FM EOR Review Flashcards
(254 cards)
1
Q
What is the MC initial presentation of type 1 DM?
What is the 2nd MC?
A
MC = Hyperglycemia without acidosis with polyuria, polydipsia, polyphagia
2nd MC = DKA
2
Q
What are the rapid-acting insulins?
A
Lispro (Humalog)
Aspart (Novalog)
Glulisine (Apidra)
3
Q
What is the short-acting insulin?
A
Regular
4
Q
What is the intermediate-acting insulin?
A
NPH
5
Q
What are the long-acting insulins?
A
Glargine (Lantus)
Determir (Lemevir)
6
Q
What is the MC cause of DKA?
A
Infection
7
Q
What is the triad of DKA?
A
hyperglycemia, ketonemia, acidosis (rapid onset)
8
Q
What is the presentation of DKA? (8)
A
3 Ps (Polyuria, Polyphagia, Polydipsia) Fatigue AMS Abdominal pain Tachycardia Hypotension Fruity breath Kussmaul respirations
9
Q
What is the treatment of DKA? (4)
A
- Isotonic 0.9% NS until hypotension resolves. Then switch to 1/2 NS. When glucose level becomes less than 250, switch to D5 to prevent hypoglycemia from insulin therapy
- Regular insulin
- Potassium repletion
- Search for underlying cause
10
Q
What are RF for type 2 DM?
A
Obesity, decreased physical activity, genetics
11
Q
What are the screening guidelines for DM?
A
All adults ≥ 45 yo every 3 yrs OR any adult with BMI ≥ 25 + 1 risk factor
12
Q
What diagnostic findings indicate DM?
A
- Fasting Plasma Glucose ≥ 126 (GOLD STANDARD)
- 2-hour Glucose Tolerance Test ≥ 200
- HbA1C ≥ 6.5%
13
Q
What is the MOA of Metformin?
A
Decreases hepatic glucose production, increases insulin sensitivity
14
Q
What are benefits of Metformin?
A
Reduces risk of CV death, lowers LDL
15
Q
What are SE of Metformin?
A
Diarrhea, lactic acidosis, B12 deficiency
16
Q
What are CI of Metformin?
A
Severe renal (GFR < 30) or hepatic impairment Heart failure
17
Q
What is the MOA of Sulfonylureas?
A
Stimulates non glucose dependent insulin secretion
18
Q
Which Sulfonylureas are used most commonly?
A
2nd generation (Glipizide, Glimepiride, Glyburide) *Glyburide has the highest risk of hypoglycemia
19
Q
What are SE of Sulfonylureas?
A
Hypoglycemia
Weight gain
20
Q
What is the MOA of Thiazolidinediones “-glitazone”?
A
Increase insulin sensitivity
21
Q
What are SE of Thiazolidinediones “-glitazone”? (5)
A
Peripheral edema Fluid retention/weight gain CHF Hepatotoxicity Increased fractures (females)
22
Q
What are CI of Thiazolidinediones “-glitazone”? (5)
A
Heart failure
Hx of bladder cancer
Liver disease
Pregnancy
23
Q
What is the MOA of GLP1 Receptor agonists “-tide”?
A
Increases glucose dependent insulin secretion, delays gastric emptying, decreases glucagon secretion
24
Q
What are SE of GLP1 Receptor agonists “-tide”?
A
Hypoglycemia (less than sulfonylureas), pancreatitis
25
What are CI of GLP1 Receptor agonists "-tide"?
Hx of pancreatitis
Medullary thyroid carcinoma
MEN type 2
26
What DM medications can reduce risk of major CV events?
Liraglutide
Empagliflozin
Canagliflozin
27
Which DM medication are associated with weight loss?
GLP1 receptor agonists
| SGLT2 inhibitors
28
What is the MOA of DPP4 Inhibitors "-gliptin"?
Decreases degradation of GLP-1, which increases insulin release
29
What are SE of DPP4 Inhibitors "-gliptin"?
Acute pancreatitis
| Headaches
30
What are CI of DPP4 Inhibitors "-gliptin"?
Hx of pancreatitis, renal impairment (except Linagliptin)
31
What is the MOA of SGLT2 inhibitors "-gliflozin"?
Increased glucose excretion through urine
32
What are SE of SGLT2 inhibitors "-gliflozin"?
N/V
Thirst
UTI
Yeast infections
33
What are CI of SGLT2 inhibitors "-gliflozin"?
Renal impairment (GFR <30)
34
What is the blackbox warning for Canagiflozin?
Increased risk of LE amputation
35
What are the hallmarks of hyperosmolar hyperglycemic state?
Dehydration
Increased osmolarity (>320) Hyperglycemia (>600)
Absence of acidosis
Hypokalemia
36
What is the treatment of hyperosmolar hyperglycemic state?
SIPS (saline, insulin, potassium, search)
37
What is the screening recommendation for breast cancer for woman at average risk?
Woman ages 50-74 should get a mammogram every 2 years
38
What is the screening recommendation for colon cancer for patients at average risk?
1. Colonoscopy every 10 yrs
2. Fecal Occult Blood test annually
3. Flex sig every 5 yrs + fecal Occult Blood test every 3 yrs
All adults 50-75 yrs old
39
Who is considered "high risk" for CRC?
Individuals who have a 1st degree relative with CRC or advanced stage adenoma diagnosed <60 years old OR two 1st degree relatives diagnosed at any age
40
What is the screening recommendation for colon cancer for patients at high risk?
Start colonoscopy screening at age 40 OR 10 years younger than the age at which the first relative was diagnosed
Repeat colonoscopy every 5 years
41
What is the screening recommendation for colon cancer for patients with Familial Adenomatous Polyposis?
Start annual flex sig/colonoscopy screening at age 10
42
What is the screening recommendation for colon cancer for patients with Lynch Syndrome?
Colonoscopy every 1-2 yrs, beginning at age 20-25 OR 5 yrs younger than the earliest age at diagnosis in the family, whichever is sooner
43
What is the screening recommendation for lung cancer?
Annual low-dose CT for adults age 55-80 who have a 30-pack year history and currently smoke OR have quit within the last 15 years
44
At what age should you begin screening recommendation for cervical cancer?
Screen women starting at age 21 (despite age of first sexual encounter)
45
What is the screening recommendation for cervical cancer for women 21-29?
Cytology alone every 3 years
46
What are the screening recommendations for cervical cancer for women 30-64?
1. Cytology alone every 3 years
2. Cytology and HPV DNA testing every 5 years
3. HPV alone every 5 years
47
What are the recommendations for when to stop cervical cancer screening?
Stop screening at age 65 if they have had 3 prior consecutive negative results with cytology alone or have had 2 consecutive negative Co-testing results
(Most recent results need to be within 5 years, and they cannot have a history of CIN 2+ within the last 20 years)
48
What is the screening recommendation for prostate cancer?
Consider PSA for high risk men age 40-45
| No benefit in screening past 70 years
49
What is the screening recommendation for AAA?
One-time screening recommended for males 65-75 who
- Are current or past smokers
- Have never smoked, but have a first degree relative who required repair of an AAA or died from ruptured AAA
50
What is the screening recommendation for osteoporosis?
1. Postmenopausal women < 65 yo with increased risk
2. Women ≥ 65
(DEXA scan)
51
What is the dx?
Hyperpigmented velvety plaques, most commonly associated with obesity and disorders of insulin resistance like DM and Cushing’s
Acanthosis nigricans
52
What is the dx?
Inflammatory nodules and abscesses, draining sinus tracts, and fibrotic hypertrophic scars. Commonly occurs in axillary, inguinal, and anogenital regions
Hidradenitis Suppurativa “Acne Inversa”
53
What is the tx of Hidradenitis Suppurativa?
Topical Clindamycin
54
What is a CI of Isotretinoin?
Pregnancy
55
What is first line medical tx of papulopustular rosacea?
Metronidazole
56
What is the dx?
| Well demarcated round velvety, warty lesion with “stuck on” appearance
Seborrheic Keratosis
57
What is the MC premalignant skin condition?
| What can it progress to?
Actinic Keratosis
| SCC
58
What is the dx?
| Erythematous, scaly/gritty macule or papule that may be tender
Actinic Keratosis
59
What is the most common type of skin cancer?
Basal Cell Carcinoma
60
What is the dx?
Flat, firm area with small raised, translucent, pearly, or waxy papule with raised, rolled borders and central ulceration with overlying telangiectatic vessels
Basal Cell Carcinoma
61
Where are the most common sites for mets from melanoma?
Regional lymph nodes, skin, liver, lungs, and brain
62
What is the dx?
Raised well demarcated pink-red plaques or papule with thick silvery scales, commonly on extensor surfaces and yellow/brown discoloration under the nail (“oil spots”)
Plaque Psoriasis
63
What is Auspitz sign and what disease is it associated with?
Punctate bleeding with removal of plaque or scale
| Psoriasis
64
What is Koebners phenomenon and what disease is it associated with?
New, isomorphic lesions that occur at the sites of trauma
| Psoriasis
65
What is the dx?
| Smaller papule with fine scale that spares the palms and soles, commonly occurring after strep pharyngitis infection
Guttate psoriasis
66
What is the tx of psoriasis? What should you not use?
High potency topical corticosteroids
| *DO NOT use ORAL steroids (sx worsen after d/c)
67
What is the dx?
Tiny, painless papules that evolve into soft, fleshy cauliflower like lesions ranging from skin colored to pink or red, occurring in clusters in the genital region and oropharynx
Condyloma Acuminata (genital warts)
68
What is the dx?
Single or multiple firm dome-shaped, flesh colored to pearly white, waxy papule 2-5mm in diameter with central umbilication
Molluscum Contagiosum
69
What is the dx?
Target lesions consisting of 3 components
-Dusky central area or blister
-Dark red inflammatory zone surrounding by a pale ring of edema
-Erythematous halo on the extreme periphery of the lesion
Erythema Multiforme
70
What is the etiology of Erythema Infectiosum (Fifth disease)?
Parvovirus B19
71
What is the dx?
- Prodrome
- Erythematous malar rash with a “slapped cheek” appearance and circumoral pallor
- Followed by a lacy, reticular maculopapular rash on the extremities that spares the palms and soles
- Arthralgias in adolescents and adults
Erythema Infectiosum (Fifth disease)
72
What is the etiology of Rubeola?
Measles
73
What is the dx?
- Prodrome with malaise, anorexia, high fever, and 3 C’s (cough, coryza, conjunctivitis)
- Followed by Kolpik spots and morbilliform, brick red rash beginning at hairline and spreading down
Rubeola
74
What is the dx?
- Prodrome
- Oral enanthem: erythematous macule that become painful, oral vesicles surrounded by a thin halo of erythema that undergo ulceration
- Greyish yellow vesicular macular lesions on the distal extremities often including palms and soles
Hand Foot and Mouth
75
What is the dx?
Localized macular erythema, not sharply demarcated, swelling, warmth, and tenderness
If systemic, fever, chills, lymphadenopathy, lymphangitis
Cellulitis
76
What is the tx for mild cellulitis?
PO Cephalexin, Dicloxacillin, or Clindamycin
77
What is the tx for rapidly progressing cellulitis?
IV Cefazolin, Oxacillin, or Clindamycin
78
What is the dx?
| Papules, vesicles, and pustules with weeping and later development of honey-colored, golden crusts
Impetigo
79
What is the tx of mild and moderate/severe impetigo?
Mild: Topical Mupirocin
| Mod/severe: PO Cephalexin or Dicloxacillin
80
What is the major electrolyte abnormality associated with hyperparathyroidism?
Hypercalcemia
Bones- abnormal bone remodeling and fracture risk
Stones- increased risk for kidney stones
Groans- abdominal cramping, nausea, ileus, constipation
Psychiatric overtones- lethargy, depressed mood, psychosis, cognitive dysfunction
81
What effect does Primary Adrenal Insufficiency have on
1. Cortisol
2. CRH
3. ACTH
4. MSH
5. Na
6. K
1. Decreased cortisol
2. Increased CRH
3. Increased ACTH
4. Increased MSH (hyperpigmentation)
5. Hyponatremia
6. Hyperkalemia
82
What is the dx
| Pruritic vesicles of 1-2mm on soles, palms, and sides of fingers that appear to contain grains of tapioca?
Dyshidrotic eczema
83
What is the tx of Vasospastic angina?
CCB
84
```
What type of HF is associated with:
Paroxysmal Nocturnal Dyspnea (PND)
Pulmonary congestion: cough (blood-tinged sputum), crackles, wheezes
Cyanosis
Cheyne-stokes breathing
```
Left sided HF
85
```
What type of HF is associated with:
Peripheral edema
JVD
Ascites
Weight gain/anorexia
Hepato/splenomegaly
```
Right sided HF
86
What is the tx of orthostatic hypotension?
Increasing salt and fluid intake
| Fludrocortisone if persistent symptoms (promotes Na and water reabsorption)
87
What are the guidelines for initiating statin therapy? (5)
- Patients with diabetes between ages 40-75
- Patients without CVD ages 45-75 and >7.5% risk for having MI or stroke in next 10 years
- Patients >21 with LDL >190
- Any patient with atherosclerotic CVD
- Patients <19 with familial hypercholesterolemia
88
What disease are the following associated with?
- Osler nodes (painful nodules on pads of digits and palms)
- Janeway lesions (painless macule on palms and soles)
- Splinter hemorrhages
- Roth spots (oval retinal hemorrhages with pale centers)
Infectious endocarditis
89
What is the dx?
| Systolic crescendo-decrescendo murmur best heard at the right sternal border and radiates to the carotid
Aortic stenosis
90
What is the dx?
| Diastolic blowing murmur best heard at the left upper sternal border
Aortic regurgitation
91
What is the dx?
| S1 with opening snap with a mid-diastolic rumbling murmur
Mitral stenosis
92
What is the preferred tx for symptomatic mitral valve stenosis?
Percutaneous balloon valvuloplasty
93
What is the dx?
| Blowing holosystolic murmur best heard at the apex with radiation to the axilla
Mitral regurgitation
94
What type of murmur is associated with mitral valve prolapse?
Mid-systolic click
95
What is the dx?
Always congenital
Mid-systolic ejection murmur that increases with inspiration
Pulmonic stenosis
96
What is the dx?
Always congenital
Graham-Steel murmur: brief decrescendo early diastolic murmur at LUSB with full inspiration
Pulmonic regurgitation
97
What is the dx?
Harsh mid-systolic crescendo-decrescendo systolic murmur
Increases with Valsalva and decreases with squatting
Hypertrophic cardiomyopathy
98
What is the presentation of Emphysema/COPD?
- Dyspnea
- Minimal cough
- Pink skin, pursed lip breathing
- Accessory muscle use
- Cachexia
- Barrel chest
99
What is the presentation of Chronic Bronchitis/COPD?
- Chronic productive cough
- Purulent sputum/Hemoptysis
- Dyspnea
- Cyanosis
- Peripheral edema
- Crackles, wheezes, prolonged expiration
- Obese
100
How is COPD dx?
PFTs (obstructive pattern)
| CXR (hyperinflation, flattened diaphragms, increased AP diameter)
101
What type of asthma?
Symptoms less than 2 days a week, uses SABA less than 2 days a week, less than 2 nighttime awakenings
What is the tx?
Intermittent
| SABA prn
102
What type of asthma?
Symptoms more than 2 days a week, but not daily. 3-4 nighttime awakenings a month
What is the tx?
Mild persistent
| SABA prn + low dose ICS
103
What type of asthma?
Daily symptoms and daily use of SABA. At least one nighttime awakening per week, but not nightly
What is the tx?
Moderate persistent
| SABA prn + high dose ICS or LABA
104
What type of asthma?
Symptoms throughout the day, nightly awakenings
What is the tx?
Severe asthma
| SABA prn + high dose ICS + LABA
105
What is the tx of outpatient uncomplicated PNA?
Macrolide, Doxycycline, or Amoxicillin
106
What is the tx of inpatient PNA?
B-lactam + Macrolide, or Doxycycline
107
What antibiotic is first-line therapy for human bite infection prophylaxis?
Amoxicillin-clavulanate (Augmentin)
108
What is the tx of perioral dermaitis?
Metronidazole or erythromycin
109
What is Fitz-Hugh-Curtis?
Peri-hepatitis - a complication of pelvic inflammatory disease
110
What is the dx?
| Low back pain that's most severe at night and morning stiffness that improves with exercise or movement
Ankylosing Spondylitis
111
What diseases associated with HLA-B27?
PAIR: Psoriatic arthritis, Ankylosing spondylitis, Inflammatory bowel disease, Reactive arthritis
112
How is lactose intolerance dx?
Usually clinical, lactose tolerance test, lactose breath hydrogen test
113
What is the tx of poison ivy?
Prednisone taper over 14-21
114
Which antiepileptic medication can cause hirsutism and gingival hyperplasia?
Phenytoin
115
What is the tx of Rocky Mountain Spotted Fever?
Treatment is ALWAYS doxycycline, even in children
116
What antibody is associated with Grave's disease?
TRAb (Thyrotropin receptor antibodies)
117
What antibody is associated with Hashimoto's disease?
```
TPO Ab (anti-thyroid peroxidase antibodies)
TgAb (anti-thyroglobulin antibodies)
```
118
What is the dx?
- Previous illness
- Acute asymmetric arthritis
- Conjunctivitis, arthritis, urethritis
- Labs: HLA-B27
Reactive arthritis
119
Which tetanus prophylaxis should pts overthe age of 7 receive?
Tdap
120
What are the two tx options for H. pylori infection?
Triple therapy: Clarithromycin, Amoxicillin, Omeprazole (or other PPI)
Quad therapy: Bismuth, Metronidazole, tetracycline, Omeprazole (or other PPI)
121
Fluorescein staining reveals a dendritic lesion over the cornea. What is the most likely diagnosis based on this finding?
Herpes Keratitis
122
```
What is the dx?
Chvostek’s sign (facial muscle contraction)
Trousseau’s sign (carpopedal spasm)
Hyperreflexia
Prolonged QT interval
```
Hypocalcemia
123
Which drug class should be avoided in Vasospastic angina?
Beta blockers
124
CXR shows cephalization, Kerley B lines, and pleural effusion. What are you suspicious of?
CHF
125
What is the standard pharmacologic tx of heart failure?
Loop diuretic, ACEI, and BB
126
What are the stages of HTN?
Pre-HTN: 120/139/80-89
Stage I: 140-159/90-99
Stage II: >160/100
127
What is first line tx for HTN?
ACEI/ARB
Thiazide diuretic
CCB
128
What is the dx for HTN urgency and emergency?
HTN urgency: SBP >180 and/or DBP >120 WITHOUT evidence of end organ damage
HTN emergency: SBP >180 and/or DBP >120 WITH evidence of end organ damage
129
What is the dx for orthostatic hypotension?
Hypotension within 2-5 minutes of quiet standing defined by at least a 20mmHg fall in systolic and/or 10mmHg fall in diastolic pressure
130
What are the following called and what disease are they associated with?
1. Painful violaceous nodules on pads of digits and palms)
2. Painless erythematous macules on palms and soles)
3. Linear reddish-brown lesions under the nail bed)
4. Retinal hemorrhages with pale centers)
Endocarditis
1. Osler nodes
2. Janeway lesions
3. Splinter hemorrhages
4. Roth spots
131
What is the tx of endocarditis with native valve?
PNC (Nafcillin, Oxacillin) + Ceftriaxone OR Gentamicin
132
What is the tx of endocarditis with prosthetic valve?
Vancomycin + Gentamicin + Rifampin
133
What is the tx of pericarditis?
NSAIDs (ibuprofen or Indomethacin) or ASA
| Colchicine = 2nd line
134
Name the arrhythmia:
| prolonged PR interval (>.20s), all P waves followed by QRS complexes
1st degree AV Block
135
Name the arrhythmia:
| constant prolonged PR interval and dropped QRS complexes
2nd degree AV Block type 2
136
Name the arrhythmia:
| progressive PR interval lengthening followed by dropped QRS complex
2nd degree AV Block type 1
137
Name the arrhythmia:
| AV dissociation; regular P-P intervals and regular R-R interval, but they are not related to each other
3rd degree AV Block
138
Name the arrhythmia:
| irregularly irregular rhythm, no discernable P waves
Atrial fibrillation
139
Name the arrhythmia:
| Regular, narrow-complex tachycardia, no discernable P waves (MC)
Paroxysmal Supraventricular Tachycardia (PSVT)
140
```
Name the arrhythmia:
delta wave (slurred QRS upstroke), shortened PR interval, wide QRS complexes
```
Wolff-Parkinson-White (WPW)
141
Name the arrhythmia:
| inverted or absent P waves
AV Junction Dysrhythmias
142
Name the arrhythmia:
| regular wide complex tachycardia with no discernable P waves
Ventricular Tachycardia
143
Harsh systolic crescendo-decrescendo murmur best heard at the right sternal border
Increased intensity: leaning forward, squatting, supine
Aortic Stenosis
144
Blowing diastolic decrescendo murmur best heard at the left sternal border
Increased intensity: leaning forward, squatting, supine
Aortic Regurgitation
145
What murmur radiates to the carotid?
Aortic Stenosis
146
Rumbling mid-diastolic murmur with a prominent S1 and opening snap best heard at the apex
Increased intensity: left lateral decubitus position, leaning forward, squatting, supine
Mitral Stenosis
147
Blowing holosystolic murmur best heard at the apex
| Increased intensity: left lateral decubitus position, leaning forward, squatting, supine
Mitral Regurgitation
148
Mid-late systolic ejection click best heard at the apex
Mitral Valve Prolapse (MVP)
149
What murmur radiates to the axilla?
Mitral Regurgitation
150
What causes an earlier MVP click?
Valsalva, standing
151
What causes a delayed MVP click?
Leaning forward, squatting, supine
152
Harsh mid-systolic crescendo-decrescendo murmur beast heard at left sternal border
Increased intensity: inspiration
Pulmonic Stenosis
153
What is the tx of Acute Arterial Occlusion?
Consult vascular surgery for revascularization surgery
IV heparin bolus and continuous infusion
Once stable, Warfarin for 3+ months
154
What is Virchow's triad?
Venous statis
Endothelial damage
Hypercoagulability
(DVT)
155
What is the dx?
Unilateral leg swelling > 3 cm
Palpable cord
Normal pulses
DVT
156
What vascular disease has the follow leg pain?
Worse with walking/elevation
Improved with dependency/rest
Peripheral Artery Disease (PAD)
157
What vascular disease has the follow leg pain?
Leg pain worse with dependency
Improved with walking/elevation
Chronic Venous Insufficiency
158
What is the tx of Peripheral Artery Disease (PAD)
Exercise, smoking cessation
| Cilostazol
159
In which patients would a PPD reading of 5+ mm constitute a positive test?
HIV +
Immunocompromised
Exposure
CXR consistent with old TB (calcified granuloma)
160
In which patients would a PPD reading of 10+ mm constitute a positive test?
```
IVDU
Homeless
Age < 4 yo
Immigrant
Recent travel
```
161
In which patients would a PPD reading of 15+ mm constitute a positive test?
everyone
162
Where are you most likely to see cavitations in a patient with reactivated TB?
Apex/upper lobes
163
What are SE of Rifampin?
Orange colored secretions, thrombocytopenia
164
What are SE of Isoniazid?
Hepatitis, peripheral neuropathy
165
What should be given with Isoniazid to prevent peripheral neuropathy?
Pyridoxine (vit B6)
166
What are SE of Pyrazinamide?
Hepatitis, hyperuricemia, photosensitivity
167
What are SE of Ethambutol?
Optic neuritis
168
What is the tx of latent TB?
Isoniazid + Pyridoxine (vit B6) x9 months
169
What is the most common primary lung cancer?
Adenocarcinoma
170
Which type of lung cancer is typically peripherally located?
Adenocarcinoma
171
Which type of lung cancer is aggressive and typically presents with early metastasis?
Small Cell (oat) carcinoma)
172
Which lung cancers are classified as non-small cell cancer?
Adenocarcinoma, Large cell, Squamous cell
173
GERD and Barret's esophagus are RF for which type of esophageal cancer?
Adenocarcinoma (MC in Caucasians)
174
What is the MCC of gastroenteritis in adults in the US?
Norovirus
175
What type of gastroenteritis is MC in unimmunized children?
Rotavirus
176
Which types of non-invasive infectious diarrhea have a short incubation period (within 6 hours)?
Staphylococcus aureus Gastroenteritis
| Bacillus Cereus Gastroenteritis
177
Which type of non-invasive infectious diarrhea is associated with dairy products?
Staphylococcus aureus Gastroenteritis
178
Which type of non-invasive infectious diarrhea is associated with rice?
Bacillus Cereus Gastroenteritis
179
Which type of non-invasive infectious diarrhea is associated with an exotoxin that causes secretory diarrhea leading to profound dehydration, and hypovolemia?
Vibrio Cholerae
180
Which type of non-invasive infectious diarrhea is associated with copious watery diarrhea- “rice water diarrhea” (grey with flecks of mucous and fishy odor, no blood)?
Vibrio Cholerae
181
What type of non-invasive infectious diarrhea is transmitted through raw or undercooked shellfish consumption and seawater?
Vibrio Parahaemolyticus and Vulnificus
182
What are RF for C. diff?
Recent abx use (esp. Clindamycin)
| Advanced age
183
What is the tx of C. diff?
Discontinue offending medication
Contact precautions and hand hygiene (spore forming!)
Oral Vancomycin = 1st line
184
What should never be given to pts with invasive infectious diarrhea?
Anti-motility agents
185
What are the types of invasive infectious diarrhea?
“Bloody diarrhea doesn’t sound SEECSY”
| -Salmonella (Typhoid fever), E. Coli, Entamoeba, Campylobacter, Shigella, Yersinia
186
What type of invasive infectious diarrhea causes pea-soup green colored diarrhea?
Salmonella (Typhoid fever)
187
What is the tx of Salmonella (Typhoid fever)?
Fluoroquinolones (Ciprofloxacin, Ofloxacin)
188
What type of invasive infectious diarrhea commonly transmitted via undercooked ground beef?
Enterohemorrhagic E Coli 0157:H7
189
What is the MCC of bacterial enteritis in the US?
Campylobacter jejuni
190
How is Campylobacter jejuni transmitted?
Raw/undercooked poultry (MC), puppies are common source in children
191
What is the tx of Campylobacter jejuni in severe/high risk pts?
Macrolides (Azithromycin)
192
What type of gastroenteritis causes explosive watery diarrhea that progresses to mucoid and bloody diarrhea?
Shigella
193
What is a common manifestation of shigella in children?
Neurologic manifestations (febrile seizures)
194
What is the tx of Shigella in severe cases?
Fluoroquinolones (Ciprofloxacin, Ofloxacin)
195
How is Yersinia Enterocolitica commonly transmitted?
Contaminated pork
196
What is the tx of Yersinia Enterocolitica in severe cases?
Fluoroquinolones (Ciprofloxacin, Ofloxacin)
197
What type of gastroenteritis causes frothy, greasy, foul smelling diarrhea without blood or pus? What is the tx?
Giardia
| Metronidazole
198
What type of gastroenteritis can have GI symptoms that range from mild diarrhea to severe dysentery and is associated with liver abscess?
Entamoeba Histolytica
199
What is the tx of Entamoeba Histolytica?
1. Colitis
2. Liver abscess
3. Asymptomatic
1. Metronidazole, then intraluminal parasitic (Paromomycin)
2. Metronidazole + intraluminal parasitic (Paromomycin), then Chloroquine
3. Intraluminal agent monotherapy (Paromomycin)
200
What are Charcots triad and reynods pentad?
Acute Ascending Cholangitis
Charcot’s triad: Fever, RUQ pain, jaundice
Reynolds pentad: Fever, RUQ pain, jaundice, AMS, hypotension
201
What is the MCC of UGI bleed?
PUD
202
Which types of hepatitis are transmitted via fecal-oral?
Hep A and E
203
Which type of hepatitis is most likely to develop into chronic disease?
Hep C
204
What do the following labs indicate?
| (+) HBsAg, (+) IgG
Chronic Hep B infection
205
What do the following labs indicate?
| (+) Anti-HBs
Vaccinated against Hep B
206
What do the following labs indicate?
| (+) Anti-HBs, (+) IgG
Recovered Hep B infection
207
What do the following labs indicate?
| (+) HBsAg, (+) IgM
Acute Hep B infection
208
How is acute Cholecystitis dx?
US = initial test of choice
| HIDA scan is most accurate
209
What are Cullen's sign and Grey Turner Sign?
Cullen’s sign (periumbilical ecchymosis)
| Grey Turner Sign (flank ecchymosis)
210
What is the dx:
Constant boring epigastric pain, that radiates to the back, N/V, fever
Worse lying supine\o Improved with leaning forward
Acute pancreaitis
211
What is the dx:
RUQ or epigastric pain, commonly precipitated by ingesting large, fatty meals
N/V, fever, enlarged gallbladder
Murphy’s sign and Boas sign
Acute Cholecystitis
Murphy's sign = RUQ pain or inspiratory arrest with palpation of gallbladder
Boas sign = Referred pain to the right shoulder (irritation of phrenic nerve)
212
What skin manifestation is associated with Celiacs disease?
Dermatitis herpetiformis
213
What is the MCC of large and small bowel obstructions?
```
SBO = post-surgical adhesions
LBO = malignancy (CRC)
```
214
What is the dx?
| Tearing, edema, erythema, warmth to the medial nasal side of lower lid
Dacryocystitis
215
What is the dx?
Sudden onset of severe unilateral ocular pain, halos around lights, loss of peripheral vision (tunnel vision), mid-dilated fixed pupil
Acute Narrow Angle-Closure Glaucoma
216
What is the dx?
Photopsia (flashing lights), followed by floaters, followed by painless unilateral peripheral vision loss
“Shadow or curtain coming down”
Retinal detachment
217
What is the dx?
Bilateral progressive central vision loss (including detailed and colored vision), metamorphopsia (straight lines appear bent)
Drusen bodies
Macular degeneration
218
What is the tx of AOM?
Amoxicillin
219
What is the Centor criteria for Strep pharyngitis?
Absence of cough
Cervical LAD
Fever
Tonsillar exudates
220
What is the tx of Strep pharyngitis?
PNC (Amoxicillin)
221
What is the MCC of conductive hearing loss?
Otitis media
222
What is the MC type of cervical cancer? What is the MC cause?
Squamous cell carcinoma
| HPV 16
223
What is the MC type of breast CA?
Infiltrative Ductal carcinoma
224
What is the most effective emergency contraceptive?
Copper IUD (within 5-7 days)
225
What are CI of OCP?
Ischemic heart disease
DVT/PE
Breast cancer
Smokers > 35 years old
226
What should be done in all women >35 years with obesity, HTN, or DM who present with postmenopausal bleeding?
Endometrial biopsy to rule out endometrial carcinoma
227
How is menopause dx?
```
Cessation of menses > 1 year
FSH assay (increased FSH, increased LH, decreased estrogen)
```
228
How is PID dx?
```
Must have abdominal tenderness, CMT, and adnexal tenderness, PLUS one of the following:
Positive gram stain
Fever
WBC count >10,000
Increased ESR or CRP
```
229
What is the dx?
| Laparoscopy shows “violin string” adhesions on the anterior liver surface
Fitz Hugh-Curtis syndrome
230
```
What is the dx?
Copious thin, homogenous, grayish-white vaginal discharge
Vaginal pH > 4.5
Positive whiff-amine test (fishy odor)
Clue cells on wet mount
```
Bacterial Vaginosis
231
What is the dx?
| Copious frothy yellow green discharge with cervical petechiae (strawberry cervix)
Trichomoniasis
232
What is a normal fetal HR?
120-160bpm (detected at 10-12 weeks by doppler)
233
What should the fundal height be at 20 weeks gestation?
at the umbilicus
234
What is Naegele’s rule?
Estimated date of delivery (EDD)
1st day of last menstrual period plus 7 days subtract 3 months
235
What weeks are associated with 1st, 2nd, and 3rd trimesters?
1st: 1-12
2nd: 13-27
3rd: 28-birth
236
When is screening completed for gestational DM?
24-28 weeks
237
If mother is Rh-D negative when should RhoGAM be given?
28 weeks AND within 72 hours of delivery
238
When should Group B Streptococcus screening be completed? What is the tx if positive?
36-38 weeks
| Prophylactic IV PNC G given during labor
239
In what part of the prostate does benign prostatic hyperplasia most commonly develop?
Transitional zone
240
What is Virchows node?
Palpable left supraclavicular lymph node associated with gastric and pancreatic cancers
241
What is Sister Mary Joseph sign?
Palpable nodule bulging into the umbilicusassociated with gastric and pancreatic cancers
242
What is the preferred initial diagnostic test of choice to evaluate painless vaginal bleeding in a postmenopausal patient in order to rule out endometrial (uterine) carcinoma?
```
Transvaginal US (or endometrial biopsy)
Measure endometrial thickness
Normal
Premenopausal = < 5 mm
Postmenopausal = < 3-4mm
```
243
What does a dendritic pattern on fluorescein examination indicate?
Infection with the herpes simplex virus
244
Patient presents with a erythematous, scaly plaque that is annular, has raised edges, sharply marginated, with a central clearing.
What is the tx?
```
Tinea Corporis (Ring Worm)
Topical Clotrimazole
```
245
What is the tx of ventricular tachycardia?
Procainamide, amiodarone, synchronized cardioversion (refractory)
246
What is the dx?
Morning stiffness that lasts > 1 hour, improves later in the day in small joints (wrist, MCP, PIP, MTP, ankle), spares DIP
Ulnar deviation
Rheumatoid Arthritis (RA)
247
What labs are seen with lupus?
ANA is screening test of choice but is not specific
| Anti-double stranded DNA and anti-smith are pathognomonic and specific for SLE
248
What is the tx of acute gout?
NSAIDs, steroids, Colchicine
249
What is the tx for gout prophylaxis?
Allopurinol or Probenecid
250
What triad is associated with Parkinson's disease?
Resting tremor, bradykinesia, muscle rigidity
251
What is the tx of Parkinson's disease?
```
Levodopa-Carbidopa = 1st line
Dopamine agonists (Bromocriptine, Pramipexole, Ropinirole
```
252
What is the dx?
| Sudden onset of hyperacusis 24-48 hours followed by unilateral facial weakness/paralysis involving the forehead
Bell’s Palsy
253
What is tx of Guillain Barre syndrome?
Plasmapheresis or IVIG
254
What is the tx of Alzheimer dementia?
```
ACh inhibitors (Donepezil, Rivastigmine, Galantamine)
NMDA antagonists (Memantine)
```
