IM2 Flashcards
1
Q
In a patient with hip pain and either alcoholism, sickle cell disease, SLE, or
prolonged glucocorticoid use, what dx should be considered?.
A
osteonecrosis
2
Q
How is osteonecrosis diagnosed?
A
JHip MRI
3
Q
What xray finding is seen in hip osteonecrosis?
A
Advanced disease will show flattening of the femoral head on x-ray. .
4
Q
What is the treatment of hip osteonecrosis?
A
Treatment of osteonecrosis is
often hip replacement for recalcitrant pain and disability.
5
Q
Which clinical syndrome is associated with hip lateral point tenderness and full range of motion except for painful resisted abduction?
A
greater trochanter pain syndrome,
6
Q
Which clinical syndrome is associated with pain, and ecchymoses around the joint,?
A
Ligament tear, look for ecchymoses around the joint, suggesting bleeding in the
region of the torn ligament, and any swelling or obvious deformity.
7
Q
What is the treatment of acute
ankle sprain?
A
Treatment of acute
ankle sprain includes ice, ankle immobilization followed by early remobilization with weight bearing as tolerated, and oral or topical NSAIDs.
8
Q
Which clinical syndrome is associated with a snapping sound followed by posterior ankle pain
and inability to plantarflex). Rarely, this may occur in older men who are taking a
fluoroquinolone antibiotic?
A
Achilles tendon rupture
9
Q
When should you suggest imaging in an ankle sprain?
A
Select ankle x-ray following ankle sprain only if the patient cannot bear weight or if bone pain is localized to the lateral or medial malleolus?
10
Q
Which clinical syndrome is associated with inferior heel pain,
that worsens with walking, especially with the first steps in the morning or after resting?
A
Plantar fasciitis,
11
Q
Which clinical syndrome is associated with pain, numbness, and tingling in the forefoot,
usually between the third and fourth toes, aggravated by walking on hard surfaces and
wearing tight or high-heeled shoes?
A
Morton neuroma
12
Q
Which clinical syndrome is associated with pain on the radial
side of the wrist during pinch grasping or thumb and wrist movement?
A
De Quervain tenosynovitis
13
Q
Which clinical test is associated with Pain elicited by flexing the
thumb into the palm, closing the fingers over the thumb, and then bending the wrist
in the ulnar direction?
A
Finkelstein test for de Quervain stenosing tenosynovitis.
14
Q
Which clinical syndrome is associated with pain and paresthesias, particularly at night,
localized to the thumb, first two fingers, and radial half of the ring finger?
A
carpal tunnel syndrome
15
Q
What is the first line tx for carpal tunnel syndrome?
A
finger. Splinting at
night is first-line therapy for carpal tunnel syndrome. Glucocorticoid injection or a short
course of oral glucocorticoids may provide symptomatic improvement. Carpal tunnel
release surgery is indicated for severe carpal tunnel syndrome
16
Q
What is the most common cause of shoulder pain?
A
Rotator cuff disease is the most common cause of shoulder pain.
17
Q
Which clinical syndrome is associated with pain localized to the upper arm near the deltoid insertion and is worsened with
overhead activities and when lying on the affected side?
A
Rotator cuff disease
18
Q
Which clinical syndrome is associated with pain localized to the upper arm near the deltoid insertion and is worsened with
overhead activities and when lying on the affected side?
A
Rotator cuff disease
19
Q
Which clinical syndrome is associated with an impingement pain pattern accompanied by stiffness and loss of active and passive external rotation or abduction?
A
Adhesive capsulitis (frozen shoulder)
20
Q
Which clinical syndrome is associated with shoulder pain localized to the distal end of the clavicle and is most
pronounced when the patient reaches across their body to the opposite shoulder?
A
Acromioclavicular joint pain
21
Q
Which clinical syndrome is associated with shoulder pain aggravated by lifting and wrist supination?
A
Biceps tendinitis
22
Q
Which clinical syndrome is associated with associated with a traumatic event but may be
spontaneous and presents with a visible or palpable mass near the elbow or mid arm
(“Popeye sign”) and ecchymosis?
A
Biceps tendon rupture
23
Q
Which shoulder conditions require Immediate surgery?
A
Immediate surgery is indicated for an acute full-thickness tear or chronic tears that fail
to respond to conservative therapy over several months.
23
Q
Which shoulder conditions require Immediate surgery?
A
Immediate surgery is indicated for an acute full-thickness tear or chronic tears that fail
to respond to conservative therapy over several months.
24
Which clinical syndrome is associated with this pic?
Biceps Tendon Rupture:
25
What should be considered when a patient has constant shoulder pain with normal shoulder examination ?
Constant shoulder pain with normal shoulder examination suggests referred pain
(e.g., Pancoast tumor) or neuropathic pain (e.g., cervical spine radiculopathy).
26
which Waist circumference correlates obesity and with visceral adiposity and increased risk for diabetes, CVD, and all-cause mortality?
Waist circumference ≥102 cm (40 in) in men and ≥88 cm (35 in) in women correlates
with visceral adiposity and increased risk .
27
What labs should be ordered for evaluation of obesity?
Laboratory evaluation should include:
* thyroid and liver function
* lipid levels
* screening for diabetes
28
When is Pharmacologic therapy used as adjunctive therapy in patients with obesity?
Pharmacologic therapy may be used as adjunctive therapy in patients with a BMI ≥30
or in patients with a BMI ≥27 and weight-associated comorbidities.
29
When should Bariatric surgery be considered for patients with obesity?
Bariatric surgery is considered for patients with a BMI ≥40 and for patients with a BMI ≥35 with serious obesity-related comorbidities (severe sleep apnea, diabetes, severe joint disease).
30
How is OCD treated?
Obsessive-compulsive disorder is treated with CBT and often with an SSRI.
31
What is the most important adjunctive therapy in opioid use
disorder?
Intranasal naloxone (narcan)
31
What is the most important adjunctive therapy in opioid use
disorder?
Intranasal naloxone (narcan)
32
Which clinical syndrome is associated with a life-threatening infection of the floor of the mouth causing
submandibular swelling and edema, drooling, neck pain, dysphagia, or dysphonia.?
Ludwig angina
33
What is the most common
causative pathogen for Ludwig angina?
The causative pathogen is usually Viridans streptococci.
34
Which clinical syndrome is associated with halitosis, oral pain, and ulcerated
and necrotic areas of the tonsils and gingiva with red irregular edges that may create a
grayish pseudomembrane that bleeds if scraped?
Necrotizing ulcerative gingivitis
35
How is Necrotizing ulcerative gingivitis treated?
Necrotizing ulcerative gingivitis is treated with oral antibiotics, chlorhexidine rinses, and,
if severe, debridement.
36
How is Ludwig angina treated?
Ludwig angina is treated with broad-spectrum antibiotic therapy and, if indicated,
surgical drainage.
37
Which clinical syndrome is associated with an oval herald patch on the abdomen, followed by a more generalized rash in a “Christmas tree” distribution? Can mimic syphilis except for sparing the palms and soles?
Pityriasis
rosea
38
Which is the treatment for Lichen
planus?
Topical
glucocorticoids
39
Which clinical syndrome is associated with Acute eruption of purple, pruritic, polygonal papules that most commonly presents on the wrists and ankles?
Lichen
planus
40
Which clinical syndrome can resemble secondary syphilis but does not involve the palms
and soles?
Pityriasis rosea
41
Which clinical syndrome is associated with viral URI
symptoms then fluid and inflammation in the middle ear
accompanied by symptoms of infection?
Acute otitis media
42
In what 3 situations should morphine be avoided?
Avoid in liver failure/cirrhosis, kidney injury
43
What is the recommended treatment for bone pain?
Treat bone pain with anti-inflammatory medications (NSAIDs or glucocorticoids) or
bisphosphonates (pamidronate, zoledronate).
44
What is the standard of care for refractory dyspnea in advanced disease?
Systemic opioids are the standard of care for refractory dyspnea in advanced disease.
45
What non medical therapy is effective in reducing dyspnea in nonhypoxic patients?
Fans are effective in reducing dyspnea in nonhypoxic patients.
46
what is the name of an exercise used to determine the contributors to an adverse health
event?
Root-cause analysis is an exercise used to determine the contributors to an adverse
event.
47
What is the most common methodology to improve a specific health related quality?
A common methodology to improve quality is the Plan-Do-Study-Act (PDSA) cycle. The
48
What is the best practice for handoff ?
The best practice for handoff includes person-to-person communication, providing an
opportunity to ask and respond to questions, and providing information that is
accurate and concise
49
Which clinical syndrome is associated with a positive Nikolsky sign (erosion of normal-appearing skin by application of
sliding pressure)?
Pemphigus vulgaris (VULGARIS IS VULGAR, AND MORE AGRESSIVE, SLOUGHING)
50
Which clinical syndrome is associated with painful, nonhealing oral erosions. Also
look for flaccid, hemorrhagic, or seropurulent bullae and denuded areas that ooze
serous fluid, bleed, or are covered with crusts.?
Pemphigus vulgaris
51
Compared to Pemphigus vulgaris, what is seen on Direct immunofluorescence with Bullous
pemphigoid?
With Bullous
pemphigoid, direct immunofluorescence shows linear IgG deposition at the basement membrane. With PV direct
immunofluorescence shows intercellular IgG deposition.
52
Considering Pemphigus
vulgaris vs Bullous pemphigoid, in which one is it that ORAL erosions may be the only thing clinically apparent?
Pemphigus
vulgaris. Oral lesions are uncommon in BP.
53
Considering Pemphigus
vulgaris vs Bullous pemphigoid, in which one is that oral lesions are present?
Pemphigus vulgaris
Oral lesions are uncommon in Bullous pemphigoid.
54
Which clinical syndrome is associated with this pic?
Pemphigus vulgaris
55
Which clinical syndrome is associated with autoimmune blistering disease characterized by multiple tense bullae and
occasional erosions; mucosal surfaces are typically not involved?
Bullous Pemphigoid:
56
Which clinical syndrome is associated with this pic?
Bullous Pemphigoid:
57
What is the first-line therapy for pemphigus vulgaris and pemphigoid?
Oral glucocorticoids are first-line therapy for pemphigus vulgaris and pemphigoid.
58
How do yo diagnosis pemphigus vulgaris and pemphigoid?
Biopsy is required for diagnosis.
59
Which patients should have their functional capacity assessed before surgery?
Patients with an elevated risk of MACE ≥1% should have their functional capacity assessed with a standardized tool
60
Greater than what number of functional capacity METs is considered low risk and
can proceed to surgery?
Patients with functional capacity ≥5 METs are low risk and
can proceed to surgery. Otherwise, preoperative cardiac stress testing should be
considered but only if the results will change perioperative management.
61
Patients with METS lower than 5 should be considered for peri-op eval prior to surgery ?
yes
62
In what patient population should an ECG be obtAINED within 1 to 3 months of surgery?
Obtain an ECG within 1 to 3 months of surgery in any patient
with:
* CAD
* significant arrhythmias
* cerebrovascular disease (stroke or TIA)
* PAD
63
What are 4 examples of common Low-risk surgeries that do not require cardiac testing even if a calculated risk score is elevated?
Low-risk surgeries (cataract extraction, carpal tunnel release, breast biopsy,
inguinal hernia repair) do not require cardiac testing even if a calculated risk
score is elevated.
64
For patients who have had a recent MACE and have a bare-metal coronary stent implantation for stable CAD, how long do they have to wait to undergo elective surgery?
Patients with a known recent MACE should not undergo elective surgery within:
* 14 to 30 days of a bare-metal coronary stent implantation for stable CAD
65
For patients who have had a recent MACE and have a drug-eluting coronary stent placement for stable CAD, how long do they have to wait to undergo elective surgery?
3 to 6 months of a drug-eluting coronary stent placement for stable CAD
66
For patients who have had a recent MACE and ha ACS, how long do they have to wait to undergo elective surgery?
12 months after ACS
67
Which BP meds are typically withheld throughout the perioperative period if prescribed for hypertension ??
ACE inhibitors and ARBs are typically withheld if prescribed for hypertension (unless BP is
poorly controlled);
68
Which low risk procedures can anticoagulation be continued ?.
Anticoagulation must be stopped for most surgical procedures except those with
minimal expected blood loss (cataract surgery, dermatologic procedures, endoscopic
procedures without biopsy).
69
In terms of perioperative management of anticoagulant therapy, when should warfarin be stopped compared to NOACs?
.
Stop warfarin 5 days before surgery vs Stop apixaban, rivaroxaban, and dabigatran 1 to 2 days before surgery
70
In what circumstances should bridging be considered in patients to taking warfarin?
Bridging should be considered only in patients taking warfarin with a high thrombotic risk:
* high-risk AF
* AF with mechanical valve
* AF with moderate to severe mitral stenosis
* older generation mechanical valves (ball-cage or tilting disc)
* recent thromboembolic event (e.g., CVA, TIA, VTE within previous 3 mo)
* aortic mechanical valve plus additional risk factor for thrombosis
* moderate to severe mitral stenosis
71
In terms of bridging therapy, when should UFH heparin be stopped compared to LMWH?
* Stop UFH 4 to 6 hours before surgery.
* Stop LMWH 12 hours before surgery.
72
In terms of bridging therapy, when should UFH heparin be restarted after surgery?
Restart heparin 24 hours after surgery.
73
In terms of bridging therapy, when should Warfarin be restarted after surgery?
Restart warfarin 12 to 24 hours after surgery.
74
In terms of bridging therapy, when should NOACs be restarted after surgery?
Restart dabigatran, rivaroxaban, and apixaban 24 hours after surgery.
75
In terms of Perioperative Management of Antiplatelet Therapy, how long should DAPT be continued in pts with bare-metal stent placement for stable CAD before having a surgery?
Dual antiplatelet therapy should be continued: 14 to 30 days after bare-metal stent placement for stable CAD
76
In terms of Perioperative Management of Antiplatelet Therapy, how long should DAPT be continued before having a surgery in pts with drug-eluting stent placement for stable CAD?
Dual antiplatelet therapy should be continued:
* 3 to 6 months after drug-eluting stent placement for stable CAD
77
In terms of Perioperative Management of Antiplatelet Therapy, how long should DAPT be continued in ACS pts before having a surgery?
Dual antiplatelet therapy should be continued:
* ≥1 year in patients following ACS
78
How many criteria have to be present to treat and/or even test a patient for group A Strep?
More than 2 of the below:
* fever (subjective)
* absence of cough
* tender anterior cervical lymphadenopathy
* tonsillar exudates
* ≥3: obtain a rapid antigen detection test (RADT); management is based on
results
79
For adolescents and young
adults with a negative rapid antigen detection test for STREP, and an unusually prolonged and severe pharyngitis, what causative agent should be considered?
Fusobacterium necrophorum infection should be considered in adolescents and young
adults with a negative RADT and an unusually prolonged and severe pharyngitis. F.
necrophorum is the causative agent of Lemierre syndrome,
80
How is F. necrophorum is treated?
F. necrophorum is treated with ampicillin-sulbactam.
81
How is group A Strep treated?
Select oral penicillin for 10 days. Choose a macrolide for patients allergic to penicillin.
82
What are the two main things that help prevent pressure injuries in at-risk persons?
Advanced static mattresses and overlays help prevent pressure injuries in at-risk persons.
83
Which clinical syndrome is associated with that lesions in different stages of development (macules, papules, vesicles,
pustules, crusted erosions) are present simultaneously on any one part of the body;
lesions are most prominent on the trunk rather than the extremities?
Primary Varicella (chickenpox).
84
Which clinical syndrome is associated with erythema, scaling, and induration on the
extensor surfaces, scalp, ears, intertriginous folds, and genitalia?
Chronic plaque psoriasis
85
Which clinical syndrome is associated with Red, thin plaques with a variable amount of scale in the axillae, under the breasts or pannus, intergluteal cleft, and perineum?
Inverse psoriasis
86
Which clinical syndrome is associated with Pustular psoriasis?
Abrupt onset of generalized erythema and “lakes of pus,” typically following abrupt discontinuation of glucocorticoids
87
Which clinical syndrome is associated with Many small drop-like papules and plaques on the trunk often developing after infection with β-hemolytic
Streptococcus?
Guttate psoriasis
88
Which clinical syndrome is associated with Thick, erythematous lesions with silvery, adherent scale anywhere on the body?
Chronic plaque psoriasis
89
Which clinical syndrome is associated with indentations, pits, and oil spots often involving multiple nails?
Nail psoriasis
90
Which clinical syndrome is associated with this pic?
Chronic Plaque Psoriasis
91
Which clinical syndrome is associated with this pic?
Inverse Psoriasis
92
Can you treat systemic glucocorticoids for the treatment of psoriasis?
Never select systemic glucocorticoids for the treatment of psoriasis.
93
Which 2 population groups are most likely to develop widespread scabies?
Patients with AIDS and those in institutions such as nursing homes and hospitals may
develop widespread scabies with extensive scaling that may not itch.
94
Which clinical syndrome is associated with “itchy rash” frequently occurring between the fingers and on the wrists,
penis, scrotum, areolae, and nipples.
Scabies
95
Microscopic identification of the mite, feces, or eggs using KOH is diagnostic of what condition
Scabies A skin biopsy may also establish the diagnosis.
96
what is the the preferred tx agent for scabies?.
Topical permethrin is the preferred agent.
97
When is Oral ivermectin preferred over topical ?
Oral ivermectin is indicated for relapsed scabies except when treating children and
pregnant or lactating women.
98
Which clinical syndrome is associated with this pic?
Scabies Rash
99
which organism is responsible for scabies?
Sarcoptes scabiei, the organism responsible for scabies,
100
Which clinical syndrome is associated with this pic?
Sarcoptes scabiei, the organism responsible for scabies,
101
Should you re-treat scabies because of persistent itchin?
Do not re-treat scabies because of persistent itching, which can continue for 2
weeks after successful treatment.
102
what are the 4 first line options for schizophreniA?
Begin a second-generation antipsychotic agent (olanzapine, risperidone, quetiapine,
aripiprazole),
103
Rapid onset of multiple pruritic seborrheic keratoses can be a sign of WHAT OTHER CONDITION?
Rapid onset of multiple pruritic seborrheic keratoses can be a sign of GI
adenocarcinoma.
104
Which clinical syndrome is associated with this pic?
Seborrheic Keratoses
105
What are signs that sinusitis is bacterial and not viral?
persistent symptoms (lasting >10 days)
* severe symptoms or high fever (lasting 3-4 days)
* “double sickness,” characterized by worsening symptoms following a period of
improvement over 3 to 4 days
106
which complications of acute sinusitis is assoc with fever, nausea, vomiting, headache, orbital edema, or cranial nerve
involvement?
cavernous sinus
thrombosis
106
which complications of acute sinusitis is assoc with fever, nausea, vomiting, headache, orbital edema, or cranial nerve
involvement?
cavernous sinus
thrombosis
107
what is The first-line choice for suspected
bacterial sinusitis?
The first-line choice for suspected
bacterial sinusitis is amoxicillin-clavulanate or amoxicillin.
108
is Nicotine replacement therapy contraindicated following MI?
Nicotine replacement therapy is not contraindicated following MI and can be
started in the hospital.
109
when should you choose conversion disorder over somatic symptom disorder ?
Choose conversion disorder if a patient has abnormal sensation or motor function (such as limb weakness) that is not explained by a medical condition
and is inconsistent with physical examination findings.
110
what are the key features of illness anxiety disorder ?
Choose illness anxiety disorder (previously hypochondriasis) if the patient has
excessive worry about general health and preoccupation with health-related
activities but has no or only minor symptoms.
111
Which clinical syndrome is associated with this pic?
Squamous Cell Carcinoma
112
Which clinical syndrome is associated with this pic?
Keratoacanthoma
113
These 4 signs signs are associated with wha type of syncope?
* previous history
* posture (prolonged standing)
* provoking factors (blood draw, pain, emotion)
* prodromal symptoms (sweating, nausea, feeling warm)
Vasovagal
syncope, the most common form of neurally mediated syncope
114
Which clinical syndrome is associated with A prodrome of nausea, diaphoresis, pallor, and
brief loss of consciousness (<1 min) with rapid
recovery and absence of postsyncopal confusion?
Vasovagal syncope
115
Which clinical syndrome is associated with Preceding pressure on the carotid sinus (tight
collar, sudden turning of head)?
Carotid sinus hypersensitivity
116
Which clinical syndrome is associated with Association with specific activities (urination,
cough, swallowing, defecation)?
Situational syncope
117
Which clinical syndrome is associated with On assuming an upright position?
Orthostatic hypotension caused by hypovolemia, pharmacologic agents, or
autonomic nervous system disorders (e.g., parkinsonism, diabetes)
118
Which clinical syndrome is associated with Brainstem neurologic signs and symptoms?
Posterior circulation vascular disease; consider subclavian steal syndrome if preceded by upper extremity exercise
119
Which clinical syndrome is associated with
Syncope with sudden onset without prodrome?
Arrhythmia, sinoatrial and AV node dysfunction (ischemic heart disease and associated with use of β-blockers, calcium channel blockers, and
antiarrhythmic drugs)
120
Which clinical syndrome is associated with Syncope following a meal?
Postprandial syncope, often in older adult patients
121
for For hypovolemia or orthostatic syncope what items should be eliminted first?
For hypovolemia or orthostatic syncope, eliminate α- and β-blockers, diuretics, and
anticholinergic agents,
122
when is Tilt-table testing indicated for syncope?
Tilt-table testing: Most commonly used in patients with recurrent vasovagal
syncope or if delayed orthostatic hypotension is suspected.
123
Which clinical syndrome is associated with unexplained fatigue lasting more than 6 consecutive months that impairs the ability to perform desired activities, postexertional malaise, unrefreshing sleep, and either cognitive impairment ?
Systemic Exertion Intolerance Disease
124
Which clinical syndrome is associated with Sudden urge to void preceding or accompanied by leakage of urine?
Urge incontinence
125
Which clinical syndrome is associated with Involuntary release of urine with increased
abdominal pressure (sneezing, coughing,
physical exertion)?
Stress
incontinence
126
Which clinical syndrome is associated with Urgency and stress incontinence?
Mixed
incontinence
127
Which clinical syndrome is associated with Unable to get to bathroom on time because of
mental or physical limitations?
Functional
incontinence
128
Which clinical syndrome is associated with Nearly constant dribbling of urine, incomplete
emptying of bladder, high postvoiding
residual urine?
Overflow
incontinence
129
in evaluation of women with urinary incontinence should you order urodynamic testing?
Do not order urodynamic testing because outcomes are no better than those
associated with management based on clinical evaluation alone.
130
which type of urinary incontinence may require
anticholinergic drugs (e.g., oxybutynin, tolterodine) or a β-
adrenergic (mirabegron) ?
Urge
incontinence
131
Which clinical syndrome is associated with wheal, a superficial, pruritic, erythematous, well-
demarcated, intermittently present plaque?
urticaria (hives)
132
in evaluating urticaria, should you select ANA, patch testing, or specific IgE measurements for acute or
chronic urticaria?
Do not select ANA, patch testing, or specific IgE measurements for acute or
chronic urticaria.
133
Which clinical syndrome is associated with ↑ESR, ↑CRP, lesions persisting >24 hours and urticaria
purpuric papules?
Vasculitic urticaria; perform skin biopsy
134
Which clinical syndrome is associated with Fever, adenopathy, arthralgias, and antigen or
drug exposure?
Serum sickness; measure CRP, ESR, and complement levels
135
what is the only cause of vaginitis that is sexually transmitted?
Trichomoniasis is the only cause
of vaginitis that is sexually transmitted.
136
Which clinical syndrome is associated with
137
Which clinical syndrome is associated with Thin, white discharge with “fishy” odor but without irritation or pain?
Bacterial vaginosis
138
Which clinical syndrome is associated with external and internal erythema with itching and irritation; nonodorous; white, curd-like discharge?
Candidiasis
139
Which clinical syndrome is associated with Frothy, yellow discharge; erythema of the vagina and cervix (“strawberry
cervix”)?
Trichomoniasis:
140
A posiitve “Whiff” testor a Fishy” odor after adding KOH is an indication of which clinical disorder?
Bacterial vaginosis
141
Which clinical disorder is associated with clue cells?
Bacterial vaginosis
142
Between Bacterial vaginosis, trichomoniasis and :
Candidiasis, which has a normal ph of less than 4.5?
Candidiasis: ≤4.5
143
What is the gold standard Test for bacterial vaginosis and trichomoniasis?
Nucleic acid testing is available for bacterial vaginosis and trichomoniasis (gold standard for
Test Characteristics
trichomoniasis)
144
Which clinical syndrome is associated with this pic?
Candida albican
145
Which clinical syndrome is associated with this pic?
Clue Cell
146
What is the treatment for Uncomplicated vaginal candidiasis?
Topical (e.g., butoconazole, miconazole, clotrimazole)
Single dose of oral fluconazole (contraindicated during pregnancy)
147
What is the treatment for Complicated vaginal candidiasis (severe symptoms, non-albicans
Candida species, >4 episodes/y, uncontrolled diabetes mellitus, immunosuppression?
Longer duration of initial oral or topical treatment
followed by maintenance treatment if needed
148
What is the treatment for Bacterial vaginosis?
Oral or topical metronidazole or topical clindamycin (safe during pregnancy)
149
What is the treatment for Trichomoniasis?
Oral metronidazole and also for male partner (safe during pregnancy). Test for other STIs. Retest within 3 months of
treatment.
150
With which cause of vaginitis is the boyfriend required ot be treated?
Trichomoniasis
151
Should you treat ASYMPTOMATIC women for
identification of Candida species?
Because vaginal yeast is found in 10% to 20% of healthy women, the
identification of Candida species in patients without symptoms does not require
treatment.
152
What is The first step to distinguish central from peripheral causes of vertigo?
The first important step is to distinguish central from peripheral causes with the HINTS
exam or the Dix-Hallpike maneuver.
153
which is worst< central or peripheral vertigo?
Diseases associated with central vertigo may be
life threatening.
154
For patients with suspected central vertigo what immediate work up should be obtained?
Obtain an MRI of the brain for
suspected central vertigo.
155
In differentiating peripheral vs central vertigo, during the head impulse test, what does it mean to have the presence of catch- up saccades vs the absence of catch-up saccades?
1. Presence of catch- up saccades is consistent with peripheral cause of vertigo)
2. Absence of catch-up saccades consistent with
central cause of vertigo)
156
In differentiating peripheral vs central vertigo, during the nystagmus test, what does it mean to have unidirectional nystagmus vs Bidirectional?
Unidirectional nystagmus (fast-phase contralaterally) associated with peripheral vertigo
Bidirectional nystagmus (fast- phase nystagmus
alternating) associated with peripheral vertigo
157
In differentiating peripheral vs central vertigo, during the Test of skew deviation (vertical
deviation of one eye compared with the other), which vertigo is associated with Absence of vertical
skew vs the presence of vertical skew?
The Absence of vertical skew is associated with peripheral vertigo and Presence of vertical
skew associated with central
158
What is the most common cause of acute, recurrent, and brief episodes of vertigo.?
BPPV
159
How is BPPV dx?
Dix-Hallpike maneuver.
160
Which clinical syndrome is associated with Brief vertigo (10-30 s) and nausea associated with abrupt head movement (turning over in bed)?
BPPV
161
Which clinical syndrome is associated with Severe and longer lasting vertigo (days), nausea, and often vomiting?
Vestibular neuronitis
162
What extra symptoms differentiates Labyrinthitis from to vestibular neuronitis?
Labyrinthitis has hearing loss
163
In Interpretation of Dix-Hallpike Maneuver, which condition (Peripheral Disease vertigo vs Central Disease vertigo) is associated with DELAYED Latency of nystagmus (lag time between
maneuver and onset of nystagmus)?
Peripheral
163
In Interpretation of Dix-Hallpike Maneuver, which condition (Peripheral Disease vertigo vs Central Disease vertigo) is associated with DELAYED Latency of nystagmus (lag time between
maneuver and onset of nystagmus)?
Peripheral
164
In Interpretation of Dix-Hallpike Maneuver, which condition (Peripheral Disease vertigo vs Central Disease vertigo) is associated with Fatigability (findings diminish with repetition)?
Peripheral
165
In Interpretation of Dix-Hallpike Maneuver, which condition (Peripheral Disease vertigo vs Central Disease vertigo) is associated with Unidirectional Direction of nystagmus?
peripheral
166
Which clinical syndrome is associated with peripheral vertigo, hearing loss, tinnitus, unsteadiness, facial nerve involvement?
acoustic neuroma
167
Which clinical syndrome is associated with vertigo, hearing loss, tinnitus?
Meniere disease
168
Which clinical syndrome is associated with peripheral vertigo: herpes zoster ?
(Ramsay Hunt syndrome)
169
what is the the treatment of choice for
BPPV?
Canalith repositioning with the Epley maneuver is the treatment of choice for
BPPV.
170
what is the the treatment of choice for Meniere
disease?
Vestibular rehabilitation and/or diuretics are the treatment of choice for Meniere
disease.
171
What is the tx for warts?
Warts are usually self-limited, and treatment is not necessary except for protracted
courses or in immunocompromised patients. Treat common warts with salicylic acid (a
keratolytic agent).
172
Which clinical syndrome is associated with antigen exposure (e.g., agricultural dusts), fever, cough, and fatigue and physical examination reveals inspiratory crackles?
Hypersensitivity pneumonitis
173
What is the tx for Hypersensitivity pneumonitis?
Antigen removal results in resolution of symptoms in 48 hours. Glucocorticoids are provided for severe symptoms.
174
Is it possible to have latex allergy as the cause of anaphylaxis ?
Consider latex allergy as the cause of anaphylaxis during surgery or anaphylaxis
in a woman during coitus.
175
What is the first-line therapy for Anaphylactic shock?
IM or IV epinephrine is first-line therapy even if the only presenting signs are hives or
pruritus.
176
In the setting of angioedema without urticaria, what dx should be considered?
Bradykinin-mediated angioedema is NOT associated with urticaria. In the setting of
angioedema without urticaria, the differential is very limited. Diagnose by testing for
quantitative and functional levels of C1 esterase inhibitor and C4 complement levels.
177
In patients with urticaria and angioedema, should you consider diagnose hereditary
angioedema?
In patients with urticaria and angioedema, do not diagnose hereditary
angioedema.
178
For patients with choose hereditary angioedema, what is the management and treatment?
Serum C4 and C1 inhibitor levels (functional and antigenic) and treatment of severe acute episodes of swelling with C1 inhibitor concentrate.
