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Step 2 > Screening, Optho, Derm, ID > Flashcards

Screening, Optho, Derm, ID Flashcards

1
Q

HPV Ages

A

Men 9-21, women 9-26

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2
Q

Hyperlipidemia screening? How often

A

Men, 35, every 5 years

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3
Q

Colonoscopy screening? Alternative?

Relatives?

After UC?

A

Alternative - annual fecal blood
Colonoscopy - 50 - 75

1st relative - 40 y.o

UC - 8 yr after diagnosis - 1-2 years after

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4
Q

Mammography screening?

A

(40) 50-75

Every 2 years

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5
Q

AAA screening?

A

65-76 in smokers

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6
Q

Dexa screening?

A

65 y.o

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7
Q

Pneumococcus in normal?

Medium risk?

High risk? HIV/CKD/SS/Splenectomy?

A

After 5y.o, give PCV 13, followed by 23 in 1 years.

In “medium risk” such as COPDers etc, give one 23 solo, then reset and give 13 -> 23 at 65.

In HIV/CKD/SS/Splenectomy - give 13->23 after 8wk. In HIV, repeat and give every 5 years. Not sure about other hgih risk

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8
Q

Bladder screening? Pancreas screening?

A

Dont screen for either bladder or pancreas

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9
Q

Lung CA screening? Age? How?

A

30+ pack year. Low dose CT from 55-80

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10
Q

CEA screening

A

50,60. male. 70% for asx/sx female

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11
Q

DM screening?

A

Multiple bp over 135/80; multiple risk factors (obese etc)

Start Statin in diabetic patients 40-75

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12
Q

Initial HTN dx,. What should tests to run?

A

UA, BMP, Protein/Cr, Lipids, EKG

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13
Q

Best nonpharm ways to control HTN?

A

Weight Loss, Dash, Execise, Sodium restrick, ETOH - in that order. Smoking not on the list

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14
Q

Is verbal consent enoguh to release info?

A

Yes - per HIPPA

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15
Q

Best way to screen for MEN2?

A

Genetic screening better than calctonin or metanephrines. Still get metanephrines first if you are concerned about pheo… then screen later.

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16
Q

HIV screening

A

HIP p24 antigen and Antibody test.

HIV RNA if negative results and high suspicion

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17
Q

HyperK treatment?

A

Ca Gluconate > Insulin , albuterol.

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18
Q

Hyper Ca tx? Short term? Long term?

A

IV hydration, calcitonin.

Long term - bisphosphnates

NO DIURETICS (unless extreme?)

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19
Q

Tumor lysis findings?

A

HyperP, Hyper K, HyperUricemia. HypoCa (Excess P binds Ca)

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20
Q

Hyper Na tx in hypovolemic?’

Mildly dehydrated

Very dehydrated?

A

Mild: 1/2NS+D5

Very dehydrated: Hydrate w/ NS.
Usually I would go with this. Also for any sort of resuscitation, always NS

When euvolemic - can switch to 1/2 NS

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21
Q

Acute Angle glaucoma presentation?
Triggers?
Dx?
Tx?

What not to give?

A

Sudden onset w/ pain, blurry vision.
Triggers - Decongestants
Dx - IOP w/ slit lamp (tonometry/gonioscopy)
Tx - Mannitol, acetazolamide, Pilocarpine, Timolol

DO NOT GIVE ATROPINE

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22
Q

Open angle glaucoma - presentation?

tx?

A

DEC peripheral vision. Cupping of disk.

Tx Timolol

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23
Q

Optic neuritis presentation?

What is affected?

A

Rapid color change - Central scotoma.

Afferent defect often

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24
Q

Macular degeneration?

Findings?

Dx?

A

DEC visual acuity

Dx - Straight lines -> wavy

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25
Q

Central Retinal Artery Occlusion.

Presentation?
What else has this presentation?
Difference?

Tx?

A

Sudden onset - curtain falling down

Retinal detachment also has this presentation.
Difference: on optho exam you will see PALLOR (due to ischemia) and accentuated red fovea. No retinal tears.

Tx - High flow O2, ocular massage

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26
Q

Retinal Detachement

Presentation?
What has similar presentation?
Why are these different?

Tx?

A

Sudden onset curtain coming down, vision loss.FLOATERS

Similar to centrla retinal artery occlusion, but do not see pallor and red fovea.

Instead, see elevated, grey retina.

Tx ?!

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27
Q

Virteous Hemorrhage

Presentation?

Optho finding?

A

Loss of fundal detail.

dark red glow. Floaters.

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28
Q

Preseptal cellulitis vs Orbital cellulitis? Presentation?

Risk factors for orbital cellulitils, and risk factors for the risk factor?

A

Preseptal - no change in vision.

Orbital Cellulitis - vision change, opthalmoplgia.
Viral sinusitis -> Bacterial rhinosinusitis -> Orbital sinusitis.

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29
Q

Dacrocystitis

WHt is it? Presentation? Tx?

A

Dacrocystitis - lacrimal infection - medial canthal pressure elicits purulent draininage - Discharge w/ pressure.

Tx - Staph A

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30
Q

Stye (Hordeolum) VS Chalazion

Recurrent chalazion?

A

Stye (hordeolum) - small, painless, external eye

Chalazion - Chronic, painless, usu internal
- must biopsy if recurrent - risk of sebaceous CA or BCCA

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31
Q

Choroidal rupture clinical scenario? prsentation?

A

Blurred vison after trauma

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32
Q

Pathophys behind a FRECKLE?

A

INC melanosomes, not cytes

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33
Q

BCC - Presentation?

A

75% of skin CA.

ULCERATED open sore, pearly, reddish, scar like

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34
Q

Actinic Keratosis - Presentation. What are you concerned for?

A

Sandpaper feeling.

Precursor to SCC

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35
Q

Seborrheic Keratosis - Presentation? Concern?

A

Stuck on.

Seen in Lesser Trelat sign (multiple, quick onset -> CA in gut)

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36
Q

Seborrheic dermatitis - presntation? Who do you see this in?

A

Inflam of sebaceous glands.

Seen in parkinson and HIV

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37
Q

Keratoacanthoma - Presentation? Concerns?

A

Cup shaped tumor w/ keratin debris

Low grade SCC!

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38
Q

Dermatofibroma =- POresentation?

A

Hyperpig - nontender. Central dimpling when pinched

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39
Q

Rosacea - presentation?

A

Telangiectasia - Rossy, flushing w/ emotions, heat

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40
Q

Dermatitis herpetafrmis? Association? Tx?

A

Celiac - Tx dapsone

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41
Q

Tx of acne? Tiers?

A

Comedal - retinoids

Inflam - retinoids, benzoyl, add abx.

Nodular cystic - unresponsive to the above. PO isotretinoids

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42
Q

Presentation of steroid acne?

A

Noncomedal. pustular

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43
Q

Histo of pemphigous vulgarious? bullous pemphigoid?

A

Vulgaris - IgG between epidermal cells. ((desmosomes)

Bullous - IgG to hemidesmosomes - C3 deposits.
At the dermal-epidermal border - aka the BM

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44
Q

Tx of Nail puncture leading to osteo

A

Tx for pseudomonas. Not tetani.

Staph A most common cause of osteo in adults AND kids. But in nail… concern for pseudo

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45
Q

Tx for human/dog bite?

A

Amox clauvulonic

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46
Q

Rabies bite? What to do?

A

Based off of the animal.

High risk - Rabives PPX

Low risk - dogs etc.
If you can quarantine and watch for 10 days, do so

If you cant quarantine and observe, PPX

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47
Q

Tx of Legionella?

A

Atrypical pneumo - tx w/ Macrolide (Azithro, Erythro), or Levofloxacin (Quinolone)

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48
Q

PPD + individual? Categories/Requirements?

Asx?

Sx?

A

15+mm in normal no risk pt/.

10 mm in high risk - lab worker etc

5m in HIv

Asx - 9 mo INH+B6. Or 2 months rifampin+pyrazidamine

RIPE if sx

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49
Q

PCP tx? What are classic physio findings?

A

TMP SMX PLUS STEROIDS

INC A-a gradient (emphysema, not chronic bronchitis)(

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50
Q

Contact Lense Keratitis Tx?

A

Pseudo, Serration and other GN GP.

Broad spectrum abx.

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51
Q

Prostatitis tx?

A

TMP SMX

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52
Q

Lyme tx?
In kid?
In preg?

A

Amox, Doxy, 3rd gen Ceph. All basicalyl equiv.

Dont give doxy in kids younger than 8

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53
Q

Syph Dx? Tx? In pt w/ allergy? Preg?

A

Dx - Microscopy in early stages. VDRL etc later.

Syph - Tx Penicillin.
Penicillin allergy ->doxy
In preg ladies - > desensitize to penicillin

54
Q

Condyloma lata vs accumunata

A

Lata = syph

accmunata - warps hpv - more papillary and verruncous

55
Q

Cat scratch tx?

Noncutaneous findings

A

Bacillary angiomatosis

Tx - Azitrhomycin or erythromycin.

Red friable lesions - may be seen in the liver in ICH. Hemorrhagic on biopsy.

56
Q

Disseminated GC findings?

Dx?

A

Tenosynovitis, rash, purulent or NOT arthritis

Blood cultures may be negative
Nucleic acid amplify of mucosa is better

57
Q

Blasto vs Histo? Hosts?

Tx

A

Blasto may affect normal ppl as well as ICH.

Histo is ICH mainly.

Hist has HSM, pancytopenia

Tx both with itraconazole

58
Q

Sporothrix - Presentation? Painful or not painful?

Tx ?

A

Painless! Garener

Tx - Itrac/Terbinafine > KI

59
Q

Aspergillosis - radiographic findings?

A

Halo sign - cavity with air cresents

Itrac. Resistant to fluconazole.

In dissemianted, canuse ampho and caspofungin

60
Q

babesia - presentation

tx?

A

Babesia - fever, hemolytic

Atovaquone + azitrhomycin

61
Q

Toxo - PPx? Tx?

A

Toxo

PPx - TMP SMX

Tx - Sulfadiazine + pyrimethamine

62
Q

Trichenellosis?

From where?

Clinical/lab findings?

Tx?

A

From pigs. undercooked pork

Eos! Periorbital edema , myositis, splinter hemorrhages

Tx - Albendazole

63
Q

Malaria ppx?

A

Mefloquone, doxy, atovaquone.

64
Q

Entamoeba - from where?

Dx/Findings?

Tx

A

Entameoba - traveling etc.

Blood diarrhea, may see liver cyst - DO NOT BIOPSY.

Can serologic test

Tx w/ PO metronidazole, EVEN if there are liver abscess

65
Q

Echinococcus? - from where?

Findings? How does this differ fromk entameoba?

tx

A

From dog/sheep

Liver absces - WITH EGG SHELL CALCIUM. These are not seen in entameoba (from the wild). AKA animals animals animals.

Tx - aspiration + albendazoel

66
Q

Taenia soleum

From?

Tx?

A

undercooked pork

neurocysterercosis

Tx - Praziquantel + albendazole

soleum+praziq

67
Q

HBV tx?

In whom?

A

HBV - tx in compensated
DNA >20k, ALTx2. INR less than 1.5? no depresion etc.

T
x - Tenofovir. .. Entecavir second.

68
Q

HBV needle stick?

A

Vaccinated - nothing

Unsure/not vaccinated - Hb IG and Hep B (active and passive)

69
Q

HCV - Tx?

Geno1?

A

Tx - Peginterfrom + Ribavarin

Geno1 + Telapovir (or boceprevir)

70
Q

HCV predisposes you to what 4 things?

A

Porphyrea tarda, cryoglobulin, Membranous, Membranoproliferative T1

71
Q

HIV Diarrhea - OOcysts?

A

OOcysts = Cryptosporidium

Microsporodium has spores, not oocysts

72
Q

MAC - ppd findings?

presentation??
ppx WHEN in HIV ?

tx?

A

PPD negative

Diarrhea, pneumo

PPx

73
Q

HIV vaccines - which can you give and when?

A

Do not give live.

Excespt MMR and Zoster (give the killed polio) Give these if CD4 is greater than 200.

Give HAV, HBV, Influenza, Tdap once, then Td every 10 yr
PCV13, then 23,

If less then hold.

74
Q

CMV esophagitis histo presentation?

Tx

A

Linear ulcers w/ intranucelar and intracytoplasmis

tx gancyclovir

75
Q

HSV esophagitis - histo presentation? tx?

A

Vesciular, volcano lesions. Intranuclear only.

Tx acyclovir

76
Q

CMV retinitis vs HSV retinitis?

A

CMV - painless

HSV - pauinful

77
Q

Herpetic whitlow tx?

A

None. self resolves.

78
Q

HSV encephalitis?

Dx?

Tx?

A

Dx - PCR/.

Tx - acyclovir, even before the PCR comes back.

79
Q

EBV - no sports for how long?

How doe sthis presentation differ from acute CMV infection?

A

No sports for 3 wk. Have autoimmune hemolytic anemia risk (mononucleosis) + splenomegaly, pharyngitis

CMV - splenomegaly . Got get as crazy LAD and no pharyngitis.

80
Q

When to get Tdap, when to get Td?

A

Tdap once as adult, then Td every 10 years.

Get Tdap once again in liver failure/HIV etc, Then Td every 10 years.

81
Q

Splenecotmy vaccine? when? which?

A

14 days before 14 days after.

Seq PCV13, 23 regardless of prior.

Also HiB, meningococcus.

82
Q

Post splenectomy ppx in pediatrics adults

A

pediatric - PO penicillin daily for 3-5 years or until an adult.

INC risk of pneumococcal sepsis for 30+ year

may keep abx at home at sign of fever.

83
Q

? Melanoma.

Do what?

if biopsy comes back.. as +, as BCC?

A

?Melanoma - > Excision biopsy.

If it comes back as melanoma -> 1cm margins + Sentinal LN

If comes back Basal Cell CA - no margins required.
benign = no margins.

84
Q

TB tx and PPX

A

TB tx is RIPE for 6 mo. PPx is 9 mo INH+B6 or 2mo Rifampin + Pyrazidamide

85
Q

Self breast exam?

Clinical breast exam?

A

SELF BREAST EXAM NOT RECOMMENDED – Clinical breast exam uncertain.

86
Q

Clearly necrotic ulcer in DM pt

A

– don’t need to biopsy ulcer edges because necrotic = likely not malignancy.

87
Q

Roseola

A

3d high fevers followed by maculopapular rash. Supportive care.

88
Q

OCP associate ICN and DEC risk of CA

A

DEC endometrial and ovaria. INC breast and cervical.

89
Q

Camper w/ rash that moves from arm/eg to TRUNK

A

Rocky Mountain - Rickettsia

90
Q

When to do Head CT in someone with meningitismus?

A

CONFUSION (cannot perform neuroexam to find focal deficit)

Papilledema, Seizure, Focal deficit

91
Q

If you cannot culture due to abx, what is the most SPECIFIC test?

A

Latex agglutination ANTIGENS. moreso than stain)

92
Q

Someone with acute onset fever, confusion - what to do next?

A

Must Head CD because of CONFUSION - most likley encephalitis - herpes most common

cannot LP without CT because of CONFUSION

93
Q

Mots common neuro deifict from UNTREATED BACTERIAL MENINGITIS

A

8th cranial nerve deficit/ Deafness

94
Q

Most sensitive finding for otits media?

A

Immobility > bulging, redness, etc.

95
Q

Sinusitis - most accureate dx test?

Bacterial Pharyngitis - best dx test?

A

Sinus biopsy or ASPIRATION. May not need to do and can just tx Amox Clauvulonic.

Culture of nasal discharge is ALWAYS WRONG ANSWER for sinusitis.

Rapid strep test. Tx Amox or penicillin.

96
Q

Penicillin allergy pt - can you tx w/ cephalexin?

A

If penicillin allergy is rash?

Yes

Anaphylaxis - No

97
Q

Initial best test for bloody diarrhea.

A

Blood and leukocytes

BUT if Lactoferrin is an answer,
LACTOFERRIN> LEUKOCYTES

Blood + Lactoferrin.

98
Q

Scrombroid - presentation tx?

A

Eating fish - Rapid onset - WHEEZING

Caused by Histidine in fish, NOT bacteria

Tx antihistamines

99
Q

Best sign of Active viral replication - Most benefit from antiviral, indicator of active viral replication?

Best sign that Hep C is not able to be transmitted to another?

A

e antigen

No surface antigen.

100
Q

Syphilis tx - > Jarish Herxheimer reaction (fever and worse sx)

What to do?

A

Aspirin and antipyretics - it will pass. Continue to tx.

101
Q

Uncomplciated cystitis in lady?

A

Nifurantoin for 3 days/

Not 7 (only if anatomical problem)

102
Q

Difference in tx of cystitis vs proctitis in male?

A

Same drug
(Cipro, Bactrim)

BUT, proctitis is tx for much longer (2-6wk, as oppose to 7 days)

103
Q

What is the other Bovis in Bowel organisms?

A

Clostridium septicum

104
Q

Best initial tx of Infective Endocarditis?

A

Vanc + Gent

narrowing w/ culture
Viridians -> ceftriaxine
Enterococci - Amp gent.

105
Q

What do you add if someone has Infective endocaritis with PROSTHETIC vlave w/ staph?

A

Add Rifampin + Whatever stapht x (prob vanc)

106
Q

Best initial test for HIV? Confirmatory test?

A

ELISA test

Confirm - Western blot

Infants dx w/ PCR or viral culture, since maternal ab may be present.

107
Q

Amp/Amox in sore throat causes rash

A

ebV

108
Q

Milk Alkali syndrome - CAUSES - 3 SIGNS

A

Too much Ca and Alkali absorption – HyperCa, KIDNEY FAILURE, Met Alkalosis

109
Q

Amyloidosis one way to screen?

A

abdominal fat pad

110
Q

Bee sting anaphylaxis in respiratory distress - Epi or intubate?

A

Epi first. Few times you do something before intubating in respiratory distress (also racemic epi in croup)

111
Q

JC virus imaging – MRI

A

patchy areas of white matter consistent with demyelination – Deected w/ PCR of CSF

112
Q

Greatest risk factor for stroke?

A

HTN > smoking, DM etc

113
Q

Basal cell CA – tx

A

Basal cell CA – txw/ electrodessication and curreettage or MOHS – which is why BCCA doesn’t need large margins.

114
Q

Tx for CO poisoning?

A

100% O2 with nonrebreather

115
Q

Prospective cohort

A

– cohort = group with or without risk factors. See how they develop disease incidence

116
Q

Case Control

A

Disease case and nondisease controls, assess risk factor.

117
Q

Smoking affect on BP?

A

Not significant. BP : Weigh tloss, DASH, Exercise, DEC Na, DEC ETOH. No smoking. Still encourage for other reasons.

118
Q

Gait problem in alcoholic think what 3 things?

A

B12, Wernickes, Cerbellar dysfunction. Wernickes (ataxia, ophtalmoplegia, confusion); Cerebellar (gait, ataxia, dysdiadochokinesia, intention tremor)

119
Q

Seborrheic dermatitis

A

affects head eyebrows, nasolabial folds – which Tinea capitis does not (onyly head)

120
Q

PPSV23 vs PPSV13

A

23- T cell independent B cell response. PCV13 conjugate contains protein and T cell dependent B cell response with higher affinity ab and memory cells.

121
Q

Subconjunctival hemorrhage algorithm

A

if asx, observe. Usu from simple trauma like coughing or rubbing eyes.

122
Q

Burn victim with 5 p’s

A

First think escharotomy. If no sx improval after, fasciotomy.

123
Q

HIV retinitis tx algoirthm?

A

– benign, cotton wool spots that remit spontaneously. As oppose to CMV, which although painless will have opacification and hemorrhages.

124
Q

Frostbite tx

A

rapid rewarmwith warm water (better than slow rewarm).

125
Q

CMV in ICH prsentation. Dont confuse with?

A

can develop pneumonitis (diffuse patchy infiltrates)a nd lower GI ulcers 9diarrhea, abd pain), myalgias, etc. So consider in addition to MAC

126
Q

Varicella ppost exposture

A

give varicella vaccine. If ICH – give VZIG.

127
Q

Hypothermia tx

A

– between 90-95deg, just passive warminign (blankets etc are fine, perhaps warm blankets if low). Warm fluids if only vitals unstable or severely cold.

128
Q

SS osteo, which bug do you see more of?

A

Staph > Salmonella

129
Q

Pemphigus vulgaris, first and second line?

A

Steroids, then azathioprine

130
Q

Psoriasis tx

A

– emollients, topcical steroids, vitD/A derivatieves (calcipotriene, Tazarotene) UV LIGHT . Methotrexate

131
Q

Elder abuse reporting?

A

, elder does not want reporting – still can report. Key word CAN.

Step 2 (12 decks)

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