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Family Med COMAT > Online Med Ed Wrongs > Flashcards

Online Med Ed Wrongs Flashcards

1
Q

Barretts esophagus histologically changes from normal tissue of the esophagus to tissue in the duodenum. What tissue will be seen histologically?

A

columnar epithelium

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2
Q

What are the “alarm” sx of GERD?

A

weight loss, emesis, dysphagia

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3
Q

What test do you skip to if the patient presents with alarm sx?

A

EGD

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4
Q

What is the treatment for someone with long time GERD and Barretts that has ANY amount of dysplasia?

A

Endoscopic destruction of the lesion

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5
Q

Which type of antihypertensive drugs can cause hypokalemia?

A

thiazide diuretics (and loop)

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6
Q

What type of anticoagulation do you use to prevent stroke in someone with AFIB?

A

warfarin

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7
Q

What are you wanting to increase in someone with right sided infarct? (II, V, avF)?

A

preload (give IV fluids)

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8
Q

Which drugs cause hypokalemia (and can be useful in patients with hyperkalemia)?

A
  • beta agonists (albuterol)
    • increases K+ uptake by cells
  • Insulin
    • enhances Na/K/ATPase pump with glucose
  • loop diuretics (furosemide)
    • inhibits Na/K/Cl pump in Loop of Henle
  • intestinal cation exchange resins
  • alkalinaizing agents (sodium bicarbonate)
    • increases serum pH causing potassium, shift into cells
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9
Q

What is the most common cause of secondary nephrotic syndrome?

A

DM

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10
Q

What is the most likely complication of nephrotic syndrome?

A

venous thrombosis

(due to hypercoagulable state)

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11
Q

Why do you get edema with nephrotic syndrome?

A

proteins (albumin) are lost in the urine and the oncotic pressure is decreased in the CV system–>edema

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12
Q

How is nephrotic syndrome defined?

A

>3.5 grams collected in a 24 hour urine protein collection

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13
Q

What are 5 complications of nephrotic syndrome?

A
  1. protein malnutrition
  2. hypovolemia
  3. acute kidney injury
  4. infection
  5. thromboembolism
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14
Q

Unilateral, complete hemi-facial paralysis (including forehead muscles) is due to what?

A

peripheral facial nerve palsy: characterized by dysfunction of the lower motor neuron of CN VII

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15
Q

Unilateral paralysis in the lower face (can still wrinkle forehead) is caused by what?

A

central facial nerve palsy: characterized by dysfunction of the upper motor neuron of CN VII (at a level in the brain above the pons)

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16
Q

What are the signs of peritonsilar abscess?

A

trismus (inability to open mouth), dysphagia, ear pain, fever, red, enlarged, medially displaced tonsil with uvular deviation away from the affected side

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17
Q

What is pemphigoid gestationis?

A

pregnancy-associated auto-immune disease; pruritis with papules and plaques which progress to become vessicles and bullae

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18
Q

What will a biopsy positive for pemphigoid gestationis show?

A

subepidermal bliasteing with eosinophil predominant infiltrate at the dermal-epidermal junction.

Direct immunofluorescence is positive for deposition of C3 and/or IgG along the basement membrane.

“salt split” technique shows deposition along the floor of the lesion

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19
Q

What does a positive “salt split” technique for a bullous pemphigoid show?

A

deposition along the roof of the blister

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20
Q

What is the treatment of corneal abraision in non-contact wearers?

A

polymyxin B/trimethoprim eye drops

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21
Q

What is the treatment of corneal abraision in contact wearers?

A

fluoroquinolones (ciprofloxacin) or aminoglycosides

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22
Q

What are the screening tests for dysplasia of the hip?

A

Barlow=hip flexed 90 degrees, and b/l hips adducted with posterior pressure directed at the knee

Ortolani=hip flexed at 90 degrees and b/l hips abducted and push forward on the head of the femur to push back into acetabulum

+ test=clunking sensation felt

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23
Q

Next step in a infant with both + Barlow and Ortolani tests?

A

refer to ortho

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24
Q

Next step in infant with - Bartlow and + Ortlani?

A

ortho

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25
Q

Next step in infant with + Bartlow only?

A

monitor/observe patient and repeat exam at a later date

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26
Q

Child with new onset, conductive hearing loss with intact TM with invaginaitons, granulation tissue, and small white mass beyond TM would indicate what?

A

cholesteatoma

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27
Q

What are the sx of avascular necrosis?

A

groin pain that is worse with bearing weight

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28
Q

What are risk factors for avascular nevrosis?

A

chronic use of corticosteroids and heavy alcohol use

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29
Q

What is senn on imaging in avascular necrosis?

A

“crescent sign”; a subchondral crescent-shaped radiolucent area representing an area of necrotic bone.

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30
Q

Who is at risk for avascular necrosis?

A

sickle cell, femoral neck fx, SLE, smokers

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31
Q

how does an anal fissure present?

A

sharp tearing pain with bloody bowel movements

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32
Q

Pt presents with b/l leg pain, aching, cramping that is worse with exertion and is relieved by rest. Dx?

A

intermittent claudication (angina of the legs)

*eitiology linked to peripheral artery disease and secondary atherosclerosis

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33
Q

what is minimal change disease?

A

the most common cause of nephrotic syndrome in children less than 10, gets better with corticosteroids

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34
Q

painless , gross/frank hematuria in males 10-20 within days of a viral infection (URI) or pharyngitis and HTN (no edema)?

A

IgA nephropathy

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35
Q

hematuria with RBC casts, edema, and HTN, associated with group A strep or URI weeks prior?

A

post strep/infectious glomerulonephritis

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36
Q

unexplained hyperthyroidism?

A

struma ovarii; look for elevated levothyroxine (T4)

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37
Q

Why are people with crohns more likely to get calcium oxalate kidney stones?

A

decreased intestinal absorption of bile salts and fatty acids

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38
Q

Pts with PCOS have increased risk for what type of cancer?

A

endometrial

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39
Q

name important P450 inhibitors:

A

erythromycin, cimetidine, ketoconazole, itraconozole

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40
Q

What additional vaccine are children with sickle cell supposed to get at 2 years old?

A

23-valent pneumococcal polysaccharide vaccine (PPSV-23)

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41
Q

neonatal foot deformity: midline deviation of all metatarsal bones

A

metatarsus adductus

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42
Q

neonatal foot deformity: “up and out” appearance of the foot/feet

A

calcaneovalgus

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43
Q

neonatal foot deformity: “rocker bottom feet”

A

congenital vertical talus; “reversed arch”

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44
Q

neonatal foot deformity: “clubfoot” or “down and in” foot/feet

A

talipes equinovarus

45
Q

first line treatment for insomnia?

A

CBT

46
Q

what testing should pregnant women recieve at 28 weeks?

A

gestational diabetes; 1 hr 50 gram glucose tolerance test

47
Q

what testing should pregnant women get at 36 weeks?

A

group B strep

48
Q

treatment for group b strep in pregnant patients:

A

normal=penicillin

small penicillin allergy(simple rash, no hives)=cefazolin

true penicillin allergy=clindamycin

last resort=vancomycin

49
Q

who should be treated for group b strep in pregnancy?

A
    • swab or urine
  • previous child born with GBS infection
  • nuknown GBS status at <37 weeks
  • at risk for preterm labor
50
Q

how is pneumococcal infection prevented in sickle cells kids up to 5 years old?

A

vaccine and prophylactic penicillin

51
Q

what is the next step in diagnosing a kid with gross hematuria with clots?

A

US

52
Q

treatment for febrile seizures?

A

acetaminophen and reassurance

53
Q

side effect of ethosuximide?

A

pancytopenia

54
Q

what is the next step in testing someone who has a thyroid nodule, but normal labs (euthyroid)?

A

FNA

55
Q

How long should pts fast from food before getting lipid panel?

Alcohol?

A

12 hrs, 24 hrs

56
Q

What is positive in UC?

A

bloody diarrhea, wieght loss, pANCA +, elevated ESR and CRP

rectum to colon

Increased risk of colon cancer

57
Q

What is the findings in celiac disease?

A

anti-tissue transglutaminase antibody (IgA)

58
Q

Findings in Crohn’s disease?

A

bloody stool, transmural, any part/skip lesions, string sign, +ASCA

59
Q

A patient seems depressed and refuses treatment fotr a normal problem. What is the next step?

A

psych eval for depression

60
Q

Young pt is diagnosed with HIV. What vaccine do they need?

A

13 and 23 valent pneumococcal vaccines need to be given in pts iwth HIV

61
Q

medication for ALS?

A

riluzole; inhibits glutamate release

62
Q

what can bile acid sequestrants be used for besides lipid control?

A

pruritis due to hyperbilirubinemia in liver failure patients

63
Q

how do you biopsy a hard, thyroid mass?

A

Reidels thyroiditis; open surgical biopsy

64
Q

H pylori treatment?

A
  • OAC
  • LAC
  • BMT (bismuth, metronidazole, tetracycline)
65
Q

how do you prevent G6PD crisis?

A

avoid dietary precipitants (beans)

66
Q

how often do you do a lipid pannel in someone who last had normal lipids?

A

5 years

67
Q

Pt presents with a lesion that looks like ring worm, but is absent of hyphae. What is it?

A

granuloma annulare

68
Q

normocytic, normochromic anemia in a pt with htn and dm?

A

ckd

69
Q

what is the most significant risk factor for stroke?

A

HTN

70
Q

what do you do with actinic keratosis?

A

cryotherapy so it doesnt become squamous cell carcinoma

71
Q

smoking cessation:

A

first line: nicotine pathc (dont use in people with cardiac problems)

also can use buproprion; not in alcoholics or those with liver failure

72
Q

adult polycystic kidney disease is dx by:

A

renal us; look for a pt with frank blood and kidney disease and aneurysm in family

73
Q

wide fixed split S2 heart sound at left second intercostal space?

A

atrial septal defect

74
Q

a patient with BP disorder experiences positive psychotic findings/hallucinations between manic and depressive episodes for at least 2 weeks. what is this?

A

schizoaffective disorder

75
Q

sx of schizophreniza lasting from 1-6 months?

A

schizophreniform disorder

76
Q

what is schizophrenia?

A

at least two of the following for more than 6 months (one must be a positive sx):

positive: delusions, hallucinations, pressured speech pattern

Negative: depression, etc

77
Q

schizotypal personality disorder:

A

magical thnking, thinking the news and other public messages are directed personally at them; otherwise normal

78
Q

painless hematuria in someone over 40:

A

bladder cancer: transitional cell carcinoma

biggest risk factor=cig smoking

79
Q

child with acute bloody diarrhea. WYD?

A

bacterial stool culture;

DO NOT DO ABX until culture is done because treating e.coli O157:H7 with abx can cause HUS

80
Q

vaccines that should be given to women in each pregnancy:

A

influenza and TDAP

81
Q

when should fluoride supplementaiton begin in infants?

A

6 months; 0.6 ppm

screen at 4 month visit

82
Q

first line treatment for dysmeorrhea?

A

NSAIDS, then birth control

83
Q

stepwise testing for mono:

A

1: heterophile antibodies
2: CBC
3: EBV viral capsid antibody

84
Q

what is the range for dx of prediabetes?

A

A1C of 5.7%- 6.4%

fasting sugars of 100-125

85
Q

chronic worsening pain in between the toes, worse with wearing shoes, better when taking off shoes, a “click” can be heard when palpated

A

Morton’s neuroma

86
Q

bad seide effect that should be monitored with ethosuximide?

A

pancytopenia

87
Q

what is a still;s murmur?

A

low pitched, vibratory, systolic ejection murmur heard at the left lower sternal border that gets louder when lying down

is innocent; reassure parent

88
Q

a test is 94% specific for dm. What does this mean?

A

94% of people without dm will test negative

89
Q

a test is 94% sensitive for dm. What does this mean?

A

94% of people with dm will test positive

90
Q

painless vaginal bleeding in 3rd trimester?

A

placenta previa

91
Q

why are NSAIDS contraindicated in pregnancy?

A

premature closure of patent ductus arteriosus and oligohydramnios

92
Q

what med is ok for pain management in pregnancy?

A

acetaminophen

NSAIDS and salicylates are category D; never use them

93
Q

carcinoembryonic antigen (CEA) is elevated and used to asses treatment in what cancers?

A

colon and some gyn

94
Q

cancer antigen 125 is elevated in what type of cancer?

A

ovarian

95
Q

cancer antigen 15-3 is used to monitor treatment in what kind of cancer?

A

breast

96
Q

cancer antigen 19-9 is used to monitor treatment in what kind of cancer?

A

pancreatic

97
Q

what marker is seen in liver and germ cell tumors?

A

alpha feto protein

98
Q

developmental milestones at ages 4, 6, 9, 12, and 15 months?

A
99
Q

what is craniosynostosis?

A

premature closure of the fontanelles; get x-ray, then CT

100
Q

who should recieve skin cancer screening and counseling?

A

fair skinned pts 6 months-24 years

101
Q

pt presents with evidence of B12 deficiency and mac rocytic anemia after eating raw fish. Dx?

A

diphyllobothrium latum

102
Q

why do certain men get testicular torsion?

A

congenital malformation of the processus vaginalis

103
Q

increased AFP in pregnancy indicates ? decreased?

A

increased: neural tube defects or multiple gestations
decreased: down syndrome

104
Q

first line for osteoporosis treatment and prevention?

A

bisphosphonates: -dronates

monoclonal antibodies: denosumab

105
Q

what do you use for pain relief in someone iwth OA who has CHF?

A

duloxwtine; a serotonin/norepi reuptake inhibitor

106
Q

elderly woman presents with pain in shoulder and hip joints and has a hx of temporal arteritis. What is the dx?

A

polymyalgia rheumatica

107
Q

which population can you not use A1C to monitor DM in?

A

CKD

108
Q

pt with hx of eczema or psoriasis has a thick scaly rash on extensor surfaces

A

lichen simplex chronicus

Family Med COMAT (2 decks)

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