UWorld FM Flashcards
(277 cards)
1
Q
initial evaluation of HTN
A
Chemistry panels =
- electrolytes
- creatinine
- Hgb
- Hct
Urinalysis =
- hematuria
- proteinuria
ECG =
- LVH (Leftward deviation) = Lead 1 & Lead 2 + aVF all are negative = HTN
- prior MI (U wave/decrease R wave amp - scar tissue or inverted T (MI hours/days ago)
2
Q
Lochia
A
vaginal discharge after giving birth
3
Q
Birthcontrol
<1 month postpartum & breastfeeding
HTN
A
Nonhormonal birthcontrol = copper IUD
subdermal progestin-releasing implant or the progestin-releasing IUD
Copper IUD (C/I): heavy bleeding
4
Q
Opacification of the lens = a clouding of your eye’s lens capsule
Chronic loss of visual acuity
A
Cataracts
Glares & halos
loss of red reflex
Tx: surgical removal of the lens w/implantation of a prosthetic lens
5
Q
Anal foul-smelling discharge
pruritus
pain w/ defecation
perianal skin inflammed
Pustule-like lesions
A
Anorectal fistula
Tx: surgical evaluation
6
Q
Polio sx vs GBS
A
Polio = weakness asymmetric
GBS = symmetric & begins w/ LE
7
Q
Anorexia nervosa vs Bulimia nervosa vs Binge-eating
A
- Anorexia: <18.5 tx: Olanzapine
- Bulimia: inappropriate compensatory behavior tx: SSRI
- Binge-eating: only lacks control tx: SSRI or Lisdexamfetamine
8
Q
Glycemic control = A1c goal
A
Younger, otherwise healthy: ≤7%
Elderly/comorbidities: ≤8%
Tight control only prevents microvasuclar issues = nephro/retinopathy
9
Q
Nephropathy Screening
A
Annual random
albumin/crt - <30 mg/g
Periodically
Serum crt
10
Q
Retinopathy Screening
A
Dilated eye exam 1-2 years
Annual slit-lamp exam
11
Q
Neuropathy Screening
A
Annually
* Comprehensive foot exam
Every visit
* Visual inspection
12
Q
CV risk reduction
A
Rx statin
annual lipid
BP screening
13
Q
Elderly
Wt loss
epigastric pain/tenderness
PMH: Smoking
A
Malignancy affecting the Upper GI tract
- Liver
- GB
- Pancreas
14
Q
Hinged knee brace application
A
transfer load from Medial → Lateral joint compartment = Unicompartmental OA associated Varus deformity
15
Q
Arthroscopic meniscectomy
A
tears of the meniscus → increase risk of OA
NOT a tx for pts w/ OA
16
Q
OA management
A
- exercise + wt loss
- NSAIDs/Topical NSAIDs (diclofenac) + dulozetine + topical capsaicin
- Chronic pain management = GC injectable or hyaluronic acid
- Surgery = Total knee arthroplasty (replace articular surface of the knee w/ prostetic components)
17
Q
What can reduce hypoglycemia awareness?
A
long-standing DM → blunted autonomic response
18
Q
U/L watery rhinorrhea
A
Cerebrospinal fluid → Meningitis
19
Q
Lhermitte sign
A
electric shock–like sensation down the spine with forward flexion of the neck
Associated w/ Spinal Cord Compression = myelopathy
Seen in MS
20
Q
Neck pain
LMN in UE
Unsteady gain
UMN in LE
A
Cervical spondylotic myelopathy
21
Q
TB workup
A
- Tb skin test (TBT) or Interferon gamma release assay (IGRA)
- Chest x-ray
- Sputum cultures
22
Q
HIV prophylaxis
A
TMP-SMX
- Pneumocystitis = CD4 <200
- Toxoplasma = CD4 <100
Azithromycin
- Mycobacterium avium comple (MAC) = CD4 <50 + NO ART
Azole
- Fluconazole - Coccidiomyosis (CD4<250 - US west)
- Itraconazole - Histoplasmosis (CD4<150)
Vax
- MMR/Varicella = CD4 >200
23
Q
Fever
lymphadenopathy
bone pain
A
ALL = 2-5 yo (MC) or 60+ yo
BM biopsy = >25% blast = +TdT
Tx:
- Vinceristin
- roids
- Asparginase
24
Q
Cancer in 65+
Pancytopenia
DIC - association
A
AML
Dx:
- Auer rods
- +myeloperoxidase
- >25% blast
Dauorubicin + Cytaraabine
25
Antiphospholipid Syndrome Dx
1 Clinical + 1 Lab
Clinical
- thrombosis
- prego = 3+ miscarriages + pre-eclampsia + fetal demise
Lab
- Lupus anticoagulant = dilute ressull venom viper test
- Anti-cardiolipin (ELISA IgM/IgG)
- Anti-b2 glycoprotein (ELISA IgM/IgG)
26
# Skin lesion
Pearly
waxy
Peripheral telangiectasia
Bleeding ulceration
Scaly (dried) plaque (raised)
Basal Cell Carcinoma
Dx: shave, punch, excisional biopsy
## Footnote
Tx:
Excision
Topicial: 5-FU or Imiquimod
27
systemic sclerosis = scleroderm
Limited vs Diffused
Limited
* C = Calcinosis -fingers
* R = Raynaud syndrome
* E = Esphogeal dysfunction
* S = Sclerodactyly
* T = Telangiectasia
Diffused = Organ involvement
- GI = Esophgeal/Dysphagia/pepsisa
- Pulm = Interstitial fibrosis (decrease vol.) + Pulmonary HTN (pulm artery narrowing)
- CV = Myocardial fibrosis + pericarditis (rub)
- Renal = HTN + renal crisis (hemolytic anemia + oliguria + ↓ platelet)
28
RA management
1. DMARD - Methotrexate
2. NSAID or roid
3. DMARD + Biologic
Flares = roids
29
HTN 1st line
Wt ↓ > Diet > Exercise > ↓ Salt > ↓ EtoH
ACEi/ARB
thiazides
CCB
## Footnote
>140/90
>130/80 - high risk pts
30
AAA Screening
65+ & smoker
Ab US
* Small aneurysms (3.0–3.9 cm) - every 3 yrs
* 4.0–4.9 cm - annually
* Aneurysms 5.0–5.4 cm - every 6 months
Aneurysms **5.5+ cm** + rapidly growing should be **evaluated for surgery**
31
what determines severity of COPD
FEV1
32
Joint fluid values
Normal: <200
OA: <2,000
crystals +RA: <100,000
Septic: 500,000+
33
When should revascularization w/ carotid endarterectomy occur?
50%-99% - in men
70-99% - in women
## Footnote
Antiplatelet (ASA) + Stain + BP control should be started
34
# Elderly F
High-pitched bowel sounds
distended loops of bowel w/ air-fluid levels
Fullness + tenderness w/n right groin
Small bowel Obstruction → femoral hernia (MC in elderly female)
35
Incarcerated vs Strangulation
**Incarceration** = hernia trapped w/m sac → small bowel obstruction
**Stranulation** = reduced venous outflow → ischemia + necrosis
36
Sensorineural hearing loss
Lateralization to oppose side
Air conduction B/L or to affected side
Etiology
- **Meniere's** = asymmetric + vertigo
- **Schwannoma** = facial numbness + U/L hearing loss
- Congenital
- Presbycusis = Aging + B/L
- Noise-induced hearing loss = Corti (sterocilia damage due to loud noises) → rupture tympanic membrane
- Ototoxic rx = aminoglycosides
- MS = young f w/ UMN sx
- CVA
- CNS infection = meningitis + neurosyphilis
37
Pelvic Organ Prolapse management
Asx = anterior bulge w/o urinary retention or hydronephrosis - reassurance + observation
Sx =
- Kegel exercises
- Pessary placement = nonsurgical correction of cystocele
38
Ear pain/fullness
Retraction of the tympanic membrane
Chronic otitis media → conductive hearing loss
| could also show fluid in the middle ear
39
Night sweats
Wt loss
nonproductive cough
Cavity - CXR
Reactivated TB
| Endemic > Smoking
40
Conductive hearing loss
Both Lateral & Bone on same side
Etiology
- **Otitis media** = pain/fullness + retaction TM + fluid
- **Cholesteatoma** = keratin debris
- **Otosclerosis** = young prego + normal ear exam = stiff stapes
- Tympanic membrane perforation
- Eustachian tube dysfunction = Asymmetric hearing loss + popping/pain + middle ear effusion
41
Excessive fundal pressure + traction of umbilical cord → postpartum hemorrhage + vaginal mass + fundus no longer palpable
Uterine inversion
## Footnote
Tx: manual replacement of uterus
42
# Child
Fever
Rash
Conjunctivia = sclera injected
extremity edema
Kawasaki disease = Ig + ASA
43
Postvoid residual = Obstructive uropathy
>50mL
44
DM + kidney
Microangiopathy = nephrotic syndrome
45
TM-SMX & prego
SAFE in 2nd trimester
give fosfomycin in 1st trimester
46
CAP vs Atypical Pneumo
CAP
* Dx: ↑ sputum + fever + rhonchi
* Tx: Amoxicillin-clavulante + doxycycline
Atypical
* Dx: nonproductive cough + fever + rhonichi
* Tx: Azithromycin + doxycycline
47
Scabies dx
Microscopic prep
## Footnote
Tx: 5% permethin & oral Ivermectin
48
# Middle age F
Facial redness
Telangietasias
Burning/stinging
Edema
dryness
Rosecea
## Footnote
Tx: Topical Brimonidine = α2-adrenergic receptors agonist
49
onychomycosis
Fungal infection of toe nail
Dx: KOH microscopy scrapings + PAS stain + cultures of clippings
## Footnote
Tx:
**Oral terbinafine** or itraconazole
Topical = ciclopirox or efinaconazole
50
Saph scalded skin syndrome vs Toxic Shock Syndrome
Scalded skin = bullae w/ sloughing
tx: fluids + Nafcillin + vancomycin
Toxic Shock = Fever + ↓ BP + Rash + desquamation
tx: vancomycin + clindamycin
51
Tinea corporis management
Topical azoles or Terbinafine
52
Chlamydia Screening
all sexually active women 24 years or younger
women 25+ who are at increased risk for infection
| dx: NAAT
## Footnote
Tx:
Azithromycin or Doxycycline + Ceftriaxone (for Gonorrhea co-infection)
53
Syphillis
Screen
treponemal test
- FTS-Ab = Fluorescent treponemal antibody absorption test
- TP EIA = syphilis enzyme immunoassay
nontrepnemal
- RPR = Rapid plasma reagin testor
- VDRL =
Venereal disease research lab test
54
Giant cell arthritis vs TMJ
Age
Giant cell arthritis = old 50+
TMJ = younger <50
55
Fibromuscular dysplasia vs Pheochromocytoma
HTN
Headache
Fibromuscular dysplasia = sub-auricular **carotid bruit (systolic)** + tinnitus + TIA/stroke
Phenochromocytoma = episodic sx including sweating + ↑HR
56
Kleihauer-Betke testing
Rh-neg /vag bleeding
57
Irregular vaginal bleeding - postcoital (after intercourse)
Cervical mass
Cervical friability = bleeding w/ manipulation
invasive cervical cancer = raised, exophytic mass
Prego →↑ vascularity →↑bleeding
Cervical biopsy
58
Braces are used when
Ligamentous injuries occur
59
Immobilizes are used
W/ fractures
60
# Young F
**Anterior Knee pain**
Sensation that the knee will "give way"
Compressing patella → trochlear groove reproduces the pain
Patellofemoral pain syndrome (PFPS) aka runners knee aka Chondromalacia Patellae
## Footnote
Managment:
-activity modification = reduce intensity of exercise
- NSAIDs
- Stretching & strengthening of quads/hip abductors
61
Round well-circumscribe mass dorsal wrist
Transilluminate
Ganglion cyst = tissue outpouching - tendon sheath + joint capsule + bursae
## Footnote
Observe = spontaneous resolve
Needle aspiration = pain + paresthesia
Surgical excision
62
Diffuse cutatnous scaling (dry)
rough
fish-like scales
trunk + extremities
Hyperlinear palms = increased linear creases on palms
worsen during winter
Ichthyosis vulgaris = FLG → defective keratinocyte desquamation
## Footnote
Tx
- long baths = removes scales + moisturizers (keratolytics - a hydroxy acid = lactic acid + urea+ salicyclic acid)
63
Pustular rash
Migrating arthralgia = multiple joints
tenosynovitis = clear synovial fluid + leukocytosis (G- organism)
Disseminated gonococcal infection
64
Prego
Friable
dome-shape nodule
Small abnormal capillaries & granulation tissue
bleed w/ minor trauma
Pyogenic granuloma
| regress postpartum
65
Bacillary angiomatosis =
- multiple small reddish/purple papules
- friable nodules
- fever
- malaise
- night sweat
Bartonella infection
66
Contraception → UTI
Spermicide (nonoxynol-9) = alters vaginal microbiome
Diaphragm → urinary stasis by applying pressure on the anterior vaginal wall = increases bacterial replication
67
Midline trachea
COPD/Cystic fibrosis
fremitus decrease U/L
breath sound decrease U/L
Rupture of an apical alveolar bleb → leak air into the pleural space = pneumothorax
68
Oxybutynin vs Desmopressin
Oxybutynin = night/daytime incontinence - urinary retention = anticholinergic
Desmopression = nocturnal enuresis 1st line = ADH agonist
69
Prego
New onset oligohydramnios
Spontaneous rupture of membranes
70
Pleural effusion vs Atelectasis
- decrease breath sounds
- decrease percussion = dullness
- decrease fremitus
Atelectasis = trachea towards
Pleural effusion = trachea away
71
diffuse enlargement of the breasts w/o
- pain
- tenderness
- nodules
- skin dimpling
High BMI
Pseudogynecomastia = excessive depo of fat due to wt gain
72
Aphthous stomatitis (canker sores) vs
Lichen planus
Aphthous = acutely painful + episodes only last a few days
Lichen planus = **white papules/plaques** = **Wickham striae** + B/L + symmetric + lines of minor trauma =Köbner phenomenon
## Footnote
Lichen planus = CD8+ T cells → tx GC
73
Right-sided band-like area of hyperesthesia
4+ months of persistent pain
Postherpetic Neuralgia (PHN)
## Footnote
Tx: Gabapentin + TCA
74
Meningitis in young infants is commonly caused by
Group B Streptococcus - <3 months
Listeria monocytogenes - <1 month
Neisseria meningitidis - young children & young adults (18-month-old+)
## Footnote
Tx: C (ceftrixone) V (vancomycin) S (steroid)
75
Endometrial evaluation for Post-Menopausal Bleeding
1. transvaginal US
2. endometrial biopsy
76
Lipid abnormailities workup
Including the following sx
- wt gain
- HTN
- fatigue
1. TSH levels = hypothyroidism → ↓LDL receptors
2. Statin
77
Wt loss bariatric surgery
BMI 40+
BMI 35+ w/ comorbidity
78
Associated conditions w/ pseudogout
Hemachromatosis
Gitelman syndrome
79
# funduscopy
Yellow extracellular material
B/L **central** vision loss
Age-related macular degeneration
80
med: bisphosphate
tooth extraction
jaw pain
Bisphosphonate-related osteonecrosis of the jaw
81
Well-defined erythematous (red) plaques (raise 1+cm) w/ scaling (dry)
Scraping → bleeding
Psoriasis
## Footnote
Tx: Topical betamethasone or emollients
refractory cases: Methotrexate + Cyclosporine + TNFai or ILi
82
B/L pruritius
mild leg pain
Scaling = dry
weeping (fluid leaking from your legs)/Edema
red/brown discoloration
**Chronic stasis dermatitis** result of venous insufficiency
| Workup = venous doppler US
## Footnote
Tx: compression stockings, exercise + leg elevation
83
Viral arthritis vs RA
Viral (anti-parovirus B19 IgM) = < 30 mins of morning stiffness +flu-like sx + symmetric joints tenderness
RA = < 60 mins of morning stiffness
84
Anti-cyclic citrullinated peptide Ab
RA
| also associated w/ Rheumatoid factor
85
ANA = antinuclear Ab
anti-DNA Ab
SLE
86
Female
recurrent/self-limiting rectal pain (cramping)
Proctalgia fugax
87
U/L white patch on the tongue that cannot be removed w/ scraping
**Painless**
Oral Leukoplakia
| Risk factors = tocbacco + EtOH use
## Footnote
Management: biopsy - associated w/ cancer
88
Giardia vs ETEC (Enterotoxigenic E. coli) vs Norovirus
Giardia = Bloating + foul-smelling + hiking/travel
tx: metronidazole
ETEC = Traveler's diarrhea + rice-water resembling cholera
Tx: ciprofloxacin
Norovirus = Pediatric + Outbreaks (healthcare + restaurants + schools + military) watery
Tx: supportive (self-limiting)
89
Associated conditions w/ S4
Acute MI
Concentric LVH = long-standing HTN
Restrictive cardiomyopathy
Diastolic Heart failure
90
Ischemic cardiomyopathy
Damage to heart tissue (CAD) → heart failure w/ reduced EF (Systolic heart failure)
Eccentric heart changes
ABCDs
91
Associated conditions w/ S3
AR
HF w/ reduced EF = Ischemic or dilated cardiomyopathy
High-output HF (AV fistula + thyrotoxicosis)
MR
Systolic heart failure
92
Romes Dx
3+ days for 3+ months
2+ sx
- Change in form of stool
- Change in frequency of stool
- Sx improve w/ BM
Dx IBS
93
Recurrent facial edema + ab pain
Heredirary angioedema secondary to C1 esterase inhibitor definency
| Decrease C4
## Footnote
Tx:
- C1-INH concentrate
- Fresh Frozen Plasma (FFP)
94
ACEi C/I
Pts w/ C1-INH defiency = ↑ bradykinin → angioedema
Prego pts
95
BPH vs Urethral stricture (narrowing)
-incomplete voiding
- weak stream
- elevated Postvoid residual (PVR)
- dribbling urine
BPH = 40+
Urethral stricture = < 40
96
When should you image pts w/ back pain
- Neurologic deficits (severe)
- Cancer PMH
- Osteoporosis
- IV drug us
- Constitutional sx = fever + ↓ wt + lymphadenopathy
97
How to workup back pain
Acute = < 4 weeks (NSAIDs) + refractory (baclofen = Muscle relaxants)
Subacute (4+ weeks) = imaging
- XR (non-specific sx)
- CT/MRI (radiculopathy + Spinal stenosis)
Red flags = Imaging
98
Compartment Syndrome
6 P's
- Paresthesias
- Pallor
- Poikilothermia
- Pulselessness
- Paralysis
Delta pressure 20-30
## Footnote
Tx: fasciotomy
99
Mediastinal fullness & scattered reticular opacities in upper lobe
Hypercalcemia
Hilar lymphadenopathy
↑ Vit D conversion by lung macrophages
Sarcoidosis = restrictive lung disease + fibrosis (DLCO decrease)
100
Interdigital (Morton) neuroma vs Charcot arthropathy
Morton neuroma = numbness/pain 3rd/4th toes
Charcot arthropathy = claw toe deformity (dorsiflexion MTPs) ← Diabetic peripheral neuropathy
101
Occult GI bleeding post ICU due to septic shock
Stress-induced ulcer due to mucosal injury
- splanchnic hypoperfusion
- reflux of bile salts
- accumulation of uremic toxins
## Footnote
Prophylatic acid suppressive agents
102
Chondrocalcinosis w/ moderate effusion - knee
hepatomegaly
Pseudogoat (Ca++ pyrophosphate dihydrate crystal deposition) - which is associated w/ Hereditary hemochromatosis
102
Hereditary hemochromatosis workup
1. iron studies (elevated serum irion + ferritin + transferrin saturation)
2. LFTs
3. Biopsy = if LFTs are really bad
## Footnote
Tx: Phlebotomy
103
Tx pts receiving chemo + neutropenic fever
IV vancomycin
104
Patiromer vs hemodialysis vs Ca++ Carbonate/gluconate
**Patiromer** = K+ chelator w/n the colon & excreted in feces used to tx outpt hyperkalemia (<6.5)
**Hemodialysis** = severe hyperkalemia >6.5
**Ca++ Carbonate** = hyperkalemic + rapdily stabilzation of muscle membrane (given IV)
105
Meniere disease risk factors
salt intake
Caffeine
EtOH
Allergies
## Footnote
Tx: diuretics + vasodilators
vestibular suppressants = benzo + antiemetics (promethazine)
106
increased Central Venous pressure
Cardiogenic shock = ↑ Pulmonary wedge pressure
Obstructive shock = ↓ Pulmonary wedge pressure
107
Bone metastases w/ progressive pain
< 4/10 = non-opioid analgesics (tylenol + NSAIDs)
>4/10 = Short-acting opioids (oxycodone + morphine)
108
When is topical capsaicin useful
mild-moderate neuropathic pain
109
PMH: Uveitis
SOB
Presyncope episodes
AV block
LBBB
Sarcoidosis → cardiac noncaseating granulomas
110
MC mononeruopathy in hemodialysis pts
Carpal tunnel syndrome (CTS)
dialysis-related amyloidosis → ↑beta2 microglobulin
111
Postexposure HIV prophylaxis = PEP
3 drug antiretroviral therapy for 4 weeks a combination
* nucleoside/nucleotide reverse transcriptase inhibitor (tenofovir-emtricitabine)
* an integrase inhibitor (dolutegravir + raltegravir) w/n the 1st few hrs
112
in NSTEMI which tx proven to reduce all-cause mortality
BB & Aspirin
113
indication for Ambulatory BP monitoring
signs of hypertensive disease (left-axis)
normal BP in office
114
# Elderly pt
Exertional syncope
age-related decreased baroreceptor sensitivity = vasodilation + fixed SV
115
Gestational DM screening
24-28 weeks
1. 1 hr 50g Glucose Challenge Test
140+ = abnormal
2. 3 hr 100g Glucose Challenge Test
- fasting = 95+
- 1hr = 180+
- 2hr = 155+
- 3hr = 140+
## Footnote
Tx: Diet > Insulin > Metformin
116
Venous thrombosis vs Arterial thrombosis vs Arterial emboli
**Venous** = dull/achy pain + swelling + warm
**Arterial thrombosis** = claudication + **decrease pulse** in unaffected limbs
**Arterial emboli** = pulseless + cool + weak + numb
117
Resistant HTN
PMH = CAD
Claudication = leg pain w/ activity & resolves w/ rest
**Ab bruit = periumbilical area**
Renovascular disease = Renal Artery stenosis
118
Young F
Smokes
recurrent chest discomfort = rest/during sleep
transient ST elevations
Hyperactive intimal smooth muscle = **Vasospastic angina**
- CCB (preventive)
- Nitro (abortive)
| Risk factors = CAD (HTN + DM) & SMOKING
## Footnote
During sleep = diaphoresis + Nausea + palpitations + SOB
119
Cardioprotective antidiabetic agents
GLP-1 agonist = -tide
SGLT-2i = -flozin
120
Adverse effect of implantable pacemakers or cardioverter-defibrillator
Tricuspid regurgitation (TR) = sx of right-sided HF
- JVD
- B/L edema
- Holosystolic murmur LLSB
- hepatomegaly
121
Breast Cancer workup
1. Breast imaging = mammography
2. Fine-needle aspiration
Cancer =
- eccentric (off center) to nipple
- well-defined or spiculated margins
- calcifications
122
Lipid management
1. High-intensity Statin
2. Moderate-intensity statin
3. Ezetimibe
123
HTN workup in Young F (w/ evidence of OCP)
1. Obtain more BP readings
2. Stop combined OCP
3. Start 1 of 1st line drugs
124
Screening tool for lung cancer
Annual low-dose CT
- 50-80 yo
- 20+ pack-year smoking history
- Currently smoking or stopped in the past 15 years
125
Screening tool for colon cancer
Colonoscopy
starts at 45 & repeat every 10 yrs
FH (1st degree relatives) - every 5 yrs
- 40 yo
- 10 years before the earliest age at dx
FAP - annual
- 10-12 yo
Lynch syndrome - 1-2yrs
- 20-25
IBD (Crohn/UC) - 1-2 yrs
- 8yrs post dx
## Footnote
Alternative = FIT for Hgb
126
empiric therapy for tx of human bite wounds
amoxicillin-clavulanate
127
which T2DM Rx cannot be given to pts w/ kidney issues
Metformin = b/c it is excreted 100% by kidneys
128
Celiac testing
1. Ab (**anti-tissue transglutaminase**) or quantitative fecal fat testing or **IgA endomysial antibody**
2. DEXA = dual-energy x-ray absorptiometry scan - malabsorption of Ca++/Vit. D = bone issues
129
Villous adenomas and colorectal cancer (CRC) risk factors
T2DM
Obesity
Smoking
EtOH
Red meats
130
Duke criteria
Major:
* + cultures
* TEE = mass on valve
Minor:
* fever
* Drug use
* Vascular = Janeway lesions
* Immunologic = kidney issues + RF + Osler nodes + Roth spots
* microbiologic
| bacterial endocarditis
## Footnote
Tx: Vancomycin
Prophylaxis = Amoxicillin
131
Aortic Dissection Dx
CTA = stable
TEE = unstable + CKD pts
CP/Back pain = tearing sensation
132
HOCM Dx
Harsh systolic murmur (crescendo-decrescendo) increases w/ valsalva + standing & decreases w/ squatting
1. Echo
2. CXR = mitral regurgitation
132
HOCM features
Harsh Systolic murmur that ↑ w/ ↓ preload = Valsalva + standing
Young pt
sudden collapse
133
Pericarditis Dx
ECG = diffused ST elevation
CXR = pericardial effusion
134
Pericarditis sx
Chest pain that worsens in supine position + inspiration
135
Increase risk for CVD
FH
1st degree males (father + brother) = MI before age 55
1st degree females (mother + sister) = MI before age 65
136
The MC causses of death in pts w/ CKD or DM
Cardiovascular disease = approximately 50% of deaths in this population
137
T2DM dx
- A1c measurement 6.5%+
- 2 fasting glucose at separate times = 126+ mg/dl
| every change in 30 mg/dl in serum glucose = 1 point Δ in A1c
138
- "blowing" early diastolic murmur that is best heard at the left sternal border
- a wide pulse pressure
- hyperdynamic pulses
Aortic regurgitation
| Head bobbing
139
# 58 M
Annual health maintenance examination
- screening colonoscopy at age 51
- low-dose CT scan of the chest 6 months ago
- PMH: 40 yr pack
- FH: bladder cancer in the patient's grandfather
- VS & PE: normal
Which of the following screening procedures is most appropriate for this patient at this time?
NOTHING
Colonoscopy - every 10 years
Lung cancer - every year
Bladder cancer & Prostate = not screened
140
15 cigarettes (3/4 pack) a day for 1 year =
20 cigarettes (1 pack) a day for 1 year =
40 cigarettes (2 packs) a day for 1 year =
15 cigarettes (3/4 pack) a day for 1 year = ¾ pack-year
20 cigarettes (1 pack) a day for 1 year = 1 pack-year
40 cigarettes (2 packs) a day for 1 year = 2 pack-years
141
Strongest risk factors for chronic pancreatitis vs pancreatitic cancer
Chronic pancreatitis = steatorrhea due to excess EtOH
Pancreatic cancer = pancreatitis sx + wt loss due to **SMOKING**
142
Rx & Supplements that can cause HTN
Antidepressants
- Fluoxetine
- Monoamine oxidase inhibitors
- Tricyclic antidepressants
- Venlafaxine
Biologic therapies
- Bevacizumab
- Imatinib
Decongestants
- Phenylephrine
- Pseudoephedrine
Herbal supplements
- Ephedra
- Ginseng
- Licorice
- St. John's wort
Hormonal birth control
- **Combination OCPs**
Immunosuppressants
- Cyclosporine
- Tacrolimus
Illicit drugs
- Amphetamines
- Anabolic steroids
- Cocaine
Pain medications
- Indomethacin
- Naproxen
Stimulants
- Caffeine
- Methylphenidate
143
# Young M
Runner presents
U/L LE pain w/ ambulation = signs of claudication
PE: palpable pedal pulses
Duplex US = elevated velocities in the popliteal artery w/o other abnormalities
Claudication = Popliteal artery entrapment
| Medial head of the gastrocnemius muscle
144
Initial management of **peripheral arterial occlusive disease w/ palpable pulses** is to
1. modify risk factors (tobacco cessation + regular exercise to promote collateral flow)
2. Tx T2DM - A1c < 7%
3. initiating statin + antiplatelet therapy (ASA)
4. In refractory cases= phosphodiesterase inhibitor, cilostazol, can be used to improve walking distance
145
Activities of daily living include
- transferring (bed to chair)
- toileting
- continence
- feeding
- dressing
- bathing
146
Which BP med causes
- wt gain
- ↑ blood glucose
- worsened dyslipidemia
Beta blockers
| Metoprolol = metabolic ADR
147
Greater trochanteric pain syndrome vs IT band syndrome
Lateral thigh pain
Greater trochanteric = butt pain (gluteus medius/minimus tendons on greater trocanter)
IT band = knee pain
148
Dyspareunia = pain w/ exercise + sex
U/L homogeneous low level echoes (blood)
Chronic pelvic pain
Endometriosis = endometriamas (chocolate cyst)
149
**Focal headache** or **face pain**
Fever
Vomiting - early morning
Sx of sinus infection = oropharynx erythema + **purlent discharge** + nasal drainage (green) U/L
**10+ days of URI** = cough + congestion + sore throat
Acute bacterial rhinosinusitis
Get CT scan = ring-enhancing lesion
## Footnote
tx: Amoxicillin-Clavulante or Doxycycline
150
Gonococcal proctitis vs Anorecal fistula secondary to Anal abscess
Anal discharge + pruritus + pain w/ BM
Gonococcal = white discharge + normal perianal exam
Anorecal fistula = foul-smelling discharge + indurated pustule-like lesion near anal verge
151
SCFE risk factors
obesity = due to increased mechanical strain on the physis
tall, thin adolescents during a growth spurt
## Footnote
Tx = immediate stabilization of the physis w/ surgical fixation to avoid the risk of avascular necrosis
152
H. pylori
1. PPI + amoxicillin (5 -7 days) followed by a
2. PPI + fluoroquinolone + nitroimidazole (5-7days)
3. LOAD therapy = levofloxacin + omeprazole + nitazoxanide [Alinia] + doxycycline (7-10 days)
153
Viral Conjunctivitis vs Allergic Conjunctivitis Vs Bacteria
VC = viral sx (rhinorrhea + nasal congestion + sinus tenderness + cough) + mild injection and a granular appearance of the tarsal conjunctiva
tx: Warm compress
AC = Conjunctival **edema**
tx: Olopatadine eye drops (mast cell stabilizer)
BC = dry + purlent discharge
tx: fluoroquinolones
154
Monoarticular arthritis = U/L joint pain
Achilles tendon pain
Oral ulcers
vesiculo-pustular rash (soles + palms)
polymorphonuclear leukocytes w/o organisms on Gram stain
Reactive Arthritis w/ Chlamydia trahomatis infection
155
Primary Adrenal Insufficiency = Addision disease dx
1o tumors = lung + breast + kidney can metastasize to the adrenal glands
Constitutional sx: fatigue + anorexia + wt loss
GI sx: nausea + ab pain
↓BP + ↓Glucose + ↓Na+ + ↑K+
**Dx: cosyntropin stimulation testing** = synthetic ACTH which should ↑ cortisol production
- if it doesnt increase = 1 PAI
- if it does increase = 2/3 PAI
156
Organisms associated w/ osteomyelitis
fever + ↑HR + leukocytosis
localized pain
skin changes = erythema + warmth + edema
Staph aureus
Pseudomonas aeruginosa
157
Nystatin ointment vs Clotrimazole
Nystatin = Candida species
Clotrimazole = Dermatophytes (Trichophyton)
158
Summer months
In the grass
pruritic + erythematous papules on the LE
Trombiculosis = chigger bites
## Footnote
self-limited
Management = sx control w/ topical application of vinegar, hot showers, and/or calamine lotion
159
Meniere disease vs Perilymphatic fistula
Sensorineural hearing loss
episodic vertigo
Meniere = longer vertigo episodes
Perilymphatic fistula = trauma + brief vertigo episodes + **valsalva meneuver stimiluating**
160
Cognitive impairment workup
1. Labs (CBC + B12 + TSH + CMP)
2. Imaging (CT or MRI)
Atypical
- Labs → get CSF
- Imaging → EEG
161
Xerosis
dry skin seen in elderly pts when in a dry environment
162
Anovulation vs Endometrial polyp
Anovulation = abnormal uterine bleeding
Endometrial polyp = bleeding betw regular + monthly menstr
163
Tx of Chlamydia + Gonorrhea
Empiric (pending test results): ceftriaxone + doxycycline*
Confirmed chlamydia: doxycycline*
Confirmed gonorrhea: ceftriaxone
164
Murmurs that get soft w/ squatting
MVP
HCOM
## Footnote
get louder w/ valslva + standing
165
Murmurs that get soft w/ handgrip
HCOM
AS
166
achieving strict glycemic control improves
Microvascular complications
- Retinopathy
- Nephropathy
167
Emotional & behavioral sx w/n 3 months w/ identifiable stressor
Adjustment disorder
168
What should you consider about Live-Attenuated vax among travelers
Live-attenuated vax can cause dissemenate disease in immunocomp - so don't give
- MMR
- Varicella
- Oral typhiod
- Intranasal Influenza
169
Mammography Screening
Women aged 50 to 74 year
Every 2 years
170
Cholesterol screening
begins at 40
3-5 yrs interval
171
Cutaneous horn
Keratinaceous projection from skin = conical or elongated
associated w/ seborrheic keratosis + SCC
172
Dermatofibroma vs Basal Cell Carcinoma vs Molluscum contagiosum vs Keratocanthoma
Dermatofibroma = small + firm + hyperpigmented nodule **+/- dimpling in the center w/ keratin plug & ulcerated**
MC = Large umbilicated nodules **w/o keratin plug**
BCC = **ulcerated** + sun exposed skin + slow growing
Keratocanthoma = ulcerated + keratin plug + **resolves spontaneously**
173
Rapidly growing nodule
ulcerated
keratin plug
resolve spontaneously
Sun exposed areas (face + forearm)
Keratocanthoma
174
Shin splints vs Stress fracture
Shin splints = diffuse pain
Stress fracture = point tenderness
175
Preseptal vs Orbital cellulitis
Eyelid edema + erythema
Fever
Leukocytosis
Preseptal = inital after trauma
Orbital = Opthalmoplegia (eye muscle movements + paralysis) + painful extraocular movements + proptosis + visual changes
176
Finkelstein/Eichhoff test = flexing thumb + ulnar deviation positive
Hand + wrist pain
- radial styloid pain
de Quervain tendinopathy
Tx:
- NSAIDs
- thumb spica splinting
177
Abx should be avoided in elderly pts w/ CAD + HTN + AAA + PMH: smoking
Fluoroquinolones (-floxacin)
↑ collagen degradation →
- Achilles tendon rupture
- Retinal detachement
- Aortic aneurysm rupture
178
Doxycycline ADR
Children = yellow teeth
Adult =
- skin photosensitivity
- Rx-induced esophagitis
179
Ligamentous sprain vs Inflammation at ligamentous insertions
Ligamentous sprain = traced to a specific event action + more pain w/ movement
Inflammation at insertions = worse w/ rest but improves w/ movement + <40 yo + gradual-onset pain
180
Irregular soft mass
increase in size during valsalva maneuver
No transilluminate
Scrotal heaviness
Varicocele = dilation of the pampiniform plexus
## Footnote
Dx: retrograde venous flow (US) + anechoic tubules adjacent to testis
Tx: Ligation + NSAIDs
180
# Post Injection
Joint
- ↑pain after injection
- swelling + erythema + warm
- Fever + chills + myalgias
Septic bursitis
1. image-guided aspiration
2. Abx - Staph/Strep
181
↓ fetal movement
<10 movements in 2 hrs
1. Nonstress Test (NST)
182
Nonstress test
monitors an unborn baby's heart rate for 20-30 min to see if it changes as the fetus moves and during contractions
183
Adolescent boys
pain worse at night
NSAIDs make feel better
## Footnote
Small round lucency
Osteoid osteoma = benign bone-forming tumor
184
Cough 5+ days +/- sputum
absent fever + chills
wheezing/rhonchi
chest wall tenderness
## Footnote
yellow/purulent sputum → Blood sputum
Acute bronchitis
## Footnote
Self-limiting
185
Ground-glass appearance = B/L alveolar infiltrates
Pulmonary Edema seen in ARDS
| V/Q Mismatch = high A-a gradient
## Footnote
Associated w/
- Mitral Stenosis/MR & papillary muscle rupture = Left-sided HF
- Pre-eclampsia
- Malaria
- Leukemias - AML/ALL
- HTN
- Nephritic syndrome
186
Syncope dx testing
ECG = arrhythmias
Holter monitors = arrhythmias
Echo = Structural
Stress test. = ischemia
CT = SAH
EEG = seizures
BP = hypovolemic (autonomic)
Glucose = hypoglycemia
Tilt-table testing = neural mediated syncope
187
MVP management
Reassurance
188
Orthostatic Hypotension Management
NonRx:
- salt tablets
- avoid large carbohydrate-rich meals (to prevent postprandial hypotension)
- limit alcohol intake
- adequate hydration
Rx:
Fludrocortisone = synthetic mineralocorticoid (1st-line therapy)
Midodrine = peripheral selective alpha-1-adrenergic agonist
Pyridostigmine = cholinesterase inhibitor
189
Postural Orthostatic Tachycardia Syndrome Management
NonRx:
high fluid intake
graded exercise programs
support hosiery
care with posture will improve symptoms.
Rx:
aim to increase blood volume and red blood cell mass (fludrocortisone, desmopressin, erythropoietin)
vasoconstrict (midodrine, methylphenidate, octreotide)
reduce heart rate (beta blockers)
modify central neurovascular control (SSRI, SNRI, clonidine)
facilitate neural transmission (pyridostigmine)
190
Thyroid Nodule Diagnostic Testing
High/normal TSH → US
>2 cm or >1cm w/ calcification + irregular → FNA
Low TSH = Radioactive iodine = hyperthyroidism
191
Young M
Nonproductive cough
Pulmonary nodules
Retroperitoreal lymphadenopathy = lymphatic spread - possibly neoplastic + mostly
Testicular = US & tumor markers - most likely the dx
Other options
Lung cancer = cough + SOB, CT
Liver cancer = Ab pain + mostly seen in F, US
192
Contact dermatitis vs psoriasis of the hand
CD = dorsum of hand
Psoriasis = palms + dorsum
193
↑indirect bilirubin
Mild jaundice = scleral icterus
Stress = illness + fasting + dehydration + menstruation + exercise + surgery
Gilbert =↓ UDP enzyme →↓ conjugated bili
194
Ear pain
Facial weakness = difficulty closing eye + U/L facial droop
Vesicular rash in external auditory canal
VZV reactivation → Ramsay hunt syndrome
| affects CN7 (facial) & CN8 (vestibulocochlear)
195
Annular/ target-like lesions
Painful erosions & bullae
Symmetrical
Extensor surface + palms + soles
Recent cold sores or other viral infection sx
Erythema multiforme = all-mediated immune response to viral or other Ag
196
Esophageal stricture vs esophageal adenocarcinoma vs achalasia
ES = symmetric concentric narrowing - Associated w/ GERD + issues w/ solids ONLY
EA = asymmetric irregular narrowing associated w/ Barrett esophagus - complication of GERD
Achalasia = issues w/ solids & liquids (mechanical) + dilated above LES = birds beak
197
Epicondylitis management
1. Brace
2. Short-term NSAIDs > roids
3. Surgery
198
Common Rx that cause pancreatitis
AntiHTN
Statins
Fibrates
T2DM = metformin + GLP-1 + DPP-4
199
chronic diarrhea +/- malabsorptive sx
Lymphocytes + eosinophils w/n lamina propria
Tropical Sprue
200
Osteopenia vs osteoporosis vs osteomalacia
DEXA scan
Osteopenia = > -2.5
Osteoporosis = < -2.5
Osteomalacia = > -2.5 w/ radio lucena bands = history of fractures
201
Renal Stones
Abx use post UTI
struvite (Mg++ ammonium phosphate) stone = ↑ urine ammonia production
| Staghorn
202
Acne:
Papules + pustules + nodules
Inflammatory
Topical: retinoids + tazarotene
Abx: Topical benzoyl peroxide > Topical clindamycin > Oral Doxycycline
203
Comedone:
- white = closed
- black = opened
Topical:
- Retinoids
- Salicylic
- Azelaic
- Glycolic Acid
204
Osteoporosis Screening
DEXA scan
postmenopausal women **< 65 yo** who are at increased risk of osteoporosis **(previous fractures)**
65+
205
Pneumonia management
Outpt = Macrolide (-mycin) or Doxycycline
Inpt = Bactam (Ceftriaxone) + macrolide (Azithromycin) or Flurorquinolone (Levo or Moxifloxacin)
MRSA = Vancomycin or Linezolid
Pseudomonas = Piperacillin-Tazobactam + Cefepime + Meropenem
206
- osmotic diarrhea
- crampy ab pain
- bloating
- flatulence
Lactose intolerance = lacks brush-border enzyme
Dx: Hydrogen levels 20+ ppm
|other test =
- **High** stool **osmotic gap**
- **↓ stool pH**
207
# Colonoscopy Screening
- hyperplastic polyps
- hamartomatous polyps
- submucosal polyps
does not warrant enhanced screening
208
anal fissure management
1. fiber, sitz baths, stool softeners, topical analgesics, and a topical vasodilator (nifedipine or nitroglycerin)
2. botulinum toxin injections or surgical intervention (lateral sphincterotomy)
209
tinea versicolor management
Fungus → hypopigmentation
usually seen when its hot outside
## Footnote
Tx:
Topical agents
- selenium sulfide
- sodium sulfacetamide
- ciclopiroxolamine
- azole
- allylamine antifungals
Oral antifungal tx may be considered in cases that are not responsive to topical therapy
210
brown tumors w/ Plain film radiograph
osteopenia w/ multiple cysts (blood + fibrous tissue + osteoclasts) = Osteitis fibrosa cystica = hyperparathyroidism
## Footnote
Associcated w/ hypercalcemia
211
PCKD vs Rhabdomyolysis
- Blood on UA
- Gross blood in urine
PCKD= RBCs on microscopy + FH
Rhabdo = no RBCs on microscopy
212
Morton neuroma vs Tarsal tunnel syndrome
**Morton neuroma** = squeezing metatarsal joints (clicking + numbness + pain btw 3rd & 4th metatarsals)
**Tarsal tunnel** = compression ankle (tibial nerve) causes burning + numbness + aching distal plantar surface of the foot/toes
213
A **13-year-old girl** presented with a **painless bump** on her left medial knee that had been present for about two weeks. She did not report any trauma or injury, and the **bump was not interfering with her daily activities**. Her personal and family histories were unremarkable.
Physical examination revealed no ecchymosis or knee joint effusion. On palpation, there was **a nontender bony prominence in the medial distal left femur**. There was no palpable inguinal lymphadenopathy, and her **knee range of motion was normal**.
Plain radiography was performed
Osteochondroma
214
Scars (especially burn scars) + chronic wounds are at ↑risk of developing squamous cell carcinoma
Marjolin ulcer =
- chronic inflammation
- continuous re-epithelization
- local damage to immune functions of the skin
- toxins from local cell damage
chronic inflammation and local toxin production = neoplastic changes and development of a malignancy
215
Cutaneous injury
Enlarged lymph nodes
Lymphagitis = skin injury → pathogen invasion of lymphatics in deep dermis
| Strep pyogenes + MSSA
## Footnote
Tx: cephalexin
215
Candida species vs Dermatophytes
Candida = w/n skin folds - tx: Nystatin
Dermatophytes = pruritic rash + raised border + central clearing - tx: Terbinafine cream + miconazole & oral (fluconazole + griseofulvin)
216
Fever + headache + malaise = **non-specific viral prodrome**
erythematous annular lesion - trunk
pruritic
Obliqely along the lines of tension = Christmas tree pattern
Pityriasis rosea
## Footnote
Self-limiting
pruitus sx = antihistamines + topical roids
217
How does pregnancy affect doses of Levothyroxine?
Pregnancy → estrogen ↑serum thyroxine-binding globulin = ↓ TH
| Need to increase Levothyroxine (T4)
## Footnote
Total T4 = ↑
Free T4 = normal
TSH = ↓
218
Dysmenorrhea
Symmetrically (Globular) enlarged uterus
Heavy menstrual bleeding
Adenomyosis
219
Pap test shows abundant clue cells
clear discharge
no pelvic pain
Asx = do not require tx
Sx:
1. Wet mount microscopy + KOH whiff testing
2. Metronidazole + Clindamycin
220
deQuervain tindinopathy
tendons
## Footnote
tender radial styloid
Abductor pollicis longus
Extensor Pollicis brevis
which passes under **extensor retinaculum**
221
itchy eyes
gritty sensation in eyes
crusting of eyelashes
Blepharitis
## Footnote
Contributors
- seborrheic dermatitis
- rosacea
- allergic disorder
- bacterial infection
- viral infection
- Demodex mite infection
222
Hordeolum
stye
focal inflammation of eyelash follicle or tear gland
## Footnote
tender
erythematous nodule at lid margin
223
Blepharitis vs Dry eye disease
Blepharitis = erythema + swelling + scaling of lid margins
Dry eye disease = Sjogren →inadequate or poor tear production
224
Atypical endometrial hyperplasia
Unopposed estrogen exposure (Obesity → ↑androgens) + chronic anovulation (PCOS)
- intermenstrual spotting
- Obesity
- atypical glandular cells on Pap
225
Carpal Tunnel workup
1. Phalen & Tinel
2. Nerve conduction study = slowed conduction velocities in **median nerve**
3. US (swelling) MRI (suspected mass)
| XR = for history of trauma
226
Dx Parkinson
Clinically = TRAP
- Tremor = resting
- Rigidity = ↑ w/ passive movement
- Akinesia/bradykinesia = difficulty initiating movement
- Postural instability =
227
Carpal tunnel in pregnant pts management
1. Wrist splinting
2. GC injections
3.surgery
228
Epidermis cysts
< 1 cm
Freely mobile nodules w/ central punctum (opening where cyst derived) - black dot in center
Palmer surface of digits
229
Rheumatoid nodules
Firm fibrotic masses over pressure points
Olecranon
Dorsal forearm
230
Skins of child abuse (RED FLAGS) in the presence of scald injuries
- Symmetric distribution of burn
- Uniformity of burn depths + Demarcation of wound margins = stocking or glove burn
- Absence of splash marks
- Sparing of flexural creases
231
Chest Pain work up
1. ECG (cardiac) PPIs (GI)
2. Stress test (cardiac) EDG (GI)
3. Cath (cardiac) Esophageal manometry (GI)
232
- microaneurysms
- blot & dot hemorrhages
- hard exudates
- macular edema
Diabetic retinopathy
233
Sudden U/L visual impairment = waking in the morning
Central retinal vein occlusion
234
↑ Proteins w/ normal albumin levels (meaning Globulins are ↑)
↑ AST
Autoimmune hepatitis
235
Dx delirium at bedside w/
Confusion Assessment Method (CAM) > Mini-Mental State Examination (MMSE)
236
DDx for altered mental status
Electrolyte disturbance
Pain
Respiratory infection
Urinary retention
UTI
237
Restless legs management
1. Iron replacement
2. Massage + heat + exercise
3. avoid anti-dopaminergic agents + antihistamines
Pramipexole + Ropinirole = Dopamine agonist
Gabapentin
238
Smoking Cessation
Varenicline = partial agoist of a4b2 (nicotinic Ach receptor) - sleep issues
Nicotine replacement = patch/gum
Bupriopion = Increase NE & Dopamine - seizure
239
sildenafil
enhances the effect of nitric oxide (NO) by inhibiting phosphodiesterase type 5 (PDE5)
## Footnote
MI
Erection dys
240
Thyroid Hormone replacement during prego
Methimazole = is preferred execpt during the 1st trimester (PTU)
241
# Fundoscopic exam finding
Hard exudates
Soft exudates
Drusen
Roth Spots
Hard exudates = w/n retina - yellow/creamy (DM)
Soft exudates = Cotton wool patches (HTN)
Drusen = yellow round spots beneath the retina (Macular degeneration)
Roth Spots = retinal hemorrhages (bacterial endocarditis)
242
↓ visual acuity = painless peripheral vision loss
↑ cup-disc ratio
+/- ↑ IOP
Light sensitivity
Open-angle glaucoma = decreased aqueous humous in Anterior chamber
243
↑ difficulty reading at close distance
Decreased lens elasticity
244
Uveitis
Acute eye pain
Eye reddness
## Footnote
Inflammatory = Sarcoidosis + IBD + Spondyloarthritis
Viral = HSV/VZV
Paraasitic = Toxoplasmosis
245
polycythemia
flank tenderness
Wt ↓
Renal Cell Carcinoma
| Smoking history
## Footnote
Ab CT scan
246
U/L reproducible chest pain
- palpation
- Upper body movement
- Deep breathing
- exertional activities
Fever
Cough
Costochondritis
247
Concentric = Left Ventricular Heart Failure
Preserved EF
Restrictive Cardiomyopathy
Associated w/ DM + HTN + Obesity + Aging
Diastolic Heart Failure
248
indications for statin tx
1. LDL 190+
2. Hx of ASCVD (e.g. MI, CAD, stroke, PAD)
■ ASCVD = atherosclerotic cardiovascular disease
3. 40+ y.o. + diabetes mellitus + LDL >70
4. 40+ y.o. + ASCVD risk > 7.5%
249
Vasomotor sx = hot flashes + night sweats
Vaginal atrophy
Amenorrhea
Primary ovarian insufficiency =
- autoimmune disorder
- Turner Syndrome
250
acute, poorly localized shoulder pain followed by
- increasing stiffness
- w/ **↓ active and passive ROM**
Adhesive capsulitis = contracture of the glenohumeral joint capsule
## Footnote
Tx:
- ROM exercises
- NSAIDs
- Corticosteroid injections
251
Tarsal tunnel syndrome vs Plantar fasciitis
PF = pain w/ dorsiflexion
TTS = burning pain (nerve issue)
252
Kernig sign
is the inability or reluctance to allow full extension of the knee when the hip is flexed to 90 degrees
253
Cushing Syndrome
- HTN
- ↑wt
- Proximal muscle weakness + atrophy
- ↓kalemia
- Metabolic alkalosis
## Footnote
obtain urinary free cortisol level
254
# How many weeks?
5 cm above the umbilicus
25 weeks
20 weeks + 1cm/week after
255
UTI in pregos
Avoid Nitrofurantoin in 1st trimester
Fosfomycin
## Footnote
TMP-SX - 1st trimester
Nitrofurantoin
Fosfomycin
256
trigger by minor trauma
bullae erosions ulcers
## Footnote
found on palms & soles
oral blisters w/ bottle feeding
Epidermolysis Bullosa = Mutation of proteins involved in intraepidermal & dermoepidermal adhesin complexes in basement membrane zone
| mutation of keratin gene
## Footnote
biopsy of fresh blisters for immunofluorescence microscopy
Tx: wound care + supportive measures
257
Trichlooroacetic acid
HPV infection = verrucous growths in the anogenital region
258
Conjunctival injection
Tarsal (or palpebral) inflammation
pale follicles
follicular conjunctivitis (white-yellow follicles on inflamed, upper tarsal conjunctivae
Trachoma = infection that causes blindness
Chlamydia trachomatis ABC
## Footnote
Dx: tarsal conjunctiva
Tx: Azithromycin
259
CNS disease = Parkinson
Erythematous pruitic plaques w/ greasy scles
scalp + Central Face + Ears + Chest
Seborrheic dermaitis = Malassezia colonization
## Footnote
Tx:
- Topical Anti-fung = selenium sulfide + ketoconazole
- Topical GC
260
# Kid M
Hip pain
Viral illness predrome
Limp
well-appearing
afebrile
normal xr
Transient synovitis
## Footnote
Tx: NSAIDs + rest
261
PAI vs Cushing Syndrome testing
PAI =
1. Early-morning cortisol level/Plasma ACTH
2. Cosynthropin
Cushing =
1. serum cortisol/late night salivary
2. 24 hr urine cortisol
3. Low dose dexamethasone suppression
262
diet recommendation for alcohol cirrhosis
Limit
- EtOH
- Sodium
- unhealthy fats
263
Diabetic neuropathy
Small vs Large
**Small = Positive sx**
- Pain/Tempature
- Burning/stabbing pain
**Large = Negative sx**
- Pressure
- Proprioception
- Poor balance
- numbness
264
Which HY Rx increase risk of osteoporosis
1. GC
2. Heparin
3. Phenytoin
4. Cyclosporine
265
Tender at dorsal aspect of the DIP joint
no active extension at the DIP
Mallet Finger = Extensor tendon injury at the DIP
## Footnote
Tx: splint for 6 weeks
266
Otitis Media Prevention
Pneumo vax
Influenza vax
Breastfeeding
Xylitol
267
EtOH addiction tx
1. Naltrexone = Opioid receptor blocker
- C/I Severe hepatitis = mild liver disease
2. Acamprosate = Glutamate transmission modulator
- C/I CKD
268
What are the alarm sx that prompts us to get EDG
- dysphagia
- microcyctic anemia = chronic bleeding
- wt ↓
269
Measles vs Rubella
Measles = 4 C's (cough + corynza (runny nose) + K(C)oplik spots (white mucosa) + Conjuctivitis)
Rubella = arthralgia (joint stiffness)
270
Neuroblastoma dx
- ab mass
- ecchymosis = raccoon eyes
- back pain
- Horner Syndrome sx
| Paraneoplastic = opsoclonus-myoclous
## Footnote
Dx:
1. Urine/serum catecholamines (VMA/HVA)
2. US
3. Biposy = small basophilic cells in rosettes
271
BRCA Genetic Mutation - Underlying Mechanism
Tumor suppressor proteins = DNA damage/repair in double strand breaks
AD - incomplete penetrance
1/2 = Breast & Ovarian cancer
2 = Male breast cancer + Prostate
272
HIV features
new psoriasis
Viral Sx = fever + sore throat + lymphadenopathy + headache + myalgias
**PAINFUL mucocutaneous ulcers**
Diarrhea
273
