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Family Medicine COMAT > U world Missed #2 > Flashcards

U world Missed #2 Flashcards

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1
Q

MRI for back pain is only recommended when

A

there is severe neurologic deficits or high risk features that suggest a potentially serious cause (malignancy or infection)

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2
Q

recommended first like treatment for noncomplicated lumbosacral radiculopathy

A

NSAIds and acetaminophen

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3
Q

clinical signs and symptoms of lumbosacral radiculopathy (nerve root compression)

A

pain in the low back radiating down to the posterior leg or foot

positive straight leg raise or crossed straight leg raise test

dermatomal sensory loss or myotomal weakness

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4
Q

evaluation of lumbosacral radiculopathy

A

usually diagnosed clinically
MRI recommended if there is bladder/bladder dysfunction. saddle anesthesia, epidural access etc.

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5
Q

treatment go lumbosacral radiculopathy

A

activity modification (NOT bedrest)
NSAIDS first 2 weeks
PT or glucocorticoids after 2 weeks
MRI or surgery after 6 weeks

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6
Q

what is irritant contact diaper dermatitis ?

A

the most common dermatitis in infants that results from a breakdown in the skin due to moisture and friction in the diaper

classically it looks red in the genital area region that is only in the diaper region

painless papule or confluent erythema

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7
Q

treatment of irritant contact diaper dermatitis

A

frequent diaper changes, diaper free periods, gentle cleansing soap and application of an ointment like petroleum.

refractory cases can use low potency topical corticosteroids

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8
Q
A
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9
Q

what is candida dermatitis

A

dermatitis that is a yeast superinfection on top of irritant contact dermatitis (skin fold involvement)

there are beefy red confluent plaques that involve the skin folds and satellite lesions

treat with anti fungal therapy

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10
Q

what its the colon cancer screening recommendations for patients with average risk?

A

start at age 45

colonoscopy every 10 years
gFOBT or FIT every year
FIT-DNA every 1-3 years
CT colonogrpahy every 5 years

Flexible sigmoidoscopy every 5 years or every 10 years with annual fit

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11
Q

what is the colon cancer screening recommendations for patients with a first degree relative with colorectal cancer history or a high risk adenomatous polyp?

A

colonoscopy at age 40 or 10 years prior to age of diagnosis in FDR which ever comes first

repeat every 5 years (every 10 if the FDR diagnosed after age 60)

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12
Q

what is the colon cancer recommendation screening for a patient with an adenomatous polyp

A

start screening 8-10 years after diagnosis

colonoscopy every 1-3 years

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13
Q

what is considered an advanced adenomatous polyp?

A

greater than 10mm, high grade dysplasia, villous elements

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14
Q

buckle fracture

A

a fracture common in young children that have porous bone. This results in a stable incomplete radial or ulnar fracture.

presents as pain and tenderness over the fracture , ROM can be limited and there is no swelling

need an x-ray to diagnose: a cortical bulge is visualized

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15
Q

treatment of a buckle fracture

A

pain control and prevention of reinjury (heal within a few weeks)

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16
Q

avascular bone necrosis in children presents with?

A

chronic joint pain and decreased Rom typically in the hip

X-ray shows bony fragmentation and sclerosis

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17
Q

volume and duration of menses is dependent upon?

A

surface area of the endometrial cavity, platelet aggregation and thrombi formation, uterine spiral arteriole constriction

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18
Q

how is tranexamic acid used in the treatment of uterine fibroids

A

it stops heavy menstrual cladding and reduces blood loss by stabalizing the cloths and preventing plasmin formation

it is safe in pregnancy

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19
Q

uterine fibroids cause heavy menstrual bleeding by?

A

enlarging the uterus and decreasing the response to vasoactive factors that limit spinal artery vasoconstriction

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20
Q

contraindication to OCP

A

migraine with aura (increased risk for stroke)

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21
Q

developmental milestones at age 2 months

gross:
fine:
language:
social and cognitive:

A

gross: lifts head with lying on tummy
fine: opens hands briefly

language: reacts to loud noises, makes noises

social and cognitive: social smile, clams when spoken to, tracks past midline

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22
Q

developmental milestones for a 4 months old

gross:
fine:
language:
social and cognitive:

A

gross: holds head steady and pushes up on forearms
fine: brings hands to midline/mouth and holds toy if put in hand
language: coos and turns to voice
social and cognitive:seeks attention and enjoys looking at hands

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23
Q

developmental milestones of a 6 months old

gross:
fine:
language:
social and cognitive:

A

gross: rolls over and leans hands to support seated position
fine: reaches for toy and puts things in mouth
language:blows raspberries and squeals
social and cognitive: laughs and recognizes familiar faces

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24
Q

developmental milestones in a 9 month year old

A

gross: gets to sitting unassisted and sits without support
fine: transfers objects between hands , raking grasp
language:babbles (mamma), turns to name
social and cognitive: stranger anxiety and separation anxiety

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25
developmental milestones for a 12 month old
gross: pulls to stand, cruises fine:pincer grasp language: mama and dada, understands no social and cognitive: plays pat-a-cake, looks for hidden object
26
every well child examination should include
an assessment of developmental milestones
27
when do primitive reflexes disappear
by 6 months
28
what is the only primitive reflex that may persist up to 2 years old but can disappear by age 12 months
babinksi reflex (stroking of the sole of the foot causes the big toe to up turn)
29
the initial evaluation of hypertension focuses on?
identifying complications or comorbid conditions that might change management screen for major atherosclerotic risk factors, lipid panels, and serum glucose or hemoglobin A1C
30
what is adjustment disorder
distress or functional impairment within 3 months of an identifiable stressor emotional or behavioral symptoms that are excessive for a normal stress response
31
management of adjustment disorder
psychotherapy short term pharmacotherapy with a anxiolytic or sleep aid
32
autosomal polycystic kidney disease
most patient are asymptomatic until 30-40 years old they will have flank pain, hematuria, hypertension, a palpable abdominal mass and CKD low gravity urine
33
extra renal features of polycystic kidney disease
cerebral aneurysms hepatic and pancreatic cysts Mitral valve prolapse, and aortic regurigitation, colonic diverticulosis, ventral and inguinal hernias
34
imaging for autosomal dominant polycystic kidney disease
US showing multiple renal cysts
35
treatment of autosomal dominant polycystic kidney disease
control CKD, ACE inhibitors, hemodialysis and renal transplant if in end stage renal disease vasopressin-2 receptor antagonists (stop the growth of the cysts)
36
what is secondary spontaneous pneumothorax?
acute onset of SOB with hypoxia and unilaterally decreased breath sounds in a patient with a preexisting lung disease like cystic fibrosis of COPD. chest pain and hyper resonance on percussion are also possible
37
_ markedly increases the risk of a pneumothorax
smoking
38
chronic destruction of alveolar sacs can lead to?
alveolar blebs (air pockets) which can rupture and leak air into the pleural space
39
diagnosis of a pneumothorax is made by?
chest X-Ray which will demonstrate a visceral pleural line with no pulmonary markings tracheal deviation
40
bullous impetigo
bull with yellow fluid and crusting overlying sites of ruptured bullae a superficial bacterial infection of the epidermis caused by bacterial invasion through a break in the skin barrier caused by staph aureus leaves a collarete scale with overlying crusting, yellow fluid within bullae
41
treatment of bullous impetigo
oral antibiotics
42
what is nonbullous impetigo?
papules and pustules with a honey crusted lesion caused by staph aureus OR group A streptococcus it is treated with topical antibiotics first then oral antibiotics
43
what is erythema nodosum
2-3 cm tender erythematous or violaceous nodules that usually occurs on the shins but can develop anywhere. It is a hypersensitivity reaction to various antigens.
44
what are common triggers for erythema nodosum
infections like strep inflammatory bowel disease sarcoidosis and malignancy medications (sulfonamides, penicillins)
45
biopsy of erythema nodosum shows
septal panniculitis without vasculitis
46
what is a testicular varicocele
a tortuous dilation of the pampinoform plexus that surrounds the testis it is a soft irregular mass that increases with valsalva and does NOT transilluminate more common on the left side bag of worms texture can present with sub fertility or testicular atrophy
47
48
treatment of a varicocele
gonadal vein ligation scroptal support and NSAIDS
49
ultrasound findings of a 1. varicocele 2. spermatocele 3. hydrocele
1. varicocele - retrograde venous flow, tortuous tubules, dilation of pampiniform plexus 2. Hydrocele- translumination 3. spermatocele- on the head of the epididymis, fluid filled cyst that transilluminates with a painless pass at the superior pole of the testis (does not change in size)
50
post partum thyroiditis
occurs within the first 6 months, with a brief hyperthyroid phase that quickly changes to a hypothyroid phase with fatigue, weight gain, constipation. There will be a nontender goiter , bradycardia, diastolic hypertension, and edema. TSH will be elevated and free T3 will be low *hypercholesterolemia and hyponatremia can also be a side effect has elevated titers of anti-thyroid peroxidase autoantibodies return to euthyroid state in a few months
51
post partum thyroiditis is similar to
painless (silent) thyroiditis
52
routine health maintenance in diabetes mellitus included monitoring for?
microvascular complications -annual urine albumin/creatinine ration, annual dilated eye exam, periodic foot examination to test sensation and vibration
53
the earliest sign of diabetic neprhopathy is ?
albuminuria
54
in diabetes when should an ACE or ARB be added?
if there is hypertension or microalbuminemia
55
the most common cause of travelers diarrhea is?
enterotoxigenic EColi enterotoxin causes diarrhea 1-3 days after ingestion and abdominal pain usually self resolves, can cause dehydration which can predispose people to decreased urinary output and hypernatremia
56
symptoms of a zenker diverticulum
pharyngoesophageal dysphagia, halitosis, history of regurgitating food-undigested, progressive dysphagia abnormal spasm or diminished relaxation cricopharyngeal muscles during swallowing with increased pressure and herniation of the mucosa resulting in pushing and a psuedofiverticulum
57
aspiration of regurgitated food may lead to ?
recurrent aspiration pneumonia
58
Zenker diverticulum occurs where
a zone of weakness between the inferior pharyngeal constrictor
59
chlamydia and gonorrhea in women risk factors manifestations
age less than 25 high risk sexual behaviors asymptomatic, cervitis, urethritis, perihepatitis
60
test for chlamydia and gonorrhea
annual NAAT in patients we have high and low sexual behaviors
61
the measles mumps rubella vaccination is recommended at what ages
age 1 and again at age 4
62
what is vaccine strain
a fever and maculopapular rash that can present 1-3 weeks after an MMR vaccine that is self limited people with this rash should avoid immunocompromised individuals until the rash resolves treat with reassurance
63
the onset of backpain upon walking is known as
neurogenic claudication relieved by leaning forward lumbar stenosis- MRI of the spine
64
lumbar stenosis better with- lumbar herniation better with
flexion extension
65
what are the main causes of vitamin D deficiency ?
inadequate intake (vegan diet) malabsorption (chrons, celiac) inadequate sunlight exposure metabolic disorders (CKD and chronic liver disease) increased catabolism (anticonvulsants like carbamazepine)
66
Subgaleal hemorrhage
a potentially fatal neonatal injury that is caused by scalp traction during delivery, the veins will shear and there will be an accumulation of blood between the periosteum and the galea aponeurotica , soft swelling common in vacuum assisted deliveries , presents as scalp swelling across the suture lines that moves with movement. diagnosis is critical because it can lead to hypovolemic shock, DIC or death
67
cephalohematoma
bleeding between the skill and periosteum due to subperiosteal vessel rupture firm non fluctuant swelling that does not cross the suture lines
68

Family Medicine COMAT (3 decks)

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