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EORs > FM 4 > Flashcards

FM 4 Flashcards

1
Q

hearing is better in loud places makes you think

A

conductive hering loss

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2
Q

hearing is btter in quiet places makes you think

A

sensorineural loss

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3
Q

WEBER TEST RESULTS

  • —- lateralization to AFFECTED ear
  • —-Lateralization to UNAFF ear
A

affected ear= conductive

unaffected ear=sensorineural

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4
Q

Bone conduction > Air

A

conductive

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5
Q

Air conduction > Bone

A

Sensorineural

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6
Q

labyrinthitis

  • mcc
  • CM
  • dx
  • tx
A

mcc=viral

  • bacterial
  • *infection of the inner ear

CM
-dizziness, vertigo, ear pressure, hearing loss with episodes lasting 1-2 weeks

dx=clinical

tx
*sympotamtic— antihistamines, bed rest
BACTERIAl=abx broad spectrum

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7
Q

acute onset of vertigo, hearing loss tinnitus lasting several days to weeks
+/- nausea vomiting fever HA

A

labrynthitis

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8
Q

Laryngitis

  • mcc
  • cm
  • when would you do a laryngoscopy
A

mcc= inflammation of larynx from voice strain or virus
***follows URI

CM= voice hoarsenss or loss of voice

DO laryngoscopy if > 3 weeks
***GERD is mcc of chronic– but want to r/o CA

tx= supporitve

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9
Q

what is MCC of irreversible vision loss

A

macular degeneration

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10
Q

gradual painless loss of central vision

A

macular degen

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11
Q

+ metamrphopsia

A

WET macualr degeneration

  • ** wavy or distorted vision measuring with the Amsler grid
  • *curving of straight lines
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12
Q

difference b/w wet and dry mac degen

A

DRY– 85% cases

  • progressive loss of vision
  • atrophic changes with age— slow and gradual central vision loss–usally bilateral

CM
*drusen spots— yellow retinal deposits
*atrophy
____________________________

WET— central vision loss occuring rapidly– days to weeks– and is more severe— this leads to blindness

  • metamorphopsia— curving of straight lines
  • usually unilateral

CM

  • neovascularization
  • hemorrhages
  • exudate
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13
Q

TX for dry and wet mac degen

A

BOTH= daily supplements of Zinc Oxide, Copper, Vit C, Vit E and Lutein/Zeaxanthin (Vit A)

WET

  • intravitreal VEGF inhibitors—– Bevacizumab— helps decr new abnromal vessel formation
  • Laser photocoagulation
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14
Q

Meniere Disease

A

Peripheral vertigo + low-frequency hearing loss aka sensorineural + tinittuis/ear fullness

MC adults 40-60
IDIOPATHIC

episodes last minutes to hours and decr with age

PE

  • A > B
  • weber will lateralize to unaffected side

TX
avoid triggers=== caffine, etoh
low sodium diet
Meds– diuretics (HCTZ + triamterene), histamine analogues, anticholinergic antiemetics

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15
Q

multiple polyps seen on exam— what do we think

A

cystic fibrosis

polyps look like tear drop shaped growths

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16
Q

Chronic congestion, decreased sense of smell

A

nasal polyps

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17
Q

tx for nasal polyps

A
  • topical nasal corticos for 3 MO= initial tx of choice

* ***good for small ones and reduces need for surgery

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18
Q

OE

-rhinne test finding

A

B > A

**conductive hearing loss

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19
Q

tx for malignant OE in DM

A

-IV ABX bc of aspergillus

HD ciprofloxacin 6-8 weeks 1st line

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20
Q

causes for papilledema

A 
malignant HTN 
brain tumor/abscess 
meningitis 
cerebral hemorrhage 
encephalitis

disc appears swollen, marigns blurred
INCR ICP*

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21
Q

Parotitis

A

mumps

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22
Q

parotitis

-tx

A

self limiting
vaccination
congatious for 9 days after onset

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23
Q

mcc of pharyngitis

A

viral

***adenovirus

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24
Q

+ heterophile agglutination test

A

monospot test

**EBV

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25
Q

bacterial pharyngitis mcc

A

group a beta hemolytic strep

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26
Q

centors criteria

A
  1. no cough
  2. exudates
  3. fever > 100.4
  4. cervical lymphadenopathy

3/4= get rapid strep test

if negative– culture is GS

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27
Q

tx for group a strep

A

PCN first line
azitrhomycin if allergic

COMPS= rheumatic fever and post strep glomerunonpehriits

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28
Q

which abx can cause rash if given for EBV

A

amoxicillin and ampicillin

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29
Q

elevated, superficial fleshy, triangular shaped growth/ mass in the inner corner/nasal side of eye

A

pterygium

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30
Q

ptergium assoc with

A

incr sun exposure, climates where wind, sand and dust

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31
Q

sudden vertical curtain comding down…. curtain of darkness
+/- floaters or flashes
PAINLESS

A

retinal detachement

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32
Q

PE finding for retinal detachemet

A
  • asymmetric red reflex

* flap in the viterous humor

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33
Q

RF for retinal detachement

A

nearsightedness aka myopia

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34
Q

what kind of vision loss with retinal detachement

A

peripheral

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35
Q

tx for retinal detaachement

A

IMMED REFERAL

-stay supine with head towards the side of detachement

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36
Q

cherry red spot at fovea with pale opaque fundus and arterial attenuation

A

central artery occlusion

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37
Q

painless profound visual loss over a few seconds– unilateral

A

central artery occlusion

**amaurosis fugax

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38
Q

tx for retinal artery occlusion

A
  1. prompt tx
  2. high [ ] O2 and digital massage over eyelid
  3. IV Acetazolamide to decr IOP or timolol
  4. Anterior chamber paracentesis
  5. Direct infusion of thrombolytic agent into opthalmci artery
  6. work up and management of atherosclerotic disease
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39
Q

Central vein occlusion

  • cm
  • pe
  • tx
A

MC than central artery

**sudden painless loss of vision

PE— “blood and thunder apperance”—dilated veins, heomrrahged and edema and exudates—–, retinal hemorrahges, optic disc swelling,

tx
TX: vision resolves with time (partially); workup for thrombosis

Neovascularization treated with intravitreal injection of VEGF inhibitors

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40
Q

what is leading cause of blindness in adults

A

retinopathy

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41
Q

causes of retinopathy

A

uncontrolled DM or HTN

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42
Q

what is Sialadenitis

  • cm
  • mcc
  • dx
A

bacterial infection of a salivary gland causd by sialolithiasis aka obstructing stone— in salivary gland

CM

  • acute swelling of the cheek that worsens with meals
  • affects parotid or submandibular gland, occurs with dehydration or chronic illness (Sjogren syndrome), ductual obstruction

MCC=staph A

DX

  • CT
  • US
  • MRI

TX
IV Nafcillin
hydration, warm compress, sialogogues (lemon drops) massage gland

PO ABX less severe cases— dicloxacillin, 1st gen cephalosporin, clindamycinn

2-3 weeks to resolve

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43
Q

pain, otorrhea, and hearing loss/reduction

A

tm perf

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44
Q

only class of abx that are non ototix are?

A

Floxin drops

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45
Q

Gout

  • dx TOC
  • tx— acute attack, chronic and then manintenance
  • drugs to avoid
A

TOC= arthrocentesis– negatiely birefringent needle shaped crystals

tx
lifestyle: elevation, rest, decrease purines (meats, beer, seafood, alcohol), weight loss, increase protein, limit alcohol

DOC for non acute attacks is Allopurinol **** or colchicine
ACute ATTACk—- NSAIDS 1st like Indomethacin or colchicine– but bad GI SE
Maintenance is colchicine

avoid ASA and thiazide diuretics

DO NOT START SOMEONE ON ALLOPURINOL DURING ACUTE ATTACK

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46
Q

mcc of patellar dislocation

  • cm
  • dx
A
  • *POSTERIOR MC
  • *MVA

CM= deformity to knee + diffuse edema

dx
*ap and lateral xr

+ apprehension sign–

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47
Q

tx for fibromyalgia

A
  1. Duloxetine (cymbalta)
  2. Milnacipran (savella)
  3. Pregabalin (Lyrica)

+stress reduction
-sleep
-exercise
0

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48
Q

conjunctivitis, uveitis, urethritis, arthritis

A

reactive arthritis

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49
Q

Reactive Arthritis

-mcc

A

GC/ C ***
or
GI: salmonella, shigella, campylobac

+ HLA-B27 in 80%

TX

  • NSAIDs
  • Azitrhomycin for chalmy
  • IM Ceftri for gon
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50
Q

(+) Anti-citrullinated peptide antibodies

A

most specific for RA

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51
Q

tx for RA

A

prompt start of DMARDS;

  1. Methotrexate ****
  2. Hydroxycholorquine— can be added to methotrexate–less effective as monotx
  3. Sulfasalazine– can be added to the two above for triple tx
  4. Leflonomide

NSAIDS prn

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52
Q

(+) Anti-double-stranded DNA

A

SLE

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53
Q

Anti-Smith Ab:

A

SLE

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54
Q

tx for SLE

A

TX: Manage with sun protection, hydroxychloroquine (for skin lesions), NSAIDs or acetaminophen for arthritis

Pulse dose steroids; cytotoxic drugs (methotrexate, cyclophosphamide)

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55
Q

tx for hookworm or cutaenous larva migrans

A

albendazole
or
self limitng

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56
Q

single large oval plaque with central clearing and scaly border— then later develops a diffuse pruritis erythematous plaques with central scalling

A

Pityriasis rosea

***christmas tree pattern

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57
Q

Erythematous, yellowish greasy scales, crusted lesions either on scalp or body folds

A

seborrheic dermatitis aka cradle cap

**infants its on the scalp
**adults/teens– body folds
tx= ketoconazole

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58
Q

macules that are hypo or hyperpigmented

*do not tan

A

tinea versicolor

*upper trunk, neck, proximal arms and areas where there is sebum–like face

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59
Q

A 20-year-old male with no significant past medical history presents complaining of patchy tanning. He states that he has been out in the sun without a shirt several times. Areas on his chest and back just don’t tan, and he is becoming self-conscioust

A

tinea versicolor

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60
Q

tx for tinea versicolor

A

selenium sulfide

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61
Q

bright red blood on TP

A

anal fissure

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62
Q

odynophagia, dysphagia, substernal CP

A

esophagitis

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63
Q

causes of esphagitis

A

INFECTIOUS
*Candida—DM or immunocomp
+/- oral thrush at the same time
*CMV—uncommon but seen in PT with AIDS—ulcerations at LES
*HSV–immunocomp or hx of HSV–vesicular lesions

NON-INFECTIOUS

  • esosinophilic—– chronic, immun emediated, severe dysphagia tht can cause pt to avoid food,
  • pill esophagitis–mcc seen with NSAIDs or bisphosponates
  • GERD MCC*****
  • Caustic Esophagitis— household cleaners— button batteries most corrosive
64
Q

Punched out lesions on EGD

A

HSV esophagitis

65
Q

Linear yellow/white plaques

A

Candida esophpagitis

66
Q

Large solitary ulcers OR erosions on EGD

A

CMV esophagitis

67
Q

____ ulcers worsen with food

____ ulcers get better with food

A

gastric ulcers worsen with food

duodenal ulcers get beteter with food

68
Q

H Pylori tx

A

CAP
Clarythromycin
Amoxicllin–alternative metronidazole
PPI

69
Q

PT has a lot of vomiting/retching–mc etoh abuse or bulemia

A

mallory weise tear

70
Q

The 4 cardinal signs of strangulated bowel:

A

fever
tachycardia
leukocytosis
locazlied abd tenderness

71
Q

mcc cirrhosis

2nd mc cause

A

mcc=etoh

*hep b and c

72
Q

abdominal pain, ascites, and hepatomegaly

A

hepatic vein thrombosis

73
Q

polyps in distal colon are MC?

A

benign

74
Q

polyps in proximal colon are MC?

A

cancerous

75
Q

The most common cause of painless rectal bleeding in the pediatric population

A

colonic polyps

76
Q

once polyps ID– how often do colonoscopy

A

every 3-5 yrs

77
Q

change in bowel habits, new iron def anemia, blood in stool

A

colon ca

78
Q

normally how often to do colonoscopy

A

q 10 yrs

79
Q

colon screening for avg risk pt starts when and ends when

A

at 45 and ends at 75

80
Q

sessile vs pedunculated polyps

A

sessile more likely to be malignant

81
Q

“Apple core” lesion on barium enema

A

colon ca

82
Q

causes of secondary causes of constipation

A 
dm
hypothry
MS
dehydration
meds
83
Q

1st line tx for constipation

2nd

A

bulk forming laxatives—- psyllium (metamucil), methylcellulose,

2nd= osmotic laxatives…. PEG

84
Q

Diarrhea breakout in a daycare center: ???????

Diarrhea on a Cruise Ship: ????

A

daycare= rotavirus

cruise=norovirus

85
Q

empiric tx for e-coli diarrhea aka travelers

A

Cpirofloxacin 500 mg BID and Loperamide if older than 2

86
Q

empiric tx for e-coli diarrhea aka travelers

A

Cpirofloxacin 500 mg BID and Loperamide if older than 2

87
Q

empiric tx for e-coli diarrhea aka travelers

A

Cpirofloxacin 500 mg BID and Loperamide if older than 2

87
Q

empiric tx for e-coli diarrhea aka travelers

A

Cpirofloxacin 500 mg BID and Loperamide if older than 2 cam

87
Q

empiric tx for e-coli diarrhea aka travelers

A

Cpirofloxacin 500 mg BID and Loperamide if older than 2 cam

87
Q

empiric tx for e-coli diarrhea aka travelers

A

Cpirofloxacin 500 mg BID and Loperamide if older than 2

88
Q

campy or shigella diarrhea tx

A

fluoroquinolone

89
Q

pregnant + infectious diarrhea

A

azithromycin

90
Q

traveler diarrhea prophylaxis

A

cirpofloxacin

91
Q

mucous and bloody stool

A

shigella

92
Q

shigella tx

A

Bactrim
or
ciprofloxacin

93
Q

contamination from shellfish or seafood

A

cholera

94
Q

rice water diarrhea

A

cholera

95
Q

dyspepsia + abd pain common indicators of

A

gastritis

dyspepsia= bloating belching distenting HB

96
Q

three causes of gastritis

A

HP infection mc

NSAIDs or ETOH

Autoimmune or hypersensitivity rx— pernicious anemia

97
Q

+ schilling test + decr intrinsic factor and +parietal cell abs

A

pernicious anemia

98
Q

Test OC for GERD

A

endoscopy with biopsy

99
Q

when do you order upper GI series aka barium constast study for GERD

A

to ID complications of GERD—- strcitures/ulcers

100
Q

GS for diagnosis of GERD

A

PH Probe

101
Q

tx GERD steps

A
  1. Life style mods
    +/-
  2. Antacids—- and H2— like Famotidine can be used PRN
  3. after failure of above– then add Omeprazole– MAX CAN BE ON IT 8-12 weeks
  4. failre of all the above = Niseen Fundoplication
102
Q

diarrhea after camping trip

A

Giardia

103
Q

tx for Giardia diarrhea

A

Tinidazole is first line

*Metronidazole also

104
Q

tx for pinworms

A

mebendazole or pyrantel pamote

105
Q

tx for tapeworm

A

Praziquantal

106
Q

what is tape worma ssoc with

A

b12 deficiency

107
Q

cough, weight loss, anemia, recent travel

A

hookworm

108
Q

tx for hookworm

A

mebendazole
albendazole
pyrantel

109
Q

barium enema show lead pipe apperance with loss of haustral markings

A

UC

110
Q

tx for UC

A
  • colectomy

* Prednisone and Mesalamine

111
Q

cobblestoning

A

Chrons

112
Q

skip lesions

A

chrons

113
Q

tx for flares of chrons

A

prednisone +/- mesalamine +/- metronidazole or cipro

114
Q

maintenance tx for chrons

A

mesalamine

115
Q

abx approved for IBS-D

A

rifaximin (Xifaxan)

116
Q

Anti-HBc

A

means had/have infection

  • IgM= acute
  • IgG=not acute
117
Q

Anti-HBs

A

immunity from vaccine

118
Q

HBeAg

A

highly infectious

119
Q

HBsAg

A

ongoing infection

120
Q

tylenol hepatotoxicity tx

A

N-Acetylcysteine within 8-10 hrs

121
Q

AST > ALT ratio >2:1

A

ETOH hepatitis

122
Q

ALT > AST

A

fatty liver dz

123
Q

HBsAg +
and
Anti-HBc IgM

A

acute HBV finection

124
Q

Anti-HBs +

A

person got their immunization not infection

125
Q

MC RF for developing alzheimers

A

old age

126
Q

mc form of dementia

A

alzhierms

127
Q

fourth most common cause of death in the United States

A

alzhiemers

128
Q

which memory is lsot first with alzhiemers

A

short term— like forgetting what u had for breakfaast

129
Q

tx for alzheimers

*which drug to avoid

A

1st: Donepezil, rivastrigmine, galantamine—— cholinesterase inhibiotrs
* memantine— for mod-severe
* AVOID ANTICHOLINERGICS

130
Q

bell palsy

  • cn?
  • common preceding event?
A

CN VII

URI Preceeding

unilateral facial weakness/paralysis— upper and lower parts of face are affected– CANNOT wrinkle forehead–where stroke you can wrinkle forehead

131
Q

55 yo F presents with gradual altered mental status and headache. Two weeks ago she slipped, hit her head on the ground, and lost consciousness for two minutes.

A

subdural hematoma

132
Q

delirium vs dementia (neurocognitive disorders)

A

delirium= acute, reversible, caused by. medication condiiton

dementia aka neurocognitive= long term impairment in memory usually irreversible— like alzheimres

133
Q

35 yo F presents with intermittent episodes of vertigo, tinnitus, nausea, and hearing loss over the past week

A

meiners

134
Q

How do you differentiate labyrinthitis from Meniere’s disease

A

labrynthitis= assoc with recent URI and vertigo is continuous

Menieres= vertigo is episodic

135
Q

vertigo without positional changes + NO hearing loss + recent URI

A

vestibbular neruitis

136
Q

Unilateral, excruciating, sharp, searing, or piercing pain (often at night), lacrimation, and nasal congestion

A

cluster HA

M&raquo_space;> F

137
Q

tx for cluster HA

A
  1. oxygen

2. Sumatriptan

138
Q

A headache of varying intensity, often unilateral, and accompanied by nausea and sensitivity to light and sound

A

migraine

139
Q

tx for migraines– acute and prophlaxis

A

ACUTE

  1. Triptans— not use in haert dz
  2. Ergotamine (NOT in preggo)
Prophylaxs 
atenolol
propranolol
verapamil 
TCAs
140
Q

HA that is bilateral, mild to moderate, dull pain,

Presentation: Bilateral, squeezing sensation, mild to moderate, dull pain

A

tension HA

141
Q

tx for tension HA

A

NSAIDs

muscle relaxer

142
Q

tx PD

A

<65 use dopamine agonists: bromocriptine, pramipexole, ropinirole—
*use in younger PT to delay use of Levodopa

> 65 use Sinemet (Levodopa/Carbidopa)
*AE: GI upset, NV, vivid dreams, psychosis, dyskinesias

143
Q

seizure with no alternation in consciousness only see abnormal movements or sensations

A

focal seizure aka simple partial seizure

144
Q

focal seizure with loss of awareness aka consciousness impaired

A

complex partial seixure

145
Q

tx for focal seizure (partial and complex)

A
  1. Phenytoin

2. Carbamazepine

146
Q

SE TX order

A
  1. IV benzo — diazepam or lorazepam
  2. Fosphenytoin or phenytoin
  3. Barbituate
  4. propofol
147
Q

Trauma— lucid interval– then HA, decr consciousness

A

epidural

148
Q

a 27-year-old mountain biker strikes a tree and was not wearing a helmet. He loses consciousness for several minutes but later regains consciousness and reports feeling fine. Several hours later his neurological state decompensates acutely.

A

epidural

149
Q

CT finding is lenticular, unilateral convexity, usually in the temporal region

A

epidural

150
Q

lens shaped biconvex

A

epidural

151
Q

most specific test for hemophilia

A

functional assay for factor 8 and 9 to confirm diagnosis– determines type and severtiy

152
Q

↑ PTT, normal PT and platelets,

A

hemophilia

153
Q

Secondary polycythemia is caused by

A

natural or artifical increases in production of EPO

  • altitude
  • hypoxic disease (COPD, sleep apnea)
  • bloodletting
  • genetics
  • neoplasms: pheochromocytoma, liver tuomrs

EORs (15 decks)

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