Family Medicine

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"Atypical" pneumonia organisms include Mycoplasma, Legionella, Chlamydia, and viral, whose CXR presents with bilateral diffuse infiltrates

"Atypical" pneumonia organisms include _______________, whose CXR presents __________

"Barking cough" hoarseness, stridor common in 6 mo - 6 yo suggests croup. Commonly caused by Parainfluenza. Diagnosed with XR showing "steeple sign." Treatment is based on Westley croup score and includes corticosteroids and nebulized racemic epinephrine

"Barking cough" hoarseness, stridor common in 6 mo - 6 yo suggests __________. Commonly caused by _________. Diagnosed with _________. Treatment is _________

"Beaklike" upper GI with abdominal pain and bilious vomiting are suggestive of malrotation with volvulus

"Beaklike" upper GI with abdominal pain and bilious vomiting are suggestive of ______________

"Dew drops on a rose petal" suggest Varicella chickenpox

"Dew drops on a rose petal" suggest ___________

"Frothy" greenish-yellow, or gray, vaginal discharge suggests Trichomonas vaginalis. Women complain of soreness or dyspaerunia

"Frothy" greenish-yellow, or gray vaginal discharge suggests ____________. Women complain of ____________.

"Gold" milk is also called colustrum because it is antibody-rich

"Gold" milk is also called _________

"Ground-glass" infiltrates are suggestive of Pneumocystis jiroveci pneumonia, which is actually a fungus

"Ground-glass" infiltrates are suggestive of ___________ pneumonia, which is actually ______

"Hot" nodules are typically benign. "Cold" nodules are typically biopsied.

"Hot" nodules are typically _______. "Cold" nodules are typically _______.

how long can perimenopause last

- 2 to 8 years

after a c section when is follow up

- 2 weeks

healthy crying behavior

- 2 weeks of age: 2 hours/day - 6 weeks of age: 3 hrs/day - 3 months of age: 1 hr/day

how long is a recurrent episode of depression treated

- 2-3 years

fundal height

- 20 wks the top of the uterine fundus is at the level of the umbilicus - after 20 weeks it elevates 1 cm above the umbilicus for each week of pregnancy

gold standard for confirming diagnosis of GERD

- 24 hour pH probe -

when is rhogam given

- 28 weeks gestation AND if the baby is Rh+ (?) within 72 hours after delivery - also give if there are any episodes of vaginal or intrauterine bleeding

metabolic syndrome

- 3 of the following: -hypertriglyceridemia (>150) low HDL (<40 men, <50 women) elevated fasting blood glucose (>110) excessive waist circumference (>40in men, >35 in female) HTN (>130/85)

usually when does vision screening using a chart begin

- 3 yrs old

mild persistant asthma

- 3-4 days with symptoms/week (every other day) - treat with SABA PRN and low dose inhaled corticosteroids

preconception counceling

- 400-800 micrograms of folic acid - go over substance abuse -immunizations -control any chronic diseases

average age of menopause and how many months of no period leads is needed to dx menopause

- 51 - 12 months

when do you screen for obesity

- 6yo and older

how long can it take for milk production to begin

- 72 hours

gestational htn

- >140/90 - NO proteinuria -in a previoualy normotensive pregnant woman at or after 20 weeks of gestation -tends to recur in subsequent pregnancies and increases the risk of developing htn later in life -

HTN meds for general black population including those with diabetes

- CCB or thiazide

which tests are recommended for the early management of adults with ischemic stroke

- CT & MRI of the brain -renal function -electrolytes - ECG -markers for cardiac ischemia -CBC -PT/PTT -oxygen saturation - blood glucose

imaging for RLQ

- CT with contrast

therapy for moderate COPD

- FEV1 between 50% and 80% - maintenance therapy of inhaled anticholinergics alone or in combo with SABA

diagnosing COPD

- FEV1/FVC ratio <70% or less than the 5th percentile - spiromotry (pulmonary function test) is the gold standard

when would you use FOBT vs fecal immunochemical testing (FIT)

- FIT is more sensitive and specific than FOBT for detecting a lower GI bleed, not suitable for suspected bleeding above the ligament of treitz - multiple negative FOBTs or FITs do not excluse the presence of upper or lower GI blood loss

colorectal screening

- FOBT, flexible sigmoidoscopy or colonoscopy is recommended for patients 50-75

hyaluronic acid injections

- HA injections are less effective in the short term to steroid but equivalent in the intermediate term and superior in the long term

- HBsAG + anti HBsAG - HBeAg + anti HBcAG Resolved acute Hepatitis B infection

- HBsAG + anti HBsAG - HBeAg + anti HBcAG What does this patient have?

main RF for diastolic dysfuntion

- HTN

diagnosis of COPD gold standard

- PFT is the gold standard for Dx (also best screening test) - FEV1/FVC less than the 5th percentile or less than 70% confirms Dx -

normal weight gain in a newborn

1oz per day once the moms milk comes in (2-3 days after delivery)

What is the Duke Criteria

2 Major 1 Major and 3 minor 5 minor

Tx Trigger finger

2 injections only Surgical release if injections dont work

What is diagnostic for Hypertension

2 or more BP readings at 2 seperate visits over 140/90

What are the Major criteria of the Duke Criteria

2 positive blood cultures with typical organism 1 hr apart atleast Echo positive evidence vegitation or new valve regurgitation

What is the treatment for scabies

2 topical treatments separated by 1 week apart with prescription of Permethrin 5% Apply topical med neck down leave on over night rinse in AM

How long after starting therapy are pts not contagious

2 weeks

how long do postpartum blues last

2 weeks

Even after successful treatment for scabies how long can the itching last

2-4 weeks

How long after last drink do you get delerium tremons

2-7 days

how much of ones diet can be from saturated fats

25-35%

X-ray will show ________ Lisfranc fx

2nd metatarsal shifted laterally

How ong does the rash of Rubella last

3 days

what is Ventricular tachycardia

3 or more consecutive PVC at rate > 100bpm

Door to Fibrinolytics for MI in how many min

30min

when does group B screening occur

35-37 weeks gestation

usually when does hearing evaluation through audiometry begin

4

What age group is 5ths disease MC in

4-10 years old

How long do you treat Endocarditis

4-6 weeks

migraines can last

4-72 hours

What age do you start screening for high cholesterol in women

45

if no RF are present when should diabetes screening begin

45yo

5 A's of Smoking Cessation Ask Advise Assess Assist Arrange

5 A's of Smoking Cessation ___________

5 R's to motivate Smoking Cessation: Relevance Risks Rewards Roadblocls Repetition

5 R's to motivate Smoking Cessation

Unintened weight loss that exceeds ______% in 1 month or ______% in 6 months warrant evaluation

5% in 1 month 10% in 6 months

prediabetes

5.7-6.4

for vaginal delivery when is folow up

6 weeks

What is another name for Roseola

6th disease

For an exanthematous drug eruption what is the typical timeline for onset before the rash

7-10 days

How long can scabies survive off the body

72 hours

How long after starting a drug does SJS/TEN typically occur

8 weeks

chronic cough is a cough that lasts longer than ___ weeks

8 weeks

What is the typical age of onset and peask at what age for acne

8-12 and peaks around 15-18

optimal range for fasting blood glucose

80-120

how long is the first episode of depression treated

9-12 months

Door to PCI for MI in how many min

90 min

What is the treatment goal for BP for HTN

< 140/90

acute vs chronic diarrhea

< 3 weeks acute >3 weeks chronic

Roseola MC in what age group

< 5years old

BP goal for all ages with CKD or DM

<140/90

BP goal for general population <60yo

<140/90

BP goal for general population >60 yo

<150/90

optimal range for postprandial blood glucose between 1-2 hours after meal

<180

treatment for COPD

- SABA PRN - if symptoms are still inadequately controlled a daily dose of LABA should be added - choice between b-2, anticholinergic, theophylline or combo therapy depends on availability and individual response -

suicide severity scale

- SAD PERSONS - sex (male) - age (<19 or >45) - depression, diagnosis of - previous attempt -ethanol or other substance abuse -rational thinking impaired - social supports lacking -organized plan for suicide - no sig other -sickness - one point for each factor present - 4-6 = outpatient treatment is okay - 7-10 patient should be hospitalized

SE of PPIs and adverse events associated with non-judicious short and long term use of PPIs

- SE: headache, diarrhea, abdominal pain, nausea, constipation, bloating - adverse effects: community aquired pneumonia, c-diff diarrhea, osteoperotic fracture, anti-platelet agent inhibition, iron, Mg and B12 deficieny

red zone for asthma symptoms

- SOB when walking or talking -signs of cyanosis - peak flow reading <50%

if a woman cannot have HT replacement what can she use to control vasomotor symptoms

- SSRIs and SNRIs and clonidine and gabapentin - mind & body practices

EKG findings in LVH with strain

- ST depression with T wave inversions in the lateral precordial leads -large S wave in V3

after H pylori is r/o the following therapies have been proposed for functional dyspepsia

- TCA -insufficient evidence for psyhological therapies

causes of post partum hemorrhage

- Tone (uterine atony leading to continued bleeding) Trauma (perineal or cervical lacerations, uterine inversion) Tissue (retained or invasive placental tissue in the uterus) Thrombin (a bleeding disorder-much less common that the other three causes)

preferred method of imaging to evaluate the RUQ

- US

preferred method to study the RUQ

- US - US can accurately evaluate the gallbladder: preferred method of biliary colic/gallstones

TB skin test (PPD) what is positive for person recent immigrant from area known for TB, HIV negative drug user, Mycobacterio lab personnel, Resident/emplyoees of hig-risk congregate settings, Diabetes, Silicosis, Chronic renal failure, Children <4yo, Kids exposed to adults at high risk

> or equal to 10mm

TB skin test (PPD) what is positive for person with no risk factors

> or equal to 15mm

TB skin test (PPD) what is positive for person HIV positive, recent contact with active TB, person with evidence TB on CXR, or immunosupressed pt

> or equal to 5mm

Nephrotic range for proteinuria is

>3.5g/24 hours

What level BNP for HF

>500

first choice analgesic for short and long term treatment of OA pain

- acetominophen - max dose 4gm/day

what skin condition is topical 5-FU approved for

- actinic keratoses

merchants view

- evaluate patellofemoral joint - top view of the knee obtained with the knee bent at a 45 degree angle showing the patella in the groove of the femus

when is a thyroid US indicated

- evaluation of thyroid nodules and thyroid enlargement but not hyperthyroidism - guide fine needle aspiration

how often should children with new Dx of asthma be followed

- every 2-6 weeks until their asthma is stable and then in 1 to 6 month intervals depending on the level of control and severity

how often should TC and HDL levels be screen

- every 4-6 yrs in adults 20-79 w/0 ASCVD - men>35 and women>45 at risk for coronary heart disease - men 20-35 and women 20-45 if they are at increased risk of heart disease

whats signs are often associated with a herniated disc

- exacerbation when sitting or bending and relief when lying or standing - increased pain with coughing and sneezing - pain radiating dow the leg and sometimes the foot -parasthesias - muscle weakness such as foot drop

obturator sign

- examiner has patient supine with right hip flexed to 90 degress- takes patients right ankle in his right hand as he uses his left hadnto externally/internally rotate patients hip by moving the knee back and forth

which tests have an established role in the diagnosis of CAD

- exercise treadmill tesssting: initial diagnostic testas long as EKG is not interpretable -stress echocardiography -nuclear stress testing

gout/pseudogout

- extreme pain with any movement -painful to touch -athrocentesis with clear or slightly cloudy synovial fluid - negatively biefringent rods: gout

fetal development-week 27

- eyes will open -fetus will practice breathing - by 36 weeks the fetus will gain weight more quickly

AC joint separation

- fall on point of shoulder -pain in region of the AC joint on exam or pain with cross-chest adduction

RF for breast cancer

- family history in first degree relative menarche before 12 and menopause after 45 - advanced age at first pregnancy - genetic predisposition - advanced age - female sex - increased breast density and certain exposures (DES, hormone therapy, radiation, heavy smoking)

blood glucose levels for diabetes Dx

- fasting >126 confirmed on repeat testing - random blood glucose >200 with symptoms of hyperglycemia

in patients with BMI over 25 what labs should be drawn

- fasting blood glucose, serum creatinine and lipid profile

chronic fatigue syndrome

- fatigue for more than 6 months - unrelieved by rest and wosened with exertion - four of the following physical symptoms: impaired memory or concentration, post-exertional malaise, tender lymphadenopathy, sore throat, headache, myalgia, and arthralgia

which tests are the best for evaluating the eradication of H pylori

- fecal antigen and urea breath test - if either is positive the patient will require re-treatment for resistant infection - if the tets are negative and the patient continues to have symptoms then he should be referred to a GI for upper endoscopy. also consider US to evaluate for biliary disease

disequilibrium

- feeling off balance

iron deficiency treatment

- ferrous sulfate 325 mg three times daily - docusate sodium 100mg twice daily as needed for constipation

symptoms of seasonal influenza

- fever, cough, myalgia and sore throat

what must occur in order to treat DVT as an outpatient

- hemodynamically stable - good kidney function -low risk for bleeding

stain SE

- hepatic dysfunction + measure ALT prior to initiating statin therapy - myopahty + CK measure before stating - rare cases of rhabdomyolysis with acute renal failure secondary to myoglobinuria

pain with lumbar flexion is suggestive of

- herniation, osteoarthritis, muscle spasm

PAD

- history of claudication - *ankle brachial index <.9 is consistent with disease* - biggest RF: smoking

HEEADSSS interview

- home -education/emplyment -eating -activities -drugs -sexuality -suicide/depression -safety/ violence

4 yo milestones

- hop on one foot -copy a cross -mash their own food -brush their own teeth

when is fmhx of CHD a RF

- if a first degree relative has CHD male <55 and female <65

what are the indications for starting antivirals for influenza after 48 hours

- if the pt hs moderate to severe CAP with findings consistent with influenza - if the pt is clinically worsening at the time of the initial outpatient visit

if nipple discharge is present....

- imaging studies are needed: mammogram, US, ductogram, biopsy

what findings are diagnostic of asthma

- improvement FEV1 value by >12% or an increase in the percent predicted FEV1 value by 10% after a bronchodilator is given

when are inhaled steroids added to the asthma regimen

- in all patients with persistent asthma whether it is mild, moderate or severe

when do higher rates of relapse occur

- in men , younger age, fewer social supports, drank more prior to treatment and who have poor compliance with drug therapy

when is lung cancer screening recommended

- in patients 55-65 with a 30 pack history of smoking - low dose CT

when are NSAIDs contraindicated

- in patients on anticoagulanets

grade II sprain

- incomplete tear and moderate functional impairment - some loss of motor function - stretching of joint with a definite stopping point

COPD PE findings

- increased AP diameter - decreased diaphragmatic excursion - wheezing (often end-expiratory) - prolonged expiratory phase - decreased height of larynx

when are chances of breast cancer increased

- increased risk if a first degree relative has breast cancer

increased waist circumference and increased wait-to-hip ratio

- increased waist circumference (>40 inches in men, >35 inches in women) - increased wait-to-hip ratio (>.85 for women or >.9 for men)

cigarette smoking and cervical cancer

- increases the risk 4 X

left occiput nterior

- indictaes that the back (occiput) of the fetal head is anterior in the mothers pelvis and to the mothers left

when is a full work up for sepsis required

- infants under 2 mo of age with fever above 100.4 (38 c) - this includes blood culture, CSF and urine

long term effects of uncontrolled asthma

- inflammation, mucuous hypersecretion, airway smooth muscle hypertrophy, angiogenesis, subepithelial fibrosis, less reversibility of the airway obstruction

vaccine recommendations for diabetic patients

- influenza - pneumococcal polysaccharide vaccine: all diabetics over 2yo - one time revaccintion for patient over 64 is the vaccine was first reveived greater than 5 years ago. revaccination should also occur if the patient has nephrotic syndrome, chronic renal disease or immunocompromised - hep B

treatment for copd exacerbation

- inhaled bronchodilators (esp b2 agonists) and oral glucocorticosteroids

treatment for COPD exacerbation

- inhaled bronchodilators, oral glucocorticosteroids such as prednisone with or w/o antibiotics

treatment for chronic cough

- inhlared bronchidilator and maybe inhaled corticosteroid

what is focused on with initial asthma presentation vs asthma control and assessment

- initial: focus on assessment of severity - then focus on the control of asthma

moderate intensity statin should be used when

- initiated or conitnued for adults 40-75yo in patients with diabetes - patients <75 with ASCVD - patients 40-75 with estimate 10 year ASCVD risk <7.5%

wheezes

- inspiratory/expiratory spasms of the bronchioles -continuous - asthma: can be inspiratory or expiratory - chronic bronchitis: wheezes can clear with coughin

what does the anterior drawer test examine in the ankle

- integrity of the anteriotalofibular ligament

infants born to adolescent moms are at a greater risk for

- lower birth weight -STIs - poorer developmental outcome -increased risk of fetal death

three most common causes of back pain

- lumbar strain/sprain -age related degenerative joint changes -herniated disc

triple/quad screen

- markers in the mothers blood - AFP, hCG, unconjugated estriol and dimeric inhibin (in the quad screen) -perform at 15-21 weeks

cauda equina syndrome symptoms and management

- mass effect compresses the cauda equina causing pain radiating own the leg and numbness of the leg - emergency -decompression within 72 hours - higher on differential is patient has bowel or bladder problem - urinary incontinence or retention -saddle anesthesia-anap sphincter tone decreased or fecal incontinene - b/l lower extremity weakness of numbness -progressive neuro deficits

what is included in a prenatal follow up visit. pregnancy weight gain and fundal height

- maternal weight: expected to gain 25-35 lbs if normal weight, if overweight should gain 15-25 lbs and if obeses should gain 11-20 lbs -BP elevation - fetal heat tones: first head at 10-12 wka -fundal height: at 10 wks may be palpable at the pelvis brim. from 2o weeks and on the fundal height often correlates with the weeks of gestation

treatment for chronic sinusitis

- maxamize treatment for allergic rhinitis, including regular use of nasal corticosteroid and allergen immunotherapy -nasal saline irrigation is a useful adjunct - no use to suport the use of Ab in patients with chronic sinusitis

acute bacterial prostatitis

- may present with low back pain -general malaise, chills, hesitancy and pain on urination - fever - tenderness over the prostate on rectal exam

what does a US in the first trimester measure and how close should id be to naeugels rule

- measure the crown-rump length -within 1 week - gestational scan can be seen by 4-5 weeks - fetal pole is seen by 5-6 weeks

what are the imaging methods for dementia and when do you screen

- noncontrast CT or MRI - use to r/o other structural defects

babys can loose how much birth weight and when should they re-gain it?

- normal for babys to lose up to 10% of their birth weight in the first week - weight should be back to birth weight by 2 weeks of age

vestibular suppresant medications while breastfeeding

- occasional doses of meclizine are acceptable - short term use of promethazine is okay (with repeated dosea observe infant for excess sedation)

peroneal tendon tear

- often due to inversion injury and may occur w/ lateral ankle sprain - persistent pain posterior to lateral malleolus -

when is hep C screening recommended

- one time screening for HCV infections to adults born between 1945 and 1965

rotator cuff tendinopathy

- positive apleys scratch test - weakness and pain with empty can test - limited active ROM

popliteal (bakers) cyst

- posterior popliteal area - insidious onset of mild to moderate pain in popliteal area of the knee - most common synovial cyst of knee

what is the strongest lateral ankle ligament

- posterior talofibular ligmane ta

Ca recommendations for premenopausal and post menopasusal women

- pre: 1000 mg/day - post: 1500 mg/ day

stable angina

- predictable pattern of chest discomfort that usually occurs with exertion -relieved by rest or NG in less than 5-10min

radioactive iodine treatment precautions

- pregnancy test before starting treatment - cant be near pregnant women or kids for days after treatment bc iodine excreted in pee and poop - draw TSH evert 2-3 mo until stable - alertt patients to symptoms of hypothyroidism because this will occur at some point

AF with rapid ventricular response

- presence of vtach in the presence of AF - Tx: rate control and rhythm control

AC joint sprain

- present with swelling, brusing, point tenderness of the AC joint after a fall directly on the acromion with arm adducted Type I injuries involve injury of AC ligaments with no injury to the coracoclavicular (CC) ligaments. This causes a tender AC joint that often has mild swelling. This type usually heals within a few weeks.Type II injuries involve a complete tear of the AC ligaments and a sprain or partial tear of the coracoclavicular (CC) ligaments. This causes a tender AC joint, often with significant swelling.Type III injuries involve a complete tear of both the AC and CC ligaments. Significant swelling and tenderness of CC ligaments is present along with visible abnormality of the AC joint. Type III injuries can take several weeks to months to heal.Type IV, V, VI injuries are the most severe. Treatment often requires surgery.

preterm labor

- prior to 37 weeks

dosage of stain

- select a statin based on the patients ASCVD RF (rather than adjusting the dose to target a specific LDL goal)

acute bronchitis

- self limited inflammation of the large airways - cough - purulent sputum -often viral - coughing for more than 5 days - b2 agonist for those who are wheezing

severe preeclampsia criteria

- severe hypertension of at least 160 systolic or 110 diastolic, or - severe proteinuria of at least 5 grams in a 24 hour period or 3-4 + on dipstick, or signs of fetal compromise (intra-uterine growth restriction or fetal demise, or oligohydramnios), or persistent signs and symptoms of epigastric or right upper quadrant pain, or the HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets), or persistent neurologic signs and symptoms such as persistent and severe headache, scotoma (visual field defect), or seizures (eclampsia), or other evidence of end-organ damage such as oliguria (<500 cc in 24 hours), pulmonary edema - A patient with blood pressure in this range would need an anti-hypertensive in order to prevent sequelae of severe hypertension, such as myocardial infarction or stroke. It would be important, however, not to drop the blood pressure too far or too fast, in order to avoid decreased perfusion to the uterus (as well as the brain and other vital maternal organs).

COPD v Asthma

- significantly reversible is defined as an increase in FEV1> 12% after bronchodilator note: FVC is normal to decreased in COPD but always decreased in astham - macrophages and T killer cells play a role in COPD

chronis cinusitis

- similar symptoms to acute sinusitis but last at least 12 weeks - must have 2 of the following: + nasal obstruction/congestion +mucopurulent dranage +facial pain + pressure or fullness + decreased sense of smell

joint effusion seen with osteoarthritis or degenrative meniscal inuries

- simple joint effusion with clear, straw colored transudative fluid

when is zoster vaccine recommended

- single dose for adults 60+ - vaccine is given regardless of whether they report a prior episode of herpes zoster - CI: pregnancy, immunocompromised

causes of secondary HTN

- sleep apnea, chronic renal disease, renovascular disease, drugs, pheo, primary aldosteronism, chronic steroid use, cushings, thyroid disease, parathyroid disease, coarctation of aorta

main RF for DVT

- smoking & obesity

signs that help predict COPD

- smoking more than 40 pack years - self reported history of COPD -maximal laryngeal height of 4cm or less - age at least 45

venous insufficiency

- softer than chronic lymphedema - erythema, dermatitis, and hyperpigmentation along the distal aspect of the leg and skin - may see ulceration near the medial and lateral malleoli

who is the best persin to get a stress test

- someone with an intermediate pre-test probability

herbal remedies for hot flashed

- soy, black cohosh, flaxseed and st johns wart

what is the spatula and cytobrush used for in the pelvic exam?

- spatula is used for the exo-cervical sample -cytobrush is inserted into the endo-cervix

three most common causes of bleeding in early pregnancy

- spontaneous abortion -ectopic pregnancy -idiopathic bleeding in viable pregnancy

12 month milestones

- stands alpne -pincer grasp -mama dada (specific) plus another word or so - hands parent a book to read, points when wants something, imitates activites and plays ball with examiner

if there is high clinical supicion but nothing seen on xray what do you do

- start empiric treatment and repeat chest x ray in 24-48 hrs

2 month check up

- start some foods at * 4 months* - vit D 400 units/day unless drinking 32 ounces of formula or milk a day) - most babies sleep through the night by 4-6 months - place on back to go to sleep

naegeles rule

- start with the first day of the last normal menstrual period then: - add 1 year - subtract 3 months - add 1 week

GI problems due to obesity in peds

- steatosis and gallbladder disease - screen for steatosis at 10 if BMI greater than 95% or if greater than 84-94 but with RF and every 2 years therafter with AST and ALT - refer to GI for levels that are twice the upper limit of normal

acute cholecystitis

- stone lodged in the cystic duct - similar symptoms to biliary colic but lasts longer than 4-6 hours - fever, elevated WBC

managment of rotator cuff tendinopathy and impingement

- strengthen rotator cuff and scapular stabilizers to increase the subacromial space allowing the tendon to heal

cellulitis

- strep: small skin breaks - staph: larger wounds, ulcers - RF: diabetes, vascular disease

grade I sprain

- stretching or small tear of ligament - mild tenderness and swelling - slight to no functional loss

cremasteric reflex

- stroke or pinch the superior medial aspect of the thigh - ipsilateral testicular retraction should occur - absence of the cresmaster reflex may indicate testicular torsion - note: may be absent on PE in normal testes

rooting reflex

- stroking newborns cheek, which prompts the infant to turn her head towrad stimulus - disappears around 4 mo of age

evidence of active labor

- strong regular contraction every 3-5 minutes -cervical dilation of 4-5 cm+ in the setting of contractions -fetal heart tracing does not impact the diagnosis of active labor

disease processes with low radioiodine uptake

- subactute thyroiditis, silent thyroiditis, iodine induces, exogenous L-thyroxine, struma ovarii, amiodarone

ressiting internal rotation tests

- subscapularis muscle

paraoxysmal nocturnal dyspnea

- sudden, severe SOB at night that awakens a person from sleep, often with coughing and wheezing - often associated with CHF - occurs several hours after a person has fallen asleep - often relieved by sitting upright, but does not resolve as quickly as orthopnea

when is a breast MRI indicated

- surveillence of women with more than 30% lifetime risk May be used as a diagnostic tool to identify more completely the extent of disease in patients with a recent breast cancer diagnosis. Contrast-enhanced breast MRI may be indicated in the evaluation of patients with breast augmentation in whom mammography is difficult.

DVT

- swelling, pain, discoloration in the affected extremity - homans sign: pain on passive dorsiflexion of the foot - chronic venous infsifficiency may result from DVT or valvular incompetence - may have an accompanying inflammatory response which can cause low grade fever

influenza signs of complications

- symptoms last longer than 5-7 days without any relief -difficulty breathing w-orsening cough -diffculty maintaing hydration

major depressive disorder v bereavement

- symptoms must be present 2 full months after the loss for the Dx of MDD

bacterial pneumonia

- temp grater than 38 (100.4) - step pneumo most ofren - no prodromal symptoms (myalgia, rhinorrhea) -pleuritic chest pain, fever, chills, dyspnea, cough -pleural effusion common - crackles are a cardinal feature - often head crackles

A1c testing guidlines

- test at diagnosis and 2X/year in patients who are stable and A1c < 7 - test 4X/year when therapy is changing or goals are not met

selective screening for anemia

- test if: +at risk of iron deficiency because of special health needs -low iron diet -environmental factors

testicular torsion

- testical rotates around vascular supply -surgical emergency w/ a limited window of 4-12 hrs to save the testicle -swollen tender scrotom and the cremasteric reflex is absent - causes the testicle to have a "transverse lie" - one testicle may sit higher

placental abruption

- thrid trimester bleeding - abdominal pain, uterine contraction and non-reassuring fetal heart tracing - occurs when the placenta peels away from the inner wall of the uterus before delivery-either partially or comepletely - immediate medical attention

thyroid replacement therapy. when do you recheck TSH and once it is stable how long is it checked?

- thyroxine: 1.5 - 1.8/kg - increase dose slowly -recheck TSH in 6 weeks - when stable TSH is reached, check once or twice annually

most effective pharmacologic agent for the treatment of allergic rhinitis

- topical nasal steroids

torsion of the testicular appendages

- torsion of the testiular appendage - appendix testes is a small vestigal structure locate on the anterosuperior aspect of the testis - abrupt pain , less severe than testicular torsion -pain localized to the upper pole of the testis (region of the appendix testes) w/o any tenderness in the remaining areas of the testes - blue dot sign

primary pathophysiology of GERD

- transient LES relaxations

what is legal consent to treat adolescents w/o parental knowledge in all 50 states

- treatments for STIs

benefits and risk of hormone therapy replacement

- treats: hot flashes and vasomotor symptoms, strophic vaginits and dyspareunia, osteoperosis, -risks: breast CA, endometrial CA, after 60 increases CAD, stroke,

acute migraine treatment

- triptans -ergot alkaloids

diagnostic criteria for HTN

- two elevated mesurements - five minutes apart - one in each arm, should be made on 2+ visits

when is drawing TSH indicated

- type 1 diabetes (1/yr), newly diagnoses dyslipidemia, or women 50+

causes of secondary htn in children

- umbilical arterial or venous access during perinatal period can predispose to renal vascular disease - UTI: one of the leading cuases of htn and renal insufficiency later in life due to renal scarring following the infeection - catecholamine xs - family history of renal disease -coarctation of the aorta

BMI catagorizations

- underweight: below 18.5 - normal: 18.5 - 24.9 - overweight: 25 - 29.9 - obese: 30+

when does colic peak & definition

- unexplained paroxysmal bouts of crying that lasts at least *3 hrs a day, at least 3 times a week for longer than 3 weeks* - begins 2 weeks of like and peaks at 6 weeks of life - usually resolves by 12 weeks - Tx: stick with breast milk

influenza

- upper and lower respiratory tract symptoms accompanied by systemic symptoms -very abrupt - winter - high fever of 102-104 and chills, myalgia and headache - tx: zanamivir, oseltamivir, amantadine and rimantadine decrease duration by 1 day but should be given within first 48 hous of illness

some facts about HRT

- use of combined estrogen and progesterone beyond 3 years increases the risk of breast cancer - beginning HRT after 60 increases the risk of CAD - systemic estrogen is most effective for the treatment of vasomotor symptoms - increases endometrial cancer -good for osteoperosis

upper endoscopy and GERD

- useful for evaluating of complications of GERD

what are the thiazolidinediones useful for and what are some major SE

- useful for those who cannot tolerate GI SE of emtoformin - for those who have hypoglycemia with sulfonylureas - SE: increased risk of HF, edema, and bone fracture

physical exam findings of allergies

-allergic shiners -allergic salute: horizontal crease across the bridge of the nose -clubbing -dennie morgan lines: infraorbital creases

spondylolisthesis

-anterior displacement of a verteba or the verterbal column in renlation to the vertebra below -any age - causes aching back and posterior thigh discomfort that increases with activity or bending

patellofemoral syndrome

-anterior knee pain - overuse - worse after prolonged sitting

imporatn characeristics of dementia

-aquired, progressive, global, interfers with function

rhonchi

-expiratory/inspiratory continous low pitch sounds, sound like snothing -associated with larger bronchical secretions and airway narrowing -continuous - thought to be mucous secretions -clear after coughin

What are the 4 types of non small cell carcinoma

Adenocarcinoma Squamous cell Large cell (anaplastic) carcinoma Bronchoalveolar

presyncope

-feeling light headed for faint, as opposed to actually passing out -may feel worse when they stand up quickly

gestational dating and conceptional/developmental age

-gestational age: time elapsed since the first day of the LMP - conceptional/developmental age of the embryo is calculated from the date of fertalization or 2 weeks after the first date of the LMP

diabetic ulcer management

-grade 1/2: outpatient - grade 3: evaluate for possible osteomyelitis as well as PAD - grade 5: emergent hispitalization and surgical consultation

disease processes with high radioiodine uptake

-graves, multi-nodular goiter, toxic solitary nodule, TSH secreting pituitary tumor, HCG secreing tumor

complications of PUD

-hemorrhage or performation - gastric outlet obstruction syndrome

direct occiput anterior

-indicates that the occiput is directly posterior to the pubic symphysis (with the babys face towards the rectum)

tendinitis

-inflammatory etiology that occurs only in the first days after an *acute* tendon injury

gastritis

-inflmmation of stomahc lining and can cause epigastric pain that improves immediately following a meal -associated with alcohol and NSAID use

thrombolytic therapy is most effective when

-initiated within 90 minutes of onset - can be given within 3 hours of stroke onset

what does the inversion stress test examine in the ankle

-integrity of the calcaneofibular ligament

when is ECG w/o imaging indicated

-intermediate risk for CAD - chronic and stable nature of disease - able to excercise including patients with less than 1 mm ST-segment depression or complete RBBB on resting ECG

when can intra-arterial therapy be given for a TIA

-w/in 6 hours

Physical exam of community acquired pneumonia

Adentitious sounds (crackle) Dull to percussion Bronchial sounds over consolidation Increase fremitus + Egophany

Useful treatment for mild and intermittent allergic rhinitis is antihistamines

Best treatment for mild and intermittent allergic rhinitis is _________________

Migraine prophylaxis

Beta blockers CCB TCA Anticonvulsants

Treatment options for PSVT

Beta blockers, calcium channel blockers Radiofrequency ablation

Osteopenia is present with what T score

Between -1.0 and -2.5

Bilateral lower extremity edema is MC due to chronic venous insufficiency

Bilateral lower extremity edema is MC due to _____________

SS cauda equina syndrome

Bilateral lower extremity weakness saddle anesthesia sphincter dysfunction bowel and bladder dysfunction

What is the only class of lipid therapy safe in pregnancy

Bile Acid Sequestrants Cholestyramine

Biphosphonates should be taken with an empty stomach and full glass of water. Patient should stay upright for 30 minutes after taking pill

Biphosphonates should be taken with _______________

Bipolar disorder is treated with lithium, valproate, carbamazepine

Bipolar disorder is treated with ____________

Differential diagnosis for acute dyspnea

Bronchospasm PE pulmonary edema pneumothorax pneumonia MI Anxiety/panic attack anemia upper airway obstruction

What is characteristic of a brown recluse spider

Brown spider with a dark brown violin shaped marking on the belly

Buproprion is CI in: Eating disorders MAOi use within 2 weeks Seizures Typically started 1-2 weeks before quitting

Buproprion is CI in __________ Typically started __________

Buproprion is associated with risk of seizures and therefore contraindicated in hx of them.

Buproprion is associated with __________

Button batteries if ingested are concerning because electric conduction with esophageal wall may cause perforation

Button batteries if ingested are concerning because ____________

chronic diarrhea without apparent cause work-up should include

CBC, ESR, stool for ocult blood, ova and parasites, stool assay

Lab tests for jaundice

CBC, UA, Lifer function panel, alkaline phosphatase, albumin

DX studies and results for walking pneumonia

CBC- WBC usually normal or slight elevated CXR- segmental lower lung zone infilltrates

What is a good 1st line tx for AA people

CCB

Tx prinzmetals angina

CCB and nitro

What are the genes that make up the risk for familial melanoma

CDKN2A, CDK4, BRACA2

How do you determine if long term stroke prophylaxis is needed

CHA2DS2 VASc Score

CHD equivalents are: Peripheral Arterial Disease Cerebrovascular disease Abdominal Aortic Aneurysm DM

CHD equivalents are ___________

Differential diagnosis for chronic dyspnea

CHF COPD Asthma interstitial lung disease pulmonary hypertension pleural effusion obesity ascites kyphoscoliosis anemia anxiety lung mass

Causes of bilateral leg edema

CHF Pulmonary hypertension Venous insufficiency Cirrhosis Renal disease Hyopalbuminemia Chronic renal failure Glomerulonephritis Nephrotic syndrome Medications Myxedema (Hypothyroidism) Allergic reaction Idiopathic edema

What is the CHAD VAS 2 score

CHF +1 HTN +1 Age <65 +0 65-74 +1 >75 +2 Diabetes +1 Stroke/TIA/Thromoembolism hx +2 Vascular Dz +1 Sex Male +0 Female +1

neck vein distension, peripheral edema, and rales suggest

CHF or pulmonary hypertension

Lesions with low probability for malignancy can be watched how often

CT every 3 months for a year and if stable CT can be reduced to every 6 months for the next 2 years

What are some indications for hospitalization of a patient with pneumonia

CURB 65 Score Confusion BUN > 19 Respiratory rate > or equal to 30bpm Blood Pressure Systolic < 90 and Diastolic < 60 Age > 65

DX bronchitis

CXR

DX foreign body aspiration

CXR- only helpful if radiopeque PA/Lat xray of neck soft tissue Rigid Bronchoscopy

CXR for PE results

CXR- usually normal Hamptoms hump or Westermarks sign

DX studies and results for community acquired pneumonia

CXR: lobar or segmental infilltrates Sputum: gram stain CBC Procalcitonin: Increase if bacterial cause

What is a Ranke complex

Calcified primary focus and calcified hilar lymph node represent a healed primary infection

What is a Ghon complex

Calcified primary focus represent a healed primary infection

mcmurray test

Can assess the medial and lateral menisci, though it has low sensitivity and specificity for diagnosing meniscal tears The physician holds the patient's heel with one hand and grasps the knee over the medial and lateral joint lines with the other hand. The patient's knee is flexed as much as possible. The tibia is rotated either internally (tests lateral meniscus) or externally (tests medial meniscus) as the knee is extended to about 90 degrees. A varus stress (lateral meniscus) or valgus stress (medial meniscus) is applied across the knee joint while the knee is being extended. The test is positive if a clunk or click is felt, or if testing causes reproducible knee pain.

If a pregnant woman contracts 5ths disease what will happen to the fetus

Can cause hydrops fetalis

What is Kaposi Sarcoma

Cancer of connective tissue

What is prinzmetals angina

Caused by vasospasm usually wakes people early morning transient chest pain at rest

Inpatient tx community acquired pneumonia

Ceftriaxone and macrolide or Floroquinolone

Causes of unilateral leg edema

Cellulitis DVT Hematoma/ soft tissue injury Baker Cyst Venous insufficiency Lymphedema Extrinsic Compression Neoplasm Lymphoma

who should be screen for hyperlipidemia

Adults > 20 yrs should be screened for hyperlipidemia if at increased risk for CAD (i.e., diabetic, hypertensive, premature personal history of atherosclerosis or family history of CAD in males < 50 yrs or females < 60 yrs)

How and where does erysipelas appear

Affects lower extremities and face Pain, superficial redness, and plaque-like edema with sharp defined margin to normal tissue

After a laceration, first step is IRRIGATION, then consider Tetanus shot

After a laceration, first step is __________

If 3rd trimester bleeding present when can you do a speculum exam

After a transvaginal US is done to determine the location of the placenta and if no placenta previa or vasa previa then a speculum exam can be done.

After breast cyst aspiration, follow up in 4-6 weeks to check for recurrence

After breast cyst aspiration, follow up in _______________

After delivery, brown-colored lochia occurs for about a week. White-yellowish lochia occurs for about 3-6 weeks

After delivery, brown-colored lochia occurs for _____. White-yellowish lochia occurs for _________.

Age-related macular degeneration is characterized by loss of central vision

Age-related macular degeneration is characterized by loss of ____________

What is the MC chronic arrhythmia

Atrial fibrilation

Diagnosis of PCOS is based on: Hyperandrogenism Chronic anovulation Polycystic ovaries on ultrasound

Diagnosis of PCOS is based on _____________

DM Goals: HA1c < 7 BP 130/80 LDL < 100

DM Goals HA1c ____ BP _____ LDL _____

What is Aortic Regurgitation

Diastolic Murmur Back flow from aorta to left ventricle

What is Mitral Stenosis

Diastolic Murmur Flow obstruction of flow from left atrium to left ventricle causing increase left atrial pressure

What criteria is used to help diagnose Endocarditis

Duke Criteria

MC type of ulcer in gastric system

Duodenal MC than gastric

vertigo can be central or peripheral

Central: associated brainstem or other neurologic features Peripheral: isolated vertigo with or without hearing loss

antitussives can be centrally or peripherally acting list examples of each

Centrally: codine, dextromethorphan Peripherally: benzonatate

Chronic hepatitis C may lead to cirrhosis, hepatocellular carcinoma, hepatic decompensation

Chronic hepatitis C may lead to ____________

What is acne rosacea

Chronic inflammatory condition located at the "flush" areas of the face Papules and pustules superimposed on background of telangiectasias and general erythema

What are some clinical manifestations of pulmonary TB

Chronic, productive cough chest pain hemoptysis night sweats fever/chills anorexia and weight loss

Classic sign of a herniated disc is sciatica

Classic sign of a herniated disc is __________

DX MI

Clinical Hx EKG- ST segment elevation in 2 or more anatomically contiguous leads Cardiac enzymes ( CK and Troponin)

How do you dx seborrhic keratosis

Clinical or dermatoscope

How do you diagnose murmurs

Clinically and Echo

What doe pustular psoriasis look like

Clinically apparent pustules

What does acne start as______ and becomes ______

Clogged pores or comedones and gets debris stuck in pores which leads to inflammation of papules/pustules that have erythema and edema

Tx nocturnal monoclonus

Clonazepam

Close contacts of someone with menigococcal infection should be given Cipro or Rifampin prophylactically

Close contacts of someone with menigococcal infection should be given ___________

Closure of bite wounds should be limited to lacerations < 6 hours old

Closure of bite wounds should be limited to ___________

TX intertrigo

Clotrimazole cream or nystatin cream

What does cocaine withdrawl look like

Cocaine bugs depressed

What are pulmonary nodules known as

Coin lesions

DM treatment that is acceptable with renal insufficiency is Thiazolidinediones. These benefit DM by increasing insulin sensitivity in the adipose tissue, decreases triglycerides and increases HDL.

DM treatment that is acceptable with renal insufficiency is ____________. These benefit DM by _____________

Signs and symptoms of A-fib

Fatigue, Tachypnea, dyspnea, palpitation, lightheaded

Fecal occult blood tests recommended annually Sigmoidoscopy every 3-5 years Colonoscopy every 10 years

Fecal occult blood tests recommended ____ Sigmoidoscopy every _____ Colonoscopy every _____

What are risk factors for drug reactions

Female Prior history of drug reaction Recurrent drug exposure HLA type

Steidas fracture

Femoral avulsion fracture of MCL

Fetal heart tones are heard by 10 weeks

Fetal heart tones are heard by __________

What is Centor criteria and used to determine what

Fever > 100.4F Anterior cervical lymphadenopathy Lack of Cough Exudates on tonsis Indicates need for throat culture and Group A Strep

Fever over 104, Tachycardia, Metabolic acidosis, Rhabdomyolysis suggests Malignant hyperthermia

Fever over 104, Tachycardia, Metabolic acidosis, Rhabdomyolysis suggests ______________

Fever, cough, tachypnea, toxic-appearing suggests pneumonia

Fever, cough, tachypnea, toxic-appearing suggests ___________

What is the prodrome for Hand foot and mouth disease

Fever, sore throat, malaise for 2 days

Fever, sore throat, muffled voice, with child leaning forward with chin thrust forward suggests epiglottitis. Diagnosed with "thumbprint sign" on XR. Treatment is with airway management and antibiotics

Fever, sore throat, muffled voice, with child leaning forward with chin thrust forward suggests ________. Diagnosed with ________. Treatment is _____________

Signs and symptoms of Endocarditis

Fever, weight loss, EKG conduction abnormalities, Murmur, palor, splenomegaly, Splinter hemorrhage

What is the best drug to treat hypertriglyceridemia

Fibrates= Gemfibrozil and Fenofibrate

Special test DeQuervians

Finklestein

First line treatment for Tourette's is clonidine due to ability to control ADHD and OCD. Haloperidol and pimezole are more potent, but have worse side effects

First line treatment for Tourette's is __________ due to ___________. ___________ more potent, but have worse side effects

First line treatment for osteoporosis is Biphosphonates

First line treatment for osteoporosis is ____________

First line treatments for Parkinson's are levodopa for motor impairment, dopamine agonists (pramipexole, ropinirole) against to lower the risks of complications, and MAO inhibitors

First line treatments for Parkinson's are _____________

First-line treatments for CHF include: ACEIs low-dose BBs

First-line treatments for CHF include _____________

What do the later lesions of SJS/TEN look like

Flaaccid blisters that spread and break easy and leaving large areas of red exposed oozing dermis

SS ant shld dislocation

Flattened deltoid, fullness in anterior chest, prominence of acromion, guarding

FABER Test

Flexion, Abduction, and External Rotation The Faber test looks for pathology of the hip joint or sacrum (sacroiliac pain from sacroiliitis). The test is performed by flexing the hip and placing the foot of the tested leg on the opposite knee. Pressure is then placed on the tested knee while stabilizing the opposite hip. The test is positive if there is pain at the *hip or sacral joint or if the leg can not lower to the point of being parallel to the opposite leg* The FABER test should be done on all patients suspected of having sacroiliac pain, not just in the elderly patients. Sacroiliitis can occur in the young population as well.

Jersey Finger

Flexor tendon injury Pain and swelling at volar aspect of DIP jt Inability to flex at affected DIP jt

Signs and symptoms of left sided heart failure

Fluid on lungs Dyspnea Paroxsymal nocturnal dyspnea rales, ronchi chronic non productive cough Pink frothy sputum HTN S3 or S4

How do you treat Benzo intoxication

Flumazenil

diarrhea due to shigella should be treated with

Fluoroquinolone or if organism sensitive use trimethoprim sulfamethoxasole (bactrim)

Salmonella diarrhea tx with

Fluorquinolones

Hx of actinic keratosis and HPV increases the risk of squamous cell carcinoma

Hx of ______________ increases the risk of squamous cell carcinoma

Give example of thiazide Diuretics

Hydrochlorathiazide Chlorthalidone

Hypercalcemia results from: Increase in calcium resorption from bone Decreased renal excretion of calcium Increase in calcium absorption from GI

Hypercalcemia results from ___________

Physical exam emphysema

Hyperinflation Hyperresonance to percussion decrease/ abscent breath sounds decrease fremitus Barrel chest quite chest Pursed lip breathing

TX surgical and non surgical achilles rupture

Non: Cast and PT Surg: 2-3 months recover for ADL

Folic acid recommendations are: 400-800 micrograms/day (If Diabetic/Neuroleptic mom) 1 mg (If one child has neural tube defect) 4 mg

Folic acid recommendations are: 400-800 micrograms/day (If Diabetic/Neuroleptic mom) 1 mg (If one child has neural tube defect) 4 mg

Osmotic Laxatives examples and MOA

Nonabsorable solutes that draw fluid into the intestinal lumen Lactulose Milk of magnesia Magnesium citrate Sorbitol

Noncardiac causes of palpitations include: Anemia Electrolyte disturbance Thyroid disorder Hypoglycemia Hypovolemia Fever Pheochromocytoma

Noncardiac causes of palpitations include ________

Nonfunctioning thyroid nodules > 1 cm are examined with fine needle aspiration, which is highly sensitive and specific

Nonfunctioning thyroid nodules > __ are examined with __________, which is highly sensitive and specific

Stool specimen with < 3-4 WBC usually indicates

Noninflammatory

2 presentations of acute diarrhea

Noninflammatory or Inflammatory

If liver disease is suspected what labs should be ordered

Hepatitis A, B, C Antimitochondrial antibody screen for cirrhosis Serum iron, transferrin saturation and ferritin Urine copper levels

Hepatitis E is transmitted fecal-orally. Treatment is supportive

Hepatitis E is transmitted ______. Treatment is _________

Hepatitis B causes 80% of hepatocellular carcinoma

Hepatitis ___ causes 80% of hepatocellular carcinoma

Hepatitis B & C have the risk of becoming chronic. Risk is related inversely to age

Hepatitis ___ have the risk of becoming chronic. Risk is related _________

Hepatitis A is self-limited, but may turn into fulminant Hepatitis, if patient also has Chronic Hepatitis C

Hepatitis ___ is self-limited, but may turn into fulminant Hepatitis, if patient ________

Hepatitis e antigen usually replications and infectivity

Hepatitis e antigen usually __________

Tx Biceps tendon tear

Nonsurg: partial tears or elderly pts brace for 4 wks Surg: full tear in younger pts

what type of anemia would a man who was found to have incidental finding on CBC while in the hospital for alcohol abuse

Normal MMA and decreased serum folate level

Normal menstrual cycles are between 21-35 days

Normal menstrual cycles are between _________

MC cause of viral diarrhea in adults

Norwalk virus- cruise ships

What is Diastolic heart failure

Occurs due to muscles of heart unable to relax adequately and allow heart to fill appropriately

Pneumothorax

Occurs when potential space between the parietal and visceral pleura of the lungs fills with air and collapses the lung

Of the IBD, Ulcerative Colitis is a strong risk factor for colon cancer

Of the IBD, __________ is a strong risk factor for colon cancer

Only Orlistat is FDA approved for long-term treatment of obesity. Only Phentermine is FDA approved for short-term treatment of obesity

Only _________ is FDA approved for long-term treatment of obesity. Only _______ is FDA approved for short-term treatment of obesity

How do you treat moderate papular/ pustular and moderate nodular no scaring acne

Oral antibiotics, topical retnoid, topical benzoyl peroxide

What is the treatment for erysipelas

Oral antibiotics- bactrim, doxy, clinda

If topical antifungals dont treat tina corporis or cruris what can you use

Oral antifungal 7-14 days Terbinafine

Treatment of choice for Onychomycosis

Oral antifungals becuase topcial respond poorly ORAL: terbinafine 250mg daily 12 weeks

How do you treat severe nodular acne

Oral isotretinoin

30 year old male has both mild and persistent asthma and chronic environmental allergies. What medication is indicated for his management

Oral montelukast is indicated for both persistent asthma and chornic allergies

What class of drug should NEVER be used in psoriasis patients because it can severely flare the psoriasis upon discontinuation of drug

Oral steroids

TX for radiculopathy pain

Oral steroids NSAIDS Gabapentin Steroid injection PT

Joint pain that increases with use suggest what arthritis

Osteoarthritis

Osteoporosis is diagnosed with DEXA score of -2.5

Osteoporosis is diagnosed with __________

Complications of Measles

Otitis media and pneumonia

Direct damage to 8th cranial nerve results from

Ototoxic drugs or acoustic neuroma

Ottawa Ankle Rules apply to patients that are: Nonpregnant Normal mental status Do not have other injuries

Ottawa Ankle Rules apply to patients that are _________

What are some Physical exam findings of Pneumothorax

Hyperresonance percussion, tracheal deviation, decreased breath sounds, decreased tactile fremitis

Physical exam for pneumothroax

Hyperresonence decrease fremitus decrease breath sounds unequal respiration expansion Tachycardia tachypnea hypoxia hypotension

classes of obesity

I. BMI 30-34.9 II. 35-39.9 III. > 40

Snapping Hip

IT band snap over greater trochanter

IUD effective for 10 years is Paraguard T380. IUD effective for 5 years is Mirena

IUD effective for 10 years is ______. IUD effective for 5 years is _______.

If the use of an antidepressant triggers an episode of mania, suspect Bipolar disorder or drug abuse

If the use of an antidepressant triggers an episode of mania, suspect ____________

Initial studies for unstable angina include: CBC BUN Creatinine PT/INR PTT ECG CXR CK MB Troponin I and T

Initial studies for unstable angina include _____________

MC loctaion for Trigger finger

MP joint

Gold standard to Dx

MRI

Outpatient tx community acquired pneumonia

Macrolide (Azithromycin) or Doxycycline

Clinical Manifestations of Kaposi Sarcoma

Macular, papular, nodular plaque-like brown/pink/red or violaceous lesions

Torsades treatment

Magnesium

Majority of primary hyperparathyroidism is caused by adenoma of a parathyroid gland

Majority of primary hyperparathyroidism is caused by ____________

What is the MC valve affected by endocarditis and then the order MC to least common

Mitral-> Aortic-> Tricuspid-> Pulmonic

What do epidermal inclusion cysts look like

Mobile dermal nodule often with overlying punctum

Are people with latent TB contagious

NO

Tx for COPD inhaled corticosteroids should they be used as monotherapy

NO may be added to long acting bronchodilators Salmeterol + fluticasone

TX H.pylori

PPI, amoxicillin or flagly, clarithromycin, +/- PeptoBismaul

What is tinea versicolor (Pityriasis versicolor)

NOT A DERMATOPHYTE it is a colonization of malassezia a yeast

TX impingement

NSAIDS PT 6wks Steroid injection Arthoscopic repai

TX CAM impingement

NSAIDS and PT Surgical

Treatment for pericarditis

NSAIDS and steroids in severe cases

Best treatment for rheumatoid arthritis

NSAIDS initally, but due to progressive disease send to rheumatology for DMARDS (methotrexate)

Tx rotator cuff tear

NSAIDS, PT, possible steroid injection

Tx DeQuervians

NSAIDS, Thumb spica, Steroid injection

TX SCFE

NWB with crutches till surgery for pinning

What are the subtypes of basal cell carcinoma and which one is MC

Nodular- MC Ulcerated Pigmented Superficial Morphaform

Tx Non operative

Non op: wear figure 8 brace or sling

Chronic nausea and vomiting imaging recommended

Endoscopy or barium studies

What is a 2nd degree deep partial thickness burn

Epidermis + Deep dermis

What is a 3rd degree burn

Epidermis + Dermis + hypodermis

What is a 2nd degree superficial partial thickness burn

Epidermis + Superficial dermis

Treatment of Anaphylaxis

Epinephrine Beta Agonist: Albuterol Benadryl (H1 receptor blocker) tx cutaneous effects Cimetidine (H2 receptor blocker) tx rxn and urticaria Methylprednisolone 125mg IV 1x

what maneuver can be done to help treat Benign Positional Vertigo

Epley Maneuver

What is Leriche syndrome

Erectile dysfunction PAD in illiac artery Claudication

What is another name for 5ths disease

Erythema infectiosum Slapped cheek disease

Erythematous macular rash starting at the face and neck, moving to the trunk and extremities suggests Rubella or German measles

Erythematous macular rash starting at the face and neck, moving to the trunk and extremities suggests ______________

Erythematous macular rash starting at the forehead and moving down the body with Koplik spots suggests Rubeola or Measles

Erythematous macular rash starting at the forehead and moving down the body with Koplik spots suggests ____________

What is atinic keratosis

Erythematous papule or thin plaque with a rough or gritty scale appearance

What form of psoriasis is a Dermatologic Emergency

Erythrodermic posriasis

travelers diarrhea MC caused by

Escherichia Coli

Maisonneuves Fx

Eversion ankle stress deltoid, talus forced and distal syndismosis seperated and causes a rotational stress up fibula and causes proximal fibular fracture

MC bone to get a stress reaction

Tibia

Examples of anticholinergics

Tiotropium- spiriva Ipratropium- atrovent

What does Heroin intoxication look like

Track mars, euphoria, decrease consciousness and respiration

Vesicular enanthem on tongue on lips and mouth; maculovesicular rash on hands, feet, buttocks and groin suggests Hand, foot, and mouth disease by Coxsackie Virus

Vesicular enanthem on tongue on lips and mouth; maculovesicular rash on hands, feet, buttocks and groin suggests ____________ by _________

vertigo in association with viral illness is called ______ and when accompanied by hearing loss is called _____

Vestibular nerutisi Labyrinthitis

A young woman eats raw seafood and 2 days later develops fever, abdominal cramping, and watery diarrhea what is the most likely cause of her symptoms

Vibro

What does PCP withdrawl look like

Violence

MC cause of bronchitis

Viral (influenza A, B; parainfluenza; adenovirus)

Risk factors for Pulmonary emoblism

Virchows Triad: Hypercoag state, venous stasis, Vascular intimal injury

Treatments for venous insufficiency include: Compression stockings Leg elevation Low sodium diet, decreased fluid intake Weight loss Avoid aggravating medicines

Treatments for venous insufficiency include _______

What does ETOH withdrawl look like

Tremor (8-18 hrs), tachycardia, hypertension, agitation, seizure (48hrs) hallucinations

Trisomy can be screened at a prenatal visit during: Nuchal translucency at 1st trimester hCG and PAPP-A weeks 10-13 hCG, AFP, estriol at 2nd trimester hCG, AFP, estriol, inhibin weeks 16-18

Trisomy can be screened at a prenatal visit during ____________

What cardiac enzyme is most sensitive

Troponin

What cardiac enzymes are first to rise

Troponin

TX bronchial carcinoid tumors

Tumor excision

Best treatment for osteoarthritis

Tylenol and then NSAIDS nsaids have more side effects

Bupropion may be used on top of nicotine therapy for Smoking Cessation

__________ may be used on top of nicotine therapy for Smoking Cessation

Bupropion and Varenicline are "Pregnancy Category C" For Smoking Cessation

___________ are "Pregnancy Category C" For Smoking Cessation

Vaccinations CI during pregnancy include live MMR and live influenza

Vaccinations CI during pregnancy include ________

Vaccines available for HPV include Gardasil and Cerverix

Vaccines available for HPV include _____________

Vaccines contraindicated in HIV+ patients: Live MMR Live Varicella Live influenza

Vaccines contraindicated in HIV+ patients _______

TX SVT

Vagal maneuver Adenosine to medically convert Definitive radiofrequency ablation

Varenicline CI in: Psychiatric disorders Typically started 1 week before quitting

Varenicline CI in ___________ Typically started __________

Variable decelerations are due to umbilical cord compression during contractions

Variable decelerations are ___________

"Clock draw" and "three-item recall" are fairly reliable when assessing dementia

___________ are fairly reliable when assessing dementia

Tx 5th metatarsal fx zone 1

Walking boot

TX for stress fracture

Walking boot and NWB 2-12 weeks depending on extent

What is another name for atypical pneumonia

Walking pneumonia

Treatment for A-fib

Warfarin or a blood thinner of some type and possibly medication of control their rate

How do you treat bedding, clothing, and other items for scabies

Wash clothing and bedding HIGH HEAT Items bag for 3-7days then wash off

What is hamoptons hump

Wedge shape infarct on Cxr for PE

what are non drug treatments for HTN

Weight loss Dash diet- sodium restriction <2.4 g/ day smoking cessation Exercise >30min most days Limited alcohol comsumption

What does Tinea versicolor look like

Well demarcated tan, salmon, or hypopigmented patch

What are other treatments for lice

Wet combing treat contacts

Classic triad for foreign body aspiration symptoms

Wheezing Cough Deminished breath sounds

When a subarachnoid hemorrhage is suspected, but not proven by dry CT, perform a lumbar puncture

When a subarachnoid hemorrhage is suspected, but not proven by dry CT, perform a __________

When a women expresses postpartum depression, SSRIs are 1st line, pregnancy-safe and breastfeeding-safe

When a women expresses postpartum depression, ______ are 1st line, ___________

When an individual has an acute infection of Hepatitis, serology shows Antibody Hepatitis core antigen IgM

When an individual has an acute infection of Hepatitis, serology shows _____________

When an individual has been vaccinated for Hep B, serology shows Hepatitis B surface antibody

When an individual has been vaccinated for Hep B, serology shows ____________

When anterior shoulder does not readily pass through pubic symphysis, suspect shoulder dystocia. McRoberts maneuver or hyperflexion of the hips, episiotomy, rotation, or suprapubic pressure usually work

When anterior shoulder does not readily pass through pubic symphysis, suspect ____________. ___________ usually work

When bereavement lasts > 2 months, considered depression

When bereavement lasts ____, considered depression

When choking, perform Heimlich or back blows (in infants). If at the hospital, bronchoscopy

When choking, perform ____________. If at the hospital, __________

When dealing with a possible MI, workup includes: EKG CBC BUN Creatinine PT INR PTT CXR CKMB Troponins

When dealing with a possible MI, workup includes _______________

When following up with narcotic use, inquire about constipation

When following up with narcotic use, inquire about ____________

When hypoglycemia is observed, administer 50% dextrose

When hypoglycemia is observed, administer ____________

When managing possible depression, r/o: Hypothyroidism Anemia Toxic screen

When managing possible depression, r/o ____________

When performing physical exam on HTN patients, evaluate: Retinopathy Obstructive sleep apnea Palpate thyroid Bruits Peripheral pulses Organomegaly

When performing physical exam on HTN patients, evaluate _______

When suspected CVA seen, perform dry CT to r/o hemorrhage, tumor, or abscess. CBC, CMP, Lipid, ESR, ANA, Serology, A1c, EKG are indicated as well

When suspected CVA seen, perform __________

When suspecting hepatitis, inquire about: Medications IV drug use Blood transfusions Sexual histories Tattoos Travel and contaminated foods (Hep A)

When suspecting hepatitis, inquire about _________

What does heroin withdrawl look like

Yawning, sweating itching, pain, lacrimation

What does opiate withdrawl look like

Yawning, sweating, lacrimation, pain, itching

What is a pustule

a pus filled papule

What is a furuncle

a pus filled sac >1cm

eye emergencies that are sight threatening are:

acute close angle glaucoma iritis corneal ulceration

What is Steven Johnson Syndrome and Toxic Epidermal Necrolysis Syndrome

acute life threatening mucocutaneous reaction characterized by extensive necrosis and detachment of the epidermis and mucosal surfaced

What age should women get mammograms and how often

age 40 and then screen every 1-2 years pending results

SS compartment syndrome

Pain perasthesia pluslessness pallor paralysis shiny skin

Pain in the hip, thigh, or groin in an obese individual or athlete suggests slipped capital femoral epiphysis

Pain in the hip, thigh, or groin in an obese individual or athlete suggests _________________

Sings and symptoms Clavicle Fx

Pain to ant. clavicle, visible deformity, grinding with ROM, tenderness, crepitus

What does 2nd degree superficial partial thickness burn look like

Painful, blisters, blanch with pressure

What do 4th degree burns look like

Painless, black, dry

What does a 3rd degree burn look like

Painless, waxy/white, dry and leathery

Dupuytrens Contracture

Palm fibromatosis Nodular thickening and contraction palmar fascia

Pap smears are recommended annually. If three consecutive normal paps occur, may space out to every 3 years

Pap smears are recommended ________ . If ______ consecutive normal paps occur, may space out to _________

In Hypertensive Crisis what is an easy way to determine acute organ damage

Papilledema (Optic disc edema)

What does impetigo look like

Papules, plaques, bullae, or ulcerative areas with overlying honey-colored crust

What cases Measles

Paramyxovirus

How do you make definitive dx of TB

Positive ID of M. Tuberculosis from culture (6-8wks to grow) or DNA or RNA amplification technique (1-2days)

MC type of hip dislocation

Posterior

Postexposure risk to HIV involves treatment with: Immediate cleaning with PEP Antiretroviral therapy ...within 2 hours x 4 weeks

Postexposure risk to HIV involves treatment with __________

Postpartum fever, uterine tenderness, and foul-smelling lochia suggests endometritis

Postpartum fever, uterine tenderness, and foul-smelling lochia suggests ____________

What is the treatment for nummular eczema

Potent topical steroid ointment (Fluocinonide)

Tx vitiligo

Potent topical steroids Photo therapy

What cuases molluscum

Pox virus

stages of behavior change

Pre-contemplative - Not aware of need to change or not interested in changing behavior. Contemplative - Currently interested in changing behavior. Active - Currently making a behavior change. Relapse - Attempted behavior change but no longer making the change.

Minor criteria of Duke Criteria

Predisposing factors (abnormal valve, IVDU, Indwelling cath) Fever > 100.4F Vascular (Janeway lesions, pulmonary emobli) Immuno: (Osler nodes, Roth spots) Echo not meeting major criteria Positive blood culture not meeting major criteria

Risk factors Vericose veins

Pregnancy Obesity family history prolonged sitting or standing history of phlebitis

Pregnancy Category B: Not good in animals Ok in humans Ok in animals Not tested in humans

Pregnancy Category B _______

Pregnancy Category C Not good in animals Not tested in humans Not tested in animals or humans

Pregnancy Category C _________

Pregnancy Category D: Not good in humans

Pregnancy Category D ________

Prehepatic jaundice is typically from hemolysis of RBCs, causing unconjugated hyperbilirubinemia Hepatic jaundice may cause un/conjugated hyperbilirubinemia Posthepatic jaundice typically due to obstruction of the flow to the bile causing conjugated hyperbilirubinemia

Prehepatic jaundice is typically from ______, causing ___________ Hepatic jaundice may cause __________ Posthepatic jaundice typically due to ___________, causing ___________

What are PVC

Premature ventricular contractions

What is the gold standard for Dx PE

Pulmonary angiogram

Tx little league shoulder

Rest till sx subside and pain free ROM gradual return to throwing

TX foreign body aspiration

Rigid bronchoscopy

What is tinea corporis

Ringworm, sharply marginated erythematous annular plaque with central clearing

Tx for PAD

Risk factor modifications BB, ACEI, Statins Antiplatelet therapy with aspirin or clopidogrel Revascularization srugery

Risk factors of breast cancer: FMHx BRCA-1 BRCA-2 Early menarch, Late menopause

Risk factors of breast cancer ______

What is the number 1 risk factor for lung cancer

SMOKING

If patient presents with multiple erythematous papules on the trunk, extremities, and genitals, and burrows present in 2-3rd web spaces what is the likely diagnosis

Scabies

sandpaper like exanthems and Strawberry tongue can indicate

Scarlet Fever

What is the Koebner Phenomenon

Scratching causing the spread of skin infection

What is pancoast syndrome

Shoulder pain hroners syndrome (miosis, ptosis, anhydrosis) atrophy of hand/arm muscles

What degrees require surger

Sometime III Always 4, 5 and 6

If suspect PE what test is best to perform

Spiral CT or Ventilation/perfusion test

Spiral fracture of femur or humerus is suspicious of child abuse

Spiral fracture of ________ is suspicious of child abuse

Give example of potassium sparing diuretics

Spironalactone Amiloride

What are common agents used to treat hormonal acne

Spironolactone 50-100mg daily Oral contraceptives

Tx mallet finger

Spling 6-8 wks and surgery if splint fails

Which type of non small cell is typically associated with cavitary lesions

Squamous cell

Which type of non small cell is typically located centrally

Squamous cell

Substernal pressure for < 30 minutes, radiating to the arm, neck, jaw, with dyspnea; aggravated with exertion, improved with rest suggests Angina

Substernal pressure for < 30 minutes, radiating to the arm, neck, jaw, with dyspnea; aggravated with exertion, improved with rest suggests ____________

Substernal pressure for > 30 minutes, radiating to the arm, neck, jaw, with dyspnea; aggravated with exertion, improved with rest suggests MI

Substernal pressure for > 30 minutes, radiating to the arm, neck, jaw, with dyspnea; aggravated with exertion, improved with rest suggests ____

SS pneumothorax

Sudden onset chest pain Shortness of breath dyspnea cough +/- pain prominent in back and shoulders

SS hospital acquired pneumonia

Sudden onset fever productive cough tachycardia and tachypnea

Sudden onset of pleuritic pain, with tachycardia, tachypnea, and hypoxemia suggests pulmonary embolism

Sudden onset of pleuritic pain, with tachycardia, tachypnea, and hypoxemia suggests ______________

Sudden onset of tearing pain with radiation to the back suggests aortic dissection

Sudden onset of tearing pain with radiation to the back suggests _______________

Sulfonylureas benefit DM by stimulating pancreatic beta-cells to secrete insulin

Sulfonylureas benefit DM by _________

Treat melasma

Sun avoidance Daily sunscreen atleast SPF 30 Hydroquinone cream BID

What is folliculitis

Superficial bacterial infection of the hair follicle

What are the 4 types of Melanoma

Superficial spreading Lentigo Acral Lentiginous Nodular

What are the 2 MC forms of melanoma

Superficial spreading Nodular

Superficial spreading melanoma typically found in the elderly is the Lentigo Maligna. Most patients reside in Hawaii

Superficial spreading melanoma typically found in the elderly is the _____________. Most patients reside in _________

What is a 1st degree burn

Superficial, epidermis involved

Treatment Hand foot and mouth disease

Supportive Self limiting 10 days

Treatment Measles

Supportive anti-inflammatories Isolation 1week from onset rash

What is treatment for Rubella

Supportive and anti-inflammatories

TX amphetamine overdose

Supportive care

Tx walking pneumonia

Supportive care

TX for bronchitis

Supportive care Oral steroids or steroid inhaler Cough med: tylenol with codine or dextromethorphan Bronchodilators

Treatment 5ths disease

Supportive therapy Self limiting 5-10 days

Stage 1 of labor: (Latent) 1-3 cm cervix dilation (Active) 4 cm- complete dilation Stage 2: Complete dilation - delivery of baby Stage 3: Delivery of baby - delivery of placenta

Stage 1 of labor ________. Stage 2 ___________. Stage 3 ___________.

Treatment temporal arteritis

Steroids

If blood or WBC present in stool specimen then order

Stool culture

How do you treat Drug induced hypersensitivity syndrome

Stop all non-essential medications Consult Dermatology

Treatment of fixed drug eruption

Stop offending agent Lesions resolve days to weeks after drug stopped Tx with either topical steroid ointment or antimicrobial ointment

How do you treat an exanthematous drug reaction

Stop offending medication Resolves in a few days to a week Can use topical steroids, oral antihisamines, and reassurance

How do you treat minor burns

Stop the burning process Pain control- NSAIDS Wash area with soap and water Apply topical ointment

Special tests for radiulopathy

Straight leg raise pain recreated at less than 60 degrees of hip flexion

If a pt has rust colored sputum what is the MC causative agent

Strep Pneumonia

MC cause of community acquired pneumonia

Strep pneumoniae

Guttate psoriasis is often preceded by

Streptococcal pharyngitis

MC cause of Pneumonia in an HIV + patient

Streptococcous pneumonia or Pneumocystis Jiroveci if CD4 cound <200

Most common cause of community acquired pneumonia

Streptococcus pneumonia

What is little leagures shoulder

Stress fx of proximal humeral physis

Treatment for tension headaches

Stress reduction biofeedback NSAIDS 400-600 mg TID

Strokes that affect small branches of the main arteries of the brain are called lacunar infarcts

Strokes that affect small branches of the main arteries of the brain are called ____________

Strongest evidence supports the use of amitriptyline, propranolol, timolol, and divalproex sodium for migraine headache prevention

Strongest evidence supports the use of ____________ for migraine headache prevention

Treatment vericose veins

TED stockings Leg elevation regular exercise

What are Osler Nodes

TENDER nodes on pads of digits

If a pregnant woman gets Rubella it is considered what syndrome

TORCH

What are the types of diuretics

loop potassium sparing thiazide

Examples of ototoxic drugs

loop diuretics aminoglycoside abx

example of antimotility drugs

loperamide

What is skin erosinon

loss of part of or all of the epidermis

SS walking pneumonia

low grade fever dry nonproductive cough myalgia fatigue sore throat Head ache nausea/ vomiting/ diarrhea Red TM Bollous Myringitis- rare

What is the clinical presentation of Rubella

low grade fever, sore throat, cough, lymhadenopathy and pruritic pink to red macules begin on face and spread to trunk over 24 hours

SS for Drug induced hypersensitivity syndrome

macular exanthem, erythematous centrofacial swelling, fever, malaise, lymphandenopathy

Medications to treat labyrinthintis, vestibular neuritis, BVP include

meclizine, dimenhydrinate, antiemetics, and benzodiazepines

Night stick fracture

mid to distal ulnar fx

IBS affects- age range and M or W more?

middle age young adults 2:1 females over males

CXR for primary TB shows

middle or lower lobe consolidation

At 16 weeks gestation where should you feel the fundal height

midway between the pubis symphysis and the umbilicus

symptoms of tension headache

mild- moderate intensity bilateral bandlike pain

children should ride in a rear facing car seat until

more than 20 lbs and older than 1 year old

With nummular eczema will KOH be positive or negative

negative

vertigo

sensation of room spinning

What can Rubella cause to an unborn fetus

sensorineural deafness mental retardation eye abnormalities Congenital heart dz hip displasia

in 3rd trimester bleeding...Do not perform a digital or speculum vaginal examination until what is confirmed and why

normal placental position is confirmed by US, as disruption of the cervical-placental junction could precipitate catastrophic hemorrhage.

Symptoms of cluster headache

severe unilateral localized to periorbital/temporal area 1 of the following: lacrimation, rhinorrhea, ptosis, miosis, nasal congestion, eyelid edema

What does seborrhic keratosis look like

sharply marginated pigmented lesion that appears waxy and "stuck on"

Q waves on EKG=

old or recent MI

What other disease of the foot is tinea pedis associated with

onychomcosis- fungal infection toenail

When do you operate on Clavicle fx

open fx neurovascular injury associated tenting of skin multiple segments dominant arm of overhead athlete

Treatment of Uticaria

oral antihistamines Benadryl Avoid trigger in future

physical exam for dizziness/vertigo should include

orthostatic blood pressures ear exam neurologic exam hearing assessment

morning stiffness that lessens with movement and then prolonged standing or walking may worsen symptoms indicates what type of arthritis

osteoarthritis

Meniscal tear

pain and swelling joint line + thessalys and McMurrays

SS Cam impingement

pain in groin region sharp pain with turning or twisting catching and clicking

What is angioedema

painless, deeper form of uticaria affecting lips, tongue, eyelids, hands and feet

medical conditions associated with depression

parkinsons, hypothyroidism, dementia

What are the xray findings associated with rheumatoid arthritis

periarticular soft tissue swelling periarticular osteopenia uniform loss of joint space bony erosions

Diffuse ST elevation on EKG =

pericarditis

SS spondylolysis

persistant pain and risk of progression

2 forms of chronic diarreha

persistent or recurrent

What is the danger of Atinic Keratosis

premalignant lesions that have the potential to develop into skin cancer- SCC

What is Abruptio Placenta

premature separation of a normally implanted placenta from the uterine lining

primary vs secondary headaches

primary: no underlying cause: migraine, tension, cluster Secondary: result underlying cause mass, infection, CVA, drug withdrawl, metabolic disorders

Symptoms of bacterial Diarrhea

prodrome fever, headache, anorexia, fatigue, stools watery then become bloody

What is Secondary (reactivation) TB

reactivation of latent TB with waning immune defenses

SS foreign body aspiration

respiratory distress cyanosis altered mental status wheezing decrease air entry cough

How is Measles spread

respiratory droplets

How is Rubella spread

respiratory droplets

What is the pahtophys behind chronic bronchitis

productive cough 2-3months x 2 years consecutivley chronic airway inflammation causing increase airway resistance and mucous plugging

itching, watery (tearing) discharge from the eye indicates

allergic

SS of asthma

progressive SOB non-productive cough wheezing all lung fields chest tightness from decrease air flow

Compartment Syndrome

prolonged elevation of compartment pressure and decrease blood supply

If paitent younger than 40 with COPD you should suspect the cause to be

alpha 1 antitrypsin deificency

what could cause a false + on the skin TB test

pt had the BCG vaccination within 2-10 years

DO NOT use antidiarrheal meds when

pt with a fever or suspect infectious or inflammatory diarrhea

What is chronic (latent) TB

pts control initial primary infection via granuloma formation and become PPD + in 2-4 wks

WBC casts in urine indicate

pyleonephritis or interstitial nephritis

antibiotic use within 2 weeks and diarrhea suggests

alteration in bowel flora or Clostridium Defficile

What is pityriasis rosea

an acute exanthematos eruption that mainly occurs in young people pathogen not understood

What is a fixed drug eruption

an adverse drug reaction characterized by formation of a solitary erythematous patch or plaque that will recur at the same site with re-exposure to the drug

What is uticaria

an allergic reaction that results in hives or wheals

presence of bile in vomit suggests

an open pylorus

Colonoscopy indicated for constipation when:

anemia, weight loss, heme-positive stools, suspected malignancy

What is a herald patch

annular red 2-10cm patch anywhere on body with peripheral scaling and central clearing

Treatment of V tach Stable sustained

anti-arrhytimics ( amioderone, lidocaine)

Ventricular arrhythmias are treated with

antiarrhythmics and an implantable defibrilator

Treatment allergic conjunctivitis

antihistamines

How do you use the shampoo for tinea versicolor

apply to body let stand 10min then rinse repeat daily for 4 weeks

Clinical manifestations of bronchial carcinoid tumors

asymptomatic carcinoid syndrome (diarrhea, flushing, wheezing , hypotension)

crossed leg raise

asymptomatic leg is raised Test is positive if pain is increased in the contralateral leg; this correlates with the degree of disc herniation. Such results imply a large central herniation. Cross SLR test is much less sensitive (0.25) but is highly specific (about 0.90). Thus, a negative test is nonspecific, but a positive test is virtually diagnostic of disc herniation.

Osteoperosis is present with what T score

at or below -2.5

What is a common cause of peripheral vascular disease

atherosclerosis

What is Tinea pedis

athletes foot fungal infection

Small cell lung cancer tends to originate where and metz where

central bronci and metz to regional lymph nodes

Initial therapy fro lymphadenitis

cephalosporin, erythormycin, or dicloxacillin

What are some risk factors for placenta previa

cesarean delivery, multiple uterine surgeries, advanced maternal age, minority group status, cigarette smoking, and cocaine use.

if child is not getting better with pneumonia when they return to the office in 24 to 48 hours....

change Ab

What are clinical manifestations of lung cancer

changing cough hemoptysis pain anorexia wt. loss lymphadenopathy hepatomegaly clubbing of fingers Parneoplastic syndrome

Treatment viral conjunctivitis

rest, cool compresses, time

How can most spider bites be treated

rest, ice and elevation wound cleaning Tetanus shot if out of date

Symmetric polyarthritis is consistent with

rheumatoid arthritis

What is impetigo

common superficial bacterial infection of skin from Staph aureus

Staph aureus diarrhea from

custard filled pastries

What is rhinophyma and another name for it

dermal and sebaceous gland hyperplasia of the nose "whiskey nose"

most frequenct cause of new blindness among aduls

diabetes

Antispasmotics drugs example

dicyclomine

What are side effects of bisphosphonates that are used to treat osteoperosis

esophagitis, gastritis must take on an empty stomach with a full glass of water and stay upright 30min after taking

How often should you get a pap

every 3 years if normal

What is hyperlipidemia

excess lipids in blood

How do you treat basal cell carcinoma

excision with 3-4mm margins

What is stable angina

exertional pain lasting 5-15 min and relieved by rest or nitro, ischemia

S/S anterior hip dislocation

external rotaion shortened flattened lat hip Inability to ADD and IR

An infection of the glands Zeis of the eye causes

external-hordeolum

muscle atrophy and low back pain

f quadriceps and calf muscles; lack of atrophy, despite patient's complaints of long-term weakness, suggests malingering.

SS biceps tendon tear

felt a pop ecchymosis decrease AROM and MMT

What is a macule

flat spot less than 1cm

What is a vesicle

fluid filled papules that are <1cm

What is a bulla

fluid filled sac >1cm

What are common triggers for uticaria

food, medications, infections, insect bites, environmental

What is systolic HF

hearts inability to pump blood forward in ciruclating system "loss of squeeze"

What is CURB 65 score

help determine admit status of older pts with pneuo

painful nodules on or along the lid indicate

hordeola/ chalazion

What is the inital tx of choice for tinea pedis

hygine and topical antifungals

What will you see on a KOH prep for tina pedis

hyphae

When patients are prescribed Oral isotretinoin they must also sign what

iPLEDGE Females must enroll in FDA program and must use 2 forms of contraception and for 1 month after treatment has ended

cause of elevated conjugated bilirubin

impaired excretion of bilirubin from the liver

What does hyperinflation look like on PFT's

increase lung volume Increase RV, TLC, and FRC

obesity metabolic effects on the body

increases + insulin resistance +LDL +VLDL +TG decreases +HDL

What are individual risk factors for Melanoma

increasing age Fair skin Greater than 100 acquired nevi Atypical nevi Personal or family hx

What is seborrheic dermatitis

inflammatory reaction to to Malassezia yeast that thrives on oily skin

How do you get Salmonella

ingesting contaminated poultry or eggs

What is the treatment for stasis dermatitis

leg elevation, topical corticosteroids, compression therapy

What does Inverse/flexural psoriasis look like

lesions located in the skin folds

What level of ankel brachial index indicates PAD

less than or equal to 0.9

Oval fat bodies in urine indicate

lipiduria and nephrotic syndrome

What are risk factors for cellulitis

local trauma- bug bite, laceration Underlying skin infection edema and impaired lymphatics Preexisting skin infection

What is Dariers Sign

localized uticaria appearing where the skin is rubbed (Histamine induced)

how do the lesions of SJS/TEN initally start

located face, trunk, proximal extremities and spread erythematous irregularly shpaed dusky red to purpuric macules

what is the most commonly dislocated joint

shoulder

Where doe you get tina pedis from

showers, gyms,

Differential diagnosis for hematruia

sickle cell glomerulonephritis benign familial hematuria Renal vein/artery embolus TB pyleonephritis Polycystic kidney disease Interstitial nephritis tumor stones cystitis prostitis urethritis BPH

What is the secondary eruption of pityriasis rosea

similar salmon colored oval patches and plaques erupt symmetircally over trunk and proximal extremities (Christmas tree pattern)

How do you spread molluscum

skin to skin contact, fomite exposure, autoinoculation Associated with public water- pools hot tubs Wrestlers

CXR for miliary TB shows

small millet-seed like nodular lesions 2-4mm

what is the main cause of death in this country

smoking (lung cancer, ischemic heart disease, COPD)

What is a lipoma

solitary collection of fat under the skin

What is allergic contact dermatitis

source of vessicles that the main symptom is itching

What is Bowens disease

squamous cell carcinoma in situ and does not affect the dermis

What stage of sleep do sleep terrors occur

stage 3 and 4 (delta sleep)

What stage of sleep does sleepwalking occur

stage 3 and 4 of sleep in first 1/3 of the night & REM sleep later in the night

What is the common pathogen for folliculitis

staph aureus

How does pityriasis rosea initally appear

starts with a herald patch

Tx narcolepsy

stimulants- dextroamphetamine

diagnostic tests for acute diarrhea

stool specimen

Chronic nausea and vomiting usually caused by

structural lesions affecting the upper GI tract

new onset worst headache of my life

subarachnoid hemorrhage

nonblanching red "spot" painless without visual changes or discharge from eye indicates

subconjunctival hemorrhage

What is primary TB

the outcome of initial infection and usually self limited

What does crusted scabies look like

thick scaly white-grey plaques with minimal pruritis and localized to scalp, face, back, buttocks, and feet

What is Breslows depth

thickness of primary melanoma measured from the granular layer of epidermis to deepest part of tumor

AUDIT-C

three item alcohol screen that can help identify persons who are hazardous drinkers or have active alcohol use disorders

Pulmonary Embolism arise from

thrombi in system venous circulation or from the right side of the heart

treatment subconjunctival hemorrhage

time resolve over 7-14 days

What is Vasa Previa

umbilical vessels course in the amniotic membrane at the level of the cervical os, so that when the cervix begins to dilate in labor with membrane rupture, the blood vessels tear

Migraines require 2/4 characteristics to diagnosis migraine and associated with atleast 1 of the following 4 symptoms

unilateral location pulsatile quality moderate to sever intensity aggravation by movement photophobia, phonophobia, nausea, vomiting

Menieres disease

unkn etiology causes endolympatic hydrops and increased pressure in semicircular canals and damages the sensory hair cells

how long can a post infectious cough occur from a viral illness

up to 8 weeks

When do symptoms of Drug induced hypersensitivity syndrome usually occur

usually around 3rd week of new medication or new dose

Mechanism for posterior shoulder disslocation

usually seizure or electrical injury

What can cause abruptio placenta

uteroplacental insufficiency and fetal distress or demise or trauma

What underlying disease is stasis dermatitis often associated with

venous insufficiency

mode of examination for breasts

vertical strip pattern

What does dishydrotic eczema look like

vesiculopapules on palms and soles and sides of fingers "Tapioca pudding"

clear, mucoid discharge from the eye indicates

viral conjunctivitis

Labyrinthitis (vestibular neuronitis)

viral infection of the semicircular canals causing vestibular dysfunction and vertigo

treatment hordeolum or chilazion

warm compress may require abx ointment or drainage

How should clothing and bedding be treated for lice

washed and dryed HIGH HEAT

Noninflammatory diarrhea

watery

symptoms of a viral gastroentereitis

watery stool, low-grade fever, headache, nausea, vomiting, achiness

how to calculate BMI

weight in kg/ height in m^2

Tx sleep apnea

weight loss CPAP

When should you suspect secondary hyptertension

when hypertension is refractory to treatment with medication and diet

Who is usually affeced by Molluscum contagiosum

young kids sexually active adults Immunocompromised pts

when does a quad screen occur

- 15 to 20 weeks

amniocentesis

- 15 weeks - risk of spontaneous abortion - 1/300 to 1/500

Nodular melanoma grows how

Vertical and rapid

What is anaphylaxis

A lifethreatening allergic reaction

What type of non small cell is MC type in smokers, women, and nonsmokers

Adenocarcinoma

Which type of non small cell is typically located in the periphery

Adenocarcinoma

What is the MC cause of embolic stroke

Atrial Fibrilation

Lab test for constipation

CBC, BMP (electrolytes), TSH, Calcium

PE treatment

Heparin and warfarin started and bridge to warfarin

What is the true name for a brown recluse spider

Loxosceles Reclusa

Treatment of acute MI

MONA has HepB Morphine Oxygen Nitro Aspirin Heparin Beta Blocker

how do you diagnose temproal arteritis

Temporal artery biopsy

What are the cardinal features of Meniers

Vertigo, tinnitus, and hearing loss

high pitched bowel sounds are an early sign of

bowel obstruction

5th metatarsal Fx zone 2

"Jones fx" Fx extended 4/5 articulation

"Olive-shaped mass" suspect pyloric stenosis

"Olive-shaped mass" suspect ___________

5th metatarsal Fx zone 3

"Pseudo Jones Fx" Stress fx extend diaphysis for 1.5cm

categoriations of alcohol use

"Risky/hazardous drinking" means the patient's alcohol consumption exceeds the National Institute on Alcohol Abuse and Alcoholism per occasion threshold for men of 4 drinks per occasion. "Problem drinking" entails significant physical, social, or psychological harm from drinking. "Alcohol abuse" requires a maladaptive pattern of use with one or more of the following: Failure to fulfill work, school, or social obligations Recurrent substance use in physically hazardous situations Recurrent legal problems related to substance use Continued use despite alcohol-related social or interpersonal problems "Alcohol dependence" requires three or more of the following: Tolerance Withdrawal Substance taken in larger quantity than intended Persistent desire to cut down or control use Significant time spent obtaining, using, or recovering from alcohol use Social, occupational, or recreational tasks are sacrificed Use continues despite physical and psychological problems

"Rust-colored" sputum is suggestive of Strep pneumonia

"Rust-colored" sputum is suggestive of ___________

"Sausage-shaped mass" suspect intusussusception, commonly located at ileocecal junction

"Sausage-shaped mass" suspect ________________, commonly located at ________

"Slapped cheek" rash followed by a lacy, pruritic exanthem on the trunk suggests Parvovirus B19

"Slapped cheek" rash followed by a lacy, pruritic exanthem on the trunk suggests _____________

"Thinner" gray vaginal discharge, with a "fishy" order suggests bacterial vaginosis .Discharge has a pH of > 4.5

"Thinner" gray vaginal discharge, with a "fishy" order suggests _____________. Discharge has a pH of ____

"Tightness" sensation of chest, dyspnea, and tachycardia suggests anxiety

"Tightness" sensation of chest, dyspnea, and tachycardia suggests _____________

"Typical" pneumonia organisms are common in the very young or very old. "Atypical" pneumonia organisms are common in adolescents and young adults

"Typical" pneumonia organisms are common in ___________. "Atypical" pneumonia organisms are common in ___________

"Worst headache" suggests subarachnoid hemorrhage

"Worst headache" suggests ____________

What is the parkland formula

% burnd x Body weight in kg x 4 half of the formula needs to be replaced in 1st 8 hours The second half given over the next 16 hours

targeted HR calcuation

(220-age) X (.7-.8)

Special test achilles rupture

+ Thompson test

Tension pneumothorax

+ air pressure pushes lung, trachea and heat to opposite side

different quadrants of the abdomen

-

peds weight management recommendations

-

age of initiating diabetes screening in children

- *10 years of age or at onset of puberty, whicever is earlier - screen every 3 years*

intermittent asthma

- - < 2 days/week - treat with SABA PRN

when is LABA used in kids with asthma

- - used daily in kids with moderate persistent and severe asthma in addition to medium dose inhaled corticosteroids and SABA rescue meds -

moderate or severe persistent asthma

- -daily symptoms or symptoms throughout the day - SABA PRN w/ medium dose inhaled corticosteroids

MciSaac Decision Rule

- 1 pnt for each of the following: 1. fever more than 38 - absence of cough -tonsillar exudate -anterior cervical lymphadenopathy -age less than 15 - take one pnt away for age older than 45 - <1 = symptomatic treatment - 2 or 3: order strep test and treat with Ab dependent on results - >4: order throat culture and start empiric Ab

eclampsia

- 1+ convulsions in the presence of preeclampsia - highest risk in white, nulliparous women from lower socioeconomic backgrounds and women older than 25 and in teens and low twenties

how many episodes are needed to Dx tension, cluster and migraine headaches?

- 10 for tension - 5 for migraine and cluster

quadruple therapy

- 10-14 days (75-90% eradication rate) -PPI standard dose once or twice daily (OR ranitidine 150 mg twice daily) - metronidazole 250 mg four times daily - tetracycline 500mg four times daily - bismuth subsalicylate 525 mg four times daily

sensory foot testing in diabetes

- 10g monofillament + either vibration w/ 128hz fork, pinprick, ankle reflex or vibration perception threshold

how much vitamin D and Ca should women over 50 consume

- 1200mg of Ca and 600 IU vit D

preeclampsia

- >140/90 on at least 2 readings in a woman with previously normal BP and is over 20 weeks gestation WITH proteinuria of .3 grams in 24 hour urine sample or 1+ or 30mg/dL on dipstick on two occasions - most likley in women who develop gestational htn early in pregnancy - most common in african american women - r/o HELLP syndrome via evaluation of renal and liver function and CBC

age RF for HTN

- >55 men - >65 women

guidelines for glycemic control

- A1c <7% prevents microvascular disease

CMV follow up guidelines

- ABR or otoacoustic emissions until at least 12 mo- then age appropriate - recommended for patients when newborn then at 3, 6, 9, 12, 18, 24, 30, and 36 months then annually until school age - ophthamloscopy (vision function): test when patient is newborn, 12 months, 3 years and preschool - neuro exam/developmental asessment by primary care physician: perform at each check up until patient is school age - neuro: as indicated by clinical findings

ACA mammography guidelines vs USPTF guidelines

- ACA: every year starting at 40 - USPTF: every other year from 50-74

HTN medication for general non-black population including those with diabetes

- ACE-I -ARB -CCB - or thiazide ( JNC 8 recommends against using an ACE-I in black patients, even those with diabetes)

management of systolic HF

- ACE-I : reduced mortality and hospitalizations -ARBs: also reduce mortaity -digoxin: -loop diuretics -metoprolol - eplerenone

HTN meds for population with CKD

- ACE-I or ARB

when is hemarthrosis seen

- ACL tear - knee sprain -acute meiscal tear

x ray view to evaluate for OA

- AP, lateral and standing weight bearing views should be obtained

graves disease aka toxic diffuse goiter

- Ab that acts at the TSH receptor (thyrotropin receptor antibodies/thyroid stimulating immunoglobulins) - hypervascularity may result in bruit or thrill upon auscultation -exophthalmos & eyelid retraction is characteristic - corneal irritation due to eyelid retraction - increased radioactive iodine uptake - pretibila myxedema - thyroid peroxidase antibodies - treatment does not help the eye manifestations

pap smear recommendations

- At 21 years of age -- cervical cancer screening should begin. Between the ages of 21-29 years -- screening should be performed every three years. Between the ages of 30-65 years -- screening can be done every three years with cytology alone, or every five years if co-tested for HPV. Women older than 65 years who have had adequate screening within the last ten years may choose to stop cervical cancer screening. Adequate screening is three consecutive normal pap tests with cytology alone or two normal pap tests if combined with HPV testing.

anti-anginal medications

- B blockers: decreases myocardial oxygen consumption by slowing HR and decreases BP - CCB: dilate coronary arteries and increase coronary blood flow while also decreasing myocardial oxygen consumption -nitrates: dilate systemic and coronary arteries but are primary venodilators. the anti-ischemic effect of nitrates is due to systemic venodilation that leads to reduced preload and a decrease in myocardial oxygen demand

bariatric surgery

- BMI >40 or BMI >35 with associated health complications who have not succeeded in losing weight with other treatment methods -

BMI guidelines in periatrics

- BMI age and sex specific percentiles are used to interpret the BMI - the amount of body fat changes with age and the amount of body fat differs between girls and boys - Pediatrics: +healthy: 5th-85th percentile +overweight: 85th-95th percentile -obese: >95th %

when evaluation for BPH what should you check. flow rate? voided volume?

- DRE, urinalysis, PSA, BUN & creatinine -urine flow rate and post-void residual urine volume - flow rate greater than 15 basically excludes bladder outlet obstruction - voided volume should be more than 150ml

what tests are indicated in initial workup of essential HTN

- EKG, urynaliysis, blood glucose, Hct, serum K - creatinine/GFR, lipid profile, albumin excretion and albumin/creatinine ratio, serum Ca

what conditions are comorbid with asthma

- GERD, chronic sinusitis/uncontrolled allergic rhinitis, stress/depression, obstructive sleep apnea, overweight/obese

SE of NSAIDs

- GI upset - decreasing the effectiveness of htn meds -incresing the effect of sulfoylureas - chronic users have increased risk of ESRD - hepatotoxic - coagulopathy

INR goal for warfarin and time is takes to get there

- INR: 2-3 - half life of warfarin is 40 hours and it takes 5-7 days for the steady state to be stable

UTI treatment

- IV ceftriaxone

how long do you conitnue heparin with warfarin

- LMWH, UFH or fondaparinux be continued for atleast 5 days after beginning warfarin and until INR >2 for 24 hours

the definition of CAD

- MI, unatable angina, coronary artery procedures, myocardial ischemia - CAD equivalents include DM, symptomatic carotid artery disease, PAD, abdominal aortic aneurysm

theraoy for herniated disc

- NSAIDS and/or muscle relaxant -moist heat - MRI if not beter in 4-6 weeks

ACL sprain-

- noncontact deceleration frces - moderate to severe joint effusion -sweeling within 2 hours of pop

T2DM RF and screening

- RF BMI at or above 85%, increased fasting glucose of 100, and elevated faasting insulin - screening: *screen all children at 10 who have BMI >85 and RF for diabetes >95% without RF, rechecking every 2 years*

high cholesterol RF, screening and treatment

- RF: elevated BMI - screening: *fasting lipid profile on every child with BMI >85 percentile.* -total cholesterol should be 170 and LDL 130 - Tx: *drugs used when LDL >190 or LDL>160 with RF. only use drugs in kids over 10 who are either tanner 2 (male) or achieved menarche*

biliary colic

- RUQ pain, epigastric pain, or chest pain that is constant - pain lasts 4-6 hours or less and often radiates to the back (often the R shoulder blade) - nausea and vomiting - often follows a heavy and fatty meal - hall mark is that the stone is mobile and eventually moves away from the outlet allowing resumption of normal gallbladder function - new studies show that a cholecystectomy within the first 24 hours of diagnosis may be helpful

cholecystitis

- RUQ pain, nausea and vomiting and occurs following a fatty meal - causes by a stone that is NOT dislodged from the cystic duct outlet - symptoms persist -often associated with fever -elevated WBC - may require urgent cholecystectomy -

hepatitis clinical manifestations

- RUQ pain, nausea vomiting, malaise, anorexia, itching and icterus.jaundice, hepatomegaly

nonasthmatic eosinophilic bronchitis

- chronic cough >8 weeks -normal chest x ray - improve with corticosteroids - normal spirometry

peptic ulcer disease

- epigastric abdominal pain that improves with meals - episodic or recurrent epigastric aching or gwaning - relieved by meals

BPPV

- acute onset vertigo, cant be associated with nausea and vomiting and intact hearing - caused by Ca+ carbonate debris in the semicircular canals - often episodic rather than constant triggered by positional change - symptoms usually resolve several seconds to minutes following position change

when are short acting opiates indicated

- acute pain or breakthrough pain, when long acting agents are insufficient to control symptoms - for chronic pain when non-opiate therapties are not sufficient

acute v chronic bronchitis

- acute: productive cough lasting 1-3 weeks - chronic: productive cough for at least 3 months for the past 2 years

when should PPSV23 be administered early

- adults 19-64 with chronis heart disease, chronic lund disease, chronic liver disease, alcoholism, DM

high intensity statin should be used when

- adults 40-75 yo with diabetes with a >7/5% estimated 10yr ASCVD - patients >75 with clinical ASCVD - LDL >190

right middle cerebral infarct

- affects the right pariteal hemisphere - difficultues with spatial and perceptual abilities -left visual neglect - will not recognize their functional impairments -

what ethnic group has the highest rate of coronary heart disease

- african americans

when is it especially important to rest after an ankle injury

- after the first 72 hours

major traditional RF for CVD/ASCVD

- age>55, male, current smoking, dyspilidemia diabeetes, htn

who should be screened for htn

- all adults over 18

when does a child need an CXR

- all kids with a chronic cough (longer than 3 weeks)

who should be started on statins

- all patients >21yo (with or w/o diabetes) who have an LDL >190 shuld be started on statins

when is a statin indicated

- all patients over 21 with an LDL > 190

chlamydia screening recommendations

- all pregnant and non prego women 24 and younger - 25+ if at increased risk regardless of pregnancy status -RF: history of chlamydia or other STI, new or lots of sex partners, inconsitent condom use

dix-hallpike maneuver

- allows confirmation of BPPV - turn pnts head to 45 degress and then lay them supine with head just over the end of the exam table -then turn head to the side which should reproduce symptoms of dizziness and produce nystagmous - observe for 20-30 seconds - if present, the nystagmous will have the fast component in the direction of the pathology - next, sit the patient up and observe again for nystagmous

classic signs of pregnancy

- amenorrhea, fatigue, nausea/vomiting, breast changes -enlarged uterus

AB for 3mo to 5yr for pneumonia

- amoxicillin to cover strep pneumo

cardiac syndrome X

- angina like pain and have abnormal stress testing consistent with CAD - normal angiogram

what screening tests should be done for women with HNPCC

- annual screening for endometrial cancer with endometrial biopsy beginning at age 35

when is lung cancer screening recommended

- annual screening with los-dose CT for adults 55-80 who have a 30 pack year smoking history and currently smoke or have quit within the past 15 years

patients with inherited thrompiphilia

- anticoagulated indefinitely after an episode of thromboembolic disease

ottowa knee rules

- any of these criteria = knee xray - 55 and older -isolated tenderness of the patella - tenderness at the head of the fibula - inability to flex to 90 degrees - inability to bear weight both immediately and in the ER (4 steps; unable to transfer weight twice onto each lower limb regardless of limping)

impingement syndrome with bursitis

- apleys scratch test causes pain and/or limited range of motion - neer and hawkins kenedy tests used to r/o

SE of stimulant medication

- appetite suppresion -tic disorder -insomnia -decrease in growth velocity

weight loss drugs

- approved for BMI >30 (most also indicated for BMI >27 with at least one obesity related comorbidity)

complications of GERD

- esophagitis -peptic strictures: - barretts esophagus -> adenocarcinoma

what therapy is for prevention of noncardioembolic stroke

- aspiring or aspirin in combo with extended release dipydidamole -plavix - (anti platelet)

appropriate steps for managing high risk ASCVD

- asprin and moderate to high intensity statin

causes of wheezing

- asthma - COPD -CHF -foreign bosy aspiration - persistent bronchittis -upper airway cough syndrome -vocal cord dysfunction PE

atypical symptoms of GERD are what and are caused by what

- asthma, chronic cough, dental enamel loss, globus sensation, hoarseness, noncardiac chest pain, recurrent laryngitis, recurrent pharyngitis, subglottis stenosis - when severe reflux reaches the pharynx and mouth or is aspirated

indications for exercise stress test

- asymptomatic male over 45 with 1+ RF may obtain useful info from exercise testing

fetal development-2 trimester

- at 18 weeks the baby will have facial expression, early skeletal development and display perceptible movements - babys sex can be seen via US - baby will begin to have hair, fingerprints and footprint - lungs, liver and immune system will mature

chronic sinusitis diagnosis

- at least 12 weeks of at least 2 of the following: -nasal obstruction -mucopurulent drainage -facial pain - pressure or fullness -decrease sense of smell - inflammation must be deomonstrated by one of the following: + purulent mucus of edema in the middle meatus or ethmoid region + polyps in the nasal cavity of middle meatus area + inflammation of the sinuses on radiographic imaging

recommendations for frequncy and duration of excercise

- at least 30 minutes on most days of the moderate excercise - at least 20 minutes at least 3 days a week of vigorous activity - moderate intensity: can talk during activity but noy sing -target HR for moderate exertion is 50-70% of max HR (220-age)

when should you get a PFT for someone with COPD

- at least annually

carpal tunnel exam: tinnels sign and phalens test

- atrophy of the thenar eminence - tinnels: tap the median nerve at the wrist - phalens: flex wrists and place dorsal surface of hands together for 30-60s

endometrial hyperplasia

- atypical complex hyperplasia is a premalignant lesion that has a 25% probability of progressing to cancer

viral pneumonia

- atypical presentation - influenza, RSV, measles, aricella, adeno, rhino, para - 4 mo-5 years - often hear crackles

two most common complications of influenza

- bacterial pneumonia ( + bronchitis) & otitis media - could also have aseptci meningitis, guillain barre, febrile seizures - complications common in kids less than 5

secondary prevention of CAD

- beta blockers - if BB are CI use a CCB - stable angina with normal LV function should use ACE-I ( conflicting evidence that they reduce exercise induced angina)

when does nausea occur in most women

- between the 4 and 7 week and resolves by the 20

USPSTF mammography screening recommendations

- biennial screening mammography for women 50-74

where is monofillament testing done

- big toe & 1,3,5, metatarsal heads

increaed abdominal aortic size is...

- bigger than 2 cm

what does a US in the 2 trimester measure and how close should id be to naeugels rule

- biparietal diameter -head circumference -abdominal circumference -femus length -within 2 weeks

car seat safety

- children under 13 should not sit in the front seat - until age 2 children should face backward 2-4: forward facing car seat in back -4-8:booster seat in back (booster seat until you reach 4'9" - over 8: seat belt in back -13: seat belt in rear or front

when do you use antibiotics for otitis media

- children under 6 months get antibiotics - over 6 months with uncomplicated unilateral otitis media may be observed first -over 2 is treated with additional observation

what is treatment for alzheimers

- cholinesterase inhibitors, vitamin E, memantine, respite care, atypical antipsychotics for behavioral disturbances

pathophysiology of asthma

- biphasic inflammatory response - The first phase is referred to as the early asthmatic reaction and lasts for approximately an hour. After bronchial provocation with an allergen or environmental stimulus, mast cells and eosinophils release mediators such as prostaglandins and leukotrienes, leading to increased vascular permeability, mucus hypersecretion and a rapid bronchoconstriction. The second, or late, asthmatic reaction starts about 2-3 hours after the original exposure, reaches a maximum by about 4-8 hours and resolves in about 24 hours. This phase is due to neutrophil, eosinophil and lymphocyte infiltration into the bronchial epithelium which results in epithelial destruction, fibrotic remodeling and hyperplasia of the bronchial smooth muscle. This overall increase in airway hyperresponsiveness may persist for days to weeks after the late reaction appears to have resolved.

chronic htn in pregnancy

- blood pressure elevation first detected before the 20th week of pregnancy that persists beyond 12 weeks postpartum

1 mo milestones

- bring hands within range of their eyes and mouth and some of their jerky body movements smooth out - they will listen when you talk to them and focus on you when holding them - move head from side to side when lying on stomach - head will still flop if unsupported and their hands are in tight fists -preference for the human face, mature hearing, recognition for some sounds such as mother voice

estimating daily caloric reuirments

- caloric intake: Basal metabolic rate + additional calories for activity - basal metabolic rate : body weight in pound X 10 - additional calories: multiple the body weight in pounds by 1.3 if sedentary 1.5 for moderate activity 1.7 for heave 1.9 for intesne - to lose weight the caoloric intake should be less than the estimated caloric needs

post partum depression

- can be Dx up to 6 months after childbirtch -however formal criteria is depression during the peripartum period and up to 4 weeks following childbirtch - in practice onset may often be within the first year after delivery

bile acid sequestrants

- can cause an increase in TG - GI effects and cinstipation - SE: may exacerbate dyslipopproteinemia or hyperTG

neuroblastoma

- can regress at stage 4S -some cases are AD with low penetrance - most cases are due to somatic mutations

what should follow a positive stress test

- cardiac cath

non-pharm recommendations for management of knee OA

- cardiovascular and/or resitance land based excercise - aquatic excercise -lose weight

bronchioloitis

- caused by viruses such as RSV - seen in young children with the incidence peaking at 6 months of age - often start as a viral illness and progresses to wheezing, couh, dyspnea and cyanosis -

CCBS

- causes leg edema - CI: essential HTN & hypertensive urgencies

if a woman is GBS positive and allergic to PCN what should she receive

- cefazolin

tramadol

- centrally acting mu opioid receptor that stimulates release of serotonin and inhibits reuptake of NE - lower abuse potential than other opioids - SE: seizures, serotonin syndrome, respiratory depression, angioedema, bronchospasm, constipation, anusea, dizziness and pruritis

active labor

- cervical dilation >4cm in the presence of contractions -contractions are normally 3-5 minutes apart -fetus is not in distress

dependence

- characterized by maladaptive pattern of opiod use causing clinically significant imapirement or distress - manifested by at least 3 of the following: Tolerance, withdrawal, increasing doses, desire or inability to cut down, significant amount of time spent in search of drug, interference with social, occupational or recreational activities and continued use despite persistent/recurrent physical or psychological problems due to the drug.

when do you draw a lipid panel and how often is it drawn?

- check fasting lipids in all adults over 21 every 4-6 years - draw in fasting state with at least 8 hours after the last food intake

unstable angina

- chest pain that occurs at rest or with increasingly less exertion - also considered aunstable if it is new onset, worsening in severity, frequency, duration - acute coronary syndrome and requires emergency care

RF for complication on influenza

- children < 5, COPD, conditions that affect the ability to handle respiratory secretions/increased risk of aspiration, CHD, metabolic conditions, chronic renal disease, immunosuppression, long term aspirin therapy

symptoms and Dx of TB in a child

- children have very few symptoms - all lobar segments of the lung are at equal risk of initial infection - often involves hilar adenopathy, focal hyperinflation and then atelectasis with minimal evidence of the primary lung focus itself - in asymptomatic kids use a PPD (TST)+ positive testL >5mm in high risk children, >10mm in moderate risk children, >15 mm in low risk children - in symptomatic children culture the sputum or from a first morning gastric aspirate in young kids

JNC8 blood pressure medications for diabetics

- choose either an ACE, ARB, CCB, or thiazide - for blakcs: CCB or thiazide

new 23-valent pneumococcal vaccine recommendations

- chronic disease patients (including those with CAD) receive the pneumovax once prior to the age of 65 and then once more at 65 - patients with asplenia or immunocompromised may be given a booster vaccine 5 yrs after their initial pneumovax

ankylosing spondylitis

- chronic, inflammatory arthritis -- 15-40 yo - morning stiffness and achiness over SI joint and lumbar spine

relatives with colon cancer

- close relatives of someone diagnosed with cancer before age 60 should start screening when they are 40

central vertigo

- cns pathology - nystagmous: + purley horizontal, vertical, or rotational + does not less when the patient focuses gaze persists for a longer period + nystagmus changes direction with gaze

colon cancer screening options

- colonoscopy every 10 years - FOBT collected at home annually - flexible sigmoidoscopy every 5 years with FOBT every 3 years - double contrast enemas every 5 years - begin at 50 and continue until 75

diagnose testicular torsion w/ what?

- color dopper US & radionucline scintigraphy - radionuclide scintigraphy has 100% sensitivity but doppler is faster and more readily avalable

vestibular neuritis

- commonly associated with a recent URI -nystagmus will NOT change with direction gaze (because this a peripheral lesion) - inflammations of vestibular branch of the eighth cranial nerve

grade III sprain

- complete tear and loss of integrity of ligaments - inability to bear weight - stretching of the joint with stress, w/o a definite stopping endpoint

intraarticular coticosteroid injections

- consider if joint inflamed - no more than 3 injections/year - no more than 1 injection per month - triamcinolone prefered - 1 ml steroid + 3 ml local anesthetic - 24 hours of imobalization following the injection is helpful but prolonged rest should be avoided

guidelines is HbA1c > 8

- continue lifestyle change + metformin + sulfonylurea or glimepride or basal insulin or insulin detemir on intermediate acting insulin - if HbA1c is >8 on reassessment then add basal insulin or intensity of insulin regiming

PE findings for suspected HF

- crackles in the lung bases and dullness to percussion -JVD - PMI laterally displaced from the mid0clavicular line towards the axillary line - S3 from rapid ventricular filling or poor left ventricular functioning -enlarged liver, hepatojugular reflex and distension and shifting dullness indicating ascited - LE edema and check pulses -sacral edema

ASCVD statin benefit groups

- current ASCVD - LDL >190 - diabetes age 40-75 - estimated 10 year ASCVD risk >7.5%

symptomatix treatment of upper respiratory infection

- decongestant or saline nasal spray for congestion -acetaminophen for fever and pain

fish oil

- decrease TG and slightly increase HDL

pathophysiology of CHF

- decreased complaiance of the ventricles leads to increased filling pressures, which leads to congestion

pain with lumbar extension is suggestive of

- degenerative disease or spinal stenosis

tendinopathy

- degenerative pathology - chronic condition with lack of acute phase reactants and collagenous degeneration

when you suspect depression in an elderly person what else should be screened for and with what tool?

- dementia - mini-cog (more sensitive and specific than MMSE)

elderly abuse RF

- dementia - shared living situation of elder and abuser - caregiver substance abuse or mental illness - heavy dependence of caregiver on elder - social isolation of elder from people other than the abuser

primary dysmenorrhea RF

- depression, anxiety, smoking

what is often comorbid with dementia

- depression: may cause pseudo-dementia

diabetic opthalmology referrals

- dialated yearly exams - T1DM should have first yearly exam 5 yrs after diagnosis -T2DM should have first dilated exam when they are first diagnoses

what is the dialated exam sensitive for

- dialted exam is sensitive for detecting retinal thickening from macular edema and for neovascularization

therapeutic lifestyle changes to decrease risk of CHD and cholesterol treatment plan

- diet with saturated fat <7% of calories - cholesterol intake <200mg/day - increased soluble fiber intake -excerise and weight control

analgestic rebound headache

- diffuse, b/l - everyday: may prsent on first waking up in the morning - improves slightly with meds, but worstens when the medication wears off - more than 15 headaches/month -regular overuse of analgesic for more than 3 months -development or worstening of headache during med overuse (must use meds 15 times per month for 3 months)

peripheral vertigo treatment

- diretics: useful for menieres bc they decrease endolymphatic pressure - eply maneuver: treatment for BBPV - vestibular rehabilitation: unilateral peripheral vestibular dysfunction - vestibular suppressant meds:

what is the laryngeal height

- distance from the sternal notch to the top of the thyroid cartilage

asprin therapy in patients with diabetes

- does not reduce the likelihood of CVD in patients with diabetes w/o preexisting disease - consider patients with diabetes for aspirin therapy as any patient without diabetes would be treated -USPSTF: use apirin for med 45-79 yrs whne the potential beenfit for reduction in MI outweights the harm due to an increase in GI hemorrhage and in women 55 to 79

anemia screening

- done at 12 months and againt at preschool or kindergarden entry

MRI imaging for headaches

- dont do imaging for uncomplicated headaches - 1. pnt has migraine with atypical patterns or neuro signs -2. patient is high risk of significant abnormality -3. results of study would alter management of headache Symptoms that increase the odds of positive neuroimaging results include: Rapidly increasing frequency of headache Abrupt onset of severe headache Marked change in headache pattern A history of poor coordination, focal neurologic signs or symptoms, and a headache that awakens the patient from sleep. A headache that is worsened with use of Valsalva's maneuver Persistent headache following head trauma New onset of headache in a person age 35 or over History of cancer or HIV

what are the recommendations for screening asymptomatic diabetics for CHD

- dont do it

how is heparin dosed and titrated

- dosed based on body weight and titrated based on aPTT

b-hcg levels in normal pregnancy

- doubles every 48 hours for the first 6-7 weeks of gestations - pregnancy detected when b-hcg 1500-1800 - transvaginal US can detect pregnancy at b-hcg 1500-1800 - b-hcg is 5000 by the time an abdominal US can detect a pregnancy - in ectopic and spontaneous abortion hcg levels are lower than normal - molar and multiple gestations are associated with higher than normal hcg - note: intrauterine contents are not expected to be seen until the quantittive b-hcg >1500 - double every 2.2 days over the first few weeks and then doulbe more slowly every 3.5 days by 9 weeks - peak at 10-12 weeks and then decline rapidly until 22 weeks when levels rise until delivery

orthostatic hypotension

- drop in systolic BP of >20 mmHG OR - drop in diastolic BP of >10 + when changing position from supine to standing -accompanied by feelings of dizziness of light headedness

when are drug and surgery indicated in obese patients

- drugs: BMI of 30 or 37 +comorbidities - Sx: 40 or 35 with comorbidities

talar dome fracture

- due to acute injury - potential for interruption of the blood supply - may be missed by initial x ray

direct hernia

- due to weakness in the transversalis fascia area of the hesselbach triangle -triangle is defined inferiorly by the inguinal ligament, laterally by the inferior epigastric arteries and medially by the conjoint tendon

palpitation due to cardiac cause is more likley when what is present

- duration of palpations greater than 5 minutes - dscription of irregular heart beat -male - affects sleep or during work

when do refer to GI for endoscopy

- dysphagia - initial onset of upper GI symptoms after 50 - early satiety -hematemesis - hematochezia -iron deficiency anemia -odynophagia (painful swallowing) -recurrent vomiting -weight loss

orthopnea

- dyspnea when lying flat - person is forces to sleep on pillows or in a chair

when should B-blockers be used?

- effective in preventing a second MI in patients who have already had one, even if their blood pressure is normal

test of choice for carpal tunnel

- electrodiagnosis test (nerrve conduction velocity study)

what is elevated in colon cancer and what does it suggest

- elevation above 5ng/ml is associated with a worse prognosis at each stage and is helpful in determining prognosis

initial treatment for GERD, gastritis and PUD before a Dx is made

- empirit treatment with PPI or histamine-2 antagonist: this helps Dx GERD - stop anti-secretory therapy after successful 4-8 wk course or in a pulse dose manner - refer to endoscopy in setting of alarm setting or in cases that do not respond to empiritc treatment after 8 weeks

endocrinology and weight gain

- endocrine disease that cause weight gain usually limit growth and lead to short stature

transvaginal ultrasound and endometrial cancer

- endometrium <4 mm reassuring

stridor

- entirely inspiratory wheeze that is louder in the neck indicating partial obstruction of the airway - high pitched inspiratory noise that is the result of a partial obstruction of extrathoracic airways such as larynx/trachea - classic for coup, inhaled foreign body with partial obstruction and laryngomalacia

atypical pneumonia

-YOUNG ADULTS -mycoplasma, chlamydia - often hear crackles

mononeucleosis

- fever, pharyngitis, lymphadenopathy - posterior cervical lymphadenopathy - palatal petechiae on posterior oropharync (palatal petichiae can also be seen in GABHS) - suspicion with negative strep test in a patient who is ill for more than 7-10 days - monospot is not positive for atleast 7 days into illness -early in illness may have maculopapular generalized rash that is faint, rapidly disappears and is nonpruritic

how do you know when headache symptoms are under control

- fewer than 2 per week or 8 per month -relived with lifestyle modification and acute treatment medicine - controlled headaches do not require additional follow up unless the headaches change or get worse

fetal development first trimester

- first 12 weeks: heart, spine, arms, legs and other organs develop - neural tube closes by 4 weeks - 7-8 wees: heart begins to beat and the fetus will move

fibric acid derivatives

- first line therapy for reducing TG - hepato & renal toxic, myopathy (esp in combo with statins)

asthma exacerbation treatment

- first oxygen -then albuterol and ipratropium - then IV or oral corticosteroids

pharm guidelines in BPH

- first: alpha adrenergic antagonists - then you can try 5-alpha reductase inhibitors and then can try a combo of both - avoid decongestants and antihistamines

crackles

- fluid in the lungs - discontinious - can be heard at early, mid or end inspiration of expiration (typically inspiratory) - acute pnemonia: usually fine mid inspiration crackles -resolving pneumonia: couarse and late inspiratory crackles

prenatal visit recommendations

- folic acid 400-800 mcg (1mg in patients with diabetes or epilepsy and 4mg in patients who had a child with a previous NT defect) -carried screening -screening for infectious disease - environmental toxins

2 year milestones

- follow 2 step commands - listen to short stories -parallel play - hold a panecil, immature grip and imitates prencil strokes - remove pants and sock -need help to undess completely - throw a ball overhand

H pylori triple therapy

- for 10-14 days (70-85% eradication rate) - PPI atandard dose twice daily - amoxicillin 1 gram twice daily - clarithromycin 500 mg twice daily

SE of aspirin

- gastritis, PUD, bleeding (esp when used with clopidogrel)

osteoarthritis

- generalized or joint line tenderness - aggravated by weight bearing activity, relieved by rest - crepitus - joint stiffness

definition of atopy

- genetic predisposition for the development of an IgE mediated response to common allergens

steps to decrease maternal blood loss

- give oxytocin after baby is born to help the placenta detach quicker, pull the coord when the placenta appears to have detaches and massage the uterus - early clamping of the umbilical cord: delay 2 minutes to give baby the right amount of blood but not cause the mom too loose too mch

thyroiditis

- gland increases in size (viral/pregnancy) and xs hormone leaks out - there is LOW uptake of iodine

venous doppler

- good sensitivity and specificity for DVT

blue dot sign

- hard, tender nodule palpable in the upper pole of the testis - pathognomonic for appendiceal torsion when tenderness is also present

stoop test

- have patient go from standing to squatting - in patients with central spinal stenosis, squatting will reduce pain

crossed leg test

- have the patient cross their legs with the injured leg resting at the midcalf on the knee to detech high ankle sprains

diabetes diagnostic criteria

- hba1c > 6.5 OR - fasting (no caloric intake for at least 8 hours) plasma glucose >126 OR - 2 hour plasma glucose >200 during an oral glucose tolerane test following a glucose load of 75 g glucose OR - patent with symptoms of hyperglycemia, a random plasma glucose >200

common side effects of SSRI and SNRI

- headache -sleep disturbance - GI problems - SIADH - serotonin syndrome - increased risk of GI bleeding - may decreased bone density so worry about falls in elderly

symptoms of hyperthyroidism

- heat intolereance -tachycardia -fatigure -weight loss -tremor -increased sweating -exertional dyspnea - depression & hyperreflexia are less common -diarrhea and light periods can also occur

excercise ecg w/ imaging and excercise echo are indicated when?

- intermediate probability of cAD - can excercise and have either pre-excitation syndrome or more than 1 mm of ST-segment depression on resting ECG - pts with a history of previous revascularization procedures, those who take digoxin, LVH -

negative inversion test

- invert patients ankle. laxity indicates injury of the calcaneofibular ligament

syndesmotic sprain

- involves the interosseus membrane and the anterior inferior tibiofubular ligament - pain and disability are often out of proprtion to the injury - positive ankle squeeze test

most common cause of goiter worldwide

- iodine deficiency

most common cause of CHF

- ischemic cardiomyopathy - often the result of long term RF such as HTN, hyperlipidemia, diabetes

what does acitve and passive loss of motion suggest in an injury

- joint disease (while loss of only active ROM is more suggestive of a muscle disease)

radiographic features of OA

- joint space narrowing -subchondral sclerosis ( hardening of tissue beneath the cartilage. increased periarticular bone density) -ostephytes -subchondral cysts (fluid filled sacs in the bone marrow)

L5 and S1 distrubution to test in lower back pain

- l5: great toe -s1: lateral mallelous and posterolateral foot

clunk and o'brien test

- labral injury clunk: With the patient supine, the examiner rotates the patient's arm and loads (force applied) from extension through to forward flexion. The examiner is checking for a "clunk" sound or clicking sensation arising from the glenoid labrum that can indicate a labral tear even without instability. obrein: hands on hips with anterior force on the elbow

achilles tendon rupture

- landing on ball of foot -popping sound - pain in posterior ankle - unable to plantarflex

iliotibial band tendonitis

- lateral knee pain - overuse -worse with activity

most common ankle injury and damaged ligaments

- lateral sprain due to inversion and plantal flexion - injured: anterior talofibular, calcaneofibular, and posterior talofibular ligaments - anterior talofibular ligament is the most easily injured

salvage therapy for H pylori

- leofloxacin triple therapy is an option that may be considered for persistent H pylori - levofloxain triple therapy for 10 days: standard dose PPI twice daily, amoxicillin 1 gram twice daily, levofloxacin 500 mg one daily

blood pressure goal for patients with diabetes

- less than 140/90

lipid goals for peds

- less than 17o for TC and LDL less than 130 - children with a fmhz of high cholesterol or who are overweight or obese should have cholesterol checked

non germ cell tumors

- leydig and sertoli - rare; malignant in only 10% of cases

management of prehypertension in kids

- lifestyle change - BP rechecked in 6 months - no need for work up unless something concern based on fmhx,or PE exam

guidelines for when HbA1c > 6.5%

- lifestyle change + metformin

torn rotator cuff

- limited ROM with significant pain - in complete tear the patient will no be able to raise his arms over his head -significant weakness with strength testing

back pain due to malignancy

- localized to the affected bones - dull thrbbing progresses slowly - increases with recumbency or cough -patients over 50

realistic weight loss goals

- long term: 5% to 10% reduction in body weight - short term: lose half a pound to 1 pound a week

LMWH advantages over unfractionated heparin

- longer half life so can administer subQ once or twice daily - lab monitoring is not rquired -thrmobytopenia less likley -fixed dosing - can be used in outpatient setting

major risk factors for CHF

- low HDL - diabetes -current smoking

tobacco use during pregnancy is associated with...

- low birth weight in the fetus

echocardiogram

- measures the size of the chambers, thickness of the walls and size of cavity - evalutates the movement of heart structures - doppler assesses blood flow through the valves and chambers - the ratio of LV filling velocities (E/A) is a marker of diastolic dysfunction . This ratio is reduced when the diastolic dysfunction is present

3 hour glucose tolerance test

- measuring the patients glucose after fasting and then 1,2, and 3 hours after ingesting 100g glucose load -abnormal test = 2+ of the following values + fasting serum glucose >95 -one hour serum glucose >180 -2 hour serum glucose >155 - 3 hour serum glucse >140

management of primary htn in children

- medsications -diet changes (reduce sweets, fats, red meats and Na+) - weight loss -physical activity

in what groups are blood pressure rates the lowest

- mexican americans and native americans

when is migraine prophylaxis considered and important

- migrines more frequently than twice a week at at risk for medication overuse headache and migraine prophylaxis should be considered

GERD

- mild epigastric pain -symptoms commonly worsten after meals - burning pain -substernal -tends to worsen when gstric volume is increased, when gastric contents are located near the GE junction (reclining or bending). intra-abdomial pressure is increased

management of diastolic heart failure

- minimize fluid overload with diuretics -control BP - slow down HR - manage comorbid CHD - many physicians start with a B-blocker or non-dihydropyridine CCB in order to slow th heart rate, increase the ventricular filling time and decrease BP -excessive diresis and preload reduction can worsten diastolic failure

placenta previa

- more commin in women who have has a prior pregnancy, older than 35, smoke, have had twins, previous uterine Sx or C-section -more likley to resolve when detected earlier in pregnancy -marginal or incomplete previas are more likley to resolve than complete - bleeding most often occurs in the late 2 or 3 trimester - if it does not resolve, c-section is usually needed - often presents with painless vaginal bleeding -usually bright red -usually no abdominal pain

when would a transvaginal US be indicated

- more reliable for dating at 6 weeks gestation

when do reflexes disappear

- moro: 4 months - palmar grasp: 2-3 months - plantar grasp: 8 month -asymmetric tonic neck reflex: 6 months -babinski: normal in 1-2 years

distinguishing between viral URI and sinusitis

- mosre likley to be vial if the symptoms are less than 10 days and they are not worsening

cervical polyps

- most common in postpartum and perimenopausal women

germ cells tumor

- most common testicular tumors - further divided in seminomas and nonseminomas - nonseminomas: embryonal tumor, mixed GCT, teratoma, teratocarcinomas - *yolk sac tumors* aka endodermal sinus tumors are the most common prepubertal GCTs and are most often malignant . They have a good prognosis and require Sx and chemo. - choriocarcinoma is the most lethal but the least common NSGCT

nicotinic acid

- most effectice agent to increase HDL - exacerbates DM, group, PED, hepatotoxic

epididymitis

- most frequent cause of sudden scrotal pain in adults - slowly progressive over several days - patient may appear comfortable, except when examined -often high fevers are involved cremaster reflex is present, testis in normal location and position

intoeing

- most resolve by age 8 -if not resolved spontaneously by 4 years of age, refer to ortho

ethnicities more at risk for diabetes

- native americans, africans, asian americans, latin ameircans, pacific islanders

acute peancreatitis

- nausea, vomiting, epigastric pain - abdominal tenderness -grey turners sign: ecchymotic discoloration in the flank -cullens sign: ecchymotic discoloration in the periumbilial region

tolerance

- need for increasing doses of medication to achieve the initial effect of the drug

CAGE questionairre

- need to CUT down - felt ANNOYED by criticism - had GUILTY feelings - taken a morning EYE opener - 2+ positive answers = more intensive evaluation - consumption of more than 14 drinks per week or more than 4 drinks per occasion for men and more than 7 drinks per week or more than 3 drinks per occasion for women is a positive screen

how big should a non pregnant ladies uterus be

- no larger than 8 weeks in size (clenched fist) -

ace-i and arbs in african americans

- no recommended unless thy have ckd - 2-4 times more likley to develop angioedema

factor Xa inhibitors

- no weekly lab monitoring of INR - difficult to reverse anticoagulation in the face of a bleed

when is is acceptable to administer a t-pa

- onset of neurologic symptoms has been within three hours of the onset of symptoms, emergent CT scan does not show an intracranial bleed, an early acute infarct , or a brain mass

delerium treatment

- oral haloperidol -SE of haloperidol: sedation, constipation, tardive dyskinesia, QT prolongation (rare)

what corresponds best to pain vs disease progression with OA xray

- ostephytes: pain - joint space narrowing: disease progression

RF for diabetes in kids

- overweight (BMI >85th percentile) plus any two of the following: + fhx of t2dm in first or second degree relative + native american, african american, hispanic american, asian/south pacific islander + signs of insulin resistance or conditions associated with insulin resistance such as acanthosis nigricans + maternal history of diabtes or gestational diabetes during the childs gestation

what is suggestive of a mechanical cause of back pain

- pain worse with movement and sitting - lumbar strain/spain: spasm of the paraspinous muscle

lymphedema

- painless or chronic dull and heavy sensation -early on there is pitting - chronic: woody, indurated, fibrotic

inguinal hernia

- painless, becomes painful and tender when incarcerated

how does V tach usually present

- palpitations, lightheadedness and syncope

major deppression diagnostic criteria

- patient must have at east five of the following 9 criteria for a minimum of two weeks - SIG E CAPS - Sleep: insomia, hypersomina - Interest: loss of - Guilt - Energy: decreased -Concentration: decreased or crying -Appetite: increased or decreased - Psychomotor retardation - Suicidal ideation

absolute contraindications to digital cervical exam

- patient reports of vaginal bleeding with an undocumented placental location (or known previa ): b/c may worsten bleeding -leaking vaginal fluid with prematurity (or known PPROM): b/c may introduce bacteria into the uterus

primirive reflexes

- patients with advanced dementia or other neurodegenerative diseases may develop these with loss of frontal lobe control - reflexes seen in infants, including grasp, suck and glabellar tap

postpartum blues

- peak around 4th day and end around 10 days

most common site of mets for colorectal cancers

- pelvic lymph nodes -liver -lungs

first line treatment for strep pharyngitis

- penicillin V

diagnosing sinusitis in a child should be done when

- persistence of b/l nasal discharge of any quality or daytime cough or both lasting more than 10 days without significant improvement (unilateral symptoms suggest a nasal foreign body) OR - worsening after initial improvement OR - high fever and purulent nasal discharge for more than 3 days

indirect hernia

- persistent process vaginalis - begins at internal inguinal ring and courses along the inguinal liagament to the external ring located medial to the interior epigstric arteries -contents follow the tract of the testicle down into the scrotal sac

hyperemesis gravidum

- persistent vomiting, dehydration, ketosis, electrolyte disturbances and weight loss

prehn sign

- physical lifting of testes relieves pain caused by epiditymitis but not pain caused by torsion - + sign: pain relieved by lifting of the testicle

which of the following pain characteristics speak against the likelihood of angina

- pleuritic -pulsating -positional -reproduced by palpation - stabbing pain

peripheral vertigo

- problems with the inner ear or vestibular system - nystagmous: + unidirectional (usually horizontal and rotational) and does not change direction + inhibited by fixating on a point and intensifies when fixation is withdrawn - frenzel glasses prevent fixation and bring out the nystagmous

what birth control methods are okay to start immediately post partum

- progestin-only pills, injectable progestin, progestin implants - take the pill at the same time everyday - if exclusively breast feeding begin progestin only contraception after 6 weeks

suggestive of vertebral fracture

- prolonged use of corticosteoids - mild trauma over age 50 - age greater than 70 - history of osteoporosis - recent significant trauma at any age -previous vertebral fracture

PQRST for racing heart exam

- provocation/palliation (cold, stress, meals, sex) -quality - region/radiation

common rashes of pregnancy

- pruitic urticaial papules and plaques of pregnancy: papulovescicular lesions on the trunk and extremities - prurigo of pregnancy: excoriated areas on the trunk or limbs -pruritic folliculitis

when is a pharm stress test with myocardial perfusion imagine and dobutamine echo used

- pts with intermediate pretest for CAD & an electronically paced ventricular rhythm of LBBB

CHF PE findings

- pulmonary edema (evidenced by inspiratory crackles and/or dullness ro percussion) - S3 - PMI diffuse and laterally displaced - peripheral edema - increased JVD - hepatojugular reflux

diagnostic criteria for DM

- random glucose >200 + symptoms of hyperglycemia - fasting plasma glucose >126 - HbA1c >6.5

what do you do if the INR is elevated on warfarin

- rechck INR in 24 hours if INR is between 5-9 - if >9 : stop warfarin and give vitamin K

screening for group B strep

- rectovaginal swab at 35-37 weeks - Ab prophylaxis should begin at least 4 hours prior to delivery for optimal protection - if not screened prophylaxis is still given for those with RF such as delivery at less than 37 weeks gestation or prolonged rputure of the membranes greater than 18 hrs

arbs

- reduce microalbuminuria & macroalbuminuria -heart remodeling effects - avoid in pregos

orthostasis

- reduction of systolic or diastolic blood pressure of atleast 20 or 10 mmHg respectively, measured 3 mnutes after a patient who has accommodated to the supine position assumes a standing or sitting position -some also consider a + when the pulse rate remains increased by 20 beats/min (16 in elderly)

labral tear

- repetetive damage from glenohumeral joint instability or secondary to trauma - clunk and o briens test - often a dx of exclusion

progesterone levels and vaginal bleeding

- result >25 is associated with sustainable pregnancy - <5 suggets miscarriage or ectopic prgnancy - levels between 5-25 cant distinguish between intrauterine and ectopic pregnancy

RISE pneumonic for preventive visits

- risk factors - immunizations -screening tests -education

premature rupture of the membranes

- rupture of fetal membranes prior to onset of labor -can occur at any gestational age - large gush or steady trickle of clear vaginal fluid - preterm PROM is PROM prior to 37 weeks of gestation is the leading identifiable cause of premature birth

correct way to measure BP

- seated for 5 minutes with back supported - arm at heart level - length of the bladder of the cuff should be 80% of the arm and the width must be 40% of the arm circumference

cocaine and sitmulants during pregnancy

- vasocontriction _> placental insufficiency and low birth weight

symptoms of severe preeclampsia

- visual disturbances, severe headache, RUQ or epigastric pain nausea, vomiting, decreased urine output

when do most deaths due to PE occur

- w/in an hour or two

what therapy is for prevention of cardioembolic strokes

- warfarin (oral anticoagulant)

ACE-I

- watch K, Na and creatinine -renal protective -reduces microalbuminemia - first line in diabetes and renal disease -heart remodeling effects - increase 35% above baseline creatinine is acceptable after initiating use - SE: can cause cough & angioedema, renal dysfunction, hyperK - avoid in pregos

vocal cord dysfuntion

- wheezing -dont respond to astham meds - spirometry: flattening on inspiratory loop -abnromal vocal cords with laryngoscopy

when do you retest to see if Hpyloi was eradicated?

- when a patient has an Hpylori associated ulcer, persistent symptoms despite appropriate therapy, MALT lymphoma, history of resection for early gastric cancer and pts planning to resume chronic NSAID therapy

when does an MI in a family member increase the risk of CAD

- when it occurs in a first degree relative for a male <55 and female <65

with influenza when can u go back to school

- when most symptoms have improved and the child has been afebrile for 24 hours

when would TSH levels not reflect the level of circulation thyroid hormone?

- when there is a primary pituitary prblem )failure or the development of an adenoma that is not suppressed by excess thyroid)

when is a D -dimer used to diagnose a DVT

- when there is a very low pretest probability

when is risk of stroke greatest in patients with AF

- when they have had it for more than 48 hours or in those who have not been given 3 weeks of prior anticoagulant therapy

cotton wool spots

- white spots with fuzzy borders that indiate previous infarction -- seen in severe non proliferative retinopathy of diabetes

when is sling immobilization of the shoulder recommended

- with a shoulder dislocation or proximal humeral fracture

what does a US in the 3 trimester measure and how close should id be to naeugels rule

- within 3 weeks - fetal size cannot be accurately used to assess EGA or EDD and should not change a due date - do not use 3 trimester measurments for dating the EGA or EDD- - according to another case the US can be used to date when there is a discrepancy of more than 3 weeks in the 3 trimester - most accurate for dating when used before 20 weeks

when is a DEXA scan indicated for osteperosis screening

- women 65 yo - 0 to -1 is normal - osteopenia -1 to -2.5 - below -2.5 is osteoperosis - lifetiem risk of about 9.3 indicates screening as well

when can you stop doing pap smears

- women over 65 if they had had recent screening with normal paps

prostatitis

- young and middle aged men - pain (perineum, lower abdomen, testicles & penis, & w/ ejaculation), bladder irritation, bladder outlet obstruction and sometimes blood in semen

CVS

-10-13 WKS -sample of placental tissue - higher risk of spontaneous abortion and limb defects

triple therapy in patients allergic to pcn

-10-14 day regimine (70-85% eradication rate) - PPI standard dose twice daily - calrithromycin 500 mg twice daily -metronidazole 500 mg twice daily

when do you start screening for HTN

-18

when is US in pregnancy recommended

-18-20 weeks

screening for gestational diabetes

-24-28 wks with a 1 hour glucose tolerance test - use a fasting glucose and a one-hour glucose following a 50g glucose load - if fasting >126 OR one-hour glucose is greater than 130 then the patient is considered to have a positive result - if positive the pt should undergo a three-hour GTT with 100g glucose load

when to use aspirin

-45 to 79 in men to reduce MI risk -55-79 women for ischemic stroke - weight against GI hemorrhage -JNC 8 has no recommendation about aspirin and htn

postvoid residual volume

-50mL = normal -50-200 = equivocal - >200 = abnormal

what should an initial pregnancy evaluation include

-CBC, RPR, HIV, Rubella, blood type & Hep B -

therapy for severe COPD

-FEV1 <50% - inhaled glucocorticoids be added to bronchodilator treatment (LABA) -

late decelerations

-Late decelerations are decelerations in the fetal heart rate that begin after a contraction begins, with the nadir after the peak of the contraction. They can be an indication of utero-placental insufficiency, meaning that the baby may not be getting enough oxygen and late decelerations can be an early sign of hypoxemia during contractions.

NSAIDS and GERD

-NSAID can worsten GERD esp if taken on empty stomach

passive straight leg raise test

-The normal leg can be raised 80 degrees. If a patient only raises their leg <80 degrees, they have tight hamstrings or a sciatic nerve problem. To differentiate between tight hamstrings and a sciatic nerve problem, raise the leg to the point of pain, lower slightly, then dorsiflex the foot. If there is no pain with dorsiflexion, the patient's hamstrings are tight. The test is positive if pain radiates down the posterior/lateral thigh past the knee. This radiation indicates stretching of the nerve roots (specifically S1 or L5) over a herniated disc. This pain will most likely occur between 40 and 70 degrees. Pain earlier than 30 degrees is suggestive of malingering. Pain in the opposite leg during a straight leg raise is suggestive of root compression due to central disc herniation. When compared to MRI, the straight leg raise test has a sensitivity of 0.36 and specificity of 0.74 The ipsilateral straight leg raise test has a sensitivity of 0.80 and a specificity of about 0.40. Thus, a negative test makes a herniated disc unlikely, but a positive test is non-specific.

how do you treat patients with gout in which NSAIDs or colchicine is CI

-based on the number of joints - 1 or 2 joints are involved: artherocentesis with intra-articular glucocorticoid injections - polyarticular: oral glucocorticoids

first line treatment for HTN in a patient with a known CAD or previous MI

-beta blockers and ACE-I

chdwicks sign

-blue puriple tint of vaginal walls and cervix in pregnancy

systemic treatment for tinea capitus and tinea unguium

-capitis: griseofulvin - unguium: terbinafine, itraconazole in pulse therapy

main causes of palpitations

-cardiac arrhythmias -structural heart disease -psychosomatic disorder -systemic causes -effects of medical or recreational drugs

radiographic findings of CHF

-cardiomegaly: width of heart is more than half of the width of the throax - central vascular congestion and hilar fullness - pleural effusion -cephalization of pulmonary vasculature (esp in upper lung fields) - kerley B lines: small linear densiries 2-3 cm in length seen in the periphery of the lung fields on the PA view. repesent interstitial fluid in the lung tissue

acute pancreatitis

-causes severe abdominal pain, associated nausea and vomiting, ill appearance on exam, and clinical signs of dehydration such as tachycardia - epigastric area w/ radiation to the back and worstens with eating - may be caused by alcohol use -

tx for strep when pcn allergy present

-cephalosporin if pcn allergy is not an immediate type HS -macrolide for pts with pcn allergy

which bedside instrument is the best for diagnosing delerium

-confusion assessment method (CAM)

retinal hemorrhage

-dark blots with indistrinct borders that indicate partial obstruction and infarction -- seen in severe non proliferative retinopathy of diabetes

what is essential in the clinical staging of colorectal cancer

-depth on invasion of the bowel wall. cannot be determined until the cancer is surgically removed - endorectal US may help oncologist estimate the depth on invation -

MCC of ESRD

-diabetes

common childhood growth pattersn

-double birth weight by 4-5 months -triple birth weight by 1 year of age - double their birth length by 4 years

duodenal ulcer

-epigastric pain - relieved by food and antacids -

how often should you assess major ASCVD RF

-every 4-6 years in adults 20-79 yo who are free from ASCVD

vestibular migraine

-variant of migraine that can cause central vertigo - at time of vertigo may not present with headache

benefits from quitting smoking

-lung funtion decreased at twice the rate in patients who conitnued verses throse who quit -quitting smoking provded benefit whenever the person quit -contonuing smoking or relapsing worsened lung function - major benefits occured in the first year after smoking cessation

extragonadal testicular tumor

-lymphoma, leukemia and melanoma are the most common malignancy that met to the testis

hydrochlorothiazide

-may cause elders to become incontinent of urine - doses above 25 mg do not decrease BP further or further reduce morbidity and mortality - low dose has a better outcome on coronary heart disease than high dose - in elders dose should be below 25mg - CI in patients with CKD - avoid in patients with gout (increases uric acid) - watch for hyponatermia

what is the fundus photography exam sensitive for

-more sensitive for retinopathy

testicular cancer

-most common malignancy affecting males between 15-35 - most common among african americans - can present as a nodule or painless swelling - may present with dull ache or heavy sensation in the lower abdomen, perianal area, or scrotom

most effective meds for patients with allergic rhinits

-nasal corticosteroids

proliferative retinopathy

-neovascularization

what are the majority of dyspepsia cases due to

-non-ulcer dyspepsia (specific etiology for dyspepsia cannot be identified) in 50% of cases

in well controlled asthma how ofter should SABA be used

-not more than 2 times per week

atypical angina

-often diabetics, women and the elderly - may only present with weakness and SOB

referred scrotal pain in children and adolescents

-often due to a retrocecal appendicitis

abdominal aortic anuerysm screening

-one time US in men 65-75 who have any history of smoking

hemoarthosis with fat globules

-osteochondral fracture

post menopausal bleeding increases risk of

-ovarian cancer

conditions that contirbute to hyperglycemia

-overeating missing doses of medication, dehydration, infection, illness, stress

psoas sign

-passive extension of the patients thigh as he lies on his side with knees extended, or asking the patient to actively flex his thigh and hip causes abdominal pain

strongest RF fir delayed ulcer healing and amputation in diabetes patients

-pedal pulses

addiction

-persistent drug craving, loss of control over drug use, compulsive use, strong tendency to relapse after withdrawal

bisphosphanates

-potent inhibitors of bone resportion and resuce bone turnover

microaneurysms

-punctate dark lesions that indicate vascular dilation - seen in severe non proliferative retinopathy of diabetes

non specific white matter changes on MRI

-represent microvascular disease - generally irrelevant and very common

esophageal spasm

-sharp, stabbing substernal pain and can be triggered by temperatire extremes - often at night and after consumption o meal

compartment syndrome sign and treatment

-signs: pain, pallor, pulselessness, parasthesia, perishing cold, paralysis - Tx: fasciotomy

goodells sign

-softening of the cervix in pregnancy

hegars sign

-softening of the uterus in pregnancy

typical symptoms angina

-substernal chest iscomfort with a characteristic duration and features -exertional in nature -relief with rest or nitroglycerin

severe persistent asthma

-symptoms throughout the day - LABA is used here

b-2 agnost overuse symptoms

-tachycardia - exaggerated somatic tremor -hypokalemia

resisting external rotation

-tests infraspinatous and teres minor muscle

when is abortion legal

-up to 22 weeks of pregnancy

head thrust test

-used to demonstrate peripheral cause of vertigo - with a peripheral lesion: the vestibular ocular reflex will be disrupted. so when you ask a pt to stare at your nose and turn their head to the side, his eyes will more with the head and then saccade back to center when his head is moved in the direction of the lesion - a normal thrust test in the presence of vertigo means the peripheral vestibular system is intact and the lesion is central

symptoms and findings of atrophic vaginitis

-vaginal dryness, dyspareunia, urinary symptoms, vaginal pruritis

whenCAP is suspected when is an xray indicated

-when a kid is hypoxic or isnt responding to treatment

ectropion

-when the central part of the cervix appears red from the mucous producing endocervical epithelium protruding through the cervical os

What scores need stroke prophylaxis

0= Aspirin 1= Warfarin or Aspirin 2 or higher = Warfarin

What is a TIMI score and what is it used for

1 point for each item below and if score 3 or more increased risk of death from MI 65 or older 3+ risk factors for CAD Aspirin use in last 7 days Known CAD with stenosis > 90% 1 or more episodes resting angina last 24 hrs ST seg deviation 0.5mm Increase cardiac markers

stages of labor

1) - lacent stage: regular contractions have started, but the cervix is less than 4cm dilated - active phase: begins when 4cm dilated; ends when fully dilated 2) begins at full dilation, ends when the baby is delivered 3) begins with the birth of the baby; ends with delivery of the placenta

Symptoms of giardia diarrhea

greasy, foul smelling, bulky stolls

non REM has 4 stages

1,2,3,4

SS community acquired pneumonia

1-10 day hx increase cough sputum shortness of breath tachycardia pleuritic chest pain fever sweats/ rigors

How many days typically do lice survive away from the scalp and eggs

1-2 days lice 10 days eggs

Where are the murmurs best heard 1. Aortic Stenosis 2. Aortic Regurg 3. Mitral Stenosis 4. Mitral Regurg

1. 2nd Right intercostal space 2. 2nd-4th left intercostal space 3. Apex 4. Apex

long term management of asthma in children: a stepwise approach

1. Classify severity: Assign patient to most severe step in which any feature occurs (PEF is % of personal best; FEV1 is % predicted). 2. Gain control as quickly as possible, then step down to the least medication necessary to maintain control. 3. Minimize use of short-acting inhaled beta2-agonists. Over-reliance on short-acting inhaled beta2-agonists (e.g., use of approximately one canister a month even if not using it every day) indicates inadequate control of asthma and the need to initiate or intensify long-term-control therapy. 4. Asthma management is a multifaceted approach, including patient education on self-management and controlling environmental factors that make asthma worse (e.g., allergens and irritants). 5. Refer to an asthma specialist if there are difficulties controlling asthma or if step 4 care is required. Referral may be considered if Step 3 or greater care is required.

cardinal movements of labor

1. Engagement The presenting part of the fetus has entered the pelvic inlet. 2. Descent Described by the "station" on cervical exam. The fetus is at 0 station when the widest part of the presenting part is between the ischial spines. 3. Flexion When a fetus is in the occiput anterior position, the fetal head is flexed by the soft and bony tissues of the maternal pelvis, which facilitates passage through the birth canal. 4. Internal rotation The fetal head must rotate in order to further descend 5. Extension Occurs as the fetal head passes under the symphysis pubis, which occurs during crowning and delivery of the head 6. External rotation The head rotates to realign with the shoulders (also called restitution) 7. Expulsion Completing the delivery, with the anterior shoulder of the fetus being pushed out first, then the posterior shoulder and the rest of the body.

shoulder impingement testing

1. Neer & Hawkins-kennedy test

diabetes screening recommendations

1. Overweight or obese patients (body mass index 25 kg/m2) who have one or more of the following additional risk factors: Physical inactivity Race/ethnicity (e.g., Native American, Pacific Islander, Latino, African American, Asian American) First-degree relative with diabetes Previously diagnosed impaired fasting glucose (100-125 mg/dL) or impaired glucose tolerance (2-hour plasma glucose > 140 mg/dL following a 75 gram glucose load) Hypertension (Blood pressure > 140/90 mmHg) HDL cholesterol < 35 mg/dL and/or triglycerides > 250 mg/dL (2.83 mmol/L) History of gestational diabetes mellitus, or delivering a baby > 9 lbs. Polycystic ovarian syndrome History of cardiovascular disease A1C ≥5.7%, impaired glucose tolerance, or impaired fasting glucose on previous testing Other clinical conditions associated with insulin resistance (e.g., acanthosis nigricans, severe obesity) 2. In the absence of the above risk factors, screening should begin at 45 years of age. 3. If results are normal, testing should be repeated at least at three-year intervals, with consideration of more frequent testing depending on risk status and initial results.

wagner grading system of ulcers

1. diabetic ulcer (superficial) 2. ulcer extension) into ligaments and muscle but no bone involvement or abscess formation 3. deep ulcer with abscess or osteomyelitis 4. gangrene forefoot (partial) 5. extensice gangrene of foot

PHQ-2 for depression

1. have you been bothered by feeling down, depressed or hopeless? 2. have you often been bothered by little interest of pleasure in doing things? - yes to either question is a positive screen

treatment of graves

1. methimazole: suppress thyroid hormone production / SE include agranulocytosis. takes 3 mo to work. continue for several years. blood work needed as doses changed often2. PO radioactive Iodine:most commonly used in US. few SE. may need eventual thyroid replacment because much of the gland is destroyed

Where do the murmurs radiate 1. Aortic Stenosis 2. Aortic Regurg 3. Mitral Stenosis 4. Mitral Regurg

1. neck and left sternal border 2. apex and right sternal border 3. little or NONE may have opening snap 4. Left axilla

how do you test for H.pylori

1. rapid urease test- sample tissue from biopsy 2. histologic staining- 3. serologic tests 4. fecal antigen tests 5. Urea breath test

when should tPA therapy be delayed

1. there is clinical suspicion of a bleeding abnormality or thrombocytopneia 2. the pt has received heparin or warfarin 3. use of anticoagulants unknown

How long can Rhus dermatitis last for

10-21 days and initial episode longest up to 6 weeks

Treatment cluster headaches

100% oxygen at 7-10L/min for 10-15min Prednisone 60-80mg/day with 2-4 week taper help shorten duration of episodes and deminish frequency

What is the daily calcium and vitamin D intake recommended for osteoperosis

1200 mg Calcium 400-800 IU of vitamin D

Cluster headaches last

15-90min many times a day on and off for 4-6 weeks with 3-4 symptom free periods

What is the new treatment guide for BP control in patients over 60y/o

150/90

severe gestational htn/preeeclampsia is

160/110 - leads to increased complications of preterm delivery, SGA, placental abruption

if you just had a kid when is it okay to get pregnant again

18-23 mo

A high-potassium and high-calcium diet reduces blood pressure significantly

A __________ diet reduces blood pressure significantly

A child may use a booster seat when > 40 lbs

A child may use a booster seat when _______

A high fever of 3-5 days followed by a rash suggests Roseola, by Human Herpes Virus 6. Rash starts starts on the trunk and spreads to extremities, sparing the face

A high fever of 3-5 days followed by a rash suggests ______________. Rash starts __________

A rare cause of COPD is deficiency of alpha1-antitrypsin

A rare cause of COPD is _________

What is cellulitis

A spreading non-fluctuant tender plaque as a result of an infection of the dermis

What is erysipelas

A superficial cellulitis with marked dermal lymphatic involvement

USPSTF grading system

A: The USPSTF recommends this service. There is high certainty that the service improves health outcomes - net benefit is substantial. B: The USPSTF recommends this service. There is high certainty that the service improves health outcomes - net benefit is fair or fair certainty that the net benefit is moderate - substantial. C: The USPSTF recommends against routinely providing this service. There is moderate or high certainty that health outcomes are not improved - net benefit is small. However there may be occasions that warrant provision of this service in a patient. D: The USPSTF recommends against providing this service. There is moderate or high certainty that the service does not have any net benefits or harms outweigh benefits. I: There is insufficient evidence to recommend for or against the service.

MOA of anterior hip disolocation

ABD and ER of femur

Operative Tx AC joint sprain

AC joint fixation and coracoclavicular ligament fixation

TX for HF long term

ACE inhibitors Diuretics Diet and exercies

What is considered 1st line tx for HTN

ACE inhibitors or ARB's in non african american people

What injury do you have a high risk of having with a secgond fracture

ACL tear

X-ray views for SCFE

AP and frog leg

Imaging to Dx Shld disslocation

AP, Axillary, and Y views

What test do you run to help determine Post streptococcal glomerulonephritis

ASO titer (antistreptolysin)

What is a 3rd Degree block

AV dissassociation P waves not related to QRS more P's than QRS

Ab for uncomplicated pneumonia in child more than 5

AZITHROMYCIN

Mechanism of ant shoulder dislocation

Abduction and External rotation

What is Parasomnias

Abnormal behaviors during sleep: Sleep terrors nightmares sleepwalking enuresis

What is the pathophys behind Emphysema

Abnormal enlargement of terminal airspaces decrease gas exchange surface and loss of elastic recoil causing Air trapping (Pink Puffer)

Absence of red reflex may suggest congenital cataracts, glaucoma, or retinoblastoma

Absence of red reflex may suggest ______________

Acanthosis nigricans is a sign of insulin resistance

Acanthosis nigricans is a sign of ______________

Complication of anterior hip dislocation

Acetab Fx Ligamentum Teres Injury

Complication of Posterior hip dislocation

Acetabular fx Siatic nerve injury Rupture lig teres artery-> avascular necrosis femoral head

What type of melanoma is more common on darker skin individuals

Acral Lentiginous

What is the MC type of melanoma found in African Americans and Asians

Acral Lentiginous Melanoma

wells criteria dignosis for DVT

Active cancer (treatment ongoing or within previous 6 months or palliative) 1 Paralysis, paresis, or recent plaster immobilization of the legs 1 Recently bedridden for more than 3 days or major surgery within 4 weeks 1 Localized tenderness along the distribution of the deep venous system 1 Entire leg swollen 1 Calf swelling by more than 3 cm compared with the asymptomatic leg (measured 10 cm below the tibial tuberosity) 1 Pitting edema (greater in the symptomatic leg) 1 Collateral superficial veins (non-varicose) 1 Alternative diagnosis as likely or wider than that of deep vein thrombosis -2 Low probability 0 or less, moderate probability 1-2, high probability 3 or more.

Acute DVT is treated with low-molecular weight heparin, and possibly warfarin. INR is normal, discontinue heparin

Acute DVT is treated with ____________. If INR is normal, ____________

MC trigger for acute asthma

Acute URI

Pain, tearin, dilated pupil, shallow anterior chamber, halos around lights, and steamy cornea indicates

Acute angle- closure glaucoma

Acute onset of painless jaundice should prompt an examination for pancreatic cancer

Acute onset of painless jaundice should prompt an examination for ____________

What is the difference between acute bacterial and subacute bacterial endocarditis

Acute: infection in normal valves with Staph Aureus Subacute: indulent infection of abnormal valves with Strep Viridans

What are some triggers for rosacea

Alcohol, heat, hot beverages, spicy foods, sunlight

Differential diagnosis for weight loss

Alcohol/substance abuse anorexia CHF- end stage depression dementia Hepatitis Medications Ulcer disease Uremia Splenomegaly Bowel obstruction Gastric Bypass Pancreatic insufficiency Inflammatory bowel disease Celiac Sprue Cholestasis Diabetes uncontrolled Fistula Chronic infection (TB/ HIV) Malignancy Hyperthyroidism Poor dentition

All patients diagnosed with depression, should be questioned about the possibility of mania

All patients diagnosed with depression, should be questioned about the possibility of ________

pale boggy nasal mucosa and swollen turbinates indicate

Allergies

What are examples of fungicidal agents for tinea pedis second line

Allyamines: terbinafine, butenafine 4-6wks

Stimulant Agents examples and MOA

Alter mucosal permeability and stimulate the activity of intestinal smooth muscle Phenolphthalein- ExLax Bisacodly- Dulcolax

symptoms of IBS

Alternating Diarrhea/ constipation chronic recurring diarrhea abdominal pain relived by defecation fecal urgency bloating small amounts of mucus in stool

Amaurosis fugax is caused by a blockage of the opthalmic artery, which branches from the ICA

Amaurosis fugax is caused by ______________

What 4 features are related to the pathogenesis of acne vulgaris

Androgens in circulation- hormones Bacteria in hair follicle- p. acnes follicular plugging sebum secretion from increased hormone presence

What is unstable angina

Angina at rest lasting > 20 min

What are some differential Dx for Anaphylaxis

Angioedema uticaria asthma epiglottitis anxiety

Gold standard for dx PAD

Angiography

MC compartment affected in lower leg

Anterior compartment

MC shoulder dislocation

Anterior shoulder

What is the treatment of impetigo

Antibiotics Dicloxacillin Cephalexin Erythromycin Augmentin

TX PE in a hemodynamically stable pt

Anticoagulation IV- UFH or SQ- LMWH and PO warfarin 5-7 day bridge than warfarin for 6 months

TX DVT

Anticoagulation therapy Heparin or LMWH bridge to Warfarin and on if for 3-6months of IVC filter

What is a good first line treatment for tinea versicolor

Antifungal shampoo Selenium Sulfidine 2%, Ketaconazole shampoo

What are other areas TB can affect

Any organ Pott's Disease- spine involvement Scrofula- lymphnode involvement

Any patient with QT interval > 500 msec is at increased risk for dangerous dysrhythmias

Any patient with QT interval ______ is at increased risk for dangerous dysrhythmias

CXR for reactivation TB shows

Apical/ upper lobe fibrocavitary disease

What is vitiligo

Areas of well circumscribed depigmented macules and papules (michael Jackson)

What is an epidermal inclusion cyst

Arise from hair follices NOT OIL glands can be called sebacous cysts

When are compression stocking contraindicated

Arterial insufficiency

What are some clinical manifestations of HTN on fundoscopic exam

Arterial narrowing A-V Nicking Retinal hemorrhages, soft exudates papilledema

What is psoriatic arthritis

Arthritis in the presence of psoriasis

What and when prophylaxis therapy for endocarditis

Artificial valve, endocarditis, congenital defects Dental procedures adn Respiratory surgery Amoxicillin 2g 30-60 min prior

Asherman syndrome may cause decreased cyclic menstrual bleeding due to a decreased endometrial surface area

Asherman syndrome may cause decreased cyclic menstrual bleeding due to a _______________

valgus and varus stress test

Assess functioning of the medial and lateral collateral ligaments These test are performed with the patient's leg in full extension with the knee flexed to about 30 degrees. The physician places his/her hand on the lateral knee joint to apply a valgus stress to the distal tibia, or on the medial knee joint to apply a varus stress to the distal fibula. Excessive motion of the knee signifies instability of the corresponding ligament.

anterior and posterior drawer signs

Assess the anterior cruciate and posterior cruciate ligaments, respectively They are performed with the patient laying supine, knee bent to 90 degrees, and the foot stabilized, most easily done by the physician sitting on the foot. The physician's thumbs are placed on the tibial tubercle, while the fingers are placed on the posterior calf. The physician then attempts to displace the tibia, either anteriorly or posteriorly. Too much motion of the tibia, or lack of a clear end-point, especially as compared to the non-painful or non-affected side, constitutes an abnormal finding.

behavioral counseling

Assess the patient's dietary practices and related risk factors. Advise the patient to change dietary practices. Agree with the patient on goals. Assist the patient in changing dietary practices or addressing motivational barriers. Arrange follow-up, support, and/or referral for the patient.

lachmans test

Assesses the stability of the anterior cruciate ligament (and not the posterior cruciate ligament) This test is performed with the patient lying supine with the injured knee raised and slightly flexed to 30 degrees. The distal femur is stabilized by the physician with one hand, while the proximal tibia is held by the other hand. Force is applied to move the tibia anteriorly. The test is considered positive if there is excessive motion of the tibia.

Asymmetrical kidneys suggest renovascular disease

Asymmetrical kidneys suggest _______________

What are the ABCDE's of moles

Asymmetry Borders Color Diameter Evolution

Asymptomatic hematuria workup includes: R/O infection with urine culture R/O malignancy with imaging or Upper urinary tract, cytoscopy, and voided cytology

Asymptomatic hematuria workup includes _____________

Treatment for constipation

At least 64oz of water a day bran, fresh fruit, veggies, beans, and whole grains Dietary fiber 20-25g daily Scheduled toilet times

At the first suspicion of anaphylaxis, aqueous epinephrine 1:1000 in a dose of 0.2-0.5 mL injected subcu or IM with repeated injections every 15-30 minutes

At the first suspicion of anaphylaxis, ______________

Cause of acute MI

Atherosclerosis Arterial thrombosis

Athletes with these murmurs should be referred to cardiology: Systolic murmur III/VI Diastolic Holosystolic Continuous

Athletes with these murmurs should be referred to cardiology ________

If need abx for bronchitis because seems bacterial in cause what is a good 1st line agent

Augmentin

Antibiotics recommended for sinusitis bacterial

Augmentin, levaquin, or doxycycline

Chronic plaque psoriasis is typically symmetric and bilateral and can exhibit what sign and phenomenon

Auspitz sign Koebner phenomenon

What is Bullous pemphigoid

Autoantibodies to hemidesmosome resulting in DEEP TENSE bullae

What causes vitiligo

Autoimmune attack on melanocytes

What is westermarks sign

Avascular markings distal to embolus on CXr for PE

Primary tx migraine headache

Avoiding triggers NSAIDS Abortive therapy with Triptans

Secgond Fracture

Avulsion fracture of knee involves lateral aspect of knee and tibal plateau Due to IR and Varus stress

what is the ABX of choice for travelers diarrhea in children and pregnant women

Azithromycin

labs for vomiting

CBC, BMP possible BUN and pregnancy or drug levels of know meds like Digoxin

BMI is not accurate in: CHF patients Pregnant women Athletes Elderly Body builders Certain ethnic groups

BMI is not accurate in ____________

What labs should be ordered with burns

CBC, CMP, BUN, Cr, UA, CXR, EKG, ABG's

BRCA 1 and BRCA 2 gene associated with breast, ovarian, and colorectal cancer

BRCA 1 and BRCA 2 gene associated with _________ cancer

What are some topical ointments for minor burns

Bacitracin or Slivadine

Back pain relieved with sitting or stooping suggests spinal stenosis

Back pain relieved with sitting or stooping suggests __________

purulent discharge from eye indicates

Bacterial conjunctivitis

What is the tx of choice for pneumonia in pts with HIV

Bactrim

Complications of shoulder disslocation

Bankhart lesion Hillsachs lesion

Most common type of skin cancer

Basal cell carcinoma

What is the MC skin cancer

Basal cell carcinoma

Routine lab for edema

CBC, CMP, UA, CXR

When does the rash begin with 5ths disease

Begins with bright read cheeks and then a systemic red lacelike rash appears on trunk and extremities

Benefits of exercise: Decreases cardiovascular risk factors Increases insulin sensitivity Decreases metabolic syndrome

Benefits of exercise include ______________

Lesions that are calcified tend to be benign or malignant

Benign

Benign cause of unconjugated hyperbilirubinemia is Gilbert's syndrome. Jaundice appears with stress or illness

Benign cause of unconjugated hyperbilirubinemia is _____________. Jaundice appears with _________

TX of cocaine overdose

Benzodiazapine Calcium channel blocker

Treatment of ETOH withdrawl

Benzodiazepines

Tx sleep terror and sleepwalking

Benzodiazepines

What is Auspitz sign

Bleeding after removal of a scale

Side effects bulk forming agents

Bloating, impaction above strictures, fluid overload

Side effects Osmotic laxatives

Bloating, magnesium toxicity ( with renal failure)

Bloody nipple discharge shoule be evaluated with mammography, prolactin and thyroid levels measured and treated with surgical excision of terminal duct involved

Bloody nipple discharge shoule be evaluated with ___________ and treated with ____________

What are the major causes of 3rd trimester bleeding

Bloody show- labor Placenta Previa Abruptio placenta Vasa previa

What are koplic spots

Bluish white dots on the mucosal surface in the mouth

Where are bouchard and heberden nodes located and what disease are they associated with

Bouchard PIP joints of hands Heberden DIP joints of hands Osteoarthritis

What are risk factors for SCFE and common ages

Boys 11-16 Girls 10-14 African american Athletically inclined Obese kids

What is the single most important prognosis information for Melanoma

Breslow measurement- thickness of tumor

When and where does the rash appear

Bright pink macules and papules with red hals on skin and red erosions like ulcers in mouth

What is the treatment of choice for outpatient cellulitis

Broad spec abx: Augmentin if not purulent Broad spec abx if purulent: Clindamycin or doxy

Which of the 4 non small cell has best prognosis

Bronchoalveolar

How do you dx bronchial carcinoid tumors

Bronchoscopy that reveals pink to purple well vascularized central tumor

MOA for little league shoulder

Caused by rotational forces and stress on proximal hum. physis during throwing

MC cause of Left HF

CAD and HTN

Triptans contraindicated in

CAD or PVD

How do you Dx Orbital cellulits

CBC Head CT to determine extent of dz +/- Blood cultures

Causes of atrial flutter

COPD, HF, Atrial septal defects, CAD

what is the imaging study of choice for chronic sinusitis or orbital cellulitis

CT

How do you treat Molluscum Contagiosum

Cantharidin- topical best for kids Cryotherapy May resolve on own

Cardiac problems seen in Marfans: Mitral Valve Prolapse Aortic root dilation Aortic arch aneurysm

Cardiac problems seen in Marfans __________

Cardinal movements during labor include: Flexion Internal rotation Extension External rotation

Cardinal movements during labor include ________

Cardinal signs of Parksinson's: Resting tremor Rigidity Bradykinesia Postural instability Asymmetrical onset

Cardinal signs of Parksinson's _______________

TX atrial flutter

Cardioversion electrial 50 J Treat with anti coagulation and rate control prior to cardioversion

What is the histologic hallmark of TB

Caseating granulomas or necrotizing granulomas

Chantax and Buproprion are what pregnancy category for smoking cessation

Cat. C

Nicotine inhaler, nasal spray, and gum are what pregnancy category for smoking cessation

Cat. D

Characteristic rash of Lyme disease is erythema migrans, caused by Borrela burgdorferi by the Ixodes tick. Treatment is doxycycline

Characteristic rash of Lyme disease is ___________, caused by ________ by the _______. Treatment is ________

Tx of small cell carinoma

Chemotherapy with or without radiation

Chest pain reproducible with chest and back compression suggests costochondritis

Chest pain reproducible with chest and back compression suggests ______________

Tx lg pneumothorax

Chest tube

Chickenpox is commonly observed during seasons winter or early spring

Chickenpox is commonly observed during seasons _____________

Child should stay in a rear-facing seat until 20 lbs AND at least 1 year old

Child should stay in a rear-facing seat until ____________

TB screening guidelines

Children who should have annual Tuberculin Skin Test: Children infected with HIV Incarcerated adolescents Validated Questions for Determining Risk of Latent Tuberculosis Infection in Children in the United States: Has a family member or contact had tuberculosis disease? Has a family member had a positive tuberculin skin test? Was your child born in a high-risk country (countries other than the United States, Canada, Australia, New Zealand, or Western European countries)? Has your child traveled (had contact with resident populations) to a high-risk country for more than one week?

Chorionic villi sampling may be performed at week 10-12. Amniocentesis at week 15

Chorionic villi sampling may be performed at week _____. Amniocentesis at week ______

What is nickname for pityriasis rosea

Christmas tree disease

A 65 year old man with a history of rheumatoid arthritis is found to have microcytic anemia. He had a colonosocpy 1 year ago that was normal and stool guaiac was negative. What is the likely cause of his anemia

Chronic Disease

Chronic bronchitis is cough and sputum production on most days for at least 3 months for 2 consecutive years

Chronic bronchitis is cough and sputum production on most days for at least ____________

Colon cancer is the second cause of cancer deaths between men and women

Colon cancer is the _______ cause of cancer deaths between men and women

Tx for COPD- Bronchodilators

Combo therapy B2 agonist and anticholinergics show greater response

What are the 3 classifications of acne

Comedonal: open and closed comedones Inflammatory: papules and pustules Nodulocystic: nodules and cysts

Common causes of hypoglycemia are fasting, sulfonylurea abuse, exogenous insulin, autoimmunity

Common causes of hypoglycemia are _____________

Common causes of postpartum hemorrhage: "Four T's" Tone (Atony) Trauma Tissue (Retained placenta or membranes) Thrombin (Coagulopathies)

Common causes of postpartum hemorrhage ____________

which type of migraine MC

Common so no aura

Common treatment for diverticulitis is quinolone and metronidazole

Common treatment for diverticulitis is ________________

Common triggers of migraine headaches: Menses Fatigue Hunger Stress

Common triggers of migraine headaches ________

Complications of Strep infections include: Scarlet fever Rheumatic fever Acute post-strep glomerulonephritis

Complications of Strep infections include ___________.

What is Cauda Equina Syndrome

Compression of cauda L2-S1

If the patient presents with acute, PAINFUL vaginal bleeding or with acute abdominal/uterine pain consider what diagnosis

Consider placental abruption

What is a 1st degree Block

Constant prlonged PR interval > 0.20 sec

What is a 2nd Degree Mobitz Type 2

Constant prolonged PR interval till drop QRS

Constipation, diarrhea, alternating constipation, with diarrhea, and periods of normal bowel habits that alternate with constipation and/or diarrhea are suggestive of Irritable bowel syndrome. Abdominal pain is frequently in the LLQ

Constipation, diarrhea, alternating constipation, with diarrhea, and periods of normal bowel habits that alternate with constipation and/or diarrhea are suggestive of __________. Abdominal pain is frequently in the ____

Consumption of undercooked chicken may suggest Salmonella or Shigella. Undercooked hamburgers suggest E. coli. Mayonnaise suggests S. aureus or Salmonella. Raw seafood suggests Vibrio, Salmonella, Hepatitis A

Consumption of undercooked chicken may suggest _________. Undercooked hamburgers suggest _______. Mayonnaise suggests _______ Raw seafood suggests ___________.

management of late decelerations

Continuous fetal monitoring. Position the patient on her side to decrease pressure on her vena cava, and increase blood return to the heart, in order to maximize cardiac output and blood flow to the uterus. Monitor blood pressure. If her blood pressure is low, she may benefit from a fluid bolus to further increase blood flow to the uterus. Oxygen by face mask, to maximize placental oxygen delivery. Although there is no clear evidence to support this, it is unlikely to cause harm with short term use, other than minimal patient discomfort.

Contraindications to breastfeeding include: HIV + Acute Hep B infection Nipple transplant

Contraindications to breastfeeding include __________

Contraindications to vaccinations are previous anaphylactic reaction, but minor illnesses are NOT contraindicated

Contraindications to vaccinations are __________, but ___________ are NOT contraindicated

What is the causative agent of Hand foot and mouth disease

Coxsackie A16 virus

What does amphetamine withdrawl look like

Crash Depression Fatigue Headache Stomach cramps Profuse sweating

different vehicles for skin medication

Creams: The cream base is a mixture of several different organic chemicals (oils) and water, and usually contains a preservative. It can be used in nearly any area and therefore most often prescribed. It is cosmetically most acceptable. It has a drying effect with continuous use, therefore best for acute exudative inflammation. Ointments: The ointment base contains a limited number of organic compounds consisting primarily of grease such as petroleum jelly, with little or no water. Ointment is desirable for drier skin and has a greater penetration of medicine than a cream and therefore has enhanced potency. Lotions and gels: Lotions contain alcohol, which has drying effect on an oozing lesion. Lotions are most useful in the scalp area because they penetrate easily and leave little residue. Gels have a jelly-like consistency and are beneficial for exudative inflammation, such as poison ivy.

Crops of vesicles of different ages with an abnormal lung examination may suggests chickenpox Varicella complicated by pneumonitis

Crops of vesicles of different ages with an abnormal lung examination may suggests _______________

DDX for bronchitis

Croup, whooping cough, pneumonia, asthma exacerbation, COPD exacerbation, URI

Immue suppressed or neurologically impaired individuals are at increased risk of developing what type of scabies

Crusted scabies

Medications helpful in managine Meniers

Diuretics (acetazolamide or HCTZ) and salt restrictions

DSM IV Criteria for dementia include: Aphasia Apraxia Agnosia

DSM IV Criteria for dementia include __________

How do you tell the difference nits vs. Dandruff

Dandruff moves freely along hair shaft and nits do not

PCL tear

Dashboard Laxity and joint effusion + posterior drawer

MOA posterior hip dislocation

Dashboard injury Forced ER at knee with hip flexed to 90

Ddx for dementia include: Medications Stroke Thyroid disorder Syphilis Workup includes: TSH ESR CMP Anemia panel CT of head without contrast

Ddx for dementia include __________ Workup includes ________

Treatment for Hypertensive Crisis

Decrease BP by 10% in first hour and additional 15% over the next 2-3 hours using IV agents Lopressor, Carvadelol, Nitro, Hydralizine

What does obstruction look like on PFT's

Decrease FEV1 Decrease FVC Decrease FEV1/FVC <70%

Decreased Free T4, Elevated TSH suggests Primary hypothyroidism Decreased Free T4, decreased TSH suggests Secondary hypothyroidism.

Decreased Free T4, Elevated TSH suggests __________. Decreased Free T4, decreased TSH suggests ______________.

what type of anemia is suspected in a 67 year old man with dizziness and a positive stool guaiac

Decreased ferritin; decreased MCV; decreased serum iron level (Iron deficiency)

CXR emphysema

Decreased lung markings at apices flattened diaphragm hyperinflation small, thin appearing heart parenchymal bullae and blebs

Stool Softeners examples and MOA

Decreased surface tension and allows water and fat to mix in the stool Docusate sodium- Colace

What is a 4th degree burn

Deep tissue down to (muscle, tendon, bone)

What is a DVT

Deep vein thrombosis partial or complete occlusion of a vein and inflammatory changes

What is Spondylolysis

Defect in pars interarticularis lumbar vertebrae

What is a spondylolisthesis

Defect in pars interarticularis with forward translocation of one verebra on another

Treatment pulsless V tach

Defibrillation/ CPR

Tx Ventricular fibrillation

Defibrllation and CPR Defib x3 ( 200, 300, 360J) CPR Epi 1mg IV q 3-5min

Test for compartment syndrome

Delta Pressure (Diastolic BP- Comp Pressure) Delta pressure <30 needs FASCIOTOMY

Depression is considered major mood disorder for at least 2 weeks with 5/9 characteristics

Depression is considered major mood disorder for ____________

Risk factors for mI

Diabetes Age > 65 HTN Hyperlipidemia Family history Obesity Smoking

When do you see Hypertriglyceridemia

Diabetes ETOH Obesity Steroids Estrogen therapy

What does cocaine intoxication look like

Dilated pupils HTN crisis Psychosis Tachycardia

What does amphetamine intoxication look like

Dilated pupils fever- over heating Tachycardia Water intoxication

Clinical manifestations of vericose veins

Dilated, tortuous veins in lower extremities Distal edema skin ulceration

How does infection of scabies spread

Direct contact with infected individual

MC mechanism for AC joint seperation

Direct force

What is a SCFE

Displaced femoral head

Colles fracutre

Distal radius fracture with fragement tilted dorsally +/- involvement of articular surface radius +/- ulnar styloid fx

Smiths Fracture

Distal radius fracture with fragment tilted ventrally

determining the need for selective screening for lead toxicity

Does your child live in or regularly visit a house or child care facility built before 1950? Does your child live in or regularly visit a house or child care facility built before 1978 that is being or has recently been renovated or remodeled (within the last six months)? Does your child have a sibling or playmate who has or did have lead poisoning? test if any of these are (+)

Diagnostic studies for PAD

Doppler US Ankle brachial index Angoigraphy

Special tests

Drop Arm

What is andother name for Drug induced hypersensitivity syndrome

Drug Reaction with Eoxinophilia and Systemic Symptoms (DRESS)

What can cause a change in mental status

Drugs Polypharm ETOH intoxication Gases: carbonmonoxide, cyanide, ethylene glycol Withdrawl Infections- Sepsis Electrolyte imbalance Hyocarbia Hypoxia Hyper or Hypo- glycemia Wernikes encephalopathy Head injuries Psych Disorders Delerium Dementia

What does 2nd degree deep partial thickness burn look like

Dry, blister, +/- pain, no capillary refill

Lumbar radiculopathy

Dysfunction or irritation to nerve root causes pain, sensory impairment, weakness, decreased DTR

Clinical manifestations of emphysema

Dyspnea on exertion accessory muscle use prolonged expiration mild cough

Dyspnea on exertion, bilateral leg edema, pillow orthopnea, and pink forthy sputum suggest congestive heart failure

Dyspnea on exertion, bilateral leg edema, pillow orthopnea and pink, frothy sputum suggest ___________

Dysthmic disorder is 2 years of less acute depression

Dysthmic disorder is ____________

A 40 year old man travels to Mexico and develops diarrhea 1 day after coming back to the US. What is the most likely cause of his diarrhea

E. coli

How do you diagnose A-fib

EKG

What should be included in the work up for syncope

EKG BP and Orthostatics Then other options: Stress test, holter/even monitor, Echo, tilt table test

How do you dx Stable angina

EKG ST depression with exertion Stress test

2 diagnostic studies for new onset chest pain

EKG and CXR

Early deceleration are caused by compression of the fetal head.

Early deceleration are caused by _________________

How do you treat SJS/TEN

Early recognition Stop offending & all non-life threatening medications CONSULT DERM Treat like a burn patient if more than 25% BSA affected

Diagnose HF

Echo CXR BNP EKG

What are some differential dx for abdominal pain

Ectopic pregnancy Appendicitis AAA- rupture MI PID Biliary Dz Bowel obstruction Diverticulitis Mesinteric Ischemia Testicular or Ovarian torsion

What is the MC joint dislocated in Kids

Elbow

Who is usually affected by bullous pemphigoid

Elderly patients

if cant determine central vs peripheral what test do you order

Electronystagmography and audiometry and possible brain MRI

Elevated PTH, Elevated serum calcium levels suggest Primary hyperparathyroidism

Elevated PTH, Elevated serum calcium levels suggest __________

Elevated PTH, Low serum calcium levels suggest Secondary hyperparathyroidism

Elevated PTH, Low serum calcium levels suggest ________________

TX PE in a hemodynamically unstable pt where thrombolytics are contraindicated

Embolectomy

Causes of syncope

Emotional stress pain dehydration pooling blood in legs d/t sudden change body position Violent coughing spells cardiac problems metabolic disorders psych disorders pulmonary disorders

TX hospital acquired pneumonia

Emperic abx: Cefepime and FQ

What is the treatment for Endocarditis

Emperic therapy Gentamicin and Ceftriaxone or Gentamicin, Vanco and Cefepime

2 types of COPD

Emphysema Chronic Bronchitis

Special Tests for Impingement

Empty can Nears Speeds Hawkins Kennedy Scap liftoff

most frequent test ordered when evaluating symptoms of heartburn

Esophagogastroduodenoscogy (EGD)

Essential hypertension is rare in children, but when observed, may be from renal parenchymal disease. Perform UA, C&S, renography

Essential hypertension is rare in children, but when observed, may be from ___________. Perform __________

Antidote for methanol, ethylene glycol OD

EtOH, fomeprizole, dialysis

Evaluation of CHF includes: CBC CMP Cardiac Enzymes ECG Echo

Evaluation of CHF includes _______

Examples of 2nd generation antihistamines include: Fexofenadine Cetirizine Loratadine

Examples of 2nd generation antihistamines include ___________

A drug reaction that occurs after a medication that results in a widespread, symmetric, erythematous macules and papules on the truk or extremities indicates what reaction

Exanthematous drug reaction

Excessive daytime sleepiness and cognitive impairment suggests obstructive sleep apnea. Evaluation includes Comprehensive sleep evaluation, Epworth Sleepiness scale, polysomnography. Most effective therapy is Continuous positive airway pressure

Excessive daytime sleepiness and cognitive impairment suggests ______________. Evaluation includes ________. Most effective therapy is _________

What is hypersomnia

Excessive daytime sleepiness generally more a problem in patients with sleep apnea, narcolepsy, or nocturnal myoclonus

Achilles Tendon rupture MOA

Explosive force or rapid contraction

Exudative pharyngitis, fever, "sandpaper rash" and "Strawberry tongue" suggests Scarlet fever, a complication of group A Strep

Exudative pharyngitis, fever, "sandpaper rash" and "Strawberry tongue" suggests ______________

True or false it is ok to use topical antibiotics as a monotherapy for acne

FALSE

What is the Glasgow Comma Scale

Eye opening: Spontaneous 4, Verbal command 3, Pain 2, None 1 Verbal Response: A&O 5, confused yet coherent 4, Inappropriate words 3, Incomprehensible sound 2, none 1 Motor Response: Obeys commands 6, Localize to noxious stimuli 5, withdrawl noxious stimuli 4, Abnormal flexion (Decorticate) 3, Abnormal extension (Decerebrate) 2, No response 1

FDA-approved alcohol abuse treatments are Naltrexone, Disulfiram, and Acamprosate

FDA-approved alcohol abuse treatments are _______________

FDA-approved medications for osteoporosis include: Alendronate Risdedronate Ibandronate Zoledronic acid Calcitonin PTH (Teriparatide) Selective estrogen receptor modulate (Raloxifene)

FDA-approved medications for osteoporosis include __________

Scaphoid fracture MOA

FOOSH injury

Campylobacter diarrhea tx with

FQ or Bactrimerythormycin

E. Coli with bloody diarrhea tx with

FQ or bactrim

Factors diagnostic of DM: FBG > 125 RBG > 200 with classic symptoms BG > 200 after 75-g glucose delivered 2 hours prior HA1c > 6.5

Factors diagnostic of DM __________

What are risk factors for basal cell carcinoma

Fair skin Hx prolonged ultraviolet exposure Radiation exposure arsenic ingestion Immune supression

Frequent 1st line treatments for depression include SSRI, (such as Fluoxetine, Paroxetine, Sertraline, Citalopram, Escitalopram) or SNRI (such as Venlafaxine, Desvenlafaxine, Mirtazapine, Duloxetine)

Frequent 1st line treatments for depression include _____ (such as __________)

risks for vertical transmission of HIV

Frequent, unprotected sex during pregnancy (This increases the risk for chorioamnionitis, and chorioamnionitis and other sexually transmitted infections increase the risk of HIV transmission.) Advanced maternal HIV disease, which may indicate high viral load Membrane rupture greater than 4 hours prior to delivery if mother is not on antiretroviral therapy Vaginal delivery Breastfeeding Premature delivery (i.e., delivery before 37 weeks' gestation)

What are the first line antifungals for tinea pedis

Fungistatic's: Imidazoles Clotrimazole or miconazole 4-6wks

Give example of loop diuretics

Furosemide Bumetanide

Boxers fracture

Fx 5th metacarpal at MCP joint

GBS culture is obtained during gestational week 35-37

GBS culture is obtained during gestational week ________

GFR levels Stage I CKD: 90-120 Stage II CKD: 60-90 Stage III CKD: 30-60 Stage IV CKD 15-30 ESRD: < 15

GFR levels ___________

Side effects of Stimulant agents

Gastric or rectal irritation, degeneration of myoneural plexuses

What deos erythrodermic psoriasis look like

Generalized erythema covering nearly the entire body surface with varing degree of scales

Gestational diabetes is tested at week 26-28 with 1-hour 50-g glucose challenge test. If positive, perform 3-hour glucose tolerance test at fasting, 1-hour, 2-hour, and 3-hour

Gestational diabetes is tested at week ____ with ______. If positive, ______

MC cause of parasitic diarrhea

Giardia

Causes of jaundice

Gilbert Crigler-Najjar syndrome Hepatitis

What is a Bandhart lesion

Glenoid labrum avulsion anterior to inferior

Goals of treating parkinsons are slowing down progression and treating symptoms

Goals of treating parkinsons are ______________

Greenish exudates accompanied by sore throat and dysuria indicate what cause

Gonococcal pharyngitis

hemoptysis combined with hematuria is a symptom for what syndrome

Goodpastures

Gout exacerbations may occur from: Alcohol Trauma Large meal Surgery Thiazide diuretics Aspirin

Gout exacerbations may occur from ______

What are common organisms for orbital cellulitis

Group A beta hemolytic Strep Stre. Pneumoniae H. Influenza Staph Aureus

Scarlet fever is associated with what etiology

Group A beta heymolytic streptococci

What is the main pathogen of erysipelas

Group A strep

What is the most common pathogen of cellulitis

Group A strep and stachlococcus

What is a patch

Larger than 1cm and flat

TX for Kaposi Sarcoma

HAART therapy

HCM murmurs increase with Valsalva and decreases with squatting

HCM murmurs increase with __________ and decreases with __________

Kaposi Sarcoma MC in what patient population

HIV and Immunosupressed patients

HIV infects the helper T cells

HIV infects the _________

HIV is tested with ELISA, confirmed with Western blot

HIV is tested with _______, confirmed with _________

prenatal lab screening includes

HIV, rubella, hep B - blood type and Rh - urine drug screen

HIV/AIDS Stages I. CD4 cell count > 500 II. 200 - 499 III. (AIDS) < 200 IV. Lab parameters with AIDS-defining condition

HIV/AIDS Stages ___________

What is PSVT

HR > 100bpm and narrow complex

Worry about pneumonia if what symptoms are present

HR >100 Temp >100.4 RR >24 Age >64 Chest exam + consolidation findings

Causes of diastolic heart failure

HTN Infilltrative cardiomyopathy Diabetes left ventricular hypertrophy CAD Chronic heart valve stenosis

What is secondary hypertension

HTN due to an underlying Identafiable and often correctable cause

What is primary hypertension

HTN due to idiopathic etiology

What does benzo wtihdrawl look like

HTN, tachycardia, seizure, psychosis, anxiety

TX PCP overdose

Haldol Acidify the urine and increase urine excretion

What is the Rule of 9's

Head 9% Ant Trunk 18% Post Trunk 18% Each arm 9% Each leg 18% Genitalia 1%

what are the 3 different variants of lice

Head louse- pediculus capitus Body louse- pediculus corporis Pubic louse- Phthirus Pubis

Indications for neuroimaging

Headache recent onset <6months headache beginning after 50 yo worsening headaches headahce that does not fit primary pattern assocaited seizures focal neurologic sings/ symptoms personality changes severe headaches unresponsive to therapy history trauma new headache in a cancer patient

Headache with jaw pain or jaw claudication suggests temporal arteritis

Headache with jaw pain or jaw claudication suggests ________________

If you were to biopsy Molluscum contagiosum what would the histopathology show

Henderson-Paterson bodies

Hearing screening in newborns occurs with auditory brainstem response or evoked otoacoustic emission

Hearing screening in newborns occurs with ___________

What is a good initial test for PE

Helical CT scan

Glomerularniphritis usually presents with

Hematuria RBC casts mild-moderate hypertension Edema +/- proteinuria in smaller amounts

Differential Dx for Jaundice

Hemolytic anemia Thalassemia Gilbert Crigler Hepatocellular dysfunction Hepatitis Cirrhosis Drugs Sepsis Pancreatic cancer

What is Charcots triad and what does it indicate

High fever, RUQ pain, Jaundice cholangitis

Bulk forming agents examples and MOA

High in fiber Psyllium- metamucil Methylcellulose- citrucel Fibercon

If the psoriasis covers less than 5% body surface area what is the 1st line treatment

High potency topical steroids in combination with calcipotriene

SS of posterior hip dislocation

Hip IR and shortened, inability to ABD and ER

Femoralacetabular impingement (CAM)

Hip impingement between femoral head and acetabular pincer

List 3 methods to relocate an anterior disslocation

Hippocratic Stimson Hennipen

x-ray for lower back pain indicated when

History of trauma Strenuous lifting in patient with osteoporosis Prolonged steroid use Osteoporosis Age <20 and >70 History of cancer Fever/chills/weight loss Pain worse when supine or severe at night Spinal fracture, tumor, or infection

What is uticaria

Hives and a vascular reaction

If positive airway pressure is not improving symptoms, consider adding heated humidification

If positive airway pressure is not improving symptoms, consider __________________

What is Kaposi Sarcoma caused by

Human herpes 8 virus

What causes Roseola

Human herpes virus 6 and 7

If taking Coumadin, monitor PT, INR

If taking Coumadin, monitor _______

TX orbital cellulits

IV Abx- Vancomycin Surgical drainage if severe

How do you control rate for A-fib

IV- CCB (Diltiazem) or BB (Metropolol) HF present: digoxin and amiodarone NO HF: metropolol, Diltiazam, Verapamil

TX PE in hemodynamically stable pt where anticoagulation is contraindicated

IVC filter

Non operative Tx AC joint sprain

Ice, sling till pain decrease 7-10 days then start PT and no activity 3-4 weeks

Idiopathic gradual onset of hip, thigh, or knee pain and limping over few months suggests Legg-Calve-Perthes disease

Idiopathic gradual onset of hip, thigh, or knee pain and limping over few months suggests ___________

If < 3 hours from onset of CVA symptoms, administer thrombolytic therapy. If < 48 hours, administer aspirin

If < 3 hours from onset of CVA symptoms, administer ______________. If < 48 hours, administer ______

If CVA neurologic signs have resolved, MRI is preferred study to differentiate between TSI and TIA

If CVA neurologic signs have resolved, ____is preferred study to __________

If a DVT is suspected, order D-dimer (Sensitive, NOT specific) Doppler (confirms)

If a DVT is suspected, order ___________

If a breast cyst is observed, aspirate. If aspiration does not resolve cyst, is bloody, or if lesion recurs, further evaluation is warranted

If a breast cyst is observed, aspirate. If aspiration ___________ further evaluation is warranted

If bilirubin is present in UA, suggestive of conjugated hyperbilirubinemia

If bilirubin is present in UA, suggestive of ______________

When can you stop pap

If had a hysterectomy and the cervix is gone or between the age of 65-70

If pheochromocytoma is suspected, 24-hour urine collection for catecholamines and metanephrines is required

If pheochromocytoma is suspected, _____________

If taking Heparin, monitor PTT

If taking Heparin, monitor ______

If using OCP while breastfeeding, use minipill progestin only as combined hormones may interfere with breastfeeding. Other options include Depo Provera or IUD 6 weeks postpartum or lactation-induced contraception for about 6 months

If using OCP while breastfeeding, use ____________. Other options include ___________.

Immunization does not guarantee severity, but a less severe presentation of a disease

Immunization does not guarantee severity, but _______________

Immunizations indicated for 60 year olds include Herpes Zoster vaccine and 65 year olds includes Pneumo and Tdap

Immunizations indicated for 60 year olds include _______ and 65 year olds includes __________

What is a hillsachs lesion

Impression fracture to posterior lateral portion of humeral head

In COPD, the ratio of FEV1 and FVC are less than 0.7

In COPD, the ratio of FEV1 and FVC are _________________

In IBS, Constipation may be treated with: Fiber intake Lubiprostone Diarrhea may be treated with: Loperamide Alosetron

In IBS, Constipation may be treated with ________ Diarrhea may be treated with _________

In IBS, abdominal pain may be treated with: Antispasmodics (Dicyclomine) 1st line TCAs SSRIs Rifaximin Probiotics Peppermint

In IBS, abdominal pain may be treated with _______

In a CVA with Aphasia, contralateral hemiparesis, sensory loss, spatial neglect, and impaired conjugate gaze, suspect middle cerebral artery to be affected

In a CVA with Aphasia, contralateral hemiparesis, sensory loss, spatial neglect, and impaired conjugate gaze, suspect _________ to be affected

In a CVA with foot and leg deficits > arm deficits, suspect anterior cerebral artery to be affected

In a CVA with foot and leg deficits > arm deficits, suspect ____________ to be affected

In anaphylactic shock, administer: 0.3-0.5 mL of 1:1000 epinephrine (Repeat in 10-15 minutes PRN) Antihistamines Steroids (If severe) Bronchodilators

In anaphylactic shock, administer ___________

In bloodwork levels, conjugated bilirubin is direct bilirubin. Unconjugated is measured from subtracting "Direct" from "Total"

In blood work levels, conjugated bilirubin is _______. Unconjugated is measured from ___________.

In patients with a pleural effusion and pneumonia, consider empyema

In patients with a pleural effusion and pneumonia, consider ________

In patients with sickle cell disease, Parvovirus B19 infection can lead to aplastic crisis with anemia and leukopenia

In patients with sickle cell disease, ____________ infection can lead to aplastic crisis with anemia and leukopenia

In peptic ulcer disease, duodenal ulcers are more common overall and gastric ulcers are more common with NSAID use

In peptic ulcer disease, _______ ulcers are more common overall and ________ ulcers are more common with NSAID use

In women who are Rh negative, next step is assessing antibodies or indirect Coomb's test.

In women who are Rh negative, next step is ________.

In women who are not breastfeeding, menstrual periods return around 3 months postpartum

In women who are not breastfeeding, menstrual periods return around _____________

What is heart failure

Inability of the heart to pump sufficient blood to meet the metabolic demands of the body

Greenstick Fracture

Incomplete fx of tension side of cortex with buckling of compression side

Asthma

Increase inflammation of airways as well as bronchospasm of bronchial smooth muscle

CXR for chronic bronchitis

Increased interstitial markings at bases Diaphragms not flattened

Increased risk of cardiovascular outcomes in women taking estrogen or estrogen and progesterone combination

Increased risk of _________ in women taking estrogen or estrogen and progesterone combination

What is endocarditis

Infection of the endothelium/valves secondary to colonization of bacteria

Infertility in PCOS can be treated with clomiphene, aromatase inhibitors, or gonadotropins

Infertility in PCOS can be treated with ____________

What is bronchitis

Inflammation of large airways of lungs and usually self limited to a period of up to 3 weeks

What is intertrigo

Inflammation of large skin folds and can be complicated by candidia

DeQuervians Tenosynovitis

Inflammation of sheath surrounds ABD pollicus longus and extensor pollicus brevis

Initial management of asymptomatic diverticuli is high-fiber diet

Initial management of asymptomatic diverticuli is __________

prolonged morning stiffness and pain worse in the AM, improves with motion, and associated with systemic symptoms (fever)

Inflammatory arthritis

TB treatment for active TB

Initial 4 drug regime for 2 months, D/C Pyrazinamide after 2 months and continue rest for 4 more months Isoniazid Rifampin Pyrazinamide (Ethambutol or Streptomycin)

Initial workup of anemia includes CBC with RBC indices Peripheral blood smear Reticulocyte count

Initial workup of anemia includes ______________

Mallet Finger

Injury to tip of finger with avulsion of insertion of extensor tendon at distal finger

Signs and symptoms SCFE

Insidious onset Hip, thigh, KNEE pain Painful limp Loss of IR of hip

Insulin resistance in PCOS can be treated with metformin and thiazolidinediones

Insulin resistance in PCOS can be treated with ___________

Clinical manifestations of PAD

Intermittent claudication thigh or buttocks pain with walking Femoral and distal pulses weak numbness or tingling ischemic ulcerations

Bartons Fracture

Intra-articular fracture associated with subluxation of carpus of radius

Irregular shaped plaques or nodules with raised borders suggest squamous cell carcinomas

Irregular shaped plaques or nodules with raised borders suggest ________________

What is A-FIB

Irregularly irregular rhythm No p waves Atrial rate 350-600bpm

Causes of systolic heart failure

Ischemic heart disease s/p MI CAD HTN Fluid overload Valvular dz Cardiac dysrhythmia Renal Dz

What clinical changes occur in chronic venous insufficiency

Itching, dull pain with standing, ulceration above the ankle, shiny skin, thin skin, dark pigmentation changes to skin

What is an oral medication that can be prescribed for scabies

Ivermectin 200mcg/kg and repeat a dose 2 weeks later

JVD and lower extremity edema suggest cor pulmonale due to chronically elevated pressures in pulmonary circulation

JVD and lower extremity edema suggest ____________

What is becks triad and what does it indicate

JVD, Muffled heart sounds, and decreased blood pressure suggest cardiac tamponade

Jaundice is first observed in the sclera or under the tongue

Jaundice is first observed in _____________

What is tinea cruris

Jock itch- tinea in the groin area

Joint aspirate of gout appears as monosodium urate crystals with strong negative birefringence

Joint aspirate of gout appears as _____________

Joint aspirate of pseudogout appears as calcium pyrophosphate dehydrate crystals with rod-shaped, rhomboid, weakly positive birefringence

Joint aspirate of pseudogout appears as ___________________

Joint pain that is worse in the morning and improves as the day goes by suggests Rheumatoid Arthritis

Joint pain that is worse in the morning and improves as the day goes by suggests ______________

Joint pain worsened with activity and improved with rest suggests osteoarthritis

Joint pain worsened with activity and improved with rest suggests __________

Joint paint that awakens a child at night suggests malignancy

Joint paint that awakens a child at night suggests _______________

How do you diagnosis tinea pedis

KOH (potassium hydroxide) exam

How do you diagnose tinea versicolor

KOH prep and will see "spaghetti and meatball" pattern with hyphae and spores

DX intertrigo

KOH prep reveas pseudohyphae

Imaging used to check for bowel obstruction

KUB xray

In children under 5: fever, strawberry tongue, conjunctivitis, rash involving hands and feet that leads to desquamation of palms indicates

Kawasaki Disease

If you use dermatoscope on seborrhic keratosis what do you see

Keratin Pseudocysts- small white spots

Who should get pneumona vaccine

Kids 6wks-15months series of 4 kids 2-5 Over 65

diminished hip flexor strength suggests a lesions where

L2, L3 or L4

Innervation L3 L4 L5 S1

L3: hip flx; ant/med thigh; patellar reflex L4: knee ext; ant leg/ med foot; Patellar reflex L5: DF and gret toe ext; lat leg S1: PF; post leg/lat foot; Achilles reflex

difficulty with heel walk is associated with

L5 disc herniation - seen with L5 disc herniation there should be normal strenght of the knee flexion and ankle dorsiflexion - with L5 impingement a hypoactive ankle tendon reflex is also present

Laboratory studies recommended at first prenatal visit include: CBC HBsAg HIV RPR UA Rh Pap Ct and Ng

Laboratory studies recommended at first prenatal visit include _____________

Laboratory tests suggesting rheumatoid arthritis are Rheumatoid Factor and anti-CCP. Anti-CCP is more specific

Laboratory tests suggesting rheumatoid arthritis are __________. _______ is specific

A 58 year old woman comes in complaining of fatigue adn has also noticed burning sensation in her feet over the past 6 months. CBC shows anemia with an increased MCV. what is the most likely cause of anemia

Lack of intrinsic factor (B12 deficiency)

Which type of the 4 non small cell is very aggressive

Large cell

Late decelerations are manifests of uteroplacental insufficiency

Late decelerations are ______________

Lateral ligaments usually involved in an inversion injury include Anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament. ATFL is the MC injured ligament

Lateral ligaments usually involved in an inversion injury include ___________. ______ is the MC injured ligament

What are common causes of fixed drug eruptions

Laxatives Tetracyclines Metronidazole Sulfonamides Barbiturates NSAIDS Salicylates

ACL tear

Laxity and joint effusion + anterior drawer, lachmans, pivot shift

MC cause of Right HF

Left sided HF

Leiomyomatas or fibroids cause an increase in cyclic menstrual bleeding due to increasing endometrial surface area

Leiomyomatas or fibroids cause an increase in cyclic menstrual bleeding due to ______________

What is Koebner phenomenon

Lesion induced by trauma (Scratching)

What is the difference in itching between lice and scabies

Lice itch all the time Scabies mainly itch at night

Lower GI bleeding is defined as pathology below the ligament of Treitz

Lower GI bleeding is defined as pathology below the ____________

What is the treatment of choice for atinic keratosis

Liquid nitrogen cryotherapy or shave excision

What labs should be done before starting Terbinafine

Liver function because has risk to cause hepatotoxicity

What is important to do with electrical burns

Look for entrance and exit burns and get an EKG to look for cardiac arrhythmias

Low PTH, Elevated serum calcium suggests PTH-related peptide and malignancy until r/o!!!

Low PTH, Elevated serum calcium suggests _____________

Low back pain, incontinence, and saddle parasthesis suggests cauda equina. Treated with decompression

Low back pain, incontinence, and saddle parasthesis suggests _______. Treated with _________

What is the prodrome of 5ths disease

Low grade fever, malaise, headache, coryza, joint pain

What are other treatments for seborrheic dermatitis

Low potency topical steroid- Desonide 1-2wks Antidandruff shampoo for scalp and chest

What is the leading cause of cancer death in men and women

Lung cancer

MC antibiotics associated with pseudomembranous colitis or "C diff" are Clindamycin, Cephalosporins, Penicillins

MC antibiotics associated with pseudomembranous colitis or "C diff" are ______________

MC bacteria isolated in a human bite wound is Eikenella corrodens

MC bacteria isolated in a human bite wound is _________________

MC cause of lymphedema is secondary to malignancy (of prostate, ovary, lymphoma), surgery and radiation therapy

MC cause of lymphedema is secondary to ________________

MC cause of sudden cardiac death in adolescents is HCM

MC cause of sudden cardiac death in adolescents is _______

Patellar dislocation MOA

MC d/t twisting force

Patellar bursitis

MC from direct contact

What is the best class of drugs to reduce LDL

MHGcoA Reductase Inhibitors (Statins)

What are emergent causes of chest pain

MI, Aortic dissection, PE, Pneumothorax

What is 2nd line if lice resistant to permethrin

Malathion 0.5% to clean dry hair for 8-12 hours then rinse

Mammographies should begin at age 50 every 2 years

Mammographies should begin at age __ every __________

Management of uterine atony include oxytocin and bilateral uterine massage. If no improvement, Prostaglandin F2a (ci in asthma) or misoprostol.

Management of uterine atony includes __________. If no improvement, ___________.

Nephrotic syndrome usually presents with

Massive Proteinuria Hyperlipidemia lipiduria hypoalbuminemia Edema

Mastitis may be treated with Cephalexin and Dicloxacillin

Mastitis may be treated with _____________

Maternal benefits of breastfeeding include: Quicker return to normal body Quicker return of uterine tone Reduced incidence of breast and ovarian cancer

Maternal benefits of breastfeeding include _____________

MC cause of low back pain

Mechanical low back pain

Epicondylitis another name for Medical and Lateral

Medial= golfers elbow Lateral= Tennis elbow

Median survival in those with CHF is between 3-5 years

Median survival in those with CHF is ___________

Medications associated with edema include: NSAIDs CCBs OCPs

Medications associated with edema include __________

Medications that may cause galactorrhea include: TCAs SSRIs BBs CCBs H2 Blockers Opiates

Medications that may cause galactorrhea include _________

Melanoma typically invasive by the time of diagnosis is Nodular melanoma.

Melanoma typically invasive by the time of diagnosis is ____________.

Men should consume no more than 2 alcoholic drinks a night

Men should consume no more than _____ alcoholic drinks per night

Audiometry good for diagnosing ____

Menieres dz low frequency hearing loss

Metabolic Syndrome is: Waist Expanded (42" in men, 35" in women) Increased Glucose ( > 100) HTN HDL decreased Triglycerides elevated

Metabolic Syndrome is ____________

Metformin benefits DM by decreasing gluconeogenesis, increasing insulin sensitivity, and decreasing glucose reabsorption in the intestine

Metformin benefits DM by _____________

Metformin use is contraindicated with creatinine level > 1.4, hepatic insufficiency, chf

Metformin use is contraindicated with ___________

TX heroin addiction

Methadone

Tx for opiate abuse

Methadone

C. Diff and Giardia diarrhea tx with

Metronidazole- flagly

What is the preferred treatment for diarrhea caused by clostridium defficile toxin

Metronidazole/flagyl

Galiazzi fracture

Mid to distal radial fx Carpoulnar dislocation

Monteggia fracture

Mid to proximal ulnar fx Radial head dislocation

MC location to fx clavicle

Middle 1/3

Where are Brown recluse spiders found

Midwest and Southeast

18 year old male presents for follow up on his asthma. he has symptoms no more than 1 day per week adn 1 night per month. What level of asthma does he have and What treatment is appropriate for him

Mild intermittent asthma as needed inhaled albuterol inhaler

When you see dome shaped pearly, flesh colored to translucent and umbilicated papules what do you think of

Molluscum contagiosum

What test do you order for Mono

Mono spot test ( Heterophile antibody) Blood test

Monoarticular joint pain with associated systemic signs such as fever suggests septic arthritis

Monoarticular joint pain with associated systemic signs such as fever suggests ______________

Monoarticular swollen joint, hot-to-touch, with edema commonly to the great toe suggests gout. Exacerbations include EtOH, trauma, large meal, or thiazide diuretics. Aspiration shows negative bire-fringent monosodiumurate crystals

Monoarticular swollen joint, hot-to-touch, with edema commonly to the great toe suggests _____. Exacerbations include _________. Aspiration shows ________.

fever, posterior cervical adenopathy, general malaise and sore throat indicate

Mononucleosis caused by epstine barr virus

What is the treatment of pityriasis alba

Mositurization Sunscreen Consider low potency topical steroid

Most TIAs last for < 1 hour

Most TIAs last for ______

Clinical manifestations of hyperlipidemia

Most asymptomatic Xanthomas pancreatitis

Most common cause for false-positive serum screen is incorrect gestational age

Most common cause for false-positive serum screen is __________

Most common cause of bacterial community-acquired pneumonia is Strep. pneumo, others include H. flu and Moraxella

Most common cause of bacterial community-acquired pneumonia is ___________, others include ___________

Most common cause of chorea is Huntington's, inherited at autosomal dominant pattern, with an abnormality at chromosome 4

Most common cause of chorea is _________, inherited at __________, with an abnormality _________

Most common cause of pinkeye is adenovirus, usually lasts 2 weeks

Most common cause of pinkeye is ___________, usually lasts _______

Most common causes of postoperative fever: "5 W's" Wind (Pneumonia) Water (UTI) Wound (SSI) Walk (DVT) Wonder drugs (Drug fever)

Most common causes of postoperative fever _______

Most common melanoma found in African Americans and Asians is Acral Lentiginous Melanoma. Common sites include under the nails, soles of feet, palms of hands

Most common melanoma found in African Americans and Asians is ________________. Common sites include ______________

Most effective treatment and first-line therapy for long-term management of mild to moderate allergic rhinitis is ICS

Most effective treatment and first-line therapy for long-term management of mild to moderate allergic rhinitis is ____

Most effective treatment for depression is psychotherapy combined with pharmacotherapy

Most effective treatment for depression is _______________

Most patients with atrial fibrillation require warfarin

Most patients with atrial fibrillation require _________

Motor or sensory loss in all four limbs, cross signs, disconjugate gaze, nystagmus, dysarthria and dysphagia suggest vertebrobasilar artery to be affected

Motor or sensory loss in all four limbs, cross signs, disconjugate gaze, nystagmus, dysarthria and dysphagia suggest __________ to be affected

What are common areas affected by Fixed drug eruptions

Mouth Genitalia face acral areas

What is a topical treatment option for impetigo

Mupirocin ointment

What is the MC cause for walking pneumonia

Mycoplasma pneumoniae

Antidote for acetominophen OD

N-acetylcysteine

Tx bullous pemphigoid

NEVER POP and consult dermatology

TX for opiate overdose

Nalaxone

TX of heroin overdose

Nalaxone

S/S Bronchitis

Nasal congestion, rhinorrhea, pharyngitis, cough >5 days

TX for asthma acute attack

Nebulizer B2 agonist (Albuterol)

TX tension pneumothorax

Needle decompression (14G angio cath 2nd intercostal space MCL) followed by chest tube

What is the most aggressive form of Melanoma

Nodular melanoma

Work up for Hypertensive Crisis

Neuro exam- CT r/o stroke Cardiac exam- EKG, CXR, CK/Troponin Renal: UA, BUN, Cr Retinal Exam

Complications of Hypertensive Crisis

Neurologic: enecphalopathy, stroke Cardiac: Acute coronary syndrome, HF, Aortic dissection Renal: AKI, Protenuira, Hematruia

mri for lower back pain is indicated when

Neurological deficit Radiculopathy Progressive major motor weakness Cauda equina compression (sudden bowel/bladder disturbance) Suspected systemic disorder (metastatic or infectious disease) Failed six weeks of conservative care

symptoms suggestive of serious underlying cause for diarrhea

New onset >40yo Nocturnal symptoms aggressive course rectal fissures anemia Elevated ESR

Indication for EGD

New onset heartburn after 45yo evidence GI bleed early satiety and vomiting symptoms that persist after treatment

Nipple discharge may be tested for blood with fecal occult blood test card

Nipple discharge may be tested for blood with ___________

treatment bacterial conjunctivitis noncontact and contact lense wearers

No contacts: erythromycin or trimethoprim-polymixinB drops Contacts: cover for pseudomonas use FQ drops (cipro)

what is ventricular fibrillation

No effective pumpig action

What age do you start screening for osteoperosis with no other risk factors and with risk factors

No risk factors 65 Risk factors 60

Trigger finger

Nodular thickening of flexor tendon

OCPs may be reduced in efficacy with: Antibiotics Barbiturates Antifungals May prolong effects of : Theophyllines Benzodiazepines Caffeine

OCPs may be reduced in efficacy with _______, but may prolong affects of ____________

Mechanism for inferior shoulder disslocation

Overhead injury

Risk factors for spondylolysis

Overloading pars (trunk extension, hyperextension, Ext with rotaion)

Patellar tendonitis

Overuse injury "jumpers knee" Local pain and crepitus

What is the only medical therapy proven to decrease mortality in COPD pts

Oxygen therapy

What are Janeway lesions

PAINLESS red macules on palms and soles

PCOS is a syndrome of insulin resistance and androgen excess

PCOS is a syndrome of ____________

Parkinson's disease develops due to the degeneration of dopamine in the substantia nigra and proliferation of Lewy bodies

Parkinson's disease develops due to ______________

How do you determine fluid resuscitation for burns

Parkland formula

What is the MC cause of transient aplastic crisis in patients with sickle cell disease

Parovirus B-19

What is the cause of 5ths disease

Parovirus B-19

Patients treated for a first episode of depression must be on treatment for 6-9 months

Patients treated for a first episode of depression must ____________

Patients treating depression with MAOIs must be on a tyramine-restricted diet to prevent a hypertensive crisis

Patients treating depression with MAOIs must _____________

Patients with BMI over 40 without improvement from diet and exercise or 35 with comorbid conditions are potential candidates for surgical treatment of obesity

Patients with _____________ are potential candidates for surgical treatment of obesity

antibiotics for copd exacerbation should be given when

Patients with exacerbations of COPD with the following three cardinal symptoms: *increased dyspnea, increased sputum volume, and increased sputum purulence* Patients with exacerbations of COPD with two of the cardinal symptoms, if increased purulence of sputum is one of the two symptoms Patients with a severe exacerbation of COPD that requires mechanical ventilation (invasive or noninvasive).

Patients with ventricular tachycardia should be cardioverted and given amiodarone

Patients with ventricular tachycardia should be _____________

Pearly papules with central ulceration or multiple telangiectasias suggest basal cell carcinomas

Pearly papules with central ulceration or multiple telangiectasias suggest __________

What are some medications that can cause proteinuria

Penicillin Cephlosporins NSAIDS ACE inhibitors cyclosporins sulfonamides

What is the treatment of choice for strep pharyngitisq

Penicillin or Augmentin for 7-10 days

Pepto Bismol is CI in: HS to aspirin Pregnancy Methotrexate use Probenecid use Doxycycline use for malaria

Pepto Bismol is CI in ___________

TX stable angina

Percutaneous transluinal coronary angioplasty Percutaneous coronary intervention Nitro, BB or CCB and Aspirin

What is the 1st line over the counter and prescription lice treatment

Permethrin 1% to clean dry hair and leave 10min rinse off

What is forcheimer's sign

Petechial lesions on soft palate and uvula associated with Rubella

Pharmacologic options for Smoking Cessation: Nicotine gum or patch Bupropion Varenicline

Pharmacologic options for Smoking Cessation are ________

What are the 3 systemic treatment options for psoriasis

Phototherapy- UVB Oral Medications: Methotrexate Biologic agents: Alefacept, Infliximab, Etanercept, Adalumimab

Physiologic sinus tachycardia in response to stress, caffeine, fever, hyperthyroidism with an immediate onset and regular rhythym suggests PSVT

Physiologic sinus tachycardia in response to stress, caffeine, fever, hyperthyroidism with an immediate onset and regular rhythym suggests _______

What glands does acne affect

Pilosebaceous follicles

What does Bowens disease look like

Pink to red patch or thin plaque with scaly or rough surface

Signs and symptoms of right sided heart failure

Pitting edema distended neck veins hepatic congestion decrease appetite/nausea ascites cyanosis increase hepatojugular reflex

Psoriasis of the nail can occur with any type of psoriasis what are the nail changes seen

Pitting: punctate depression of nails Onycholysis: separation of nail plate from bed Subungual hyperkeratosis: abnormal keratinization of distal nail bed Trachyonychi: rough nails as if scraped with sandpaper

What are hypopigmented patches of the face in kids that have hx of atopy

Pityriasis alba

Complete placenta previa

Placenta completely covers the internal os

Partial placenta previa

Placenta partially covers the internal os

What is the MC type of psoriasis

Plaque

What are the 5 types of Psoriasis

Plaque Inverse/flexural Guttate Erythrodermic Pustular

Pneumonia after an influenza episode is suggestive of S. aureus

Pneumonia after an influenza episode is suggestive of _________

Pneumonia in an individual with underlying COPD suggests H. flu

Pneumonia in an individual with underlying COPD suggests _______

Pneumonia presented with diarrhea is suggestive of Legionella

Pneumonia presented with diarrhea is suggestive of ____________

What is considered rhus dermatitis

Poison ivy, oak, and sumack

Asthma history should include what questions

Previous episodes prior ED visits Need for prior intubation Hospitalization/ ICU admits Steroid use Inhaler use Medication compliance

How does superficial spreading melanoma usually grow

Primarily horizontal rather than down into the dermis

What is the clinical manifestations of Roseola

Prodrome HIGH fever 3-5 days after the fever gone a rose pink macules and papules surrounded by white halos begin on trunk and spread

Clinical manifestations Chronic bronchitis

Productive cough prolonged expiration

Progress of labor depends on Power (Uterine contractions) Passenger (Fetus) Pelvis (Shape and size)

Progress of labor depends on ________

What is a 2nd Degree Mobitz Type 1 (Wenckebach)

Progressive PR interval until drops QRS

Prophylaxis for HIV+ patients includes: Bactrim when CD4 < 200 against P. jirovecci Azithromycin when CD4 < 50 against MAC

Prophylaxis for HIV+ patients includes __________

positive birefringent crystals

Pseudogout

Signs and Symptoms of orbital cellulitis

Ptosis Eye lid edema Exopthalamos Purulent drainage Conjunctivitis Decrease vision Pain with occular movement Fever

What is the gold standard for Dx COPD

Pulmonary function testing/ Spirometry

Causes of A-fib (P3IRA2TES)

Pulmonary: COPD, PE Phenochrochromocytoma Pericarditis Ischemic heart Dz Rheumatic heart Dz Anemia Atrial myxoma Thyrotoxicosis Ethanol (holiday heart) Sepsis

Toys and non washable items treatment for lice

Put in sealed bag 3-7 days wash off after

projectile vomiting in children can suggest

Pyloric stenosis

Questionnaire for alcoholics is: "CAGE" Cut back Annoyed Guilty Eye opener

Questionnaire for alcoholics is ____________

What stage of sleep do nightmares occur

REM sleep

TX patellar tendonitis

REST patellar strap PT ICE

Rabies is typically caused by bats, skunks, dogs, foxes

Rabies is typically caused by _______________

What is nursemaid elbow

Radial head disslocation

Radiation exposure > 5 is associated with fetal harm

Radiation exposure > __ is associated with fetal harm

Radiographs with cystic changes in the joint and punched-out lesions and soft-tissue calcifications suggests gout

Radiographs with cystic changes in the joint and punched-out lesions and soft-tissue calcifications suggests __________

What is a plaque

Raised areas >1cm they cast a shadow with side lighting

Raised borders and brown lesions with pinks, whites, grays or blues, spreading superficially is the Superficial Melanoma. Men commonly affected on torso, Women to the legs.

Raised borders and brown lesions with pinks, whites, grays or blues, spreading superficially is the __________. Men commonly affected on _______, Women to the ______.

What is a papule

Raised lesions <1cm caused by proliferation of cells in epidermis or superficial dermis

Physical exam findings chronic bronchitis

Rales, crackles, ronchi wheezing Signs of cor pulmonale (peripheral edema, cyanosis)

Biceps tendon tear MOA

Rapid eccentric contraction of biceps=> distal tendon tear

What are the 2 states of sleep

Rapid eye movement (REM) and non REM

Rash that starts on wrists and ankles and spreads centrally to palms and soles suggests Rocky Mountain spotted fever. Treatment is doxycycline

Rash that starts on wrists and ankles and spreads centrally to palms and soles suggests _____________. Treatment is _________

Treat A-fib

Rate control over rhythm control

Recommendation for postmenopausal women includes 1200 mg calcium in divided doses and 800-1000 IU of vitamin D and perform regular weight bearing exercises.

Recommendation for postmenopausal women includes ____________.

Recommendations to reduce developing osteoporosis: 1200 mg Calcium supplement 400-800 IU Vitamin D supplement Weight-bearing exercise Avoid tobacco, EtOH

Recommendations to reduce developing osteoporosis ______________

Recommended prenatal visits are: Q 4 weeks until 28 weeks Q 2 weeks between 28-36 weeks Q week after 36 weeks

Recommended prenatal visits are _______

SS rotator cuff tear

Recurrent shoulder pain cant sleep on affect side Weakness, catching, grating when lifiting

What is the clinical presentation of a brown recluse spider bite

Red- peripheral erythema White- blanching Blue- Central violaceous area

Tx patellar dislocation

Reduction

How is 5ths disease transmitted

Respiratory droplets

What are some causes of secondary hypertension

Renal vascular cuases, Renal artery stenosis

Olecranon Bursitis MOA

Repeated trauma

Shoulder impingement syndrome

Repetivie microtrauma from old injures or from Abduction and External rotation

ABG lab for chronic bronchitis

Respiratory acidosis pH<7.35 PCo2 < 35

ABG labs for emphysema

Respiratory alkalosis pH > 7.45 and increase PCo2 > 45

What are roth spots

Retinal hemorrhage or petechi

Signs and symptoms of MI

Retrosternal chest pain Pain radiates to L arm, jaw, back or abdomen Pain at rest > 30 min Diaphoresis Dyspnea Nausea/ vomiting Weakness

Rheumatic fever is suggested by: Arthritis Carditis Subcutaneous nodules Erythema marginatum Sydenhams chorea

Rheumatic fever is suggested by ____________

If group A strep goes untreated what are 2 potential complications

Rheumatic fever leading to rheumatic heart disease Post streptococcal glomerulonephritis

What type of arthritis is associated with morning stiffness that lasts longer than 60min

Rheumatoid arthritis

RhoGam is given to Rh-negative mom during week 28 and if any instance of trauma

RhoGam is given to Rh-negative mom during week ___

What is the MC cause of allergic/contact dermatitis

Rhus dermatitis

Right bundle branch block with an elevated J point > 2 mm with flat or negative T waves in V1, V2, or V3 suggests Brugada syndrome, common in Asian males

Right bundle branch block with an elevated J point > 2 mm with flat or negative T waves in V1, V2, or V3 suggests _______, common in _______

MC location for foreign body aspiration objects to be located

Right main bronchus

Rome III diagnostic criteria for IBS includes symptoms for at least 3 days/month for the past 3 months

Rome III diagnostic criteria for IBS includes symptoms for at least ______

During the winter a daycare worker develops watery diarrhea. What is the most likely cause of her symptoms

Rotavirus

MC cause of acute diarrhea in kids

Rotovirus

What is another name for German Measles

Rubella

What is the other name for Measles

Rubeola

How do you estimate total body surface area burned

Rule of 9's

Spontaneous pneumothroax usually caused by

Ruptured bleb

difficulty with toe walk is associated with

S1 disc herniation

EKG results for PE

S1Q3T3 Wide deep S in lead 1 isolated Q wave in lead 3 Twave inversion in lead 3

SABAs are used PRN. Examples include: Albuterol Levalbuterol Pirbuterol

SABAs are used ______. Examples include ________.

What are medications that can induce SJS/TEN

SATAN Sulfa, Allopurinol, Tetracycline, Anticonvulsants, NSAIDS, Thiacetazone

When looking at elbow x-ray what sings are you looking for to help show fractures

Sail sing( Fat pad sign) = occult fracture

What are some examples of long acting beta agonists

Salmeterol/ Servent Formoterol Bambuterol/ AstraZeneca

What is Atrial Flutter

Saw tooth pattern no pwaves Rate 250-350 bpm Rate usually regular

Screenings for newborns involve: Pheynylketonuria Hypothyroidism Galactosemia Hemoglobinopathies

Screenings for newborns involve _________

56 year old man presents with symptoms consistent with allergic rhinitis. Past med history positive for BPH he works in a warehouse as a forklift drive. What medication would be best to treat his allergies

Second generation antihistamine Fexofenadine

What is a common cause of orbital cellulitis

Secondary infection to sinusitis

Treatment Roseola

Self limited

Treatment of pityriasis rosea

Self limiting 5-8 weeks Soothing anti itch lotions OTC

Self-limited inflammatory response hip pain often following a viral infection suggests transient synovitis

Self-limited inflammatory response hip pain often following a viral infection suggests ______________

What leads are and what artery innervates them Septal Anterior Lateral Inferior Posterior

Septal= V1 and V2, proximal Left anterior descending Anterior= V2, V3, V4, Left anterior descending Lateral= I, aVL, V5, V6, Circumflex Inferior= II, III, aVF, right coronary artery Posterior= ST depression V1 & V2, RCA and Circumflex

Cardiac enzymes are tested how

Serial 3 sets every 3-6 hours

What do bronchial carcinoid tumors secrete

Seritonin, ACTH, ADH, MSH

What is the prefered dx test for 5ths disease

Serum parovirus B-19 specific IgM antibody

Tx persisten asthma Step 5

Short acting beta agonist as needed + high dose inhaled corticosteroid + Long acting beta agonist + consider omalizumab if allergies too

Tx persistent asthma Step 3

Short acting beta agonist as needed + low dose inhaled corticosteroid + Long acting beta agonist

Tx persistent asthma Step 4

Short acting beta agonist as needed + medium dose inhaled corticosteroid + Long acting beta agonist

SPIKES system for delivering bad news

Setting up the interview: Arrange a private room where you can sit face to face with the patient. Encourage the patient to bring family members for support. Make eye contact during the interview. Perception: Use the rule, "before you tell, ask." Find out what is the patient's understanding of the situation before launching into an explanation. This allows you to dispel misinformation and identify denial. Invitation: Because a minority of patients do not want to learn about bad news, ask how the patient would like you to explain the information about the diagnosis. Give Knowledge and information to the patient: Expressing your own emotions about the bad news can lessen the shock of the news (e.g. "It makes me very sad to have to tell you that..."). Make sure to use non-technical words and avoid being overly blunt. Address the patient's Emotions with empathic responses: First, identify the emotion the patient is expressing and identify the reason for it (usually this is related to the bad news). Then let the patient know that you understand their emotion (e.g. "I can tell you weren't expecting to hear this." "I imagine this isn't what you wanted to hear."). Strategy and Summary: Laying out a plan for what will happen next, including how the patient can contact you and when you will see them again, can relieve anxiety and uncertainty for the patient. Summarizing the information and checking for understanding can prevent misunderstandings and avoid either an overly optimistic or pessimistic response by the patient.

SSRIs and pregnancy/lactation

Several of the selective serotonin reuptake inhibitors (SSRIs) are a Category B for breastfeeding. Concerns have been raised about infants' exposure to SSRIs during lactation and neurodevelopment, and the results of studies have been mixed. During pregnancy: There is no clear consensus about use of SSRIs in pregnancy except data which suggest that both untreated maternal depression and pregnancy with continual use of SSRIs are associated with a 20% preterm delivery incidence. Postpartum: There are significant risks associated with untreated postpartum depression, which might outweigh the risks associated with use of SSRIs during lactation.

Severe heart failure can results in hyponatremia

Severe heart failure can results in __________ (electrolyte imbalance)

How do you differentiate between Steven Johnson Syndrome and Toxic Epidermal Necrolysis Syndrome

Severity based on body surface area involved <10% BSA is Seven Johnson Syndrome 10-30% BSA is Combo SJS/TEN >30% BSA is Toxic Epidermal Necrolysis Syndrome

Sharp chest pain radiating to trapezius, worsened with respiration; improved with sitting forward suggests Pericarditis

Sharp chest pain radiating to trapezius, worsened with respiration; improved with sitting forward suggests _________

What is dermatographism

Sharply localized edema or wheal withing seconds to minutes after the skin is rubbed

bacterial diarhea causes

Shigella, Salmonella, Campylobacter

Tx intermittent asthma Step 1

Short acting beta agonist as needed

Tx persistent asthma Step 6

Short acting beta agonist as needed + High dose inhaled corticosteroid + Long acting beta agonist + Oral corticosteroids

Tx persistent asthma Step 2

Short acting beta agonist as needed + Low dose inhaled corticosteroid

When do you do surgery on rotator cuff tear

Significant symptoms Failed rehab >3-6month Traumatic

What exam findings will be present for TB

Signs of consolidation rales/ronchi near apices dullness

Signs of nephritic syndrome include: Coca-Cola urine (Hematuria) HTN Oliguria

Signs of nephritic syndrome include __________

Signs of nephrotic syndrome include: Peripheral edema Proteinuria Hyperlipidemia Hypoalbuminemia

Signs of nephrotic syndrome include _______

What happens in Drug Induced hypersensitivity syndrome

Skin eruption with systemic symptoms (Fever) and internal organ involvement

Side effect of stool softeners

Skin rash, hepatotoxicity

How do you confirm dx of scabies

Skin scraping with mineral oil preparation

Tx insomnia

Sleep hygine Medications: antihisamines or hypnotics (zolpidem)

DX sleep disorders

Sleep study ( Polysomnography) assesses EEG activity, HR, respiratory mvt, and O2 sats

What does ETOH intoxication look like

Slurred speech, blackout, ataxia, impaired judgement

Which type of bronchogenic cancer metz early

Small cell

What are the 2 categories of bronchogenic carcinomas

Small cell (oat cell) carcinoma Non small cell carcinoma

Small kidneys on imaging suggest irreversible damage

Small kidneys on imaging suggest _______________

What is a nodule

Small knot caused by proliferation of cells in mid-deep dermis

MC risk factor for COPD

Smoking or exposure smoke

Sneezing, nasal congestion, nasal itching, rhinorrhea, itchy eyes suggest allergic rhinitis

Sneezing, nasal congestion, nasal itching, rhinorrhea, itchy eyes suggest _________

Sodium should be restricted to 2-4 g/day in CHF patients

Sodium should be restricted to ____ in CHF patients

Stages of COPD and treatments include: 1: FEV1 > 80% Tx: SABA 2: FEV1 50-80% Tx: LABA 3: FEV1 30-50% Tx: ICS 4: FEV1 <30% Tx: O2 therapy

Stages of COPD and treatments include __________

several friends develop vomiting and diarrhea 6 hours after eating food at a private party. What is the most likely etiology of the symptoms

Staph auerus

What is the MC cause of hospital acquired pneumonia

Staph aureas or pseudomonias

Tx cardiac ischemia for NSTMI or Unstable angina

Start antithrombotic therapy Heparin

Tx acute MI

Start heparin, Nitro drip

When should paps begin

Starting at age 21 or within 3 years of becoming sexually active which ever is first

Where does the rash start

Starts in mouth and presents later on hands and feet

What is the morphology and spread of the rash for Measles

Starts on the face and spreads to the body the rash mobiliform brick red rash last 7 days

Tx for non small cell lung cancer

Surgery

Tx 5th metatarsal fx zone 3

Surgical consult for ORIF

Tx 5th metatarsal fx zone 2

Surgical consult possible ORIF

What is the treatment of choice for squamous cell carcinoma

Surgical excision

TX of epidermal inclusion cysts

Surgical excision and they may come back

Tx Jersey finger

Surgical repair and splint after

Treatment for Murmur

Surgical repair or valve replacement

What can cause foreign body aspiration

Swallowing a variety of objects

Symptomatic SVT can be treated with Vagal stimulation. If unsuccessful, adenosine

Symptomatic SVT can be treated with ______. If unsuccessful, ________

Treatment of V tach Unstable with pulse

Synchronized cardioversion 100-300J

What is Mitral Regurgitation

Systolic Murmur Backflow from left ventricle into left atria causeing left ventricular overload and decrease cardiac output

What is aortic stenosis

Systolic Murmur Left ventricular outflow obstruction leads to fixed cardiac output and increase afterload causeing Left ventricular hypertrophy

What BP indicates a Hypertensive Urgency

Systolic great or equal 220 Diastolic great or equal to 120 NO END ORGAN DAMAGE

What blood pressure indicates a Hypertensive Crisis/ Emergency

Systolic great or equal to 220 Diastolic greater or equal to 120

What is syncope

Temporary loss of consciousness caused by a fall in blood pressure, insufficient blood flow to the brain

Tachypnea, Toxic-appearing, fever, cough suggests pneumonia, diagnosed using Chest XR looking for infiltrates

Tachypnea, Toxic-appearing, fever, cough suggests ____________, diagnosed using _________

Tay-Sachs carrier state includes French-Canadian or Ashkenazi Jew. Sickle cell carriers include African Americans. Thalassemia carriers include Asians and Middle Eastern, Mediterranean. Cystic fibrosis carriers include Ashkenazi Jews and Caucasian

Tay-Sachs carrier state includes ___________ Sickle cell carriers include _________ Thalassemia carriers include _______ Cystic fibrosis carriers include _____

Deadly causes of chest pain

Tension pneumothorax aortic dissection PE Unstable angina Myocardial Infarct

3 main types of headaches

Tension, cluster, migraine

pelvic compression test

Test is performed by forcibly pressing together the hips A positive test elicits pain in the sacroiliac joint.

Test of choice in determining the source of lower GI bleeding is colonoscopy

Test of choice in determining the source of lower GI bleeding is __________

What are some examples or oral antibiotics that can be used to treat acne

Tetracycline, doxycycline, minocycline

statin recommendations in diabetic patients

The ACC/AHA guidelines for cholesterol management recommend that all patients with type 1 or 2 diabetes age 40-75 years old should be on either a moderate-intensity statin, or (if their estimated 10-year ASCVD risk >7.5%) a high-intensity statin.

breast cancer screening recommendations

The U.S. Preventive Services Task Force (USPSTF) recommends screening mammography, with or without clinical breast examination (CBE), every two years for women aged 50 to 74 years (Grade B recommendation). They recently updated their recommendation regarding mammography for women aged 40-49. Whereas they previously recommended routine mammography, they now recommend that patients and doctors should make individual decisions based on the patient's risks and health preferences (Grade C recommendation). Teaching self-breast examination (SBE) is not recommended (Grade D recommendation) as it has shown only to increase rates of biopsy without improving cancer detection or treatment. USPSTF also recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing (Grade B recommendation).

labor dystocia

The average speed of dilation is about 2 cm/hour for multiparous women and about 1 cm/hour for primiparous women, so the average length of the active phase of the first stage of labor is 2.4 hours for multiparous women and 4.6 hours for primiparous women. Failure to progress (or active phase arrest) occurs if there is no cervical change for two hours in the active phase of labor. - can also be diagnosed in the second stage of labor if the fetal presenting part does not descent significantly in the pelvis after 2 hours of pusghin (or 3 hours with an epidural0 - IN AN ACTIVE PHASE ARREST WE CAN GIVE IV OXYTOCIN AND/OR ARTIFICIAL RUPTURE OF THE MEMBRANES

The difference between a crystal-induced aspirate and a septic joint aspirate is: Crystal-induced has 2,000-6,000 WBC with < 90% neutrophils Septic joint has 100,000 WBC with > 90% neutrophils

The difference between a crystal-induced aspirate and a septic joint aspirate is _____________

The goal LDL level cholesterol in anyone with a history of CAD or DM is < 70 mg/dL

The goal LDL level cholesterol in anyone with a history of CAD or DM is ________

The inability to pinch fold of skin on the base of the 2nd toe is Kaposi-Stemmer sign, suggestive of lymphedema

The inability to pinch fold of skin on the base of the 2nd toe is ____________, suggestive of ___________

The type of anemia usually associated with alcoholics is folate deficiency anemia

The type of anemia usually associated with alcoholics is ___________

Tx PVC

Usually none needed

Thick, white, "curd-like" vaginal discharge that may be pruritic suggests a fungal infection. Discharge has a pH of 4-5

Thick, white, "curd-like" vaginal discharge that may be pruritic suggests _____________. Discharge has a pH of _____

Primary spontaneous pneumothroax usually occurs in what types of patients

Thin young men with a hx of tobacco use

Things to evaluate when a patient presents with dyspnea: Toxic appearance Accessory muscle use Pulse ox

Things to evaluate when a patient presents with dyspnea __________

subtypes of sponeateous aborption

Threatened abortion - bleeding before 20 weeks gestation. Threatened abortion is simply a pregnancy complicated by bleeding before 20 weeks gestation, and is - in some ways - a "catch-all" descriptive diagnosis. Inevitable abortion - dilated cervical os. Incomplete abortion - some but not all of the intrauterine contents (or products of conception) have been expelled. Missed abortion - fetal demise without cervical dilitation and/or uterine activity (often found incidentally on ultrasound without a presentation of bleeding). Septic abortion - with intrauterine infection (abdominal tenderness and fever usually present). Complete abortion - the products of conception have been completely expelled from the uterus.

What is the "gold standard" for diagnosing strep pharyngitis

Throat culture

TX PE in a hemodynamically unstable pt

Thrombolytic therapy Alteplast (tpA), Streptokinase, Urokinase

What is the cause of acute arterial occlusion

Thrombosis or embolism

Tx scaphoid fx

Thumb spica splint 10-14 days and re-xray if still negative splint still and refer to Ortho

PVC's and PAC's treatment

Usually nothing but can symptomatically treat with a beta blocker

To calculate estimated delivery date, use Naegele's rule (Subtract 3 months, Add 7 days)

To calculate estimated delivery date, use ____________

To confirm rupture of membranes: Visualizing amniotic fluids Pooling of amniotic fluid pH > 6.5 in vagina fluid with Nitrazine paper "Ferning" on fluid sample

To confirm rupture of membranes ___________

To diagnose a thyroid disorder, uptake of technetium 99 or iodine 123 is assessed. Hyperthyroidism presents with large uptake amount. Thyroiditis presents with patchy uptake.

To diagnose a thyroid disorder, uptake of _______ is assessed. Hyperthyroidism presents with ________. Thyroiditis presents with ________.

To enhance the levels of levodopa/carbidopa, add entacapone

To enhance the levels of levodopa/carbidopa, add ___________

To have Hepatitis D, you must have Hepatitis B. Treatment is Interferon

To have Hepatitis D, you must have _________. Treatment is ___________

To prevent embolic strokes, use anticoagulants. To prevent noncardioembolic ischemic strokes, use antiplatelets

To prevent embolic strokes, use ________. To prevent noncardioembolic ischemic strokes, use __________

To rule out secondary causes of osteoporosis, laboratories run should include: Alkaline phosphate Calcium 24 Hydroxy Vitamin D

To rule out secondary causes of osteoporosis, laboratories run should include _____________

To treat acute gout, use NSAIDs and Colchicine. Chronic gout is treated with Allopurinol or Probenecid

To treat acute gout, use __________. Chronic gout is treated with ____________

What cuases Rubella

Togavirus

Treatment of tinea corporis and cruris

Topical antifungals minimum 2 wks Clotrimazole or Miconazole

What is the 1st line tx seborrheic dermatitis

Topical ketoconazole 2x daily reduce yeast

Tx rhus dermatitis

Topical steroid and oral antihistamines If severe require oral steroids for 3 weeks

What is the treatment for rosacea

Topical- metronidazole or azelaic acid Oral Abx- Tetracycline Laser and light devices for erythema

MOA compartment syndrome

Trauma, premature cast, exercise

Trazadone may cause priapism and sedation

Trazadone may cause __________

Treatment for C dif is metronidazole or vancomycin

Treatment for C diff is ____________

Treatment for COPD exacerbation is similar to asthma; O2, bronchodilators, steroids

Treatment for COPD exacerbation is _________

Treatment for Huntington's is to target the signs and symptoms. There is no treatment to slow the progression. Chorea is treated with Tetrabenazine. Insomnia is treated with Benzodiazapene.

Treatment for Huntington's is ___________. Chorea is treated with _________. Insomnia is treated with ______

Treatment for Rheumatoid Arthritis includes NSAIDs, glucocorticoids, DMARDs (Sulfasalazine, Methotrexate) ,anticytokines (Infliximab, Etanercept), topical analgesics

Treatment for Rheumatoid Arthritis includes __________

Treatment for Traveler's diarrhea is Fluoroquinolones. Azithromycin (for children and pregnant women)

Treatment for Traveler's diarrhea is _____________

Treatment for acute bronchitis include bronchodilators, analgesics, antiussives

Treatment for acute bronchitis include _____________.

Treatment for acute hepatitis B is supportive. Chronic hepatitis is treated with antivirals

Treatment for acute hepatitis B is _______. Chronic hepatitis is treated with __________.

Treatment for cluster HA involves 100% O2, dihydroergotamines, and triptans

Treatment for cluster HA involves ______________

Treatment for dog or cat bite is Augmentin

Treatment for dog or cat bite is __________

Treatment for essential tremors is propranolol, primidone, gabapentin

Treatment for essential tremors is _______________

Treatment for hyperthyroidism includes Methimazole, Propylthiouracil, BBs. Definitive treatment is radioactive iodine or surgery (for pregnant patients)

Treatment for hyperthyroidism includes _______________. Definitive treatment is ______________

Treatment for opioid abuse is Naloxone

Treatment for opioid abuse is ___________

Treatment of choice for idiopathic edema is spironolactone

Treatment of choice for idiopathic edema is _________________

Treatment of choice in hyperprolactinemic disorders is dopamine agonists. Treatment of choice in hyperprolactin-induced anovulatory infertility is Bromocriptine

Treatment of choice in hyperprolactinemic disorders is ____________. Treatment of choice in hyperprolactin-induced anovulatory infertility is ___________

Treatments for dementia include: Donepezil Galantamine Rivastigmine Memantine

Treatments for dementia include ___________

Treatments for mastalgia include: Topical NSAIDs Soy protein Low-fat high-carb diet Chasteberry extract Danazol

Treatments for mastalgia include _________

Tx seborrhic keratosis

Usually nothing if irritating curettage, cryotherapy, shave removal

Types of colon neoplasms: Tubulous adenomas is the most benign Tubulovillous adenomas Villous adenomas is the least benign

Types of colon neoplasms __________

Types of emergency contraception include Mifepristone and Levonorgestrel

Types of emergency contraception include __________

What is Gamekeepers Thumb

UCL sprain at the 1st MCP joint

common causes of a cough

URI, irritants, allergies, asthma, COPD, cancer, GERD

What does the prodrome of Measles look like

URI: cough, coryza, conjunctivitis and Koplik spots

Best imaging study for the gallbladder and pancreas

US

to distinguish a solid mass from a cystic one in the breast

US

At 20 weeks gestation where should the fundal height be

Umbilicus

Clinical manifestations of DVT

Unilat swelling and leg edema Calf pain and tenderness + Homan's sign Phlebitis

Unilateral limb swelling is MC due to venous insufficiency, lymphedema, dvt

Unilateral limb swelling is MC due to _____________

Unilateral sharp, pleuritic pain of sudden onset suggests pneumothorax

Unilateral sharp, pleuritic pain of sudden onset suggests ___________

Bronchitis often follows what

Upper respiratory infection

Antidote for salicylates

Urine alkalization, dialysis, activated charcoal

When replacing fluids what do you need to monirto

Urine output via foley cath

S/S Anaphylaxis

Urticaria, erythema, pruritus Nasal congestion, sneezing, coryza, cough, tachypnea Sensation of throat tightness Tachycardia, Hypotension

Useful treatment for patients with both asthma and allergies are leukotriene inhibitors

Useful treatment for patients with both asthma and allergies are ____________

Rotator Cuff Tear

Usually age related degeneration or chronic impingement

What does squamous cell carcinoma look like

Various appearances papule, plaque, noudle, scale, pink/red/skin colored, may be a cutaneous horn

DX DVT

Venous duplex ultrasound D-dimer Venography

MC arrhythmia in cardiac arrest patients

Ventricular fibrillation

What are risk factor for DVT

Verchows Triad Venous stasis Endothelial damage Hypergoacuability

What does PCP intoxication look like

Vertical and horizontal nystagmus aggressive Impossible strength

What is a left bundle branch block

Wide QRS > .12 sec Broad, slurred R in V5 and V6 Deep S in V1 ST elevation V1-V3

What is a right bundle branch block

Wide QRS > .12 sec RSR in V1 and V2 Wide S wave in V6

What do PVC look like

Wide bizarre QRS occuring earlier than expected

With a red, swollen joint, ASPIRATE

With a red, swollen joint, _______________

With a shoulder injury: Hawkin's test and Empty can test rule in Supraspinatus External rotation test rule in Infraspinatus and Teres minor Internal rotation test rule in Subscapularis

With a shoulder injury _________

With an ankle injury: Anterior drawer test rule in ATFL Inversion test rule in CFL Squeeze test rule in Syndesmosis

With an ankle injury ___________

With an knee injury: Lachman test and Anterior drawer rule in ACL Valgus stress rule in MCL Varus stress rule in LCL McMurrays rule in Meniscal tears

With an knee injury __________

With extremity injuries, evaluate sensation, peripheral pulses, and capillary refill

With extremity injuries, evaluate _____________

With lymphedema, treatment is pneumatic compression, drainage, and possible surgery

With lymphedema, treatment is ___________

With pelvic pain, ALWAYS DO UA with Beta-HCG

With pelvic pain, ALWAYS ______________

With venous insufficiency, always consider a differential diagnosis of pulmonary hypertension

With venous insufficiency, always consider a differential diagnosis of _______________

A delta wave on an EKG suggests

Wolf Parkinson White syndrome

Wolf-Parkinson-White syndrome's classic finding is the delta wave

Wolf-Parkinson-White syndrome's classic finding is the _________

Women over 35 and smoking should not take OCP

Women _____________ not take OCP

Women of age 65 are recommended to screen for osteoporosis screening with DEXA scanning

Women of age 65 are recommended to screen for ___________ with ___________

Women with a new breast solid mass over 35 undergo triple assessment: Examination Mammography Core biopsy

Women with a new breast solid mass over 35 undergo triple assessment __________

How do you dx vitiligo

Woods light exam distinguishes hypopigmented from depigmented lesions DEPIGMENTED (bone white) = Vitiligo

Tx Dupuytrens Contracture

Xiaflex injection and manipulation next day

Are people with reactivation TB contagious

YES

Is impetigo contagious

YES

5th metatarsal Fx zone 1,2,3

Zone 1: avulasion fx peroneus brevis/peroneus longus "Dancers fracture"

High Triglyceride sare suggestive of hyperlipidemia from dietary choices. High cholesterol and normal triglyceride sare suggestive of hyperlipidemia from genetics

______ are suggestive of hyperlipidemia from dietary choices. ______ are suggestive of hyperlipidemia from genetics

Furosemide is the treatment of choice in CHF exacerbation with pulmonary edema due to diuretic effect and bronchial vasculature vasodilation

______ is the treatment of choice in CHF exacerbation with pulmonary edema due to __________

Elevated BNP > 500 and pro-BNP is a specific and sensitive lab marker for diagnosis of CHF

_______ is a specific and sensitive lab marker for diagnosis of CHF

Hepatitis C is the most common cause of Chronic liver disease. 60% of those with acute Hepatitis C infection will develop Chronic liver disease

_______ is the most common cause of Chronic liver disease. 60% of those with _______ infection will develop Chronic liver disease

Minipill is the most effective method of birth control for women postpartum desiring to breastfeed

_______ is the most effective method of birth control for women postpartum desiring to breastfeed

Kocher criteria is used to assess risk for septic arthritis

________ criteria is used to assess risk for septic arthritis

Lewy body dementia presents early with vivid hallucination, fluctuation in cognition, and parkonsinion extrapyramidal signs and postural instability

________ dementia presents early with vivid hallucination, fluctuation in cognition, and parkonsinion extrapyramidal signs and postural instability

Rotavirus is a common cause for watery diarrhea, especially in the winter

________ is a common cause for watery diarrhea, especially in the winter

Delirium is an acute change in mental status characterized by fluctuations in levels of consciousness. Usually caused by acute illness, medication use, or withdrawal

________ is an acute change in mental status characterized by fluctuations in levels of consciousness. Usually caused by ____________

ACEIs reduce short-term mortality when started within 24 hours of acute myocardial infarction

________ reduce short-term mortality when started within 24 hours of acute myocardial infarction

Vascular dementia is related to the amount and location of neuronal loss with sudden onset

_________ dementia is related to the amount and location of neuronal loss with sudden onset

Hypomagnesium may increase the incidence of Torsades, therefore magnesium sulfate should be given if low

_________ may increase the incidence of Torsades, therefore _________ should be given if low

S. aureus usually causes vomiting and diarrhea within 6 hours of eating contaminated food

_________ usually causes vomiting and diarrhea within 6 hours of eating contaminated food

E. coli is the most common cause for Traveler's diarrhea

__________ is the most common cause for Traveler's diarrhea

Ulcerative colitis causes continuous inflammation of the large bowel beginning at the rectum and extending proximally, may be pancolitic. Crohn's causes focal "skip lesions" anywhere between the mouth and rectum, may be transmural

___________ causes continuous inflammation of the large bowel beginning at the rectum and extending proximally, may be _______. ________ causes focal "skip lesions" anywhere between the mouth and rectum, may be ________

Conjunctival pallor is a reliable sign of anemia in the elderly

___________ is a reliable sign of anemia in the elderly

Echocardiography is the gold standard diagnosis for CHF

___________ is the gold standard diagnosis for CHF

Superficial melanoma is the MC melanoma in both sexes

____________ is the MC melanoma in both sexes

PTH, Calcitonin, and 1,25-dihydroxyvitamin D (Calcitriol) are responsible for regulating calcium levels

_____________ are responsible for regulating calcium levels

Elevated methylmalonic acid level can be used to confirm Vitamin B12 deficiency

_____________ level can be used to confirm Vitamin B12 deficiency

Elevated homocysteine level can be used to confirm folate deficiency

_____________ level can be used to confirm folate deficiency

Aspirin and heparin reduce the risk of subsequent MI and cardiac death in patients with unstable angina

_____________ reduce the risk of subsequent MI and cardiac death in patients with unstable angina

Polysomnography confirms diagnosis of OSA if: AHI or RDI > 15 or > 5 with symptoms. Severe is > 30

______________ confirms diagnosis of OSA if ______

Inflammatory bowel disease (crohns or collitis) symptoms- broad

abdominal pain bloody stools fever

Acute treatment for acute glaucoma

acetazolamide to lower intra occular pressure and then administer pilocarpine to constric pupils

Lisfrac fx

articulation btwn 3 cuniefiroms and base of 1st and 2nd metatarsals

What is the time frame for a positive mono test

as early as 5 days into infection and as long as 3 weeks

TX patellar bursitis

aspiration NSAIDS Surgical excision

MOA lisfranc Fx

axial loading in Plantar flexion/ hyper plantar flexion

Treatment for blepharitis

baby shampoo to eye lids warm wash cloths

Tx GERD

behavior modifications H2 blockers: cimetidine, famotidine, ranitidine PPI: omeprazole, esomeprazole, pantoprazole

What is another name for an Open comedone

black head

What are clinical manifestations of uticaria

blanchable, edematous pink papules, wheals, or plaques that may coalesce

Chronic lid margin erythema, scaling, loss of lashes indicates

blepharitis

Bidirectional or vertial nystagmus suggests

brainsem origin of vertigo

What are bronchial carcinoid tumors

bronchial gland tumor well differentiated neuroendocrine tumor

Buckle fracture

buckling of cortex

first line medication for quiting smoking

burproprion

what is COPD

chronic obstructive pulmonary disease It is progresive, largely irreversible airflow obstruction

palmar erythema, spider telangectasias, and ascites suggest

cirrhosis

What are the symptoms of Peripheral arterial disease

claudication, ischemia, and pain with exercise causing significant limitation of activity or disability

Treatment of folliculitis

cleansing the area with antibacterial soap and water 3x day oral or topical anti-staph agents may be used

How is lice spread

close physical contact and fomites

What is an ulcer

complete loss of the epidermis in addition to part of the dermis

buring, itching, discharge, lid edema indicate

conjunctivitis

Contact dermatitis occurs from what

contact to substance externally applied body doesnt like Nickle, detergents, soaps,

what iud is approved for use post partum

copper -can be placed immediately. higher expulsion rate than if you wait 4-6 weeks to place hormone releasing wait 4-6 weeks . more likley to perforate

pain, "foreign body" sensation in eye indicates

corneal abrasion/ foreign body

What is the tx for dishydrotic eczema

potent topical steroids

Treatment for Hypertensive Urgency

decrease BP by 25% in 24-48 hours using ORAL agents Atenolol, Metropolol

What does opiate intoxication look like

decrease consciousness and respiration Pin Point Pupils Euphoria

What does benzo intoxication look like

decrease consciousness and respiration coma

if think cough d/t ACE inhibitor tx?

discontinue ACE and cough should resolve within 4 weeks

Tx small pneumothorax

resolve on own monitor

What occurs in REM

dreaming

SS pulmonary emoblism

dyspnea tachypnea pleuritic chest pain hemoptysis +/- cough diaphoresis crackles Tachycardia

Causes of V tach

electrolyte imalance frequent complication acute MI Dilated cardiomyopathy Promonged QT Torsades

How do you treat vasa previa

emergency delivery

What is somatization

emotional or physiologic distress that is experienced and expressed as physical complaints in multiple organ systmes

How do you test for onychomycosis

fungal culture with KOH or fungal stain

What is onychomycosis

fungal infection of the nailbed

negative birefringent crystals

gout

S/S little league shoulder

gradual onset of pain usually 6-8 months Pain usually only with throwing

what is the MC presenting symptom of bladder Ca in people over 50

hematuria

acute labyrinthitis

infection affects both branches of the nerve resulting in tinnitus and/or hearing loss as well as vertigo

Most common causes of nausea and vomiting in primary care setting

infection, gastroenteritis, food poisoning, metabolic disorders, and medication side effects.

An infection of the meibomian gland of the eye causes

internal-hordeolum

chronic use of nitrofurantonin (Macrobid) can cause a cough secondary to ?

interstitial fibrosis

Pain, photophobia, papillary constriction, cloudy cornea, and anterior chamber of eye indicates

iritis

Classic symptom of intertrigo

it burns more than it itches

What type of fluids do you give burn patients

lactated ringers

What is chronic uticaria

last longer than 6 weeks and waxes and wanes Idiopathic in nature and often induced by stress

Direction of patellar dislocation

laterally

LCL tear

laxity and joint effusion + Varus stress test

MCL tear

laxity, joint effusion + valgus stress test

What is the nickname for melasma

mask of pregnancy

How do you treat abruptio placenta

maternal stabilization cardiotocographic monitoring to detect fetal distress emergency obstetric consultation Place two large-bore IVs; obtain a CBC, metabolic panel, coagulation panel, fibrin degradation product, and fibrinogen levels; and type and cross-match maternal blood. Administer RhoGAM® if the mother is Rh negative.

S/S lisfranc fx

max tenderness and swelling over tarsometatarsal Jt ecchymosis in arch Pain with rotation and translocation stress forefoot

What does nummular eczema present as

multiple coin shaped eczematous plaques on the extremities and trunk Very pruritic and can weep and crust

What does folliculitis usually look like

multiple follicular pustules surrounding erythem in areas of hair

What is the cause of TB

mycobacterium Tuberculosis

most common cause of walking pneumonia

mycoplasma pneumonia

Tx carpel tunnel

night splints NSAIDS surgical release

common migraines

no aura

What are the xray findings in osteoarthritis

nonuniform joint space narrowing changes in subchondral bone osteophytes

Diagnostic study for gastrophoresis

nuclear study, gastric emptying study

Who typically gets Obstructive sleep apnea

obese middle aged and older men hypertension

Elevated conjugated bilirubin and urine dipstick postive for bili indicates

obstruction: cholestasis or hepatocellular injury

Causes of PVC

occur increase frequency if myocardium irritated by ischemia or electrolyte imbalance, or benign

Definition of constipation

passing less than 3 stools a week

Definition of diarrhea

passing more than 3 abnormally loose stools per 24 hours

What is Melasma (Chloasma) characterized by

patchy light to dark brown hyperpigmentation of the face

Bites frequently occur when

patients are disturbing areas where spiders seek shelter (attics, clothing, shoes)

How is Basal cell carcinoma often described

pearly papule or nodule with rolled border and telangiectasias

If a pregnant women presents with painless bright-red vaginal bleeding in the 3rd trimester think

placenta previa

What is Placenta previa

placenta that extends near, partially over, or beyond the internal cervical os, caused by implantation lower in the uterus

Patients with HIV are at an increased risk to get pneumonia from

pneumocystis carinni

Medical conditions that can inhibit colonic motility

poor fluid and dietary intake, hypothyroidism, hypercalcemia, hypokalemia, scleroderma, diabests, multiple sclerosis, Parkinsons medications

Inflammatory diarrhea

presence of blood or WBC in stool

What does guttate psoriasis look like

presents with drop lesions, 1-10mm salmon-pink papules with fine scale

What does seborrheic dermatitis look like and where is it located

red scaling patches on the scalp, hariline, eyebrows, eyelids, central face, external auditory canals, central chest, and nasolabila folds

What is does stasis dermatitis look like

red, scale, pruritis, erosions, exudate and crust usually of the lower 1/3 of leg superior to medial malleolus

Carpel Tunnel

reduced size of or space of carpel tunnel and compression of median nerve

TX radial head diss

reduction. Bring into full supination and reduce then up into full flexion will feel clunk

What causes uticaria

release of hisamines, bradykinins, and other vasoactive substances from mast cells

Where does tinea pedis appear and look like

scaling and redness between toes and may have associated maceration

Where are characteristic locations for plaques to form

scalp, ears, elbows, knees, extensor surfaces, umbilicus, gluteal cleft, nails, recent trauma sites

What does plaque psoriasis look like

scaly, erythematous patches, papules, and plaques that are sometimes pruritic

What population is walking pneumonia common in

school aged, college, barracks

What is the atopic triad

seasonal allergic rhinitis Asthma Atopic dermatitis

causes of eleveated unconjugated bilirubin

secondary to overproduction hemolysis defects in bilirubin conjugation

What occurs in narcolepsy

sudden, brief sleep attacks, cataplexy, sleep paralysis and hypnagogic hallucinations

Squamous cell carcinoma most often occurs where on the body

sun exposed areas

What are vericose veins

superficial venous insufficiency and valvular incompetence

TX of lipoma

surgical excision if patient wants

SS radial head disslocation

swelling, pain, TTP

What are some medications that can trigger or exacerbate psoriasis

systemic corticosteroid withdrawal Beta blockers Lithium Interferons

2 blood tests that screen for celiacs disease

tTG: tissue tansglutimase antibody EMA: endymysial antibody

diseases for over production of bilirubin

thalassemia B12 deficiency

diagnosing ADHD

to be diagnosed with ADHD, individuals must meet specific criteria. In children, the diagnosis of ADHD is usually not made until a child is at least six years old. The symptoms must be more frequent or severe compared to other children the same age. In addition, the behaviors must be present in at least two settings, such as home and school and be *present for at least six months.*

How do you treat mild comedonal acne

topical retnoid (retinoic acid), +/- topical benzoyl peroxide

How do you treat mild papular/pustular acne

topical retnoid, topical antibiotics (erythromycin), topical benzoyl peroxide

vertigo defined as

true spinning, weaving or rocking and commonly associated with head movements

Marginal placenta previa

which reaches the internal os but does not cover it

What is another name for a closed comedone

white head

when is ortho consult of a rotator cuff injury warranted

with a complete tear

classic migraine

with aura

What stage of sleep does childhood enuresis typically occur

within 3-4 hours of bedtime

Hospital acquired pneumonia has to occur when

within 48 hours after admision and ICU pts at greatest risk

food poisoning usually occurs how many hours after eating

within 6 hours of the meal

What does a 1st degree burn look like

wound is red, painful and well demarcated

is the influenza vaccine recommended for pregnant women

yes


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