Review Flashcards
(119 cards)
1
Q
Sensitivity definition
A
the ability of a test to detect a person who has the disease
2
Q
Specificity definition
A
the ability of a test to detect a person who is healthy (or to detect the person without the disease).
3
Q
Finkelstein’s test
A
positive in De Quervain’s tenosynovitis.
4
Q
Anterior drawer maneuver and Lachman maneuver
A
positive if anterior cruciate ligament (ACL) of the knee is damaged
5
Q
McMurray’s sign
A
positive in meniscus injuries of the knee.
6
Q
A rare but serious adverse effect of angiotensin-converting enzyme inhibitors (ACEIs)
A
Angioedema
7
Q
Preferred drugs to treat hypertension in diabetics and patients with renal disease because of their renal-protective properties.
A
ACEIs or angiotensin receptor blockers (ARBs)
8
Q
Penicillins
A
Amoxicillin (broad-spectrum penicillin), penicillin VK
9
Q
Macrolides
A
Erythromycin, azithromycin (Z-Pack), or clarithromycin (Biaxin)
10
Q
Cephalosporins
A
First-generation: cephalexin (Keflex)
Second-generation: cefaclor (Ceclor), cefuroxime (Ceftin), cefprozil (Cefzil)
Third-generation: ceftriaxone (Rocephin), cefixime (Suprax), cefdinir (Omnicef)
11
Q
Quinolones
A
Ciprofloxacin (Cipro), ofloxacin (Floxin)
12
Q
Quinolones with gram-positive coverage
A
Levofloxacin (Levaquin), moxifloxacin (Avelox), gatifloxacin (Tequin)
13
Q
Sulfas
A
Trimethoprim–sulfamethoxazole (Bactrim, Septra), nitrofurantoin (Macrobid)
14
Q
Tetracyclines
A
Tetracycline, doxycycline, minocycline (Minocin)
15
Q
Nonsteroidal anti-inflammatory drugs (NSAIDs)
A
Ibuprofen, naproxen (Aleve, Anaprox)
16
Q
COX-2 inhibitor
A
Celecoxib (Celebrex)
17
Q
Category B drugs for pain relief
A
Acetaminophen (Tylenol) instead of NSAIDs such as ibuprofen (Advil) or naproxen (Aleve, Anaprox).
18
Q
Preferred treatment for cutaneous anthrax and contagion
A
Ciprofloxacin 500 mg orally twice a day for 60 days or 8 weeks.
If allergic to ciprofloxacin, use doxycycline 100 mg twice a day.
Cutaneous anthrax is not contagious; it comes from touching fur or animal skins that are contaminated with anthrax spores
19
Q
Vitamins for breast-fed babies
A
Breastfed infants should be started on vitamin D during the first few days of life; then at age 4 months, iron-supplementation is recommended
*formula contains vitamins/minerals so no need to supplement
20
Q
6 months developmental milestones
A
At the age of 6 months, infants can sit without support; roll over front to back, then from back to front; transfer objects from one hand to the other; use a raking grasp; and babble.
21
Q
Levels of evidence rankings [ highest/best level of evidence (#1 ranking) ]
A
- Meta-analysis and/or systematic reviews (Cochrane/MEDLINE/CINAHL/PubMed)
- Randomized controlled trials (RCTs): used for testing medical treatment effectiveness, subjects assigned at random to either a control or treatment group.
- Experimental studies (control group, intervention group, randomization)
- Cohort/case control studies
- Retrospective chart reviews
- Expert/specialty society opinions
22
Q
Nodular melanoma findings
A
Usually has pigment such as brown or black color with irregular borders.
23
Q
Impetigo findings and pathogen
A
Initially appears as papules that develop into bullae. These rupture easily, becoming superficial, bright-red “weeping” rashes with honey-colored exudate that becomes crusted as it dries. The rashes are very pruritic and are located on areas that are easily traumatized, such as the face, arms, or legs.
Bacterial skin infection caused by group A Streptococcus and Staphylococcus aureus.
24
Q
Type of cellulitis caused by strep. It resembles a bright-red, warm, raised rash (plaque-like) with discrete borders usually located on the face or the shins. Blistering is not present.
A
Erysipelas
25
Legionella pneumonia (Legionnaire’s disease) findings
History of exposure to “nebulized” water sources (e.g., air conditioners, fountains). Presents with pneumonia signs/symptoms that are accompanied by gastrointestinal (GI) symptoms (diarrhea, nausea/vomiting).
26
Hemoglobin levels (Males vs Females)
Males: 13.0–17.5 g/dL
Females: 12.0–16 g/dL
27
Hematocrit levels (Males vs Females)
Males: 40%–50%
Females: 36%–45%
28
MCV (mean corpuscular volume)
80–100 fL
29
RDW (red cell distribution width)
>14.5%
The RDW is a measure of the variability in size of red blood cells (RBCs; or anisocytosis).
30
Platelet count
150,000 to 450,000 platelets per microliter of blood
<150,000/mm3 (increased risk of bleeding, disseminated intravascular coagulation)
31
Reticulocytes
0.5%–1.5% of red cells (↑ acute bleeding),
| starting treatment for vitamin deficiencies (iron, B12, folate), acute hemolytic episodes
32
Total WBC (white blood cell) count
4,500–11,000/mm3 (↑ bacterial infections)
33
Neutrophils (or segs)
55%–70% (↑ bacterial infections)
34
Band forms (immature WBCs)
>5% (↑ severe bacterial infections)
| Also called “shift to the left”
35
Eosinophils
>3% (↑ allergies, parasitic diseases, cancer)
36
TSH (thyroid-stimulating hormone)
>5.0 mU/L = hypothyroidism
| <0.4 mU/L = hyperthyroidism
37
PSA (prostate-specific antigen)
<4.0 ng/mL (↑benign prostatic hyperplasia [BPH], prostate cancer)
38
Ferritin
<15 mcg/L = iron-deficiency anemia
39
ESR (erythrocyte sedimentation rat); sed rate
Men 0–22 mm/hr
Women 0–29 mm/hr
Elevated = giant cell arteritis, rheumatoid arthritis [RA], lupus, inflammation
40
CRP (c-reactive protein)
Elevated = inflammation, autoimmune diseases, a risk factor for heart disease
41
cTnT (cardiac troponins)
Elevated in myocardial infarction, heart damage, heart failure
Sensitive test for myocardial cell damage (myocardial infarction, unstable angina)
42
BNP (B-type natriuretic peptide)
Elevated in heart failure
43
Potassium
3.5 - 5.5 mEq/L
| Critical values <2.5 or >8 mEq/L
44
Microcytic anemia
Low MCV
Differential diagnosis for microcytic anemia is iron deficiency and alpha or beta thalassemia trait or minor
45
Iron-deficiency anemia
Serum ferritin and serum iron levels: Decreased
TIBC and RDW: Elevated
*most common anemia in the world for all ages/races/gender
46
The gold-standard test to diagnose any anemia involving abnormal hemoglobin (e.g., thalassemia, sickle cell)
Hemoglobin electrophoresis
47
Clue cell findings
Mature squamous epithelial cells in the vagina with numerous bacteria on the cell surface and borders
positive for bacterial vaginosis
48
Normal vaginal pH
Acidic (pH of 3.5–4.5)
49
Bacterial vaginosis (BV)
Only vaginal condition with an alkaline pH; not considered an STD (it is caused by an imbalance of vaginal bacteria)
BV does not cause inflammation (the vulvovagina will not be red or irritated). Microscopy slide will have very few WBCs and a large number of clue cells.
50
Candida vulvovaginitis
Vaginal discharge in Candida infection is a white color with a thick and curdlike consistency. It frequently causes redness and itching in the vulvovagina because of inflammation. The microscopy in candidiasis will show a large number of WBCs, pseudohyphae, and spores. Test with vaginal swab (PCR)
51
Trichomonas infection (or trichomoniasis)
Vaginal discharge is copious, bubbly, and green in color. It causes a lot of inflammation, resulting in itching and redness of the vulvovagina. It is considered to be an STI. The sex partner also needs treatment. Test with urine specimen (PCR)
52
First-line treatment of CAP in healthy patients (no comorbidities)
Macrolides (azithromycin, clarithromycin, or erythromycin).
53
Calcium channel blockers (CCBs) adverse effects
Swollen ankles (not associated with heart failure) and headache
54
Thiazide diuretics adverse effects
Hyperuricemia and hyperglycemia
55
Beta-blockers adverse effects
Fatigue and depression
56
Most common cancer in females (prevalence)
Breast Cancer
57
Most common cancer in males (prevalence)
Prostate cancer
58
Cancer causing the most deaths overall for both males and females (mortality)
Lung Cancer
59
Most common type of gynecological cancer
Uterine; second most common gynecological cancer is Ovarian cancer
60
Breast cancer USPSTF Screening Guidelines
Baseline mammogram at age 50 years
Screen every 2 years until age 74 years (biennial)
After age 75 years (insufficient evidence)
61
Cervical cancer USPSTF Screening Guidelines
Baseline Pap smear/cytology at age 21 years (do not screen younger)
Screen every 3 years until age 65 years; at age 30–65 years, another option is to screen every 5 years using hrHPV testing alone or in combination with cytology (cotesting).
Hysterectomy (no cervix): Do not screen (if no history of precancer or cervical cancer).
62
Lung cancer USPSTF Screening Guidelines
Aged 55–80 years with 30 pack-year history of smoking or quit smoking up to 15 years previously
Annual screening with LDCT
63
Prostate cancer USPSTF Screening Guidelines
Aged 55–69 years, PSA-based screening should be individualized; ≥70 years, against prostate cancer screening.
64
Testicular cancer USPSTF Screening Guidelines
Routine screening is not recommended.
65
Colorectal cancer USPSTF Screening Guidelines
Baseline screening at age 50 years
Use high-sensitivity fecal occult blood test (yearly) or sigmoidoscopy (every 5 years) or colonoscopy (every 10 years) from age 50 to 75 years; aged 76–85 years, individualize.
66
Skin cancer USPSTF Screening Guidelines
Current evidence insufficient to assess benefits/harms of visual skin exam.
Educate fair-skinned persons to avoid sunlight (10 a.m.–3 p.m.) and use sunblock ≥SPF 15.
67
Fall prevention in community-dwelling older adults USPSTF Screening Guidelines
Adults aged ≥65 years, exercise interventions to prevent falls in adults at increased risk; against vitamin D supplementation.
68
Ovarian cancer USPSTF Screening Guidelines
Routine screening is not recommended.
High-risk (BRCA mutation, family history of breast/ovarian cancer) are screened by specialist; refer for genetic counseling.
69
Abdominal aortic aneurysm USPSTF Screening Guidelines
One-time screening (men aged 65–75 years) for cigarette smokers or those who have quit.
Screening test is ultrasound of abdomen.
70
Barrett’s esophagus
Precancerous lesion of esophageal cancer. It is best managed by a gastroenterologist (not an oncologist).
Patients diagnosed with Barrett’s esophagus typically have endoscopic examinations with biopsy by a gastroenterologist annually (or every 6 months for high-grade lesions).
Patients with Barrett’s esophagus are treated with high-dose PPIs for a “lifetime.”
71
Tanner Stages (Girls)
Stage I: Prepubertal pattern
Stage II: Breast bud and areola start to develop.
Stage III: Breast continues to grow with nipples/areola (one mound/no separation).
Stage IV: Nipples and areola become elevated from the breast (a secondary mound).
Stage V: Adult pattern
72
Tanner Stages (Boys)
Stage I: Prepubertal pattern
Stage II: Testes and scrotum start to enlarge (scrotal skin starts to get darker/more rugae).
Stage III: Penis grows longer (length) and testes/scrotum continues to become larger.
Stage IV: Penis become wider and continues growing in length (testes are larger with darker scrotal skin and more rugae).
Stage V: Adult pattern
73
Migraine headaches and MAOIs (Marplan, Nardil, and Parnate) -- diet
Avoid high tyramine content: Aged cheeses/meats, red wine, fava beans, draft beer, fermented foods
74
Tetracycline and food interactions
dairy: do not drink milk within two hours (either before or after) of taking tetracycline.
75
Foods and supplements containing stimulants, such as caffeine and ephedra, are best avoided by patients with...
hypertension, arrhythmias, high risk for MI, hyperthyroid disease, albuterol use, amphetamine use
76
Celiac disease -- diet
Lifetime avoidance of gluten-containing cereals such as wheat, rye, and barley is necessary.
Gluten free: Rice, corn, potatoes, peanuts, soybeans, meat, dairy, all fruits/vegetables; most people with celiac disease can eat oats.
77
Hypertension -- diet
Maintain an adequate intake of calcium, magnesium, and potassium.
Calcium: Low-fat dairy, low-fat yogurt, cheeses
Magnesium: Wheat bread, nuts (almonds, peanuts, cashews), some beans
Potassium: Most fruits (apricot, banana, oranges, cantaloupes, raisins), green vegetables
Avoid high-sodium foods: Cold cuts, pickles, preserved foods, canned foods, preservatives
78
Anticoagulation therapy (e.g., warfarin sodium or Coumadin) -- diet
Avoid eating large amounts of leafy green vegetables (kale/collard greens, spinach, cabbage, broccoli) and cooking with canola oil (high in vitamin K); use other oils instead.
High levels of vitamin K decrease the effects of warfarin sodium.
79
Tricyclic antidepressants (TCAs) adverse effects
Anticholinergic effects (dry mouth, sedation, arrhythmias, confusion, urinary retention, etc.).
Ex: amitriptyline (Elavil), nortriptyline (Pamelor), doxepin (Sinequan), desipramine (Norpramin).
80
First-line treatment for unipolar depression (major/minor depression), OCD, generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, PTSD, and premenstrual mood disorder
Selective serotonin reuptake inhibitors (SSRIs) -- carry an FDA warning that they increase suicidality in children and young adults up to age 23 years.
Ex: citalopram (Celexa), escitalopram (Lexapro), fl uoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).
81
Iron-deficiency anemia clinical findings
Pica
| Spoon-shaped nails (or koilonychia).
82
Scarlatina
Rash has a sandpaper-like texture and is accompanied by a sore throat, strawberry tongue, and skin desquamation (peeling) of the palms and soles. It is not pruritic.
83
Cutaneous larva migrans (creeping eruption)
Rashes are shaped like red raised wavy lines (serpiginous or snake-like) that are alone or a few may be grouped. They are red and very pruritic, and they become excoriated from scratching (appears maculopapular).
The areas of the body that are commonly exposed directly to contaminated soil and sand, such as the soles of the feet, extremities, or buttocks, are the most common locations for larva migrans.
Systemic treatment with either ivermectin once a day (for 1–2 days) or albendazole (for 3 days) is the preferred therapy for larva migrans.
84
Best location to auscultate for the S3 heart sound
Mitral area, sometimes called the cardiac apex
Located at the left fifth intervertebral space, along the midclavicular line.
The left lateral recumbent position brings the apex closer to the wall and improves the practitioner’s ability to hear the left ventricular S3.
85
Pulmonary tuberculosis (TB)
Caused by Mycobacterium tuberculosis
Mantoux test (TB skin test [TST]): positive = induration
Sputum culture is the gold standard
Treatment is started with at least three antitubercular drugs because of high rates of resistance. When the sputum culture and sensitivity result are available, the antitubercular antibiotic treatment can be narrowed down or changed. Another drug can be added.
TB is a reportable disease. Noncompliant patients who refuse treatment can be quarantined to protect the public.
A baseline LFT level and follow-up testing are recommended for patients on isoniazid (INH).
86
Degenerative joint disease (DJD)
| AKA
osteoarthritis
87
Atopic dermatitis
| AKA
eczema
88
Lupus
| AKA
systemic lupus erythematosus (SLE)
89
Otitis media with effusion (OME)
| AKA
middle ear effusion (MEE)
90
Group A beta Streptococcus
| AKA
S. pyogenes
91
Tinea corporis
| AKA
ringworms
92
Enterobiasis
| AKA
pinworms
93
Vitamin B12
| AKA
cobalamin or cyanocobalamin
94
Vitamin B1
| AKA
thiamine
95
Scarlet fever
| AKA
scarlatina
96
Otitis externa
| AKA
swimmer’s ear
97
Condyloma acuminata
| AKA
genital warts
98
Tic douloureux
| AKA
trigeminal neuralgia
99
Tinea cruris
| AKA
jock itch
100
Thalassemia minor
| AKA
thalassemia trait (either alpha or beta)
101
Giant cell arteritis
| AKA
temporal arteritis
102
Psoas sign
| AKA
iliopsoas muscle sign
103
Tinea capitis
| AKA
ringworm of the scalp
104
Light reflex
| AKA
Hirschberg (corneal reflex) test
105
Sentinel nodes
| AKA
Virchow’s nodes *lymph nodes into which a tumor drains
106
Erythema migrans
| AKA
early Lyme disease
107
Sinusitis
| AKA
rhinosinusitis
108
Major depression
| AKA
unipolar depression
109
Benzodiazepines indication
treat anxiety or insomnia
110
Mood stabilizers indication
treat bipolar disorder; lithium
111
TCAs prophylactic treatment
Migraine headaches, chronic pain, and neuropathic pain (i.e., tingling, burning) such as postherpetic neuralgia.
Ex: amitriptyline (Elavil), nortriptyline (Pamelor), doxepin (Sinequan), desipramine (Norpramin).
*Do not give suicidal patients a prescription for TCAs, because of the high risk of hoarding the drug and overdosing. Overdose of TCAs can be fatal (cardiac and central nervous system [CNS] toxicity).
112
CAGE is a screening tool
A positive response to two out of four questions is highly suggestive of alcohol abuse.
C: Do you feel the need to cut down?
A: Are you annoyed when your friends/spouse comment about your drinking?
G: Do you feel guilty about your drinking?
E: Do you need to drink early in the morning (eye-opener)?
113
Rocky Mountain spotted fever (RMSF)
Dog/wood tick bite; spirochete called Rickettsia rickettsii
Empiric treatment should be started early if RMSF is suspected. Refer the patient to the closest ED as soon as possible -- Doxycycline is the preferred agent for both children and adults. Treat with doxycycline 100 mg orally or by IV for a minimum of 7 days or longer.
114
Early Lyme disease (erythema migrans rash stage):
Ixodes (deer) tick bite; spirochete called Borrelia burgdorferi
Treat with doxycycline × 21 days.
Majority of the cases are in the mid-Atlantic and New England states (i.e., Connecticut, Massachusetts, New York, New Jersey, Pennsylvania).
115
Idiopathic thrombocytopenic purpura (ITP) findings and treatment
Severity ranges from mild to severe (platelet count <30,000/μL). Platelets are broken down by the spleen, causing thrombocytopenia. Look for easy bruising, petechiae, purpura, epistaxis, and gingival bleeding (combined with low platelet count).
Initial treatment for ITP is glucocorticoids (i.e., prednisone) based on platelet response.
116
When girls start menarche, their periods may be very irregular for several months up to 2 years.
ovaries may not ovulate monthly (resulting in irregular periods) when starting menarche.
117
Renal function labs
A GFR value of 60 mL/min/1.73 m2 or less is a sign of kidney damage (refer to a nephrologist)
eGFR is a better test of renal function compared with the serum creatinine concentration
The serum creatinine is affected by age (less sensitive in elderly), gender (higher in males), ethnicity (higher with African background), and other factors.
The BUN is a waste product of the protein from foods that you have eaten. If you eat more protein before the test, it will increase (or decrease with low protein intake).
Dehydration will elevate the BUN value.
118
Digoxin level
Normal range 0.7 to 1.5 ng/mL
119
Macular degeneration (changes in central vision), which can be attributed to (medication) use
Atenolol
