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Family Med > General > Flashcards

General Flashcards

1
Q

Vulvovaginal Candidiasis Presentation

A

Thick, whitish discharge that has no odor

Significant pruritis of external and internal genitalia

Vaginal area can be edematous with erythema

Discharge has pH 4.0-5.0

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2
Q

Protocol for newborn with HBV+ mother

A

HBV vaccine + Hepatitis B immune globulin within 12 hr birth Dose 2 @ 1-2mo Dose 3 @ 6 mo If hepatitis status of mother is unknown, give vaccine @ birth, test mother, and if positive give IG within 7d.

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3
Q

COPD with FEV1 50-80%

A

Stage 2 (Moderate COPD) Long-acting bronchodilators

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4
Q

Lesion? Causes?

A

“Ringworm” = Trichophyton rubrum or Tinea tonaurans, T mentagrophytes, M canis

Well demarcated plaque with central scaling, usually pruritic.

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5
Q

PNA tx for hospitalized patient NOT in ICU

A

Beta-lactam (Piperacillin/tazobactam, cefepime, imipenem, or meropenem) + fluoroquinolone (levofloxacin, moxifloxacin) OR aminoglycoside

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6
Q

Centor Criteria for Rapid Strep Test

A

Patient gets one point for each of the following:

  1. absence of cough
  2. enlarged/tender anterior cervical adenopathy
  3. fever of at least 100.4F
  4. tonsillar exudates
  5. pt age 3-14 yr
  6. Deduct a point for age of 45 or higher

0-1 Points = no further testing and no abx indicated

2-3 points = perform rapid strep or throat culture and tx with antibiotic if positive

4+ points = consider empiric abx

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7
Q

Spermatocele

A

Asymptomatic nodules, generally found attached to the spermatic cord.

No further tests needed unless diagnosis remains unclear, then can use US.

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8
Q

Sleep aid for transient sleep onset problems?

A

Zolpidem (ambien) Eszopiclone (Lunesta)

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9
Q

Outpatient PNA treatment

A

Macrolide (clarithromycin or azithromycin)

OR

Doxycycline

Follow up 3-4d to assess response to therapy

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10
Q

Treatment options for abdominal pain in IBS

A

Antispasmodics: dicyclomine & hyoscyamine

Low-Dose TCAs

SSRIs if comorbid depression or anxiety

Rifaximin of NO constipation symptoms

Probiotics & peppermint oil

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11
Q

Laryngitis + Pharyngitis?

A

Most commonly viral in nature and only supportive care is needed.

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12
Q

Outpatient PNA treatment for patient with comorbidities

A

Fluoroquinolone (levofloxacin, moxifloxicin))

OR

Beta-lactam (amoxicillin, amoxicillin-clavulunate, cefpodoxime, cefuroxime) + macrolide

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13
Q

Symptoms of Alcohol Withdrawal

A

<12 hour: insomnia, tremors, anxiety, GI upset, diaphoresis, headache, palpitations

12-24 hr: visual, auditory, or tactile hallucinations

24-48 hr: generalized tonic-clonic seizures

48-72 hr: DTs (hallucinations, tachycardia, fever, HTN, etc…)

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14
Q

Hypovolemic Hyponatremia Common Causes

A

(Urinary Na < 20 mEq/L)

Cerebral Salt Wasting

Skin loss

Diuretic use

GI losses

Mineralcorticoid deficiency

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15
Q

COPD-cough, sputum production, normal spirometry

A

Stage 0 (At Risk)

Vaccines Address risk factors: smoking, occupational exposure, smoke from cooking/heating fuel

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16
Q

Headache that begins after age 50 y/o especially with jaw pain on chewing

A

Differential:

  1. Temporal arteritis
  2. Mass lesions

Workup:

  1. neuroimaging
  2. ESR
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17
Q

Side Effects of Phenothiazines Antiemetics (compazine and phenergan) and tigan?

A

Drowsiness

Dry mouth

Dizziness

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18
Q

Symptoms of opioid withdrawal

A

Muscle cramps & arthralgias

Anxiety

Vomiting & diaphoresis

Piloerection

Lacrimation and rhinorrhea

Elevated BP

Insomnia

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19
Q

Scoring Criteria for Risk of Ischemic stroke in First 7 Days after TIA

A

ABCD2 Criteria

Age ≥ 60 (1 point)

BP ≥ 140/≥90 (1 point)

Clinical Features

  • Unilateral Weakness = 2 points
  • Isolated speech disturbance = 1 point
  • Anything else = 0 points

Duration

  • ≥ 60 min = 2 points
  • 10-59 min = 1 point
  • < 10 min = 0 points

Diabetes = 1 point

Scoring System

Score 0-3 = Low risk

Score 4-5 = moderate risk (`4%)

Score 6-7 = high risk (8 %)

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20
Q

Prophylactic Tx of Cluster Headaches

A

CCB-nifedipine

Indomethacin

Prednisone

Lithium

Note: to be used only during the attack period

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21
Q

Hypernatremia Common Causes

A

High Urine Osm (>400 mOsm/kg): Excessive sweating, GI losses

Low Urine Osm (<300 mOsm/kg): Diabetes Insipidus

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22
Q

ACA Stroke Sx

A

Lower extremity deficits

Cognitive or personality changes

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23
Q

Trichomoniasis Presentation

A

Thin, frothy, green-yellow or gray malodorous discharge

Vaginal soreness or dyspareunia

Sx/ may be exacerbated during menses

Cervix can have “strawberry” appearance (erythematous with punctuation) or redness of the vagina and perineum

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24
Q

Who should receive imaging for neck pain?

A

ONE HIGH-RISK FACTOR: age > 65, dangerous mechanism of action, or numbness/tingling in extremities

IS THERE A LOW RISK FACTOR? Simple rear-end collision, patient ambulatory at scene, absence of neck pain at scene, absence of c-spine tenderness (if no to any of these, need imaging).

CAN PT ACTIVELY ROTATE NECK 45 DEGREES TO L AND R, regardless of pain. (“No” requires imaging)

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25
Q

Characteristics that make palpitations more likely to be cardiac in origin?

A

Male

Description as “irregular heartbeat”

Personal hx of heart disease

Event duration > 5 min

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26
Q

Iron Deficiency Tx

A

Oral ferrous sulfate @ 325mg (65mg elemental iron) TID for ~6-8wk

Pt with malabsorption, CKD, HF, or significant blood loss may need IV iron

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27
Q

Oral Herpes Tx

A

Topical antiviral

Chronic suppression can decrease frequency of symptomatic recurrence and asymptomatic viral shedding

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28
Q

Treatment for mild acne

A

Topical antibiotics + Benzoyl peroxide gel + topical retinoids

Improvement occurs over 2-5 months

Apply topical retinoids at night and topical antibiotics and benzoyl peroxide gel in the day

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29
Q

Fever 1-4wk post-op

A

Infectious

  1. SSI
  2. C-Diff
  3. Cather-related infection
  4. Device-related infection
  5. Abscess

Non-infectious:

  1. Med toxicity
  2. DVT/PE
  3. Thrombophlebitis
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30
Q

Symptoms of tobacco withdrawal

A

Headaches

Irritability, depresison, anxiety

Cognitive & attention deficits

Sleep disturbances

Increased appetitie

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31
Q

Trichomonias Treatment

A

Oral metronidazole given in single 2g oral dose

1 week of 500mg BID metronidazole for both and partner

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32
Q

Involvement of GI tract in Crohn Disease vs. Ulcerative Colitis

A

CROHN DISEASE: extends from mouth → anus (mostly ileum and colon), skip lesions, rectum usually spared ULCERATIVE COLITIS: always involves rectum with continuous lesions

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33
Q

Treatment for PID

A

Outpatient management: ceftriaxone 250mg IM + doxycycline 100mg BID for 14d +/- metronidazole 500mg BID for 14d

If patient is pregnant, presents with fever and vomiting, or if surgical intervention cannot be ruled out, should be treated inpatient.

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34
Q

Acral Letiginous Melanoma

A

Most common melanoma in African Americans and Asians

Flat, irregular, dark-brown or black lesions that occur on the palms, soles, and under nails

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35
Q

HTN Tx in nonblack patient >60 y/o

A

CCB

Thiazide diuretic

ACE inhibitor/ARB

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36
Q

Ottowa Knee Rules

A
  1. Age 55 or older
  2. Isolated patella tenderness
  3. Tenderness of the head of the fibula
  4. Inability to flex the knee to 90 degrees
  5. Inability to bear weight for 4 steps immediately and in the exam room
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37
Q

Clinical Manifestations of Crohn Disease vs. Ulcerative Colitis

A

CROHN DISEASE: diarrhea, only bloody if colitis

ULCERATIVE COLITIS: bloody diarrhea

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38
Q

Prehn Sign

A

Testicular pain relieved upon elevation of the testicle while the patient is supine.

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39
Q

COPD with FEV1 < 30%

A

Stage 4 (Very severe COPD) Long-term O2 therapy Possible surgical intervention

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40
Q

Lesion? Treatment?

A

Tinea capitis

Systemic therapy necessary for cure

  • Griseofulvin 4-8wks (1st line)
  • Fluconazole 3-4wk
  • Can also use terbinafine, itraconazole, fluconazole, and ketoconazole

Topical ketoconazole shampoo or selenium sulfide lotion may kill spores on hair.

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41
Q

Rosacea Treatment

A

First line = oral antibiotics like minocycline and doxycycline

Can also use topical metronidazole, antibiotics, and sodium sulfacetamide

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42
Q

Treatment for sleep Maintenence problem?

A

Zaleplon (Sonata)

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43
Q

Rome Criteria for IBS

A

Recurrent abdominal pain or discomfort at least 3d/month for the past 3 months with at least 2 or more of the following…

  1. Improvement with defecation
  2. Onset associated with change in frequency of stool
  3. Onset associated with change in form (appearance) of stool
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44
Q

Primary amenorrhea evaluation in pt with secondary sex characteristics

A
  1. Labs: pregnancy test, TSH, prolactin
  2. Progestin challenge
  3. If no withdrawal bleeding from progestin, do estrogen-progestin challenge to distinguish inadequate estrogen production from outflow tract obstruction
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45
Q

Causes of fever intra-operatively up to 24 hr after surgery

A

Infectious:

  1. Preexisting infection
  2. Bacteremia from urologic procedures
  3. Intraperitoneal leak (up to 36 hr)
  4. Invasive soft-tissue infection
  5. TSS

Non-infectious:

  1. Surgical trauma
  2. Meds
  3. Blood products
  4. Malignant hyperthermia
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46
Q

Treatment for Lyme Disease

A

EARLY LOCALIZED DZ: amoxicillin or doxycycline for 2-3wk

EARLY DISSEMINATED DZ: IV ceftriaxone or cefotaxime + chloramphenicol for 2-3wk

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47
Q

Common causative organisms of epididymitis?

A

Sexually active men < 35 y/o = N. gonorrheae or Chlamydia (less commonly d/t ureaplasma or mycoplasma)

Monogamous men > 35 y/o = Enterobacter in association with prostatitis

48
Q

Amelanotic Melanoma

A

Non-pigmented melanoma —> often missed or confused for eczema, SCC, fungal infection, etc…

49
Q

2nd line treatment for rhinosinusitis

A

Amoxicillin-clavulanic acid, 2nd or 3rd gen cephalosporin (cefuroxime, cefaclor, cefprozil), fluoroquinolones, or 2nd gen macrolides (azithromycin, clarithromycin)

Use one of these if patient failes initial regimen or have recurrent or severe dz

50
Q

COPD with FEV1 ≥ 80%

A

Stage 1 (Mild COPD) Short-acting bronchodilators

51
Q

7-Valent Pneumococcal Vaccine (PCV7)

A

Usual Schedule = one dose @ 2, 4, 6, and 12-15 months All healthy children 24-59 months who have NOT completed their primary immunizations for PCV7 should get one dose

52
Q

Causes of fever 1d-1wk post-op

A

Infectious:

  1. UTI
  2. PNA
  3. SSI
  4. Cather-related infection
  5. Cellulitis
  6. Viral URI
  7. Pre-existing infection

Non-Infectious

  1. Acute MI
  2. Alcohol/drug withdrawal
  3. Gout
  4. Pancreatitis
  5. PE/DVT
  6. Benign post-op fever
53
Q

Common description of ventricular premature beats?

A

“Flip-flopping” in chest

Random, episodic, and instantaneous

54
Q

Nodular Melanoma

A

Most aggressive melanoma, 2nd most common Often black but can also be brown, blue, tan, or red

55
Q

Imaging in Legg-Calve-Perthes Disease

A

Early on x-rays may be normal but as diseae progresses can get collapse, flattening, and widening of femoral head

56
Q

Hypokalemia Presentation

A

Fatigue, muscle aches

ascending muscle weakness or cramps

Rhabdo

EKG Changes: U waves, ST depression, flattened T-waves

57
Q

Side effects of reglan?

A

Prokinetic → diarrhea and extrapyramidal reactions

58
Q

Spurling Test (aka Neck Compression Test)

A

Requires patient to bend his/her head to the side and rotate the head toward the side of pain, while the examiner exerts downward pressure.

Will reproduce upper extremity symptoms in patient with nerve root injury (high specificity but low sensitivity for cervical radiculopathy)

IF maneuver causes discomfort only, likely mechanical pain

59
Q

Headahce with sudden onset, max severity, or new/different headache?

A

Differential:

  1. SAH
  2. Pituitary apoplexy
  3. Hemorrhage into mass lesion or vascular malformation
  4. Mass lesion

Workup:

  1. Neuroimaging
  2. LP if neuroimaging negative
60
Q

Labs for limp w/pain in Child

A

CBC if concern for malignancy, inflammatory arthritis, or infection

ESR + CRP if infectious or rheumatologic cause suspected

ASO titer if recent pharyngitis

Chlamydia & ghonorrhea titers if sexually active

61
Q

Metabolic Syndrome

A

3 or More of the Following…

  1. Waist circumference > 102 cm (M) or 88cm (F)
  2. Hypertriglyceridemia (>150 mg/dL)
  3. Low HDL: <40 (M) or <50 (F)
  4. Fasting plasma glucose > 100 or diagnosed T2DM
62
Q

Characteristics of neck pain d/t osteoarthritis or spondylosis?

A

Pain aggravated by movement

worse after activities

associated with a dull-ache

limited ROM

63
Q

Microscopy in Crohn Disease vs. Ulcerative Colitis

A

CROHN DISEASE: noncaseating granulomas ULCERATIVE COLITIS: no granulomas

64
Q

B12 Deficiency Treatment

A

1000 ug IM daily for 7 days —> weekly for 4 wk —> monthly for lifetime

1000-2000 ug PO in similar regimen

65
Q

Cerebellum stroke sx

A

Ipsilateral imb and gait ataxia

66
Q

Diagnostic Criteria for Bacterial Vaginosis

A

Three out of four…

  1. Thin, homogenous vaginal discharge
  2. Vaginal pH > 4.5
  3. Positive KOH “whiff” test (fishy odor on KOH prep)
  4. Presence of clue cells in wet mount
67
Q

Side effects of Zofran?

A

Serotonin antagonist → dizziness and headache

68
Q

Psoriasis Treatment

A

Topical corticosteroids

Topical pimercrolimus if located in perinatal and genital regions, face, or ear canals

For systemic/generalized psoriasis can use MTX or retinoids

69
Q

Headache that is increasing in severity and frequency, brought on by valsalva or physical exertion

A

Differential:

  1. Mass lesion
  2. Subdural hematoma
  3. Medication overuse

Workup:

  1. Neuroimaging
  2. Drug screen
70
Q

Cervical dystonia (torticollis) treatment?

A

Botulinum toxin

71
Q

Major vs. Intermediate Clinical Predictors for Preop Cardiac Evaluation

A

MAJOR CLINICAL PREDICTORS: (need coronary evaluation prior to surgery): unstable coronary syndromes, decompensated CHF, arrhythmia, severe valvular disease

INTERMEDIATE CLINICAL PREDICTORS: (determine functional capacity) mild angina, prior MI, compensated CHF, DM, renal insufficiency

72
Q

Testicular pain with absent cremaster reflex AND positive prehn sign?

A

Epididymitis

Hernias

Orchitis

Cancer

73
Q

Most likely cause of pancreatitis with elevated ALT?

A

Gallstones

74
Q

CCB that can be used for migraine prophylaxis? (Not first line)

A

Verapamil

75
Q

Ottowa Ankle Rules

A
  1. Bony tenderness of the posterior edge or tip of the distal 6 cm of either the medial or lateral malleolus
  2. Tenderness in the midfood coupled with point tenderness over the bony aspects of base on 5th metatarsal or the navicular
  3. Unable to bear weight
76
Q

Pharmacology for stimulant withdrawal

A

Metylphenidate

Propranolol

Desipramine

Bupropion

77
Q

COPD with FEV1 30-50%

A

Stage 3 (Severe COPD) Inhaled steroids

78
Q

Antibiotics indicated for diarrhea

A

Ciprofloxacin 500 mg BID for 3d

Azithromycin in single 1000 mg dose in adults or 10mg/kg in kids for 3 days

Noninvasive E coli can use rifaximin (200 mg TID for 3 days)

79
Q

Septic arthritis in infants and toddlers?

A

Usually associated with systemic signs like fever; child will often lay with their hip abducted and externally rotated to reduce pain

Elevated ESR, WBC, and CRP

Kids < 4 mo = GBS or staph

Kids < 5yr = Staph or Strep pyogenes

80
Q

Hypervolemic Hyponatremia Common Causes

A

HF

Cirrhosis

Nephrosis

81
Q

Kocher Criteria for Risk of Septic Arthritis

A

Criteria:

  1. Fever > 101.3
  2. Non-weight bearing
  3. ESR > 40
  4. WBC > 12,000

1 criteria = 3% chance

2 criteria = 40% chance

3 criteria = 93% chance

82
Q

Hyperkalemia Causes

A

Meds: ACE inhibitors, ARBs, potassium-sparing diuretics

Intracellular Shifts: acidosis, insulin deficiency, burns

Reduced renal excretion: insufficiency, Addison’s disease, RTA IV

83
Q

Clinical presentation of uterine leiomyoma?

A

Usually asymptomatic

Can cause low midline pressure and menorrhagia or metorrhagia.

84
Q

Who should get statin therapy?

A
  1. Pt 21-75 y/o with clinical CVD
  2. Pt >21 y/o with LDL cholesterol ≥ 190
  3. Pt 40-75 y/o with diabetes and LDL ≥ 70
  4. Pt 40-75 y/o with a 10yr CVD risk ≥ 7.5% and LDL ≥ 70 mg/dL
85
Q

Vertebrobasilar stroke Sx

A

Motor or sensory loss in all 4 extremities

Crossed signs

Disconjugate gaze

Nystagmus

Dysarthria

Dysphagia

86
Q

HTN tx in African American Pt

A

CCB

Thiazide diuretic

87
Q

Superficial Spreading Melanoma

A

Spreads superficially before moving vertically

Most commonly occurs on the legs in women and torso in men

Raised borders and brown lesions w/whites, greys, pinks, or blues

88
Q

Treatment for constipation-predominant IBS

A

Soluble fiber

Polyethylene Glycol

Lubiprostone (Amitiza) = selectively activates chloride channels

Linaclotide = stimulates cGMP production to increase motility and fluid secretion

89
Q

Intussusception

A

2nd most common cause of GI bleed in children (Meckel’s diverticulum is #1)

Will present with abdominal pain, vomiting, bloody stool, and palpable “tube-like” mass in abdomen

90
Q

MCA Stroke Sx

A

Aphasia if dominant hemisphere

Contralateral hemiparesis

Sensory loss

Spatial neglect

Contralateral impaired conjugate gaze

91
Q

1st Line Tx Rhinosinusisits

A

Amoxicillin or Bactrim for 10-14d

92
Q

Symptoms of stimulant withdrawal

A

Paranoia

Depression, anxiety, irritability

Somnolence

Pyschomotor retardation

Increased appetite

93
Q

Lentigo Melanoma

A

Least common overall, but most common in Hawaii

Most common in elderly on sun-damaged skin.

Tan or brown lesions with irregular borders

94
Q

Gross appearance in Crohn Disease vs. Ulcerative Colitis

A

CROHN DISEASE: transmural inflammation with linear mucosal ulcerations, cobblestoning, and creeping fat

ULCERATIVE COLITIS: mucosal & submucosal inflammation, pesudopolyps

95
Q

Common causes of limp WITHOUT pain in child

A
  1. Congential dislocation of hip
  2. Spastic hemiplegia (CP)
  3. Legg-Calve Perthes
  4. Leg-length discrepancy
  5. Proximal focal femoral dysplasia
  6. Congenital bowing of the tibia
96
Q

Treatment for IBD

A

Antidiarrheal meds

Anti-inflammatory meds: aminosalicylates (sulfasalazine), corticosteroids

Immunosuppressive agents

Definitive tx for UC = colectomy

97
Q

Transient Synovitis in Young Kids

A

Self-limited inflammatory response that is a common cause of hip pain in kids 3-10 y/o after viral infection

Presentation = gradually increasing hip pain with limp or refusal to walk, low grade or no fever, normal WBC and ESR. Xray is normal or shows moderate swelling.

98
Q

Common presentation of ovarian cyst?

A

Unilateral dull pain that can become diffuse & severe if the cyst ruptures.

On physical exam, will feel a smooth, mobile adnexal mass with peritoneal signs if the cyst has ruptured.

99
Q

Intestinal manifestations of Crohn Disease and Ulcerative Colitis

A

CROHN DISEASE: fistulas, strictures → bowel obstruction, and abscesses

ULCERATIVE COLITIS: toxic megacolon

100
Q

HTN Tx in nonblack patient <60 y/o

A

ACE inhibitor/ARB

Thiazide diuretic

CCB

101
Q

Diverticulitis Tx

A

Bowel rest Metronidazole + quinolone

102
Q

Primary Amenorrhea

A

Absence of menses at 16 y/o in the presence of normal secondary sex characteristics or absence of menses at 14 y/o in the absence of secondary sex characteristics.

Most common cause = gonadal dysgenesis

103
Q

Hypokalemia Causes

A

Decreased net intake

Intracellular Shifts: alkalosis, excess insulin

Renal losses

Extra-renal losses

104
Q

Rosacea

A

Stage 1 = persistent erythema often with telangiectasias

Stage 2 = papules & tiny pustules

Stage 3 = Erythema that is deep and persistent with dense telangiectasias and sebaceous hyperplasia and lymphedema

105
Q

Hypernatremia S/Sx

A

Anorexia

Muscle Weakness

N/V

Lethargy

106
Q

Euvolemic Hyponatremia Common Causes

A

SIADH

Hypothyroidism

Water intoxication

Low solute intake

RTA

107
Q

Most likely cause of n/v that occurs in the morning before eating?

A

Pregnancy

Alcohol withdrawal

Increased ICP (meningitis, space-occupying lesions)

108
Q

Fever > 1 month after surgery

A

Infectious:

  1. Blood-transfusion related infection: viral, parasite, etc…
  2. Infective endocarditis
  3. Post-pericardiotomy syndrome
  4. SSI
  5. Device-related infection
  6. Vascular graft infection

Non-infectious

  1. Post-pericardiotomy syndrome
109
Q

Pharmacology for opiod withdrawal

A

Methadone

Buprenorphine

Naltrexone

110
Q

HTN Tx in pt with hx of CAD

A

beta-blocker

ACE inhibitor/ARB

111
Q

Vulvovaginal Candidiases Treatment

A

Uncomplicated: short term intravaginal preparations or single dose oral therapy (fluconazole 150mg)

112
Q

Keratocanthoma characteristics

A

May look similar to basal cell carcinoma or nodular SCC, it has much more rapid growth, achieving size of 2.5cm within a few weeks

113
Q

Thyroid Hormone Dosing

A

Healthy, non-pregnant adults require ~1.6 ug/kg daily

In patients >50 y/o start with a dose 25-50 ug daily and increase by 25 ug ever 3-4 weeks until optimal dose is reached

In pregnant pt may need up to 30% more than normal

Follow up with TSH Q4-6 weeks initially

114
Q

Treatment for Diarrhea-Predominant IBS

A

Loperamide to reduce frequency of loose stools an decrease urgency

Rifaximin = gut bacteriostatic

Alosetron for severe diarrhea of at least 6 months

115
Q

Meds for Alzheimer Dementia

A

Cholinesterase Inhibitors: Donepezil, Galantamine, or Rivastigmine

Memantine (NMDA antagonist)

116
Q

Brugada Syndrome

A

Ion channel disorer common in asian males and characterized by a RBB and elevation at the J point that is >2mm with a slowly descendign ST segment with a flat or negative T-wave in V1, V2, or V3

Family Med (3 decks)

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