Family medicine Flashcards
(182 cards)
1
Q
Chorioretinitis, hydrocephalus, and intracranial calcifications
A
congenital toxoplasmosis
2
Q
Woman with recurrent HA, pulsatile tinnitus, neck pain, or flank pain, HTN
A
Fibromuscular dysplasia
3
Q
Treatment of bacterial endocarditis with ischemic stroke
A
IV antibiotics
Surgery if significant dysfunction with HF, or continued septic embolization
4
Q
2 mo old with seizures, increased head circumference, AMS after minor trauma
A
Think abuse
Subdural bleeding
5
Q
Newborn with closed fists and overlapping fingers, micrognathia, prominent occiput
A
Trisomy 18 (edwards syndrome)
6
Q
Three types of proteinuria in children
A
Transient
Orthostatic
Persistent
7
Q
Most common cause of unilateral acute lymphadenitis in children
A
S. aureus, Strep pyogenes
8
Q
intoxication causing tachycardia, HTN, dry mouth, conjunctival injection and increased appetite
A
MJ
9
Q
corneal vesicles and dendritic ulcers
A
Herpes simplex keratitis
10
Q
Vaccines for pts with HIV
A
- Hep B
- Annual flu
- PCV13 and PPSV23
- Varicella
11
Q
Tx for patients with severe penicillin allergy and syphilis
A
Doxycycline
12
Q
profuse frequent (10-20) BM per day. Nocturnal BM with painful abd cramps. Dark brown discoloration of colon with pale lymph follicles
A
Factitious diarrhea
laxative abuse
13
Q
Abdominal pain radiating to the scapula
A
Think gallbladder
14
Q
epigastric pain radiating to the back
A
pancreatitis
15
Q
presentation of appendicitis in elderly
A
Abnormal presentation
must have high suspicion with abdominal pain and fever
16
Q
Diagnosis of choledocholithaisis
A
ERCP
17
Q
Initial Ranson’s criteria
A
>55yo WBC >16,000 Glucose >200 LDH>350 AST>250
18
Q
When do you repeat a pap if it shows atypical squamous cells of unknown significance with negative HPV?
A
When next pap is due (3yrs)
19
Q
HPV+ on pap. then what?
A
Colposcopy
20
Q
Labs for AoCD
A
Serum iron and TIBC decreased
Ferritin increased
21
Q
prophylactic tx for sickle cell pain crisis
A
adequate O2 and H2O
22
Q
Screening Age: Breast cancer
A
Women 50-75
23
Q
Screening frequency: Breast cancer
A
Mammogram every 2 years
24
Q
Screening age: Cervical cancer
A
Women 21-65
25
Screening frequency: Cervical cancer
pap every 3 years
26
Screening age: colon cancer
50-75
27
Screening frequency: colon cancer
Fecal occult blood test yearly OR colonoscopy every 10 yrs
28
Screening age: HIV
15-65
29
Screening frequency: HIV
One time
30
Screening age: Hyperlipidemia
Men 35+ (unless there are risk factors)
31
Screening frequency: Hyperlipidemia
Lipid panel every 5 years
32
Screening age: HTN
18+
33
Screening frequency: HTN
BP every 2 years
34
Screening age: Osteoporosis
Women 65+
35
Screening frequency: Osteoporosis
At least one DEXA
36
Overweight woman with HA, transient vision loss, papilledema, pulsatile tinnitus
Idiopathic intracranial HTN
37
Diagnosis of idiopathic intracranial hypertension
MRI +/- MRV
| then LP for opening pressure (>250)
38
Relative risk associated with what kind of study
Cohort study
39
Odds ratio associated with what kind of study?
Case-Controlled
40
When can odds ratio approximate the relative risk?
When the disease is rare and disease incidence is low
41
Equation for relative risk
RR=[a/(a+b)] / [c/(c+d)]
42
Equation for odds ratio
OR=ad/bc
43
Most common cause of brain abscess
Viridians strep
or
S. aureus
44
Muffled voice, unilateral lymphadenopathy, and deviated uvula after fever, chills and sore throat
Peritonsillar abscess
45
Treatment of a peritonsillar abscess
Aspiration and IV antibiotics
46
Most common head and neck cancer
SCC
47
Treatment for severe cancer pain
Short acting opioids (morphine, hydromorphone, oxycodone)
48
How to diagnose follicular thyroid cancer
Excision of tumor and identification of invasion of the tumor capsule and/or blood vessels
49
Treatment of pyelonephritis in diabetic patient
IV ceftriaxone w/in 48 hrs
| then switch to oral fluoroquinolone and bactrim 10-14d
50
Treatment for uncomplicated infection
Bactrim or cipro
| OR ceftriaxone if severe
51
Screening for hemoglobinopathies
CBC
52
Monocular transient vision loss with sense of "a curtain falling down"
Amaurosis fugax
Cause: retinal emboli
53
When to use steroids in the treatment of PCP
if PaO2 <70 or A-a gradient >35
With TMP-SMX
54
diagnosis of pesudoachalasia
endoscopy
55
flaccid bullae, easy separation of epidermis, mucosal erosions
Pemphigus vulgaris
56
pruritic tense bullae in flexural surfaces, groin and axilla
bullous pemphigoid
57
Risk factors for squamous cell carcinoma of the esophagus
smoking, alcohol, dietary deficiency of beta-carotene, B1, zinc, hot beverages, smoked foods
58
Risk factors for adenocarcinoma of the esophagus
GERD, obesity, high dietary calorie and fat intake.
59
Causes of rapidly progressive ascending paralysis
Tick-borne paralysis: absence of fever and sensory abnl w/ nl CSF
GBS: autonomic dysfunction and abnl CSF
60
Causes/risks of Bartonella infection
- Cat exposure
- Homelessness (lice)
- Severe immunocomprimise
61
Manifestations of Bartonella
```
Vascular cutaneous lesion (small reddish/purple papule--> nodular lesions)
Constitutional symptoms (fever, malaise night sweats)
```
62
Risk factors for C. diff
- Recent antibiotics
- Hospitalization
- PPI
63
Who should get PPSV23 alone
Chronic heart, lung, or liver dz
DM, smoker, alcoholics
all under 65
64
First line treatment of acute otitis media
Amoxicillin
65
Cause of acute otitis media
S. pneumo
66
Treatment for otitis externa
topical antibiotics
67
LE edema that spares the feet
Lipedema
68
Chronic unilateral leg swelling
Venous insufficiency
Compression stockings
69
HIV pt w/ CD4<50, nonspecific systemic symptoms, splenomegaly, elevated alk phos
MAC
70
CD4 count <50 prophylaxis
Bactium (PCP)
| Azithromycin (MAC)
71
Appearance of SCC
Keratinized (thickened and rough), ulcerated with crusting and bleeding
72
Most common skin malignancy in pts on chronic immunosuppression
SSC
73
Treatment for cancer related anorexia
```
Progesterone analogues (megestrol acetate)
OR corticosteroids
```
74
Most common malignancy of the lip
SCC
75
SE of cyclosporine
```
Nephrotoxicity
HTN
Neurotoxicity
Glucose intolerance
infection
Gingival hyperplasia
GI issues
```
76
SE tacrolimus vs. cyclosporine
same except tacrolimus does not have hirsutism and gum hypertrophy
77
Major toxicity of Mycophenolate
Marrow supression
78
Major toxicity of azathioprine
dose-related diarrhea, leukopenia, hepatotoxicity
79
dome-shaped, firm, freely moving cystic nodule with small central ounctum
Epidermal inclusion cyst
80
Elevated conjugated bili and alk phos
Malignancy, PBC, PSC, Choledocholithiasis
Get abdominal US
81
difference between vascular dementia and NPH
VaD has asymmetric neurologic findings and occurs suddenly
82
Clinical presentation of disseminated gonococcal infection
Purulent arthritis w/o skin lesions
OR
Triad: Tenosynovitis, Dermatitis, Migratory asymmetric polyarthralgia
83
Treatment for disseminated gonococcal infection
IV ceftriaxone 1g/day for 7-14 days then switch to PO cefixime when clinically improved
Plus azithromycin for chlamydia
84
Treatment for multi-drug resistant pyelo
Aminoglycosides
(amikacin)
Can be nephrotoxic
85
Treatment for viral conjunctivitis
treat symptoms
associated with adenovirus
86
Chest pain at night or that is precipitated by exercise, hyperventilation, emotional stress, or cold exposure. Plus transient ST elevation
Variant angina
87
Treatment of variant angina
CCB or nitrates
88
What region effected if there is contralateral sensory loss and burning pain weeks to months later
Lacunar stroke of the posterolateral thalamus
89
Ovarian cyst that has hyper echoic nodules and calcifications on US
Dermoid ovarian cyst
90
Adnexal fullness in asymptomatic patient
Mature cystic teratoma (dermoid ovarian cyst)
91
Sudden, severe, unilateral pelvic pain w/ n/v with history of enlarged ovary
```
Ovarian torsion
(decreased blood flow leading to ischemia and necrosis)
```
92
Sudden onset, severe, unilateral lower abdominal pain immediately following strenuous or sexual activity. With pelvic free fluid
Ruptured ovarian cyst
93
Treatment for stable ectopic pregnancy
methotrexate
94
How to diagnose intraamniotic infection (chorioamnioitis)
Maternal fever and one or more of:
- uterine tenderness
- maternal or fetal tachycardia
- malodorous amniotic fluid
- purulent vaginal discharge
95
Risk factor for chorioamnionitis
- Prolonged rupture of the membranes
| - prolonged labor
96
Treatment for chorioamnionitis
IV Broad spectrum antibiotics (amp, gentamicin, clinda)
- Oxytocin to accelerate labor
- Antipyretics
97
Treatment for erb-duchenne palsy
gentle massage and PT to prevent contracturs
Surgical intervention if infant with no improvement by age 3-6mo
98
Recovery from erb-duchenne palsy
up to 80% spontaneous recovery w/in 3 mo
99
Ddx for night sweats, insomnia and irregular menses in middle-aged woman
Menopause
| Hyperthyroidism
100
Presentation of cryptococcal meningoencephalitis
HA, fever, malaise, signs of elevated ICP
| Subacute
101
When HIV pts get Cryptococcus neoformans
CD4 <100
102
Signs and symptoms of JC virus
Progressive multifocal leukoenchephalopahty
MRI shows patchy areas of white matter consistent with demyelination
103
Causes of acute epididymitis in <35yo
Sexually transmitted (chlamydia, gonorrhea)
104
Causes of acute epididymitis in >35yo
Bladder outlet obstruction (coliform bacteria, e coli)
105
Treatment for acute epididymitis in >35yo
Levo
106
Type of lung cancer associated with PTHrP production
Squamous cell carcinoma
107
Paraneoplastic syndromes associated with small cell carcinoma
ACTH production and SIADH
108
Elevated Maternal alpha fetal protein associations
Open neural tube defects
ventral wall defects
multiple gestations
109
Associations with low alpha fetal protein
Aneuplodies
110
Reversal for warfarin
Vitamin K
| Adding back factors (prothrombin complex concentrate)
111
Reversal of heparin
Protamine sulfate
112
Causes of acute limb ischemia
cardiac emboli, thrombosis (hypercoag or vascular stent) or trauma
113
Cardiac source of arterial emboli
Left ventricular thrombus
thrombus due to a fib
aortic atherosclerosis
114
How to screen for LV thrombus
Echo
115
Management of LV thrombus
anticoag, vascular surgery, TTE
116
Difference between toxic epidermal necrolysis and stevens johnson syndrome
SJS <10% of body
| TEN >30%
117
What size PPD induration to treat with no exceptions
> or = 15mm
118
Treatment for outpatient cellulitis
Oral nafcillin
119
SIRS criteria
Fever >38
RR >20
HR >90
WBC > 12,000
120
Treatment for Iron def anemia
Oral ferrous sulfate
121
Click after S1 loudest at the apex
think about MVP
122
When to start colon cancer screening for pts with one first degree relative with hx colon cancer before 60yo or two second degree relatives
start screening at age 40 or 10yrs before earliest age family member was effected.
Repeat every 5 years.
123
drugs that cause pleuritis
Hydralazine, procainamide, quinidine
124
Recommendation for daily aspirin in women (what for)
women ages 55-79 to prevent stroke
125
Recommendation for daily aspirin in men (what for)
ages 45-79 for preventing MI
126
Findings of hypocalcemia
Hyperreflexia, trousseau's sign, heart block, seizures, paresthesias
127
When to test a woman with gestational diabetes for diabetes post partum
6-12 wks
128
Nail changes in cirrhosis
- Muehrcke's nails (transverse white bands)
| - Terry's nails (whitish nail beds sparing the tips)
129
USPSTF recommendation for ovarian cancer screening
Recommends against it.
130
Tests for spondylolysis
Single photon emission computed tomography
131
HTN med that acts directly on the heart
Diltiazem and verapamil
132
Contraindications to estrogen
History of migraines
DVT
breast cancer in past 5 yrs
smoking, ischemic heart disease, stroke, liver disease, major surgery with immobilization, poorly controlled HTN
133
HbH disease treatment
Lifelong blood transfusion and deferoxamine
134
When does acute stress disorder become PTSD
one month of symptoms
135
How to prevent addisonian crisis post pituitary gland tumor removal
pre treat with glucocorticoids (dexamethasone)
136
JVD, decreased heart sounds, hypotension
Beck's triad
| Cardiac tamponade
137
Four mechanisms that produce shock after trauma to the thorax
1. cardiac tamponade (cardiogenic)
2. Tension pneumothorax (cardiogenic)
3. Cardiac wall rupture (cardiogenic)
4. Hypovolemic
138
First line treatment for PSC
Ursodeoxycholic acid
139
treatment for uncomplicated pyelonephritis
fluoroquinolones (cipro)
140
First line treatment for symptomatic hyperthyroidism
Beta blocker (treat cardiac symptoms)
141
Second line treatment for hyperthyroidism once symptoms are controlled
Methimazole
142
Side effects of hydroxyurea that require monitoring
- myelosupression (cbc with retic count)
| - hepatotoxicity (LFT)
143
Most common kidney stone with hyperPTH
Calcium phosphate
144
first line treatment for CAP in output
Azithromycin
145
First line for CAP in pts that need to be hospitalized
CTX and azithromycin
146
Causes of diarrhea in patients with AIDS: severe watery diarrhea, low-grade fever, weight loss
Cryptosporium
CD4 less than 180
147
Causes of diarrhea in pt with AIDS: watery diarrhea, cramps, weight loss, no fever
Microsporidium/isosporidium
CD4 less than 100
148
Pt with AIDS, watery diarrhea, High fever, weight loss
MAC
CD4 less than 50
149
Pt with AIDS, small, frequent volume diarrhea, hematochezia, abdominal pain, low grade fever, weight loss
CMV
CD4 less than 50
150
Location of morton neuroma pain
between third and fourth toes on plantar surface with clicking sensation
151
Diagnosing VAP
1. abnormal chest x-ray
| 2. culture sputum
152
Diagnosis of aortic dissection
- CT if hemodynamically stable
| - TTE (good for pts with renal insufficiency)
153
Bladder pain with filling, relief with voiding, increased frequency and urgency, dyspareunia
Interstitial cystitis (painful bladder syndrome)
154
Treatment of WPW
Procainamide and amiodarone
155
Treatment for mild persistent asthma
ICS and PRN SABA
156
treatment for moderate persistent asthma
ICS+LABA OR Montelukast
157
Target of infliximab
TNF inhibitor
158
Infliximab increases risk of what?
Infections
| Screen for TB, Hep B and C before starting
159
Positive hep C antibody enzyme immunoassay and recombinant assay with negative HCV RNA PCR means what?
Past infection with HCV now resolved
160
When to hold metformin
Prior to CT with IV contrast due to risk of kidney dysfunction thus lactic acidosis
Also preop when risk of lactic acidosis
161
ODC: do pts recognize that obsessions are excessive?
yes
162
Treatment for HAP
(antipesudomonal PCN or ceph or carbapenem) + (FQ or genta+azithro) + MRSA coverage
163
Treatment for outpt pneumonia with no recent abx
macrolide or doxycycline
164
Treatment for outpt pneumonia with recent abx or comorbidities:
resp FQ or (macrolide + (high dose amox+clav Or 2 gen ceph)
165
Which SSRI should be avoided in pregnancy?
Paroxetine
166
20 yo female with acute dysuria, frequency and pyuria with negative culture
STI
| chlamydia, gonorrheae, HSV
167
Top intervention for anorexia nervosa
family based treatment
168
when to stop preventative aspirin
80 yo
169
baby with microcytic, hypo chromatic anemia. next steps?
prescribe oral iron
170
Symptomatic treatment for mitral valve prolapse
Beta blockers
171
Treatments for high altitude sickness
Acetazolamide (sulfa)
| Dexamethasone
172
Most common drug to cause acute interstitial nephritis
Antibiotics
PENICILLINS
cephalosporins
sulfonamides
173
Most common cause of erythema multiforme
HSV
174
Treatment for pyogenic tenosynovitis
W/in 1st 48hrs- PO abx and splinting
| >48hrs- Surgical drainage and abx
175
Causes of elevated BNP
heart failure, renal failure, PE, Pulm HTN, chronic hypoxia
176
what further evaluation pre op does a pt with <4 METs require
A dipyridamole-thallium scan (cardiac stress test)
177
risks of long term omeprazole use
increased risk of CAP and C. diff. decreased absorption of B12 and Ca (increased risk of hip frx)
178
older than 35 with abnormal vaginal bleeding. what is next step?
Assess for endometrial assessment to exclude endometrial hyperplasia or cancer
179
Treatment for hemodynamically unstable patients with a flutter
electrical cardiovert
180
Treatment for atrial flutter in hemodynamically stable patient
Digoxin and verapamil
181
treatment for unipolar depress with multiple failed SSRIs
Lithium or T3
182
treatment for acute cervical radiculopathy and normal x-ray
NSAIDs
