Family Medicine Board Review misc – Flashcards
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ABI
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Ankle-Brachial index
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PPI
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Proton pump inhibitor
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Sarcoidosis
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Bilateral hilar adenopathy Typically female 20-40 y/o non smoker Bilateral facial paralysis
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SLE
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Female, 20-30 y/o Shrinking lung syndrome due to decrease lung capacity
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Tuberculosis
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Miliary nodular pattern Consolidation cavities Ghon particles (calcified lymph nodes) Hilar adenopathy TX- INH
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Histoplasmosis
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Bird and Bat droppings Focal, patchy infiltrates Hilar adenopathy TX-amphotericin B; Itraconazole
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Rotator Cuff Tear
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• difficulty with arm abduction ( +/ -pain), "shoulder shrug" sign • drop arm test weak ER and supraspinatus test ("empty can" test) • 2 : 1 GH to ST ratio with abduction
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Adhesive Capsulitis
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difficulty witharm abduction • normal strength with ER and supraspinatus test • loss of 2 : 1 GH to ST ratio with abduction
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Piriformis Syndrome (Deep Gluteal Syndrome)
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Clinical Findings• tender mid buttocks • pain with passive hip ER with hip flexed • pain with passive hip IR with hip extended (Freiberg sign) • equivocal SLR test Beware herniated disc, SI dysfunction, sacral stress fx, ischial bursitis, hamstring strain
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Piriformis Syndrome (Deep Gluteal Syndrome) TX
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ice• antiinflammatories • stretch . . stretch . . stretch ! ! ! • avoid prolonged sitting or pressure • consider diagnostic lidocaine test followed by corticosteroid injection
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Patellofemoral Pain Syndrome
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Clinical Findings• anterior knee pain with peripatellar tenderness • + / - effusion and crepitation • biomechanical ? weak VMO, hip abductors ? inflexible hams, ITB ? excessive Q angle ? femoral anteversion ? foot overpronation ? tight lateral restraints
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Patellofemoral pain Syndrome TX
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ice, antiinflammatories, relative rest• strengthening, hamstring / ITB flexibility • correct biomechanical abnormalities • patellar tracking knee sleeve or taping • surgery rarely necessary
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Tibial Stress Fracture
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pain with weight-bearingand tibial tenderness to palpation and percussion • Xrays may be negative • bone scan or MRI diagnostic Beware ? risk of stress fx in women with athletic amenorrhea, disordered eating (Female Athlete Triad)
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True statements regarding the prevalence and nature of depression in the elderly include which of the following? (Mark all that are true.) Depression is roughly two to three times more common in the elderly than in younger patients Physicians are more likely to correctly diagnose depression in elderly patients than in younger patients Treatment of depression in the elderly is less important than in younger patients because the depression is generally less severe Patients who are elderly when their first episode of depression occurs have a relatively high likelihood of developing chronic or recurring depression
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Critique: Depression is not a part of normal aging and is actually less common in the elderly than in younger patients. Physicians are often less accurate in diagnosing depression in the elderly because they assume that all elderly patients are somewhat depressed; by the same token, depressed elderly patients are less aggressively treated because it is commonly believed that depression is normal in this age group. Somewhat paradoxically, a patient who develops major depressive disorder for the first time in later life actually has a much higher risk of recurrence or chronicity, probably because of both social support deficiencies and neurochemical abnormalities.
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True statements regarding the relationship between depression and high utilization of medical care include which of the following? (Mark all that are true.) Depressed patients classified as high utilizers commonly present with defined medical conditions In patients classified as high utilizers, the incidence of current or past major depressive disorder is twice that of other patients The prevalence of defined medical conditions is higher among high utilizers who are classified as being depressed, compared to those who are classified as non-depressed Depressed patients classified as high utilizers have rates of medical resource utilization similar to those of nondepressed high utilizers
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Critique: Patients classified as high utilizers of medical care have high rates of depression, with the depression being largely unrecognized or inadequately treated. High-utilizing patients who are depressed are more likely to present with nonspecific complaints, compared to nondepressed high utilizers, who tend to present with physical complaints related to their defined medical disorders. Depression in high utilizers is associated with higher resource utilization.
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what is SPECIFICITY?
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1. Ability to detect people WITHOUT the disease. 2. % TRUE NEGATIVES. 3. use for CONFIRMATORY tests like Western Blot for HIV 4. if Western Blot Positive - have HIV 5. SPECIFIC ( more expensive ) test to eliminate the False Positives 6. SPIN SPecific test Positive result rules IN the disease
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what is SENSITIVITY?
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1. Ability to detect people WITH disease. 2. % TRUE POSITIVES 3. SCREENING tests like ELISA for HIV very sensitive - don't want to miss any. 4. SNOUT: SeNsitive test with Negative result rules OUT disease. Use HIGHLY SENSITIVE ( less expensive ) test first to catch everyone with the disease.
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what are the 4 main Erythemas?
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1. Erythema nodosum - reactive painful nodules 2. Erythema multiform - minor and major ( Stevens Johnsons involve mucosa ). target lesions with central clearing start on extremities, HSV 3. Erythema chronicum migrans (EM)- target lesion Lyme's - a skin reaction to the Borrelia burgdorferi bacteria carried by the mosquito. 4. Erythema infectiosum - Parvovirus B19; slapped cheek; congenital abnormalities
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what are steps for Acne treatment?
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1. Topical - Retinoids - Retin - A; benzoyl peroxide 2. Oral antibiotics 3. Hormonal - OCP's or spironolactone for women
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what are 3 stages of Lyme disease?
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1. rash + flu symptoms ECM Erythema Chronicum Migrans 2. cardiac / neuro symptoms 3. arthritis and chronic neuro
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how do you treat impetigo?
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1. topical plus oral Abx ( beta lactamase resistant ) mupirocic oint + diclox or cephalexin
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what is bug in Impetigo?
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Staph aureus
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what is Charcot's Triad in GB disease?
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1 .Pain RUQ 2. fever 3. jaundice - elevated Bili
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what is Cullen's sign?
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peri-umbilical bruising. hemorrhagic pancreatitis.
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what is Fox's sign?
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Inquinal bruising associated with retroperitoneal bleeding.
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what is Grey Turner's sign?
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flank bruising associated with retroperitoneal bleeding
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What does Psoas Sign suggest?
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retroperitoneal appendicitis
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where does biliary pain refer to?
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scapula
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where does renal pain refer to?
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flank
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where does pancreatic pain refer to?
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mid back
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who do we screen for depression?
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1. adults and adolescents 2. NOT children
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what are bugs in Neonatal sepsis?
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GEL 1.GBS 2.E.coli 3.Listeria
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what is significant temperature for significant fever in first month of life?
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temp greater than 38 C or 100.4 F
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what are testing steps in neonatal sepsis?
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1.CBC with diff, CRP, lactic acid, BMP 2. blood culture, urine culture 3. LP for CSF - C;S, micro, gram stain
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what are treatment steps in neonatal sepsis?
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IV antibiotics: amp /gent / cefotaxime / acyclovir NO ceftriaxone less than 2 months - kernicterus risk
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how does Rh disease develop?
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Rh negative mother is exposed to Rh positive baby, and the mother produces antibodies ( IgG ) against the Rhesus D antigen on her baby's red blood cells - causing destruction of the baby's blood cells leading to anemia in the baby.
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when is Rh negative pregnant mother given RhoGam?
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28 weeks ( with or without booster at 34 weeks)
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what is Indirect Coombs test for?
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test of MATERNAL blood for IgG antibodies that may pass through placenta and cause HDN ( Hemolytic Disease of Newborn )
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what is Direct Coombs test for?
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test of FETAL Blood to confirm if baby has immune mediated Hemolytic Anemia.
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what are Asymptomatic Bacteriuria in pregnancy guidelines?
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1. screen by urine culture at 1st prenatal visit 2. ; 100,000 cfu/mL significant 3. treat with Cephalexin - not ampicillin 4. do not use sulfa / nitrofurantoin or tetracycline in pregnancy.
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what are details of HSV suppressive therapy in pregnancy?
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1. suppressive therapy after 36 weeks for active case 2. level B evidence 3. Acyclovir 400 mg PO bid, or Valtrex 500 mg BID
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according to CDC - how much folic acid should women of child bearing age consume?
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0.4 mg folic acid daily
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What is the most common medical disorder during pregnancy?
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Hypertension
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What is Preeclampsia / Eclampsia?
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BP elevation AFTER 20 wks gestation in woman with previously normal BP with proteinuria or symptoms.
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How do you define Preeclampsia?
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1. BP ; 140 / 90 2. Proteinuria ; 0.3 g 3. increased BP with Headache, Blurred Vision, Abdominal Pain, Abnormal labs ( low platelet, abnormal LFT's ).
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What is HELLP syndrome?
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a life threatening OB complication considered to be a varient of pre-eclampsia - late pregnancy and sometimes after delivery: 1. Hemolysis 2. Elevated Liver Enzymes 3. Low Platelet count < 50,000
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What are lab criteria for HELLP?
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1. thrombocytopenia < 50,000 2. hepatic dysfunction 3. hemolysis ( elevated LDH )
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What is Chronic Hypertension of pregnancy?
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BP elevation ( above 140/90 ) before 20 weeks gestation.
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What is Gestational Hypertension?
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elevated BP detected after 20 weeks WITHOUT proteinuria.
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What are the 3 types of hypertension associated with pregnancy?
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1. chronic hypertension ( before 20th week ) 2. gestational hypertension ( after 20th week - if resolves may be transient, or if persists may be chronic ) 3. Preeclampsia - Eclampsia
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What is treatment for Eclampsia?
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1. Magnesium Sulfate MgSO4 2. BP meds: Labetolol 20-40 mg I V bolus 3. Vaginal delivery
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what are findings of PCOS?
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-androgen excess -ovarian dysfunction -exclusion of other causes.
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how do you evaluate Amenorrhea?
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1. r/o pregnancy 2. TSH to check thyroid status 3. Prolactin to look for pituitary tumor 4. determine relative estrogen status - progestin challenge test ( 5 mg medroxyprogesterone daily x 10 days ) any bleeding within 10 days is positive 5. High FSH / LH - ovarian failure
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what is good treatment of menorrhagia?
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1. NSAIDS 2. Endometrial Ablation
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what is Menorrhagia?
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1. menstrual bleeding over 80 cc, or over 7 days 2. Prolonged or excessive menstrual bleeding that occurs at regular intervals
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what is Polymenorrhea? what is Oligomenorrhea?
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Poly: lots of periods - cycles less than 21 days Oligo: few periods - cycles greater than 35 days
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what is Dysfunctional Uterine Bleeding?
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1. Anovulatory bleeding with No pathology 2. diagnosis of exclusion
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what is treatment of choice for DUB?
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1. OCP's, I V estrogen ( cause clotting ) 2. cyclic progestin 3. note that D;C is not advised
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what are tests for DUB?
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1. lab: preg test, pap test, cbc 2. endometrial biopsy
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what are new ACOG Pap screen guidelines?
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1. age 21-29: q3 years ( reflex HPV if ASCUS +'ve) 2. age 30-65: cotest with HPV q5 years, or q3 if no HPV 3. stop at 65 if 3 negs, or 2 cotest negs within 10 years
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what is ASCUS?
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Atypical Squamous Cells of Unknown Significance
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Acute bronchitis
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No treatment if otherwise healthy > supportive measures
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acute bronchiolitis
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RSV is most common cause less than 1 Chest Xray is normal treat with supportive measures, consider ribavirin if infant
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RSV
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most common cause bronchiolitis and pneumonia under age 1 incubation - five days coryza, cough, pharyngitis, wheeze, rhonchi, fever Antigen test from nasopharyngeal secretions supportive treatment - ribavirin, bronchodilators, corticosteorids (ribavirin - contraindicated in pregnancy) Synagis vaccine for premature at risk, C F Monoclonasl RSV antibody - palivizumab (prophyalxis IM / 6 mo)
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Epiglottitis
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H. influenza sudden onset high fever and resp distress drooling, sitting forward, muffled voice cherry red epiglottis Xray - thumbprint sign secure airway - life threatening third gen cephlosporin 10 days - cefotaxime or ceftriaxone Hib vaccine has decreased number of cases
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Croup
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Parainfluenza mainly, Adenovirus sometimes, harsh seal bark, inspiratory stridor Xray steeple sign Dexamethasone 0.6 mg/kg IM or PO O2 + racemic epinephrine, Albuterol not effective
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Influenza
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A or B Tx: ribavirin, zanamivir or oseltamivir
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Pertussis
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Bordetella pertussis gram neg bacterium Catarrhal stage - sneeze, cough, coryza Paroxysmal stage: rapid cough with inspiratory wheeze Convalescent stage: decrease frequency and severity of cough Treat with macrolide
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CAP
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strep pneumonia H.FLU staph aureus
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Rust colored spututm
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strep pneumonia
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COPD pneumonia
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H.FLU
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ALCOHOLICS n pneumoniae
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klebsiella
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current jelly and pneumonia
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klebsiella
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most common community acquired pneumonia C A P
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strep pneumoniae
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CAP - treatment
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start tx prior to culture Healthy: outpt abx (doxy, erythro, clarithro, azithro, or fluroquin) Not healthy: neutropenia > 1 lobe - then cover for strep and legionella ceftriaxone or cefotaxime pluz azithro or a fluroquinolone
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Prevention for C A P
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PNEUMOCCOCCAL conjugate vaccine 6-15 mo Pneumococcal polysaccharide vaccines 2-5 yrs and > 65 yrs prevents sepsis, not pneumonia
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walking pneumonia
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mycoplasma pneumonaie
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bullous myringitis
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mycoplasma pneumonaie - young adults - college - low grade fever cough
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Tx mycoplasma pneumoanie
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erythromycin or another macrolide
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Chlamydia pneumonia
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young adults, college longer prodrome - sore throat / hoarseness macrolide / tetracycline
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Legionella pneumonia
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air conditioning + older men no bacteria - large PMNs HIGH fever, dry cough, dyspnea Xray: segmental unilateral lower lung infiltrates Tx: azithro/ fluroquin
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most common atypical CAP
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mycoplasma pneumoniae
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Hospital acquired on vents
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pseudomonas aeurginosa Tx: very strong abx - cefepime (ticarcillin/clavulonic acid, piperacillin/tazobactam, meropenam
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Most Common HIV pneumonia
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PCP PneumonCystis Pneumonia pneumoncystis jiroveci (MC- with HIV CD4 <200). Previous Carinii but that now applies to bats
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Tx TB
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latent: INH for 9 mo or RIF for fourth months or RIF and pZA for two mo Active: INH/RIF/PZA/ETHAMBUTOL FOR TWO MONTHS then INH/RIF for four months
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Side effects of TB drugs
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INH - hepatitis, polyneuropathy, co admin vit b 6 RIF: heaptitis, flu, orange body fluid EMB - opticneuritis (red green vision loss)
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Pleural effusion: types
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1) exudates- leaky capillaries - inf, malig, trauma 2) transudates "intact capillaries" - increased hydrostatic or decrased oncotic pressure > CHF, atelectasis, renal or liver disease 3) empyema - inf within the pleural space 4) hemothorax - bleeding into the pelural space d/t trauma or malignancy
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Radiographs of effusion
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blunting of costophrenic angles, loss of demarcation of diaphragm and heart, lateral decubs: show small effusions and loculated vs. free floating
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Labs of pleural effusion
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thoracentesis is gold standard
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transudates vs. exudates (light's criteria)
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it is an exudate if it meets an of the following 1) pelural protein to serum ; 0.5 2) pleural LDH to serum LDH ; 0.6 3) pleural fluid LDH greater than 2/3 the upper limit of normal for serum LDH
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Treatment of pleural effusion
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thoracentesis transudative effusions: resolve when underlying cause is treated
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visceral pleural line on CXR
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pneumothorax
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Carcinoid tumor
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pink or purple central lesion on broncoscopy flushing, diarrhea, wheezing, hypotension
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what are features of bronchiectasis?
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foul purulent sputum CT di study of choice - finger clubbing - bibasialar rales, chest PT, abx PRN acute failure
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Cystic fibrosis
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abnromal production of mucous by almost all exocrine glands increased risk of malignancy hx of chronic lung disease, pancreatitis or infertility, PND, steatorrhea, diarrhea, abdominal pain apical crackles Labs: compensated respiratory acidosis PFTs: mixed obstructive/restrictive pattern elevated quantative sweat chloride test on two different days - diagnostic
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Chronic bronchitis
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blue bloater. labs: decrease O2 with increase CO2 Complications: cor Pulmonale (right heart failure) and pulmonary hypertension
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Emphysema (pink puffer)
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"quiet chest", hyperventilate Labs: normal O2, with less CO2 Complications: resp failure, pulm htn, cor pulmonarle, PTX, hemotpysis, CA risk
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what is Organic Dust Toxicity Syndrome? O D T S
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endotoxins aerosolized from moldy hay or manure lead to cough, fever, wheeze. Chest Xray normal
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what is Hypersensitivity Pneumonitis?
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Farmer's Lung, Actinomyces fevers, chills, dyspnea Oral steroids help - antibiotics and inhaled steroids do not help Avoid exposure, respirator may help
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coal workers pneumoconiaosis
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small opacities seen throughout upper lung fields Comp: progressive massitve fiborissis > restirctive dysfunction
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Silicosis
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(MINING, sandblasting, stone work) - small rounded opacities throughout, hilar lymph nodes may be baclified Comp: increased risk of TB, progressive massive fiboris
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Asbestosis
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construction workers: insterstitial fibrosis, thick pleura, calcified plaques, on diaphragms of lateral chest wall lung CA and mesothelioma, esp smokers Tx: supportive, oxygen, vaccinations and rehab Corticosteorids (relive chorinc alveolitis in silicosis)
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sarcoidosis
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multi organ disease of idiopathic cause noncaseating granulmatous inflammation North american blacks bilateral hilar and right paratracheal adenopathy and bilateral diffuse reticular infiltrates fine needle bx confirms dx corticosteroids
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CXR with "ground glass appearance"
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hyaline membrane disease
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what are the three leading causes of morbidity or illness?
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S O B 1. Smoking. 2. Obesity. 3. Booze. Alcohol use.
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what is primary prevention?
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Prevent a disease from occurring. Immunization programs. Primary Prevent. Good evidence for immunization - not so good for statins.
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what is Secondary Prevention?
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Screening in asymptomatic patients. Mammograms. Secondary screen. Screening after the disease occurs. Statins after M I.
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what is Tertiary Prevention?
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Treatment of identified disease. Treatment of diabetes. Tertiary treat.
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Primary prevention.
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Primary prevents disease. Immunizations prevent disease.
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Secondary prevention.
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Secondary screens for disease - mammograms.
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Tertiary prevention.
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Tertiary treats - treat diabetes based on hemoglobin A 1 C.
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what are the leading causes of PREVENTABLE DEATH worldwide?
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Hypertension, Smoking, High cholesterol, Malnutrition, STD's, Diet, Obesity
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what is new pap smear frequency?
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Every 3 years from age 21 to 65. Every 5 years from age 30 if co test with H P V.
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who don't you screen for pap?
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women younger than 21, or over 65, or women who have had hysterectomy with no major cancer findings.
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when do you stop pap test?
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Age 65 with adequate screening history. Three consecutive negative results or two consecutive negative co tests within the past 10 years.
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when should a woman who has had a hysterectomy with removal of cervix have a pap test?
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if she had cervical cancer with CIN 2 or higher.
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what is A C I P ?
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ACIP is the Advisory Committee on Immunization Practices - part of CDC
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what are new H P V guidelines?
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Quadrivalent H P V vaccine advised for Girls and Boys ages 11 to 12.
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what are Hep B - Hepatitis B guidelines?
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Hep B given at Birth before discharge total 3 doses, 0, 2 and 6 months
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what do you do with Hepatitis B surface antigen positive mother?
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Hep B vaccine and H big ( HBIG) hepatitis B immune globulin within 12 hours of birth
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what are Rotavirus guidelines?
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Rotavirus causes diarrhea Rotarix RV-1 is 2 dose series at 2 and 4 months Do not start after 15 weeks Maximum age for 1st dose is 14 weeks +6 days
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what are Diptheria, Tetnus and Pertussis guidelines?
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DTap 5 dose series at 2,4, 6 and 15 months (15-18) and 4 years (4-6 years).
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when is T Dap or Adacel given?
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TDap is given starting at age 11
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what are Hib Hemophilus influenza type b guidelines?
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Hib 2, 4, 6 months and booster at 15 months
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when is Pneumococcal vaccine given?
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P C V 13 Pneumococcal Conjugate Prevnar -13 vaccine 4 doses at 2, 4, 6 months then booster at 12 - 15 months T cell response
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what is the Pneumococcal polysaccharide vaccine?
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PPSV23 Polyvalent vaccine with 23 serotypes B cell response single dose after 65 years
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MMR
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Live attenuated vaccine 12 months and age 4 Give with varicella or 28 days apart do not give in pregnancy do not give if immune deficiency
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varicella
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Live attenuated virus 12 months and 4 years give with MMR or 28 days apart do not give in pregnancy
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Hep A
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2 doses starting 12 months
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What Vaccines are contraindicated in pregnancy?
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MMR, Varicella, Flu mist all are live attenuated vaccines.
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influenza vaccine
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everyone over 6 months of age pregnant women any trimester - but not live vaccine
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what are flu treatments?
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Tamiflu or Oseltamivir for B
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when are women screened for asymptomatic bacteriuria?
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first prenatal visit
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what is the definition of asymptomatic bacteriuria?
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greater than 100,000 C F U per mL of a single bacterial species. It is usually E coli.
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what is the treatment for asymptomatic bacteriuria?
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treat with cephalexin or keflex - not with amoxicillin. There is too much resistance to amoxicillin. Do a urine culture after treatment to ensure cure.
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what are the antibiotics to avoid in pregnancy?
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T N T. Tetracycline. Nitrofurantoin. Septra ( Sulpha ).
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how soon does ultrasensitive beta H C G detect pregnancy?
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5-7 days after fertilization.
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what is Naegeles's rule for E D C ?
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subtract 3 months from date of L M P, and add 7 days.
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what are first O B appointment lab tests?
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1. C B C, blood type and R H. Antibody screen. 2. Urine culture. 3. serum testing for rubella and varicella. 4. S T D testing for Hepatitis B surface antigen, H I V, Chlamydia and Gonorrhea. 5. Optional testing - if needed: Pap exam per guidelines, Cystic Fibrosis, Sickel cell anemia
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what are the Cystic Fibrosis screening recommendations in prenatal visit?
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1. all couples offered screening. 2. screening should be offered BEFORE conception.
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what are 4 infections that are not screened for prenatal?
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1. Hepatitis C. 2. Herpes Simplex Virus. 3. H P V , Human Papiloma Virus. 4. Parvovirus B 19
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what does Parvovirus B 19 infection result in?
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1. first trimester miscarriage. 2. second trimester fetal anemia, hydrops fetalis and stillbirth
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what is the two step gestational diabetes screening test?
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1. 50 gram oral glucose load, test in 1 hour and if greater than 130 then do the 3 hour test. 2. 3 hour O G T T - Oral Glucose Tolerance Test - overnight fast then give 100 gram oral glucose and test at 0, 1, 2, and 3 hours. If 2 abnormal then gestational diabetes. Abnormals are 95 at 0; 180 at 1 hour, 155 at 2 hour, and 140 at 3 hour.
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what does ACOG advise for diabetes screening?
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screen all pregnant woman. If high risk can screen at first prenatal, and if average risk can screen between 24 and 28 weeks.
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what are trimester dates?
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1. 0 to 13. 2. 14 to 28. 3. 29 to delivery.
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what is the two step gestational diabetes screening test?
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1. 1 hour 50 gram oral glucose load. 2. 3 hour 100 gram O G T T - oral glucose tolerance test.
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when is gestational diabetes screened?
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24 to 28 weeks, unless high risk including obesity, previous gestational diabetes.
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what is the cut off for the 50 gram oral insulin load test?
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130 mg / dL
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what are the cut offs for the 3 hour glucose tolerance test?
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95 at baseline; 180 at one hour; 155 at two hours and 140 at three hours.
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what are the treatment targets for diabetes in pregnancy?
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fasting glucose 96 or less; one hour after eating 140 or less, and two hours after eating 120 or less.
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what is gestational diabetes treated with?
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diet, exercise and insulin.
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what is the most common pregnancy related liver disorder?
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I C P Intrahepatic Cholestasis of Pregnancy
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what are features of I C P?
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elevated bile acids pruritis jaundice 50%
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what is treatment of I C P ?
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Ursodiol
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what are the causes of late pregnancy bleeding?
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1. placenta previa 2. placenta abruption 3. vasa previa 4. cervical trauma
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why is immunization important?
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1. most effective form of health care delivery. 2. more americans die from vaccine preventable disease than breast C A, H I V or M V A's
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how is Rotavirus vaccine given?
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It is a live attenuated virus given orally at 2, 4, and 6 months. Do not repeat spit out or vomited dose. Full series must be completed by 8 months.
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what are the most common childhood malignancies?
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1. leukemia. 2. brain tumors. 3. lymphomas - Hodgkins is most common.
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what are leukemia signs and symptoms?
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pallor, fatigue, fever, recurrent infections, bruising, bone pain.
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what are brain tumor symptoms?
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persistant headache - usually in morning - wake up with it, nausea, vomiting, ataxia, visual disturbance, seizures, neurological symptoms.
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what is the most common type of lymphoma?
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Hodgkins lymphoma
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what are the characteristics of Hodgkins lymphoma?
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B cell lymphoma. Reed Sternberg cells - giant B cells - arise in mediastinum and cervical lymph nodes.
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what is Non Hodgkins lymphoma?
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N H L. Includes all other B cell, T cell and N K cell tumors.
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what are the B symptoms in lymphomas?
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B symptoms include fevers, sweats, and weight loss. B means symptoms present, A means they are absent. B has a poor prognosis.
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what is Polycythemia Rubra Vera?
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Myeloproliferative disorder Bone marrow producing too many rbc's Itching and pruritis hemoglobin over 16 woman, 18 men Plates over 400,000 WBC over 12,000 Vitb12 over 900
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what are the two main forms of hearing loss?
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Conductive or Sensorineural.
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what does sensorineural hearing loss involve?
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Converting vibrations to electrical potential in the brain. Most age related hearing loss is sensorineural.
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what does conductive hearing loss involve?
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conductive hearing loss involves obstruction from wax, perforated tympanic membrane, tympanosclerosis, otitis media, and otosclerosis.
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how much does hearing decline with age?
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after 60 years of age, hearing declines 1 decibel every year. 80 percent of adults over 85 years of age have hearing loss of 25 decibels.
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who has more hearing loss - men or woman?
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men lose more hearing earlier in life than woman.
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what is Acute diverticulitis?
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Acute diverticulitis is inflammation of the colonic diverticulum, which may involve perforation or micro perforation.
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what is Uncomplicated diverticulitis?
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Uncomplicated diverticulitis is localized inflammation - ANTIBIOTICS ARE NOT NEEDED in mild cases.
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what is Complicated diverticulitis?
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Complicated diverticulitis is inflammation associated with an abscess, fistula, obstruction, bleeding, perforation or phlegmon.
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what is test of choice for suspected diverticulitis?
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Abdominal CT
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what is the role of colonoscopy in diverticulitis?
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Colonoscopy contraindicated in acute diverticulitis. Colonoscopy in four to six weeks after resolution. Rule out other causes - colorectal cancer.
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how is most diverticulitis treated?
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Outpatient basis. Clear liquid diet. Oral broad-spectrum antibiotics - cipro and flagyl. Close follow up - two to three days.
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how is moderate diverticulitis treated?
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Inpatient management. N P O - no food or drink by mouth. Intravenous fluid resuscitation. Intravenous antibiotics, cipro and metronidazole.
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what is the primary goal in lipid lowering?
answer
LDL - c
question
according to NCEP ATP III Basics National Cholesterol Education Program Adult treatment protocol III, what is an "essential modality" for change?
answer
Therapeutic lifestyle change
question
what age does USPSTF recommends screening lipids?
answer
- All men;35(A) - Men 20-35 (B) and women ; 45 (A) at increased risk for CHD
question
at what age does ATP III guidelines advise lipid screening?
answer
all starting at age 20, then every 5 years
question
What are main features of Psoriasis?
answer
erythematous scaly plaques, patches that are often pruritic and painful.
question
What are the different kinds of psoriasis?
answer
1. Plaque Psoriasis - 90 %. Extensor surfaces 2. Inverse Psoriasis - skin folds, less scaly, flexor surfaces, axillary, inguinal, intergluteal. 3. Guttate - eruptive psoriasis with lesions over trunk - often occurs after a URI
question
what skin areas does Inverse Psoriasis affect?
answer
flexor surfaces, axillary, inguinal, intergluteal.
question
what are the main lesion types?
answer
1. Macules 2. Papules 3. Nodules 4. Plaques and Scales 5. Pustules 6. Vesicles 7. Wheals 8. Crusts 9. Erosions / Ulcers 10. Fissures 11. Scars
question
Erythema Chronicum Migrans - Lyme. Erythema Infectiosum - Parvovirus B19 Erythema multiforme - target lesions ; HSV Erythema Nodosum - reactive
answer
what are the 4 main Erythema rashes?
question
1. Acne Rosacea - papules, pustules, erythema base with telangectasia. 2. seborrheic dermatitis - redness, greasy scale, nasolabial folds. 3. Acne vulgaris - papules, pustules, comedomes. 4. Contact dermatitis - redness, scale, blisters. 5. Butterfly rash of Lupus.
answer
what are 4 common facial rashes - and one uncommon one?
question
1. basal cell CA 2. squamous cell CA 3. actinic keratosis 4. melanoma
answer
what are 4 skin cancers?
question
what are characteristics of stemi ?
answer
S T elevation and release of biomarkers. M C T. Myoglobin, Creatinine Kinase, Troponin.
question
what is biomarker of choice?
answer
Troponin T or I is Biomarker of choice - 3-6 Hours after onset of ischemia. Single negative Trop DOES NOT exclude MI - need serial levels. Remains elevated for 7-10 days after MI.
question
what is good for diagnosing re-infarction?
answer
CKMB - rise and fall faster than troponin.
question
what are time guidelines for STEMI treatment?
answer
less than 2 H - fibrinolytics, greater than 2 hours PCI
question
what does S T segment elevation mean?
answer
myocardial injury
question
when does Q wave develop?
answer
12 hours post plaque rupture and means dead myocardium
question
what meds lead to post MI survival?
answer
ACE, Beta-blockers, Statins, ASA
question
what is Systolic heart failure?
answer
ineffective contraction, low cardiac output, EF ; 40%. enlarged ventricles fill with blood, but pump out less (less than 40%)
question
what are symptoms of Left sided systolic heart failure?
answer
dyspnea, orthopnea, PND, pulmonary edema with crackles ( back up into lungs )
question
what are symptoms of Right sided systolic heart failure?
answer
peripheral edema, elevated JVP, hepatomegaly / pulsatile liver
question
what is one of the mechanisms of heart failure?
answer
Low cardiac output triggers neurohormonal activation, which ultimately results in premature apoptosis of cardiac myocytes with less contractility.
question
what are Sympathetic blockade meds for CHF?
answer
Beta blocker ( carvedolol )
question
what are Preload reducers for CHF?
answer
diuretics ( loop ) furosemide, nitrates
question
what are Afterload reducers for CHF?
answer
ACE, ARB,nitrates, aldosterone meds ( spironolactone )
question
what is Diastolic heart failure?
answer
ineffective ventricular filling, EF often ; 40.
question
what is Systolic heart failure?
answer
enlarged ventricles fill with blood, but pump out less (less than 40%)
question
what is the difference between systolic and diastolic heart failure?
answer
Systolic is pump failure. Diastolic is filling failure.
question
what is the mechanism of Diastolic heart failure?
answer
results from increased ventricular stiffness and decreased compliance
question
how do you treat diastolic heart failure?
answer
careful decrease in heart rate using B-blocker or non DHP CCB ( diltiazem )
question
what lab is there to test for heart failure?
answer
B N P. Brain naturetic peptide - secreted from ventricles in response to ventricular volume expansion
question
what is the N Y H A New York Heart Failure Classification?
answer
Class I - symptoms with heavy activity / exertion Class II - symptoms with ordinary activity Class III - symptoms with minimal activity Class IV - symptoms at rest WORSE
question
what is Acute Coronary Syndrome?
answer
U A Unstable angina, Non S T elevation M I, S T elevation M I ( UA, NSTEMI, STEMI ).
question
what is cause of acute coronary syndrome?
answer
Occlusive thrombus developing on top of a disrupted atherosclerotic plaque. Reduced O2 supply, with increased O2 demand. ( spasm - Prinzmetals, dissection SCAD, inflammation Kawasaki's Disease, drugs like Cocaine ).
question
what is Framingham criteria
answer
10 year risk for C A D 7 factors Age, Gender, TChol, HDL, Smoker, Systolic BP, on bp med? no LDL, no diabetes
question
Colic Treatment
answer
Many strategies have been suggested to relieve colic but available evidence offers limited support for only three: a trial of non-cow's milk formula for formula-fed (but not breastfed) infants; a low-allergen diet for mothers of breastfed infants (specifically, avoidance of milk products, eggs, wheat, and nuts); and, reduced stimulation of the infant, often accomplished by swaddling the child.
question
Breast Feeding Contraindications
answer
Maternal HIV (US) and active tuberculosis.
question
Daycare Requirements
answer
Director with bachelors degree in child development. 1:2 staff to infant ratio 1:4 staff to child ratio Monthly firedrills.
question
Dental Facts
answer
Cariogenic bacteria usually colonized at time or eruption from sharing food with mother. Flouride supplementation at 6 month if low water.
question
Adolescent Hypertention
answer
Based on age, height and gender (not weight) High Blood Pressure in Children and Adolescents classifies any adolescent with blood pressure (BP) ;120/80 mm Hg as having, at a minimum, pre-hypertension. Prehypertension - BP ;120/80 mm Hg, or a BP between the 90th and 95th percentiles. Stage 1 hypertension - between the 95th and 99th percentile, or up to 5 mm Hg above the 99th percentile. Stage 2 hypertension - more than 5 mm Hg above the 99th percentile
question
Driving
answer
Most accidentts involve alcohol Most common cause of adolescent death Classes may increase risk by serving as an alternative to graded experience.
question
Bullying
answer
Increases likelihood of bringing weapon to school No tolerance and formal programs help
question
Anabolic steroids
answer
Permanent risks include growth of breasts and permanent hair loss. Reversible effects include an increase in libido and aggressive behavior, a decreased sperm count, shrunken testicles, elevation of blood pressure, acne, liver abnormalities, clotting, elevation of LDL-cholesterol, and reduction of HDL-cholesterol
question
Discipline
answer
Time-out - 18 months and 5 or 6 years of age. Spanking, although it is used in greater than half of U.S. families during the early teens, is associated with increased rates of physical aggression when used in this age group, as well as substance abuse, crime, violence, poor self-esteem, depression, and low educational achievement.
question
Pulmonary ejection murmur
answer
Most common innocent murmur in older children. It is a soft, grade 1-2 systolic ejection murmur heard at the left upper sternal border. It is louder in the supine position and softens with standing or the Valsalva maneuver.
question
Atrial septal defect
answer
Best heard in the left upper sternal border, do not change with standing, and cause an increase in precordial activity. They can also cause a diastolic rumble. They are often confused with innocent murmurs.
question
Venous hum
answer
Innocent diastolic sounds in the upper right sternal border that are heard continuously during sitting and disappear in the supine position or with light pressure over the jugular vein.
question
Still's murmur
answer
Most common innocent murmur of early childhood (age 2 years to preadolescence). It is a systolic murmur usually heard in the left lower sternal border, and decreases with standing.
question
Ventricular Septal Defect
answer
Systolic murmur at the left lower sternal border that does not change with standing. The murmur of hypertrophic cardiomyopathy is best heard at the left lower sternal border and increases with standing.
question
Overweight
answer
>95th%tile Weight Maintainance appropriate if 7 and no complications. Weight Loss if > 7 and especially if hyperlipidemia, hyperglycemia, htn For those who are overweight and over age 7 two additional physician visits are recommended, along with two nutritionist visits and screening tests, including fasting lipids, glucose, AST, ALT, and HgbA1c. Weight loss, rather than weight maintenance, is recommended for this group of children, regardless of complications.
question
Smoking Prevalence
answer
From 1999 to 2005, this survey found that students aged 13 to 15 in the Americas had a 22.2% prevalence of use of any tobacco products. This was higher than any other region of the world. Boys and girls had equal rates of cigarette smoking (17%) but boys had a higher rate than girls of other tobacco use, including cigars (15% vs. 8%).
question
LAIV Contraindications
answer
History of hypersensitivity to any of the components of LAIV or to eggs age <2 years or ?50 years any underlying medical condition that is an indication for routine influenza vaccination, including asthma, reactive airways disease, chronic pulmonary or cardiovascular disease, or known metabolic diseases known or suspected immunodeficiency diseases or immunosuppressed states a history of Guillain-Barré syndrome after influenza vaccination current use of aspirin or other salicylates (because of the association of Reye syndrome with wild-type influenza virus infection) a history of asthma or wheezing during the preceding 12 months in a child 2-4 years of age pregnancy
question
Potty Training Readiness
answer
Ability to imitate parents' behavior, Demonstrating independence by saying "No," Expressing interest in toilet training, walking and sitting, Communicating the need to eliminate Ability to pull clothes up and down. Ability to follow a two-step command
question
Calcium RDA
answer
500 mg for ages 1-3 years, 800 mg for ages 4-8 years 1300 mg for ages 9-18 years Neither boys or girls get what they need but girls are worse
question
Head Lice
answer
Not dangerous School screening not helpful Ok to return to school after treatment (contrary to many school no-nit policies) Retreat in 10 days if live lice. Removal of nits is necessary only to prevent diagnostic confusion
question
what is Relative Risk?
answer
1. ratio of outcome incidence in exposed to unexposed. 2. experimental event rate (exposed) divided by control event rate (not exposed)
question
equation 1: Relative Risk R R
answer
R R = E E R divided by C E R ( RR = EER / CER )
question
Relavtive Risk Reduction R R R
answer
R R R = C E R - E E R, all divided by C E R (RRR = (CER - EER)/CER))
question
equation 2: Absolute Risk Reduction: A R R
answer
A R R = C E R minus E E R ( ARR=CER-EER)
question
Equation 3: Number Needed to Treat N N T
answer
N N T = 1 divided by A R R (NNT=1/ARR)
question
Equation 4: Sensitivity
answer
Ability to detect people who have the disease - the percent True Positives. Use for screening - rule out disease. ELISA for H I V - don't want to miss anyone.
question
Sensitivity
answer
percent true positives (Sensitivity = TP / ( TP + FN ) x 100)
question
Sensitivity
answer
ability to detect people who have disease
question
SNOUT
answer
SeNsitive test with a Negative result rules OUT the disease
question
Specificity
answer
Ability to detect people who DO NOT have the disease. Used to confirm result. Western Blot for HIV good example
question
Specificity
answer
percent % True Negatives (TN / ( FP + TN ) x 100)
question
SPIN
answer
Specific test with a Positive result rules IN the disease
question
hyperparathyroidism
answer
hypercalcemia > 10.5 elevated PTH parathyroid adenoma bones, stones, abdominal growns, psychic moans, with fatigue ECG: prolonged PR, short QT, bradyarrythmias, heart block and asystole Tx :surgery hydration, bisophosphate, Ca receptor agonists, avoidance of immobility; Post menopausal estrogen supplementation, propranolol.
question
Hypoparathyroidism
answer
hypocalcemia - cramping, twitching, tetany of muscles thyroidectomy vs Autoimmune chvostek's and Trousseau's, loss of eyebrow's, hyperreflexia high Ca, Low PTH ECG: Prolonged QT avoid phenothiazines, and furosemide Emergency tetany tx: IV Ca gluconate Maintenance therapy: oral Ca and Vit D prep
question
Hashimotos
answer
Hypothyroid - low T4, high TSH autoimmune thyroiditis weight gain, thinning hair, hyporeflexia low T4, high TSH treat levothyroxine 1.6 mcg/kg/day
question
Grave's disease
answer
Hyperthyroid - high T4, low TSH TSH receptor auto - antibody tremor, weight loss, irritable, goiter beta blocker, methimazole, PTU (1st trim preg), radioactive iodine
question
thyroid Cancer
answer
Papillary CA - painless nontender firm nodule thyroid function tests normal hot nodule, radioactive uptake fine needle biopsy
question
Metabolic syndrome
answer
large waist circumference high BP HIGH TRIGLYCERIDES low HDL high serum glucose
question
Cushing disease
answer
chronic excess glucocortiocoid obesity, hypertension, thirst and polyuria with or without glycosuria *most specific signs - proximal weakness with pigmented striae more then 1 cm wide free cortisole in urine > 125 is diagnostic overnight dexamethasone suppression test
question
Addison's Disease
answer
adrenal glands do not produce sufficient steroid hormones -glucocorticoids and often mineralocorticoids. low plasma 8am cortisol accompanied by high ACTH = diagnostic Addison crisis = aggresive IV saline, glucose, glucocortoicds as well as tx underlying cause
question
Framingham score
answer
10 year risk for C A D 7 factors: Age, Gender, T Cholesterol, HDL, Smoking, BP, On BP med
question
Diabetes Insipidus
answer
Diabetes Insipidus excessive thirst, dilute urine, no glycosuria Central DI: deficiency of ADH antidiuretic hormone or vasopressin Nephrogenic : insensitivity of kidneys to ADH Fluid deprivation test treat with desmopressin
question
Niacin deficiency - pellegra
answer
diarrhea, dermatitis, dementia, death associated with ETOH, poor diet
question
Treatment of acute atrial fibrillation with rapid ventricular response.
answer
Diltiazem or verapamil
question
To convert a paroxysmal supraventricular tachycardia
answer
Adenosine
question
Class I recommendations for tPA
answer
Age less than 75 and less than 12 hours of chest pain
question
Most common precipitator of erythema multiforme
answer
Herpes simplex
question
hyperparathyroidism
answer
hypercalcemia ; 10.5 elevated PTH parathyroid adenoma bones, stones, abdominal growns, psychic moans, with fatigue ECG: prolonged PR, short QT, bradyarrythmias, heart block and asystole Tx :surgery hydration, bisophosphate, Ca receptor agonists, avoidance of immobility; Post menopausal estrogen supplementation, propranolol.
question
Hypoparathyroidism
answer
hypocalcemia - cramping, twitching, tetany of muscles thyroidectomy vs Autoimmune chvostek's and Trousseau's, loss of eyebrow's, hyperreflexia high Ca, Low PTH ECG: Prolonged QT avoid phenothiazines, and furosemide Emergency tetany tx: IV Ca gluconate Maintenance therapy: oral Ca and Vit D prep
question
Hashimotos
answer
Hypothyroid - low T4, high TSH autoimmune thyroiditis weight gain, thinning hair, hyporeflexia low T4, high TSH treat levothyroxine 1.6 mcg/kg/day
question
Grave's disease
answer
Hyperthyroid - high T4, low TSH TSH receptor auto - antibody tremor, weight loss, irritable, goiter beta blocker, methimazole, PTU (1st trim preg), radioactive iodine
question
thyroid Cancer
answer
Papillary CA - painless nontender firm nodule thyroid function tests normal hot nodule, radioactive uptake fine needle biopsy
question
Metabolic syndrome
answer
large waist circumference high BP HIGH TRIGLYCERIDES low HDL high serum glucose
question
Cushing disease
answer
chronic excess glucocortiocoid obesity, hypertension, thirst and polyuria with or without glycosuria *most specific signs - proximal weakness with pigmented striae more then 1 cm wide free cortisole in urine ; 125 is diagnostic overnight dexamethasone suppression test
question
Addison's Disease
answer
adrenal glands do not produce sufficient steroid hormones -glucocorticoids and often mineralocorticoids. low plasma 8am cortisol accompanied by high ACTH = diagnostic Addison crisis = aggresive IV saline, glucose, glucocortoicds as well as tx underlying cause
question
Framingham score
answer
10 year risk for C A D 7 factors: Age, Gender, T Cholesterol, HDL, Smoking, BP, On BP med
question
Diabetes Insipidus
answer
Diabetes Insipidus excessive thirst, dilute urine, no glycosuria Central DI: deficiency of ADH antidiuretic hormone or vasopressin Nephrogenic : insensitivity of kidneys to ADH Fluid deprivation test treat with desmopressin
question
Niacin deficiency - pellegra
answer
diarrhea, dermatitis, dementia, death associated with ETOH, poor diet
question
Chronic cluster headache treatment
answer
Verapamil or lithium
question
Chronic cluster headache prevention
answer
Verapamil
question
Complication of long term opioid therapy
answer
Hypogonadism
question
Virchow's node
answer
Solitary enlarged left supraclavicular lymph node , associated with GI malignancy
question
Tdap in pregnancy
answer
All pregnant women receive Tdap during every pregnancy between 27 and 36 weeks gestation
question
CHADS
answer
CHF, HTN, Age, DM, Stroke
question
CHADS Score
answer
1 for CHAD 2 for stroke
question
Pulmonary embolism plus hypotension, what is the treatment?
answer
Thrombolytics (tPA)
question
Indication for aspirin in males for primary prevention
answer
Men 45 to 75 years old No prior CAD Intermediate risk
question
New limp in patient with Crohn's Disease
answer
Psoas muscle abscess until proven otherwise
question
Interstitial lung disease causes
answer
Amiodarone Amphotericin Bleomycin cyclophosphamide Nitrofurantoin Methotrexate Leflunomide
question
Hypoxemia in COPD
answer
V/Q mismatch
question
Normal or increased TLC
answer
Obstructive lung disease
question
Aplastic anemia
answer
Acquired causes sulfonamides, chloramphenicol, parvovirus B19, hepatitis b and c
question
MILD TO MODERATE ALLERGIC RHINITIS FIRST LINE THERAPY
answer
NASAL STEROIDS second line is the rest including antihistamines
question
SEPTIC ARTHRITIS OF HIP IN CHILDREN
answer
T.38.5, won't wt bear , incr WBC, sed rate, CRP U/S for effusion which can be aspirated
question
HHT ( hereditary hemorhagic telangiectasia)
answer
also called Osler-Weber-Rendu Syndrome 15- 30 % also have pulmonary A-v malformation screen with contrast echo
question
METHADONE
answer
cardiac toxicity due to QT prolongation and torsades de pointe
question
TREATMENT FOR HEPARIN OVERDOSE OR BLEEDING DUE TO HEPARIN
answer
PROTAMINE SULFATE
question
END STAGE ACUTE MOUNTAIN SICKNESS
answer
Caused by cerebral edema ataxia and altered mental status can also have high altitude pulmonary edema treat or prevent acute mountain sickness with acetazolamide ( diamox) or dexamethasone start day before
question
MEDICARE ELIGIBILITY FOR HOME O2
answer
PaO2 ; 55 mmHg or ; SaO2 88%
question
FEMALE ATHLETE TRIAD
answer
amenorrhea, disordered eating and osteoporosis Use Z score on DXA
question
Bone density
answer
Z SCORE compares to age matched equal T SCORE compares to young adult at peak bone mass
question
PCV polycythemia vera
answer
splenomegaly, pruritis after hot shower low erythropoietin, incr hct
question
CROHN'S DISEASE
answer
non contiguous skip lesions transmural, small and large colon steroids first, no surgery
question
ALCOHOLIC LIVER DISEASE
answer
AST/ALT RATIO > 2 ELEVATED GGT
question
METFORMIN AND KIDNEY DISEASE
answer
STOP WHEN CR > 1.5
question
Lachman test
answer
ACL tear
question
Posterior drawer test
answer
PCL
question
McMurray and Thessaly
answer
Meniscal tears
question
COLON CANCER SCREENING
answer
at age 50 or if high risk, at age 40 or 10 years before the age at which youngest relative was diagnosed
question
TTP
answer
30 % mortality hospitalize and plasma exchange schistocytes on peripheral smear ( anemia) fever, abdo pain, nausea, weakness
question
MARFAN SYNDROME
answer
Autosomal dominant, armspan > HT men greater that 72 inches and women greater that 70 inches should have screening echo if aortic abnormality,need b blocker and echo q 6 months
question
Duchenne Muscular Dystrophy
answer
X linked most common neuromuscular disorder of childhood usually dx at age 4 to 5 can dx earlier by measuring CK ( massive elevation)
question
SCAPHOID FRACTURE
answer
High risk is fracture through proximal third ( tend to cause loss of circulation and non union or avascular necrosis) .....refer these to ortho fractures through distal third or middle can be treated by fam doc with thumb spica cast for 10 - 12 weeks
question
post drug- eluting stent thrombosis prevention
answer
ASA 162 -325 MG PLUS Plavix ( clopidogrel) for 12 months then ASA 75 to 165 mg indefinitely
question
Meningitis due to Neisseria mengitidis
answer
CEFTRIAXONE gram neg diplococci cipro and rifampin are used as prophylaxis for close contacts
question
ophthalmia neonatorum
answer
ceftriaxone for treatment 25 - 50 mg /kg single does IM or IV erythromycin ointment is for prophylaxis GRAM NEG DIPLOCOCCI
question
hypercalcemia symptoms and causes
answer
SYMPTOMS stones, bones, groans and psychiatric overtones =kidney stones, bone pain, abdo pain, and depression/anxiety/confusion also constipation, weakness etc MOST COMMON CAUSE IS HYPERPARATHYROIDISM also malignancy, multiple myeloma, excess vit D, milk-alkali syndrome,thiazide diuretics, theophylline
question
EKG IN HYPERCALCEMIA
answer
short QT INTERVAL ST Elevation mimicking STEMI
question
WHAT DOES PTH DO
answer
controls calcium in tight range from 9-10.1 PTH stimulates osteoclasts to resorb bone and release calcium from bone in kidneys PTH decreases calcium clearance and stimulates production of 1,25 dihydroxy vit D which stimulates Ca absorption from GI tract
question
hyperparathyroidism symptoms
answer
same as hypercalcemia plus osteoporosis/ penia bone pain, kidney stones, abdo pain, constipation confusion, memory loss , keg changes etc 75%women
question
PRIMARY Hyperparathroidism parathyroid adenoma
answer
PTH can be high or normal if PTH is normal and calcium high then that is abnormal because should be very low most have 1 gland with tumor but 20% may have two glands involved ( 4 glands altogether) WOMEN TWICE AS LIKELY, >50 YEARS OLD TXMENT IS SURGERY
question
parathyroid hyperplasia ( 4 glands overproducing)
answer
LITHIUM for years kidney dialysis ( secondary hypoparathyroidism) MEN syndrome
question
hypoparathyroidism
answer
usually due to neck surgery TXMENT WITH CALCITRIOL ( VIT D)
question
SECONDARY HYPERPARATHYROIDISM
answer
usually because of decreased 1,25 dihydroxy Vit D hyperphosphatemia and hypocalcemia in CHRONIC KIDNEY DISEASE or other forms of Vit D DEF
question
ADVANCED RENAL FAILURE AND CALCIUM
answer
usually low calcium, high po4 and low vit D but with advanced renal failure, appropriate parathyroid hyperplasia can progress to overproduction of PTH called tertiary hyperparathyroidism treat usual with calcium and vit D supplement
question
DIAGNOSIS OF PRIMARY HYPERPARATHYROIDISM
answer
HIGH SERUM CALCIUM increased or inappropriately normal PTH Don't forget to measure Vit D levels 1,25 and 25 hydroxy
question
PCO symptoms and associations
answer
hirsutism, infertility, acne, insulin resistance, incr LH weight gain, DM2, CV disease, endometrial hyperplasia
question
PCO diagnosis
answer
two of following criteria reduced or no ovulation clinical or biochemical signs of excessive secretion of androgens polycystic ovaries ( at least 12 follicles)
question
PCO labs for diagnosis
answer
TFTs, Prolactin, free testosterone, androstenedione, FSH, LH. LH/FSH RATIO OVER 3
question
ANEMIA OF CHRONIC DISEASE
answer
MILD ( 9-11) normochromic and normocytic can be microcytic iron and TIBC are decreased ferritin is increased NO TREATMENT other than treatment of the underlying disease
question
Frequent associated condition with hereditary hemorrhagic telangictasia
answer
pulmonary arteriovenous malformation - screen for this with contrast echocardiogram - Sx of recurrent unprovoked epistaxis (w/HHT)
question
starting dose of warafin in elderly pts (and in pts w/HF, liver dx, hx of recent surgery)
answer
5 mg (per American College of Chest Physicians)
question
LDL target in (1) high-risk pts (2) very high risk pts
answer
;100 mg/dl and ; 70 mg/dl
question
Rx to improve depression in terminal dying pt
answer
Ritalin (methylphenidate)
question
Tx for venous ulcers
answer
compression Tx, and Trental (pentoxifyline) - shown effective when used WITH compression tx
question
pt with pain in bil wrists, exam shows warm wrists, foggy on palpation, and lack 30 degrees both flexion and extension, x-rays normnal, mild inc sed rate, negative RF
answer
Rheumatoid arthritis - usu symmetrical, usu wrist and joints with high ratio of synovium to articular cartilage, RF often Neg in early months of Dx, may be positive later
question
LBP after inc activity, w/o neuro Sx or radiculopathy
answer
Tx - nonbenzodiazepine mm relaxants (ie, cyclobenzaprine/Flexeril), shows relief of acute LBP 1st 7-14 days after onset Sxs; (NOT bed rest)
question
Greatest potential to be misinterpreted by pt when discussing end-of-life issues
answer
"It is time to consider withdrawal of care" - may think physician no longer wants to care for pt
question
Rx that can worsen gout / inc uric acid levels
answer
diuretics (HCTZ); losartan shown to decrease uric acid
question
Rx that reduces calcium carbonate absorption
answer
PPIs; always take Ca carbonate with food to inc absorption
question
What form calcium is well absorbed regardless of GI acid
answer
calcium citrate; can take with or without food
question
most concerning early Sx of dangerous drug reaction
answer
pruritis around mouth, palms of hands and soles of feet
question
Sxs of chronic bacterial prostatitis
answer
irritative voiding Sxs, testicular, perineal and LBP, recurrent UTIs, and distal penile pain
question
Tx of chronic bacterial prostatitis
answer
fluoroquinolones are 1st line - have best tissue penetration / concentration in the prostate
question
heat wave-related deaths in elderly is highest in:
answer
homebound pts (confined to bed, not leaving home daily, unable to care for self
question
best long term Tx for lateral epicondylitis (tennsi elbow)
answer
conservative care that offloads involved tendons (modified work, etc.), corticosteroid injections reduce acute pain up to 6 weeks, but inc rate of poor long term outcome
question
best intervention shown to SLOW decline in lung function in smokers
answer
Smoking cessation (Rx help improve Sx COPD, but do not slow progression of COPD
question
cardiovascular parameter that increases with normal aging
answer
Blood pressure
question
hematologic finding consistent with myelodysplastic syndrome
answer
Macrocytic anemia, also thrombocytopenia, neutropenia, or combination of these; anemia in 80-85% pts, usu macro
question
metabolic abnormal most likely seen in pts with stage 4 kidney disease
answer
hyperparathyroidism (present in more half pts with GFR ;60
question
current guidelines in stage 4 kidney Dx recommend monitoring what:
answer
serum calcium and phosphate levels q 3-6 months bone-specific alkaline phosphatase activity q 6-12 month
question
AAFP and AAP recommendations for Tx for otitis media
answer
10-day course Abx for pts 2 yr, recommend Tx if Dx is certain, but option of observation and f/u if not severe, and f/u guaranteed
question
1st line Tx for otitis media
answer
Amoxicillin 80-90 mg/kg/day in 2 divided doses
question
Tx for otitis media in pts ; 5 yrs
answer
Tx Abx 5-7 days appropriate; oral decongestants and antihistamines NOT recommended for children with AOM
question
physical findings possibly associated with structural heart dx in child
answer
increased intensity with standing, holosystolic murmur, grade 3 or higher murmur, harsh quality, an abnormal S2, maximal intensity at the upper left sternal border, a diastolic murmur, or a systolic click; ECHO best study
question
characteristcs more likely associated with innocent murmurs
answer
systolic murmur, soft sound, short duration, musical or low pitch, intensity that varies with phases of respiration, increased loudness in supine position, increased loudness with exercise, anxiety or fear
question
1st line Tx for acute migraine (abortive therapy)
answer
Rx - triptans (ie, Imitrex) OTC - NSAIDS and acetaminophen/aspirin/caffeine NOT opiates and barbiturates (d/t potential for abuse) Tylenol not effective alone
question
age range of SIDS and most common age / peak
answer
age - first 6 months of life, peaks 2-4 months, quickly drops by age 6 months
question
exposure to what secretions of an HIV-positive pt would require possible post-exposure prophylaxis
answer
breast milk, vaginal secretions, semen and blood Not require prophylaxis - saliva, sweat, urine, feces
question
Sx of vestibular neuronitis ? cause ?
answer
sudden onset severe dizziness, sensation of abnormal rotation of environment, occas HAs, nausea, resting nystagmus, vertiginous in all positions; unknown cause
question
Sx of BPV (benign positional vertigo)b? Sx of Meniere's Dx ?
answer
- brief attacks of vertigo - tinnitus and hearing loss
question
Work up for urethritis in men (per CDC)
answer
gonorrhea and Chlamydia testing of penile discharge or urine, UA with Mx if no d/c preset, VDRL or RPR testing for syphillis, and HIV and hepatitis B testing
question
Empiric Tx for men with purulent urethral d/c or positive urine test (positive LE or >10 WBCs/hpf in 1st void urine)
answer
azithromycin 1 gm po x 1 dose OR doxycycline 100 mg bid x 7 days, PLUS ceftriazone 125 mg IM OR cefixime 400 mg po x 1 dose
question
at what degree of curvature of scoliosis in adolescents warrants treatment ?
answer
recommend observation for curvatures less than 20 degree, and consideration for bracing and/or surgery for more severe curvatures
question
what is the recommended f/u options for pt with ASC-US Pap results
answer
(1) two repeat Paps at 6-month intervals (2) reflex testing for HPV (if negative, repeat Pap as usual) (3) single colposcopic examination (not if HPV negative)
question
Tx and causes of pneumonia in children
answer
5 yrs - atypical pneumonia more common - esp Mycoplasma - empiric Tx with macrolide Abx (zithro) For both, viruses most frequent cause of pneumonia
question
Most effective adjunctive Tx for treatment-resistant unipolar depression
answer
lithium, triodothyronine (T3), and atypical antipsychotics (lease effective of 3) - all can provide clinic improvement when used in conjunction with ineffective antidepressant
question
effective adjunctive Tx for bipolar affective disorder
answer
anticonvulsant medications - ie, gabapentin
