IM Flashcards
1
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IM Key Points
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patients aged 20 years or older with an LDL cholesterol level of 190 mg/dL (4.92 mmol/L) or higher should receive high-intensity statin therapy for primary prevention of atherosclerotic cardiovascular disease.
2
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The decision to initiate breast cancer screening in women aged 40 to 49 years should be an individualized one based on patient context and values regarding specific benefits and harms.
3
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For patients undergoing orthopedic surgery without increased bleeding risk, postoperative dual venous thromboembolism prophylaxis low-molecular-weight heparin should be continued for up to 35 days.
4
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Gabapentinoids and serotonin-norepinephrine reuptake inhibitors are first-line therapy for neuropathic pain syndromes.
5
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Methylphenidate is a rapid-acting psychostimulant that is well tolerated and effective in the treatment of depression at the end of life; results can be seen as quickly as 24 to 48 hours after initiation.
6
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Bacterial conjunctivitis is characterized by redness of the conjunctival membrane obscuring the tarsal vessels, matting of both eyes in the morning, and thin mucopurulent discharge; treatment may include topical antibiotics, such as trimethoprim–polymyxin B or erythromycin.
Because of concerns about antimicrobial resistance and cost, topical fluoroquinolones (such as levofloxacin) are not first-line therapy
7
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The acceptability of the number needed to treat as a means of comparing one treatment with another depends on the risks associated with the condition, the cost and side effects of the treatment, and other treatments available.
(NNT = 1/absolute risk reduction)
8
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The most common infectious cause of acute bacterial prostatitis is Escherichia coli or other gram-negative bacilli; the treatment of choice is a prolonged course of trimethoprim-sulfamethoxazole or ciprofloxacin.
9
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Men younger than 35 years who are sexually active and men older than 35 years who engage in high-risk sexual behavior should be treated with regimens that cover Neisseria gonorrhoeae and Chlamydia trachomatis. Ceftriaxone and doxycycline, or ceftriaxone and azithromycin, would be appropriate treatment choices
10
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Health care workers are at increased risk for acquiring and transmitting measles, mumps, and rubella and should receive a second dose of the MMR (measles, mumps, and rubella) vaccine.
Health care workers born after 1957 are at increased risk for acquiring and transmitting measles, mumps, and rubella and should receive a second dose of the MMR vaccine at least 28 days after the first dose.
11
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Nerve root involvement of the cauda equina requires immediate imaging, preferably with MRI, and surgical intervention to prevent permanent neurologic damage.
12
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For women younger than 30 years with a low-risk breast mass, ultrasonography is usually the only imaging required.
13
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More than half of patients with bipolar disorder initially present with a depressive episode; however, recognition of previous manic or hypomanic episodes is crucial because the treatment of bipolar disorder requires mood stabilizers, either alone or in combination with antidepressants.
14
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Bariatric surgery should be considered in patients who do not lose weight with lifestyle modifications and have a BMI of 40 or greater, or a BMI of 35 or greater with obesity-related comorbid conditions, such as type 2 diabetes mellitus, coronary artery disease, obstructive sleep apnea, or osteoarthritis.
15
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In patients with chronic cough who have a normal chest radiograph and are taking an ACE inhibitor, the first intervention is discontinuation of the ACE inhibitor.
16
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Patients who undergo direct-to-consumer genetic testing should be advised of the risks and limitations of these tests, including the possibility for misinterpretation.
17
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Tinnitus associated with unilateral sensorineural hearing loss suggests acoustic neuroma and requires advanced imaging with MRI.
18
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Pulmonary rehabilitation can provide significant benefits for patients with chronic lung disease and has been shown to improve subjective dyspnea in patients with severe COPD and following an acute exacerbation of COPD.
19
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Patients with decompensated liver disease should avoid elective surgery and be referred for liver transplant evaluation.
20
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A discharge summary that includes the evaluations performed, medication reconciliation, pending test results, required follow-up tests, and follow-up appointments is an important tool in the communication between the hospital and the follow-up clinician.
21
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IM Key points
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Adhesive capsulitis is characterized by loss of shoulder movement accompanied by pain; examination discloses significant loss of both active and passive range of motion.
Patients with acromioclavicular joint degeneration typically report pain localized to the acromioclavicular joint. Physical examination findings include tenderness to palpation of the joint
Rotator cuff disease would not be expected to cause pain with both active and passive movement of the shoulder;
22
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The most effective pharmacologic options for premature ejaculation is the combination of a selective serotonin reuptake inhibitor plus a phosphodiesterase-5 inhibitor and topical anesthetics.
23
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Stress urinary incontinence is characterized by urine leakage associated with activities that cause increased intra-abdominal pressure, such as coughing, laughing, or sneezing; it is best managed with pelvic floor muscle training exercises.
Bladder training and suppressive therapy are recommended by the ACP for urgency and mixed incontinence.
Oxybutynin is a treatment for urgency urinary incontinence when bladder training is only partially successful or has failed
24
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25
IM Key point
Bisphosphonates can cause muscle pain
26
IM Key point
Simvastatin and Amlodipine causes elevavted in stsatin levels
27
IM Key point
Pioglitazones can cause lower extremity edema
28
IM Key point
DEXA Scan, women over 65, and those under 65 with risk factors and those over 50 who have had fractures
29
IM Key point
T score of less than 2.5 is osteoporosis
-1 to -2.5 is osteopenia
Normal, more than -1
30
IM Key point
A bile acid sequestrant, such as cholestyramine, may be considered as an optional alternative agent for patients with ezetimibe intolerance and a triglyceride level less than 300 m
31
IM Key points
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and ezetimibe are the preferred nonstatin drugs for patients with clinical atherosclerotic cardiovascular disease who do not achieve goal LDL cholesterol reduction with maximally tolerated statin therapy.
32
IM Key points
2016 USPSTF guideline recommends sensitive gFOBT or FIT annually or multitargeted stool DNA testing every 3 years.
CT colonography can be performed every 5 years.
Flexible sigmoidoscopy is recommended every 5 years, but if combined with FIT (or possibly gFOBT), the interval can be increased to every 10 years,
33
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34
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Preoperative electrocardiography is reasonable for patients with known atherosclerotic cardiovascular disease, including coronary artery disease, arrhythmia, peripheral artery disease, cerebrovascular disease, or significant structural heart disease, who are undergoing moderate- to high-risk surgeries; cardiac stress testing should generally be reserved for patients at elevated risk for major adverse cardiac event with a functional capacity less than 4 metabolic equivalents, but only if the results of the test will change perioperative management.
35
IM Key
Ulnar nerve entrapment, also known as cubital tunnel syndrome, is caused by impingement of the ulnar nerve at the elbow by bone spurs, fibrous tissue, ganglion cysts, or ulnar nerve subluxation; characteristics include pain at the elbow that worsens with flexion, paresthesias and numbness of the fourth and fifth fingers, and weakness of the interosseous muscles.
Carpal tunnel syndrome is associated with wrist pain and symptoms of median nerve dysfunction, namely numbness in the first three fingers and pain that radiates into the forearm and hand.
36
IM Key points
Estrogen-containing hormonal contraceptives are contraindicated in women older than 35 years who smoke more than 15 cigarettes a day because of an increased risk for venous thromboembolism.
Contraindications to estrogen-containing preparations (including oral contraceptives and estrogen-progestin vaginal rings) include breast cancer, liver disease, migraine with aura, uncontrolled hypertension, and venous thromboembolism. They are also contraindicated in women older than age 35 years who smoke more than 15 cigarettes per day, such as this patient, because of an increased risk for venous thromboembolism
37
IM Key points
Weight-loss medications are recommended when a trial of comprehensive lifestyle modification, including reduced dietary intake, exercise, and behavioral therapy, fails to achieve a 5% to 10% reduction in weight after 3 to 6 months.
Bariatric surgery is recommended for patients with BMI of 40 or greater, and for patients with BMI of 35 or greater who have obesity-related comorbidities and who have tried all other weight loss therapies without achieving significant weight loss or improvements in comorbid conditions.
38
IM Key points
Low serum ferritin levels are strongly correlated with restless legs syndrome
39
IM Key points
The initial evaluation of chronic insomnia involves obtaining a sleep diary to identify adverse environmental factors, inappropriate exposure to electronic screens before bedtime, and sleep patterns.
40
IM Key points
The hallmarks of optic neuritis are acute vision loss, eye pain with movement, color perception change, and afferent pupillary defect; results of a funduscopic examination may be normal.
41
IM Key points
all PDE-5 inhibitors (viagra, etc) are contraindicated with nitrates
42
IM Key points
OCPs can have a side effect of daily headaches
43
IM Key points
Patients with postoperative urinary retention and residual bladder volume of 800 mL or more should be treated with bladder decompression and urinary catheterization.
44
IM Key points
The USPSTF defines adequate screening as three consecutive negative cytology (Pap smear) results or two consecutive negative cytology plus human papillomavirus (HPV) test results within the last 10 years, with the most recent test occurring within 5 years.
45
IM Key points
Following diagnosis and treatment of a woman with Trichomonas vaginalis infection, the sexual partner should be treated and both individuals should be screened for other sexually transmitted infections; retesting of women for T. vaginalis infection within 3 months of treatment is also recommended.
46
IM Key points
Pregabalin is a calcium channel blocker and likely produces edema by the same mechanism as other calcium channel blockers; it is associated with peripheral edema in up t
47
IM Key points
The diagnosis of systemic exertion intolerance disease requires the presence of fatigue of at least 6 months' duration with substantial reduction in preillness activities, postexertional malaise, unrefreshing sleep, and either cognitive impairment or orthostatic intolerance.
48
IM Key points
The diagnosis of systemic exertion intolerance disease requires the presence of fatigue of at least 6 months' duration with substantial reduction in preillness activities, postexertional malaise, unrefreshing sleep, and either cognitive impairment or orthostatic intolerance.
49
IM Key points
A positive Prehn sign (relief of pain with scrotal elevation) suggests a diagnosis of epididymitis, although it does not rule out other possibilities, such as testicular torsion.
A transillumination study, which is performed to identify a hydrocele
50
IM Key points
51
IM Key points
In patients taking dual antiplatelet therapy, if the risk of surgical delay exceeds the risk for stent thrombosis, discontinuation of the P2Y12 inhibitor can be considered after a minimum of 30 days in the case of bare metal stent placement or 3 months after drug-eluting stent placement.
52
IM Key points
In patients taking dual antiplatelet therapy, if the risk of surgical delay exceeds the risk for stent thrombosis, discontinuation of the P2Y12 inhibitor can be considered after a minimum of 30 days in the case of bare metal stent placement or 3 months after drug-eluting stent placement.
53
IM Key points
Cyclic mastalgia is often related to hormonal changes that occur with ovulation, resulting in diffuse premenstrual breast pain that resolves with the menstrual cycle; the most appropriate management is education, reassurance, and appropriate breast support.
54
IM Key points
In patients with central vertigo, the Dix-Hallpike maneuver produces nystagmus with an immediate onset (no latency), longer duration (>1 minute), no fatigability, and vertical or horizontal directionality without a torsional component.
Dix-Hallpike maneuver results that suggest peripheral vertigo include nystagmus that is delayed in onset (presence of latency), is of short duration (<1 minute), exhibits fatigability (habituation), and is primarily unidirectional
55
IM Key points
An advanced static mattress or mattress overlay made of specialized sheepskin, foam, or gel provides the best protection against the development of pressure injuries in hospitalized patients.
56
IM Key points
Sexually active gay, bisexual, and other men who have sex with men and injection drug users should be screened for HIV infection at least annually.
57
IM Key points
The U.S. Preventive Services Task Force (USPSTF) recommends low- to moderate-intensity statin therapy in asymptomatic adults aged 40 to 75 years without ASCVD who have at least one ASCVD risk factor (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year ASCVD event risk of 10% or higher.
In patients with a fasting triglyceride level of 500 mg/dL (5.65 mmol/L) or higher, triglyceride-lowering drug therapy is useful to prevent pancreatitis.
58
IM Key points
A postvoid residual urine volume, determined by ultrasonography, can confirm a suspected case of overflow urinary incontinence.
Botulinum toxin injection is used in the treatment of urgency urinary incontinence that persists despite behavioral and pharmacologic therapies.
Oxybutynin is an anticholinergic agent used in the treatment of urgency incontinence. Anticholinergic drugs (oxybutynin, darifenacin, fesoterodine, solifenacin, tolterodine, trospium) block the muscarinic cholinergic receptors and decrease bladder contractility.
59
IM Key points
Treatment of chronic pelvic pain syndrome demands a multimodal approach, with options including both pharmacologic and nonpharmacologic strategies; among the pharmacologic options are neuromodulatory agents, such as pregabalin, gabapentin, and nortriptyline.
60
IM Key points
Central retinal artery occlusion presents as acute, profound, and painless loss of monocular vision associated with an afferent pupillary defect and cherry red fovea.
Acute angle-closure glaucoma typically presents with severe eye pain and visual loss.
etinal detachment most commonly presents with photopsias (flashes of light); patients may also report seeing cobwebs and large floaters.
61
IM Key points
In the primary and secondary prevention of cardiovascular events, the addition of aspirin to long-term anticoagulation is associated with significantly increased bleeding events and is not routinely recommended.
62
IM Key points
Achilles tendon rupture most commonly results from sudden, forceful plantar flexion, such as occurs with jumping and sprinting. Patients report sudden onset of heel pain and often hear a popping sound at the time of the injury. On examination, patients have weak or absent plantar flexion. Absent plantar flexion with calf squeezing (Thompson test) also suggests the diagnosis. This
63
IM Key points
Topical antifungal imidazole therapy, such as intravaginal clotrimazole, is an effective treatment for uncomplicated vulvovaginal candidiasis, which is usually caused by Candida albicans.
Oral metronidazole is used to treat bacterial vaginosis, the most common cause of vaginal discharge, as well as to treat trichomoniasis. Accepted clinical criteria for diagnosing bacterial vaginosis include the presence of three of four characteristics: vaginal pH greater than 4.5, amine (“fishy”) odor on the application of 10% potassium hydroxide to vaginal secretions (whiff test), the presence of a thin homogeneous vaginal discharge, and the finding of at least 20% clue cells on a microscopic saline wet mount examination.
64
IM Key points
Transthoracic echocardiography to evaluate preoperative cardiac risk is appropriate for patients with moderate to severe valvular stenosis or regurgitation in the absence of an assessment in the previous year or for those whose clinical status has changed or who have referable symptoms.
65
IM Key points
Selective serotonin reuptake inhibitors are generally well tolerated among patients with major depressive disorder, but sexual side effects (such as anorgasmia, delayed orgasm, and reduced libido) are common
66
IM Key points
Varenicline is an effective therapy for smoking cessation and should be considered in smokers with a recent cardiac event.
Bupropion, a norepinephrine and dopamine reuptake inhibitor with nicotinic receptor activity, effectively increases smoking cessation rates. Bupropion should not be used in patients with a history of seizure disorders, stroke, brain tumor, brain surgery, or head trauma.
67
IM Key points
Frailty is a quantifiable geriatric syndrome that may predict a patient's response to medical treatment.
The Timed Up and Go test is used to identify patients at risk for falls. The individual components of the test (rising from the chair, gait, walking speed, balance maintenance while turning, and sitting) offer insight into the various mechanics of mobility and can guide a more focused evaluation and intervention.
68
IM Key points
Stimulants, such as methylphenidate, are first-line pharmacologic therapy for attention-deficit/hyperactivity disorder; when stimulants are contraindicated, atomoxetine, bupropion, and tricyclic antidepressants can be used.
69
IM Key points
Patients with noncyclic mastalgia with focal breast pain but no palpable mass should undergo targeted breast ultrasonography because approximately 1% of such patients may have breast cancer at the site of pain.
Reassurance, coupled with the regular use of a fitted support bra, would be appropriate management for a patient with cyclic mastalgia and a normal physical examination.
70
IM Key points
Likelihood ratios (LRs) are a statistical indicator of how much the result of a diagnostic test will increase or decrease the pretest probability of a disease in a specific patient; a clinical rule of thumb is that positive LRs of 2, 5, and 10 correspond to an increase in disease probability of 15%, 30%, and 45%, respectively.
With a pretest probability of 50%, a positive result on treadmill stress echocardiography would increase the likelihood of disease by approximately 45%, leading to a posttest probability in the range of 95%;
71
IM Key points
For patients undergoing nonorthopedic surgery who are at high risk for postoperative venous thromboembolism as defined by the Caprini score, pharmacologic prophylaxis with low-molecular-weight heparin or low-dose unfractionated heparin and the addition of mechanical prophylaxis are recommended.
72
IM key points
Male patients with urgency urinary incontinence who have not achieved satisfactory relief of symptoms with behavioral therapy may benefit from the use of anticholinergic agents or mirabegron.
Dutasteride is a 5α-reductase inhibitor used to treat benign prostatic hyperplasia. In this patient who is already being treated with tamsulosin and in whom postvoid residual bladder volume suggests that bladder outlet obstruction has been adequately addressed, there is no additional benefit from adding another therapy for benign prostatic hyperplasia;
73
IM key points
In adult patients, first-line therapy for symptomatic left-sided varicocele that is not associated with testicular atrophy or infertility is analgesic agents and scrotal support.
Treatment with ceftriaxone plus doxycycline is recommended for infectious epididymitis.
74
IM Keypoints
Rheumatoid arthritis is one of the most common diseases associated with scleritis, which can be vision-threatening and lead to thinning of the sclera and perforation.
Episcleritis is an abrupt inflammation of the superficial vessels of the episclera, a thin membrane that lies just beneath the conjunctiva. The cause is often unclear; rarely, it is associated with systemic rheumatologic disease. Patients with episcleritis frequently present without pain or decreased visual acuity
75
IM Key points
The treatment of systemic exertion intolerance disease involves a structured, multimodal, nonpharmacologic approach that includes regularly scheduled office visits, cognitive behavioral therapy, and sleep hygiene education.
76
IM Key points
Before initiating hormonal contraception, a negative pregnancy test result must be documented if 7 days have passed since the onset of the last menstrual period.
77
IM Key points
Patients with diabetes mellitus are at significantly increased lifetime risk for cardiovascular events and should receive statin therapy for primary prevention.
78
IM Key points
Symptoms of neurogenic thoracic outlet syndrome include paresthesias and pain that typically worsen with activities that involve continued use of the arm or hand, especially those that include elevation of the arm; first-line therapy includes improving posture and strengthening the shoulder girdle muscles.
Surgical decompression is not considered to be first-line therapy for neurogenic TOS, especially in patients who lack neurologic abnormalities. The procedure is reserved for patients who do not respond to conservative measures or for those with progressive or disabling neurologic symptoms.
79
IM Key points
All patients with sudden sensorineural hearing loss should undergo audiometric evaluation, and most patients will require MRI.
Meniere disease, which is associated with endolymphatic hydrops (excess fluid in the endolymphatic spaces), can cause unilateral sensorineural hearing loss, but its presentation is characterized by episodic vertigo (lasting between 20 minutes and 24 hours) and tinnitus,
80
IM Key points
Hydrocolloid or foam dressings are superior to standard gauze dressings in the treatment of pressure injuries; protein supplements and the use of electrical stimulation to accelerate wound healing are also recommended treatment strategies.
81
IM Key points
In older men and persons who practice insertive anal intercourse, infectious epididymitis should be treated with ceftriaxone and a fluoroquinolone, such as levofloxacin.
In younger patients (age <35 years), the most common infectious etiologies of acute epididymitis include Chlamydia trachomatis and Neisseria gonorrhoeae. Ceftriaxone is adequate coverage for N. gonorrhoeae but not C. trachomatis infection, and would not be an appropriate choice in a younger patient. In these men, and in the absence of risk factors for gram-negative infection (anal intercourse, urologic instrumentation), empirically treating with ceftriaxone and doxycycline (or azithromycin, if the patient is intolerant to doxycycline) would be appropriate.
82
IM Key points
For evaluation of palpable breast abnormalities in women aged 40 years or older, mammography, followed in most cases by ultrasonography, is recommended.
Ultrasonography is often preferred in women younger than age 30 years because the increased density of breast tissue in younger women limits the usefulness of mammography.
83
IM Key points
In patients on warfarin who are undergoing surgery, bridging anticoagulation is typically reserved for patients at highest risk for thromboembolism.
Anticoagulant therapy increases the risk for perioperative hemorrhage and should be discontinued in most patients before surgery. Bridging anticoagulation is the administration of therapeutic doses of short-acting parenteral therapy, usually heparin, when anticoagulant therapy is being withheld during the perioperative period in patients with elevated thrombotic risk. This patient is undergoing a procedure associated with elevated bleeding risk, and she has no history of stroke, transient ischemic attack (TIA), or intracardiac thrombus. Therefore, the risks of bridging anticoagulation outweigh the thrombotic risk,
84
IM Key points
Hormone therapy is an option for women with moderate to severe vasomotor symptoms of menopause who are younger than 60 years and within 10 years of menopause onset, provided they are at low risk for breast cancer, coronary heart disease, stroke, and thromboembolic disease.
For women who have had a hysterectomy, estrogen alone would be the preferred hormone therapy but would be inappropriate for this patient.
85
IM Key points
Labyrinthitis is characterized by sudden-onset, severe, persistent peripheral vertigo accompanied by hearing loss; it is most often preceded by a viral infection affecting both branches of the vestibulocochlear nerve (cranial nerve VIII).
Vestibular neuronitis is similar but has NO hearing loss
86
IM Key points
Hydromorphone is the preferred opioid to treat cancer-related pain in patients with chronic kidney disease.
Morphine is a prototypical opioid agonist, but its active metabolites accumulate in the setting of kidney failure and increase the risk for adverse neuroexcitatory effects with aggressive titration.
87
IM Key points
Preoperative cardiac stress testing should be considered in patients at elevated risk for a major adverse cardiac event or if functional capacity cannot be determined, but only if the results of stress testing will change perioperative management.
88
IM Key points
Erectile dysfunction in a patient who experiences nocturnal penile tumescence is most likely situational or mood related; cognitive behavioral therapy, biofeedback, or sensory awareness exercises with a psychotherapist are first-line therapies.
testosterone therapy should be avoided in patients with untreated obstructive sleep apnea.
89
IM Key points
Hallmarks of a Morton neuroma are pain between the metatarsal heads, the sensation of walking on a pebble, and no obvious abnormalities of the foot upon clinical examination or palpation.
Plantar fasciitis typically causes pain localized to the medial inferior heel at the insertion of the plantar fascia in the medial calcaneal tubercle. Pain is usually present at activity initiation following prolonged rest and improves with further walking
90
IM Key points
Characteristic features of acute angle-closure glaucoma include the sudden onset of headache, nausea, vomiting, and vision changes; the appearance of halos around lights; and the presence of a mid-dilated, nonreactive pupil.
Central retinal vein occlusion, which is often caused by a thrombus in the retinal vein, presents as painless onset of blurry vision or vision loss. It is not usually associated with redness or pupillary changes; ho
91
IM Key points
For women with anovulatory abnormal uterine bleeding and contraindications to combination oral contraceptive use, a progestin-containing intrauterine device will likely reduce blood loss and maintain the stability of the endometrium, thereby reducing the risk for uterine cancer.
92
IM Key points
The treatments of choice for persistent postural-perceptual dizziness are vestibular and balance rehabilitation therapy and medical therapy with selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors.
The canalith repositioning maneuver (Epley maneuver) is used to treat benign paroxysmal positional vertigo (BPPV). Patients with BPPV have brief episodes of vertigo (10-30 seconds) precipitated by abrupt head movement. T
93
IM Key points
Lead-time bias occurs when survival time (time from diagnosis to death) appears to be lengthened because the screened patient is diagnosed earlier during the preclinical phase but does not live longer in actuality. To guard against this bias, disease-specific mortality rates rather than survival time should be used as an outcome derived from randomized clinical trials.
94
IM keypoint
Naltrexone, which is available in both oral and long-acting injectable forms, is associated with a substantial decrease in 30-day readmission and emergency department visits when prescribed to patients with alcohol dependence at the time of hospital discharge.
Acamprosate cant be used in CKD
Disulfuram- is a deterrent- does not decrease motitvation to drink but causes unpleaant sick feeling if drinking
95
IM key point
In patients in whom statin therapy is being considered, an alanine aminotransferase level should be obtained at baseline to evaluate for liver dysfunction; further hepatic monitoring is unnecessary if the baseline level is normal.
96
IM key point
Clinical diagnosis of bacterial vaginosis requires three of the following four features: vaginal pH greater than 4.5, thin and homogenous vaginal discharge, positive whiff test result, and clue cells comprising at least 20% of all squamous cells on saline microscopy; culture is not a reasonable test to confirm the diagnosis of bacterial vaginosis and would also be costly and inefficient compared with an office-based diagnosis.
Vulvovaginal candidiasis is typically characterized by vaginal itching, irritation, and discharge and may be associated with dysuria and dyspareunia. Examination reveals vulvar edema and excoriation, with thick, white, curdy vaginal discharge. The diagnosis can be made when a saline or 10% potassium hydroxide wet mount of vaginal discharge shows yeast, hyphae, or pseudohyphae.
97
IM key point
For patients with concomitant benign prostatic hyperplasia and erectile dysfunction, a trial of tadalafil (a phosphodiesterase-5 inhibitor) has been shown to be effective and is the only FDA-approved option to treat both conditions.
Tamsulosin and other α-blocking agents are first-line medical therapy for symptomatic BPH. However, α-blockers have numerous side effects, including hypotension, orthostasis, and sexual dysfunction. Tamsulosin could worsen this patient's erectile dysfunction and thus would not be the most appropriate treatment choice.
98
IM key point
In patients undergoing noncardiac surgery, β-blockers and statins should be continued in those who have been taking the drugs long term, and aspirin generally should be continued in patients with coronary stents unless the bleeding risk is prohibitively high.
99
IM key point
In patients with findings concerning for centrally mediated vertigo (nystagmus, dysphagia, dysarthria, diplopia, ataxia, postural instability, hemiparesis, or mental status changes), or in patients with acute sustained vertigo and risk factors for vertebrobasilar stroke (advanced age, hypertension, hyperlipidemia, diabetes mellitus, peripheral vascular disease, atrial fibrillation), urgent evaluation with MRI is strongly recommended.
100
IM key point
Genitourinary syndrome of menopause is a clinical diagnosis characterized by vulvar itching, vaginal dryness, and dyspareunia; pelvic examination findings include pale, shiny vaginal walls; decreased rugae; and petechiae.
Lichen sclerosus is an inflammatory condition that often presents as white, atrophic patches on the genital and perianal skin. It differs from lichen planus in its clinical presentation of white patches that circumferentially involve the vaginal introitus and perianal area (“figure 8” appearance).
101
IM key point
When it is necessary to discontinue anticoagulant therapy for surgery, non–vitamin K antagonist oral anticoagulants can be stopped 2 to 3 days preoperatively because of their short half-lives.
Discontinuing apixaban 5 or 7 days before surgery would expose this patient to a small but increased thrombotic risk during that time frame.
102
Name the concept: The ability of a test to detect a disease when it is truly present
Sensitivity
103
Name the concept: is the ability of a test to exclude disease when it is truly absent.
specificity
104
How does the positive predictive value of a condition change with an increase in prevalence?
As the prevalence of a condition increases, the positive predictive value increases and the negative predictive value decreases.
105
How does changes in prevalence alter the sensitivity or specificity ?
Changes in prevalence do not alter the sensitivity or specificity but do alter the predictive values.
106
How often should the flu vaccine be given?
One dose annually (for all persons 218 y), including pregnant women and those with HIV infection
107
For pregnant women, which vaccines should be avoided?
For pregnant women, do not select live vaccines, including MMR, intranasal influenza, yellow fever, varicella, and zoster vaccines
108
How often should TDAP and TD booster be given?
One dose TDap, then Td booster every 10 y for all adults
109
When should TDAP be given in pregnant women?
one dose Tap each between 27 to 36 weeks' gestation
110
Who should receive the varicella vaccine?
Anybody who is immunocompetent and has not had it
111
who should get thew herpes zoster (shingles) vaccine?
all immunocompetent over age 50
112
who should get the HPV vaccine?
Women aged 19-26 yo, men aged 11-21 yo; men aged 22-26 yo who are HIGH RISK, immunocompromised or who have sex with other men
113
who should get the HPV vaccine?
Women aged 19-26 yo, men aged 11-21 yo; men aged 22-26 yo who are HIGH RISK, immunocompromised or who have sex with other men
113
who should get the HPV vaccine?
Ages 19-26 y
Ages 27-45 y based on shared clinical decision-making
114
who should get the MMR vaccine?
Adults born after 1957 who do not have immunity. It is live, so avoid in pregnant
114
who should get the MMR vaccine?
Adults born after 1957 who do not have immunity. It is live, so avoid in pregnant
115
which vaccines are live vaccines?
Nasal influenza, MMR, yellow fever, varicella, zoster
116
who should receive the meningococcal vaccine?
First-year college students residing in dormitories, travelers to endemic areas, military recruits, and exposed persons; asplenia or complement deficiencies; boost every 5 years if risks remains.
117
Are flu vaccines safe in patients with egg allergies?
all flu vaccines are safe in those with egg allergies
118
When is the PCV13 vaccine recommended compared with the PPSV23 vaccine for immunocompetent adults?
Age 65, and PCV13 once, followed by PPSV23 ONE YEAR AFTER pcv13. Can give PPSV23 again at 5 years after first dose.
119
how long after should immunocompetent adults receive the PPSV23 wafter getting the PCV13 ?
one year
120
Which PNA vaccine is recommended for immunocompetent people with chronic heart, lung, or liver disease, diabetes mellitus, alcoholism, cigarette smoking
PPSV23
120
Which PNA vaccine is recommended for immunocompetent people with chronic heart, lung, or liver disease, diabetes mellitus, alcoholism, cigarette smoking
PPSV23
121
Which PNA vaccine is recommended for immunocompetent people with chronic heart, lung, or liver disease, diabetes mellitus, alcoholism, cigarette smoking
PPSV23
122
Which PNA Vaccine should someone with sickle cell, hemoglobinopathy or anatomic asplenia receive?
both PCV13 and PPSV23
123
Which PNA Vaccine should Immunocompromised persons with EITHER HIV, chronic kidney disease, nephrotic syndrome, leukemia, lymphoma, Hodgkin Ssesse, multiple myeloma, generalized malignancy, taking immunosuppressant drugs, congenital immunodeficiencies,
solid organ transplant RECEIVE?
Both PCV13 and PPSV23
124
Which PNA Vaccine should SOMEONE with a PMH CSF leaks or cochlear implants receive?
Both PCV13 and PPSV23
124
What are the 5 recommended scenarios in which aspirin is used as a primary prevention of ASCV and colon cancer?
* adults aged 50-59 years
* 10-year CVD risk >10%
* life expectancy >10 years
* no increased risk for bleeding
* willing to take low dose aspirin daily ≥10 years
124
Who should be screened for One -time abdominal ultrasonography?
One-time abdominal ultrasonography in all men ages 65-75 y who have ever smoked.
125
Who should be screened for diabetes?
Ages 40-70 y who are overweight or obese as part of risk assessment for cardiovascular disease.
125
Who should be screened for lipid disorders?
Ages 40-70 y who are overweight or obese as part of risk assessment for cardiovascular disease.
125
Who should be treated for HTN?
You have to get measurements outside of the clinical setting for diagnostic confirmation and before you start treatment
126
what demographic should be screened for osteoporosis?
Women age >65 y; postmenopausal women less than 65 y of age when 10-year fracture risk is greater than 9.3%
127
What is the age recommendation for ASA primary
prevention of ASCVD?
The ACC/AHA and the ADA recommend that aspirin may be considered for primary
prevention of ASCVD in adults aged 40 to 70 years who are at higher ASCVD risk but
not at increased bleeding risk.
128
What is the recommended screening for HIV?
HIV infection One-time screening for all adults aged 15-65 y; at least annually for adults at high risk
129
Who should be screened for HBV, syphilis, and
latent TB?
Only All adults at high risk
130
What is the recommended screening for mammography?
Biennial (taking place every other year) screening mammography for women aged 50-74 y; initiation of screening before age 50 y should be individualized
131
Who should be screened for chlamydia and gonorrhea?
All sexually active women aged ≤24 y; all sexually active older women at increased risk of infection
132
What is the screening recommendation for cervical cancer ?
Women aged 21-65 y with cytology (Pap smear) every 3 y; in women aged 30-65 y who want to lengthen screening, screen with cytology and HPV testing every 5 y or high-risk HPV testing alone every 5 y
133
Should you screen women for cervical cancer following hysterectomy and cervix removal for benign disease?
Do not screen women following hysterectomy and cervix removal for benign disease
134
Who should be screened for colon cancer?
All adults aged 45-75 y. USPSTF recommendations do not support one form of screening test over another for
detecting early stage CRC in average-risk patients.
135
Who should be screened for lung cancer with annual CT?
Annual low-dose CT scan in high-risk patients (adults aged 50-80 y with a 20-pack-year smoking history, including former smokers who have quit in the last 15 years)
136
Who should be screened for prostate cancer?
Men aged 55-69 years should make an informed decision about prostate cancer screening with their physician.
Physicians should not screen men unless they express a preference for screening, and routine screening for men
137
For average risk colon cancer screening, how often should you screen if you are using Guaiac fecal occult blood test (FOBT)?
Annually
138
For average risk colon cancer screening, how often should you screen if you are using Fecal immunochemical test (FIT)?
Annually
139
For average risk colon cancer screening, how often should you screen if you are using flex sig ?
q 5 years
140
For average risk colon cancer screening, how often should you screen if you are using Flexible sigmoidoscopy plus annual FIT ?
q 10 years
141
For average risk colon cancer screening, how often should you screen if you are using FIT-DNA?
Every 1 or 3 years
142
For average risk colon cancer screening, how often should you screen if you are using Colonoscopy ?
q 10 years
143
For average risk colon cancer screening, how often should you screen if you are using CT colonography ?
q 5 years
144
what are the 3 most common causes of abnormal uterine bleeding?
* PCOS
* hypothyroidism or hyperthyroidism
* hyperprolactinemia
145
for postmenopausal women, what is the required test for abnormal uterine bleeding?
Endometrial biopsy is indicated in postmenopausal women.
146
Besides endometrial biopsy what other option is available to assess for structural abnormalities in the uterus and to determine endometrial thickness?
Pelvic ultrasonography is
an option to assess for structural abnormalities in the uterus and to determine
endometrial thickness.
146
Besides endometrial biopsy what other option is available to assess for structural abnormalities in the uterus and to determine endometrial thickness?
Pelvic ultrasonography is
an option to assess for structural abnormalities in the uterus and to determine
endometrial thickness.
147
What size is endometrial biopsy indicated when
endometrial thickness is found on ultrasound?
In postmenopausal women, endometrial biopsy is indicated if
the endometrial thickness is >4 mm on ultrasound.
148
For women with abnormal uterine bleeding and anovulatory cycles who wish to preserve fertility, what is the best treatment AUB?
For women with anovulatory cycles who wish to preserve fertility medroxyprogesterone acetate used for the second half of the menstrual cycle
will restore cyclic withdrawal bleeding.
149
For women with AUB who are interested in contraception, what is the treatment for their AUB?
For women interested in contraception:
* combined oral contraceptive pills or
* levonorgestrel intrauterine device may be used
150
Which clinical syndrome is a chronic inflammatory skin disorder that affects the cheeks and nose and
usually occurs after the age of 30 years?
Rosacea
151
In early stages, rosacea can resemble the malar rash of SLE. How can you differentiate the two?
The rash of SLE spares the nasolabial folds. The development of papules, pustules, and flushing is
inconsistent with SLE and supports the diagnosis of rosacea.
152
which clinical syndrome is this?
Rosacea
153
Which clinical condition is common in athletes and consists of follicular papules; pustules; occasional furuncles on any hair-bearing area, especially scalp, buttocks, and thighs. Most common cause is S. aureus?
Bacterial
folliculitis
154
which clinical condition includes discrete papules and pustules on an erythematous base around the mouth, but typically sparing the skin directly around the lips?
Perioral
dermatitis.
155
What clinical syndrome is this?
Perioral dermatitis.
155
Which ACNE retinoids can be used in pregnancy?
All topical retinoids and oral isotretinoin are contraindicated in pregnancy.
156
Which topical meds can be used safe in pregnancy?
Topical clindamycin, azelaic acid, and erythromycin are safe in pregnancy.
157
How does the treatment for erythrotelangiectatic rosacea differ from Treatment of papulopustular rosacea?
Treatment of erythrotelangiectatic rosacea focuses primarily on behavioral modifications, such as avoidance of identified triggers of flushing, proper use of sun protection, and use of gentle skin cleansers. Treatment for papulopustular rosacea includes topical metronidazole, an azelaic acid
formulation, and topical ivermectin. Topical glucocorticoids should be avoided.
158
How does the treatment for erythrotelangiectatic rosacea differ from Treatment of papulopustular rosacea?
Treatment of erythrotelangiectatic rosacea focuses primarily on behavioral modifications, such as avoidance of identified triggers of flushing, proper use of sun protection, and use of gentle skin cleansers. Treatment for papulopustular rosacea includes topical metronidazole, an azelaic acid
formulation, and topical ivermectin. Topical glucocorticoids should be avoided.
159
For treatment of moderate to severe
acne can oral or topical antibiotic monotherapy be used?
Avoid oral or topical antibiotic monotherapy for treatment of moderate to severe
acne because of increased antibiotic resistance; combine with topical benzoyl
peroxide.
160
For MILD noninflammatory acne (comedones), which is the recommended treatment?
Comedolytic agent (topical retinoid such as tretinoin, adapalene, and tazarotene). For mild, topical is the best
161
For moderate to severe inflammatory acne what is the recommended treatment ?
Topical retinoid, topical antibiotic, and an oral antibiotic (tetracycline or others)
162
For moderate noninflammatory acne what is the recommended treatment?
Topical retinoid and benzoyl peroxide or azelaic acid
163
For women with Severe recalcitrant nodular acne, what is the recommended treatment?
Oral isotretinoin (women require two forms of birth control when taking this drug because it is teratogenic)
164
which clinical syndrome includes lesions located on sun-exposed sites and appear as 2- to 3-mm, elevated, flesh-
= colored or red papules with adherent, whitish scale or “rough spots”?
Actinic keratosis
165
what is the clinical significance or implications of Actinic keratosis?
Actinic keratosis is a precursor to SCC.
166
which clinical syndrome is shown in the pic?
Actinic keratosis
167
What is the difference in treatment for actinic Keratoses for those with a single lesions vs those with numerous lesions?
Destruction by liquid nitrogen or curettage is the preferred treatment for most single lesions.
Topical 5-FU or imiquimod cream is used for the treatment of numerous lesions.
168
which clinical syndrome is associated with fever, chills, dysuria, pelvic pain, cloudy urine,
obstructive symptoms, and blood in the semen?
acute prostatitis
169
How is acute prostatitis diagnosed?
The diagnosis is established by finding a tender prostate on physical examination and a positive urine culture.
170
What is the recommended treatment for acute prostatitis for patients who appear toxic?
For patients who appear toxic, hospitalize and add gentamicin to a fluoroquinolone, cefotaxime, ceftazidime, or piperacillin/tazobactam.
171
What is the recommended treatment for acute prostatitis?
Begin empiric antibiotics that cover gram-negative organisms (trimethoprim-sulfamethoxazole, fluoroquinolone) for 2 to 6 weeks.
172
The absence of the cremasteric reflex on the affected side is nearly 99% sensitive for what condition?
testicular torsion
173
In patients with testicular torsion does testicular elevation relieve pain?
Testicular elevation will not
relieve pain.
174
What does Doppler flow ultrasonography
demonstrates in Testicular torsion?
Doppler flow ultrasonography
demonstrates diminished blood flow to the affected testicle.
175
Which clinical syndrome is associated with pain localizing to the posterior and superior aspects of the testicle with dysuria, pyuria, and fever?
Epididymitis
176
With Epididymitis how does the pain change with testicular elevation?
Pain may decrease with testicular
elevation.
177
In which condition, associated with mumps, does ultrasonography demonstrates normal or increased blood flow to the testicle ?
In epididymitis and orchitis
178
What is the treatment of testicular torsion?
Treatment of testicular torsion is immediate surgical exploration and reduction.
179
In men younger than 35 years with epididymitis what is the treatment and what conditions are you covering?
In men younger than 35 years with epididymitis, treat for gonorrhea and chlamydial
infection (ceftriaxone and doxycycline).
180
In men older than 35 years at low risk for STIs,
what is the treatment for epididymitis?
In men older than 35 years at low risk for STIs,
treat with levofloxacin
181
In men engaging in anal intercourse, what is the treatment for epididymitis?
For all men engaging in anal intercourse, treat with ceftriaxone and oral levofloxacin.
182
Which clinical syndrome is associated with sudden onset of acute pain and swelling of the affected salivary gland, which may be accompanied by fever?
Sialadenitis
183
What is the most common bacterial cause of Sialadenitis?
Sialadenitis typically has a bacterial cause,
most commonly Staphylococcus aureus;
184
What is the treatment for sialadenitis?
Warm compresses and sialagogues (sour candies or vitamin C lozenges); salivary gland
massage; increased fluid intake; oral hygiene; and, in cases of bacterial sialadenitis,
antibiotics are indicated.
185
Elevations in which lab values are suggestive of alcohol use disorder?
Laboratory clues such as an elevated MCV, γ-glutamyl transferase level, and AST-ALT ratio >2 are
suggestive
186
what is the first step in Screening for alcohol use disorder ?
Screening for alcohol use disorder begins with quantifying the amount of alcohol
consumed, not CAGE or AUDIT-C questions.
187
what is the tx indicated for hospitalized patients with previous alcohol-related seizures or delirium?
Benzodiazepines
188
Which medication can be used IN ACTIVE drinkers to prevent relapse of alcohol abuse and dependence?
Naltrexone
189
In what two main conditions is Naltrexone contraindicated?
Naltrexone is contraindicated in patients receiving or withdrawing from any opioid and in those with liver failure or hepatitis.
190
Which alcohol dependence treatment is contraindicated in kidney disease?
Acamprosate
.
191
Which alcohol dependence treatment is a second-
line treatment that causes the accumulation of acetaldehyde if alcohol is consumed, resulting in flushing, headache, emesis, and the need to avoid all additional alcohol-containing items?
Disulfiram
192
For alcohol withdrawal, which us preferred long term or short term benzos?
Long-acting benzodiazepines are typically preferred.
193
Is a continuous infusion therapy with short-acting
benzodiazepines better than oral therapy for acute alcohol withdrawal?
No evidence supports that continuous infusion therapy with short-acting
benzodiazepines provides better outcomes than oral therapy for acute alcohol
withdrawal.
194
In treating alcohol withdrawal, should thiamine or glucose be given first?
Give thiamine replacement before administering glucose.
195
Which clinical syndrome is associated with a young person, nasal polyposis, chronic sinusitis, malnourishment, infertility, and chronic or recurrent bronchitis?
Cystic fibrosis
196
Which clinical syndrome is associated with rhinitis, nasal polyps, asthma, and aspirin intolerance (respiratory symptoms)?
Aspirin-exacerbated respiratory disease (triad
asthma or Samter syndrome)
197
What is first-line therapy for allergic rhinitis+?
Intranasal glucocorticoids are first-line therapy.
198
Which clinical syndrome is associated with refractory congestion after chronic use of topical nasal decongestants?
Rhinitis medicamentosa
199
What is the recommended treatment for SEVERE allergic rhinitis?
Combination intranasal glucocorticoids
and intranasal antihistamine are indicated for severe symptoms.
200
If treatment for SEVERE allergic rhinitis does not work, what is the next best step in evaluation?
Choose skin testing and allergen immunotherapy if symptoms are not well controlled
by intranasal glucocorticoids with supplemental antihistamines or decongestants.
201
What is the treatment for ADHD?
Treat ADHD with stimulants (e.g., amphetamine or methylphenidate)
202
Which SNRI is approved for treatment of ADHD in adults?
Atomoxetine is an SNRI approved for treatment of ADHD in adults. CBT may be
beneficial alone or used as an adjunctive therapy.
202
What conditions should you beware of before deciding to treat for ADH with stimulants?
Use with caution in patients with hypertension or cardiovascular disease.
203
Which clinical syndrome is associated with pink, pearly, translucent papule or nodule with
telangiectasias, rolled borders, and central depression with ulceration?
Basal Cell Carcinoma
204
Which clinical syndrome is shown in this photo?
Basal Cell Carcinoma
204
What is the treatment for most BCCs?
Most BCCs are treated with simple excision.
Ill-defined lesions, high-risk histologic types, and tumors on the face and hands areoften best
treated with Mohs micrographic surgery.
204
Which basal cell carcinomas are treated with Mohs micrographic surgery?
Ill-defined lesions, high-risk histologic types, and tumors on the face and hands are often best treated with Mohs micrographic surgery.
205
Which clinical syndrome is associated with grouped, itchy papules in close configuration (“breakfast, lunch, and dinner”) on exposed body areas? These Bites are typically noticed in the morning
Bed bugs
206
Which clinical syndrome is associated with the image?
bed bugs
207
Clinical syndrome associated with (urinary urgency, frequency, and nocturia) and
obstructive symptoms (decreased urinary stream, intermittency, incomplete emptying,
and straining)?
BPH
208
What are the two major classes of BPH drugs?
The two major BPH drug classes
include:
* α-adrenergic blockers (terazosin, tamsulosin, doxazosin, alfuzosin, and prazosin)
* 5-α reductase inhibitors (finasteride, dutasteride)
209
which BPH drug class (α-Adrenergic blockers or 5-α reductase inhibitors) is more effective?
α-Adrenergic blockers are superior to 5-α reductase inhibitors. α-Adrenergic blockers
plus finasteride are more effective than either drug alone but are associated with
increased adverse effects.
210
For patients with concomitant BPH and erectile dysfunction what is the best treatment for BPH?
Tadalafil, a PDE-5 inhibitor, improves lower urinary tract symptoms and may be used in
patients with concomitant BPH and erectile dysfunction.
211
What is the next best tx for patients with severe urinary symptoms, urinary retention, persistent hematuria, recurrent UTIs, or kidney disease clearly attributable to BPH?
Surgical treatment is indicated in patients with severe urinary symptoms, urinary
retention, persistent hematuria, recurrent UTIs, or kidney disease clearly attributable to
BPH.
212
what is the most effective mood stabilizer for bipolar disorder?
Lithium is the most effective mood stabilizer, but long-term therapy carries significant
side effects, including kidney disease, hypothyroidism, and DI.
213
What is the potential issue with Monotherapy
with SSRIs in pts with bipolar disorder?
Monotherapy
with SSRIs may unmask mania in patients with untreated bipolar disorder.
214
what is the next step for women who test positive for BRCA?
Women with a positive result on the risk
assessment tool should receive genetic counseling and, if indicated after counseling,
genetic testing.
215
Which patients should be evaluated with an
appropriate brief familial risk assessment tool for breast cancer?.
The USPSTF recommends that women with a personal or family history of breast,
ovarian, tubal, or peritoneal cancer or who have an ancestry associated with breast
cancer susceptibility 1 and 2 (BRCA1/2) gene mutations be evaluated with an
appropriate brief familial risk assessment tool.
216
What medications are used for pre-menopausal women vs post menopausal women for breast cancer prevention?
* tamoxifen before menopause
* tamoxifen and raloxifene, or exemestane after menopause
217
In a patient under 30 with a Palpable breast lump or mass what work up should you choose?
Choose ultrasonography
218
In a patient under 30 with a Palpable breast lump or mass, If simple cyst is found on ultrasound, what should the next step in evaluation be?
If simple cyst on ultrasound, aspirate and repeat clinical breast examination in 4-6 weeks
219
In a patient under 30 with a Palpable breast lump or mass , If complex cyst is found on ultrasound, what is the next step in evaluation?
If complex cyst on ultrasound, biopsy
220
In a patient under 30 with a Palpable breast lump or mass, If solid breast cyst is found on ultrasound, what is the next step in evaluation?
If solid on ultrasound, biopsy or excise
221
In a patient OVER 30, with a Palpable lump or mass, what is the next step in evaluation?
Mammogram
222
In a patient of any age, who comes in with bilateral nipple MILKLY discharge, no mass, What is the next step in evaluation
Start with a pregnancy test, if negative, choose endocrine evaluation.
223
In a patient of any age, who comes in with persistent, unilateral, one duct, or serous/bloody: what is the next step in evaluation?
choose mammography and surgical referral for duct exploration
224
In a patient with skin changes (erythema, peau
d’orange, scaling, nipple excoriation,
eczema) who is LESS than age <30 years, what is the likely diagnosis and treatment?
Consider mastitis and treat with antibiotics if appropriate and reevaluate in 2 weeks;
225
In a patient with skin changes (erythema, peau
d’orange, scaling, nipple excoriation,
eczema) who is OVER age <30 years, what is the likely diagnosis and treatment?
Perform bilateral mammography: if normal, obtain skin biopsy; if abnormal or
indeterminate, obtain needle biopsy or excision
226
What findings on a breast mass are
suspicious for malignant disease?
On mammography, an irregular mass with microcalcifications or spiculation is
suspicious for malignant disease, and biopsy is mandatory.
227
What is the age interval and screening recommendation for cervical cancer?
The USPSTF recommends screening women aged 21 to 65 years every 3 years with
cytology (Pap test). In women aged 30 to 65 years who want to lengthen the screening
interval, high-risk HPV testing (preferred) or cytology combined with high-risk HPV
testing can be performed every 5 years (cotesting).
228
When can screening for cervical cancer be discontinued?
Screening can be discontinued at age 65 years in non–high-risk women with adequate
previous screening:
* three consecutive negative cytology results, or
* two consecutive negative cytology plus HPV test results within the last 10 years,
with the most recent test occurring within 5 years
229
Can HPV vaccine be given to patients who are HIV positive or otherwise immunosuppressed?
HPV vaccine can be given to patients who are HIV positive and otherwise
immunosuppressed.
230
Should you screen women following a hysterectomy with cervix removal for benign
disease (e.g., fibroids) for cervical cancer?
no
231
Which clinical syndrome is associated with postnasal drainage, frequent throat clearing, nasal discharge, COBBLESTONE appearance of the oropharyngeal mucosa, or mucus dripping down the oropharynx?
Upper airways cough syndrome
232
For patients with Upper airways cough syndrome, what should be done before evaluated?
All patients should undergo chest x-ray. Smoking cessation and discontinuation of ACE
inhibitors are indicated for 4 weeks before additional evaluation.
233
what is the recommended treatment for patients with Upper airways cough syndrome?
First-generation antihistamine-
decongestant combination or intranasal glucocorticoid (for allergic rhinitis)
234
What clinical syndrome is associated with Asthma, cough with exercise or exposure to cold?
Cough-variant
asthma
235
How is Cough-variant asthma diagnosed?
Methacholine or exercise challenge if
diagnosis is uncertain Standard asthma therapy
236
In a patient with normal chest x-ray findings, normal spirometry, and negative
methacholine challenge test; failed empiric PPI therapy what diagnosis should be considered?
Possible nonasthmatic eosinophilic bronchitis
Sputum induction or bronchial wash for
eosinophils or exhaled nitric oxide testing
Treat with inhaled glucocorticoids; avoid
sensitizer
237
Which clinical syndrome is associated with chronic pelvic pain worse before and during menses associated with dysmenorrhea?
Endometriosis
238
Which clinical syndrome is associated with a history of sexual abuse and normal physical examination and ultrasonography but with pelvic pain?
Chronic pelvic pain syndrome
239
Which clinical syndrome is associated with urinary frequency, urgency, nocturia, and dysuria; suprapubic pain possibly relieved with voiding; and
examination that shows vestibular and suprapubic tenderness?
Interstitial cystitis
240
In a woman with chronic pelvic pain, what are the first two things to do to work it up?
A urine pregnancy test and pelvic/transvaginal ultrasonography are used to evaluate
women with chronic pelvic pain.
241
For a patient with chronic pelvic pain who has a
sudden increase in pain intensity, which potential diagnosis should be indicated?
patient with chronic pelvic pain who has a
sudden increase in pain intensity, which may indicate a superimposed acute
process such as appendicitis.
242
What is the first and second line therapy for endometriosis?
NSAIDs are first-line therapy for endometriosis, followed by oral contraceptives if
pregnancy is not desired.
243
What is the gold standard for diagnosis for endometriosis?
The lesions can be visualized by laparoscopy, the gold standard for diagnosis,
244
Should endometriosis be considered in a patient with chronic pelvic pain, fever or vaginal discharge?
Endometriosis does not cause fever or vaginal discharge.
245
What are First-line therapy for Chronic Venous Insufficiency?
First-line therapy includes compression (stockings, wraps, pumps) and leg elevation.
246
Which clinical syndrome is associated with
* leg heaviness, tiredness
* dependent leg edema
* hyperpigmentation, especially at medial ankle
* pruritus and eczema
* varicose or reticular veins
* venous ulceration
Chronic Venous Insufficiency
247
Can loop diuretic therapy be used as first-line therapy for edema from chronic venous insufficiency?
Loop diuretic therapy is not recommended as first-line therapy for edema from chronic venous insufficiency.
248
What is the advantage of using a Combined (estrogen-progesterone) transdermal patch for birth control?
It is a single patch changed weekly
249
What is the disadvantage of using a Combined (estrogen-progesterone) transdermal patch for birth control?
Higher levels of estrogen, increased VTE risk
250
What is the advantage of using a Combined (estrogen-progesterone) vaginal ring for birth control?
Vaginal ring Ring is changed every 3 weeks
251
What is the advantage of using Progesterone-only
Oral contraceptive pill for BC?
It is Safe when estrogen is contraindicated
252
What is the Disadvantage of using Progesterone-only Oral contraceptive pill for BC?
Irregular bleeding,
breakthrough bleeding
253
What is the advantage of using Progesterone-only Depot medroxyprogesterone acetate for BC?
Administered every 3 months, Decreases menstrual frequency
254
What is the disadvantage of using Progesterone-only Depot medroxyprogesterone acetate for BC?
Irregular bleeding, Delayed return to fertility
(up to 10 months), Weight gain, decreased bone mineral density
255
What is the advantage of the copper IUD?
Effective up to 10 years
256
What is the advantage of the Levonorgestrel IUD?
Effective 3 to 5 years
257
What are the contraindications to combination hormonal products for BC?
Contraindications to combination hormonal products include:
* uncontrolled hypertension
* breast cancer
* VTE
* liver disease
* migraine with aura
258
In what age and polulation of women is Estrogen-containing preparations contraindicated?
Estrogen-containing preparations are contraindicated in women >35 years who smoke
more than 15 cigarettes per day.
259
What are the two options for Emergency contraception ?
Emergency contraception is postcoital hormonal contraception used to prevent
pregnancy after inadequately protected coitus. Options include:
* over-the-counter levonorgestrel
* prescription ulipristal
260
which clinical syndrome should be diagnosed when depression is accompanied by previous or current manic symptoms?
Select bipolar disorder if depression is accompanied by previous or current manic symptoms.
261
Which 2nd gen (first line) anti-depressant is safe for patients with cardiovascular disease?
Sertraline
262
Which anti-depressant has fewest effects on sexual function and weight gain?
Bupropion has fewer effects on sexual function and weight gain.
263
Which anti-depressant causes sedation and weight gain?
Mirtazapine causes sedation and weight gain (useful for patients with insomnia
264
Which SSRI has the highest rate of sexual dysfunction among SSRIs, a higher rate of weight gain, and the highest rate of discontinuation syndrome ?
Paroxetine is classified as pregnancy category D (do
265
Which SSRI is classified as pregnancy category D (and should not be used?
Paroxetine is classified as pregnancy category D (do
266
If a patient does not have greater than a 50% reduction in symptoms after starting an SSRI, what should be done next?
In nonresponding patients, modify treatment
(increase dose, switch, or add another drug) if the patient does not have ≥50% reduction in symptom score with pharmacotherapy within several weeks.
266
If a patient does not have greater than a 50% reduction in symptoms after starting an SSRI, what should be done next?
In nonresponding patients, modify treatment
(increase dose, switch, or add another drug) if the patient does not have ≥50% reduction in symptom score with pharmacotherapy within several weeks.
267
At what point should long-term maintenance therapy foer depression be considered?
After Three or more recurrences of depression,
recurrence within 1 year of successful
treatment, or suicide attempt
268
Can Antidepressant drugs should be stopped abruptly?
NO
269
In patients taking SSRIs, particularly with concurrent use of other SSRIs, MAOIs, St. John's wort, trazodone, dextromethorphan, linezolid,
tramadol, or buspirone, what syndrome can be precipitated?
serotonin syndrome
270
which clinical syndrome is associated with nausea, vomiting, flushing, and diaphoresis, hyperreflexia, myoclonus, muscular rigidity, and hyperthermia.
serotonin syndrome
271
which clinical syndrome is associated with redness and a “tile-like” pattern on dry skin with evidence of trauma because of scratching?
Xerotic dermatitis
272
Which syndrome is shown in this pic
Xerotic dermatitis
273
Which clinical syndrome is associated with ITCHY purpuric macules or patches, most commonly on the forearms, due to minor trauma?
damage.
Actinic purpura There is no
treatment for actinic purpura, but sun protection is recommended to prevent further
damage.
273
Which clinical syndrome is associated with ITCHY purpuric macules or patches, most commonly on the forearms, due to minor trauma?
damage.
Actinic purpura There is no
treatment for actinic purpura, but sun protection is recommended to prevent further
damage.
274
Which clinical syndrome is associated with this picture?
Actinic purpura
275
Which clinical syndrome is associated with tan or light brown, 1- to 3-cm well-defined macules on sun- exposed areas of older adults?
Solar lentigines
And when they are larger than 1 cm or irregular in shape, melanoma is in the differential diagnosis, and biopsy should be considered.
276
which clinical syndrome is associated with this pic
Solar lentigines
277
There are some Dermatologic Signs of Systemic Disease such as Porphyria cutanea tarda and palpable purpura that are associated with which condition?
hep c
278
There are some Dermatologic Signs of Systemic Disease such as Severe or recalcitrant seborrheic
dermatitis or abrupt onset of severe
psoriasis that are associated with which condition?
Initial HIV
279
There are some Dermatologic Signs of Systemic Disease such as Erythema nodosum that are associated with which conditionS?
IBD, TB, sarcoidosis, coccidioidomycosis, streptococcal infection; look particularly for
Löfgren syndrome
280
Which condition is associated with bilateral hilar lymphadenopathy, erythema nodosum, and lower
extremity arthralgia?
Löfgren syndrome
281
There are some Dermatologic Signs of Systemic Disease such as Dermatitis herpetiformis that are associated with which conditionS?
Celiac disease
282
There are some Dermatologic Signs of Systemic Disease such as Livedo reticularis that are associated with which conditionS?
Atheroemboli (previous vascular catheterization), thrombophilia, hyperviscosity
syndrome, vasculitis
283
There are some Dermatologic Signs of Systemic Disease such as Pyoderma gangrenosum that are associated with which conditionS?
IBD, inflammatory arthritis, lymphoproliferative disorders
284
There are some Dermatologic Signs of Systemic Disease such as Mechanic's hands (hyperkeratotic,
fissured skin on the palms) that are associated with which conditions?
Dermatomyositis/antisynthetase syndrome (myositis, Raynaud syndrome, interstitial
lung disease with anti–Jo-1 antibodies)
285
what is the main Yeast infection infecting humans?
Yeast infections include Candida, the main yeast species infecting humans
286
Which fungus causes pityriasis versicolor?
Malassezia
287
How is the Diagnosis of dermatophyte infection is made?
Diagnosis of dermatophyte infection is made by examination of the scale or subungual
debris with KOH demonstrating the presence of branching hyphae.
288
Which clinical condition is associated with yeast spores characterized by “spaghetti
and meatballs” microscopic appearance?
Pityriasis (tinea) versicolor
289
Which clinical condition is associated with pseudohyphae and spores?
Candida is associated with pseudohyphae and spores.
290
What clinical condition is associated with the photo?
Pityriasis Versicolor
291
What is the MAIN difference between Tinea cruris and intertrigo?.
Tinea cruris spares the scrotum, whereas intertrigo does not.
292
Which clinical condition is associaTED WITH THIS PIC?
Tinea Infection
293
Which clinical condition is associated with a round or oval erythematous scaling patch that
spreads centrifugally with central clearing. It has an active border that is raised,
consisting of tiny papules or vesicles and scale
Tinea Infection:
294
Which clinical syndrome is associated with this pic?
Chronic Tinea Pedis:
295
Which clinical condition is associated with the pic?
296
Which clinical condition is associated with aright red papules, vesicles, pustules, and patches with satellite papules and pustules?
andidiasis.
297
Which clinical syndrome is associated with this pic?
Onychomycosis
298
What is the recommended treatment of pityriasis versicolor?
Topical ketoconazole, selenium sulfide
299
What is the recommended tx for Confirmed onychomycosis, tinea capitis, extensive tinea corporis, or treatment-resistant dermatophytosis?
Oral terbinafine or itraconazole
300
Whare ate most Most dermatophyte infections except tinea capitis and
onychomycosis tx with?
Topical terbinafine or imidazole creams, such as miconazole, clotrimazole, and ketoconazole
301
What are Candida infections typically tx with?
Candida infections Topical nystatin, miconazole, clotrimazole, ketoconazole, econazole
302
When is Treatment of onychomycosis required?
Treatment of onychomycosis is typically not necessary but is recommended for
patients with peripheral vascular disease or diabetes to prevent the development of
cellulitis.
303
If a patient has thick, yellow, and crumbling toenails without KOH scraping or positive culture for dermatophytes, do they require tx?
Do not select antifungal treatment for thick, yellow, and crumbling toenails
without KOH scraping or positive culture for dermatophytes.
304
When is tx with a combination of a topical antifungal agent and a glucocorticoid for
of an unknown skin rash or dermatophyte infection acceptable?
Never select a combination of a topical antifungal agent and a glucocorticoid for
treatment of an unknown skin rash or dermatophyte infection.
304
When is tx with a combination of a topical antifungal agent and a glucocorticoid for
of an unknown skin rash or dermatophyte infection acceptable?
Never select a combination of a topical antifungal agent and a glucocorticoid for
treatment of an unknown skin rash or dermatophyte infection.
305
When is oral ketoconazole as initial antifungal treatment indicated?
Do not choose oral ketoconazole as initial antifungal treatment because of the
risk of severe hepatotoxicity.
306
which clinical conditions can present as a
hypopigmented, scaly macules present on the chest?
Pityriasis Versicolor:
307
Which clinical syndrome is associated with acute onset of generalized papular eruption, facial edema, fever, arthralgia, generalized
lymphadenopathy, elevated serum aminotransferase levels, eosinophilia, and lymphocytosis?
Drug-induced hypersensitivity syndrome (also known as DRESS)
308
What is the difference in percent coverage for
SJS vs TEN ?
Spectrum ranges from classic target lesions (EM), to involvement of mucous membranes with
systemic symptoms (SJS), to a life-threatening loss of epidermis (TEN)
SJS involves <10%, SJS/TEN overlap involves 10%-30%, and TEN involves >30% skin
detachment
309
Which clinical syndrome is associated with body flushing, hypotension, and muscle pain associated with vancomycin and ciprofloxacin?
Red man syndrome
310
Which clinical syndrome is associated with tender subcutaneous nodules on lower leg; often preceded by a prodrome of fever, malaise,
and/or arthralgia?
Erythema nodosum
311
What is the most common type of drug reaction; symmetric distribution, usually truncal, hardly ever on palms or soles, and associated with fever and pruritus?
Maculopapular and morbilliform
311
What is the most common type of drug reaction; symmetric distribution, usually truncal, hardly ever on palms or soles, and associated with fever and pruritus?
Maculopapular and morbilliform
312
Does The absence of eosinophilia does not rule out drug reaction or DRESS?
No
313
what is the treatment for drug-induced hypersensitivity syndrome ?
Treat drug-induced hypersensitivity syndrome with systemic glucocorticoids.
314
What is the tx for SJS/TEN?
SJS/TEN treatment is supportive (fluid and electrolyte management, wound care); the
effectiveness of IVIG and glucocorticoids is uncertain.
315
Discrete round to oval lesions are characteristic of which rx?
Discrete round to oval lesions are characteristic of a fixed drug eruption.
316
Which clinical syndrome is associated with this pic?
Fixed Drug Eruption
317
Which clinical syndrome is associated with this pic?
Drug-Induced Hypersensitivity Syndrome
318
Which clinical syndrome is associated with this pic?
Morbilliform Drug Eruption
319
Which clinical syndrome is associated with of symmetrically arranged erythematous
macules and papules—some discrete and others confluent.?
Morbilliform Drug Eruption:
320
Which clinical syndrome is associated with the appearance of a maculopapular rash and with the use of ampicillin?
The appearance of a maculopapular rash is associated with the use of ampicillin in EBV
and CMV infections or underlying ALL. This is not a drug allergy.
321
who should be screened for high cholesterol?
The USPSTF recommends universal lipid screening in adults aged 40 to 75 years to calculate risk for ASCVD using the AHA/ACC Pooled Cohort Equations.
322
When is it appropriate to obtain lipoprotein(a), apolipoprotein B, or LDL particles in the evaluation
of dyslipidemia?
Do not obtain lipoprotein(a), apolipoprotein B, or LDL particles in the evaluation
of dyslipidemia.
323
When should adults use a low- to moderate-dose statin for the primary prevention of CVD events and mortality ?
The USPSTF recommends that adults use a low- to moderate-dose statin for the
primary prevention of CVD events and mortality when all of the following criteria are
met:
* age 40 to 75 years
* ≥1 CVD risk factors (e.g., dyslipidemia, diabetes, hypertension, smoking)
* calculated 10-year risk of a cardiovascular event of ≥10%
324
When should patients be evaluated for familial
hypercholesterolemia?
Patients with an LDL cholesterol level of ≥190 mg/dL and those with an ST-segment
elevation myocardial infarction at age ≤50 years should be evaluated for familial
hypercholesterolemia.
325
When should Ezetimibe be used for primary prevention of ASCVD ?
Ezetimibe may be used for primary prevention of ASCVD in patients with an LDL cholesterol level ≥190 mg/dL who do not achieve a 50% reduction and/or have an LDL cholesterol level ≥100 mg/dL while taking maximally tolerated statin therapy.
326
In which conditions should patients use statins for for secondary prevention of ASCVD?
* acute coronary syndrome
* history of MI, stable or unstable angina, coronary or other arterial
revascularization
* stroke or TIA
* PAD or abdominal aortic aneurysm
327
Which baseline labs should be obtained prior in patients starting a statin?
Baseline laboratory studies and monitoring:
* baseline fasting lipid panel and ALT level
328
In patients starting a statin, when should MONITOR ALT and CK ?
monitor ALT and CK only if a patient develops symptoms of hepatic or muscle
disease
329
At what level are Fibrates are indicated in patients with severe hypertriglyceridemia?
Fibrates are indicated in patients with severe hypertriglyceridemia (≥500 mg/dL) to prevent acute pancreatitis.
330
What potential complication can occur with hypertriglyceridemia (≥500 mg/dL)?
acute pancreatitis.
331
In patients with persistently elevated triglyceride levels despite statin therapy who have
ASCVD or diabetes and several other risk factors, what else can be added to decrease the risk for cardiovascular events?
the addition of icosapent ethyl may
decrease the risk for cardiovascular events.
332
What are two options for first line treatment of primary dysmenorrhea?
Primary dysmenorrhea is treated symptomatically without further testing with NSAIDs
and COX-2 inhibitors.
333
What are two options for second line treatment of primary dysmenorrhea?
Second-line therapy includes combined hormonal contraceptive therapy.
334
What are effective first-line treatments for PMS and PMDD?
Fluoxetine, sertraline, and paroxetine are effective first-line treatments for PMS and
PMDD.
335
What clinical syndrome is associated with the pic?
Dysplastic Nevi
336
When should be the next step when Dysplastic nevi develop increased characteristics associated with melanoma (fuzzy or ill-defined borders,
multiple colors, diameter ≥5 mm), have otherwise changed, or stand out from other nevi ?
must be removed and sent for pathology.
337
Which diagnostic clues suggest the restricting type of anorexia ?
* low BMI
* fear of weight gain
* distorted body image
* amenorrhea
338
Which two electrolyte abnormalities can be seen in those with anorexia and refeeding syndrome?
During the first few weeks of eating, patients are at risk for the refeeding syndrome, which can include cardiac arrest and delirium caused by
exacerbation of hypophosphatemia and hypokalemia.
339
Can you consider bupropion as an option for eating disorders?
Do not choose bupropion for eating disorders because of the increased
incidence of seizures.
340
Which type of anprexia has episodes of binging with loss of control followed by purging (vomiting, diuretic or laxative abuse), fasting, or excessive exercise WITH normal weight?
bulimia nervosa
341
Which electrolyte abnormalities can be seen in those with bulimia nervosa?
electrolyte
derangements (low chloride and potassium), and metabolic alkalosis.
342
What is the difference in treatment for anorexia nervosa, compared to bulimia ?
For anorexia nervosa, psychotherapy is considered first-line treatment. Psychotropic
drugs do not work.
Patients with bulimia respond to CBT; antidepressants may be beneficial.
343
Which clinical syndrome is associated with dry skin, intense pruritus with erythematous papules and vesicles, crusting, and oozing, skin thickening from chronic scratching, with scaling and fissuring?
Acute eczematous dermatitis
344
which clinical syndrome is associated with development of eczema in patients with allergic rhinitis, asthma?
Atopic dermatitis
345
Which infection is most associated with atopic dermatitis?
complicating S. aureus infection evidenced by pustules, crusting, and erosions
346
Which type of hypersensitivity is associated with contact dermatitis?
Contact dermatitis includes allergic contact dermatitis (type IV hypersensitivity
reaction)
347
which clinical syndrome is characterized by pruritic, erythematous plaques
on the palmar and dorsal hands, which can lead to fissuring and lichenification?
hand dermatitis
348
Which clinical syndrome is associated with inflammatory, scaling, itchy dermatosis that most
commonly affects the scalp but can also involve the eyebrows, nasolabial folds, chin,
central chest, and perineum?.
Seborrheic dermatitis
349
Explosive onset of WHICH CLINICAL DERM SYNDROME may be a sign of HIV infection?
Seborrheic dermatitis
350
A 28-year-old man is evaluated for severe seborrheic dermatitis of acute onset. What should be the next step?
Answer: For evaluation, order HIV testing.
351
Which two ointments, commonly used for wound care, can cause an allergic contact dermatitis that mimics a wound infection?
Neomycin and bacitracin, commonly used for wound care, can cause an allergic
contact dermatitis that mimics a wound infection.
352
Which clinical syndrome is associated with discretely grouped red vesicles and bullae in a linear distribution ?
Discretely grouped red vesicles and bullae in a linear distribution are characteristic of
contact dermatitis caused by poison ivy.
353
which clinical syndrome is associated with this pic?
Contact Dermatitis
354
which clinical syndrome is associated with this pic?
Atopic Dermatitis
355
which clinical syndrome is associated with the antecubital fossae, with lichenification and surrounding excoriations?
Atopic Dermatitis
356
What is the recommended treatment for Seborrheic dermatitis?
Seborrheic dermatitis:
* selenium sulfide or zinc pyrithione shampoos
* ketoconazole shampoo (not oral ketoconazole)
357
which clinical syndrome is associated with this pic?
Seborrheic Dermatitis
358
For facial eczema, is it reasonable select potent glucocorticoids for the face?
Do not select potent glucocorticoids for the face because of the risk of steroid-
induced acne and cutaneous atrophy.
359
Where do Ninety percent of epistaxis cases originate?.
Ninety percent of epistaxis cases originate in the anterior nasal septum.
360
Which cases of epistaxis are more likely to result in significant hemorrhage?
Posterior
bleeds are more likely to result in significant hemorrhage.
361
What is the initial management of Anterior nose bleeds vs for continued nose bleeding ?
Anterior bleeds can be managed with compression of the lower one third of the nose. If
anterior rhinoscopy can identify the bleeding site, topical vasoconstrictors (e.g.,
oxymetazoline) and nasal cautery are used for continued bleeding.
362
In a patient with erectile dysfunction WHO has the ability to achieve nocturnal and early morning erections, which alternate cause should be considered?
Erectile dysfunction occurring with preserved ability to achieve nocturnal and early morning
erections should raise suspicion for psychogenic cause.
363
What testing should be obtained in all patients with suspected erectile dysfunction?
Obtain a morning total testosterone level for all patients.
364
In a patient with ED, when should you suspect overuse of steroids?
Suspect androgen steroid
abuse in patients with infertility, muscular hypertrophy, testicular atrophy, and acne;
laboratory data show elevated hemoglobin and suppressed LH and FSH levels.
365
What options are First-line pharmacotherapy for erectile
dysfunction ?
First-line pharmacotherapy for erectile dysfunction is oral PDE-5 inhibitors (sildenafil, vardenafil [on demand], or tadalafil
[daily]).
366
What are the two main contraindications to use of oral PDE-5 inhibitors (sildenafil, vardenafil, tadalafil)?
These drugs are contraindicated in men who receive nitrate therapy in any form and in men with a history of nonarteritic anterior ischemic optic neuropathy.
367
What are the potential caution ramification for taking α-blockers along with PDE-5 inhibitors (sildenafil, vardenafil, tadalafil) for ED?
They
should be used with caution in men taking α-blockers because of the risk of
hypotension.
368
For men who can not take PDE-5 inhibitors for treatment of ED, Whatt is the second line option?
Intraurethral or intracavernous alprostadil is a second-line therapy for men who cannot take PDE-5 inhibitors.
369
which clinical syndrome is associated with this pic?
Erythema Multiforme
370
which clinical syndrome is associated with a target-like lesions with outer rings around a violaceous or dark center, blister,
or erosion?
Erythema Multiforme
371
What is the most common inciting factor for Erythema Multiforme?
Recurrent HSV infection is the most common inciting factor.
372
For Recurrent episodes of EM, what is the best next step in management?
Recurrent episodes of Erythema Multiforme may be managed with antiviral suppressive therapy for HSV
infection.
373
Should acute EM-associated HSV with antivirals?
Do not treat acute EM-associated HSV with antivirals.
374
What is the difference between EM and erythema migrans?
Do not confuse EM with erythema migrans, the rash of Lyme disease (red macule
with central clearing as the macule expands).
375
which clinical syndrome is associated with with otalgia, ear discharge, pruritus, and
conductive hearing loss?
typical external otitis
376
what is the different in patients who have malignant external otitis vs typical external otitis?
Malignant external otitis is characterized by systemic toxicity and evidence of
infection spread beyond the ear canal (mastoid bone, cellulitis) and is typically found in older adult patients with type 2 diabetes
377
What is the most common cause of malignant external otitis in older adult patients with type 2 diabetes or patients who are
immunocompromised?
It is most commonly caused by Pseudomonas aeruginosa.
378
Which clinical syndrome is caused by varicella-zoster viral infection and characterized by facial nerve paralysis, sensorineural hearing loss, and vesicular lesions on and in the ear canal?
Ramsay Hunt syndrome
379
which clinical syndrome is associated with this pic?
Ramsay Hunt Syndrome:
380
What is the recommended treatment for malignant
external otitis vs Ramsay Hunt syndrome?
Select systemic antipseudomonal antibiotics and hospitalization for malignant external otitis, and antiviral agents for Ramsay Hunt syndrome.
381
What is the next step for any patient with combination of red eye, ocular pain, and visual loss ?
The combination of red eye, ocular pain, and visual loss warrants emergent referral to
an ophthalmologist.
382
Which clinical syndrome is associated with unilateral then bilateral mucoid/purulent discharge without pain
or visual disturbance?
Bacterial
conjunctivitis
383
What is the treatment for bacterial
conjunctivitis?
Topical trimethoprim-polymyxin B or erythromycin for immunocompromised
patients.
384
Which clinical syndrome is associated with eye inflammation associated with herpes zoster rash involving ophthalmic division of fifth cranial nerve?
Herpes
zoster
conjunctivitis
385
What is the treatment for Herpes
zoster conjunctivitis?
Emergency ophthalmology referral
386
which clinical syndrome is associated with Acute hyper purulent discharge in a sexually active adult?
Neisseria
gonorrhoeae
conjunctivitis
387
Topical and systemic antibiotics and
emergency ophthalmology referral
388
which clinical syndrome is associated with Unilateral then bilateral conjunctivitis with daytime watery or mucoid discharge? and how is it treated?
Viral conjunctivitis and supportive care
389
Which clinical syndrome is associated with Itching and tearing of the eyes, nasal congestion ?
Allergic
conjunctivitis
390
What is the clinical syndrome associated with Severe eye discomfort with difficulty keeping the affected eye open, blurred or diminished vision, photophobia, circumferential redness (ciliary flush) at the corneal limbus (junction of the cornea and sclera)?
Keratitis
391
which clinical syndrome is associated with Unilateral deep ocular pain, nausea, vomiting, fixed nonreactive
pupil, shallow anterior chamber?
Acute angle closure glaucoma
392
which clinical syndrome is associated with Severe ocular pain that worsens WITH eye movement and light exposure;?
Scleritis
393
which clinical syndrome is associated with ankylosing spondylitis and reactive arthritis, has Circumferential redness (ciliary flush) at the corneal limbus
(junction of the cornea and sclera), hypopyon may be visible?
Iritis (anterior uveitis)
394
What is the difference between episcleritis and scleritis?
episcleritis is non painful, Localized nonpainful red, flat, superficial lesion that allows
visualization of the underlying vasculature
395
Should you ever treat a red eye with topical glucocorticoids?
Do not treat a red eye with topical glucocorticoids.
396
which clinical syndrome is associated with this pic?
Bacterial Conjunctivitis
397
which clinical syndrome is associated with this pic?
Herpes Zoster
398
which clinical syndrome is associated with this pic?
Viral Conjunctivitis
399
which clinical syndrome is associated with this pic?
Allergic Conjunctivitis:
Allergic conjunctivitis with prominent cobble stoning of the palpebral conjunctiva is
shown.
400
which clinical syndrome is associated with this pic?
Episcleritis
401
which clinical syndrome is associated with this pic?
Iritis:
402
Which clinical syndrome is associated with floaters, flashes of
light (photopsias), and squiggly lines, followed by a sudden, peripheral visual field defect that resembles a black curtain and progresses across the entire visual field?
Retinal Detachment
403
which clinical syndrome is associated with glare sensitivity and vision impairment, particularly at night?
Cataracts
404
which clinical syndrome is associated with bilateral ocular pain, foreign-body sensation, light sensitivity, tearing, and irritation/redness.?
Dry eye (keratoconjunctivitis sicca)
405
which clinical syndrome is associated with peripheral visual field loss, progression to central vision loss ?
Primary Open-Angle Glaucoma
406
What associated condition should be considered in patients with dry eye (keratoconjunctivitis sicca?
Consider Sjögren syndrome.
407
which clinical syndrome is associated with include severe eye pain, foreign-body
sensation, light sensitivity, and tearing FOLLOWING mechanical trauma?
Corneal Abrasions
408
In a patient with a history of one fall in the past year or those who feel unsteady or unbalanced what evaluation should they have next?
Patients with a history of one fall in the past year or those who feel unsteady or
unbalanced should be evaluated for balance or gait disturbance with a Timed Up and
Go test.
409
What is an abnormal Timed Up and Go test?
Timed Up and Go test. A time of longer than 12 seconds is abnormal, and the patient should be referred for full fall evaluation.
410
In a woman with sexual dysfunction, what other condition should be screened for?
Screening for concurrent
depression is indicated because sexual dysfunction and depression often coexist.
411
what is the first-line therapy to alleviate dyspareunia from vaginal atrophy?
Use lubricants
412
What is second-line therapy for women with female sexual dysfunction and sx
Low-dose vaginal estrogen is second-line therapy for women without contraindications to
estrogen.
413
which med can be used to treat women with low sexual desire?
Flibanserin may be used to treat women with low sexual desire; however, its use is
limited by side effects.
414
Benzos should be avoided in patients with what disorder?
Benzodiazepines should be avoided in patients with a history
of substance use disorder.
415
In patients with conductive hearing loss, how does the weber test result?
Louder in the affected ear. Wbber is loud and affected.
416
In patients with Sensorineural hearing loss, how does the weber test result?
Louder in the good ear
417
In patients with Sensorineural hearing loss, how does the rinne test result?
As loud or louder in the
affected ear (air conduction >
bone conduction)
418
For patients with
progressive AAAAsymmetric sensorineural hearing loss, which test should be next in evaluation?
For patients with
progressive asymmetric sensorineural hearing loss, select MRI or CT to evaluate for
acoustic neuroma.
419
Who should get the recombinant zoster vaccine ?
Administer the recombinant zoster vaccine to adults 50 years and older to prevent or
attenuate illness caused by herpes zoster infection and to reduce the risk of postherpetic neuralgia.
420
Which clinical syndrome is associated with localized pain and a vesicular rash in a dermatomal distribution are characteristic
features?
Herpes Zoster
421
For patients with severe, complicated, or recurrent herpes zoster what testing should be considered next?.
Severe, complicated, or recurrent herpes zoster should trigger testing for possible
associated HIV infection.
422
Which clinical syndrome is associated with vesicles in the ears, diminished taste on the anterior two thirds of the tongue,
and ipsilateral facial paralysis? What is the next step?
(Ramsay Hunt syndrome), require referral to an ENT
specialist.
423
What is the treatment for Herpes zoster?
Give valacyclovir, famciclovir, or acyclovir if lesion onset is within 72 hours of
contemplated treatment.
424
How do you diagnose Herpes zoster ?
Typically a clinical diagnosis; Obtain rapid tests, such as direct-
fluorescent antibody and PCR studies on scrapings from active vesicular skin lesions that have not yet crusted, or viral culture from a vesicle when the diagnosis is unclear.
425
How does the treatment for Disseminated zoster differ?
Disseminated zoster requires IV therapy and both contact and airborne precautions.
426
What are the treatment options for postherpetic neuralgia?
Treat postherpetic neuralgia with gabapentin, pregabalin, tricyclic antidepressants, or
topical lidocaine or capsaicin.
427
Should you Administer recombinant varicella-zoster vaccine to patients 50 years and older if no previous history of varicella infection or previous immunization with live attenuated vaccine?
Administer recombinant varicella-zoster vaccine to patients 50 years and older
regardless of previous history of varicella infection or previous immunization with
live attenuated vaccine.
428
Can you use topical acyclovir or penciclovir for the treatment of herpes zoster?
Do not select topical acyclovir or penciclovir for the treatment of herpes zoster.
429
Which clinical syndrome is associated with this pic?
34. Herpes Zoster
430
For what two conditions should we obtain polysomnography?
Obtain polysomnography only
for suspected sleep apnea or periodic limb movement disorder.
431
Which clinical syndrome is associated with An uncomfortable or restless feeling in the legs most prominent at night and at rest, associated with an
urge to move and alleviated by movement?
Restless legs
syndrome
432
Which deficiency is associated with Restless legs syndrome?
Look for iron deficiency
433
Which clinical syndrome is associated with repetitive pauses in breathing during sleep without upper airway occlusion?
Central sleep apnea
434
In Central sleep apnea
syndrome, what other conditions are associated with this?
history of HF or CNS disease
435
Which clinical syndrome is associated with upper airway obstruction during inspiration in sleep, history of snoring, witnessed pauses in respiration, large shirt collar size, and daytime sleepiness?
Obstructive sleep apnea syndrome
436
Which clinical syndrome is associated with daytime sleepiness with cataplexy, hypnagogic hallucinations, and sleep paralysis frequently coexisting with other sleep disorders?
Narcolepsy
436
Which clinical syndrome is associated with daytime sleepiness with cataplexy, hypnagogic hallucinations, and sleep paralysis frequently coexisting with other sleep disorders?
Narcolepsy
436
Which clinical syndrome is associated with daytime sleepiness with cataplexy, hypnagogic hallucinations, and sleep paralysis frequently coexisting with other sleep disorders?
Narcolepsy
437
What is the first line vs second treatment for insomnia ?
CBT for insomnia (first-line therapy), and pharmacologic therapy is second-line treatment for insomnia. Nonbenzodiazepine
drugs (zolpidem, zaleplon, eszopiclone) are preferred to benzodiazepines; sedation,
438
What is the treatment for restless legs syndrome?
Restless legs syndrome is treated with dopaminergic agents (pramipexole or ropinirole)
or with levodopa-carbidopa.
439
When do you prescribe supplemental iron for patients with restless legs
syndrome ?
Prescribe supplemental iron for patients with restless legs
syndrome when the serum ferritin level is <75 ng/mL.
440
Which nutrient deficiency is associated with Ecchymosis?
Vitamins C and K
441
Which nutrient deficiency is associated with Petechiae, perifollicular hemorrhage, gingival bleeding?
Vitamin C
442
Which nutrient deficiency is associated with Angular stomatitis and cheilosis?
Vitamin B complex, iron, and protein
443
Which nutrient deficiency is associated with Acro-orificial dermatitis (erythematous, vesiculobullous, and pustular)?
Zinc
444
Which nutrient deficiency is associated with Skin pigmentation, cracking, and crusting?
Niacin
445
Which nutrient deficiency is associated with memory disturb?
Vitamin B12
446
Which nutrient deficiency is associated with Ophthalmoplegia and foot drop?
Thiamine
447
Which nutrient deficiency is associated with Glossitis?
Niacin and vitamin B12
448
Which nutrient deficiency is associated with Wernicke-Korsakoff syndrome?
Severe thiamine deficiency
449
Which nutrient deficiency is associated with Night blindness?
Vitamin A
450
Which nutrient deficiency is associated with depression?
vitamin c
451
Which clinical syndrome is associated with this pic?
Lentigo Maligna
452
Which skin cancer appears as a brown patch on sun-exposed skin?
Lentigo Maligna. This melanoma in situ appears as a brown patch on sun-exposed skin.
453
Which clinical syndrome is associated with asymmetric pigmented skin lesion has irregular, scalloped, notched, and
indistinct borders with variegated coloration.?
Melanoma
454
Which clinical syndrome is associated with this pic?
Melanoma
455
Which clinical syndrome is associated with this pic?
Acral Melanoma
456
Which clinical syndrome is associated with skin cancer on the toe?
Acral Melanoma
457
What is the preferred biopsy technique for most varieties of melanoma?
Complete excision is the preferred biopsy technique for most varieties of melanoma
458
When is sentinel lymph node biopsy is indicated for melanomas ?
Sentinel lymph node biopsy is indicated for melanomas >1 mm thick. The extent of
the surgical excision depends on the thickness of the primary melanoma.
459
Should you order hormone levels to diagnose menopause.?
no
460
What are the most Common contraindications to hormone therapy for menopause?
Common contraindications to hormone therapy include pregnancy, unexplained vaginal
bleeding, liver disease, CAD, stroke, VTE, breast cancer, and endometrial cancer.
461
Which clinical conditions is associated with inflammation of a bursa that lies in the posterior aspect of the elbow and presents
as a fluid-filled mass, may result from repetitive trauma, infection, or systemic inflammatory conditions.?
Olecranon bursitis
462
what is the man physical exam difference between Olecranon bursitis and MSK joint related
issues?
Olecranon bursitis does not
cause restricted movement with range of motion of the elbow, whereas joint pathology
causes pain and restricted movement.
463
Under what circumstances should you aspirate a bursa?
Aspirate a bursa if tender or warm to analyze fluid for crystals and infection.
464
What is the first-line treatment for Olecranon bursitis?
NSAIDs, elbow protection pads, and rest (if noninfectious) are first-line treatments.
465
Should you obtain imaging studies in patients with findings compatible with epicondylitis?
Do not obtain imaging studies in patients with findings compatible with
epicondylitis.
466
Which clinical syndrome is associated with involves pain and tenderness at either the insertion of the extensor radii
tendons or the flexor carpi radialis tendons?
Epicondylitis involves pain and tenderness at either the insertion of the extensor radii
tendons (lateral epicondylitis) or the flexor carpi radialis tendons (medial epicondylitis).
466
Which clinical syndrome is associated with involves pain and tenderness at either the insertion of the extensor radii
tendons or the flexor carpi radialis tendons?
Epicondylitis involves pain and tenderness at either the insertion of the extensor radii
tendons (lateral epicondylitis) or the flexor carpi radialis tendons (medial epicondylitis).
467
Which back pain red flags suggest the need for early imaging?
malignancy (history of cancer, weight loss)
* spinal infection (localized pain, fever, injection drug use, UTI)
* fracture (trauma)
* cauda equina syndrome (bilateral leg weakness, urinary retention, saddle anesthesia)
468
Which are signs of hernated disk that require imaging?
* positive straight leg raise test
* weakness of the ankle and great toe dorsiflexion (L5)
* loss of ankle reflexes (S1)
* less commonly, loss of knee reflex (L4)
469
which two exam findings are most suggestive of spinal stenosis?
A wide-based gait and/or abnormal Romberg test is >90% specific for spinal stenosis.
470
which type of back pain requires urgent surgery?
Neoplastic epidural spinal cord compression, including cauda equina syndrome, is a
surgical emergency.
471
What is the next best step in management for a patient with spinal cord compression, including cauda equina syndrome?
Begin management by administering dexamethasone and
obtaining immediate MRI of the entire spine.
472
what is The most common cause of knee pain in patients aged <45 years, especially women?
The most common cause of knee pain in patients aged <45 years, especially women, is
the patellofemoral pain syndrome.
473
Which clinical syndrome is associated with knee pain exacerbated by overuse (running), by descending stairs, or after prolonged sitting?
patellofemoral pain syndrome.
474
what is the physical exam finding to confirm patellofemoral pain syndrome?
Diagnosis is confirmed by firmly compressing the patella against the femur and moving it up and
down along the groove of the femur, reproducing pain.
475
Which clinical syndrome is associated with anterior knee pain and swelling anterior to the
patella, caused by trauma
or repetitive kneeling?
Prepatellar bursitis
476
Which clinical syndrome is associated with of knife-like lateral knee pain that occurs with vigorous flexion-extension activities of the knee (running)?
Iliotibial band syndrome
477
Which clinical syndrome is associated with knee pain that is worse with activity and at night, located medially about 6 cm below the joint line?
Anserine bursitis
478
