FM CASE FILES 1 Flashcards
(159 cards)
1
Q
What is Strabismus?
A
ocular misalignment
2
Q
Define failure to thrive.
A
- weight below 3rd or 5th percentile, or
2. decelerations of growth that have crossed 2 major growth percentiles, in a short period
3
Q
Most common cause of amblyopia.
A
Strabismus
4
Q
Name 2 required newborn screening tests.
A
PKU and congenital hypothyroidism
5
Q
Name some common newborn screening tests.
A
hemoglobinopathies (sickle), galactosemia
6
Q
How do you evaluate for iron deficiency in children?
A
get hemoglobin or hematocrit bt 6-12 months of age
7
Q
what is the meaning of a red reflex in an ophthalmoscopic exam of a newborn
A
no cataracts or retinoblastoma
8
Q
how do you test for strabismus
what do you do if the child tests positive
A
asymmetric light reflex, or
cover-uncover test
child focuses on object with both eyes, then cover one eye, if the uncovered eye deviates then it is a sign of strabisumus
refer to ophthalmologist asap to prevent amblyopia
9
Q
leading cause of death in children under 1yo
A
SIDS
10
Q
what is the car safety law for children
A
rear-facing car seat until 1yo and weighs 20 lbs
front-facing seat btw 20-40 lbs
booster seat when >40lbs, with shoulder belt
11
Q
leading cause of death of children older than 1 yo
A
accidents and injuries
12
Q
contraindications to vaccines
A
hx of anaphylactic reaction to vaccine or its component (regardless if having fever or not)
13
Q
sx: nasal itching, sneezing, rhinorrhea
A
allegic rhinitis
14
Q
signs: nasal turbinates swollen (boggy), pale/bluish color
A
allergic rhinitis
15
Q
tx for allergic rhinitis
A
antihistamines, decongestants or intranasal steroids
16
Q
complications of tx for allergic rhinitis
A
excess use of decongestants can cause rebound congestion
rhinitis medicamentosa
17
Q
name sx of allergic rhinitis
A
sneezing itching (nose/eyes/ears) rhinorrhea - thin/watery postnasal drip congestion anosmia HA earache tearing/red eyes drowsiness
18
Q
contrast the mucous secretion of rhinitis vs sinusitis
A
rhinitis - thin/watery
sinusitis - thick/purulent
19
Q
how do you test for nasal polyps
A
spray a topical decongestant, the polyp does not shrink, but the surrounding nasal mucosa does
20
Q
name some 1st gen antihistamines
A
diphenhydramine
chlorpheniramine
hydroxyzine
21
Q
name some 2nd gen antihistamines
A
loratadine
fexofenadine
cetirizine
22
Q
why do 2nd gen antihistamines have less sedative effects than 1st gen
A
less penetration into cns
23
Q
name a decongestant and its mech of action
A
pseudoephredine
alpha agonst
24
Q
why avoid oral decongestants
A
may cause tachycardia, tremors, insominia
25
side effects of corticosteroid nasal sprays
nosebleeds, pharyngitis, URI
26
describe urticaria
large, irregularly shaped
pruritic
erythematous wheals
27
describe angioedema
painless
deep
subcu swelling
involves:
periorbital
circumoral
28
describe anaphylaxis
```
systemic rxn:
skin findings
dyspnea
visceral edema
hypotension
```
29
immediate tx for anaphylaxis
epi
| SQ or IM
30
what is asthma
msucle spasms
31
signs/sx
| asthma
```
wheezing
SOB
cough
increase airway sections
increased expiratory phase
```
32
what 2 major triggers of asthma
viral infx
| allrgens
33
acute relief of asthma
beta2 agonist
| albuterol
34
tx for persistent asthma
long acting b2 agonist (salmeterol)
inhaled corticosteroids
35
bacterial conjunctivitis
name them
```
staph
strep
hemophilus
moraxella
pseudomonas
```
36
cause of pink eye
adenovirus
37
how is conjunctivitis spread
by direct contact
38
smoking cessation interventions
meds: buproprion
nicotine replacement:
gum, patch, inhaler, nasal spray
39
5As a physician should use to assist in smoking cessation
```
ask about tobacco use
advise to quit (talk about risks/benefits)
assess willingness to quit
assist to quit
arrange follow-up/support
```
40
buproprion contraindicated in what kinds of pts
seizures
eating disorders
MAO-I
41
can pregnant women use the nicotine or buproprion to stop smoking
yes
42
are physicians required to report STIs?
YES!
43
what is emancipation
legal process to declare a person under 18 a legal adult: housing, education, healthcare, conduct
but u still cannot drink EtOH, smoke or vote
44
besides emancipation, what is another way a child may consent to receive medical care w/o parents
"Mature Minor Doctor"
court may deem the child to be "mature"
45
what are the moral principles of ethics
autonomy - patient choice
beneficence - do right for patient
nonmaleficence - do no harm
justice - be fair and nonbiased
46
reliable sign of anemia in elderly
conjunctival pallor
47
general signs of anemia
fatigue
weaknesss
dyspnea
48
general signs of vit b12 def
```
glossitis
decreased vibratory/positional senses
ataxia
paresthesia
confusion
dementia
pearly gray hair
```
49
initial workup of anemia
cbc
peripheral blood smear
retic count
50
iron panel results for iron def anemia
low iron
low ferritin
high TIBC
51
how do u confirm vit b12 def
elevated methylmalonic acid
52
other diseases or conditions causing vit 12 def
pernicious anemia
history of gastrectomy
is associated w/ malabsorption (bacterial infxn, crohn dis, celiac)
53
folate def is assoc with what condition
alcoholism
54
causes of acute diarrhea
virus
| bacteria (e coli, campylobacter, shigella, salmonella, giardia)
55
causes of chronic diarrhea
```
crohns
UC
gluten intolerance
IBS
parasites
```
56
bacterial causes of bloody diarrhea
e coli
yersinia
shigella
e histolytica
57
stool leukocytes is indicative of what orgs
```
salmonella
shigella
yersinia
e coli
c dif
campylobacter
e histolytica
```
58
travelers diarrhea
enterotoxigenc e coli
59
campers diarrhea
giardia
60
daycare diarrhea
shigella
giardia
rotavirus
61
diarrhea from nursing homes or recent hospitalization
c dif colitis from antibiotic use
62
how do u check for c dif colitis
stool c dif toxin
63
first step in tx of diarrhea
fluid resuscitation and electrolytes
64
best way to prevent viral diarrhea
handwashing
65
tx for traveler's diarrhea
quinolone (cipro 500mg bid)
for 1-2 days
or azithromycin
bactrim is more resistant now so avoid it
66
bugs in each diarrhea time course:
within 6 hours
8-12 hours
12-14 hours
s aureus
c perfringens
e coli
67
how to reduce risk of developing osteoporosis
daily Ca2+ / Vit D
| weight-bearing exercise
68
how often do u do mammograms
start at 40
| every 1-2 yrs after that
69
screening for HTN in adults
starts at 18
| measure blood pressure
70
lipid screening guidelines
lipid screen starting at 45yo for women
71
how long should HRT be used
lowest dose
| as short as possible
72
when to start screening for cervical cancer
21
| or within 3 yrs of having sex
73
how is screening for osteoporosis done
dexa scan (bone density)
74
which joint is most likely to be affected in osteoporosis
hip
75
osteoporosis is present if dexa results should a t-score is below what value
- 2.5
| 2. 5 SD below a young woman's
76
how do u dx osteopenia
dexa scan
| T value = -1 to -2.5
77
mech of injury of an ankle sprain
inversion of ankle while plantar flexed
78
most commonly injured ligament in ankle sprain
lateral ankle more injured than medial ankle
anterior talofibular ligament
79
what is a grade 1 ankle sprain
stretching of the ATFL
(anterior talofibular ligament)
pain and swelling
no mechanical instability or loss of fxn
80
what is a grade 2 ankle sprain
partial tear of ATFL
stretching of CFL (calcaneofibular lig)
severe pain, swelling, bruising
mild-to-moderate joint instability, pain with weight bearing, loss of ROM
81
what is a grade 3 ankle sprain
complete tear of ATFL and CFL
partial tear of PTFL (posterior talofibular ligament)
signifcant joint instability
loss of fxn
inability to bear weight
82
ottawa rules
| when do u perform a foot x-ray
bony tenderness over:
navicular bone (medial midfoot)
base of 5th metatarsal (lateral midfoot)
unable to bear weight (immed or during exam)
posterior edge or tip of medial/lateral malleolus
83
management of ankle sprain
```
PRICE
protection (splint/cast)
rest
ice (minimize swelling/pain)
compression (reduce swelling)
elevation (reducing swelling)
```
NSAIDs / acetaminophen
84
how do you test for supraspinatus injury/tear
Empty Can Test
with arm abducted, elbow extended, thumb point down
patient elevates arm against resistance
85
how do you test for infraspinatus or teres minor injury/tear
External Rotation
with elbows at side and flexed at 90 degrees
patient externally rotates against resistance
86
how do you test for subscapularis tear
Lift-Off Test
patient places dorsum of hand on lumbar back and attempts to lift hand off of back
87
how do you test for ATFL injury or tear
| Anterior Talofibular Ligament
Anterior Drawer
pull forward on pts heel while stabilizing lower leg
excess translation of joint suggests ATFL tear
88
how do you test for CFL injury or tear
| Calcaneofibular Ligament
Inversion Stress Test
invert ankle with one hand while stabilizing lower leg with other
excessive translation or palpable "clunk" of talus on tibia suggests ligament tear
89
how do you test for syndesmosis injury
Squeeze Test
examiner compresses tibia/fibula at midcalf
pain at anterior ankle joint (where you're squeezing) suggests syndesmotic injury
90
how do you test for ACL injury/tear
Lachman Test or Anterior Drawer
put knee in 20 degree flexion
pull forward on upper tibia
91
howd you test for MCL injury/tear
Valgus Stress
in full extension and at 30 degree flexion, medial-directed force on knee, lateral directed on ankle
look for excess translation
92
how do you test for LCL injury/tear
Lateral Collateral Ligament
Varus Stress
in full extension and at 30 degree flexion, lateral-directed force on knee and medial-directed force on ankle
93
according to ottawa knee rules, perform knee x-ray when....
| 5 things
```
age 55 orolder
isolated patella tenderness
fibular head tenderness
can't flex knee to 90
can't bear weight for 4 steps
(then or now, regardless of limp)
```
94
if x-ray of joint is normal, but symptoms persist, whats the next test
MRI
95
most common cause of persistent stiff or painful joints following sprains
inadequate rehab
96
single most important risk factor for development of skin cancer
exposure to UV radiation (sun)
97
what are risk factors for skin cancer
```
prior history of skin cancer
family hx of skin cancer
fair skin
red/blonde hair
burn easily
exposure to chemicals (arsenic, radium)
suppressed immune system
```
exposure to UV radiation
98
most common type of melanoma
superficial spreading melanoma
radial growth phase is slower than vertical phase (grows into dermis and can metastasize)
99
most common type of melanoma in the elderly and hawaii
lentigo maligna
found on chronic sun-damaged skin (face, ears, arms and upper trunk)
(however this is the least of the 4 in total)
100
most common type of melanoma in african-american and asians
acral lentiginous melanoma
found under nails
soles of feet
palms of hands
101
most aggressive type of melanoma
| invasive at time of dx
nodular melanoma
102
ABCD of Melanoma
a - asymmetry (symm vs asymm)
b - border (defined vs ragged)
c - color (uniform vs variegated)
d - diameter (less vs greater than 6 cm)
103
tx for benign melanoma
monitor
| educate patient
104
tx for suspicious melanoma
excise with 2-3 mm margin
105
how do you excise malignant melanomas
5 mm margin
if on face, refer to plastic surgeon
106
what is follow-up after excising a melanoma
annual follow-up
| observe for new/changing lesions
107
most important prognostic indicator for melanoma
thickness of tumor
(aka breslow measurement)
less than 1mm thick has low rate of metastasis
108
how to prevent melanomas
reduce exposure to UV radiation
clothe properly
sun-screen
109
describe basal cell carcinomas
pearly papules
central ulceration
multiple telangiectasias
bleeds or itches
110
tx for bcc
excision
rarely metastasizes
111
which metastasizes more: scc or bcc
scc
112
describe scc
irregularly shaped plaques or nodules with raised borders
scaly
ulcerated
bleed easily
113
tx for scc
excision
114
how do you image the upper urinary tract
IV Pyelo
115
how do you image the lower urinary tract
cystoscopy
116
define microscopic hematuria
>3 RBC per HPF
from 2-3 Ua tests
freshly voided
morning
clean catch
midstream urine
117
eos in the urine
interstitial nephritis
118
how long does exercise-induced hematuria last
less than 72 hours
119
pt with hematuria, has repeat Ua showing hematuria again, what do you do next
full work-up
Ua
microsopy of urinary sediment
Ucx to r/o UTI
BMP to get Cr --> focus on renal cause if elevated (May need renal bx)
120
what exactly is an IVP
x-ray of urinary tract after administration of contrast
121
CT with or without contrast to look for calculi
non-con
122
complication of CT with con or IVP
risk factor for it
how do you prevent it
nephropathy
renal insufficiency
premedicate with N-acetylcysteine
123
if patient has renal insuff, whats another way to evaluate for upper urinary tract
retrograde pyelography with renal ultrasound
place catheter in the bladder and inject contrast up ureter to kidneys
124
how do you examine for transitional cell carcinoma
cystoscopy
125
patient with hematuria, but with a thorough negative work-up
what do you do now?
do BP measurements
Ua
voided urine ctyologic studies
all done at 6, 12, 24 and 36 months
basically you're looking for any underlying lesions, after this if they are still asymptomatic, then no further tests required
however, if they still have sx (i.e. hematuria, dysuria, develops HTN, proteinuria, casts), refer to urologist
126
is radioactive iodine therapy safe in pregnant woman
no
radioactive isotope can cross placenta and cause fetal thyroid ablation
alternative: surgical removal of thyroid
127
meds for graves
antithyroid drugs (PTU and methimazole)
beta-blockers to counter peripheral effects
these are only temporary
128
definitive tx for graves
radioactive iodine
| destroys thyroid gland
129
signs and sx
| thyroid storm
fever
confusion
restlessness
psychotic-like behavior
```
tachycardia
elevated BP
dysrhythmias
dyspena on exertion
peripheral vasoconstriction
```
130
signs and sx
| hyperthyroidism
```
nervous
palpitations
wt loss
fine resting tremor
dyspnea on exertion
difficulty with concentration
```
131
50% of graves has this finding
exophthalmos
132
how do you diagnose hyperthyroidism
low TSH
| high Free T4
133
you suspect graves dz
| whats your next step
imaging with technetium-99
its a radionucleotide scan
tells you active/inactive areas
usually DIFFUSE uptake
134
radionucleotide scan in thyroiditis vs graves
graves - diffuse uptake
thyroiditis - patchy uptake
135
how does PTU and methimazole work?
inhibits organification of iodine
PTU also prevents peripheral conversion of T4 to T3
136
side effect of PTU and methimazole
agranulocytosis
137
is PTU and methimazole safe during pregnancy
YES
PTU is preferred however
138
for graves, when is surgery indicated
pregnant women
cannot tolerate side effects of PTU
large goiter compressing nearby structures
139
signs and sx of hypothyroidism
```
lethargy
weight gain
hair loss
dry skin
slow mentation/forgetfulness
constipation
intolerance to cold
depression
```
140
in elderly, differential dx for dementia
alzheimers
| hypothyroidism
141
side effect of PTU and methimazole
agranulocytosis
142
is PTU and methimazole safe during pregnancy
YES
PTU is preferred however
143
for graves, when is surgery indicated
pregnant women
cannot tolerate side effects of PTU
large goiter compressing nearby structures
144
signs and sx of hypothyroidism
```
lethargy
weight gain
hair loss
dry skin
slow mentation/forgetfulness
constipation
intolerance to cold
depression
```
145
in elderly, differential dx for dementia
alzheimers
| hypothyroidism
146
in women, differential dx for depression
depression
| hypothyroidism
147
physical findings of hypothyroidism
```
low BP
bradycardia
nonpitting edema
hair thinning or loss
dry skin
diminished relaxation of reflexes
```
148
most common cause of hypothyroidism
Hashimoto thyroiditis
149
what are secondary causes of hypothyroidism
hypothalamic or pituitary dysfxn
pts received intracranial irradiation or surgical removal of a pituitary adenoma
150
dx of primary and secondary hypothyroidism
primary:
high TSH
low Free T4
secondary:
low tsh and free T4
151
how would you distinguish between hypothalamic vs pituitary hypothyroidism
inject TRH
if TSH increases, its a hypothalamus problem
if TSH remains low, its a pituitary propblem
152
as you age, you may need to decrease levothyroxine dosage
| why?
thyroid binding to albumin decreases b/c albumin also decreases with age
monitor TSH annually in elderly
153
you find thyroid nodules on PE
what do you do next?
why?
evaluate thyroid fxn (tsh/t4)
functional adenomas with hyperthyroidism are rarely malignant
to rule out malignancy in solitary nodules
154
risk factors for thyroid malignancy
history of head/neck irradiation
family hx of thyroid cx
cervical LA
recent development of hoarseness of voice
155
tx for hyperfunctioning thyroid nodules
surgery
| radioactive ablation
156
nonfunctioning thyroid nodules
what do you do next?
assuming you found this nodule by ultrasound or physical exam
FNA biopsy
157
FNA of thyroid nodule is INDETERMINATE
whats the next step
you need a definitive dx by surgery only
this is b/c indeterminate means that you cannot distinguish between follicular cell malignancy from its benign equivalent
158
tx for thyroid malignancy
thyroidectomy
| followed by radioactive ablation
159
pregnant woman with thyroid nodule
next step?
FNA to find out what it is
thyroidectomy is SAFE
radioisotope scan is CONTRAINDICATED
or just wait til postpartum period b/c thyroid cancer is relatively indolent
