FM Practice Flashcards
(156 cards)
1
Q
Pt presents with swan neck deformity in the digits and a malar rash. What disorder should come to mind?
A
Systemic lupus erythematosus
2
Q
Pt collapses choking on a piece of chewed up meat that results in complete airway obstruction is called
A
Cafe coronary syndrome
3
Q
Name the prophylactic drugs for migraines
A
Propranolol, Verapamil (CCB), Amitriptyline (TCA), Valproate/Topiramate (anticonvulsants), Botulinum toxin (last line)
4
Q
Name treatments for acute migraines
A
Dihydroergotamine, triptans, NSAIDs, acetaminophen, antiemetics
5
Q
First line treatment for osteoarthritis
A
NSAIDs (oral)
6
Q
Treatments for osteoarthritis
A
Oral/topical NSAIDs, topical capsaicin, duloxetine, intra-articular corticosteroid injections
7
Q
First line treatment for a bacterial sinus infection
A
Amoxicillin or Augmentin (if resistance)
Allergy = doxy
8
Q
What meds are CI for acid reflux during pregnancy?
A
Antacids with sodium bicarbonate (TUMs or rollaids) and Magnesium trisillicate
9
Q
First line for mild to moderate Alzheimer’s
A
Cholinesterase inhibitors = rivastigmine, galantamine
10
Q
What drug can be used as monotherapy in severe Alzheimer’s?
A
NMDA receptor antagonist = memantine
11
Q
Most sensitive screening tool to diagnose hypothyroidism?
A
TSH assay
12
Q
MC cause of primary hypothyroidism?
A
Hashimoto thyroiditis
13
Q
47 y/o pt presents with lengthening and irregular periods with hot flashes
A
perimenopause
14
Q
Most effective treatment for menopausal symptoms?
A
Estrogen
15
Q
Female in menopause wants to treat her symptoms. What are her treatment options?
A
Uterus = E2 + progesterone Hysterectomy = E2 unopposed
16
Q
Pt with menopause labs will show
A
Decreased E2 and elevated FSH
17
Q
Ocular pain, eye lid swelling, erythema, pain with eye movement
A
Orbital cellulitis
18
Q
How to dx and treat orbital cellulitis
A
CT scan and broad spectrum abx (vanc + piperacillin-tazobactam)
19
Q
Difference between hordeolum and chalazion
A
- hordeolum is a PAINFUL, erythematous stye or bump on eyelid eyelash line
- chalazion is non-tender, non-erythematous bump on eyelid
20
Q
Difference btw pterygium and pinguecula
A
pterygium = triangular shaped tissue that extends into cornea from sclera that may interfere with vision Pinguecula = yellowish elevated bump that does not extend over cornea
21
Q
Janeway lesions vs osler nodes
A
Janeway = non-tender, erythematous macules/nodules on palms or soles of feet (tiny blood clots in capillaries)
Osler: Tender, palpable lesions (immune complexes)
22
Q
Janeway lesions (non-tender), osler nodes (tender), and roth spots on the retina should all make you think of
A
Infective endocarditis
23
Q
2 major diagnostic criteria for infective endocardititis
A
- Positive blood cultures for typical microorganisms (S. aureus, S. Viridans are MC)
- New murmur or finding on echo
24
Q
Elevated FSH is most likely indicative of
A
premature ovarian failure
25
First line medications for PCOS pt trying to become pregnant?
Clomiphene, letrozole, metformin
26
MC non-small cell lung cancer
adenocarcinoma
27
72 y/o male presents with cough, chest pain, SOB, and bright red sputum. EKG is normal. What is most likely the diagnosis?
NSCLC = adenocarcinoma of the lung
28
Pt's age 50-80 with 20 pack year smoking history should get what annually
Low dose helical CT of the chest
29
Rapid, abrupt decline in mental status over 2 days
Delirium
30
First line med for delirium
Haloperidol
31
What drug is CI in delirium
BZDs
32
What MUST be monitored when a pt is on allopurinol?
Creatinine bc it's renally excreted
33
First line med for an acute gout flare up
NSAIDs and ice
34
What two drugs are CI in pts with gout and WHY?
ASA and loop & thiazide diuretics. Both increase uric acid reuptake
35
Treatment for acute gout other than NSAIDs
Triamcinolone injection, prednisone, colchicine
36
Long term goat therapy
Allopurinol or febuxostat
37
Episodic vertigo, sensorineural hearing loss, tinnitus should make you think of what disease
Meniere's disease
38
Pt presents with aural fullness, sensorineural hearing loss, tinnitus, and episodic vertigo. What is the first line treatment
Low sodium diet
39
Medical treatment for meniere's disease
Diuretics, betahistine (increases cochlear BF), prednisone, BZDs
40
What does the epley maneuver treat?
BPPV
41
Cobblestoning on colonoscopy indicates
Crohn's disease; skipped areas of involvement throughout SI and LI is normal
42
Complication of crohn's that involves other systems
Fistulas
43
Pt presents with non-bloody diarrhea, ASCA positive (antibodies), skip lesions on colonoscopy, cobblestoning mucosa, and transmural inflammation.
Crohn's disease
44
Alcoholics are at risk for the 3 D's. What are they and what causes them
Dermatitis, Diarrhea, Dementia (also death) from Pellagra = niacin deficiency
45
What is measured in the blood to determine niacin status
N-methylnicotinamide (this will be low in alcoholics)
46
What cells are seen on biopsy in pts with non-hodgkin's lymphoma?
Reed-sternberg cells
47
What is recommended for women with non-hodgkin's lymphoma once remission has been established?
Mammograms at 40y/o or 5-8 years after radiation
48
USPSTF recommends mammography for who?
Women biennially ages 50-75
49
Describe mammary Paget's disease
Eczematous skin around nipple and areola. Rare breast cancer
50
MC type of breast cancer
Invasive ductal carcinoma
51
Diminished S1 with a holosystolic murmur best heard at the apex is a hallmark finding for
Mitral regurgitation
52
Listening at the RIGHT second intercostal space allows you to listen to the
Aortic valve
53
Listening at the lower left sternal border =
Tricuspid valve
54
Listening at left second intercostal space =
Pulmonic valve
55
High pitched diastolic murmur heard at R 2nd intercostal space
Aortic regurgitation
56
Pt presents with angina upon exertion, dyspnea, and a harsh systolic ejection murmur that radiates to the carotids best heard at the right 2nd intercostal space. What murmur is this?
Aortic stenosis
57
Rumbling diastolic murmur best heard in the left lateral decubitus position
Mitral stenosis
58
How do you know a kid swallowed a battery instead of a coin?
Double rim on x-ray
59
What FB should be emergently removed?
Batteries, magnets, sharp FB, FB that will not pass
60
Foreign bodies most commonly get lodged at what level
C6 > T4 > T11
61
Pt presents to the ED with blood in anterior chamber, unequal pupils, and decrease in vision. What do you do?
Emergency consult to opthalmology
62
What is ghost cell glaucoma?
Increased intraocular pressure from hyphema
63
isolated thrombocytopenia with platelets of primarily normal morphology would indicate what condition
Primary immune thrombocytopenia
64
4 y/o pt presents with petechiae, gingival bleeding, epistaxis, and easy bruising. What is your first line treatment?
High dose corticosteroids for immune thrombocytopenia (or low dose with IVIG)
65
No active or passive movement in the shoulder is called what and how do we treat it?
Adhesive capsulitis = frozen shoulder
| Tx: corticosteroid injection
66
What two endocrine disorders are thought to correlate with adhesive capsulitis?
Diabetes and hypothyroidism
67
What might you see on MRI with adhesive capsulitis
Coracohumeral ligament thickening
68
Fixed PR intervals with a dropped beat is referred to a
Mobitz type II; second degree heart block type II
69
Lengthening PR intervals with a dropped beat
Second degree heart block type I; Wenkebach or Mobitz I
70
PR interval >200ms is a
first degree heart block
71
Pt presents with bulbar conjuntiva (erythema of sclera) and serous discharge. Dx?
VIRAL conjunctivitis. MC is adenovirus
72
Somatic complaints are typical in depression (T/F)
T
73
76 y/o male presents with swelling anterior to his ear. IT's tender and there is purulent discharge coming from the Stenson's duct. What is the first step in management
Hospitalize pt and start fluids and IV abx:
Nafcillin + metronidazole
OR
pipercillin/sulbactam
74
Bilateral parotitis in a 12 y/o should make you think of
Mumps
75
Pt presents with a CVA. She had an MI 2 months ago. What is contraindicated?
Fibrinolytics
76
When can you give fibrinolytics to a pt with a CVA?
Onset <4.5 hrs ago
77
Name 2 disorders associated with a spontaneous pneumothorax
Marfan's syndrome and Homocystinuria
78
Name the 3 biggest predictors of future bone fractures
Age, low bone mineral density, and previous fractures
79
Name 3 treatments for hyperthyroidism
Propranolol, propylthiouracil, methimazole
80
Pt presents with constipation, anorexia, polydypsia, nephrolithiasis, and hypercalcemia. What do you think is the diagnosis?
Hyperparathyroidism
81
Episodic headache, sweating and tachycardia....what should you think of?
Pheochromocytoma
82
What drug should be used to treat hyperthyroidism during pregnancy?
PTU
83
What is the gold standard diagnostic study for PAD?
Angiogram. (CT angio)
84
Pts that are 60y/o or older are held to what standard of systolic BP according to the JNC 8?
<150
85
MC cause of pancreatitis
Gallstone related disease
86
How elevated are pancreatic enzymes in acute pancreatitis?
3x the UL of normal
87
Name 2 types of bruising associated with pancreatitis
```
Grey Turner (flank)
Cullen's sign (umbilicus)
```
88
Pt with a first degree relative with hx of colon cancer should get their first colonoscopy at age
40
89
Initial therapy for anal fissure
Topical nifedipine or nitro
90
BBs that do not carry a risk associated with glucose intolerance
Carvedilol and nebivolol
91
Scrotal mass lateral to epigastric artery is an
Indirect inguinal hernia
92
Scrotal mass medial to epigastric artery is a
direct inguinal hernia (directly BEHIND the inguinal ring)
93
What type of hernia passes through the inguinal ring
Indirect
94
MDs don't LIe stands for
```
Medial = direct
Lateral = indirect
```
95
What OTC drug that is used often for pain relief is known to cause tinnitus?
NSAIDs
96
Accumulation of bile salts in the liver is called
Cholestasis
97
What is Charcot's triad?
Jaundice, fever, and abd pain from cholangitis
98
Gastric vs duodenal ulcer
```
Gastric = early satiety
Duodenal = wakens pt at night, relieved with food
```
99
Treatment for H. Pylori
Omeprazole 20mg BID
Clarithromycin 500mg BID
Amoxicillin 1000mg BID
x14 days
100
The genetic tendency to develop allergic diseases =
Atopy
101
Pt presents with daily headaches, pruritis after a warm shower, and elevated Hb and HCt. What is the diagnosis and treatment?
Polycythemia Vera.
| Tx: Hydroxyurea, ASA, or phlebotomy
102
What genetic mutation is associated with polycythemia vera
JAK2
103
What do you see on blood smear with G6P deficiency?
Heinz bodies
104
A black male presents with fatigue. CBC shows low RBC, Hb, and HCT. Coombs test is negative. What is the likely dx?
G6P deficiency = non-immune mediated hemolytic anemia
105
Pt is positive for the Philadelphia chromosome. What is the most likely dx?
Chronic myeloid leukemia
106
Pt presents with TGs >150mg/dL. What blood test should you run and why?
TSH. Increased risk for hereditary genetic syndromes
107
Pt presents with BILATERAL hand/wrist pain that begins with MORNING STIFFNESS. There is swelling in the PROXIMAL joints. What is the dx and confirmation of the dx? Tx?
Rheumatoid arthritis.
Dx: Confirm with anti-cyclic citrullinated antibodies
Tx: Methotrexate
108
What antigen is positive with reactive arthritis?
HLA-B27
109
42 y/o woman comes in with sudden new onset chest pain. EKG is normal. Pain is reproducible when palpating area between sternum and ribs. Dx and Tx?
Costochondritis
| Tx: NSAIDs. Poss corticosteroids.
110
Treatment for acute prostatitis in pts < and > 30y/o
>30 y/o: FQ: levofloxacin or ciprofloxacin for 4-6 weeks OR Bactrim x 28 days
<30y/o: Ceftriaxone and Doxycycline x14 days
111
58 y/o male presents with dysuria, urinary frequency, and fever. On DRE, his prostate is tender and boggy. UA shows WBCs (pyuria) and bacteriuria. What is the MC pathogen of this dx?
E. Coli is the MC cause of acute prostatitis. If sexually active, could be gonorrhea or chlamydia (treat with ceftriaxone AND doxy)
112
Alkaline phosphatase is a marker of what two things
Bone turnover and the biliary system
113
Pt presents with moon facies, buffalo hump central obesity, and purple striae. How can you confirm your diagnoses? What is the tx?
Dx: Urinary free cortisol, dexamethasone suppression test, late night salivary control, or CRH stim test
Tx: Eliminate steroid exposure
114
What cancer is associated with ACTH/cushings
Small cell lung cancer
115
What are the 2 first line agents in CAD and/or hypercholesterolemia
Atorvastatin and Rosuvastatin
116
Ludwig's angina vs saliadenitis presentation
Drooling vs dry mouth
| Bilateral vs unilateral chin swelling
117
Causes of Saliadenitis
Viral: mumps, HIV
Bacterial: staph aureus
Autoimmune: Sjogren syndrome
118
Tx of saliadenitis
Warm compresses, sialogogues
| Dicloxacillin 500mg 4x daily for 7-10 days
119
25 y/o female presents with dysuria, frequency, pain in suprapubic region. Denies CVA tenderness. UA is positive for cystitis. What are the first line treatments?
Nitrofurantoin or Bactrim
120
What will be positive on UA to confirm cystitis?
Leukocyte esterase and nitrites
121
What other virus coexists with Hep B?
Hep D
122
Unstable A-fib first line therapy is
Cardioversion
123
When should ablation be considered for a-fib?
Younger pts without valve disease, pts >65y/o, pts resistant to drug therapy
124
First line drug therapy for a-fib
Diltiazem and metoprolol
125
What level of cholesterol and LDL are risk factors for heart disease
Cholesterol >200
| LDL >190
126
At what age is a FH of MI a risk factor?
<55 y/o for males
| <65 y/o in females
127
What is the first line treatment for severe salmonella?
FQs: Ciprofloxacin or Levofloxacin 500mg BID x7day
128
What is the sign on PE when evaluating cholecystitis?
Murphy's sign = pain in RUQ
129
First test and definitive test for cholecystitis
Ultrasound and then HIDA scan
130
What is Mirizzi syndrome?
Common cystic duct blockage = compression of common bile duct = jaundice
131
TB treatment regimen
2 mos rifampin, isoniazid, pyrazinamide, ethambutol followed by
4 months of rifampin and isoniazid
132
What fibrate should NOT be used in conjunction with a statin due to rhabdomyolysis risk
Gemfibrozil
133
What increases your risk of fibrocystic breasts?
Frequent alcohol consumption
134
Shistocytes on blood smear indicates
Hemolysis
135
Howell-jolly bodies on blood smear indicates
Sickle cell anemia
136
Iron deficiency anemia will show what type of cells on blood smear
Hypochromic, microcytic RBCs
137
Angular chelosis, koilonychia, fatigue, and ice chip cravings are all hallmark signs of
Iron deficiency anemia
138
Decreased serum iron and ferritin levels along with INCREASED TIBC is consistent with
Iron deficiency anemia
139
PID in a non-pregnant woman treatment
Ceftriaxone + Doxy + Metronidazole
140
Bulls-eye lesion with central clearing should make you think (along with fatigue and muscle aches)
Lyme disease
141
Pt presents with fever, HA, myalgias, and petechiae. What should you be thinking of
RMSF
142
Treatment for lyme disease and RMSF
Doxy
143
S3 is a sign of
systolic HF, a normal child, pregnant woman
144
S4 is a sign of
diastolic HF and aortic stenosis
145
Drusen, or yellow deposits around the macula, are found in
NON-exudative macular degeneration
146
Chorodial Neovascularization and subretinal fluid/hemorrhage is found in
Exudative macular degeneration
147
Exudative age-related macular degeneration should addressed ASAP because
It can lead to blindness in a few months
148
MC cause of blindness in teh elderly
Macular degeneration
149
Aortic stenosis leads to an
S2 split and audible 4th heart sound
150
MC risk factor for testicular cancer? (seminoma)
Cryptorchidism
151
Most common hematologic disorder associated with other previous hematologic disorders
AML
152
Fatigue, persistent infection, petechiae, and auer rod cells on blood smear all indicate the pt has
Acute myeloid leukemia
153
Pt's <50 who are non-smokers with COPD should be considered for
Alpha-1 antitrypsin deficiency
154
What are the 2 interventions that lead to decreased mortality in COPD pts
Smoking cessation
| Oxygen
155
Nikolsky's sign
Sloughing of skin after being touched commonly seen in SJS
156
SJS vs. Toxic epidermal necrolysis
```
SJS = <10% of the body
Necrolysis = >30% of the body
```
