Miscellaneous Flashcards
(205 cards)
1
Q
What is the obturator sign?
A
test for acute appendicitis/ectopic rupture - PT supine rotates hip through full ROM => positive if pain with movement or flexion of the hip
2
Q
What is the psoas sign?
A
test for acute appendicitis/ectopic rupture - pain with passive extension of the thigh while the patient is lying on his/her side with knees extended (90 degrees) or with active flexion of his/her thigh at the hip
3
Q
What is the recommended care for women with mild preeclampsia?
A
bed rest with bathroom privileges; weight and BP monitoring; close tracking of protein, serum protein, creatinine, and platelet counts => Rx of methyldopa (Aldomet) PO is not a first line Tx
4
Q
What are common signs of pregnancy induced HTN?
A
edema of face/upper extremities, weight gain, blurred vision, elevated BP, proteinuria, headaches
5
Q
What are signs and symptoms of B12 deficiency?
A
tingling/numbness in fingers and toes, difficulty walking, mood changes/depression, memory loss, disorientation, dementia
6
Q
What does the acronym TORCH stand for?
A
Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes - conditions which can cause microcephaly, mental retardation, hepatosplenomegaly, and intrauterine growth retardation in the fetus
7
Q
What is apraxia?
A
disorder of the nervous system in which the brain is affected and the patient is unable to move the arms/legs when asked to do so
8
Q
What is Murphy’s sign?
A
test for cholecystitis - provider palpates RUQ while the PT takes a deep inspiration => positive if PT abruptly stops breathing during maneuver due to pain
9
Q
What are clue cells?
A
squamous epithelial cells with blurred margins (cells with bacteria adherent giving a stippled, granular appearance) - indicative of bacterial vaginosis
10
Q
What are the signs and symptoms of bacterial vaginosis?
A
copious off-white to grey discharge, foul odor, lack of vaginal erythema/irritation, clue cells, positive Whiff Test (strong fishy odor when vaginal discharge mixed with one drop of KOH)
11
Q
What is lichen sclerosus?
A
disease of the skin - white spots appear on the skin and change over time, found mainly in genital/rectal areas, spots are shiny and smooth and eventually spreads into patches, skin is thin and crinkled and tears easily, bright red or purple bruises are common, skin can become scarred
12
Q
What is a tonometer?
A
used to measure intraocular pressure of the eye to screen for glaucoma - normal = 10-22 mmHg
13
Q
What are the signs and symptoms of CHF?
A
S1/S2/S3 heart sounds, fatigue, SOB with activity, edema of lower extremities
14
Q
What is Rovsing’s sign?
A
identifies acute abdomen (e.g., appendicitis) - PT supine, provider palpates deep into LLQ of the abdomen, PT reports referred pain to RLQ (R for Rovsing and Referred)
15
Q
What is Cullen’s sign?
A
superficial bleeding and bruising in the subcutaneous (sub-c for Cullen) fatty tissue around umbilicus causes yellowish-blue color - occurs in ruptured ectopic pregnancy and acute pancreatitis (due to pancreatic enzymes that run along the ligament and subcutaneous tissues around the umbilicus)
16
Q
What is the difference between condyloma lata and condyloma acuminata?
A
condyloma acuminata (genital warts) are caused by human papilloma virus subtypes 6, 11, and others while condylomata lata are white lesions associated with secondary syphilis
17
Q
What type of anemia is associated with lead poisoning?
A
microcytic anemia - lead mimicks healthful minerals and is absorbed by the bones, where is interferes with the production of RBCs
18
Q
What is podagra?
A
pain in the joint of the great toe due to the accumulation of uric acid and salts in the joint
19
Q
How is a pulse deficit calculated?
A
counting apical and radial pulses at the same time the subtracting the difference between the two
20
Q
What is anergy?
A
when the immune system is unable to perform a healthy, normal immune response when the body is challenged with a particular antigen
21
Q
How is anergy tested?
A
application of tetanus, Candida, or mumps antigen to the right forearm and PPD to the left forearm and read results in 48 to 72 hours => if control side is negative patient is immunocompromised and PPD testing is unreliable
22
Q
Which tests are performed to assess kidney function?
A
BUN, creatinine, estimated GFR, urinalysis
23
Q
What is the common name for enterobiasis?
A
pinworms - small worms that infect the intestines, causing itching around the anus (worse at night)
24
Q
What is the screening test for pinworms?
A
Scotch tape test - application of scotch tape to the anus in the morning => worms come out at night and stick to the tape
25
What is myxedema?
rare, sometimes fatal, disease in which the thyroid is severely underactive and causes life-threatening symptoms (low BP, decreased breathing, decrease body temp, unresponsiveness, coma) - associated with severe atherosclerosis due to increased serum cholesterol (i.e., LDL) => also used to describe the dermatologic changes that occur in hypothyroidism and occasionally hyperthyroidism - deposition of mucopolysaccharides (mucin) in the dermis and other tissues, which results in a dry, waxy swelling of the affected area (when skin changes occur in hyperthyroidism, mostly Graves disease, it’s called pretibial myxedema)
26
What is Auspitz sign?
presence of pinpoint bleeding spots from psoriasis where the skin is scraped off
27
What is Kernig's maneuver?
test for meningitis - patient flexes both hips and legs then straightens the legs against resistance => flexion of hip/knees is positive sign
28
What is Brudzinski's maneuver?
place patients hands behind the head and tucking chin to chest - severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed
29
What is Homan's sign?
flexion of foot causes pain in the calf - may be suggestive of DVT
30
What is the mechanism of action of RhoGAM?
given to mothers with Rh- blood when the fetus is Rh+ => protects the mother from developing antibodies by destroying the Rh+ fetal RBCs in the mother's blood system
31
What are vesicular breath sounds?
soft and/or blowing, heard throughout inspiration and fade with expiration - best hear over the base of the lungs
32
What is pulsus paradoxous?
a fall of systolic blood pressure of >10 mmHg during the inspiratory phase (due to the increased pressure in the chest) - most commonly occurs in severe acute asthma, emphysema, and cardiac tamponade => apical pulse can still be heard even though radial pulse is no longer palpable
33
What is pes planus?
flat feet - fat pads on an infant's feet can cause them to appear flat
34
Which class of antibiotics is recommended for the treatment of community-acquired pneumonia?
no comorbidity: macrolides (clarithromycin/Biaxin, azithromycin/Z-pack, erythromycin for 5-10 days) or tetracycline (doxy for 10 days); comorbidity: respiratory fluroquinolones (levaquin, gatifloxacin, moxifloxacin/Avelox for 5-10 days) or high dose amoxicillin PLUS a macrolide
35
What is Virchow's node (sentinel node)?
lymph node in the left supraclavicular fossa (the area above the left clavicle) that takes its supply from lymph vessels in the abdominal cavity => the finding of an enlarged, hard node (also referred to as Troisier's sign) is strongly indicative of the presence of cancer in the abdomen (i.e., gastric cancer) that has spread through the lymph vessels
36
How is cholesterol classified?
normal: < 200; borderline: 200-239; high: >= 240
37
What is balanitis?
candida albicans infection of the glans penis - more common in uncircumcised men, diabetics, and immunocompromised => Tx: topical OTC azole creams (treat partner if also infected)
38
What produces the S1 heart sound?
closure of the mitral and tricuspid (atrioventricular) valves
39
What produces the S2 heart sound?
closure of the aortic and pulmonic (semilunar) valves
40
What is the S3 heart sound?
occurs during early diastole (ventricular gallop/sounds like "Kentucky") - always considered abnormal after age 35 => pathognomic for CHF - best hear with bell of stethoscope
41
What is the S4 heart sound?
caused by increased resistance due to stiff left ventricle - usually indicated LVH (normal in some elderly if no signs/symptoms of heart/valvular disease) => occurs in late diastole (sounds like "Tennessee") - best heard at apex using the bell of the stethoscope
42
What is a split S2?
benign sound caused by splitting of the aortic and pulmonic components - normal if it appears during inspiration and disappears at expiration => best heard over the pulmonic area (second ICS left of the sternum)
43
Which heart sounds are best heard with the bell of the stethoscope?
low tones (bell-low): S3, S4 and mitral stenosis
44
What is the role of prostaglandins in dysmenorrhea?
prostaglandins are hormones the body produces prior to menses - they cause the uterus to contract to shed the endometrial lining, causing pain => the greater the amount of prostaglandins, the more pain - treat dysmenorrhea with NSAIDs due to their effects on prostaglandins
45
What is the plan for management of acne vulgaris?
(1) wash with medicated soap at bedtime, (2) benzoyl peroxide and salicylic acid, (3) topical retin A 0.25% gel, (4) oral agents (tetracycline), (5) Accutane
46
When are microaneurysms seen on fundoscopic exam?
with diabetic retinopathy
47
Which organism causes pneumonia in children and people with cystic fibrosis?
Pseudomonas aeruginosa (also the most common cause of otitis externa)
48
What is roseola infantum (exanthema subitum)?
common viral macupapular rash caused by the herpes virus that appears in infants (6 months to 2 years) a few days after a high fever breaks - first appear on trunk and spread to extremities
49
Which infection presents with three stages of rash?
erythema infectiosum/Fifth disease - 3 stages: (1) URI with low-grade fever, headache, chills, and malaise; (2) red rash on cheeks (slapped cheek rash) for 2-3 days; (3) rash moves to arms and legs and becomes lacy appearing (flat/purple appearance)
50
What is the treatment for post-herpetic neuralgia?
tricyclic antidepressants and anticonvulsants
51
What is the Somogyi effect?
nocturnal hypoglycemia (2-3 a.m.) stimulates the liver to produce glucagon to raise blood sugar - fasting blood glucose levels will be elevated
52
What is 1st line treatment for essential tremor?
propranolol (Inderal) - essential tremors are permanent and cannot be cured => order EKG beore prescribing to rule out heart block
53
What are the findings on the Weber and Rinne tests with conductive hearing loss?
Weber: lateralization to affected ear; Rinne: BC > AC in the affected ear
54
What is bacterial endocarditis (infective endocarditis)?
serious bacterial infection of the heart valves and endocardial surface - Dx with three blood cultures taken at separate sites 1 hour apart
55
What are the signs and symptoms of bacterial endocarditis?
Osler's nodes (subcutaneous red painful nodules on the finger pads), subungal splinter hemorrhages on the nailbeds (caused by microemboli), Janeway's lesions (painless red papules and macules caused by bleeding under the skin), conjunctival hemorrhages, petechaie, cardiac friction rubs, arrhythmias, murmurs
56
What are the findings on pulmonary function testing with COPD?
reduction in FEV1 (forced expiratory volume in 1 second) and FVC (forced vital capacity) - lungs lose recoil AND increase in TLC (total lung capacity) and RV (residual volume) - lungs are always full of air that is hard to squeeze out
57
What is Armour thyroid?
desiccated thyroid - a natural supplement composed of dried pork thyroid glands
58
What is the rule of 9s in burn assessment?
- torso = 36% (front and back of chest and abdomen each 9%)
- legs = 36% (each leg 18% - 9% each front and back)
- arms = 18% (each arm 9% - 4.5% front and back - 2% upper arm, 1.5% lower arm, 1% hand)
- head = 9% (front and back each 4.5%)
- groin = 1%
59
What is the 1st line Tx for C diff?
metronidazole (Flagyl) 500 mg PO TID x 10 days
60
What is the preferred antibiotic for strep throat in a patient with penicillin allergy?
azithromycin (Z-pack)
61
Which type of anti-hypertensive agent has a positive effect on the bones?
thiazide diuretics - decrease calcium excretion by the kidneys and stimulate osteoclast production
62
How is Colchicine used?
prescribed during a gouty attack - give only 10 pills and do not refill => have patient take 1 tablet every 1-2 hours until relief is obtained or adverse GI effects occur (max dose is 6 mg/day)
63
What test should be ordered prior to prescription of hydroxychloroquine (Plaquenil)?
comprehensive eye exam - Plaquenil can affect the retina
64
Which ethnic groups are most commonly affected by thalassemia?
alpha - Asian (Chinese or Filipino)
| beta - Mediterraneans (Greeks or Italians)
65
What is Chvetock's sign?
contraction of the facial muscles when the facial nerve is tapped briskly in front of the ear (anterior to the auditory canal) in the setting of hypocalcemia
66
What is polymyalgia rheumatica?
self-limited (few months to 3 years) rheumatic condition that involves the joints and arteries - high risk of giant cell arteritis (temporal arteritis) => treated with oral steroids - hallmark is rapid improvement in symptoms after starting steroids
67
What is the classic triad of symptoms with Meniere's disease?
vertigo, tinnitus, hearing loss
68
How frequently should Kegel's be performed to treat for stress incontinence?
10 exercises 3 times per day
69
How is the ankle-brachial index (ABI) test used?
to assess the severity of arterial blockage for patients with PAD - normal: 1.0-1.4, less than 1.0 is abnormal
70
What are the major criteria for diagnosis of PID?
tenderness of cervical motion, adnexa, or uterus
71
What are the features of the eyes that produce vision?
- fovea - center of the macula, responsible for sharpest (20/20) vision
- cones - receptors on the fovea that allow seeing in color and detail (cones and color both start with C)
- rods - receptors that allow for night vision
- macula - responsible for central vision
72
What is the mnemonic for remembering anticholinergic effects?
dry as a bone, red as a beet, mad as a hatter, blind as a bat
73
What is the Grey-Turner sign?
bluish discoloration located on the flank area - sign of severe pancreatitis (but can also indicate a ruptured ectopic pregnancy)
74
What is a Tzanck smear?
scraping of an ulcer base to look for Tzanck cells - used to test for chickenpox and herpes zoster
75
What is the cause for a positive obturator or psoas sign?
obturator and psoas are muscles (hip flexors) located in the retroperitoneal area that assist with hip movement - with acute appendicitis, blood and pus irritate these muscles causing pain with hip movement (can also be positive for ruptured ectopic pregnancy)
76
What is Ortolani's maneuver?
part of the physical examination for developmental dysplasia of the hip - tests posterior dislocation of the hip => relocates the dislocation of the hip joint that has just been elicited by the Barlow maneuver
performed by an examiner first flexing the hips and knees of a supine infant to 90 degrees, then with the examiner's index fingers placing anterior pressure on the greater trochanters, gently and smoothly abducting (O = out) the infant's legs using the examiner's thumbs - positive sign is a distinctive 'clunk' which can be heard and felt as the femoral head relocates anteriorly into the acetabulum
77
What is Barlow's maneuver?
physical examination performed on infants to screen for developmental dysplasia of the hip (B = bad to dislocate hip)
performed by adducting the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly - positive if the hip is dislocatable (hip can be popped out of socket with this maneuver) => Ortolani maneuver is then used, to confirm the positive finding (i.e., that the hip actually dislocated)
78
When is the Hep B vaccine given to children?
birth, 1-2 months, 6-18 months
79
Which 5 vaccines are given at 2, 4, and 6 months of age?
rotavirus, DTaP, Hib, PCV13, and IPV (6-18 months)
80
Which 5 vaccines are given at 12 months of age?
Hib, PCV13, MMR, VAR, Hep A (2-dose series separated 6-18 months)
81
When should influenza vaccine be started?
6 months
82
Which 5 vaccines should be given at 15 months of age?
influenza, DTaP (boosters of Hib, PCV13, IPV, if not given at 12 months) => MMR, VAR, and Hep A, if not started at 12 months
83
Which 5 vaccines should be given at 4-6 years of age?
influenza, DTaP, IPV, MMR, VAR
84
Which 3 vaccines should be given at 11-12 years of age?
meningococcal, Tdap, HPV
85
Which vaccine should be given at 16-18 years of age?
meningococcal
86
What is the description of a Stage I pressure ulcer?
non-blanchable erythema of intact skin
87
What is the description of a Stage II pressure ulcer?
partial-thickness skin loss involving the epidermis and/or dermis
88
What is the description of a Stage III pressure ulcer?
deep crater with full-thickness skin loss involving necrosis of subcutaneous tissue extending down to the underlying fascia
89
What is the description of a Stage IV pressure ulcer?
full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures
90
What are Pastia lines?
accentuation of erythema in the flexural creases in cases of the rash associated with scarlet fever (sandpaper texture rash and gooseflesh appearance)
91
What is the best treatment for urticaria (hives)?
removal of offending agent
92
What is erysipelas?
bacterial skin infection involving the upper dermis that characteristically extends into the superficial cutaneous lymphatics - it is a tender, intensely erythematous, indurated plaque with a sharply demarcated border that commonly occurs on skins or cheeks (may also see fever and chills) => most commonly caused by Group A Strep - Tx penicillin or 1st generation cephalosporin
93
What are the signs and symptoms of retinal detachment?
"curtain coming down over the eye," vision change (blurred vision, flashing lights, floaters) in one eye that progressively worsens, lack of pain or redness,
94
What is ciliary flush?
a ring of red or violet spreading out from around the cornea of the eye - commonly occurs with iritis
95
How do you test for near vision?
Rosenbaum chart (chart with large number 95 held 12-14 inches from the client's eyes)
96
What are the signs and symptoms of acute angle-closure glaucoma?
seeing halos around lights, severe eye pain and redness, nausea and vomiting, headache, blurred vision, conjunctival injection, cloudy cornea, mid-dilated pupil, increase intraocular pressure - medical emergency
97
What is the Allen vision test?
vision screening test that uses pictures - used for children ages 2.5 to 3 years
98
How is strabismus tested?
cover-uncover test
99
What are the phases of Tx in BPH?
(1) alpha adrenergic blocker (tamsulosin/Flomax, terazosin/Hytrin, doxazosin/Cardura, prazosin/Minipress) - improves irritative symptoms by decreasing resistance along the bladder neck, prostate, and urethra and improving urine flow
(2) 5-alpha-reductase inhibitors (finasteride/Proscar) - blocks conversion of testosterone to dihydrotestosterone and reduces prostate size => Proscar also shown to reduce incidence of acute urinary retention
(3) phosphodiesterase type 5 (PDE-5) inhibitor (sildenafil citrate/Viagra, vardenafil/Levitra, tadalafil/Cialis) - promotes relaxation of smooth muscles in the lower urinary tract and may improve urinary tract symptoms
100
What is the most common cause of male infertility?
varicocele - excess venous supply causes increase in temperature around the testicles, reducing sperm production
101
What is Reiter's syndrome?
type of reactive, migratory (comes and goes) arthritis that happens as a reaction to a bacterial infection (e.g., gonorrhea or chlamydia) in the body - the infection usually happens in the intestines, genitals, or urinary tract => signs and symptoms include redness, joint swelling and pain, often in knees, ankles, and feet, along with inflammation of the eyes and urinary tract (including ulcers on the glans penis) - Tx is supportive (NSAIDs)
102
Where are the Bartholin's and Skene's glands located?
Bartholin (B = before) - posterior on each side of the vaginal orifice and open onto the sides of the vestibule in the groove between the labia minor and hymen => secrete mucus to lubricate the vagina
Skene's - located on the upper wall of the vagina and around the lower end of the urethra ("female prostate") => drain into the urethra and near the urethral opening and are surrounded by tissue that includes a part of the clitoris extending up into the vagina, which swells up with blood during sexual arousal, producing a different type of orgasm, frequently known as the ‘g-spot orgasm’
103
In musculoskeletal disorders, what is the Allen test?
a test to assess the patency of the radial and ulnar arteries
104
In musculoskeletal disorders, what is the Thomas test?
used to rule out hip flexion contracture and psoas syndrome - patient supine on the examination table and holds the uninvolved knee to his or her chest, while allowing the involved extremity to lie flat - holding the knee to the chest flattens out the lumbar lordosis and stabilizes the pelvis => if the iliopsoas muscle is shortened, or a contracture is present, the lower extremity on the involved side will be unable to fully extend at the hip (positive Thomas test)
105
What is Dupuytren's contracture?
fibrosing disorder most commonly observed in persons of Northern European descent (males 40-60 years old) that results in slowly progressive thickening and shorting of the palmar fascia and leads to debilitating digital contractures, particularly of the metacarpophalangeal (MCP) joints or the proximal interphalangeal (PIP) joints (palmar tissue between the skin and distal palm/fingers - most often 4th and 5th) - usually affects the fourth and fifth digits (the ring and small fingers) => Tx is usually surgical
106
What is Trousseau's sign?
test for hypocalcemia (tetany) - positive when carpopedal spasm occurs after a few minutes of inflation of a sphygmomanometer cuff above systolic blood pressure
107
What is pheochromocytoma?
rare, catecholamine-secreting tumor that may precipitate life-threatening hypertension - 4 classic symptoms are: headaches, palpitations, diaphoresis, and severe hypertension => Dx: plasma metanephrine testing or 24-hour urinary collection for catecholamines and metanephrines - Tx: surgery
108
What is a Colles' fracture?
a fracture of the distal radius in the forearm with dorsal (posterior) and radial displacement of the wrist and hand - sometimes referred to as a "dinner fork" or "bayonet" deformity due to the shape of the resultant forearm => commonly occurs after a fall onto an outstretched hand
109
What is koilonychia?
spoon nails - a nail disease that can be a sign of hypochromic anemia, especially iron-deficiency anemia
110
What is a Shilling test?
test to diagnose cobalamin (B12) deficiency - small radioactive tracer dose of cyanocobalmin (0.5-2 mg) is given by mouth and 24-hour urine sample is taken
111
What is Rett syndrome?
rare, severe neurological disorder that affects mostly girls - after birth, girls have 6 to 18 months of apparently normal development before developing severe problems with language and communication, learning, coordination, and other brain functions => at 12 to 18 months, affected girls lose purposeful use of their hands and begin making repeated hand wringing, washing, or clapping motions; other signs and symptoms include microcephaly; breathing abnormalities; seizures; scoliosis; sleep disturbances
112
What is a blepharitis?
chronic inflammatory condition along the eyelid margin that presents with bacteria and oily flakes at the base of the eyelashes - eyelids are red, swollen, or feel like they are burning => very common among people who have oily skin, dandruff or dry eyes
113
What is a chalazion
a painless, hard mass due to noninfectious blockage of the meibomian (oil) glands - may cause nystagmus
114
What is a hordeolum (stye)?
acute focal infection (usually staphylococcal) involving either the glands of Zeis (external hordeola, or styes) or, less frequently, the meibomian glands (internal hordeola) - painful infection of eyelash follicle
115
What are the components of Cushing's triad?
HTN, bradycardia, irregular respirations
116
What is a Wilm's tumor?
nephroblastoma (congenital tumor of the kidney) - asymptomatic abdominal mass that extends from the flank toward the midline (rarely crosses midline) - signs and symptoms include abdominal pain, hematuria (microscopic or gross), HTN => peak age 2-3 years - most common renal malignancy in children - SHOULD NEVER BE PALPATED
117
What is Zollinger-Ellison syndrome?
gastrinoma (gastrin-secreting tumor) located on the pancreas, lymph nodes, intestines, or stomach - causes secretion of high levels of acid in the stomach leading to multiple, severe ulcers in the stomach and duodenum => signs and symptoms: epigastric or mid-abdominal pain, tarry stools - screen via fasting gastrin level
118
What is McBurney's point?
area between the superior iliac crest and umbilicus in the RLQ - tenderness or pain is sign of possible appendicitis
119
What is the Markle (Heel Jar) test?
ask PT to raise heels and drop them suddenly or jump in place - if pain is elicited or PT refuses to perform due to pain, appendicitis is possible
120
What is a cholesteatoma?
"cauliflower like" tumor (not cancerous but can erode into the bones and damage CN VII) in the ear, accompanied by foul-smelling ear discharge (no TM or ossicles are visible) - can lead to hearing loss => Hx of chronic otitis media - Tx: Abx and surgical debridement
121
What is the Battle sign?
acute onset of bruise behind the ear over the mastoid area after recent trauma - indicates fracture of basilar skull => look for clear golden serous discharge (CSF) from the ear or nose - refer to ED for x-rays and Abx
122
What is atypical pneumonia?
lung infection caused by atypical bacteria/walking pneumonia - signs and symptoms: gradual onset, paroxysmal cough, cold-like symptoms, wheezing/crackles/rales, clear mucus, interstitial inflitrates, CBC may be normal => causative organisms: Mycoplasma/Chlamydia/Legionella pneumonia - Tx: macrolides (Z-pack, clarithromycin/Biaxin, erythromycin), antitussives, increase fluid and rest
123
What is arcus senilis?
opaque grayish to white ring at the periphery of the cornea - develops gradually with no vision change => caused by deposits of cholesterol and fat (check fasting lipids)
124
What are the Keith Wagener Barker Grades for uncontrolled HTN?
signs seen on funduscopic exam:
Grade 1: arteriolar constriction ("silver wiring") and vascular tortuosities
Grade 2: AV niking
Grade 3: cotton wool spots and flame hemorrhages
Grade 4: swelling of optic disc (papilledema)
125
What are the tests of renal function?
* best indicator* Glomerular Filtration Rate (GFR) - calculated from the serum creatinine level using age and gender with adjustment for those of African American descent (>= 90 is normal, <= 60 indicates dysfunction)
* most commonly used in primary care* creatinine (product of muscle breakdown) clearance rate determines how efficiently the kidneys are clearing creatinine from the blood - best estimate of GFR
blood urea nitrogen (BUN) provides a rough measurement of the glomerular filtration rate, the rate at which blood is filtered in the kidneys
126
What is one factor that distinguishes placenta previa from placenta abruptio?
in placenta previa the uterus feels soft and is not tender => in placenta abruptio the uterus is rigid (hypertonic) and very tender
127
What is Hashimoto's thyroiditis?
chronic autoimmune disorder (most common in middle-aged/oder women) - body produces antimicrosomial antibodies (presence is gold standard for Dx) against the thyroid gland => severe hypothyroidism (myxedema) - puffy face/hands/feet, thickening of skin, thinning of outer 1/3 of eyebrow, slowed thinking, poor short term memory, depression
128
What is the Koebner phenomenon?
development of new psoriatic plaques over areas of skin trauma
129
What are bibasilar crackles?
bubbling or crackling sound originating from the base of the lungs that occur when the lungs inflate or deflate - usually brief, and may be described as sounding wet or dry => due to excess fluid in the airways - can occur in pneumonia, bronchitis, pulmonary edema, COPD, CHF, uncontrolled HTN
130
What are the types of abortion?
- spontaneous (miscarriage): loss of fetus before viability (< 20 weeks)
- threatened: vaginal bleeding but cervical os remains closed
- inevitable: cervix is dilated and unable to stop process
- complete: vaginal bleeding with cramps - placenta and fetus expelled completely
- incomplete: vaginal bleeding with cramps - placental products remain in the uterus
131
What is the blue dot sign?
abrupt onset of blue colored round mass located on the testicular surface - caused by infarction and necrosis of the appendix testis => mimics testicular torsion but not an emergent condition
132
What is the gold standard for diagnosis of pernicious anemia (type of B12 anemia)?
increased levels of antiparietal antibodies (autoimmune condition where body attacks intrinsic factor - helps your intestines absorb vitamin B12)
133
What is G6PD anemia?
inadequacy of glucose-6-phosphate dehydrogenase - hereditary condition that leads to hemolysis of RBCs and hemolytic anemia => more common in African Americans - Dx via blood levels of G6PD
134
What is Fitz-Hugh-Curtis syndrome?
inflammation of the membrane lining the stomach (peritoneum) and the tissues surrounding the liver (perihepatitis) - signs and sypmtoms: severe pain in the upper right area (quadrant) of the abdomen, fever, chills, headaches, and a general feeling of poor health (malaise) => associated with Neisseria gonorrhoeae and Chlamydia trachomatis (complication of PID)
135
What is an indirect Coombs test?
used in prenatal testing of pregnant women and in testing blood prior to a blood transfusion - detects antibodies against RBCs that are present and unbound in the patient's serum => positive test in Rh-negative pregnant woman means that the mother has autoantibodies against Rh-positive RBCs - administer RhoGAM at 28-30 weeks gestation and within 72 hours postpartum
136
What are the differences in symptoms of right-sided and left-sided heart failure?
- right-sided: caused by left-sided heart failure => blood returning from the body becomes backed up (edema and jugular vein distension)
- left-sided: the heart can no longer adequately bring in fresh blood from the lung and pump it out to the body - causes blood to back up and pool in the left lung => SOB, heaviness in the chest, weight gain, nonproductive cough, fine crackles in lower lobes, positive for egophony
137
What is the significance of having more than 5 cafe au lait spots?
strong indication of neurofibromatosis (genetic disorder that causes tumors to form on nerve tissue) or von Recklinghausen's disease (neurological disorder with seizures and learning disorders)
138
What are Koplik spots?
clustered, white lesions on the buccal mucosa (opposite the lower 1st and 2nd molars) and are pathognomonic for measles - prodromic (manifesting two to three days before the measles rash itself)
139
What is first line Tx for OCD?
selective serotonin reuptake inhibitors (SSRIs) - Fluoxetine (Prozac), fluvoxamine, paroxetine (Paxil), and sertraline (Zoloft)
140
What is Jarish-Herxheimer reaction?
an immune-mediated reaction - acute febrile reaction that can occur during first 24 hours of treatment for early syphilis (due to destruction of large number of spirochetes after Abx injection) => signs and symptoms: fever, chills, headache, myalgia
141
What is a pinguecula?
yellow triangular thickening of the bulbar conjunctiva (skin covering the eyeball) - caused by UV light damage to collagen => Tx with steroid drops
142
What is a pterygium?
yellow triangular thickening of the conjunctiva that extends *onto* the cornea on the nasal or temporal cornea - caused by UV light damage to collagen (starts as a pinguecula "i" comes before "t") => Tx with steroid drops
143
What is tic douloureux?
trigeminal neuralgia - a severe, stabbing pain (people can become afraid to talk, eat, or move during periods of attacks) to one side of the face => pain is usually triggered by a light touch of the face or mouth on the same side as the pain - Tx: anticonvulsant medications, most commonly carbamazepine (Tegretol)
144
What are the primary adverse effects of NSAIDs?
```
#1 renal
#2 GI
```
145
What happens to vision with macular degeneration?
leading cause of vision loss (central vision) - use Amsler grid to assess => may see Drusen bodies on funduscopic exam
146
If a person has allergies to Baker's yeast, which vaccines should they avoid?
Hep B and HPV
147
What is marasmus?
severe undernourishment causing an infant's or child's weight to be significantly low for their age (e.g., below 60 percent of normal) - caused by a deficiency in calories and energy => more common before age 1
148
What is kwashiorkor?
malnutrition caused by a lack of protein in the diet => more common after age 18 months
149
What are the components of the HEADSS questionnaire?
```
Home Environment
Education and Employment
Activities
Drugs
Sexuality
Suicide/Depression
```
150
What is Fragile X syndrome?
genetic (X-linked dominant) condition that causes intellectual disability (mental retardation), behavioral and learning challenges and various physical characteristics (large ears, long face, prominent forehead, soft skin and large testicles)
151
What is scleroderma?
chronic connective tissue disease generally classified as one of the autoimmune rheumatic diseases - hardening and tightening of the skin and connective tissues
152
What is the most common type of stroke?
lacunar (thrombotic) - results from the occlusion of small penetrating arteries that provide blood to the brain's deep structures
153
What is myasthenia gravis?
chronic autoimmune neuromuscular disorder that is characterized by fluctuating weakness of the voluntary muscle groups (weakness improves with rest) - Dx: anti–acetylcholine receptor (AChR) antibody (Ab) test
154
What is seborrheic dermatitis?
red, itchy rash on your scalp that has flaky scales (dandruff) - Tx: preparations with tar, antifungal antibiotics, zinc pyrithione, or selenium sulfide => infants: wash with baby shampoo and use soft brush to remove plaques or imidazole cream (clotrimazole 1%, econazole 1%, or miconazole 2%) BID
155
What is malignant melanoma?
most aggressive and malignant neoplasm of melanocytes => Tx: surgery
156
What is Paget's disease?
chronic condition of bone characterized by disorder of the normal bone remodeling process - bone that is formed is abnormal, enlarged, not as dense, brittle, and prone to breakage => Tx: bisphosphonates or injectable calcitonin
157
What is telogen effluvium
diffuse thinning of hair (during telogen phase of hair growth - recognized by a small bulb of keratin on the root end) on the scalp, which can be a bit more severe in some areas of the scalp than others - most often, the hair on top of the scalp thins more than it does at the sides and back of the scalp => causes: vaccinations, crash dieting, physical trauma such as being in a car crash, having surgery, postpartum, antidepressants, chronic stress, diet deficiency
158
What does a decrease in glucose in CSF suggest?
bacterial or fungal meningitis - in a patient with a normal CSF glucose concentration but with increased number of WBCs, viral meningitis should be suspected
159
What is psoriasis?
characterized by skin cells that multiply up to 10 times faster than normal - leads to plaques of red skin, often covered with loose, silver-colored scales (lesions may be itchy and painful, and they sometimes crack and bleed) => Tx: topical corticosteroids, vitamin D analogues (calcipotriene/Dovonex), anthralin (Dritho-Scalp) to slow skin growth, alcineurin inhibitors — tacrolimus (Prograf) and pimecrolimus (Elidel) — reduce inflammation and plaque buildup, salicylic acid, coal tar
160
What are the tests for myasthenia gravis?
- Tensilon (edrophonium) - used with ptosis => acetylcholinesterase inhibitor - prolongs acetylcoline in neuromuscular junction leading to immediate increase in muscle strength
- ice pack - used with ptosis => applying ice pack to eye improves symptoms
- repetitive nerve stimulation => progressive decrease in response
- electromyography => simultaneous recording of action potentials of 2 muscle fibers - increase in "jitter"
161
What is myasthenia gravis?
autoantibodies against acetylcholine receptor or receptor-associated protein (muscle specific tyrosine kinase) => hallmark is muscle weakness (not fatigue)
162
What are the steps in asthma treatment?
1: SABA PRN
2: SABA + low-dose ICS
3: SABA + low-dose ICS + LABA or medium dose ICS
4: SABA + medium dose ICS + LABA
5: SABA + high-dose ICS + LABA and omalizumab (for PTs w/allergies)
6: SABA + high-dose ICS + LABA + oral corticosteroid and omalizumab (for PTs w/allergies)
163
What are the steps in COPD management for moderate severity and higher?
1. short-acting beta agonist (SABA - albuterol/terbutaline) or short-acting anticholinergic (SAAC - ipratropium)
2. SABA and SAAC
3. SABA/SAAC (Berodual/Combivent) + LAAC (tiotropium) and/or LABA (salmeterol/formoterol)
4. SABA/SAAC + LAAC + ICS (fluticasone or budesonide)/LABA combo (+/- methylxanthine/Theophylline)
5. SABA/SAAC + LAAC + ICS/LABA combo (+/- theophylline) + long-term O2 therapy (consider lung transplant or lung volume reduction surgery)
164
Where is the best place to auscultate S3 heart sound?
pulmonic area
165
Which is the only vaginal infection with an alkaline pH?
bacterial vaginitis (not considered an STD - no need to treat partner)
166
What is the microscopic appearance of Candida infections?
spaghetti and meatballs
167
What is the most common drug interaction in primary care?
warfarin and Bactrim - increases INR and risk of bleeding
168
What are the drugs that most commonly cause drug-drug interactions?
- macrolides
- antifungals
- cimetidine (Tagamet)
- citaprolam (Celexa)
169
Which drugs have the narrowest therapeutic index?
- warfarin (track INR - antidote: vitamin K)
- digoxin (blood levels - antidote: digibind)
- theophylline (blood levels)
- carbamezapine/Tegretol
- phenytoin/Dilantin
- levothyroxine
- lithium
170
What are side effects of ACE inhibitors?
chronic cough and angioedema
171
What are side effects of beta blockers?
fatigue and depression
172
What are side effects of calcium channel blockers?
swollen ankles and headache
173
What is herpes keratitis?
damage to corneal epithelium due to herpes virus infection (secondary to shingles) - acute onset of severe eye pain, photophobia, blurred vision in one eye => Dx: fluorescein dye - look for fernlike lines in corneal surface (permanently damages corneal epithelium = corneal blindness - refer to ED or ophthalmologist STAT)
174
How does diphtheria present?
sore throat, fever, markedly swollen neck ("bull neck"), hoarseness, dysphagia, grey/yellow colored pseudomembrane that is hard to displace => high contagious - refer to ED
175
What is an abnormal finding on a vision screening (with Snellen chart)?
two line difference between eyes or less than 4 of 6 letters correct
176
What is bullous myringitis?
actue otitis media with blisters on TM (TM bulging or retracted, decreased mobility, straight line on tempanogram) - unilateral facial pressure worse with bending over, pain in upper molars, frontal headache, purulent yellow/green post nasal drip => Tx: amoxicillin (all age groups) - second line (Augmentin, Ceftin, Cefzil) if severe disease or treatment failure
177
What is the treatment for otitis externa?
Cortisporin otic drops (keep water out of ear during treatment) - prophylaxis: Otic Dodedoro (boric) or alcohol and vinegar drops
178
What is meningococcemia?
dissemination of meningococci (Neisseria meningitidis) into the bloodstream - signs and symptoms: sore throat, cough, fever, headache, stiff neck, photophobia, changes in LOC, abrupt onset of petechial rash (axillae, flanks, wrist, ankles) => Tx: ceftriaxone (Rocephin) IV + vancomycin IV - spread by droplets: rifampin prophylaxis for close contacts
179
What is acral lentiginous melanoma?
most common melanoma in African Americans and Asians - dark lesions found in nailbeds, palms, plantar surfaces of feet, and mucous membranes
180
What is a subungal hematoma?
blood under the nail bed (risk of permanent ischemia) => Tx: draining (trephination) - 18-gauge needle heated until very hot and pushed onto nail bed to create hole for drainage
181
Which medications are most commonly implicated in Stevens-Johnson Syndrome?
penicillins, sulfas, barbituates, phenytoin (Dilantin) - higher risk among PLHIV (exposure to Bactrim)
182
What is a xanthelasma?
raised yellow plaque in the brow or eye lids - may be sign of hyperlipidemia
183
What is tinea versicolor?
superficial skin infection caused by yeasts (pityrosporum orbiculare/ovale) - hypopigmented round macules on chest/shoulders/back (seen after sun exposure) => KOH slide shows hyphae and spores (spaghetti and meatballs) - Tx: selenium sulfide or ketoconazole (Nizoral) shampoo
184
What is herpetic whitlow?
viral skin infection of the fingers caused by herpes simplex virus (1 or 2) - red bumps and blisters on sides of fingers => Tx: NSAIDs, acyclovir/Zovirax for severe cases (cover with Band-Aid until healed
185
What is acne rosacea?
chronic and relapsing inflammatory skin disorder among persons of Celtic background - acne-like papules and pustules around nose, mouth, and chin can lead to rhinophyma (hyperplasia of tip of nose) => Tx: meronidazole/Metrogel or azelaic acid/Azelex
186
Which type of heart valve problem is associated with an S2 "click" followed by a systolic murmur?
mitral valve prolapse
187
What are the components of metabolic syndrome?
*abdominal obesity, *HTN, *hyperlipidemia, fasting plasma glucose > 100, elevated triglycerides, decreased HDL
188
What factors are included in calculation of peak expiratory flow (PEF)?
height, age, gender
189
What is the treatment for impending respiratory failure in an asthmatic patient?
adrenaline injection STAT, O2 at 4-5 L/min, albuterol nebulizer treatment, parenteral steroids and antihistamines (diphenhydramine and cimetidine) => signs and symptoms: tachypnea (> 25/min), tachycardia/bradycardia, cyanosis, anxiety, exhaustion, fatigue, diaphresis, use of accessory muscles to breathe, "quiet" lungs with no wheezing or breath sounds audible
190
What are the factors in CURB-65?
```
C onfusion
U rea nitrogen (BUN) > 19.6
R espiration > 30/min
B lood pressure (systolic) < 90 diastolic < 60
65 years old or older
```
191
In the endocrine system, what is the "master gland"?
hypothalamus
192
Which hormones are excreted by the anterior pituitary?
TSH (thyroid gland), FSH (ovaries), LH (ovaries/testicles), GH, ACTH (adrenal glands), prolactin
193
Which hormones are excreted by the posterior pituitary?
vasopressin (antidiuretic hormone), oxytocin
194
What is the coverage for different types of insulin?
- rapid-acting (Humalog/Lispro): one meal at a time
- regular: meal to meal
- NPH: breakfast to dinner
- Lantus/glargine or Levimir/detimir: once a day
195
What is the starting dose of glucophage/Metformin?
500 mg daily to BID (max dose: 2,550 mg/dL)
196
What is quadruple therapy for H pylori infection?
bismuth subsalicylate (Pepto-Bismol), metronidazole, tetracycline, PPI
197
What does the urinalysis show on a UTI?
>= 10,000 colony forming units of one dominant bacteria
198
What is the most common composition of a kidney stone (nephrolithiasis)?
calcium oxalate - severe colicky flank pain in waves => Tx: increase fluid intake and avoid high oxalate foods (rhubarb, spinach, beets, chocolate, tea, meats)
199
What is aplastic anemia?
anemia caused by destruction of pluripotent stem cells inside the bone marrow due to radiation, drug effects, viral infection, etc. (affects all cell lines) => Dx: bone marrow biopsy
200
What are the signs and symptoms of a dissecting abdominal aneurysm?
acute and sudden onset "tearing" severe low back pain/abdominal pain with abdominal bruit
201
What is ankylosing spondylitis?
chronic inflammatory disorder that affects mainly the spine and sacroiliac joints - upper back pain, fever, fatigue, chest pain with respiration, loss of ROM in spine, uveitis => "bamboo spine", ESR and CRP slightly elevated, rheumatoid factor negative - Tx: NSAIDs
202
What is Korsakoff's syndrome?
neurological disorder with hypotension, visual impairment, and coma - complication of chronic alcohol abuse => Tx: high dose parenteral vitamins (thiamine/B1)
203
What is the Hirschberg test?
screen for strabismus - abnormal corneal light reflex (off centered)
204
What is a neuroblastoma?
nerve cell cancer that presents as a painful abdominal mass (fixed, firm, irregular) that frequently crosses the midline - most commonly found on the adrenal medullary => signs and symptoms: weight loss, fever, Horner's syndrome (miosis, ptosis, anhidrosis), periorbital ecchymoses ("racoon eyes"), bone pain, HTN
205
What are the signs and symptoms of Kawasaki disease?
high fever (104 degrees F), enlarged lymph nodes, bright red rash, conjunctivitis, dry cracked lips, "strawberry tongue," skin peels off hands and feet - risk of aortic dissection, aneurysms, blood clots => Tx: high dose aspirin
