolloids and hydrogels) +/- wound vacuum
How do you manage Achalasia
Decrease LES pressure via botulinum injection, nitrates, CCBs, pneumatic dilation of LES
How do you manage a SAH
Decrease mechanism of straining (provide stool softeners, bedrest, antianxiety meds), manage hypertension, surgery: clipping or wrapping of aneurysm
How do you workup early pregnancy bleeding
Decreased beta HCG and ultrasound findings
What labs are seen with hypocalcemia
Decreased calcium, decreased PTH, increased phosphate
How does pneumothorax present on chest x-ray
Decreased peripheral lung markings
How do you diagnose HUS
Decreased platelets + anemia + renal failure
How do you diagnose TTP
Decreased platelets + anemia + schistocytes + negative coombs test
How do you diagnose DIC
Decreased platelets, increased bleeding time, increased PT/PTT, positive d-dimer
What causes Parkinson's disease
Degeneration of the basal ganglia in the substantia nigra
Patient is a 77-year-old female who for the past 4 days, has been crying easily, confused, and rambling incoherently. Her medical history is remarkable for mild dementia and well-controlled hypertension. She has never had anything like this in the past and she has not had any recent changes to her medications. When questioned, she has no difficulty articulating a sentence but difficulty remembering what she was asked. Laboratory testing is significant for leukocytosis. What is this patient experiencing
Delirium
What is a Hill-Sachs lesion
Dent in the humeral head or more properly a compression chondral injury of the posterior superior humeral head following glenoid impaction
The prognosis of melanoma is strongly associated with what
Depth of lesion
In patients with mono what can happen if you treat them with Ampicillin
Development of maculopapular or petechial rash
What comorbidity puts patients at the highest risk of having coronary artery disease
Diabetes
Low urine sodium, high serum sodium, urine osmolality <250 and polyuria indicate
Diabetes insipidus
What are common causes of hypernatremia
Diarrhea, burns, diuretics, hyperglycemia, diabetes insipidus
What should be on your ddx for Achalasia
Diffuse Esophageal Spasm - non-peristaltic esophageal contractions and Zenker's diverticulum
What can be used for elective abortion in up to 18 weeks
Dilation and evacuation (D&E)
What causes Alzheimer
Diminished acetylcholine, loss of brain cells, beta-amyloid plaques and neurofibrillary tangles
What is the most common mechanism of injury for clavicle fracture
Direct fall on the shoulder, direct blow to lateral aspect of the shoulder, birth trauma (newborns)
What type of inguinal hernia is medial to inferior epigastric artery, found within Hesselbach's triangle and doesn't reach the scrotum
Direct inguinal hernia
What is the mechanism of LCL tear
Direct-force trauma to the inside of the knee causing varus stress
What components make up the female athlete triad
Disorder eating, amenorrhea, osteoporosis
What are some signs seen on physical exam with suspected SBO
Distention, hyperactive bowel sounds early, hypoactive bowel sounds late
How do you manage Meniere's disease
Diuretics, salt restriction, unilateral CN 8 ablation in severe cases
How do you manage Zenker's Diverticulum
Diverticulectomy, cricopharyngeal myotomy
Patients is a 48-year-old male complaining of LLQ pain. When asked about his diet patient states that he doesn't get a lot of fiber and is usually constipated. He has an in-office temperature of 38 C. You notice leukocytosis on CBC and positive guaiac. What does this patient likely have
Diverticulitis
What is the most common cause of lower GI bleeding
Diverticulosis
How do you diagnose benign positional vertigo
Dix-hallpike maneuver
How do you treat Lyme disease in early stage
Doxycycline BID x 10-21 days (Azithromycin or Erythromycin if Doxy contraindicated or PCN allergic)
What are triggers of TTP
Drugs (quinine, clopidogrel, cyclosporine), SLE, infections, AIDs, malignancies
What are other causes of secondary amenorrhea
Drugs, herbals, hormonal meds, stress, weight changes, eating disorders, exercise, premature ovarian failure (FSH is >40)
Hereditary conjugated hyperbilirubinemia due to decrease hepatocyte excretion of conjugated bilirubin (gene mutation MRP2) is called
Dubin-Johnson Syndrome
What are the top 3 cause for nipple discharge
Duct ectasia, intraductal papilloma and carcinoma
What is the most common type of pancreatic carcinoma and what part of the pancreas is it most commonly found
Ductal adenocarcinoma and head of pancreas
What part of the small intestine is responsible for most SI absorption and rate control of gastric emptying
Duodenum
How do you diagnose carotid disease
Duplex doppler ultrasound (>50% stenosis is moderate and >70% is severe)
Patient is a 35-year-old woman with concerns about heavy menstrual periods for the past year that occur at irregular intervals. She explains that sometimes her menses comes twice a month, but other times will skip two months in a row. Her menses may last 7 to 10 days and require 10 to 15 thick sanitary napkins on the heaviest days. She admits to some fatigue, but she denies any lightheadedness. She has no pain with menses or intercourse and denies any vaginal discharge. She has had normal Pap smears in the past. She is in a stable monogamous relationship with her husband and denies a history of STIs. On physical examination, her blood pressure is 120/ 80 mm Hg and her body mass index (BMI) is 32. Her pelvic examination is normal. What does this patient have
Dysfunctional uterine bleeding
Patient is a 13-year-old with a pruritic vesicular eruption comprised of clear, deep-seated vesicles without erythema erupting on the lateral aspects of fingers, the central palm, and plantar surfaces. What does this patient have
Dyshidrosis also called pompholyx
Patient is a 19-year-old nulligravid college female who complains of dull, throbbing, cramping lower abdominal pain during menses for the past three years. She reports nausea and vomiting during menses but denies irregular or heavy periods, pain with intercourse, or abdominal pain outside of menses. Pain tends to peak 24 h after onset of menses and subsides after 2 to 3 days. A pelvic exam is normal. What does this patient have
Dysmenorrhea
What are some ALARM symptoms associated with GERD
Dysphagia, odynophagia, wt loss, bleeding (suspect malignancy)
How does emphysema present
Dyspnea most common symptom, cachectic, pursed lip breathing, hyperresonance, barrel chest, absent breath sounds
What is the most common bacterial cause of cholecystitis
E. Coli
What are the most common causes of bacterial meningitis in neonates
E. coli (gram negative rods) and S. agalactiae (group B streptococcus)
What is the initial test of choice in someone with angina
ECG
What should your workup of syncope include
ECG, pulse ox, possibly echocardiography, tilt table testing
How do you treat lead poisoning
EDTA
What test should you order for melena
EGD
What is the diagnostic test of choice for Mallory-Weiss tears, peptic ulcer disease and suspected malignancies
EGD (Esophagogastroduodenoscopy)
What should your workup of unstable angina include
EKG and stress testing, but angiography is gold standard
How do you acutely manage NSTEMI
EKG within first 10 minutes, MONA: morphine, oxygen (4L/min), nitroglycerin (sublingual), aspirin (160-325 mg)
What test is used to screen for HIV
ELISA test
What is the diagnostic test of choice in suspected choledocholithiasis
ERCP
What is the most sensitive test for chronic pancreatitis
ERCP
What study is used to dx & tx disorders of the bile ducts or the pancreatic ducts (gallstones, tumors, infex, cholangitis)
ERCP - Endoscopic Retrograde Cholangiopancreatography
What is the gold standard for diagnosing cholangitis
ERCP or percutaneous transhepatic cholangiography
How do you manage choledocholithiasis
ERCP stone extraction
How do you manage inoperative pancreatic carcinoma
ERCP with stent placement
What are risk factors for developing cervical cancer
Early sex, multiple partners, cigarette smoking
What should your workup of right heart failure include
Echo and doppler, gold standard is right heart cardiac catheterization
What is the best test for diagnosing CHF
Echocardiogram
What does the above image show
Ecthyma (type of impetigo)
All women with early pregnancy bleeding and pain are assumed to have what until otherwise excluded
Ectopic pregnancy
Patient is a pruritic dry scaly areas on the flexure surfaces of both hands. The skin is thickened and edematous with papules and plaques as well as erosions and some crusts. The patient states he has had similar lesions since he was a child. What does this patient have
Eczema
What does the atopic triad include
Eczema, allergic rhinitis, asthma
Name 3 examples of nucleoside reverse transcriptase inhibitors (NRTI)
Efavirenz (Sustiva), Delavirdine (Rescriptor), Etravirine (Intelence)
Patient is a 43-year-old female complaining of intermittent rectal bleeding and perianal pain that is made worse with defecation. What does this patient likely have
Either external or internal hemorrhoid
Explain Hawkins test
Elbow is flexed at 90 degrees, shoulder is abducted at 90 and there is anterior shoulder pain with internal rotation
When are antibiotics indicated in the treatment of acute bronchitis
Elderly, underlying cardiopulmonary diseases + cough > 7-10 days, immunocompromised
How do you diagnose Graves disease
Elevated T3 and presence of anti-thyrotropin antibodies
What labs are associated with osteomyelitis
Elevated WBC, elevated ESR, elevated CRP
What lab values are seen with acute pancreatitis
Elevated lipase, Amylase x 3, elevated ALT, hypocalcemia, leukocytosis, elevated triglycerides, elevated bilirubin, elevated glucose
What are the CSF findings of bacterial meningitis
Elevated protein, decreased glucose, markedly increased opening pressure
How do you manage epidural hematoma
Emergent surgical craniotomy + managing of intracerebral pressure with mannitol, hyperventilation, steroids/ventricular shunt
How do you treat psoriasis
Emollients, vitamin D analogs, topical retinoids
Patient is a 65-year-old male complaining of fatigue and shortness of breath with exertion. The patient reports minimal cough. On physical exam you note a thin, barrel chested man with decreased heart and breath sounds, pursed-lip breathing, end-expiratory wheezing, and scattered rhonchi. Chest X-ray reveals a flattened diaphragm, hyperinflation and a small, thin appearing heart. PFTs show a decreased FEV1 / FVC ratio. What does this patient have
Emphysema: COPD
What test are used for supraspinatus tear or inflammation
Empty can: best, full can, drop arm
Viral infection of the brain parenchyma is known as
Encephalitis
What are some PPI examples
End with Azoles (omeprazole, pantoprazole, esomeprazole)
What are some examples of H2 receptor antagonists
End with Tidines (cimetidine, ranitidine, famotidine)
What is the initial treatment of choice for volvulus
Endoscopic decompression, 2nd line is surgical correction
How do you manage esophageal webs & rings
Endoscopic dilation if no reflux, antireflux surgery if reflux present
What is the treatment of choice for esophageal varices
Endoscopic ligation
How do you treat bladder carcinoma
Endoscopic resection with cystoscopy every 3 months
What is the gold standard for diagnosing PUD
Endoscopy
What is the gold standard for diagnosing gastritis
Endoscopy
How do you diagnose esophageal varices
Endoscopy (enlarged veins)
What is the gold standard for diagnosing H. pylori
Endoscopy with biopsy (use urea breath test if endoscopy unavailable)
How do you workup heartburn/dyspepsia
Endoscopy, manometry, 24-hour pH probe, barium esophagography
What is the initial test for diagnosing GERD
Endoscopy, use manometry if endoscopy is normal
What is the underlying pathophysiology of emphysema
Enlarged air spaces due to destruction of alveolar septae
Patient is a 43-year-old Caucasian male who spent the past month on a business trip in the Caribbean. Two weeks following his return, he began experiencing pea soup diarrhea, pain in his abdomen, and a headache. He presents to the hospital and is noted to be febrile with discrete, blanching, rose-colored spots on his back, chest, and abdomen. What does this patient have
Enteric fever salmonellosis
How do you manage a TIA
Enteric-coated aspirin or clopidogrel (Plavix), control modifiable factors
What type on invasive diarrhea is caused by undercooked ground beef, unpasteurized milk/apple cider and daycare centers
Enterohemorrhagic E. Coli 0157:H7
What is the most common cause of traveler's diarrhea
Enterotoxigenic E. Coli (eating unpeeled fruits and drinking unsanitary water)
What is the most common cause of viral meningitis
Enterovirus family (echovirus, coxsackie)
What are the causes of aseptic meningitis
Enterovirus, HSV, TB, fungus
What is considered a 4th degree burn
Entire skin into underlying fat/muscle/bone, painless
How do you diagnose Coccidioides pneumonia
Enzyme-linked immunoassays (EIA) for IgM and IgG followed by confirmatory immunodiffusion if EIA positive
Describe a stage 2 pressure ulcer
Epidermal damage extending into the dermis, looks pink or like a blister/abrasion
What is considered a 2nd degree partial thickness burn
Epidermis + superficial portion of dermis (papillary), erythematous, pink, blistering, moist, weeping, very painful, cap refill intact
What is considered a 2nd degree deep partial thickness burn
Epidermis into deep portion of dermis (reticular), red/yellow/white/dry/blistering not usually painful burn
What is considered a 1st degree burn
Epidermis only, think sunburn, cap refill intact
Patient is a 24-year-old snowboarder strikes a tree and was not wearing a helmet. He loses consciousness for several minutes but later regains consciousness and reports feeling fine. Several hours later his neurological state decompensates acutely. His CT scan demonstrates a lens-shaped, biconvex hyperdensity which does not cross the suture lines. What does this patient have
Epidural hematoma
A brain bleed on CT that is convex (lens shaped) is called
Epidural hematoma (arterial bleed)
How do you treat benign positional vertigo
Epley maneuver and meclizine
What virus is associated with Hodgkin's lymphoma
Epstein-Barr virus
A distinct form of cellulitis notable for acute, well-demarcated, raised superficial bacterial skin infection with lymphatic involvement is called
Erysipelas
Patient is a 4-year-old who is brought to the office by his mother. The child has had a low-grade fever, headache, and sore throat for the past week. Four days ago, he suddenly developed a bright red rash on his cheeks, which during the past 2 days has spread to the trunk, arms, and legs. What does this patient have
Erythema infectiosum
Type IV hypersensitivity reaction associated with herpes simplex virus that presents as non-pruritic target-like lesions that presents on extremities
Erythema multiforme
How do you manage C. jejuni diarrhea if severe
Erythromycin
How do you treat anemia of chronic disease
Erythropoietin if hemoglobin <10 (stop once hemoglobin reaches 11) and treat underlying case
How do you manage Stanford type n/Debakey III aortic dissections
Esmolol/labetalol are 1st line: target systolic blood pressure is 100-120 mmHg and pulse <60 bpm in 20 minutes, add nitroprusside if necessary
Patient is a 60-year-old African American female with a 10 year 1.5 ppd history of smoking and alcohol abuse complaining of initial difficulty swallowing solid food which has now progressed to fluids as well. ROS is positive for weight loss, hoarseness and chest pain. You note an enlarged left cervical node (Virchow's node) on physical exam. What does the patient likely have
Esophageal cancer
What is the diagnostic test of choice for Achalasia, nutcracker esophagus and can also be used to dx GERD
Esophageal manometry
What is the GOLD STANDARD for diagnosing Achalasia
Esophageal manometry, > 40 mmHg
How do you manage esophageal cancer
Esophageal resection, radiation therapy, chemotherapy (5-FU)
Thin membranes in the mid-upper esophagus are called
Esophageal webs
What are some complications of GERD
Esophagitis, strictures, barret's esophagus, esophageal adenocarcinoma
Patient is a 65-year-old patient with shaking that occurs with simple tasks such as tying his shoelaces, writing, or shaving. According to his wife, the symptoms are aggravated by stress, fatigue, caffeine, and changes in temperature. The patient reports his dad had the same symptoms. On physical examination, there is a 4-10 Hz tremor elicited when both of his arms are outstretched forward. There is no tremor at rest. What does this patient have
Essential tremor
How do you manage menopause
Estrogen and progesterone in symptomatic women, if uterus present use estrogen + progesterone, if no uterus use estrogen therapy
How do you manage absence (petit mal) seizures
Ethosuximide
How do you diagnose melanoma
Excision biopsy
How do you treat stage 0 cervical cancer
Excision via LEEP vs ablation vs TAH-BSO (Hysterectomy with bilateral oophorectomy)
What test is performed after completing an ECG in someone with angina
Exercise stress testing or pharmacologic stress test (adenosine or dipyridamole)
How do you diagnose pneumothorax
Expiratory chest films
What is considered a 3rd degree full thickness burn
Extend through entire skin, waxy, white, leathery, painless
Describe stage 4 pressure ulcer
Extends into muscle, tendon or bone
How do you manage anaplastic thyroid carcinoma
External beam radiation, chemotherapy, palliative tracheostomy
Inferior hemorrhoid veins distal to the dentate line is called
External hemorrhoid
How do you definitively diagnose menopause
FSH >30 mIU/mL
Burns of what location of the body are considered major burns
Face, hands, perineum, feet, cross major joints or circumferential
How does rosacea present
Facial erythema, telangiectasis, rhinophyma, no comedones due to heat, alcohol or spicy foods
Name 2 x-linked bleeding disorders
Factor VIII and factor IX (hemophilia)
What is the mechanism of injury for AC joint separation
Fall directly to the shoulder or outstretched hand
What is the mechanism of injury for anterior shoulder dislocations
Fall on an outstretched arm (full abduction and extension)
True or false, the pancreas only functions as an endocrine gland
False, it functions as exocrine and endocrine
True or false, a femoral hernia is superior to the inferior inguinal ligament
False, it is inferior to the inferior inguinal ligament
What are some genetic risk factors for the development of colorectal cancer
Familial adenomatous polyposis, Lynch syndrome (Hereditary nonpolyposis colorectal cancer), Peutz-Jehgers
If bilirubin is elevated without elevated LFTs, what should you suspect
Familial bilirubin disorders such as Dubin-Johnson Syndrome and Gilbert Syndrome
How do you treat compartment syndrome
Fasciotomy and decompression of pressure
What foods/drinks should you recommend pt's with GERD avoid
Fatty, spicy, citrus, chocolate, caffeine, peppermint, alcohol
What is the most common cause of appendicitis
Fecalith
How is hepatitis A transmitted
Feco-orAl (homosexual men, contaminated water, shellfish)
What are the risk factors for postoperative nausea and vomiting
Female, nonsmoker, history of motion sickness or previous post-op nausea/vomiting, post-op opioids
What type of hernia is seen more commonly in women as opposed to men
Femoral
How do you treat iron deficiency anemia
Ferrous sulfate 30 minutes prior to meals, along ascorbic acid to increase absorption
What is the class triad of Epstein Barr mononucleosis
Fever + posterior cervical lymphadenopathy + pharyngitis
What is the classic triad of meningitis
Fever >38 C, nuchal rigidity, headache
How does bacterial pneumonia present
Fever, dyspnea, tachycardia, tachypnea, cough +/- sputum
How does TB present
Fever, night sweats, anorexia, weight loss
How does osteomyelitis present
Fever, restriction of movement of involved extremity, pain/tenderness/inflammation of joint
Patient is a 27-year-old female with a painless mass in the left breast. She discovered this mass three months ago while showering and reports it has been unchanged since that time. Her last menstrual period was 10 days ago. There is no family history of breast cancer. On physical exam, you palpate a 3 cm, firm, and non-tender mass in the upper lateral quadrant of the left breast. The mass is smooth, well-circumscribed, and mobile. There are no skin changes, nipple discharge, or axillary lymphadenopathy. What does this patient have
Fibroadenoma
Patient is a 30-50-year-old female complaining of painful/tender, swollen lumpy breast. Patient notes that the lumps tend to increase/decrease in size depending on her menstrual period. On physical exam you note multiple, mobile, well defined lumps that are tender to touch. What does this patient likely have
Fibrocystic breast disorder
What is the most common cause of unilateral or bilateral green, straw-colored or brown nipple discharge in premenopausal women
Fibrocystic disease
How do you rule out cancer in a cold thyroid nodule
Fine needle aspiration
How do you diagnose fibrocystic breast disorder
Fine needle aspiration (strawberry colored fluid, no blood) + ultrasound/mammogram
What is the treatment of choice for fibroadenomas
Fine needle biopsy or excision biopsy, most small tumors absorb with time
2 separate fractures in 3 or more consecutive ribs is called
Flail chest
What is the classic triad of renal cell carcinoma
Flank pain, hematuria, palpable abdominal/renal mass
Describe actinic keratosis
Fleshed-colored, pink or yellow brown lesion with rough sandpaper feel that occurs on sun-exposed surfaces
What is the diagnostic test of choice for ulcerative colitis
Flex sigmoidoscopy
What area does atopic dermatitis most commonly occur
Flexor creases
What is the most common viral cause of viral pneumonia
Flu
What is the treatment for Coccidioidomycosis
Fluconazole
How do you treat candida vaginitis
Fluconazole 150 mg PO x 1 then repeat in 7 days
How do you treat Coccidioides pneumonia (valley fever)
Fluconazole or itraconazole
How do you treat pulmonary aspergillosis
Fluconazole or itraconazole
What is the 1st line treatment for Cryptococcus
Fluconazole, 2nd line is Amphotericin
How do you manage vibrio cholerae diarrhea
Fluid replacement, tetracyclines or fluoros
How do you manage diarrhea
Fluid repletion (PO preferred), bland low-residue diet (BRAT), anti-motility agents [(bismuth subsalicylate (pepto), opioid agonists (Lomotil, Immodium), Anticholinergics], antiemetics [(ondansentron) or dopamine blockers (prochlorperazine (Compazine), promethazine (Phenergan), Metoclopramide (Reglan)]
How do you treat giardia lamblia
Fluids + metro (fluoros in children)
How do you manage Enterotoxigenic E. Coli
Fluids +/- bismuths, fluoros if severe
How do you treat shigella
Fluids, if severe: Bactrim is 1st line, can use fluoroquinolones or cipro or ceftriaxone
How do you manage salmonella
Fluids, if severe: fluroquinolones (cipro or levofloxacin), ceftriaxone or azithromycin or Bactrim
How do you manage salmonella diarrhea if severe
Fluoros
How do you treat folate deficiency anemia
Folate 400 to 1000 micrograms per day
Patient is a 43-year-old alcoholic man who arrives at the hospital with alcohol withdrawal. He confabulates and trembles uncontrollably. He is started on supportive therapy for now. Bloodwork comes back with macrocytic megaloblastic anemia, an increased homocysteine, normal methylmalonic acid. What does this patient have
Folate deficiency anemia
What is the most common type of thyroid nodule
Follicular, >90% of thyroid nodules are benign
What is the mechanism of injury for PCL injury
Force to knee while flexed: dashboard knee
Patient is a 2-year-old male child who is brought to the emergency department by his mother with a sudden onset of choking, gagging, coughing, and wheezing. Vital signs are temperature 37 ° C; pulse 120/ min; and respirations 28/min. The physical examination reveals decreased breath sounds over the right lower lobe with inspiratory rhonchi and localized expiratory wheezing. The chest X-ray reveals normal inspiratory views but expiratory views show localized hyperinflation with mediastinal shift to the left. What has likely occurred in this patient
Foreign body aspiration
What is a Bankart lesion
Fracture of the anterior inferior glenoid, post humeral head impaction to glenoid
What are common causes of compartment syndrome
Fractures, crush injuries, burns, tight casts
How do you treat asymptomatic hyponatremia
Free water restriction
What is Boerhaave syndrome
Full thickness rupture of the distal esophagus due to repeated forceful vomiting or perforation during endoscopy
Describe stage 3 pressure ulcer
Full thickness/dermal loss of skin extending into subcutaneous layer
Rapid liver failure + hepatic encephalopathy is called
Fulminant Hepatitis (Acute Hepatic Failure)
What is the most specific test for hemophilia
Functional assay for factor 8 or 9
Infection of the hair follicle that has a small collection of pus
Furuncle
How do you diagnose G6PD deficiency
G6PD assay shows Heinz bodies and bite cells
Patient is a 20-year-old healthy male was treated 4 days ago for an MRSA skin infection with sulfamethoxazole-trimethoprim (Bactrim). The infection is improving but he is increasingly weak and his sclera have turned yellow. Today his hemoglobin is 11 g/ dL (13.5 to 18 g/ dL) and his MCV is 85 (80 to 100 fL); the corrected reticulocyte count is elevated, he has an increased indirect bilirubin and decreased haptoglobin. The peripheral smear demonstrates bite cells and Heinz bodies. What does this patient have
G6PD deficiency
What is the MC cause of erysipelas
GABHS
What is the difference in CSF findings for Guillain-Barre Syndrome as compared to meningitis
GBS has normal glucose and increased protein
Transient relaxation of lower esophageal sphincter due to increased gastric acid, LES incompetence, esophageal motility disorders, delayed gastric emptying or hiatal hernia is called
GERD
What are the most common causes of heartburn and dyspepsia
GERD or PUD
What are the 2 most common causes of acute pancreatitis
Gallstones and alcohol
How do you manage gastric carcinoma
Gastrectomy, radiation and chemotherapy
What type of PUD is worse with meals (1-2 hours after) and common in 55-70 yo
Gastric
Patient is a >40-year-old male complaining of dyspepsia, weight loss, early satiety and abdominal pain. Patient's history is notable for alcohol and tobacco use. When asked about his diet patient states that he eats a lot of sandwich meat. Patient also reports dark stools. What does this patient likely have
Gastric carcinoma
Hormone that stimulates stomach acid secretion and motility
Gastrin
What 3 hormones are responsible for the stimulation of parietal cells
Gastrin, Histamine, Acetylcholine
Superficial inflammation/irritation of the stomach mucosa with mucosal injury is known as
Gastritis
Patient is a 21-year-old bodybuilder presents with complaints of diarrhea, cramps, and low-grade fever for 24 hours. He has been training for a competition, eating large amounts of protein, including shakes made with raw eggs. He reports three stools with blood and mucous in the commode today. What does this patient have
Gastroenteritis salmonellosis
What should your workup include in a case of recurrent, spontaneous abortions (2-3 consecutive abortions)
Genetic testing of parents, thyroid (hypo/hyper), autoimmune (SLE and anticardiolipin antibodies)
What type of protozoan causes frothy, greasy, foul diarrhea after ingesting contaminated water from remote streams/wells
Giardia Lamblia (aka Beaver's fever or Backpacker's diarrhea) - boil water x 1 minute
Hereditary unconjugated hyperbilirubinemia characterized by reduced UGT activity (10-30% of normal) and decreased bili uptake is called
Gilbert's Syndrome
How do you treat CML
Gleevec (Imatinib)
Patient is a 66-year-old male with chronic right shoulder pain and crepitus. On physical exam his rotator cuff strength is 5/5. He has pain with both passive and active range of motion. An MRI is performed and shows no evidence of a rotator cuff tear. What does this patient have
Glenohumeral joint osteoarthritis
What does the mnemonic GALAW for Ranson's criteria upon admission stand for
Glucose >200 mg/dL, Age >55, LDH >350 IU/L, AST >250 IU/dL, WBC >16,000
What are patients with polycythemia predisposed to
Gout, DVT, PE, stroke
How do you treat varicose veins
Graduated compression stockings, leg elevations, exercise, Unna boot for large ulcers, endovenous radiofrequency or laser ablation, compression sclerotherapy, surgical stripping of saphenous tree
What are the most common bacterial causes of acute cholangitis
Gram negative E. Coli (1st) and Klebsiella (2nd)
Pt is reported to have tonic-clonic like movements with a postictal state, what type of seizure is this
Grand mal
What is the most common cause of hyperthyroidism
Graves disease
What is indicative of stable angina on ECG
Greater than 1 mm ST depression +/- T wave flattening or inversion
Within regard to acute pancreatitis, what is flank ecchymosis called
Grey Turner's sign
What is the most common cause of septic arthritis in neonates
Group b strep
Pt presents with a complaint of weakness/paresthesias that started in feet and have now seemed to work its way up. Pt also reports tachycardia and difficulty breathing. What does this patient most likely have
Guillain Barre syndrome
What are the common bacterial causes of cellulitis in adults
H. influenzae or strep pneumonia
What is the most common cause of gastritis
H. pylori
What are the 1st and 2nd most common causes of gastritis
H. pylori and NSAIDs/Aspirin
What is the most common cause for PUD
H. pylori, followed by NSAIDs
What is the 3rd stage in managing GERD
H2RA, PPI & prokinetic agents (Cisapride)
How do you manage HIV
HAART therapy for patients with CD4 <350 or viral load by PCR-RNA >55,000
What is my mnemonic for child pugh classification staging for cirrhosis
HAPTS (Hepatic encepatholopathy, Ascites, PT INR, total bilirubin, serum albumin)
What acronym identifies the 5 most important independent factors for increased likelihood of melanoma
HARMM: History of prior melanoma, Age >50, absence of a Regular dermatologist, a changing Mole, Male gender
Presence of what in the serum indicates active replication in liver
HBV DNA
Indicates acute hepatitis b infection
HBcAb (core antibody) - IgM
Indicated waning viral replication of hepatitis B and decreased infectivity
HBeAB (envelope antibody)
Increased viral replication and infectivity is signified by
HBeAg (envelope antigen)
Distant resolved infection (recovery) or vaccination (sole serologic marker) is signified by
HBsAb (surface antibody)
What is the 1st evidence of HBV infection
HBsAg (surface antigen)
What are some typical symptoms of GERD
HEARTBURN (pyrosis), regurgitation (sour taste in mouth), dysphagia, cough at night
There is a slightly increased risk for what with spermicide use
HIV
Patient is a 25-year-old white male who was recently discharged from the hospital with a diagnosis of bacterial pneumonia. His past medical history is significant for a nephrectomy after a motor vehicle accident 10 years ago, aseptic meningitis 12 months ago, and one prior episode of bacterial pneumonia 5 months ago. His physical examination is remarkable for oral thrush. A CD4 T-lymphocyte cell count was 30. What does this patient have
HIV (Human Immunodeficiency Virus)
What is used to monitor infectivity and treatment effectiveness in patients diagnosed with HIV
HIV RNA viral load
What is the recommendation for ages 30-65 years old
HPV & cytology every 5 years: preferred vs cytology alone every 3 years: acceptable
What HPV strain causes genital warts
HPV 6 and 11
Bell palsy is strongly associated with the reactivation of what
HSV
What is the most common cause of encephalitis
HSV
What is the most common cause of erythema multiforme
HSV
Bacterial pneumonia associated with COPD, smokers, postsplenectomy
Hamemophilus influenzae
Patient is a 2-year-old who is brought to the office by his mother. The child has had a low-grade fever, rash, and loss of appetite for the past two days. On physical exam, there are multiple 2-3-mm grey vesicular lesions on the bilateral palms and soles and several vesicles and ulcers on the oral mucosa. What does this patient have
Hand-foot-mouth disease
What is the rule of 9's in terms of burns
Head 9%, each arm 9%, chest 9%, abdomen 9%, anterior leg 9%, upper back 9%, lower back 9%, genitals 1%
What are some S/E of PPIs
Headache, diarrhea, B12 deficiency, increases levels of warfarin via C450 inhibition
What are some examples of minor criteria for diagnosing endocarditis
Heart condition, IV drug use, fever, vascular phenomena, immunologic phenomena
Swelling of distal interphalangeal joint is called
Heberden's node
How do you diagnosis beta thalassemia major
Hemoglobin A2 and F (minor only has A2)
How do you diagnose alpha thalassemia
Hemoglobin H
Patient is a 3-year-old boy whose mom is concerned about his prolonged nosebleeds. Ever since he was about 2 years old, he has had multiple episodes of nosebleeds that stopped only after hours. On physical exam, his right elbow is slightly swollen and tender to palpation. There is a family history of unexplained bleeding in the patient's maternal uncle. Lab results reveal increased PTT that corrects after mixing studies. Lateral radiograph of the knee shows swelling of the soft tissues from blood accumulation in the knee. What does this patient have
Hemophilia
How do you differentiate hemophilia from von Willebrand deficiency
Hemophilia has hemarthrosis while vWF does not
Menses that involve more blood loss > 7 days or > 80 mL during menses
Hemorrhagic or hypermenorrhea
What is the different for hematochezia
Hemorrhoids, anal fissures, polyps, proctitis, colorectal cancer
What is the treatment for PE
Heparin with bridging to LMWH or warfarin for a minimum of 3 months
Patient is a 50-year-old male with a history of alcohol abuse and hepatitis (B/C/D) complaining of abdominal pain. Patient states that he has been really tired and has noticed some weight loss. On exam you note jaundice and hepatosplenomegaly. What does this patient likely have
Hepatocellular carcinoma
What should you monitor in patients being treated for TB
Hepatoxicity and renal function
How does pityriasis rosea present
Herald patch, Christmas tree rash, URI prodrome thought to be associated with herpes virus 7
Patient a 42-year-old man with chest pain, difficulty swallowing, and heartburn after meals, especially when reclining. What does this patient likely have
Hiatal hernia
What is the gold standard for diagnosing acute cholecystitis
Hida scan = nonvisualization of the gallbladder
Patient is a 27-year-old obese female with tender inflammatory nodules and abscesses in her axillae and anogenital area. The lesions have waxed and waned over the past few years but have become more painful and bothersome in the past month. Some of the larger lesions are foul smelling and are draining a purulent material. What does this patient have
Hidradenitis suppurativa
How do you treat severe persistent asthma
High dose ICS + LABA (Step 5) vs high dose ICS + LABA + oral steroids (step 6)
How do you manage diverticulosis
High fiber diet, fiber supplements, vasopressin if bleeding continues
How do you manage noncomplicated hemorrhoid
High fiber diet, increased fluids, sitz baths, topical corticosteroids
How do you treat nummular eczema
High or ultra high potency topical corticosteroids, phototherapy
What is the first line treatment for dyshidrosis
High strength topical steroids, second line is oral steroids, recommend avoidance of stress or direct contact with irritants
Hormone that is produce by ECL cells in response to gastrin release
Histamine
What is the MOA of H2 blockers
Histamine receptor blocker, reduces acid/pepsin secretion
Bacterial pneumonia associated with bat droppings and looks like sarcoidosis on CXR
Histoplasma capsulatum
What fungal pneumonia is characterized by pulmonary lesions that are often apical resembling TB, cough, dyspnea
Histoplasma capsulatum
A CD4 count of < or = 150 suggest what opportunistic infection
Histoplasmosis
Patient is a 21-year-old male presents with a cough and mild shortness of breath for three days. The cough is occasionally productive of yellowish mucus. He reports a low-grade fever with this episode but says that he has otherwise been healthy. He has spent the last month working in bat caves. He denies tobacco or alcohol use. What does this patient have
Histoplasmosis pneumonia (fungal)
How do you diagnose premenstrual syndrome
History and physical exam show 1 or more symptoms such as breast tenderness, abdominal bloating, headache, irritability, depression
What is a risk factor for developing testicular carcinoma
History of cryptorchidism
How do you diagnose delirium
History, CT or MRI, CBC, cultures, chest x-ray, plasma glucose
Your workup of palpitations should include
History, ECG, echo, CMP, CBC, TSH, urine toxicology
What are some atypical symptoms of GERD
Hoarseness, aspiration pneumonia, asthma, noncardiac chest pain
What is Epstein Barr virus associated with
Hodgkin lymphoma and Burkitt's lymphoma
Explain Neer test
Hold shoulder down, arm is fully pronated, and pain is elicited with forward flexion
Elevation of what is highly suggestive of progression of peripheral arterial disease
Homocysteine
Within regard to cluster headaches, ipsilateral ptosis, miosis, anhidrosis is called
Horner's syndrome
What is Kaposi sarcoma associated with
Human herpesvirus 8 and is an AIDs-defining cancer
What is another name for Epstein Barr virus
Human herpesvirus-4
How do you treat malignant hypertension
Hydralazine
What is secreted by parietal cells
Hydrochloric acid
What are some other common symptoms of Mallory Weiss syndrome
Hydrophobia, hematochezia, melena
What is the cause of acanthosis nigricans
Hyperinsulinemia and insulin resistance causing hyperpigmentation and hyperkeratotic plaques
Patient is a 62-year-old female complaining of joint pain, polyuria, polydipsia, and generalized fatigue. The patient reports a history of recurrent kidney stones and depression. Radiographs show osteopenia and subperiosteal resorption on the phalanges (Bones, stones, abdominal groans and psychic moans). What does this patient likely have
Hyperparathyroidism
What is the cause of melasma
Hyperpigmentation due to increased estrogen
Milky discharge from multiple ducts in a woman who is nonlactating could be due to
Hyperprolactinemia or medications
How do you diagnose B12 deficiency anemia
Hypersegmented neutrophils, macrocytosis, normal folate, increased methylmalonic acid and homocysteine
What is the most important modifiable risk factor within regard to stroke
Hypertension
What is the most important predisposing factor for aortic dissection
Hypertension
Patient is a 34-year-old female complaining of irritability and nervousness, heat intolerance with increased sweating, and weight loss despite an increase in appetite. On physical exam, you note exophthalmos and pretibial myxedema. She has a pulse of 110, a fine tremor and 4+ deep tendon reflexes. Her hair is fine in texture and you note a palpably enlarged thyroid gland. What does this patient have
Hyperthyroidism
How do you treat severe hyponatremia
Hypertonic (3%) saline
What are some endocrine causes of tremor
Hypoglycemia, thyrotoxicosis, pheochromocytoma, adrenocorticosteroids
Muscle cramps, constipation, flattened/inverted T waves, U waves suggests
Hypokalemia
Muscle weakness, hyperreflexia, prolonged QT, PR and wide QRS, ventricular tachycardia, torsades de pointes suggests
Hypomagnesemia
What is a side effect of carbamazepine
Hyponatremia, SJS, blood dyscrasias
What are the 4 stages of hemorrhoids
I - doesn't prolapse, II - prolapses and spontaneously reduces, III - prolapses with straining and requires manual reduction, IV - Irreducible and may strangulate
Anterior wall infarction is indicated by q waves or ST elevation in what leads
I, AVL, V2-V6
Lateral wall infarction is indicated by ST elevation in what leads
I, AVL, V5-6 and reciprocal ST depression in inferior leads
Inferior wall infarction is indicated by q waves or ST elevation in what leads
II, III, AVF
How do you treat PID outpatient
IM ceftriaxone plus oral doxy vs IM cefoxitin + oral probenecid + doxy
How do you treat B12 deficiency anemia
IM or sublingual B12 replacement
What is 2nd line HAART regimen therapy for HIV patients considered to be naïve
INSTI + 2 NRTIs
What is the difference between TTP and ITP
ITP is insidious and chronic while TTP is acute febrile disease with multiple organ thrombosis
How do you treat hypernatremia
IV D5W
How do you treat hypocalcemia
IV calcium gluconate or calcium chloride
How do you treat PID inpatient
IV cefotetan or IV cefoxitin + doxy vs IV clindamycin + IV gentamicin
What is the treatment of choice for late/severe Lyme disease (AV block, syncope, CP, meningitis)
IV ceftriaxone or cefotaxime or penicillin G
How do you manage an extremely high calcium level
IV fluids + furosemide or calcitonin
How do you treat hyperkalemia
IV fluids, insulin, sodium bicarbonate, glucose, calcium gluconate
How do you treat DVT
IV heparin and switch to warfarin
How do you treat hypermagnesemia
IV isotonic saline
How do you treat hypomagnesemia
IV magnesium sulfate (acute) or magnesium oxide (chronic)
How do you treat moderate hyponatremia
IV normal saline +/- loop diuretics
How do you treat hypercalcemia
IV normal saline and furosemide
How do you treat hypophosphatemia
IV phosphate replacement
How do you manage cellulitis if MRSA
IV vancomycin or Linezolid, PO Bactrim
How do you treat patellar tendinitis
Ice, rest, activity modification, physical therapy, surgical excision + suture repair, cortisone injections contraindicated
How do you treat syncope
Identify and fix underlying cause
How do you treat delirium
Identify and treat underlying cause + supportive care
After completing ultrasound of a 1cm thyroid mass what should you do next
Identify if it's malignant or not: cancerous lesions don't take up iodine (COLD Nodule) vs non-cancerous lesions takes up iodine (HOT nodule)
Patient is a 42-year-old male complaining of easy bruising and gingival bleeding. He reports his symptoms began one day prior to presentation and has never occurred before. Medical history is significant for a recent diagnosis of hepatitis C infection. On physical exam, there is mild bleeding of the gums. There are petechiae throughout the chest, arms, and legs. There is no evidence of splenomegaly on abdominal exam. A complete blood count is significant for a platelet count of 24,000/μL (normal 150,000 - 400,000/μL) and peripheral blood smear demonstrates enlarged platelets. He has a + Direct Coombs Test. What does this patient have
Idiopathic thrombocytopenic purpura
What are some causes of constipation
Idiopathic, colorectal cancer, DM, hypothyroidism, opioids, hirschsprung's dz
How do you manage Parkinson's disease
If <65: dopamine agonists such as bromocriptine or pramipexole, if >65: levodopa/carbidopa
When should you administer antihypertensive medications in stroke patients
If BP >220/120 mmHg, use labetalol to lower by 15% in first 24 hours
When should you transfuse someone who has experienced hematemesis
If hemoglobin is <9 in high risk patients or <7 in low risk patients
How do you manage pancreatic pseudocyst
If lasting 4-6 weeks, percutaneous drainage and surgical decompression: pancreaticogastrostomy
When should you aspirate in suspected subacromial bursitis
If patient has fever, is diabetic or immunocompromised
How do you manage Boerhaave syndrome
If small: IV fluids, NPO, abx, H2 blockers/Surgical repair if large or severe
How do you treat influenza A and B
If symptom onset < 48 hours can use Oseltamivir and Zanamivir (think Dr. OZ)
In patients with peripheral arterial disease what question is important to ask
If they're experiencing rest pain which could be a sign of limb-threatening ischemia
How do you see past exposure to hepatitis A
IgG HAV Ab with negative IgM
How do you diagnose acute hepatitis A
IgM HAV Ab
How do you diagnose hepatitis E virus
IgM anti-HEV
What is the underlying cause of premenstrual syndrome
Imbalance of estrogen and progesterone along with excess prostaglandin production
How do you manage condyloma acuminatum
Imiquimod, podofiloc, cryotherapy, surgery or TCA
How do you manage n aorta > or = 5.5 cm or >0.5 cm expansion in 6 months
Immediate surgical repair even if asymptomatic
How do you manage shoulder fractures
Immobilize for 2-3 weeks, progress to gentle passive ROM + modalities, progress to light strengthening after 6 weeks
What is the cause of vitiligo
Immune cells destroy the melanocytes causing melanin loss
What does the above image show
Impetigo
What is the common cause of salmonella typhimurium, enteritidis, and Newport (Gastroenteritis)
Improperly handled food
How does a patient with knee dislocation present
Inability to extend knee
How do you treat breast abscess
Incision and drainage + antibiotics: Dicloxacillin, Nafcillin, Oxacillin, Cefazolin + metronidazole + continued expression of milk but discontinued breastfeeding from affected breast, fluconazole if fungal, alternative is Vancomycin
How do you manage an anorectal abscess
Incision and drainage followed by WASH: warm-water cleansing, Analgesics, Sitz baths, High fiber diet
How do you manage acute paronychia
Incision and drainage, warm compresses, soaks and antistaphylococcals
Dilated cervical os with passage of some but not all products of conception before 20 weeks of gestation is called
Incomplete abortion
What is considered a positive response to bronchodilator treatment in terms of PEFR
Increase >15 % from initial attempt
How does hypernatremia present
Increased Bun/Cr ratio >20:1, poor skin turgor, hypotension,
What are some S/E of PPIs
Increased LFTs, gynecomastia, impotence
What labs are seen with hypercalcemia
Increased PTH, increased calcium, decreased phosphorus
How do you diagnose hemophilia
Increased PTT, normal platelet count, normal PT, normal bleeding time
What lab values are seen with acute cholecystitis
Increased WBC, increased bilirubin, increased Alkaline phosphatase, increased LFTs
What labs will you see on a patient with cirrhosis
Increased ammonia levels, SAAG >1.1 g/dL if spontaneous bacterial peritonitis, decreased coags (means more bleeding)
How do you diagnose fulminant hepatitis
Increased ammonia, increased PT/INR > or = 1.5, increased LFTs, hypoglycemia
What are 3 other actions are mediated by Cholecystokinin
Increased bicarbonate release, gallbladder contraction, bile salt release
How do you manage constipation
Increased fiber, bulk forming laxatives (psyllium), osmotic laxatives (polyethylene glycol), stimulant laxatives (Dulcolax)
How does pneumothorax present on physical exam
Increased hyperresonance to percussion, decreased fremitus, decreased breath sounds
What are common causes of high output cardiac failure
Increased metabolic demand (demand higher than heart can pump): hyperthyroidism, severe anemia, beriberi or thiamine deficiency
What are the contraindication for hormonal therapy in treatment of menopause
Increased triglycerides, endometrial cancer, history of breast cancer, CVD, DVT or PE
What is the underlying cause of pneumothorax
Increasingly positive pleural pressure causes collapse of lungs
What type of inguinal hernia is found lateral to the inferior epigastric artery
Indirect inguinal hernia
Dilated cervical os without passage of tissue before 20 weeks of gestation is called
Inevitable abortion
Patient is a 35-year-old G3P2 with cervical dilatation >3 cm, ruptured membranes, bleeding >7 days, and the presence of cramping. What does this patient have
Inevitable abortion
What are some precipitating factors of thyroid storm
Infection, trauma, surgery, embolism, DKA, preeclampsia
What is the most common type of breast carcinoma
Infiltrating intraductal carcinoma (associated with lymphatic METS especially axillary, starts as ductal carcinoma)
What causes subacromial bursitis
Inflammation due to trauma or overuse
Explain the pathophysiology of acute bronchitis
Inflammation of trachea/bronchi most commonly due to virus: adenovirus most common.
Patient is a 5-year-old with sudden onset of fever, chills, malaise, sore throat, headache, and coryza. The child is also complaining of myalgia, especially in her back and legs. On physical exam, the patient appears lethargic, has a temperature of 102.5 F, and palpable cervical lymph nodes. Breath sounds are distant with faint end-expiratory wheezes. What does this patient have
Influenza
What type of bacterial pneumonia is associated with a precipitous onset and fulminant course
Influenza pneumonia
Describe constipation
Infrequent bowel movements (<2/week), straining, hard stools, feeling of incomplete evacuation
What are the other actions of somatostatin
Inhibition of insulin, glucagon, gallbladder contraction, pancreatic enzymes
How does avascular necrosis of hip present
Insidious onset of dull ache or throbbing localized to the groin, lateral hip pain or buttocks
How do you diagnose rectocele
Inspection, order colonoscopy/rectal studies if concern for cancer
Describe murphy's sign
Inspiratory arrest with palpation of RUQ after asking patient to take a deep breath
Irritability, diaphoresis, weakness, tremulousness and palpitations suggests
Insulinoma
Superior hemorrhoid vein proximal to the dentate line is called
Internal hemorrhoid
What are some complications of bariatric surgery
Internal hernia, anastomotic leak, esophageal dilation, malnutrition
What are the indications for surgery in someone with heartburn and dyspepsia
Intractability, respiratory problems, severe esophageal injury: uclers, hemorrhage, stricture, Barrett's
How does Enteric fever (salmonella typhi) present
Intractable fever, GI symptoms, headache, pea soup diarrhea, Rose spots on trunk, bradycardia
Patient is an 18-year-old woman with right breast bloody nipple discharge increasing in severity over the last three weeks. What does this patient likely have
Intraductal papilloma
What is the first line treatment for hidradenitis suppurativa
Intralesional triamcinolone
What is the most common type of cervical cancer
Invasive squamous cell
What other drugs can be used as quick relief for asthma exacerbation
Ipratropium (anticholinergic), prednisone (corticosteroid)
Patient is a 30-year-old obese white female presents with fatigue and generalized weakness for several weeks. Physical exam reveals pale nail beds, spoon nails, mucosal pallor and an atrophic tongue. Upon further questioning, the patient reveals a "craving for ice and inanimate objects." Laboratory data shows a microcytic, hypochromic appearance to the RBCs, an elevated TIBC, low serum iron of 16 µg/dl, and a low plasma ferritin of 12 µg/dl. What does this patient have
Iron deficiency anemia
Both iron deficiency anemia and thalassemia are hypochromic, microcytic, how do you differentiate the 2
Iron deficiency anemia has low RBC while thalassemia has high RBC
How does nicotine withdrawal present
Irritability, headache, anxiety, weight gain, craving
Patient presents with LLQ pain and blood diarrhea. You decide to due a colonoscopy and note no signs of diverticula, but you do see segmental ischemic changes in areas of low perfusion (splenic flexure). What does this patient likely have
Ischemic colitis
Which type of stroke is most common ischemic or hemorrhagic
Ischemic: thrombotic
How do you diagnose Gilbert's disease
Isolated indirect bilirubin with normal LFTs
How do you diagnose Crigler-Najjar Syndrome
Isolated indirect hyperbilirubinemia, type I: 20-50 mg/dL and type II: 7-10 mg/dL
In an HIV positive patient what is the 1st line agent for treating TB
Isoniazid (INH), Rifampin is 2nd line
How do you treat latent TB
Isoniazid x 9 months+ vitamin B6 (pyridoxine) to prevent neuropathy
What is the underlying mechanism of HIV
It is a retrovirus, which means it changes RNA into DNA via reverse transcriptase
What is the 1st line treatment for Histoplasmosis
Itraconazole, 2nd line is Amphotericin B
Patient is a 27-year-old obese female with tender inflammatory nodules and abscesses in her axillae and anogenital area. The lesions have waxed and waned over the past few years but have become more painful and bothersome in the past month. Some of the larger lesions are foul smelling and are draining a purulent material. What does this patient have
Kaposi sarcoma
How do you treat cystocele conservatively
Kegel exercises, pelvic floor retraining, behavioral modifications, pessary
How do you manage stage I acne vulgaris
Keratinolytic agent such as alpha-hydroxy acids, salicylic acid and azelaic acid
What are some physical exam signs you can use in someone suspected of meningitis
Kernig's sign: knee extension causes neck pain, Brudzinksi's sign: bending of neck causes leg raise, bulging fontanelle of a baby
How do you treat seborrheic dermatitis
Ketoconazole shampoo or selenium sulfide, low-potency steroid cream if on face
Bacterial pneumonia associated with alcohol abuse, currant jelly sputum, aspiriation
Klebsiella
Patient is a 23-year-old male who is the front seat passenger in a motor vehicle accident. There is a noticeable deformity in his knee. Examination reveals an inability to extend the knee and weak foot pulses. After unsuccessful attempts at closed reduction, it is noted that the pulses are no longer palpable, and the foot is cool. What does this patient have
Knee dislocation
Minor trauma causing new lesions is called
Koebner's phenomenon
Patient is a 26-year-old college football player is brought to the emergency department after being hit on the lateral side of the left knee. He reports hearing a pop and then his knee buckled. He is now in severe pain and if having difficulty walking. On examination, there is swelling over the medial aspect of the left knee. There is laxity when a valgus stress test is performed on the knee. What does this patient have
LCL tear
How do you diagnose GBS
LP (CSF shows high protein w/normal WBC)
How do you definitively diagnose meningitis
LP (shows 100-10,000 PMN, decreased glucose <45, increased total proteins, increased ICP)
Acute self-resolving episodes of vertigo
Labyrinthitis
What physical exam test are used to test for ACL tear
Lachman: most sensitive and anterior drawer test
How do you manage encephalopathy caused by cirrhosis
Lactulose (pulls ammonia into gut/causes diarrhea) or Rifaximin (decreases ammonia-producing flora), Neomycin 2nd line (reduces ammonia producing flora) and reduce protein intake
How do you manage fulminant hepatitis
Lactulose, Rifaximin/Neomycin (bacteria that decreases ammonia in GI tract), protein restriction
What syndromes are associated with small cell carcinoma
Lambert-Eaton: weakness that improves with continued use, SVC syndrome: dilated neck/chest veins, facial plethora, Cushing's syndrome, SIADH/hyponatremia
How do you diagnose Osgood Schlatter disease
Lateral radiograph of knee
What radiographic imaging view are patella fractures best seen
Lateral x-ray
What are the indications for coronary artery bypass graft
Left main coronary artery disease, symptomatic, >70% stenosis, 3-vessel disease, ejection fraction <40%
Patient is a 60-year old Caucasian male with shortness of breath and fatigue on exertion. On physical exam, you note an S3 heart sound, crackles on pulmonary auscultation, and a displaced left apical impulse. He undergoes an echocardiogram and is found to have a dilated left ventricle and an ejection fraction of 35%. What is the patient likely experiencing
Left ventricular heart failure
Avascular necrosis presenting as persistent painless limp in children is called
Legg-Calve' Perthes disease
Bacterial pneumonia associated with air conditioning, aerosolized water, hyponatremia, diarrhea and high fever
Legionella
What labs values are seen with acute cholangitis
Leukocytosis, elevated alkaline phosphatase with increased GGT, elevated bilirubin > elevated ALT and AST
What options are available for emergency contraception
Levonorgestrel: Plan B within 3 days of unprotected sex or Ulipristal: Ella within 5 days
Patient is a 16-year-old female with an acute eruption of violaceous, pruritic, polygonal, shiny, flat-topped papules involving the flexor surfaces. What does this patient have
Lichen planus
Patient is a 34-year-old male with a very itchy skin lesion on the front of the ankle of his left foot. The itching is paroxysmal and severe. On examination, there is a well-defined, thickened and hyperpigmented large plaque spreading across the front of left ankle. What does this patient have
Lichen simplex chronicus
What is the 1st stage in managing GERD
Lifestyle modifications - elevate head of bed 6 inches, avoid recumbency after eating, small meals, wt loss, smoking cessation
What test is used for subscapularis tear or inflammation
Lift off test: Gerber's lift off test
What is diffuse thickening of the stomach wall called
Linitis plastica
What lab value is most specific for acute pancreatitis
Lipase
Patient is a 30-year-old male being seen for a non-painful mass on the upper back which has grown slowly over the past year. He denies previous trauma, drainage from the area or history of dermatologic diseases. Examination reveals a four-centimeter firm, but highly mobile subcutaneous mass with no overlying skin discoloration or punctum with drainage. What does this patient have
Lipoma/epithelial inclusion cyst
What are the more common causes of bacterial meningitis in patients >50-60 years old or immunocompromised
Listeria or Cryptococcus
What should you monitor for when treating onychomycosis
Liver function tests
How do you definitively manage cirrhosis
Liver transplant
How do you definitely manage fulminant hepatitis
Liver transplantation
What are other types of breast carcinoma
Lobular, medullary, mucinoid, tubular, papillary, mammary Paget's disease of the breast
What is Nexplanon
Long acting progesterone implanted in upper arm that lasts 3 years
What is depo-provera
Long acting progesterone injection that lasts 3 months
What drug will likely be the first choice in treatment of a patient reporting to the ER in acute CHF
Loop diuretics
How do you manage status epilepticus
Lorazepam or diazepam phenytoin phenobarbital
How do you diagnosis hyperthyroidism
Low TSH with high T3 and T4
How does an adrenal adenoma present on CT
Low attenuation (<10), rapid washout (>60% washout at 15 minutes postcontrast), smooth borders
How do you treat moderate persistent asthma
Low dose ICS + long acting beta2 agonist/LTRA/theophylline (step 3) vs medium dose ICS (step 4)
How do you treat mild persistent asthma
Low dose inhaled corticosteroids (step 2)
What is patella baja
Low riding patella
What test is indicated for the evaluation of IBD, diverticulosis, colon cx, dx & tx of intussusception and colitis
Lower GI series - Barium Enema
How does Shigella present
Lower abdominal pain, explosive watery diarrhea that progresses to mucoid/blood diarrhea, tenesmus, fever, chills
How do you diagnose meningitis
Lumbar puncture, but get a CT and check for papilledema to ensure patient doesn't have increased intracranial pressure
What is the recommended treatment for breast carcinoma
Lumpectomy with breast irradiation
What is the gold standard for diagnosing chronic bronchitis
Lung biopsy: shows increased Reid index
Patient is a 65-year-old woman with a 40 pack-year history of smoking presents with a 7kg weight loss over the last 3 months and recent onset of streaks of blood in the sputum. PE reveals a thin, afebrile woman with clubbing of the fingers, an increased anteroposterior diameter, scattered and coarse rhonchi and wheezes over both lung fields, and distant heart sounds. What does this patient likely have
Lung carcinoma
When do premenstrual syndrome symptoms occur
Luteal phase (1-2 weeks before menses)
Patient is a 38-year-old New Jersey resident who went for a jog in the woods and found a tick while showering. His wife successfully removed it using a pair of tweezers. Now 7-10 days after the bite he has developed a strange red rash with clearing between the center and periphery. What does this patient have
Lyme disease
A CD4 count of >500 suggest
Lymphadenopathy
Patient is a 21-year-old male with fever, chills, and night sweats for 1-month. Exam reveals painless enlarged posterior cervical and supraclavicular lymph nodes bilaterally. CBC, HIV, and RPR are normal. Excisional biopsy of lymph node demonstrates Reed-Sternberg cells (owl-eye appearance). What does this patient have
Lymphoma
What is the most common bacterial causes of acute bronchitis
M. Catarrhalis followed by H. flu and S. Pneumoniae
Patient is a 26-year-old college football player is brought to the emergency department after being hit on the lateral side of the left knee. He reports hearing a pop and then his knee buckled. He is now in severe pain and if having difficulty walking. On examination, there is swelling over the medial aspect of the left knee. There is laxity when a valgus stress test is performed on the knee. What does this patient have
MCL tear
What are major contraindications toe curative surgical resection of a lung tumor
MI within past 3 months, superior vena cava syndrome, bilateral endobronchial tumor, contralateral lymph node metastases, malignant pleural effusion, liver metastases
How do you prevent rubeola
MMR vaccine at 12-15 months and 4-6 years old
How do you confirm diagnosis of ACL tear
MRI
How do you definitively diagnose LCL tear
MRI
How do you definitively diagnose PCL tear
MRI
How do you definitively diagnose an MCL tear
MRI
What is the study of choice if concussion symptoms persist past 7-14 days
MRI
What is the study of choice for early detection of avascular necrosis of hip
MRI (order x-ray first then MRI then bone scan)
What is the gold standard for evaluation of aortic dissection
MRI angiograph
What are some causes of increased anion gap
MUDPILES: Methanol, Uremia, DKA, Paraldehyde, Infection, Lactic acidosis, Ethylene glycol, salicylates
Mild shortness of breath, palpitations and systolic murmur with midsystolic ejection click suggests
MVP
How do you treat outpatient community acquired pneumonia
Macrolides or doxycycline are 1st line
How do you diagnose acute bronchitis
Mainly clinical but can order a chest x-ray if uncertain or patient has fever
What is the most common cause of large bowel obstruction
Malignancy
What is hypercalcemia associated with
Malignancy and hyperparathyroidism
A 22 yo female is brought in by her friends after a night out drinking. Pt's friends state pt was vomiting a lot and later started spitting/throwing up blood. Based off the pt's hx what does she most likely have
Mallory-Weiss syndrome (tears)
How do you treat peripheral arterial disease
Manage risk factors, exercise, platelet inhibitors
What is the recommended treatment for large diffuse breast carcinoma
Mastectomy
Patient is a breastfeeding woman 3 weeks postpartum complaining of a painful area of the breast that is reddened and warm. The patient feels very fatigued with a fever generally > 101 ° F and chills. She reports a burning pain present constantly or at times only while breastfeeding. On exam, the patient appears ill. Breast examination shows an erythematous right breast with a palpable mass, induration, erythema, and tenderness to palpation. What does this patient have
Mastitis
What test are used on physical exam for meniscus tear
McMurray and Apley
Pain at 1/3 the distance from the anterior superior iliac spine and navel is called
Mcburney's point tenderness
How do you manage labyrinthitis
Meclizine + steroids
Patient is a 35-year-old man with complaints of swelling and pain in left knee. The patient states that he sustained a twisting injury in a football game 3 days ago. The injury did not take him out of the game; he was able to continue participating with minimal difficulty. Over the last 2 days, the pain has progressed. He notes a catching sensation and pain that is more medially located. On physical examination, the patient is found to have tenderness over the medial joint line and limited range of motion. Forced flexion and circumduction of the joint cause a painful click. What does this patient have
Medial Meniscus tear
What are the 3 borders of Hesselbach's triangle
Medial is rectus abdominis, lateral is inferior epigastric vessels, inferior is poupart's ligament
How does histoplasmosis look on chest x-ray
Mediastinal or hilar lymphadenopathy
How does aortic dissection appear on chest x-ray
Mediastinal widening
Patient is a 67-year-old man of Irish descent who presents to your dermatology clinic for the first time. When asked why he was referred to the clinic, the patient reports that his wife has been nagging him to have his skin checked for years. On exam, you notice an asymmetric, elevated, blue-tinged lesion with irregular, scalloped borders on his shoulder. When discussing the risk factors for skin malignancy, the patient proudly asserts that he was a lifeguard in Australia for 15 years from his late teens to his early 30s. What does this patient likely have
Melanoma
Patient is a 35-year-old female who complains of worsening hyperpigmentation to her face, particularly her cheeks. Physical examination of the face reveals diffuse light-to-dark brown macules to bilateral upper cheeks. The patients has no significant past medical history and her only medication is Ortho Tri-Cyclen which she takes for birth control. What does this patient have
Melasma also called chloasma
Chronic remitting and relapsing episodes of vertigo
Meniere's disease
Patient is a 34-year-old man who is brought by his wife because she believes her husband is very ill. The patient initially had a headache that progressed to neck stiffness and an inability to look at bright lights. His temperature is 103.1° F, blood pressure is 134/82 mmHg, and respirations are 20/min. Extreme pain is elicited upon flexion of the patient's neck and the patient's legs. What does this patient have
Meningitis
What vaccines should someone with sickle cell receive
Meningococcal, pneumococcal, H. influenzae, influenza
More blood loss during menses and frequent irregular bleeding between menses
Menometrorrhagia
Patient is a 52-year-old female with no menses for 12 months she also complains of hot flushes and dyspareunia. What does this patient have
Menopause
Patient is a 56-year-old male two days post-bilateral ureterosigmoidostomy for bladder resection due to cancer. He complains of increasing shortness of breath. The patient denies cough, chest pain, or fever. Physical examination is unremarkable except for an increased respiratory rate of 30 breaths/min. Arterial blood gas reveals pH of 7.28, pCO2 22 mmHg, and HCO3 13 mEq/L. What does this patient have
Metabolic acidosis
A patient with the following ABG has what type of acid-base disorder, ph 7.52, PCO2 40, Bicarb 38 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal)
Metabolic alkalosis
What does stage IV mean with regards to breast cancer
Metastatic breast cancer
How do you treat Amebiasis
Metro or tinidazole + intraluminal agent (Paromomycin)
How do you treat trichomonas vaginitis
Metronidazole 2 g PO x 1 dose, treat partner as well
How do you treat bacterial vaginosis
Metronidazole 500 mg PO BID x 7 days, second line is clindamycin
Uterine bleeding that occurs frequently and irregularly between menses
Metrorrhagia
What is the most common route of infection for pneumonia
Microaspiration of oropharyngeal secretions
How do you diagnose iron deficiency anemia
Microcytic, hypochromic cells, MCV low, TIBC high, ferritin low, MCH high
How do you diagnose lichen simplex chronicus
Microscopy via KOH prep or culture
What is the most common clavicle fracture location
Middle 3rd
What is the most common artery involved in epidural hematoma
Middle meningeal artery
What type of headache is characterized by pulsatile/throbbing lateralized pain associated with N/V, photophobia, phonophobia
Migraine
How do you treat alpha thalassemia
Mild: no treatment, moderate: folate + avoid oxidative stress, severe: blood transfusions, iron chelating agents: deferoxamine, splenectomy
How do you diagnose Alzheimer
Mini mental status exam, clock drawing test, definitively with autopsy
Death of the fetus before 20 weeks of gestation, with products of conception remaining intrauterine is called
Missed abortion
Patient is a 6-year-old male is brought to the clinic by his mother complaining of a rash. On physical exam, you observe dozens of discrete 5-15 mm, pink, flesh-colored, waxy, dome-shaped, umbilicated pearly papules with central umbilication on the lower abdomen and genital area. What does this patient have
Molluscum contagiosum
What neoadjuvant endocrine therapy is helpful in patients with HER2 positivity (Human epidermal growth factor receptor)
Monoclonal Ab treatment: Trastuzumab - Herceptin
Patient is a 14-year-old boy with 3-days of sore throat, fever, and generalized malaise. On exam, he has a temperature of 102.2 F (39.0 C), BP 96/50, and a diffuse exudate on both tonsils. He also is noted to have palpable splenomegaly, swollen painful lymph nodes, and mild hepatomegaly. Labs show leukocytosis of 12,000/mm3 with 50% neutrophils, 12% monocytes, and 38% lymphocytes. What does this patient have
Mononucleosis
How do you diagnosis Epstein Barr mononucleosis
Monospot for heterophile antibodies (positive within 4 weeks) and >10 % Atypical lymphocytes
How often should you recommend breast self-examination
Monthly > or = 20 years immediately after menstruation or on days 5-7 of menstrual cycle
What is the recommended prenatal schedule for pregnant patients
Monthly between weeks 4-28, twice per month between weeks 28-36, weekly after week 36
What type of rash is seen above
Morbilliform (MC skin eruption)
How do you manage acute pancreatitis
Most recover in 3-7 days, NPO, IV fluids, analgesia with Meperidine (Demerol), ERCP if biliary sepsis suspected
How do you treat fibrocystic breast disorder
Most resolve spontaneously, can fine needle aspirate for symptomatic relief, recommend support bra, NSAIDs, heat or ice, avoidance of caffeine or chocolate
How does trichomonas vaginitis present on wet prep
Motile flagellated protozoa
Production of what 2 things protects the mucus layer of the stomach
Mucus and bicarbonate
What can be underlying causes of essential tremor
Multiple sclerosis or Wilson disease
What is the drug of choice for impetigo
Mupirocin (Bactroban)
How do you treat folliculitis
Mupirocin ointment and topical benzoyl peroxide
What is the underlying cause of compartment syndrome
Muscle and nerve ischemia secondary to tissue perfusion when closed muscle compartment pressure is > perfusion pressure
How does hyponatremia present
Muscle cramps and seizures, decreased Bun/Cr, JVD, pulmonary edema, peripheral and presacral edema
How does hypokalemia present
Muscle cramps, constipation, flattened/inverted T waves, U waves
How does hypomagnesemia present
Muscle weakness, hyperreflexia, prolonged QT/PR/wide QRS, VT, torsades de pointes
How does hypermagnesemia present
Muscle weakness, prolonged QT/PR, wide QRS
A CD4 count < or = 50 suggest what opportunistic infections
Mycobacterium avium complex (MAC) or CMV retinitis
What is the organismal cause of TB
Mycobacterium tuberculosis
Bacterial pneumonia associated with young people living in dorms, bullous myringitis, low temp, walking pneumonia, + cold agglutinins
Mycoplasma
How do you diagnose AML
Myeloblasts with Auer rods + 20% blasts and pancytopenia
Sustained eye blinking in response to repetitive tapping just above the nasal bridge between the eyes is called
Myerson sign or glabellar reflex, associated with Parkinson's disease
What are causative agents of PID
N. gonorrhea, C. trachomatis, anaerobes, gram-negative bacteria and streptococci
What is the most common bacterial cause of meningitis in those 1mo-18y
N. meningitidis
What is the 1st line HAART Regimen treatment for HIV patients considered to be naïve
NNRTI + 2 NRTIs or PI + 2 NRTIs
How do you manage SBO
NPO + IV fluids + nasogastric tube if nonstrangulated, surgical intervention if strangulated
How do you manage acute cholecystitis
NPO, IV fluids, antibiotics (Ceftriaxone + Metronidazole), cholecystectomy within 72 hours
What treatment can be considered for osteoarthritis is acetaminophen fails
NSAIDs
How do you treat premenstrual syndrome
NSAIDs for pain, SSRI's 2 weeks prior to menstrual cycle, OCPs
What drugs can precipitate an acute asthma attack
NSAIDs or Aspirin
What is the 1st line treatment for dysmenorrhea
NSAIDs, 2nd line is hormonal contraception
How do you manage biceps tendonitis
NSAIDs, PT strengthening and steroid injections
How do you manage glenohumeral joint osteoarthritis
NSAIDs, PT, corticosteroid injections vs total shoulder arthroplasty if unresponsive to conservative treatment
What is the 1st line tx for tension headaches
NSAIDs, aspirin, acetaminophen
What drugs should be avoided in patients with heart failure
NSAIDs, calcium channel blockers, antiarrhythmic agents
What are the most common drugs that cause bruising/bleeding
NSAIDs, glucocorticoids, antidepressants (fluoxetine, sertraline, paroxetine), antibiotics (PCN, cephalosporins), antiplatelets and anticoagulants
What is first line tx for mild symptoms of migraines
NSAIDs/acetaminophen
What is the second most common cause of gastritis
NSAIDs/aspirin
Patient is a 58-year old obese male who is brought to the emergency department with severe substernal chest pain of one hour's duration. The patient was taking a morning walk when the onset of pain led him to seek care. His past medical history includes coronary artery disease, hyperlipidemia, and hypertension. Medications include aspirin, losartan, and atorvastatin. An electrocardiogram reveals T-wave inversions in leads II, III, and aVF and ST depressions in V5 and V6. The basic metabolic panel and complete blood count were within normal limits. A point-of-care troponin I level was elevated at 1.8 ng/mL (normal ≤ 0.06 ng/mL). This patient is experiencing what
NSTEMI
How do you manage ascites caused by cirrhosis
Na restriction, diuretics (spironolactone, furosemide), paracentesis
What antibiotics are used in gram positive cocci septic arthritis
Nafcillin but vancomycin if MRSA suspected
How do you treat MSSA osteomyelitis in patients >4 months old
Nafcillin or Oxacillin or Cefazolin: Ancef
How are peripheral lung lesions diagnosed
Needle aspiration
How do you manage tension pneumothorax
Needle aspiration placed in 2nd intercostal space midclavicular line followed by chest tube placement
What 3 physical exam tests are used to test for subacromial impingement
Neer, Hawkins and drop arm
What is the most common cause of septic arthritis in sexually active young adults
Neisseria gonorrhea
What is another name for wilm's tumor
Nephroblastoma
What type of diabetes insipidus is caused by kidneys that unresponsive to normal vasopressin levels
Nephrogenic
Patient is a 45-year-old woman who presents to the ED with sharp, severe, colicky right flank pain radiating to the groin that she reports started suddenly several hours ago. She also reports discolored urine when she last voided, along with nausea and vomiting. Vital signs are within normal limits. On exam, the patient is visibly in pain and shifts positions every few minutes. Costovertebral tenderness is elicited on percussion. What does this patient have
Nephrolithiasis
What are the 2 causes of thoracic outlet syndrome
Nerve compression or vascular compression
Patient is a 70-year-old gentleman is brought to his primary care provider by his son. He states that it seems like he has struggled more and more with every day living. Initially, he forgot simple things such as dates and addresses, but this has progressed over the last few years to an inability to pay his own bills. He has even gotten lost coming home from the library which is two blocks away from his house. What does this patient have
Neurocognitive disorder: most commonly Alzheimer disease
What is pheochromocytoma associated with
Neurofibromatosis type 1, MEN 2A/2B and Von Hippel-Lindau disease
What type of diabetes insipidus is caused by deficient secretion of vasopressin (ADH) from the posterior pituitary
Neurogenic (central)
What is the differential diagnosis of lower extremity claudication
Neurogenic (nerve entrapment/disc), arthritis, coarctation of aorta, popliteal artery syndrome, chronic compartment syndrome, neuromas, anemia, diabetic neuropathy pain
How does glenohumeral joint osteoarthritis present
Night pain and with activities, glenohumeral joint tenderness and crepitus, flattening of anterior shoulder
Epidermal detachment seen with SJS is known as
Nikolsky sign
What are some causes for recurrent mastitis
Nipple cracks, fissures, fungal infection
What is the treatment for refractory GERD
Nissen fundoplication
How do you treat Prinzmetal angina
Nitrates and calcium channel blockers (diltiazem or verapamil) for prophylaxis
How do you manage Diffuse Esophageal Spasm and Nutcracker Esophagus
Nitrates, CCBs, botox, sildenafil
Define primary amenorrhea
No menses by age 13 in absence of secondary sexual characteristics or no menses by age 15 in presence of normal growth and secondary sexual characteristics
How do you treat seborrheic keratosis
No treatment needed, can use cryotherapy or electrodessication and curettage
In stable angina are troponin and CK-MB abnormal
No, they are normal
What is the difference between a pulmonary nodule and pulmonary mass
Nodule is a well circumscribed coin shaped lesion <3 cm, a mass is >3cm
Describe stage IV acne vulgaris
Nodulocystic and severe scarring
What are the 2 categories of lung carcinoma
Non-small cell (85%) and Small cell (15%)
How do you treat Legg Calve Perthes disease
Non-weight bearing initially to progressed weight bearing followed by ortho, revascularization in 2 years. Pelvic osteotomy if severe
What is the gold standard for diagnosing nephrolithiasis
Noncontrast CT of abdomen and pelvis
How do you diagnose strokes
Noncontrast head CT
How do you diagnose a subarachnoid hemorrhage
Noncontrast head CT, LP if CT unremarkable, cerebral angiography after diagnosing confirmed
How do you manage Dubin-Johnson Syndrome
None needed
How do you manage Gilbert's syndrome
None needed
Are adrenal masses more commonly functional or nonfunctional
Nonfunctional adenomas are most common (functional = pheochromocytomas, aldosteronoma, cortisol-producing adenomas
How do you diagnose von Willebrand deficiency
Normal PT/PTT but decreased von Willebrand factor
How does CSF look with viral meningitis
Normal glucose, lymphocytes, normal protein
What are the lab values of anemia of chronic disease
Normal or low MCV, low TIBC, high ferritin, low serum erythropoietin
What are the CSF findings of viral meningitis
Normal pressure, increased WBC: lymphocytes
What is the most common cause of gastroenteritis in adults in America
Norovirus (vomiting in predominant sx in most noninvasive diarrhea)
How do you manage beta thalassemia
Nothing if minor, if severe: blood transfusions, iron chelating agents: Deferoxamine, splenectomy, bone marrow transplant
How do you confirm diagnosis of condyloma acuminatum
Nucleic acid amplification tests (NAAT)
Coin-shaped eczema is called
Nummular eczema
Sharply defined discoid/coin-shaped lesions are known as
Nummular eczema
Excessive contractions of esophagus during peristalsis is known as
Nutcracker Esophagus
How do you manage acute exacerbations of chronic bronchitis
O2, beta-agonists: albuterol, anticholinergics: ipratropium or tiotropium, inhaled/IV steroids, antibiotics
What is the difference between osteoarthritis and rheumatoid arthritis
OA pain worsens with use and improves with rest, RA has morning stiffness >30 minutes and pain improves with use
How do you manage primary and secondary amenorrhea
OCPs if no desire to become pregnant vs cyclic progesterone or ovulation inducers if pregnancy desired
How do you treat alopecia areata
Observation +/- topical steroids
How do you treat erythema infectiosum
Observation and symptomatic care
How do you treat CLL
Observation if indolent, chemotherapy if lymphocytes >100,000 or patient is symptomatic
How do you manage ITP
Observation if platelets >30K and no bleeding vs corticosteroids if platelets <30K or intravenous immunoglobulins in refractory cases or corticosteroids contraindicated
How do you treat actinic keratosis
Observation, many spontaneous resolve, cryosurgery, 5 FU cream or Imiquimod
How do you manage small pneumothorax (<15-20% the diameter of the hemithorax or < or = 2-3 cm btw the chest wall & lung on CXR)
Observe at least 6 hours with repeat chest x-ray + 24-48 follow up, spontaneously resolves within 10 days (oxygen shown to speed up recovery)
Within regard to appendicitis pain in the RLQ with internal and external hip rotation with flexed knee is called
Obturator's sign
How do you manage stage 2 pressure ulcer
Occlusive dressing, transparent films, hydrocolloids
How do you manage acute bleeding due to esophageal varices pharmacologically
Octreotide
How does CLL present
Often asymptomatic, most common form of leukemia in adults, fatigue, splenomegaly, lymphadenopathy
What are the risk factors for rotator cuff tendinopathy/tear
Old age, smoking, repetitive overhead reaching
What can be noted on physical exam in a patient with pyloric stenosis
Olive-shaped nontender mass upon abdominal palpation
How do you prophylactically treat Lyme disease
One 200 mg dose of Doxycycline within 72 hours if the tick is present > or = 36 hours
Patient is a 29-year-old field worker with a rash on his nails. The patient has a history of tinea pedis and tinea manuum and thought that this might be related. On physical exam, mild paronychia, loss of the cuticle of some nails, dirt-like yellowish-green nail pigmentation, subungual debris and dystrophy of some nails is seen. What does this patient have
Onychomycosis
How does acne vulgaris present
Open comedones (blackheads), closed comedones (whiteheads), papules, pusteles, nodules or cysts
How do you treat morbilliform rashes
Oral antihistamines
How do you manage erythema multiforme
Oral antihistamines and topical corticosteroids, help lessen duration with acyclovir
How do you manage chronic pancreatitis
Oral pancreatic enzyme replacement, alcohol cessation, pain control
How do you treat onychomycosis
Oral terbinafine PO x 6 week for fingernails and 12 weeks for toenails
How do you manage testicular carcinoma
Orchiectomy (seminomatous tumors are radiosensitive while nonseminomatous are radioresistant)
How do you diagnose nipple discharge
Order mammogram or ultrasound, prolactin levels (pituitary tumor), TSH (hypothyroidism)
How do you manage knee dislocations
Orthopedic emergency: Early reduction is ESSENTIAL, check distal pulses and peroneal nerve function
Patient is a 71-year-old man with a history of BPH is hospitalized for an ST-elevation myocardial infarction and undergoes percutaneous coronary intervention. Upon discharge, he is prescribed aspirin, clopidogrel, prazosin, isosorbide mononitrate, carvedilol, enalapril, and atorvastatin. One week after discharge her presents to your office with complaints of faintness, lightheadedness, dizziness, confusion, and blurred vision that occur within seconds to a few minutes of standing and resolve rapidly on lying down. On physical examination you note a drop of > 20 mm Hg systolic and 10 mmHg diastolic after change from supine to standing. What does this patient have
Orthostatic hypotension
How do you treat influenza
Oseltamivir: Tamiflu or Zanamivir both treat influenza A and B, must be given within 48 hours
Patient is a 14-year-old boy with left knee pain. He denies any trauma to the knee. The patient runs cross country for his high school team and attends practice regularly. On physical exam, the tibial tubercle is pronounced and there is tenderness to palpation over the affected area. The patient reports pain upon resisted knee extension. What does this patient have
Osgood Schlatter disease
Patient is a 65-year-old woman with left knee pain. The pain has been present in both knees for approximately 5 years and has been steadily getting worse. She describes stiffness, sticking and grinding of the right knee. Over the last 2 weeks, she has been taking ibuprofen almost every day, requiring an increasing frequency of doses for adequate pain control. On physical exam, there is swelling of the right knee and tenderness to palpation. There is palpable crepitus. What does this patient have
Osteoarthritis
Patient is a 54-year-old male with fever, chills, and pain in the left foot. His symptoms progressively worsened over the course of a week. Medical history is significant for poorly controlled type II diabetes mellitus. On physical exam, there is tenderness to palpation of the left foot. Laboratory testing is significant for an elevated erythrocyte sedimentation rate and C-reactive protein; as well as, a leukocytosis. What does this patient have
Osteomyelitis
Bony projections that form along joints is called
Osteophytes
How do you treat asthma acutely
Oxygen, nebulized SABA, ipratropium bromide and oral corticosteroids
What lab value is positive in someone with ulcerative colitis
P-ANCA
How can the medical treatment of claudication be remembered
PACE: Pentoxifylline (increases flexibility of RBC), Aspirin, Cessation of smoking, Exercise
Patient is a 22-year-old recreational soccer player who sustained a right knee injury 6 months ago. He has been treated with rest and rehabilitation but is unable to play at his previous level due to his knee "giving way." Physical exam reveals 10° varus alignment when standing and a varus thrust with walking. Strength is full compared to the other side. Ligamentous exam reveals a stable ACL and MCL but opens to a varus stress and a 3+ posterior drawer and positive dial test at both 30° and 90° degrees of flexion. What does this patient have
PCL tear
Patient is a 68-year-old woman who underwent hip replacement surgery two weeks ago. The postoperative period was complicated by pneumonia, and the patient has been bed-ridden ever since. A nurse calls you to the patient's room due to vital sign abnormalities and complaints of chest pain. The patient's HR is 105 bpm, BP is 90/60 mmHg, RR is 35 rpm, and T is 100.2F. You note jugular venous distension and profound dyspnea. Upon auscultation you notice tachypnea and crackles. What does this patient likely have
PE
How do you manage PUD if H. pylori negative
PPI, H2 blocker, misoprostol, antacids, bismuth compounds, sucralfate
When should you begin PT and light strengthening in a patient with a clavicle fracture
PT after 4 weeks and light strengthening after 6 weeks
Is PT extrinsic or intrinsic
PT is extrinsic and PTT is intrinsic
What is the preferred treatment of hyperthyroidism in a pregnant patient
PTU
What is the most common cause for upper GI bleed
PUD
Chronic eczematous itchy, scaling ash on the nipples and areola is called
Paget's disease of the nipple
How does subacromial impingement present
Pain with reaching, lifting or overhead movements
How does Osgood Schlatter present on physical exam
Pain with resisted knee extension, lump below knee and prominent tibial tuberosity
Explain Yergason's test
Pain with resisted wrist supination while elbow is flexed at 90 degrees
What are the classic signs/symptoms of acute arterial occlusion
Pain, Paralysis, Pallor, Paresthesia, Poikilothermia and Pulselessness
What are the 6 P's of compartment syndrome
Pain, paresthesias, pallor, paralysis, pulselessness, Poikilothermia
How does Hodgkin's lymphoma present
Painless cervical lymphadenopathy + reed-Sternberg cells, bimodal age distribution: 15-35 or >60, b symptoms: fever, weight loss, night sweats
How do you treat stage 4b or recurrent cervical cancer
Palliative radiation or chemotherapy
What physical exam sign is pathognomonic for pancreatic carcinoma
Palpable nontender gallbladder also known as Courvoisier's sign
When evaluating a Wilm's tumor on physical exam, it's important to not do what
Palpate abdomen, could cause rupture
Patient is a 62-year-old obese African American male with a history of tobacco and alcohol use complaining of abdominal pain that radiates to his back, yellowing of eyes and skin, 15 lbs weight loss, and itchy skin. What does this patient likely have
Pancreatic carcinoma
Patient is a 46-year-old man with a known history of chronic pancreatitis comes to your office because he says he can feel a mass in his stomach. His records show that he has a persistently elevated serum amylase and urine amylase. What does this patient likely have
Pancreatic pseudocyst
What is a side effect of valproic acid
Pancreatitis, hepatotoxicity
How do you screen for cervical cancer
Pap smear with cytology
What is the most common thyroid carcinoma
Papillary, think P for popular
Describe stage II acne vulgaris
Papular lesions and mild scarring
What causes measles
Paramyxovirus
How do you manage hyperparathyroidism due to adenoma
Parathyroidectomy
How is hepatitis C virus transmitted
Parenteral (IVDU)
How is hepatitis B virus transmitted
Parenteral, sexual, perinatal, percutaneous
How do you manage refractory PUD
Parietal cell vagotomy or Bilroth II
Patient is a 51-year-old male with involuntary movements of the left hand, which occur only at rest. The symptom has been obvious to his wife for two months. Exam reveals a resting tremor, a significant lack of arm movement while walking, and cogwheeling of the shoulder joints with passive ROM. What does this patient have
Parkinson's disease
What formula is used to calculate intravenous fluid resuscitation in burn patients
Parkland formula: lactated ringer 4 mL/kg/% TBSA IV, half in 1st 8 hours, other half over the remaining 16 hours
Patient is a 32-year-old female with a painful index finger. She obtains regular manicures, changing colors every 2 weeks. She recently had one a week ago and started feeling pain near the nail on her left index finger. Physical exam reveals redness, warmth, and pain along the nail margin of the index finger. When applying pressure to the nail plate, some pus drains from the nail. What doe this patient have
Paronychia
What is the case of erythema infectiosum
Parvovirus B-19
What is the most common bacterial cause of osteomyelitis due to cat or dog bite
Pasteurella multocida
Patient is a 39-year-old female who sustained a knee injury after falling from a step ladder onto her flexed knee. On physical exam, there is a palpable patellar defect, significant hemarthrosis and she is unable to extend the knee. What could this patient have
Patella fracture
Patient is a 22-year-old college basketball player with chronic anterior pain of her right knee. The patient has had over 6 months of physical therapy without improvement. It initially only bothered her during training, but she is now no longer able to compete and has pain with daily activities. Physical exam reveals swelling of the anterior knee and tenderness to palpation at the distal pole of the patella in full extension and no tenderness to palpation at distal pole of the patella in full flexion. What does this patient have
Patellar tendinitis: jumper's knee
Described Apley test
Patient prone, knee to 90 degrees and axial load with rotation causes pain
Explain McMurray test
Patient supine, knee flexed and externally rotated and extended for medial meniscus vs knee flexed and internally rotated then extended for lateral meniscus
Describe Apley scratch test
Patient tries internal shoulder rotation, external shoulder rotation and reaching across body to opposite shoulder
What can be used to monitor asthma after it has been diagnosed or to assess severity and patient response
Peak flow levels
How does hyperkalemia present
Peaked T waves, prolonged QRS, muscle fatigue, paralysis
Skin changes that looks like the peel of an orange due to lymphatic obstruction is called
Peau d'orange, associated with a poor prognosis
Malformation of the chest characterized by a protrusion of the sternum and ribs, also known as pigeon chest is called
Pectus carinatum
A structural deformity of the anterior thoracic wall in which the sternum and rib cage are shaped abnormally, producing a caved-in or sunken appearance of the chest is called
Pectus excavatum
How do you manage hepatitis C virus
Pegylated interferon alpha-2b and ribavirin and screen for hepatocellular carcinoma
What is the classic triad of symptoms and signs in PID
Pelvic pain, increased vaginal discharge and fever
How does a rectocele present
Pelvic pressure, defecatory dysfunction, vaginal bulge, low back pain
What is the treatment of choice for bacterial meningitis
Penicillin G + Dexamethasone, can use Chloramphenicol or 3rd generation cephalosporin
How do you manage erysiPelas
Penicillin G or erythromycin or clindamycin if PCN allergic, vancomycin if severe
What can be used to treat pneumocystis jiroveci if patient allergic to Bactrim
Pentamidine
HCl acid converts pepsinogen into what
Pepsin
Patient is a 54-year-old male with a history of chronic NSAID use complaining of dyspepsia which he describes as a burning/gnawing hunger like epigastric pain. He stats that his symptoms have been worse at night. What does this patient likely have
Peptic ulcer disease
What is the differential for melena
Peptic ulcer, esophageal ulcer, Mallory-weiss tear, malignancy, variceal hemorrhage
What is the gold standard for treatment of STEMI
Percutaneous coronary intervention in 90 minutes but no later than 3 hours of symptom onset + BBs, nitro, aspirin, heparin, ACE inhibitors
How does a rectal fistula present
Perianal drainage, perirectal abscess and diaper rash/itching
How does chronic bronchitis look on chest x-ray
Peribronchial, perivascular markings, increased right hear border, bullae, blebs,
Vertigo due to ear trauma
Perilymph fistula
The transition between reproductive capability and menopause hallmark is irregular menstrual function, lasts 3-5 years
Perimenopause
Papulopustular plaques and scales around the mouth is called
Perioral dermatitis
What symptoms does right ventricular failure cause
Peripheral and abdominal fluid accumulation
Patient is a 63-year-old male complaining of bilateral leg pain, which has been increasing gradually over the past several months. It worsens when he walks but improves with rest. Past medical and surgical history is significant for hypertension, hyperlipidemia, and coronary artery bypass graft (5 years ago). He has a 60-pack-year smoking history. Vital signs are as follows: Temp 37 C, HR 70, BP 143/89, and RR 18. Physical exam of the lower extremities reveals palpable but weak posterior tibial and dorsalis pedis pulses bilaterally; they are warm and well perfused. Ankle-brachial indices are 0.7 and 0.8. What does this patient likely have
Peripheral arterial disease
What is the most common cause of claudication
Peripheral arterial disease which is usually due to atherosclerosis
How do you diagnose CLL
Peripheral smear shows fragile B-cells: Smudge Cells
What is bronchiectasis
Permanent dilation or destruction of the bronchial walls
How do you treat lice
Permethrin
What is the most common cause of B12 deficiency anemia
Pernicious anemia (antibody to intrinsic factor)
What nerve should you check for in a displaced tibial plateau fracture in order to avoid foot drop
Peroneal nerve (can confirm with CT/MRI)
What is the common etiology of an indirect inguinal hernia
Persistent patent process vaginalis
How does Lyme disease present in late disease
Persistent: synovitis, arthritis, neurological symptoms
How do you treat rectocele
Pessary, conservative therapy: Kegel exercises, pelvic floor retraining vs surgery
What are small bleeding lesions that suggest problems with platelet number or function
Petechiae
Hypertension, diaphoresis (episodic) and palpitation suggests
Pheochromocytoma
Patient is a 43-year-old female with high blood pressure unresponsive to therapy. She complains of headaches, palpitations, and sweating.She has a history of neurofibromatosis type 1, though without any neurological deficits. She has multiple café-au-lait spots on her body. ECG demonstrates sinus tachycardia. She is found to be hypertensive to 154/121 mmHg. What does this patient likely have
Pheochromocytoma
How do you diagnose CML
Philadelphia chromosome (translocation of 9 and 22) + striking elevated WBC
How do you diagnose PID
Physical exam shows abdominal pain, cervical motion tenderness, adnexal tenderness plus 1 of the following? Fever, WBC > 10k or pelvic abscess found on manual exam
How do you manage an ACL tear
Physical therapy and lifestyle modifications for low demand patients vs surgical reconstruction for young active patients with high demand¬
How do you manage thoracic outlet syndrome
Physical therapy is 1st line, avoid strenuous activity, ortho consult
How do you manage rotator cuff tendinopathy/tear
Physical therapy, NSAIDs, steroid injections, surgical repair for failed response to 3-6 months of conservative management
What is the classic tremor associated with Parkinson's disease
Pill-rolling 4-6 Hz tremor seen at rest, often asymmetric
Results from an abscess or sinus tract in the upper part of the natal (gluteal) cleft
Pilonidal disease
What is another name for patients with emphysema
Pink puffers due to the fact that they are constantly trying to blow off retained CO2 and they have a cachectic appearance
Patient is a one-week-old infant with a wide-scale symmetrical papular eruption over his trunk. Lesions align along skin folds. He had a mild upper respiratory infection last week prior to presenting to the clinic. What does this patient have
Pityriasis rosea
Describe lift off test
Place arm into internal rotation with dorsal surface against back and ask patient to push away from back, positive test is pain or weakness
What imaging should be order in a shoulder fracture
Plain x-rays as well MRI to rule out rotator cuff tear
How do you diagnose knee dislocations
Plain x-rays, MRI for soft tissue
What is the treatment of choice for TTP
Plasmapheresis + corticosteroids for adults or eculizumab with refractory HUS
How do you manage GBS
Plasmapheresis or IV immune globulin
How do you treat claudication caused by peripheral arterial disease
Platelet inhibitors: cilostazol, aspirin, clopidogrel; treat lipids: statins, revascularization: PTA, bypass grafts, stenting; exercise
What syndrome is characterized by dysphagia, esophageal webs, iron deficiency anemia and atrophic glossitis
Plummer-Vinson syndrome
A CD4 count of < or = 200 suggest what opportunistic infection
Pneumocystis (PCP)
Fungal pneumonia common is HIV patients with a CD4 < 200
Pneumocystis Jiroveci
Bacterial pneumonia associated with HIV CD4 <200 and immunocompromised
Pneumocystis jiroveci
What causes the crepitus to be heard on auscultation with suspected Boerhaave syndrome
Pneumomediastinum
Patient is a 62-year-old female presents to the emergency room with complaints of severe, whole-body itching. She states that she first noticed her symptoms while in the bathtub at home. Over the previous several months she has had episodes of severe joint swelling and pain in her hands as well as redness, burning pain, and swelling of her hands and feet. Her past medical history is significant for type II diabetes mellitus, hypertension, and osteoporosis for which she takes metformin, enalapril, and alendronate, respectively. In addition, she was found to have a deep vein thrombosis of her right leg five months prior to presentation. The patient's laboratory tests demonstrate elevated RBC count, hemoglobin, and hematocrit of 54%, leukocytosis with a WBC count of 19,000 cells/mm^3 with normal differential, and thrombocytosis with a platelet count of 900,000/mm^3. What does this patient have
Polycythemia
Menses that occur more frequently: menses < 21 days apart
Polymenorrhea
How do you diagnose sleep apnea
Polysomnography (can consider home sleep apnea testing in patients without comorbidities)
How does an MCL tear present
Pop, medial joint line pain of knee due to valgus stress injury + knee instability or inability to walk
Injury to what artery in knee dislocations should you worry about
Popliteal artery, diagnose with CT angiogram
What are some examples of major criteria for diagnosing endocarditis
Positive blood cultures, positive echocardiogram
Patient is a 30-year-old male arrives at the emergency room after a motor vehicle accident. Upon arrival, he has difficulty breathing and reports shoulder pain. On physical exam, he has decreased breath sounds on the right side and significant tenderness of his right shoulder. There is overlying ecchymosis, swelling, and erythema over his right scapula and limited range of motion. What does this patient have
Possible scapular fracture
How does cervical cancer present
Post-coital bleeding and vaginal discharge
What type of stroke is associated with brainstem dysfunction such coma, drop attacks, vertigo, nausea, vomiting, ataxia
Posterior circulation involvement
How do you test for PCL tear on physical exam
Posterior drawer sign, sag sign: tibia sagging posteriorly, active quad test
What is the most common location of an anorectal abscess
Posterior rectal wall
How do you treat hypokalemia
Potassium repletion with products not containing dextrose, +/- magnesium replacement
TB that spreads to the spine is called
Potts disease (type of miliary TB)
What is the cause of molluscum contagiosum
Poxvirus
What does stage 0 mean within regards to breast cancer
Precancerous DCIS or LCIS
What is Barret's Esophagus
Precancerous metaplastic columnar cells replace normal esophageal squamous epithelium
What is the most common cause of secondary amenorrhea
Pregnancy
How do you workup dysmenorrhea
Pregnancy + pelvic ultrasonography
What are causes of primary amenorrhea
Pregnancy, imperforate hymen, gonadal dysgenesis: turner's syndrome (46 XO) - short web neck, HPO axis abnormalities: eating disorders or excessive exercise
What are the risk factors for the development of varicose veins
Pregnancy, prolonged standing or sitting, obesity, OCPs
Menopause onset <40 years old is due to
Premature ovarian failure
Patient is a 25-year-old female who complains of abdominal bloating, headache, irritability, depression, poor sleep quality, and breast tenderness. These symptoms occur on a monthly basis 5 days before menses. Her symptoms greatly improve within 4 days of the onset of menses. What does this patient have
Premenstrual syndrome
Patient is a 40-year-old carpet installer who spends his working day on his knees, fitting carpets. In the past few months, he had been aware of a dull ache over his right knee, which had seemed to be aggravated by pressure and on flexion of the knee. He had been wearing kneepads, using a soft mat and trying to avoid kneeling on that knee. However, he was alarmed to wake one morning with a large, tender, fluctuant swelling over the kneecap. What does this patient have
Prepatellar bursitis: Housemaid's knee
Patient is an 80-year-old bed-boundwoman with a temperature of 104°F who you are called to see in the nursing home. The patient is disoriented and confused. On physical examination, the patient's blood pressure is 110/ 80 mm Hg, and her pulse is 72 beats/ minute and regular. You notice a purulent, foul-smell in the room. What does this patient most likely have
Pressure ulcer
How do you manage stage 1 pressure ulcer
Preventive measures, thin film dressings for protection
How does oral contraception work
Prevents ovulation by inhibiting mid-cycle LH surge, thickens cervical mucus and thins endometrium
Patient is a 17-year-old female who is concerned that she has not yet had her period. She reports being sexually active and uses condoms consistently. She denies pelvic pain. On physical exam, there is normal breast development; however, her uterus is not palpable. This is confirmed by pelvic ultrasound. Karyotype returns as 46, XX and serum testosterone level is appropriate for a female. What does this patient have
Primary amenorrhea
What are the 2 causes of hyperparathyroidism
Primary: increased PTH due to PTH secreting parathyroid adenoma vs Secondary: increased PTH due to hypocalcemia of vitamin D deficiency
Patient is a 65-year old man who presents to the ED at 1 am with 90 minutes of central chest pressure that awoke him from sleep. He says he thinks he has 'indigestion.' The pain is non-radiating, with mild shortness of breath but no nausea, vomiting or diaphoresis. He is an ex-smoker with a 20 pack-year history. There is no previous history of CAD, diabetes, hypertension or high cholesterol. On arrival, he looks well, with normal heart rate (54 bpm), blood pressure (127/86) and oxygen saturation (98% on room air). His pain has improved slightly with sublingual nitrates in the ambulance, although he still has some ongoing chest discomfort. His ECG is shown below. Troponins are positive. He is admitted to hospital and undergoes emergent cardiac catheterization, where he is without obstructive coronary disease, but his symptoms can be provoked with the administration of intravenous ergonovine. What is this patient likely experiencing
Prinzmetal angina
What are some absolute contraindications for fibrinolytic use in STEMI
Prior intracranial hemorrhage, cerebral vascular lesion, malignant intracranial neoplasm, ischemic stroke within 3 months, aortic dissection, active bleeding
What are some rescue antiemetics
Prochlorperazine and droperidol
How do you diagnose a fistula
Proctoscope
What imaging studies can be used to diagnose hemorrhoids
Proctosigmoidoscopy or colonoscopy
What are the 3 phases of measles
Prodrome of cough/coryza/conjunctivitis, enanthem showing kolpik spots (bluish-white central dots in mouth), exanthema of rash that begins on face and spreads cephalocaudally
How does chronic bronchitis present
Productive cough > or = 3 months x 2 consecutive years, wheezing, rales, rhonchi
What contraceptive pill is safe to use during lactation
Progestin-only mini pill
How does Alzheimer present
Progressive cognitive decline
What is the underlying pathophysiology of COPD
Progressive, largely irreversible airflow obstruction due to loss of elastic recoil and increased airway resistance
How do you manage septic arthritis
Prompt antibiotics guided by gram stain and arthrotomy with joint drainage
How do you manage essential tremor
Propranolol or primidone (anticonvulsant)
How do you treat vitiligo
Protect against sun and topical corticosteroids
How do you manage an isolated grade I (partial) or II (complete isolated) PCL tear
Protected weight bearing and physical therapy vs surgical repair for PCL + ACL or PCL + grade III MCL/LCL
What are nutritional causes of easy bruising/bleeding
Protein malnutrition, vitamin c deficiency, vitamin k deficiency
Pepsin is responsible for the breakdown of what
Proteins
What are the 5 P's of lichen planus
Pruritic, purplish, polygonal, plain-topped papules
How does polycythemia present
Pruritis after hot baths, gout, headache, blurred vision, dizziness, rubor of hands and feet
Bacterial pneumonia associated with ventilators and cystic fibrosis
Pseudomonas
What infection is common in bronchiectasis in patients >18 years old
Pseudomonas
What is the most common cause of septic arthritis in IV drug abusers
Pseudomonas
Within regard to appendicitis RLQ pain with right hip flexion/extension is called
Psoas sign
Patient is a 75-year-old female with patches of chronic, inflammatory, well-demarcated, erythematous, silvery scaly plaques which involves the scalp and extensor surfaces. What does this patient have
Psoriasis
What is the gold standard for definitive diagnosis of PE
Pulmonary angiography
Fungal pneumonia that occurs in people with underlying illnesses such as TB or COPD but with otherwise healthy immune systems
Pulmonary aspergillosis
What is the gold standard for diagnosing COPD
Pulmonary function testing/spirometry
What is the gold standard for diagnosing asthma
Pulmonary function tests: decreased FEV1 and FEV1/FVC
What skin abnormality can be seen with thrombocytopenia or coagulation cascade disorders
Purpura
Describe stage III acne vulgaris
Pustular lesions >25% and moderate scarring
How does hypocalcemia present
QT prolongation, trousseaus sign, chvostek's sign
How do you diagnose primary amenorrhea
Quantitative beta HCG, FSH, prolactin, TSH, T3, free T4, progesterone
How do you diagnose secondary amenorrhea
Quantitative beta HCG, TSH, prolactin, progesterone challenge, FSH
How do you treat active TB
RIPE: Rifampin (causes red/orange body fluids), Isoniazid, Pyrazinamide (causes gout), Ethambutol (causes optic neuritis)
What is a common cause of viral pneumonia in children
RSV
How do you treat stage 2b-4a cervical cancer
Radiation + chemo: cisplatin
What is the most common risk factor for thyroid carcinoma
Radiation exposure
How do you manage renal cell carcinoma
Radical nephrectomy
How do you definitively manage WPW
Radiofrequency ablation
Name 2 examples of integrase strand transfer inhibitor (INSTI)
Raltegravir (Isentress), Dolutegravir (Tivicay)
What criteria is used for the prognosis of acute pancreatitis
Ranson's criteria and APACHE score
How does Non-Hodgkin lymphoma present
Rapid onset, common in HIV patients, painless lymphadenopathy, GI symptoms: bowel obstruction, intussusception
What is a side effect of phenytoin
Rash: erythema multiforme, SJS, gingival hyperplasia
What FEV1/FVC ratio indicates chronic bronchitis
Ratio < 0.7
What can happen to HLA-B27 individuals who have shigella
Reactive arthritis
How do you treat carotid disease
Recommend smoking cessation, provide antiplatelet therapy (clopidogrel, aspirin + dipyridamole, statins)
Patient is a 50-year-old female with pelvic pressure reports a sensation of a mass present in the vagina. She reports chronic constipation and a sensation that the rectum is not completely emptied following a bowel movement. Occasionally, she experiences episodes of fecal incontinence. What does this patient have
Rectocele
How do you treat orthostatic hypotension
Reduce venous pooling, increase sodium intake, fludrocortisone or midodrine
How do you manage a shoulder dislocation
Reduce, postreduction films, sling + swath + physical therapy
How do you diagnose Hodgkin's lymphoma
Reed sternberg cells, CT, bone biopsy
How do you manage adhesive capsulitis
Rehab for range of motion therapy, anti-inflammatories, steroidal joint injection, heat vs surgery if failure to conservative treatment
How do you manage pyloric stenosis
Rehydration with IV fluids (potassium repletion if low) vs definitive management via pyloromyotomy
What drugs should you avoid in WPW
Remember ABCD: Adenosine, Beta blockers, Calcium channel blockers, Digoxin
What is the first line step in the management of cutaneous drug reactions
Removal of offending agent
How do you treat contact dermatitis
Remove offending agent, burrow's solution, zinc oxide for diaper rash
What is the gold standard for diagnosing renal vascular disease
Renal arteriography
Patient is a 65-year-old man who noticed blood in his urine earlier this morning. This has never happened before and he denies any new medications or prior infection. He also reports to having flank pain for the past few weeks. Medical history is significant for hypertension. He has a 40 pack-year smoking history. On physical examination there is a firm, nontender, and homogeneous mass in the right flank. What does this patient have
Renal cell carcinoma
What is the most common type of renal cell carcinoma
Renal clear cell followed by transitional cell
Patient is a 69-year-old man with a 55-pack-year smoking history, diabetes type II, and hyperlipidemia presents to his primary care clinic for an annual exam. He has no complaints. He reports that his blood glucose has been under tight control and that he has not smoked a cigarette for the past 5 months. Vital signs are HR 69 bpm, BP 180/100 mmHg, RR 12/min, and O2 saturation 99% on room air. Physical examination is notable for bruits bilaterally just lateral of midline near his umbilicus. You initiate an anti-hypertensive medication, but his blood pressure continues to be suboptimal. Creatinine is 3.5. What does this patient have
Renal vascular disease
How do you manage polycythemia
Repeated phlebotomy to lower hematocrit to < or = 42%, patients >60 treat with hydroxyurea +/- aspirin
How do you treat hemophilia
Replace factor 8 or 9
How do you treat secondary hyperparathyroidism
Replace vitamin D and calcium
How do you prevent development of pressure ulcers
Repositioning every 2 hours
How is hepatitis D virus transmitted
Requires hepatitis B virus (HbsAg) to cause coinfection or superimposed infection
How do you test for teres minor/infraspinatus tear or inflammation
Resisted external rotation with elbow at 90 degrees
How do you manage Bell palsy
Resolves in 1 month w/o tx, prednisone if started w/n 1st 72 hours of sx onset, artificial tears
What ABG/Labs are found in chronic bronchitis
Respiratory acidosis, elevated hemoglobin and hematocrit due to chronic hypoxia (stimulates erythropoiesis)
A patient with the following ABG has what type of acid-base disorder, ph 7.52, PCO2 25, Bicarb 22 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal)
Respiratory alkalosis
What is seen on ABG in emphysema
Respiratory alkalosis
What finding is seen on ABG in those with PE
Respiratory alkalosis secondary to hyperventilation
What are the 3 cardinal features of Parkinson's disease
Rest tremor, cogwheel rigidity and bradykinesia
How do you treat subacromial bursitis
Rest, NSAIDs, prevention of precipitating factors, cortisone injections
How do you manage subacromial impingement
Rest, ice, activity modification, NSAIDs, corticosteroid injections vs surgery if refractory to conservative measures
How does nicotine intoxication present
Restlessness, insomnia, anxiety, arrhythmias
How do you manage ischemic colitis
Restore perfusion and observe for signs of perforation
How do you manage peripheral arterial disease if conservative measures fail
Revascularization with PTA, bypass grafts, stenting
Explain pathophysiology of asthma
Reversible tracheobronchial tree hyperirritability causing airway inflammation and bronchoconstriction
Fulminant hepatitis MC seen in children associated with aspirin use during viral infections, accompanied with rash on hands/feet, intractable vomiting, liver damage, encephalopathy, dilated pupils is called
Reye syndrome
How does Lyme disease present in early disseminated stage, 1-12 weeks post-bite
Rheumatologic: arthritis; Neurologic: headache, meningitis, weakness, facial nerve palsy; Cardiac: AV block, pericarditis
Patient is a 64-year-old male with a history of coronary artery disease, hypertension, hyperlipidemia, and type II diabetes with increasing shortness of breath and ankle swelling over the past month. On physical examination, you note jugular venous distention, increased hepatojugular reflex, and hepatomegaly. His lungs are clear to auscultation. What is this patient likely experiencing
Right ventricular heart failure
How do you treat Non-hodgkin lymphoma
Rituximab, chemotherapy
Patient is a 46-year-old white woman presents with facial flushing that she notes is worse when she has her morning coffee and when she is stressed at work. Physical examination reveals the presence of localized facial erythema, telangiectasias as well as several scattered papules and pustules on her cheeks. What does this patient have
Rosacea
What is the difference between Rosacea and acne vulgaris
Rosacea doesn't have comedones
Only childhood exanthem that starts on the trunks and spreads to the face
Roseola also called sixth disease
Patient is a 69-year-old male with right shoulder pain for the past several months. He reports that he cannot reach above his head without severe pain. As a retired carpenter, he reports that this has significantly impacted his quality of life. Additionally, he is unable to lie on his left side at night due to shoulder pain. On physical exam, there is focal tenderness over the left anterolateral shoulder. Radiography reveals reduced space between the acromion and humeral head. What could this patient have
Rotator cuff tendinopathy/tear
What is the most common cause of diarrhea in children
Rotavirus
What syndrome is a similar to a mild form of Dubin-Johnson, associated with conjugated and unconjugated bilirubin but not associated with black liver on biopsy
Rotor's syndrome
What bariatric surgery is considered malabsorptive and restrictive
Roux-en-Y gastric bypass
Within regard to appendicitis pain in the RLQ with palpation of the LLQ is called
Rovsing's sign
How do you manage hemorrhoids that are unresponsive to conservative treatment
Rubber band ligation, sclerotherapy, hemorrhoidectomy (for all persistent hemorrhoids or stage IV)
3-day rash that spreads from the face to the trunk and extremities
Rubella also called german measles (spreads much more rapidly than rubeola)
Patient is a 6-year-old child who is brought to the emergency room for a complaint of high fevers and a rash. His mother reports that she thought he had "just a cold" approximately one week ago—he had a mild fever, runny nose, conjunctivitis, and cough. Then he developed a rash that started on his face and gradually spread downward. On examination, the child appears lethargic and has a temperature of 104.3. There is a mild injection of his conjunctiva and a generalized macular rash. White macules are noted on his buccal mucosa. What does this patient have
Rubeola also known as measles
What is the most common cause of cellulitis
S. aureus and GABHS
What are the common bacterial causes of cellulitis in adults
S. aureus and group A strep
What is the most common bacterial cause of meningitis in those >1 month
S. pneumo
Bacterial pneumonia that presents with rust colored sputum and common in patients who have had a splenectomy
S. pneumoniae
What are the causes of bacterial meningitis
S. pneumoniae (gram + diplococci), N. meningitidis (gram negative diplococci)
What is the most common Shigella species causing bacillary dysentery in the US
S. sonnei
How do you treat intermittent asthma
SABA PRN (step 1)
What are some major exclusion criteria to thrombotic management of stroke patients
SAH, head trauma, recent stroke or MI within past 3 months, BP >185/110, active bleeding,
What are causes of euvolemic hyponatremia
SIADH, steroids, hypothyroid
What EKG findings are indicative of PE
SIQ3T3
How does hepatitis A present clinically
SPIKED fever, decreased smoking, URI sx, N/V, alcoholic stools, hepatomegaly, jaundice
Patient is a 70-year-old male complaining of left-sided crushing substernal chest pain that began suddenly while he was walking his dog. He denies any past medical history, has not seen a physician recently and has smoked one pack per day for the past 50 years. Vital signs are BP 85/50 mmHg, HR 50 bpm, RR 22, T 99.1 deg F. Physical exam shows an obese, nervous man with jugular venous distension and clear lung fields. An electrocardiogram shows ST elevations in II, III, and aVF. What is this patient experiencing
STEMI, inferior infarct
What areas are most often affected by pressure ulcers
Sacrum and hip
What supportive medication should be avoided in children below 18 years of age with influenza and why
Salicylates, associated with Reye's syndrome
What is the common bacterial cause of osteomyelitis in patients with sickle cell
Salmonella spp.
How do you manage emphysema
Same as chronic bronchitis: Ipratropium (also albuterol inhaler), O2, oral steroids, antibiotics
What is the most common cause of scabies
Sarcoptes scabiei hominis
Patient is an 11-year-old male complaining of intense itchy, painful, red streaks between his fingers and in the groin area. The patient reports that the itchiness seems to be worse at night. His best friend who he had a sleepover with this past weekend is also having similar symptoms. What does this patient have
Scabies
Lower esophageal webs/constrictions @ the squamocolumnar junction MC associated w/sliding hiatal hernias is called
Schatzki ring
How do you diagnose pernicious anemia
Schilling test
How do you manage postoperative nausea and vomiting
Scopolamine patch, ondansetron, dexamethasone
TB that spreads to the cervical lymph nodes is called
Scrofula (type of miliary TB)
Erythematous, yellowish greasy scales, crusted lesions seen on scalp is called
Seborrheic dermatitis (cradle cap)
Patient is a 67-year-old male concerned about skin cancer. He notes that over the past several years, several greasy moles have cropped up on his back. His wife had died of melanoma and he is scared that these moles are melanomas. On exam you note several small flesh colored, grey brown and black papules/plaques with a velvety warty texture and a greasy, "stuck on" appearance. What does this patient have
Seborrheic keratosis
What is first line treatment for urticaria
Second generation antihistamine such as fexofenadine or loratadine
Patient is a 23-year-old female who is concerned that she has not had her menses over a period of four months. She is also very distressed about increased hair growth. She reports having to shave frequently above the lip, chin, chest, and lower back. Prior to this, she had a regular menses. The patient's weight is 168 lbs (76.2 kg) and height 5 feet and 1 inch (154.9 cm). She has acne on the cheeks and forehead. Hyperpigmented plaques of the skin are found on the nape of her neck. Bilateral enlarged ovaries are palpated on pelvic examination. β-hCG is negative and LH: FSH is 3. What does this patient have
Secondary amenorrhea
What hormone released by the duodenum inhibits parietal cell production and causes pancreatic release of bicarbonate
Secretin
What is the more common cause for posterior shoulder dislocation
Seizure
How do you treat tinea versicolor
Selenium sulfide
How do you treat tinea capitis
Selenium sulfide or ketoconazole shampoo
How do you manage pityriasis rosea
Self limiting but can use topical or systemic steroids + antihistamines + emollients to help with itching and scales
How do you treat molluscum contagiosum
Self-limiting
How do you treat telogen effluvium
Self-limiting
What is the most common type of testicular carcinoma
Seminoma
What does the radiograph show
Sentinel loop (localized ileus) seen with acute pancreatitis
What is another name for acromioclavicular separation
Separated shoulder
Patient is a 24-year-old male presents with abrupt onset of swelling, pain, redness, and increased warmth in his right knee. He denies any injury or previous joint issues. The symptoms began yesterday along with generally not feeling well and possible low-grade fever. He is sexually active with a recent new partner. On physical examination, T: 100°F, right knee is edematous and erythematous with increased warmth and ROM decreased by pain. Right knee synovial fluid analysis reveals increased leukocytes and absence of crystals. What does this patient have
Septic arthritis
What should your workup of NSTEMI include
Serial EKGs and first one within first 10 minutes, serial cardiac markers: 3 sets every 8 hours (troponin best marker)
What serum folate level is indicative of folate deficiency anemia
Serum folate <3
How do you diagnose basal carcinoma
Shave or punch biopsy
What invasive diarrhea presents with explosive diarrhea, febrile seizures, possible reiter's syndrome
Shigella
Patient is a 23-year-old prison inmate was brought in from the detention clinic with a 3-day history of crampy abdominal pain and diarrhea. Patient reports the stools were small volume and bloody. On examination his abdomen is tender, he has decreased skin turgor, and temperature was found to be 101.5°F (38.6°C). Stool microscopy reveals numerous RBCs and WBCs and a stool culture was ordered. What does this patient have
Shigellosis (gram negative)
What symptoms does left ventricular failure cause
Shortness of breath and fatigue
Patient is a 9-year-old boy who is brought to the emergency department by his mother. She reports that, as of this morning, he has had difficulty walking and seems unable to communicate with her. On exam, you note a thin, African American boy with mild conjunctival pallor. Vital signs reveal the following: T 36.2 C, BP 105/60 mmHg, HR 95 bpm, RR 16 rpm. Neurologic exam reveals weakness of the right arm and leg as well as expressive aphasia. What does this patient have
Sickle cell disease
Patient is a 21-year-old African-American male with "reddish urine" at his morning void. There was no pain when voiding. He has never had any symptoms like this before. He stated that he had moderate alcohol intake two nights before, but otherwise, he did not take any prescription or non-prescription medications. His past medical history is unremarkable, and he has had no recent infections. On physical exam, his vital signs are all within normal limits. He is well-appearing and in no distress. There was no costovertebral angle or suprapubic tenderness. What does this patient have
Sickle cell trait
What is the most common area for the occurrence of diverticulosis/diverticulitis
Sigmoid colon
What parts of the colon does a volvulus commonly occur
Sigmoid colon and cecum
How does septic arthritis present
Single, swollen, warm, painful joint most commonly knee, fever
How does adrenal cortical cancer present on CT
Size >4 cm, calcifications
What is the appearance of Crohn disease on colonoscopy
Skips lesions and cobblestone appearance
Patient is a 48-year-old man is brought to his physician by his wife, who is concerned about his daytime sleepiness. Last week, he fell asleep while stopped at a red light. She says that he snores loudly and sometimes stops breathing for a few seconds while sleeping. His past medical history is significant for hypertension. He has a 20-pack-year history of smoking. His temperature is 37 C (98.6 F), heart rate is 86/min, blood pressure is 156/95 mm Hg, respiratory rate is 12/min. On physical exam, he is obese, but chest auscultation and extremity exam are within normal limits. What does this patient have
Sleep apnea
What are the 2 types of hiatal hernia
Sliding and paraesophageal
What percent body area is considered to be TEN
Sloughing of skin >30%
Patient is a 26-year old with no specific underlying or family disease. Six months ago, he experienced an episodic attack of distending pain in his left lower quadrant, nausea, and vomiting; he was treated with oral drugs at a local hospital. However, his symptoms were not completely relieved and were later aggravated. A normal abdominal X-ray suggested incomplete small bowel obstruction. Physical examination revealed a soft abdomen with tenderness in the left lower quadrant. No mass was palpated in the abdomen. Examination of tumor-associated antigens showed prominent high levels of carcinoembryonic antigen (CEA). Abdominal CT scans showed many swollen lymph nodes adjacent to the abdominal aorta in the retroperitoneal space but no discernible mass. Double-balloon enteroscopy (DBE) and the following biopsy revealed at the upper jejunum that most of the lumen was obstructed by an irregular protrusive tumor of gastrointestinal origin. What does this patient have
Small bowel carcinoma
Patient is a 68-year-old female with a history of cholecystectomy, appendectomy and C-section complaining of cramping abdominal pain and distention. Patient notes vomiting and states that she has been unable to pass gas or stool. What does this patient most likely have
Small bowel obstruction
What type of lung cancer metastasizes early, associated with smoking/ACTH/ADH/hyponatremia/hypercalcemia, Lambert-Eaton myasthenic syndrome and mediastinal mass or lymph nodes on one side
Small cell
What type of bronchogenic carcinoma metastasizes early
Small cell (oat cell) carcinoma
How does folliculitis present
Small, white-headed pimples
What is the most significant risk factor in renal cell carcinoma
Smoking
What is the most common cause of bronchogenic carcinoma
Smoking (Asbestosis is 2nd)
What management is indicated for chronic disease bronchitis
Smoking cessation, ambulatory O2, bronchodilator, steroids, vaccines (pneumococcal and flu)
What is the number one risk factor for developing prinzmetal angina
Smoking, cocaine use is also important
What are the risk factors for the development of peripheral arterial disease
Smoking, diabetes, hypertension, hypercholesterolemia, advanced age, sedentary lifestyle
What are risk factors for the developing an aneurysm
Smoking, hypertension, hypercholesterolemia and heavy alcohol use
What are causes of hypovolemic hyponatremia
Sodium loss
What is the drug of choice for hypertensive emergency
Sodium nitroprusside
What hormone is released by pancreatic delta cells, inhibiting the secretion of gastrin
Somatostatin
How do you test for biceps tendonitis
Speed and Yergason's test
What is the initial method of identifying pulmonary embolus
Spiral CT
How do you manage refractory ITP
Splenectomy
How do you treat hereditary spherocytosis
Splenectomy
Expulsion of all or part of the products of conception before 20 weeks of gestation is called
Spontaneous abortion
How do you diagnose TB
Sputum for Acid fast blood smears and cultures + chest x-ray + biopsy
What type of lung cancer presents as a smoker with hemoptysis and an abnormal chest x-ray showing a large central solitary tumor
Squamous cell
Which type of bronchogenic carcinoma is associated with central location, cavitary lesions hyperCalcemia and Pancoast syndrome
Squamous cell
Actinic keratosis is a precursor to what
Squamous cell carcinoma
Patient is a 63-year-old male who comes to your office for a lesion on his lip of 8-10 months duration. His past medical history is significant for multiple actinic keratoses, treated with cryotherapy. On physical exam, you note a scaly, crusted, keratotic nodule about one cm diameter on the lateral part of the lower lip. What does this patient have
Squamous cell carcinoma
What is the most common type of esophageal cancer worldwide
Squamous cell, occurs in the upper 1/3 of esophagus
How does Diffuse Esophageal Spasm present clinically
Stabbing CP made worse w/ hot or cold liquids/foods
Patient is a 50-year-old woman with a history of hyperlipidemia and diabetes type 2complaining of "chest pain attacks." She says that these attacks tend to occur while walking up five flights of stairs to get to her apartment, they last for 15-20 minutes and are relieved by rest. She describes the pain as sharp and substernal. A baseline EKG is unremarkable. Suspecting the diagnosis, you perform an exercise stress EKG and observe transient ST depressions in the anterolateral leads after significant exertion. What is this patient experiencing
Stable angina
What are the 3 stages of pregnancy
Stage 1: onset of contraction to full dilation, stage 2: full dilation to delivery of baby, stage 3: after delivery of baby to expulsion of placenta
What infection is common in bronchiectasis in patients <18 years old
Staph
What enterotoxin cause of diarrhea is usually due to food contamination
Staph Aureus
What are the most common bacterial causes of hospital acquired meningitis
Staph and aerobic gram-negative bacteria
What is the most common bacterial cause of breast abscess
Staph aureus
What is the most common cause of septic arthritis
Staph aureus
What are the most common bacterial causes of anorectal abscess
Staph aureus and E. Coli
What is the common cause of folliculitis
Staph aureus, pseudomonas is seen in hot tub users
Bacterial pneumonia that presents with salmon colored sputum, lobar, post-flu
Staph aureus: if MRSA treat with vancomycin
What is the most common bacterial cause of osteomyelitis
Staphylococcus aureus
What is the USPSTF colorectal screening guidelines for those of average risk
Starting at age 50 colonoscopy every 10 years or flex sigmoidoscopy every 5 years + fecal occult blood testing every 3 years
What is Virchow's triad
Stasis (post-surgical, immobility, venous insufficiency), Hypercoagulable states (Factor V Leiden, cancer, OCP + smoking, pregnancy), Trauma (surgery, cellulitis)
What are indications for revascularization in carotid disease
Stenosis >70%, post-TIA or stroke
How do you treat renal vascular disease (stenosis)
Stenting: percutaneous transluminal angioplasty plus stent
How does vascular disease dementia present
Stepwise deterioration with periods of clinical plateaus, can cause sudden decline
How do you treat autoimmune hemolytic anemia
Steroids or splenectomy for severe cases
What are some risk factors for avascular necrosis of hips
Steroids, SLE, hypercoagulable states, irradiation, trauma, hematologic diseases, sickle cell, dysbaric disorders (the bends)
How does hypercalcemia present
Stones, bones, abdominal groans, psychiatric overtones, shortened QT interval
How do you dx C. jejuni diarrhea
Stool culture shows, S, comma or seagull shaped organisms
How do you diagnosis shigella
Stool cultures positive for leukocytes, leukemoid reaction: >50,000 uL, sigmoidoscopy shows punctate areas of ulceration
How do you treat melasma
Stop estrogen agent or hormone therapy, treat with sunscreen and topical hydroquinone
How do you treat aplastic anemia
Stop offending agent, provide bone marrow transplant if <50 or immunosuppressive agent if >50
What are the common causes of ACL tear
Stopping movement and changing direction, valgus stress of the knee, sports
What sign can be seen on barium studies with ulcerative colitis
Stovepipe sign, meaning loss of haustral markings
What is the most common cause of endocarditis
Streptococcus viridans
How does C. diff diagnosed
Strikingly high lymphocytosis, fever, pseudomembranous colitis
How does Crohn disease appear on barium study
String sign
Patient is a 69-year-old woman who is brought in to the emergency department by ambulance after her husband noticed that she began slurring her speech and had developed facial asymmetry during dinner approximately 30 minutes ago. Her past medical history is remarkable only for hypertension. On physical exam, vital signs are within normal limits except for a heart rate of 105 bpm. She is noted to have distinct right facial paralysis. Non-contrast head CT is performed, which is negative for blood. What is this patient experiencing
Stroke
Patient is a 42-year-old man with complaints of right shoulder pain. He does not remember any specific injury but has been playing a lot of tennis during the past 4 months. It has become difficult and painful for him to reach overhead and behind him. Even rolling onto his shoulder in bed is painful. On examination of the right shoulder, there is full range of motion in all planes with obvious discomfort at end ranges of flexion, abduction, and internal rotation. There is significant pain when you place the shoulder in a position of 90 degrees flexion and then internally rotate. There is also moderate weakness with abduction and external rotation of the shoulder. The rest of the musculoskeletal examination is normal. What does this patient have
Subacromial bursitis
Patient is a 70-year-old male with an insidious onset of left shoulder pain that is exacerbated by overhead activities and while lifting objects away from his body. He is a retired mechanic of 35 years. The patient reports that over the last several months he has been having difficulty sleeping because of the pain. On physical examination, there is notable tenderness over the left anterolateral shoulder and passive forward flexion >90°causes severe pain. An x-ray reveals proximal migration of the humeral head and calcification of the coracoacromial ligament. What does this patient have
Subacromial impingement
Patient is a 44-year-old female arrives at the emergency room with a stiff neck, photophobia, and severe headache that began while she was just sitting down to enjoy a box of Kentucky Fried Chicken. She states her symptoms came on immediately and she is in severe distress. What does this patient likely have
Subarachnoid hemorrhage
How does glenohumeral joint osteoarthritis present on x-ray
Subchondral sclerosis, osteophytes, joint narrowing
Patient is a 74-year-old female who is being treated for mild hypertension. She is found at home with right hemiparesis and brought to the emergency department. Her daughter states that the patient fell in her kitchen 2 days ago but had no complaints at that time. She did state that her mother sounded a little confused this morning. The patient's left pupil is dilated. CT shows crescent shaped, concave hyperdensity. What does this patient likely have
Subdural hematoma
Brain bleed on CT that is concave (crescent shaped) is called
Subdural hematoma (venous bleed)
What can be used for elective abortion in 12 weeks or less
Suction curettage
What are some common causes of acute mesenteric ischemia
Sudden decrease blood supply to the bowel because of embolus, thrombosis, shock, and cocaine which commonly occurs at the splenic flexure
What is the most common cause of SJS
Sulfa and anticonvulsant meds
What areas of the body does basal carcinoma normally appear
Sun-exposed areas such as face, trunk, lower legs
How do you diagnose Mallory Weiss syndrome
Superficial longitudinal mucosal erosions seen on upper endoscopy
Describe a stage 1 pressure ulcer
Superficial non-blanching area of erythema
What vein is commonly involved with varicose veins
Superficial saphenous vein
How do you manage Mallory Weiss syndrome
Supportive care and acid suppression to promote healing, if severe bleeding: epi injections, sclerosing agent, band ligation, hemoclipping or balloon tamponade
How do you treat rubeola
Supportive with anti-inflammatories, isolation 1 week post rash
How do you treat mononucleosis
Supportive: rest, analgesics, antipyretics, fluids, warm salt water gargles, fluids, avoidance of contact sports for at least first 3-4 weeks of illness
What are some metastatic signs of gastric carcinoma
Supraclavicular lymphadenopathy (Virchow's node), Umbilical lymphadenopathy (Sister Mary Joseph's node), palpable node on rectal exam (Blumer's shelf), Left axillary lymph node (Irish sign), ovarian METS (Krukenburg tumor)
Name the 4 rotator cuff muscles
Supraspinatus, infraspinatus, teres minor, subscapularis
How do you definitively manage ulcerative colitis
Surgery
How do you treat cystocele if conservative treatment failed
Surgery with mesh augmentation
How do you treat stage 1a1 cervical cancer
Surgery: TAH-BSO
How do you manage Stanford type A/Debakey I and II or acute distal type III aortic dissections with complications
Surgical
What is the differential for postoperative bleeding
Surgical bleeding: bleeding from a major artery, medications, inherited coagulation disorders, liver disease, renal failure, DIC
What can be used for elective abortion in up to 16 weeks
Surgical curettage (D&C)
How do you manage lipomas
Surgical excision
How do you manage stage 1-3 melanoma
Surgical excision
How do you treat squamous cell carcinoma
Surgical excision +/- Mohs or radiotherapy/cryotherapy/electrodessication and curettage
How do you manage bronchial carcinoid tumors definitively
Surgical excision and octreotide for symptom reduction
How do you treat pilonidal disease
Surgical excision, can empirically treat with cefazolin + metro or augmentin
What are the treatment options for severe peripheral vascular disease
Surgical graft bypass, angioplasty, endarterectomy, surgical patch angioplasty
How do you manage acoustic neuroma
Surgical intervention
How do you treat biceps tendonitis refractory to conservative treatment
Surgical release of biceps tendon
How do you manage inguinal hernias
Surgical repair
How do you manage perilymph fistula
Surgical repair
How do you manage stage 1-2 non-small cell bronchogenic carcinoma
Surgical resection
How do you treat Wilm's tumor
Surgical resection and chemo
How do you manage hepatocellular carcinoma
Surgical resection if confined to a lobe and not associated with cirrhosis
How do you manage colorectal cancer
Surgical resection if stage I-III, chemotherapy (5FU/Fluorouracil) if stage III and metastatic
How do you manage acute mesenteric ischemia
Surgical revascularization (angioplasty with stenting or bypass) vs surgical bowel resection if not salvageable
How do you manage basal carcinoma
Surgically (photodynamic therapy, tissue scraping, electrosurgery, Mohs surgery, wide local excision) + fluorouracil or imiquimod to the affected area
How do you diagnose ITP
Suspect with isolated thrombocytopenia (platelets <100,000) and + direct coombs test
How does thoracic outlet syndrome present due to vascular compression
Swelling/discoloration of arm especially with abduction of the arm
How do you treat aseptic meningitis
Symptomatic or IV acyclovir for HSV
What is the treatment of choice for acute bronchitis
Symptomatic: fluids, expectorants, analgesics, B2-agonists, cough suppressants (not recommended in children)
How do you treat viral pneumonia
Symptomatic: fluids, rest, beta 2 agonists
Describe intermittent asthma: symptoms/week, nighttime symptoms, SABA use, activity limitation, lung function
Symptoms < or = 2 days/week, nighttime symptoms < or = 2 times/month, SABA use < or = 2 days/week, no activity interference, normal lung function test
Describe mild persistent asthma: symptoms/week, nighttime symptoms, SABA use, activity limitation, lung function
Symptoms > 2 days/week, nighttime symptoms 3-4 times/month, SABA use > 2 days/week, minor activity limitations, normal lung function tests
Describe moderate persistent asthma: symptoms/week, nighttime symptoms, SABA use, activity limitation, lung function
Symptoms daily, nighttime symptoms > or = 1 time/week, SABA use daily, some limitation of activity, FEV1 > 60% but <80%, FEV1/FVC reduced 5 %
Describe severe persistent asthma: symptoms/week, nighttime symptoms, SABA use, activity limitation, lung function
Symptoms throughout the day, nighttime symptoms nightly/week, SABA use several times/day, extremely limited normal activity, FEV1 <60%, FEV1/FVC reduced >5%
How do you treat unstable WPW
Synchronized cardioversion
Patient is a 68-year-old female with a syncopal episode that lasted less than 1 minute. She states she felt nauseous prior to losing consciousness. She has no significant past medical history. Resting blood pressure is 132/84 mm Hg. ECG is normal. This patient has likely experienced
Syncope
How do you manage bullous pemphigoid
Systemic corticosteroids
What are the common causes of ischemic colitis
Systemic hypotension or atherosclerosis involving the superior & mesenteric arteries
What is the pathophysiology behind atopic dermatitis
T cell mediated and increased IgE production
How do you treat stage 1 or 2a cervical cancer
TAH-BSO vs XRT + chemo: cisplatin
Patient is a 78-year-old man with a 3-month history of weight loss, fever, fatigue, night sweats, and cough. He is a former smoker. A recent HIV test was negative. A CT scan of the chest reveals a 3 cm lesion in the upper lobe of the left lung and calcification around the left lung hilus. A sputum smear was positive for acid-fast organisms. What does this patient have
TB
What should all patients with HIV be screened for
TB via interferon gamma release assay or tuberculin skin testing
A CD4 count of 500-200 suggest what opportunistic infections
TB, Kaposi sarcoma, thrush, lymphoma, zoster
What is the tx for severe or recurrent cases of tension headaches
TCAs (amitrypline) or BBs
Patient presents with monocular vision loss, contralateral hand weakness and speech changes that have gotten better over the last 30 minutes. What does this patient have
TIA
What neodjuvant endocrine therapy is helpful in women that are estrogen receptor (ER) positive
Tamoxifen
What can be used as a preventive measure in postmenopausal or women >35 years with high risk for breast cancer
Tamoxifen or Raloxifene for 5 years
How does dyshidrosis present
Tapioca vesicles on hands and feet following stress or hot humid weather
What type of cells can be seen with iron deficiency anemia
Target cells
Scalp disorder characterized by the thinning or shedding of hair resulting from the early entry of hair in the telogen phase (the resting phase of the hair follicle)
Telogen effluvium
What is delirium
Temporary rapid onset AMS due to medical condition, substance intoxication or withdrawal
How does a clavicle fracture present on physical exam
Tenderness to palpation, swelling, erythema, tenting
What type of headache presents with bilateral tight band-like pain worsened with stress, fatigue, but has no N/V or focal neurologic symptoms
Tension
Patient is a 32-year-old male who noticed a mass on his right testicle while showering. He reports this has never happened before and denies any pain or discomfort. On physical examination, there is a firm and fixed mass on the left testicle. What does this patient have
Testicular carcinoma
Patient is a 10-year-old boy with chief complaint of paleness refer to your office. On physical exam he has splenomegaly (3 cm BCM) and lab data show these results: Hb: 8.5 (normal 12-17.5), MCV 79 (normal 80-100), MCH 22.5 (normal 25-34), WBC: 50,000, Plt: 650,000 (normal 150,000 - 400,000). What does this patient have
Thalassemia
What labs are seen with polycythemia
The 4 H's: Hypervolemia (elevated RBC), Histaminemia (increased histamine), Hyperviscosity (increased hematocrit), Hyperuricemia + Positive Jak2 tyrosine kinase mutation
What is patella alta
The pull of the patella upward due to quad muscles
How does sleep apnea present
Thick necked patient, obese or nonobese, enlarged tonsils, snoring daytime sleepiness, personality changes, decreased libido
What is Leriche's syndrome
Think CIA: Claudication of buttock/thighs, Impotence, Atrophy
What factors does PTT include
Think TENET: 12, 11, 9, 8, 10
What factors does the common pathway include
Think dollar bills below 20: 10, 5, 2 (thrombin), 1 (fibrinogen)
Patient is 35-year-old female complaining of ulnar sided arm/forearm pain and paresthesias. What does this patient have
Thoracic outlet syndrome
Bloody vaginal discharge before 20 weeks of gestation with or without uterine contractions in the presence of a closed cervix is called
Threatened abortion
How do you manage stroke patients
Thrombolysis via IV tPA within 3-4.5 hours of symptom onset and maintain BP to <185/105
What treatment option is available if cath lab is not accessible
Thrombolytic therapy (TPA and streptokinase)
How do you manage a stroke
Thrombolytics (alteplase) within 3 hours, antiplatelet therapy if >3 hours
Patient is a child with renal failure + Escherichia coli O157:H7 infections and diarrhea. What does this patient have
Thrombotic thrombocytopenic hemolytic uremic syndrome
Patient is a 34-year-old woman who arrives at the ED with acute-onset fatigue, fever, palpitations, and blurry vision. On chart review, it is revealed that she was recently diagnosed with AIDS and was on multiple antiretroviral medications. On physical exam, her skin is mildly jaundiced. She has multiple purpura over her extremities. A complete blood count is significant for a platelet count of 37,000/μL (normal 150,000 - 400,000/μL) and mild anemia. Her peripheral smear reveals schistocytes. She has a negative Coombs test. What does this patient have
Thrombotic thrombocytopenic purpura
What is the most common benign thyroid nodule
Thyroid adenoma
Patient is a 40-year-old woman who is otherwise healthy presents to your office complaining of a lump in her neck. On examination, she is found to have a firm 2-cm nodule associated with the left lobe of the thyroid gland. What does this patient likely have
Thyroid carcinoma
What is the extreme form of hyperthyroidism called
Thyroid storm
How do you treat thyroid nodules
Thyroidectomy if malignant, follow up in 6 months if benign, repeat FNA in 1-4 weeks if unsatisfactory specimen
Patient is a 28-year-old man who arrives in your ER complaining of severe right knee pain after falling from a ladder. The patient arrives in a wheelchair and physical exam is extremely difficult secondary to pain. What could this patient have
Tibial plateau fracture
Hair loss secondary to fungal infection is called
Tinea capitis
Hypo or hyperpigmented macules that do not tan and is caused by Malassezia furfur
Tinea versicolor
Your patient with anal fissures has tried all of your supportive care recommendations and still has no improvement, what 2nd line treatment do you now provide
Topic vasodilators such as nitroglycerin or Nifedipine ointment
How do you treat chronic paronychia
Topical clotrimazole or nystatin
How do you treat atrophic vaginitis
Topical conjugated estrogen creams
How do you treat atopic dermatitis
Topical corticosteroids and emollients
How do you manage atopic dermatitis
Topical corticosteroids, antihistamines for itching
What is the first line treatment for rosacea
Topical metronidazole
How do you treat perioral dermatitis
Topical metronidazole or erythromycin, steroids contraindicated
How do you treat androgenic alopecia
Topical minoxidil and oral finasteride
How do you treat scabies
Topical permethrin or oral ivermectin if severe
What is the first line treatment for > mild acne vulgaris
Topical retinoid + topical antibiotic
How do you treat lichen planus
Topical steroid ointments
How do you treat lichen simplex chronicus
Topical steroids such as high potency 0.05% betamethasone dipropionate cream or 0.05% clobetasol propionate cream
What treatment is indicated in advanced cases of osteoarthritis
Total joint replacement
How do you manage medullary thyroid carcinoma
Total thyroidectomy
How do you manage papillary or follicular thyroid carcinoma
Total thyroidectomy vs partial + radioiodine therapy
Patient presents with fever, abdominal pain, nausea, vomiting, tachycardia and rigidity. You order an abdominal x-ray and see dilated loops of colon >6cm. What does this patient likely have
Toxic megacolon
A CD4 count of < or = 100 suggest what opportunistic infections
Toxoplasmosis or Cryptococcus
Hair loss caused by pulling force
Traction alopecia
What is the most common type of bladder cancer
Transitional cell carcinoma
How do you manage acanthosis nigricans
Treat underlying case, metformin and topical retinoids or topical vitamin d analogs
How do you manage pectus excavatum or carinatum
Treatment usually not required but can use orthotic bracing or physical therapy
How do you manage Crigler-Najjar syndrome type II
Treatment usually unnecessary but can use phenobarbital to increase UGT activity
Vaginitis that presents in a sexually active woman with copious malodorous greenish discharge, dyspareunia, dysuria, strawberry cervix
Trichomonas vaginitis
How do you manage migraine headaches
Triptans or Ergotamines, Dopamine blockers (metoclopramide, promethazine, prochlorperazine) - give with Benadryl
True or false, fecal occult blood testing should be done annually
True
What procedure is used as sterilizing contraception
Tubal ligation
What is Pancoast syndrome
Tumor at superior sulcus lead to: shoulder pain, Horner's syndrome (miosis, ptosis, anhidrosis), atrophy of hand/arm muscles
What is a side effect of chemotherapy treatment in patients with AML
Tumor lysis syndrome, treat with allopurinol and manage acute renal failure
What labs can be used to diagnose pancreatic carcinoma
Tumor markers CEA and CA 19-9
How do you treat hiatal hernias
Type 1 hiatal hernias are handled medically (antacids, small meals, head elevation) vs nonresponsive or type 2 hernias with elective surgery: nissen fundoplication
What are the 2 different types of aortic dissections
Type A: proximal aortic dissection and Type B Distal Aortic dissection
What mechanism causes urticaria or angioedema
Type I IgE mediated
Describe the 5 types of AC joint dislocations
Type I: normal x-ray + ligamental strain, type II: AC ligament rupture + slight widening, type III: AC and coracoclavicular ligament rupture + significant widening, type IV: AC & CC rupture + displacement of clavicle into/through trapezius, type V: class IV + disruption of the clavicular attachments
What mechanism causes serum sickness
Type III immune antibody-antigen complex
What mechanism causes erythema multiforme
Type IV delayed (cell mediated)
What type of salmonella presents with cephalic phase characterized by headache, pharyngitis, pea soup stools (brown-green), intractable fever, bradycardia, blanching rose spots
Typhoid (enteric) fever
What are the 2 broad categories of Salmonella
Typhoid or enteric fever vs primarily gastroenteritis
Is adenocarcinoma of the lungs peripherally or centrally located
Typically peripherally
How do you diagnosis Wilm's tumor
US + CT abdomen + biopsy + resection
How do you diagnose renal cell carcinoma
US or CT + biopsy
How do you diagnosis cirrhosis
US, definitively with liver biopsy (screen for HCC with US + alpha-fetoprotein)
Patient is a 25-year-old white male complaining of LLQ pain, bloody diarrhea, and crampy rectal pain (tenesmus). What does this patient likely have
Ulcerative colitis
What is the initial imaging study of choice for abdominal aortic aneurysm
Ultrasound
What is the initial test used in suspected choledocholithiasis
Ultrasound
What is the recommended initial modality to evaluate breast masses in women <40 years old
Ultrasound
What is the test of choice for diagnosing cholelithiasis
Ultrasound
How do you diagnose thyroid masses
Ultrasound + biopsy if >1cm
How should you work up a thyroid nodule
Ultrasound - thyroid uptake scan - fine needle aspiration
How do you diagnose hepatocellular carcinoma
Ultrasound and will see increased alpha-fetoprotein
How do you diagnose fibroadenomas
Ultrasound or mammogram + fine needle biopsy or excision biopsy
How do you diagnose breast abscess
Ultrasound or mammogram in nonlactating women
How do you workup dysfunctional uterine bleeding
Ultrasound, FSH, LH, prolactin, estradiol, testosterone, TSH, T3, T4, DHEAS
What is the 1st line for diagnosing pyloric stenosis
Ultrasound, but Upper GI with contrast will show string sign
What is the initial test of choice for suspected cholecystitis
Ultrasound, thickened gallbladder >3 mm
What additional imaging can you order in suspected patellar tendinitis
Ultrasound: shows hypoechoic areas, MRI: shows tendon thickening in chronic cases
When should you order a PTT
Unexplained bleeding or bruising, or to monitor heparin use
Patient is a 58-year-old man with a history of coronary artery disease, hypertension, and hyperlipidemia presents to an emergency department for evaluation of chest pain. He reports somewhat suddenly experiencing dull left-sided chest discomfort while at rest at home that was not relieved with taking nitroglycerin. His vital signs are T 37.1, HR 94 beats per minute, BP 133/87, and O2 saturation 97% on room air. His ECG shows no ST-segment changes; serum troponin is not elevated. His chest pain subsequently resolves, and he is admitted to the cardiac service for further management. What did this patient experience
Unstable angina
What is test is indicated for evaluation of Chron's, esophageal motility disorders/webs/rings, peristalsis, scarring/strictures/lesions of upper GI tract
Upper GI Series (Barium swallow, esphogram)
What is the test of choice for Crohn disease
Upper GI series
How do you diagnose hiatal hernias
Upper GI series and endoscopy
How do you diagnose gastric carcinoma
Upper endoscopy with biopsy
What is the diagnostic test of choice in suspected esophageal cancer
Upper endoscopy with biopsy
Patient is a well-appearing 9-month-old male with a rash that comes and goes. According to the mother, citrus was recently added to the patient's diet. On physical exam, you observe a widespread rash composed of blanchable, edematous, pink, papules and wheels on the face, trunk, and lower extremities. What does this patient have
Urticaria
How long does it take rib fractures to heal
Usually 4-6 weeks with rest, analgesia and cessation of inciting activity
How does Dubin-Johnson Syndrome present clinically
Usually asymptomatic but can have mild icterus
How do you manage nipple discharge
Usually benign but can perform proximal duct excision to eliminate and diagnosis nipple discharge
How do you diagnose Lyme disease
Usually clinical, can use ELISA followed by Western blot if positive, can use IgM or IgG antibodies to B. burgdorferi
How do you diagnose influenza
Usually clinical, rapid antigen test in clinic
What is the gold standard for diagnosing dysfunctional uterine bleeding
Uterine dilation and curettage
What are alternative treatments for sleep apnea
Uvulopalatopharyngoplasty vs tracheostomy for failed conservative therapy or life-threatening sleep apnea
Posterior wall infarction is indicated by ST depression in what leads
V1-V3
How do you conservatively manage WPW
Vagal maneuvers, Class 1A antiarrhythmics such as procainamide
How do you treat vaginal dryness in menopausal women
Vaginal lubricants, lose dose estrogen creams
What is the 1st line treatment for CMV retinitis
Valganciclovir, 2nd line is Ganciclovir + Foscarnet
How do you manage grand mal seizures
Valproic acid, phenytoin, carbamazepine, lamotrigine
How do you treat MRSA osteomyelitis in patients >4 months old
Vancomycin or linezolid
What agents are available for tobacco cessation
Varenicline: Chantix, bupropion
Patient is a 77-year-old Hispanic female with a dull ache in her legs that is worsened with prolonged standing and relieved with rest and elevation of her legs. She has 14 grown children and a past medical history of obesity and hypertension. On physical exam, her bilateral lower legs are edematous with multiple dilated, tortuous superficial veins. What does this patient have
Varicose veins
Patient is a 59-year-old man presents with a visual disturbance that occurred one day ago. He reports that he experienced a "curtain coming down" over his left eye that lasted a few minutes. His past medical history includes long-standing type 2 diabetes mellitus, hypertension, coronary artery disease, and a 20 pack-year smoking history. On physical exam, he has bilateral carotid bruits. An ultrasound duplex of his carotids shows bilateral stenosis with 40% on the right and 75% on the left. What does this patient likely have
Vascular carotid disease
What is the second most common cause of dementia
Vascular disease
What are the most common causes of syncope
Vasovagal or idiopathic
What is the gold standard for diagnosing DVT
Venography
What is the first line imaging test for DVT
Venous duplex ultrasound
What small risk comes with the transdermal patch
Venous thrombus embolism
Patient is a 71-year-old male who was admitted to the acute care hospital two days following a massive CVA with possible brainstem infarct. Because he was also experiencing secondary respiratory failure, he was intubated and placed on mechanical ventilation. He was subsequently transferred to the neurointensive care unit where he was stabilized. His present vital signs are: respiratory rate 14 (ventilator rate), temperature 100.4 F. His SpO2 is 95%. His rating on the Glasgow Coma Scale is 5. What does this patient have
Ventilator associated pneumonia
Herniation through a weakness is the abdominal wall is called
Ventral (incisional) hernia
What is first line for prophylactically treating cluster headaches
Verapamil
Patient is a 9-year-old girl with multiple lesions on her hands and feet. She reports that these are not painful or itchy, but they are very embarrassing. Her past medical history includes atopic dermatitis. On physical exam, she has multiple 4-5 mm flesh-colored, sharply demarcated, rough, round, and firm nodules on her hands and feet. What does this patient have
Verrucae
How do you rapidly test for HIV
Via blood or saliva test
What enterotoxin cause of diarrhea is usually due to contaminated food/water and overcrowding
Vibrio cholerae
Patient is a 45-year-old male with a one-week history of hacking non-productive cough, low grade fever, malaise and myalgias. The chest x-ray reveals bilateral interstitial infiltrates and a cold agglutinin titer that is negative. Examination reveals scattered rhonchi and rales upon auscultation of the chest. What does this patient have
Viral pneumonia
What causes influenza
Viral respiratory infection caused by orthomyxovirus
How do you diagnose adrenal carcinoma
Virilizing features, plasma fractionated metanephrines/24-hour urine metanephrines, serum potassium, 24-hour urinary free cortisol or dexamethasone suppression test, high levels of DHEA-S
How do you diagnose pectus excavatum or carinatum
Visual inspection and chest x-ray
How do you diagnose an anal fissure
Visual inspection with anoscopy
How do you diagnose hemorrhoids
Visual inspection, DRE, fecal occult blood testing
Patient is a 38-year-old man with a history of a gastric bypass for morbid obesity comes to your office with a hemoglobin level of 10 g/ dL. His MCV is 88 mm3. His ferritin level is 35 mcg/ L, and his red cell distribution width is high. His reticulocyte count is high. Further questioning reveals mild anorexia, diarrhea, glossitis, and distal paresthesia. On exam you notice she has a swollen red tongue. What does this patient have
Vitamin B12 deficiency anemia
Patient is a 7-year-old female with large patches of depigmentation affecting the neck, upper back and the chest of three years duration. The whitish patches are sharply demarcated with some residual brownish areas within. Some hairs in the involved areas have become white as well. Wood's light examination reveals a "milk-white" fluorescence over the lesion. What does this patient have
Vitiligo
How do you diagnose a cystocele
Voiding studies and urodynamic studies
What can be a complication of compartment syndrome
Volkmann contracture
Twisting of the any part of the bowel at its mesenteric attachment site is called
Volvulus
What are causes of low anion gap (<16)
Vomiting (loss of hydrogen), bulimia, antacid overdose, bicarbonate addition
Patient is a 30-year-old woman with a recurrent history of nosebleeds and heavy menses. She recently read that taking a baby aspirin was good for the heart. However, ever since she started taking aspirin, she has been experiencing more and more nosebleeds. Her father and paternal uncle similarly have histories of prolonged nosebleeds. Labs show increased PTT, normal PT, and increased bleeding time. What does this patient have
Von Willebrand factor deficiency
What is the most common congenital disorder of hemostasis
Von Willebrand factor deficiency (autosomal disorder)
Short PR interval and a delta wave on EKG suggest
WPW
How do you treat mastitis
Warm compresses, breast pump, anti-staphylococcal antibiotics: dicloxacillin (250 mg QID x 10 days), nafcillin, cefazolin + encouragement to continue breastfeeding + NSAIDs for inflammation
What are the 3 main functions of the large intestine (cecum & colon)
Water absorption from undigested food, waste removal, vitamin absorption (Vit K & biotin)
Upper GI series is contraindicated if perforation is suspected, what contrast can be used to avoid this contraindication
Water soluble - gastrografin
How does hypophosphatemia present
Weakness, muscle and bone pain, osteomalacia, rickets
How do you diagnose osteoarthritis
Weight-bearing films of affected joint show joint narrowing, osteophytes, subchondral sclerosis
What findings can be seen on chest x-ray in someone with a PE
Westermark sign or Hampton Hump
How do you confirm the diagnose of HIV if ELISA test is positive
Western blot
Where is Coccidioides most commonly found
Western states due to fungal inhalation
How do you manage pancreatic carcinoma if the cancer is only confined to the head or duodenal area
Whipple procedure = radical pancreaticoduodenal resection
How dose lice present
White oval-shaped egg capsules at the base of the hair shafts
How do you manage small bowel carcinoma
Wide segmental surgical resection and adjuvant chemo for patient with positive lymph nodes
How do you diagnose aplastic anemia
Will see pancytopenia: lower WBC, RBC, platelets, retic, normal MCV
Patient is a 15-month-old male who is brought in to your office for his routine exam. On exam, you notice that he has no irises, consistent with aniridia. He is also found with a palpable, non-tender mass on the left side of his abdomen. On further questioning, his mother reveals that her cousin had a similar abdominal mass at a young age. What does this patient have
Wilm's tumor
When should you calculate anion gap
With metabolic acidosis: Na - (Cl + HCO3)
How soon HIV postexposure prophylaxis be started
Within 72 hours
What does stage I-III mean within regards to breast cancer
Within breast/regional lymph nodes
What is the USPSTF recommendation on screening for breast carcinoma with mammography
Women 50-74 years should undergo yearly to biennial screening (ACS says 45-54 annually and >55 biennial)
The efficacy of the transdermal patch is slightly decreased in what patients
Women > 198 pounds
Combined estrogen and progesterone OCPs should not be used in what patients
Women >35 years of age that smoke, have history of bloods clots, breast cancer or migraines with aura
How do you diagnose melasma
Wood's lamp shows unchanged appearance
How do you treat brown recluse bites
Wound care and delayed excision
How do you treat black widow bites
Wound care, opioids or benzos, anti-venom for elderly and children
What is the 1st line imaging of osteomyelitis
X-ray showing demineralization, periosteal reaction and bone destruction (MRI shows changes before bone scan)
What imaging is required to appropriately grade acromioclavicular separations
X-ray with patient holding a weight
What imaging is required in patients with suspected rotator injury
X-ray, MRI is most accurate
What imaging can be order for biceps tendonitis
X-ray, ultrasound can show thickened tendon, MRI is definitive
Patient is a 3-12-week-old male newborn presenting with complaints of non-bilious projectile vomiting
You note the patient to be dehydrated and have hypochloremic metabolic alkalosis. What does this patient likely have? Pyloric stenosis
Pt presents c/o of dysphagia, regurgitation of undigested food, cough, globus, and halitosis. On esophagram you see a collection of dye behind esophagus at the pharyngoesophageal junction. What does this pt have
Zenker's Diverticulum
Name 3 examples of Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Zidovudine (Retrovir), Emtricitabine (Emtriva), Abacavir (Ziagen)
What syndrome is associated with no suppression of gastrin levels with the Secretin test
Zollinger-Ellison syndrome
How does an anterior shoulder dislocation present clinically
abducted and externally rotated, squaring of the shoulder, sharp prominence of the acromion
How does influenza present clinically
abrupt onset of headache, fever, coryza (catarrhal inflammation of mucous membrane), cough, chills, malaise, URI symptoms and myalgias
How does a posterior shoulder dislocation present clinically
adducted, internally rotated, prominent humeral head
How does biceps tendonitis present clinically
anterior shoulder pain
How do you confirm diagnose of Toxic epidermal necrolysis
biopsy
Red, swollen and painful cluster of boils under the skin
carbuncle
How does chronic mesenteric ischemia present clinically
chronic dull abdominal pain worse after meals (intestinal angina) and weight loss due to anorexia (manage the same way as acute mesenteric ischemia)
What test is indicated to dx & tx lower GI bleed, biopsy lesions, and evaluate IBD (UC & Chron's)
colonoscopy
Patient presenting with confusion, amnesia, vomiting, headache, visual disturbances most likely has a
concussion
How does vibrio cholerae diarrhea present clinically
copious watery diarrhea (rice water stools - grey)
