U world Missed #1

Question 1

Ottawa Ankle Rules

Answer 1

X ray is required if there is pain at the malleolar zone and one of the following

1. tenderness at the posterior margin of the medial malleolus
2. tenderness at the posterior margin of the lateral malleolus
3. inability to bear weight for 4 steps

Question 2

Ottawa Foot Rule

Answer 2

X-ray is required if there is pain at the mid foot along with one of the following

1. tenderness at the navicular
2. tenderness at the base of the 5th metatarsal
3. unable to bear weight 4 steps

Question 3

What is a cluster headache

Answer 3

a headache that has a predilection for males that typically has an onset during sleep. The pain is localized behind one eye and it is sharp. It lasts about 15-90 minutes and can be associated with autonomic manifestations (sweating, flushing, nasal congestion, lacrimation, pupillary changes)

-100% oxygen can help in acute cases

Question 4

What is a migraine

Answer 4

a headache that has a predilection for females and a family history can be present. Onset is variable and it is unilateral. It is a pulsating/throbbing pain that lasts for about 4-72 hours. It is associated with aura, photophobia, nausea, and phonophobia.

Question 5

What is a tension headache

Answer 5

a headache that has a predilection for females that is common under stress it has a band like pattern of distribution and is dull, tight and persistent. It lasts for about 30 minutes to 7 days and can be associated with muscle tenderness in the shoulder, neck , and head.

Question 6

Tinea Corporis

Answer 6

slowly expanding, pruritic rash that has a raised border and central clearing caused by trichophyton rubrum (a fungus)

transmitted from contact with skin, animal or fomites

Question 7

How is Tinea Corporis Diagnosed?

Answer 7

typically general inspection but potassium hydroxide on a skin scraping can confirm the diagnosis

Question 8

Tinea Corporis Treatment

Answer 8

With topical Antifungals (terbinafine or miconazole)

Question 9

What are lifestyle risk factors for colon cancer

Answer 9

frequency consumption of red/processed meat

tobacco or alcohol use

Question 10

what are medical risk factors that increase risk for colon cancer

Answer 10

family history of adenomatous polyps or colon cancer

inherited colon cancer syndromes

ulcerative colitis, diabetes, obesity, radiation

Question 11

how are obesity and type 2 diabetes associated with an increased risk of colorectal cancer

Answer 11

hyperinsulnemia leads to increased levels of insulin like growth factor 1 which inhibits colorectal epithelial cell apoptosis and promotes neoplastic progression

obesityL increased inflammatory cytokines

Question 12

protective factors against colorectal cancer

Answer 12

high fiber diet, aspirin/NSAID use, high coffee and tea intake

Question 13

what is gonococcal proctitis

Answer 13

Neisseria gonorrhoeae a gram negative diplococci bacterium is a STD that can have direct speed from the vagina or from anal intercourse.

Symptoms of tenesmus, mucopurulent discharge, rectal pain and itchiness, constipation

Question 14

diagnosis of gonococcal proctitis

Answer 14

Nucleic Acid Amplification test of rectal swab

Question 15

treatment of gonococcal proctitis

Answer 15

ceftriaxone + doxycycline

Question 16

what is the difference between primary and secondary nocturnal enuresis

Answer 16

primary is when there is nighttime incontinence at the age of 5 or greater without a prolonged period of continence

secondary is when there is nighttime incontinence a the age of 5 or greater with prolonged period of continence before hand >6 months

Question 17

what is the cause of primary nocturnal enuresis

Answer 17

brain maturation delay and or genetics

Question 18

what is the cause of secondary nocturnal enuresis

Answer 18

an underlying medical condition like diabetes/UTI or psychological stressors

Question 19

what is the initial evaluation of nocturnal enuresis ?

Answer 19

urinalysis

Question 20

what is the management of nocturnal enuresis primary vs. secondary

Answer 20

primary: reassurance, behavioral modifications, bed wetting alarm

secondary: treat the underlying condition, behavioral modification

*behavioral modifications can include: evening fluid restriction

Question 21

what medications can lower blood pressure and minimize left ventricular hypertrophy

Answer 21

Ace inhibitors, Angiotensins Receptor Blockers, Calcium Channel blockers and thiazide diureteics

Question 22

what medication that is used for hypertension can raise uric acid and precipitate gout?

Answer 22

thiazide diuretics

Question 23

what is the preferred medication for antihypertensive patients with gout

Answer 23

Angiotensin II receptor Blockers (ARBs)

Question 24

Enuresis medical causes

Answer 24

Constipation, UTI, bladder dysfunction, CKD, diabetes, OSA

Question 25

Chronic Kidney Disease in children are most commonly due to?

Answer 25

a posterior urethral valve which blocks the outflow or urine from the bladder causes symptoms of urinanary incontience day and night ; damages the kidneys and causes recurrent UTIs and proteinuria

Question 26

Enuresis due to CKD should have what type of workup

Answer 26

evaluate the serum creatinine level renal ultrsound, voiding cysteaurethrogram

Question 27

what type of vaccine is the diphtheria-tetanus-acellular pertussis vaccine?

Answer 27

combined vaccine containing acellular pertussis antigen with diphtheria and tetanus toxoids safe and effective

Question 28

what is the DTaP immunization scheduling

Answer 28

5 does of inactivated DTap vaccine at 2 months, 4 months, 6 months, 15-18 months and 4-6 years

Question 29

adverse reaction to the DTap?

Answer 29

generally low minor symptoms like erythema at the injection site seizures caused by the pertussis vaccine is RARE

Question 30

Is a family history of seizures or personal history of seizures a contraindication to the DTaP vaccine?

Answer 30

No benefits outweigh the risks

Question 31

what is the DTap vaccine contraindicated in?

Answer 31

anaphylaxis, unstable neurological disorders like infantile spasms, and encephalopathy

Question 32

thin walled ovarian cyst with pelvic free fluid is?

Answer 32

a ruptured ovarian cyst

Question 33

a ruptured ovarian cyst that is hemodynamically stable is managed how?

Answer 33

observation and reassurance if they are hemodynamically unstable then surgery is required

Question 34

what is mittelschmerz

Answer 34

recurrent unilateral mid cycle pain prior to ovulation that lasts hours

Question 35

Pelvic inflammatory disease symptoms and ultrasound findings

Answer 35

fever/chills, vaginal discharge, lower abdominal pain and cervical motion tenderness imaging: tuboovarian access

Question 36

ovarian torsion symptoms and ultrasound findings

Answer 36

ovarian torsion: uniltateral sudden lower abdominal pain with N/C unilateral tender adnexal mass on examination enlarged ovary with decreased or absent blood flow

Question 37

Nonalcoholic fatty liver disease

Answer 37

liver steatosis on imaging that is common in people with metabolic syndrome, an AST/ALT less than 1 and hyper echoic texture on US mostly asymptomatic until liver cirrhosis occurs

Question 38

management of nonalcoholic hepatic steatosis

Answer 38

weight management and control of metabolic risk factors

Question 39

what is the prognosis of nonalcoholic fatty liver disease

Answer 39

increased risk of hepatic fibrosis, cirrhosis and liver related death

Question 40

autoimmune hepatitis

Answer 40

marked elevation in AST and ALT and bilirubin with arthranglia, anorexia, and fatigue

Question 41

common causes of mechanical obstruction in patients with GERD

Answer 41

esophageal stricture esophageal adenocarcinoma

Question 42

what is a esophageal stricture

Answer 42

reflux of gastric acid contents cause mucosal damage and collagen deposition in the esophagus they are no malignant and imaging will show a symmetric concentric narrowing of the distal esophagus

Question 43

what is esophageal adenocarcinoma

Answer 43

barretts esophagus can scause this from intestinal metaplasia of the distal esophagus imaging will show an asymmetrical and irregular narrowing of the distal esophagus

Question 44

treatment of an esophageal stricture

Answer 44

endoscopic dilation

Question 45

achalasia

Answer 45

a esophageal motility disorder with dysphagia to solids and liquids at onset peristalsis and dilation of the esophagus proximal to the LES with a bird beak appearance

Question 46

vascular rings

Answer 46

uncommon congenital anomalies in which the aortic arch vessels compress the trachea or esophagus at the level of the aortic arch (by rib 2)