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from flashcardlet > FM Pretest - Acute Conditions > Flashcards

FM Pretest - Acute Conditions Flashcards

0
Q

Describe gallbladder pain

A

-in epigastric or right upper quadrant and radiates to the scapula

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1
Q

Describe the pattern of pain in acute pancreatitis

A
  • pain in the midepigastric region that radiates to the back
  • associated with nausea and vomiting
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2
Q

Describe the pain associated with esophageal spasm

A

-often referred higher in the chest

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3
Q

Describe the pain typical of GERD

A
  • usually midepigastric

- usually does NOT radiate

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4
Q

Murphy’s sign

A
  • sudden cessation of inspiratory effort during deep palpitation of the right upper quadrant
  • seen in acute cholecystitis
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5
Q

Where does pain from kidney stones usually radiate?

A

-to the shoulder

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6
Q

Classical presentation for peptic ulcer disease?

A
  • gnawing abdominal pain in the center of upper abdomen associated with a sensation of hunger
  • darker stool
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7
Q

What “5 alarm symptoms” should prompt an endoscopy?

A
  1. upper GI bleeding
  2. an abdominal mass
  3. weight loss
  4. dysphagia
  5. vomiting
    * * especially in the elderly!
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8
Q

What is he gold standard for dx and tx of choledocholithiasis?

A
  • Endoscopic retrograde cholangiopancreatography (ERCP)

- performed when there is cholycystitis w/ increased liver enzymes, amylase, or lipase

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9
Q

What are the top 3 causes of pancreatitis (in order)?

A
  1. Gall stones
  2. Alcohol
  3. Idiopathic
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10
Q

What are the 5 Ranson’s criteria that assess the severity and prognosis of pancreatitis?

A
  1. Age > 55 yrs
  2. WBC > 16,000
  3. Glucose > 200
  4. LDH > 350
  5. AST > 250
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11
Q

What should be done next if a pap smear shows “atypical cells of undetermined significance.” And HPV testing was not performed in a post-menopausal woman?

A
  • give 1 week course of vaginal estrogen
  • repeat pap after tx is finished
  • if abnormal again, do colposcopy
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12
Q

What should be done next when a papsmear reports “atypical squamous cells of undetermined significance, favor low-grade squamous intraepithelial lesion”?

A

-do colposcopy

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13
Q

What should be done next when a pap smear has “atypical glandular cells”?

A

-colposcopy

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14
Q

What are 4 common causes of microcytic anemia?

A
  1. Iron deficiency
  2. Anemia of chronic dz
  3. Thalassemia
  4. Sideroblastic anemia
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15
Q

Antibiotic tx for lyme dz?

A
  • depends on stage of the dz
  • early localized dz = amoxicillin or doxy for 14-21 days
  • early disseminated dz = IV ceftriaxone or cefotaxime for 2-3 wks
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16
Q

Tx for Rocky Mountain Spotted Fever?

A
  • chloramphenicol

- continue for 2-3 days after the pt is afebrile

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17
Q

Tularemia tx?

A

-streptomycin intramuscularly

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18
Q

Tx of head lice?

A
  1. Permethrin 1%
  2. Permethrin 5% –> second line option
  3. Lindane 1% –> third option
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19
Q

Classical presentation of head lice?

A
  • itching scalp

- erythematous papules on scalp w/ small black bulbs at the bases of several hair follicles

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20
Q

Tx for scabies?

A

-oral ivermectin

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21
Q

Classic presentation of scabies?

A

-pruritic erythematous papules in between fingers, on wrists, and around waist –> areas where clothing is tight next to skin

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22
Q

Classic pattern of lesions for chigger bites?

A

-bite in a linear pattern over wrists, ankles, and legs

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23
Q

Typical location for bedbug bites?

A

-unclothed skin (neck, face, hands)

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24
Q

Typical location for flea bites?

A

-lower extremities

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25
Q

Tx of cat bite to the hand?

A
  • hospitalization!! Unless it is very superficial and does not appear to be infected
  • outpatient tx: amoxicillian/clavulanic acid, 5 days for prevention & 10 days for tx
  • do not ever close the bite at first!!
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26
Q

The functions of which organs should be tested to work up gynecomastia?

A
  1. Liver
  2. Kidneys
  3. Thyroid
    * *sex hormones should only be tested if progressive enlargement is noticed
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27
Q

What is BI-RADS?

A
  • breast imaging reporting and data system
  • 0 = test incomplete, additional testing should be done
  • 1&2 = mammogram is benign, routine screening can be done at regular intervals
  • 3 = lesion is probably benign
  • 4 = suspicious for cancer, tissue dx is needed
  • 5 = highly suggestive of cancer, tissue dx is needed
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28
Q

What are the 6 “alarm sx” of constipation?

A
  1. Hematochezia
  2. Family hx of colon cancer
  3. Family hx of IBS
  4. Positive fetal occult blood test
  5. Weight loss
  6. New onset of constipation in pts > 50
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29
Q

What is the tx of choice for chronic constipation? What is it?

A
  • psyllium
  • bulk-forming agent
  • can be taken regularly
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30
Q

What are the 4 most common causes of chronic cough?

A
  1. Asthma
  2. Post-nasal drip
  3. GERD
  4. Smoking
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31
Q

What is the first line antibiotic tx for pertussis?

A
  1. Erythromycin for 14 days

2. Or Azithromycin for 5 days

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32
Q

Antibiotic of choice for traveler’s diarrhea?

A

-a fluroquinolone = ciprofloxacin, ofloxacin, or norfloxacin

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33
Q

What is the recommended diet for acute viral diarrhea?

A
  • potatoes
  • rice
  • wheat
  • noodles
  • crackers
  • banannas
  • yogurt
  • boiled vegetables
  • soup
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34
Q

What is the Dix-Hallpike maneuver? What do the results mean?

A
  • distinguishes central from peripheral vertigo
  • have patient sit on the edge of the examining table and lie down suddenly with the head hanging 45° backward –> turned head to either side
  • Peripheral: latency for onset of sx of nystagmus is 3-10 sec, the sx are severe, and the direction of the nystagmus is fixed, also sx should lessen when the maneuver is repeated
  • Central: no latency to onset of sx, no lessening of sx with repeat of maneuver, the direction of nystagmus will change, sx are of mild intensity
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35
Q

4 causes of peripheral vertigo?

A
  1. Vestibular neuronitis
  2. Benign positional vertigo
  3. Meinere disease
  4. Acoustic neuroma
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36
Q

What is the first line tx for peripheral vertigo?

A
  • antihistamines

- MOA: suppress vestibular end-organ receptors and inhibit activation of vagal response

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37
Q

What is a D-dimer test for?

A
  • determines the risk for a DVT or PE
  • low result = high neg predictive value for the presence of a thrombus
  • high result –> can be confirmed with spiral CT
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38
Q

What can relieve dyspnea in cancer?

A

-opioids

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39
Q

4 common sx of acute bacterial cystitis?

A
  1. Frequency
  2. Hematuria
  3. Dysuria
  4. Back pain
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40
Q

4 factors that decrease the likelihood of UTI?

A
  1. Absent dysuria
  2. Absent back pain
  3. Hx of vaginal discharge
  4. Hx of vaginal irritation
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41
Q

Antibiotic prophylaxis for recurrent UTIs

A
  • if resistant to other measures:
    1. single dose of postcoital antibiotic
    2. Single daily dose of antibiotics for 3-6 mnths if that doesnt work
    3. If sx reoccur after discontinuation of daily prophylaxis, may need to continue for 1-2 yrs
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42
Q

Ssx of acute prostatitis?

A
  1. Frequency
  2. Urgency
  3. Back pain
  4. Pt appears acutely ill
  5. Pyuria
  6. Boggy, warm, tender prostate on exam
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43
Q

What 3 ssx should be present to make a dx of otitis media?

A
  1. Opaque TM
  2. Bulging TM
  3. Impaired TM mobility
44
Q

When should an ear effusion be referred to an ENT?

A

-if it hasnt resolved in 3 mnths

45
Q

Tx for acute OM?

A
  1. Amoxicillin –> first line
  2. Amoxicillin-clavulanate –> if severe ear pain or fever >102*
  3. Azithromycin –> should be reserved as second line tx
46
Q

Tx for external otitis?

A

-otic drops that contain antibiotics and corticosteroids

47
Q

Enuresis

A

-releated, spontaneous nocturnal voiding of urine into the bed or clothes at least 2x a week for 3 consecutive months in a kid that is at least 5 yrs old

48
Q

Primary monosymptomatic enuresis?

A
  • bed wetting w/ out history of not bed wetting

- no other sx

49
Q

Secondary monosymptomatic enuresis

A

-bed wetting after the child had previously not had bed wetting for at least 6 mnths

50
Q

Non-monosymptomatic enuresis

A

-bed wetting associated w/ urinary urgency, frequency, straining, pain,chronic constipation, or encopresis

51
Q

What happens when a pt with Mono is given a penicillin antiboitic?

A

-they can develop a diffuse, symmetrical erythematous maculopapular rash

52
Q

Fatigue due to a physical cause?

A
  • lasts less than 1 mnth
  • can be due to:
    1. Infections
    2. Endocrine imbalances
    3. CV dz
    4. Anemia
    5. Meds
53
Q

Fatigue due to psychologic factors?

A
  • lasts more than 3 mnths
  • causes:
    1. Depresssion
    2. Anxiety
    3. Stress
    4. Adjustment rxns
54
Q

Physiologic causes of fatigue?

A
  1. Overwork
  2. Lack of sleep
  3. Physical stressor (ex pregnancy)
55
Q

How long does fatigue have to last to be dx as a chronic fatigue syndrome?

A

-more than 6 mnths

56
Q

What 6 tests should be done in the initial workup for fatigue?

A
  1. CBC
  2. Sed rate
  3. Urinalysis
  4. Chem panel
  5. Thyroid testing
  6. Preg testing
  7. Age/gender appropriate cancer screening
57
Q

What is the test of choice for the dx of Meckle’s diverticulum?

A

-Technetium-99m pertechnetate scintigraphic study

58
Q

What are 3 types of drugs that can be used for migraine prophylaxis?

A
  1. beta blockers
  2. CCBs –> only verapamil
  3. Tri-cyclic anti-depressants –> esp amitriptyline
59
Q

7 Red flags for headaches?

A
  1. Onset after age 50
  2. Very sudden onset
  3. Increased severity or frequency
  4. W/ signs of systemic dz
  5. Focal neurologic sx
  6. Papilledema
  7. Headache after trauma
60
Q

Prophylaxis for cluster headaches

A
  1. Nifedipine
  2. Prednisone
  3. Indomethacin
  4. Lithium
61
Q

Most common presentation of bladder carcinoma?

A

-painless hematuria without other sx

62
Q

Risks of bladder carcinoma

A
  1. Males
  2. Smoking
  3. Working with aromatic amines = used in dye, paint, aluminum, textile, and rubber industries
63
Q

Foods that can cause pseudohematuria?

A
  1. Beets
  2. Blackberries
  3. Certain food dyes
64
Q

5 common medications that can cause discoloration of urine?

A
  1. Chloroquine
  2. Metronidazole
  3. Phenytonin
  4. Rifampin
  5. Sulfasalazine
65
Q

2 drugs that can be used for sleep onset problems?

A
  1. Zolpidem = ambien

2. Eszopiclone = lunesta

66
Q

What drug can be used for sleep maintenance problems?

A
  1. Zaleplon = sonata
67
Q

What is the most common cause of jaundice in pts < 30 yrs old?

A

-viral hepatitis

68
Q

3 most common cause of jaundice in pts > 60 yrs old?

A
  1. extra-hepatic obstruction: gall stones, strictures, pancreatic cancer
  2. Metastatic dz
  3. CHF
69
Q

What is primary amenorrhea? What is the most common cause?

A
  • absence of menses @ age 16 in the presence of normal secondary sex characteristics OR absence of menses and secondary sex characteristics @ age 14
  • gonadal dysgenesis is the most common cause (ex . Turner’s syndrome)
70
Q

Pathogenesis of primary dysmenorrhea? Tx?

A
  • prostaglandin release from endometrium

- tx: NSAIDs started a day before menstruation

71
Q

What doe the progestin challenge test do? What do the results mean?

A
  • separates pts w/ estrogen deficiency from those w/ normal or excess androgen
  • bleeding in the week after the test = pt has enough estrogen and amenorrhea is most likely due to anovulation
72
Q

Tx of gastroparesis?

A

-metoclopramide = can improve gastric motility

73
Q

What are 4 possible causes of nausea in the morning before eating?

A
  1. Pregnancy
  2. Uremia
  3. Alcohol withdrawal
  4. Increased intracranial P
74
Q

What is cervical dystonia? What is a proven tx?

A

-botox!

75
Q

Adnexal masses in girls < 15 yrs old

A
  • 80% are malignant!

- evaluate with transvaginal ultrasound

76
Q

Lymphadenopathy w/ mono?

A

-posterior cervical lymphadenopathy

77
Q

Pharyngitis with a swollen uvula is caused by? Tx?

A
  • group A beta-hemolytic strep infection

- tx: amoxicillin

78
Q

Centor criteria for probability of group A strep infection in adults?

A
  • one point for each characteristics:
    1. Tonsillar exudates
    2. Tender anterior cervical adenopathy
    3. Fever
    4. Lack of cough
  • all 4 –> tx w/ antibiotics w/out performing a lab test
  • only 3 –> chance of strep drops to 40-60%
  • only 1 –> chance of strep drops to 1-5%
79
Q

Common causes of epididymitis in younger and older men?

A
  • men < 35 yrs who are sexually active = n. gonorrhoeae or chlamydia trachomatis
  • men > 35 who are monogamous = enterobacter
80
Q

Spermatocele: ssx? Dx?

A
  • asymptomatic nodules attached to spermatic cord

- no tests are necessary

81
Q

Tx for mild acne?

A
  • use combination tx w/:
    1. Topical antibiotics
    2. Benzoyl peroxide gels
    3. Topical retinoids
  • can take 2-5 mnths to see improvement
82
Q

What drug cant be takem with isotretinoin and why?

A
  • tetracycline

- both cause pseudomotor cerebri

83
Q

First line tx for rosacea?

A
  • oral antibiotics:
    1. Minocycline
    2. Doxycycline
84
Q

What is one major difference between keratoacanthoma and basal cell carcinoma?

A

-keratoacanthoma grows very rapidly, can become 2.5 cm in only a few weeks!

85
Q

Presentation of pityriasis rosea? Tx?

A
  • herald patch, followed by a more generalized eruption of a papulosquamous rash in the next 1-2 wks
  • usually resolves in 6-12 wks
  • tx: symptomatic, antihistamines or corticosteroids to relieve itch
86
Q

Bacteria that causes impetigo?

A

-staph aureus

87
Q

Tx of choice of tinea capitis?

A
  • griseofulvin

- can also use selenium or ketoconozole topically in addition

88
Q

Cause of ring worm

A
  • also called: tinea corporis

- caused by: trichopyton rubrum

89
Q

What is on thing that is characteristic of viral conjunctivitis?

A

-palapable preauricular lymph node

90
Q

Scleritis: what is it? Sx? What is its associated with? Vs iritis?

A
  • unilateral diffuse injection of the deep scleral vessels
  • sx: decreased vision, deep “boring” eye pain, headache
  • assoc: w/ systemic autoimmune diseases (ie RA or Wegener’s)
  • iritis = similar sx, but pupil is small!
91
Q

Tx for shoulder dislocation

A
  1. relocation
  2. then immobilization for 7-10 days
  3. then PT
92
Q

Iliotibial band syndrome

A
  • most common cause of lateral knee pain in an athlete

- presentation: pain or ache over the lateral aspect of the knee, worsens w/ activity, pain and tightness over IT band

93
Q

Presentation of ACL tear?

A
  • twisting injury where the pt feels a “pop”, then immediate effusion
  • can still bear weight
  • instability
94
Q

Meniscal tear ssx?

A
  • knee pain

- locking, catching, or giving way of the knee

95
Q

Glabella tap reflex

A
  • percusssing a pts forehead will cause the obicularis oculi m to contract, both eyes will blink
  • blinking normally stops after 5-10 taps
  • persistence of blinking = myerson sign = common in Parkinson pts
96
Q

Which tx for Parkinson’s has been found to delay functional impairment and disease progression?

A

-selegiline = MOA inhibitor

97
Q

Tx for vaginal candidiasis

A
  1. Topical azole

2. Oral, one-time dose of fluconazole

98
Q

“Strawberry cervix”

A

-trichomonas vaginalis

99
Q

Tx of choice for bacterial vaginosis?

A
  • topical or oral metronidazole

- or oral or topical clindamycin as an alternative

100
Q

What is the dose of Folic acid is appropriate during pregnancy?

A

-400mcg

101
Q

What live vaccine should be offered preconception?

A

-rubella

102
Q

Low AFP?

A

Down syndrom

103
Q

High AFP?

A

-neural tube defect

104
Q

When is rhogam given?

A

-26-28 weeks

105
Q

Cradle cap, tx?

A
  • seborrhic dermatitis

- tx: diluted selsum blue

106
Q

Esotropia

A

-eye deviates toward nose

107
Q

Exotropria

A

-eye deviates toward temporal side

108
Q

Croup tx?

A
  • uncomplicated = supportive

- more complex, severe = single dexamethasone

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