question

In addition to cardiac disease, chest pain could be attributed to 4 other causes. Name them

answer

MSK, pulmonary, GI, or psychological

question

name the 4 emergent causes of chest pain

answer

PE, MI, aortic dissection, pneumothorax

question

Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.

answer

muscular chest pain (inflammation or overuse pf chest wall muscles); costochondral joint (reproduced on palpation and patient may not want to take a deep breath in); rib fractures

question

How can GERD (or esophageal motility disorders) lead to chest pain?

answer

reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

question

T or F; lung tissue has pain fibers?

answer

False- pain from inflammation or irritation is detected only by the parietal pleura. the parietal pleura is the source of chest pain during pneumonia or PE

question

patients with herpes zoster may experience what symptom before the rash appear?

answer

pain

question

Describe the presentation of myocardial pain?

answer

substernal chest tightness or pressure, that radiates to the left arm, shoulders, or jaw. Patients may also describe: diaphoresis, SOB, nausea, vomiting

question

Describe the presentation of angina?

answer

typically brought on exercise, eating, emotional excitement; pain lasts 5 - 15mins, disappears with nitroglycerin or at rest; if the pain lasts 30mins it should not be considered anginal

question

Describe the presentation of pericardial pain

answer

persistent, sharp, severe, relieved by sitting up; aggravated by breathing, laying back, coughing

question

Describe the presentation tracheobronchitis

answer

upper sternal area burning pain, associated with a productive cough

question

Describe the presentation of pneumonia

answer

occurs in overlying chest wall, and aggravated by breathing and coughing

question

sudden, sharp, unilateral, pleuritic, associated with SOB

answer

pneumothorax

question

sudden sharp chest pain, preceded by viral illness

answer

pleurisy

question

true or false: MI, pericardial tamponade, PE, GI bleed, are associated with hypotension

answer

true

question

complete the sentence: pericarditis can cause frictional rub and......

answer

pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

question

When does troponin rise following myocardial injury or infarction?

answer

1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

question

When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?

answer

w/in 4hrs and peaks 24hrs; it is important to obtain serial markers since the first set of cardiac markers are negative in 25 - 50% of patients with an acute MI

question

patients who present with an MI, unstable angina, or PE should be hospitalization of evaluation

answer

stabilize on oxygen, nitroglycerin, morphine for pain, aspirin (to decrease mortality by 20%), clopidogrel or ticolodipine. (beta blockers, heparin, nitrates, ACEi, thrombolytics (if <75 with ST segment elevation, and a history consistent with an acute MI; w/in 12hrs for older patients)

question

What are the most common causes for the common cold?

answer

1. Rhinovirus 2. Coronavirus 3. Others: Influenza, Parainfluenza, RSV, Adenovirus

question

What are the common causes for laryngitis?

answer

Influenza, Rhinovirus, Adenovirus, Parainfluenza

question

______ infections cause approximately 95% of bronchitis cases in healthy adults.

answer

Viral -Non viral causes: Chemical irritation, Mycoplasma, and Chlamydia

question

Name 4 factors that predispose an individual to develop pneumonia.

answer

1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

question

Describe the history and PE of patient presenting with common cold

answer

Hx: Scratchy throat, runny nose, nasal congestion, rhinorrhea, malaise, fever, hoarsenss, cough, low grade fever, headache PE: Swollen red nasal mucosa, fever, purulent discharge, facial tenderness

question

History for Sinusitis

answer

Persistent purulent discharge, facial pain exacerbated by leaning forward, maxillary tooth ache, "double sickening"=relapse

question

History for Acute bronchitis

answer

Productive cough and URI symptoms (runny nose, scratchy throat, nasal congestion), low grade fever, fatigue

question

History and PE for Pneumonia

answer

Hx: High fever, dyspnea, chills, chest pain, develop hypoxia or cardiopulmonary failure PE: Abnormal Vital signs (fever, tachypnea, tachycardia), Lungs (localized rales, bronchial breath sounds, wheezing, signs of consolidation-dullness to percussion)

question

Difference between Pneumonia and Bronchitis

answer

Bronchitis: Antecedent URI, Cough, No or low-grade fever, clear lungs or coarse rhonchi, Normal CXR Pneumonia: Acute onset of cough, fever, and tachypnea, chest pain, leukocytosis, pulmonary infiltrate on CXR

question

What type of imaging is need for chronic sinusitis?

answer

CT

question

Initial treatment for Rhinosinusitis

answer

-Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

question

Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days

answer

Consider AB: 1st line: Amoxicillin, Cefuroxime Penicillin allergy: clarithromycin, azithromycin, trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid, levofloxacin, gatifloxcin

question

Pneumonia tx: suitable for healthy adults less than 60

answer

Erythromycin, Macrolide (i.e. azithromycin), Doxycyline

question

Pneumonia tx: suitable for healthy adults older than 60

answer

Fluoroquinolone with good activity again Pneumococcus (levofloxacin), Macrolide, 2nd generation cephalosporin

question

Four muscles of rotator cuff

answer

SITS: Supraspinatus, Infraspinatus, Teres Minor, Subscapularis

question

The degenerative process that results in bursitis, tendonitis, and shoulder impingement often begins in the _____ or ____ tendons, which have a poor blood supply and are often under stress.

answer

Supraspinatus and bicipital tendons

question

When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?

answer

-Usually occurs in individuals over 50 to 60 yo -Involves tendons, bursae, and sometimes entire capusule

question

Things that need to be included in history of shoulder pain

answer

Age, dominant hand, medications, PMHx, type of work, and activity level, Pain-acute or chronic, Associated trauma (swelling, rendness, laxity, catching, decrease ROM)

question

Patient presents with aching shoulder, which becomes acutely painful with overhead activity

answer

Rotator Cuff problem

question

Discomfort with abducting the arm past 90 degress

answer

Rotator Cuff tendonitis

question

Chronic pain and shoulder stiffness with limited motion

answer

Adhesive capsulitis (frozen shoulder): most common in middle age women

question

Pain in shoulder when throwing, swimming, or serving a tennis ball

answer

Rotator cuff tendonitis

question

Shoulder pain with pain radiating to elbow

answer

Cervical radiculopathy

question

Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?

answer

-Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

question

What test done in PE measures instability of shoulder?

answer

Apprehension test: abducting the arm to 90 degrees, rotating it externally, and then applying anterior traction to the humerus

question

Mainstay treatment for soft tissue inflammation (Shoulder)

answer

NSAIDs, combined with ice or heat, and brief periods of rest followed by PT (maintaining ROM, flexibility, strength) -Severe: Cortisone shot

question

Who should have Xray testing for shoulder pain?

answer

Reserved for pats with hx of traumatic injury or persistent pain despite therapy

question

Describes what occurs during squamous metaplasia of the cervix.

answer

Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

question

Where does the development of abnormal cervical cells begin?

answer

Squamocolumnar junction=most common site of cervical cancer

question

What places women at higher risk of getting cervical cancer?

answer

Early sexuality and multiple pregnancies (immature cells are more common at menarche and ruing the postpartum period), hx of STDs, smoking, HIV, current or prior history of condyloma, and previously abnormal Pap smears

question

Natural history of cervical cancer

answer

Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

question

Why is the pap smear one of the most effective cancer screening tools?

answer

-Slow progression of cervical cancer changes -Availability of effective early treatment

question

What HPV serotypes are most commonly associated with cervical cancer?

answer

Serotypes 16, 18, 31,52,58

question

When does the American Cancer Society recommend obtaining Pap smear in low-risk women

answer

Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

question

In regards to a Pap smear, what should be done if a pt has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.

answer

Repeat Pap after infection treated

question

Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?

answer

4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

question

An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)

answer

HPV testing -Pos=colposcopy -Neg=repeat pap smear

question

What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?

answer

Colposcopy, Endocervical curettage, and directed cervical biopsy

question

Carcinoma in situ is generally referred to a gynecologist and requires ______

answer

conization (or LEEP): removeal of a portion of the cervix and thus pts are at risk of preterm labor, incompetent cervix, or cervical stenosis in future pregnancies

question

After treatment of dysplasia, women need Pap smears every...

answer

4 mo for 1yr, then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

question

What is considered normal blood loss during a menstrual cycle?

answer

Less than 80 ml of blood

question

Answer: Irregular cycles with excessive flow, duration, or both

answer

Menorrhagia

question

Metrorrhagia

answer

Irregular bleeding between cycles

question

Menometrorrhagia

answer

Excessive bleeding in amount, duration , or both at irregular intervals

question

Answer: Regular bleeding at intervals of less than 21 days

answer

Polymenorrhea

question

Oligomenorrhea

answer

Regular bleeding at intervals of more than 35 days

question

Uterine bleeding between regular cycles

answer

Intermenstrual bleeding

question

What is the role of FSH in one's menstrual cycle

answer

FSH released by the pitu stimulates a primary ovarian follicle to release estrogen, which stops menses and stimulates the endometrium

question

What is the role of LH in the menstrual cycle

answer

LH surge triggers ovulation

question

What occurs after ovulation

answer

The luteal or secretory phase begins, the corpus luteum develops, and pregesterone levels increase

question

Cycle length variabilty is primarily due to what?

answer

Variability in the time for follicle development during the proliferative phase

question

What is most common form of abnormal vaginal bleeding? (give what causes it with answer)

answer

Dysfunctional Uterine bleeding: caused by hormonal imbalances from a functionally abnormal hypothalamic-pitu-ovarian axis resulting in abnormal follicle development and anovulation (metorrhagia) -Corpus luteum does not develop=progesterone-deficient state

question

Describe the Hx for a pt getting an abnormal vaginal bleeding work-up

answer

Hx: Onset of menarche and duration and frequency of the menstrual period, Bleeding pattern, hx of liver, renal, thyroid disease, use of anticoags, oral contraception, hormone replacement, ROS: weight change, hirsutism (indicating PCOS=LH:FSH--2:1), exercise, increased stress, presence of galactorrhea or visual changes

question

PE for a pt getting an abnormal vaginal bleeding work up

answer

Vital signs, orthostatic blood pressure (indicating acute bleeding) and pulse, signs of pregnancy, systemic disease, and sterile speculum and bimanual exam)

question

Diagnostic Evaluation of Abnoraml vaginal bleeding

answer

-Pap Smear (unless recent normal pap) -CBC -Pregnancy test -Ultrasound if uterus is enlarged -Cervical culture in pts high risk of infection -Thyroid test and testing for systemic diseases

question

What should be considered in younger pts with menorrhagia

answer

Coag disorders

question

Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.

answer

35 (exception for postmenopausal women who have recently been started on HRT)

question

A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy

answer

DM, HTN, DVT, seizures, depression, or anxiety

question

What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?

answer

ACEi, ARBS, thiazide diuretics

question

HIgh risk pregnant patients should be evaluated for ____ and ____

answer

HIV and syphilis

question

Vaccines that should be updated before planned pregnancy

answer

Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

question

What should preconception counseling include?

answer

Genetic screening, medical assessment for chronic diseases, screening for infectious diseases, and updating of immunizations, advice on proper nutrition and exercise, help with quitting unhealthy habits, and advice on avoiding environmental hazards

question

Prenatal visit schedule for low-risk pregnancies

answer

-Preconception visit: up to 1 yr before conception -1st prenatal visit: 6-8wks after missed menses -Every 4 wks: up to 28 wks gestational age -Every 2 wks: up to 36 weeks gestational age -Every week: until delivery

question

What treatments are the cornerstone for treating cases of functional constipation?

answer

-Increasing fluid (8, 8oz glasses of water/day) -fiber

question

_____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.

answer

Bulk forming: Psyllium, Methycellulose, Polycarbophil

question

What is the mechanism of action for stimulant agents in treating constipation?

answer

Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

question

How is constipation clinically defined?

answer

Less than 3 stools per week

question

Constipation: What are indications for lab testing?

answer

Refractory constipation, a new onset of constipation in an older individual, heme-positive stools, and situations in which the etiology is unclear or the clinical evaluation suggests underlying pathology

question

Name types of laxatives

answer

-Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

question

Diarrhea is defined as an ____ in stool weight to more than ____g per day

answer

Increase; 200 g/day

question

What are the two common clinical presentations of acute diarrhea?

answer

1. Watery, noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

question

Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea

answer

Possibility of Ischemic colitis

question

Whats the diagnosis: Watery stools accompanied by a low-grade fever, headache, nausea or vomiting, and achiness

answer

Viral gastroenteritis

question

Diarrhea from custard filled pastries

answer

S. Aureus

question

What microganism is causing this array of presentations: Mild, crampy, nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura

answer

E. Coli O157:H7

question

What is the leading cause of parasitic diarrhea that presents as foul, greasy, bulky stools with associated weight loss or neuropathy?

answer

Giardia

question

What are the most common viral causes of diarrhea in kids and adults?

answer

Kids: Rotavirus Adults: Norwalk Virus

question

Define proteinuria

answer

>150mg per 24hrs

question

Define nephrotic range proteinuria

answer

>3.5g of protein per 24hrs

question

At was quantity does urine dipstick test detect elevated protein?

answer

100mg; means pt can be trace protein positive and not be detected

question

What are the primary glomerular diseases?

answer

Focal glomerular sclerosis, membranous glomerular nephripathy, IgA nephropathy

question

What are the secondly causes of glomerular disease?

answer

Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

question

Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein

answer

Albumin; low molecular weight proteins

question

How do you define persistent protein uria?

answer

Presence of proteinuria on at least two separate ocassion

question

Define the patient population typically affected by orthostatic or postural proteinuria

answer

Affects 60% of patients with asymptomatic proteinuria; pts are usually <30, secrete less than 2g protein/day: proteinuria occurs in the upright, but not supine position

question

What are the features of glomerular nephritis

answer

RBC casts and old to moderate HTN

question

What are the features of nephrotic syndrome?

answer

Massive proteinuria and edema, hypoalbuminemia, hyperlipidemia, lipiduria

question

Name some medications that can cause proteinuria

answer

ACEi, penicillin, cephalosporin, cyclosporine, NSAIDs, heavy metals, aminoglycosides, sulfonamides

question

What is benign transient proteinuria?

answer

Common problem that resolves spontaneously and is most often seen in children and young adults

question

1+ protein level on urine dipstick usually represents how much protein in the urine?

answer

300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

question

Although urine dipstick test binds to albumin what, other important protein can it fail to detect?

answer

Bence-Jones

question

What is the next best step if a patient has two or more positive dipstick tests?

answer

A 24hr urine protein collection and urine creatinine clearance determination

question

Name the diagnosis of heartburn: regurgitation, dysphagia

answer

GERD

question

Name the diagnosis of heartburn: gnawing epigastric pain, nausea, vomiting, bloating

answer

Peptic ulcer disease or gastritis

question

Name the diagnosis of heartburn: upper abdominal/ epigastric pain, bloating, belching, flatulence, nausea

answer

nonulcer dyspepsia

question

Name the diagnosis of heartburn: chest pressure, nausea, diaphoresis, palpitations

answer

coronary artery disease/ angina

question

Name the diagnosis of heartburn: colicky right upper quadrant pain, with meals, radiation to scapular regions

answer

cholelithiasis

question

Name the diagnosis of heartburn: severe constant mid abdominal pain

answer

pancreatitis

question

Name the diagnosis of heartburn: dysphagia, assoc. with immunocompromised condition

answer

infectious esophagitis

question

Name the diagnosis of heartburn: dysphagia, assoc. with ingestion

answer

medication or chemical esophagitis

question

Name the diagnosis of heartburn: associated with signs of connective tissue disease, potential risk of stricture/ dysphagia

answer

scleroderma/polymyositis with secondary gastroesophageal reflux

question

What drugs do you use to treat H.pylori + PUD?

answer

clarithromycin, amoxicillin, metronidazole PPI: cimetidine, ranitidine, famotidine, nazatidine

question

What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?

answer

Lifestyle modification: Salt restriction, weight reduction, regular aerobic exercise

question

What are the four classes of medications that are most commonly used for 1st line agents in HTN?

answer

-Diuretics -BB -CCB -ACEi

question

What type of diuretic is the most widely used for HTN? What are some SE of this drug?

answer

Thiazide (useful in patients without renal impairment) -SE: sex dysfxn, dyslipidemia, hyperglycemia, and elevation in uric acids

question

Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?

answer

Loop diuretics (Check serum K+ levels before drug admin)

question

SE Of Beta blockers?

answer

Bradycardia, fatigue, insomnia, sex dysfxn, and adverse effects on the lipid profile

question

What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?

answer

ACEi

question

Why don't ACEi work well for the elderly and African Americans when treating HTN?

answer

These patients are associated with low renin states=less likely to respond to medication

question

Hyperinsulinemia can increase vascular tone by what 4 mechanisms?

answer

1)Promoting Na+retention 2) Promoting hypertrophy and hyperplasia of vascular smooth muscles through its mitogenic properties 3) Modifying ion transport, leading to increase in intracellular Ca2+ 4) Sympathetic activation

question

Clinical Manifestations of HTN

answer

Ischemic heart disease, stroke, peripheral vascular disease, renal insufficiency, retinopathy characterized by exudates and hemorrhages, and, in severe HTN, papilledema

question

Diagnosis of HTN

answer

Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

question

What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?

answer

CBC

question

What lab tests are recommended for newly diagnosed hypertensive pts?

answer

Fasting serum glucose, K+, serum creatinine, UA, lipid profile, serum Ca2+, uric acid

question

What medications can cause heart palpitations?

answer

Theophylline, Digoxin, B agonists, OTC stimulants (pseudophedrine), antiarrhthymic med

question

Palpitations: Which patients warrant hospitalization, monitoring and aggressive eval?

answer

Pts with palpitations and dizziness, near syncope, or syncope

question

Isolated, extra pounding beats

answer

PVC or Premature atrial contraction (PAC)

question

What are the 2 psych disorders most commonly associated with palpitations?

answer

Generalized Anxiety disorder and panic disorder

question

Predictors of cardiac etiology

answer

Male, report irregular heartbeat Sx duration >5min, hx of heart disease

question

How do you know if heart palpitations are due to stimulant or medication use?

answer

Less abrupt onset and cessation of palpitations

question

Lab testing for heart palpitation

answer

Hgb, Electrolytes, and TSH

question

What imaging is used to assess cardiac anatomy in patients with heart palpitations?

answer

Echocardiogram

question

A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.

answer

24 hour halter

question

Treatment for supraventricular tachycardias

answer

BB or CCB, catheter ablation of identified bypass tract

question

Tx of chronic or intermittent afibs

answer

Anticoag with warfarin to prevent thromboembolism

question

How to NSAIDs contribute to gastritis and ulcer formation?

answer

NSAIDs block COX-1 production of prostaglandins that maintain mucosal blood flow, secretion of mucus, and bicarbonate. Without these protective factors, acid-induced inflammation and ulcers my result.

question

What is the standard tool used for diagnosis of GERD?

answer

EGD

question

What is the peripheral cause of vertigo?

answer

inflammation, stimulation, or destruction of the hair cells of the eighth cranial nerve

question

What is the cause of benign positional vertigo?

answer

Particulate matter or otoliths may form in the semicircular canal. The otoliths become dislodged and stimulate the sensory hair cells in the semicircular canals, leading to vertigo.

question

What is the cause of acute larbyrinthitis or vestibular neuronitis?

answer

Viral infection of the semicircular apparatus

question

What is the cause of Meniere disease? What are the cardinal symptoms?

answer

enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus, vertigo, hearing loss

question

What is an acoustic neuroma?

answer

a tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

question

What is a markers of CNS vertigo?

answer

other brainstem or cranial nerve findings

question

What is the Barany maneuver?

answer

The patient is seated with the head turned to the right and is quickly lowered to the supine position with the head over the edge of the examination table 30 degrees below horizontal. The test is then repeated with the head turned to the left. The test is positive if symptoms are reproduced. It is a test for true vertigo.

question

What does orthostatic positional changes that bring on dizziness suggest?

answer

-dehydration, anemia, cardiac causes

question

What are the medications used to treat labyrinthitis, vestibular neuronitis, and BPV?

answer

meclizine, dimenhydrinate, antiemetics, and benzodiazepines

question

What is the Epley maneuver?

answer

It is a test for BPV. Rotate the patients through a series of positions in an attempt to relocate the debris in the semicircular canal into the vestibule of the labyrinth.

question

True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location, pulsatile quality, moderate to severe intensity, or aggravation by movement. They must also be associated with one of the following symptoms: nausea, vomiting, photo or phonophobia. They last between 4-72 hours and may be accompanied by an aura.

answer

True

question

Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.

answer

tension headache

question

Name the type of headache: severe, unilateral, localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation, rhinorrhea, ptosis, miosis, nasal congestion, and eyelid edema; attacks occur every day, 1-8 days times per day, for 15 to 90 minutes, for 4-6 weeks. More comon in men.

answer

cluster headache

question

Name the type of headache: The patient chronically uses analgesic or antimigraine drugs, esp. those with caffeine

answer

analgesic headache

question

What diagnosis does the "worse headache of my life" suggest?

answer

subarachnoid hemorrhage

question

What are the signs of cerebral hemorrhage?

answer

-acute headache, ataxia, profuse nausea, and vomiting

question

What are the signs of acute sinusitis?

answer

-fever with frontal or maxillary tenderness

question

What are the signs of malignant hypertension?

answer

-high blood pressure, focal neurologic defecit, or papilledema

question

When is a lumbar puncture contraindicated?

answer

When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

question

What does treatment for migrans include?

answer

-triptans, ergotamine, DHE (emergency); prophylaxis- beta blockeres, tricyclic antidepressants, CCBs, anticonvulsants, serotonin antagonists, MAOIs; avoidance of stress, alcohol, caffeine, tyramine (red wine and cheese), nitrates (cured meats), artificial sweeteners

question

What are the indiciations for neuroimaging?

answer

-headache of recent onset (<6 months) -headache beginning after 50 years of age -worsening headaches -headache that does not fit primary headache pattern -associated seizure -focal neurologic signs or symptoms -personality change -severe headaches unresponsive to therapy -history of significant trauma -new headache in a cancer patient

question

Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?

answer

-temporal arteritis -biopsy of the temporal artery

question

True or False: hyperthyroidism, pheochromocytoma, anemia, dehydration, hypovolemia are non-cardiac causes of palpitations.

answer

True

question

What are the symptoms of palpitations?

answer

lightheadedness, dizziness, syncope

question

Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.

answer

paroxysmal atrial fibrillation or supraventricular tachycardia

question

Name the diagnosis: isolated extra or pounding beats; often disappear with excertion

answer

premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

question

Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias

answer

Wolff-Parkinson-White syndrome

question

When should a patient get a stress test?

answer

When the patient has symptoms in association with exercise or who describe chest pain or pressure

question

What is the difference between a Holter monitor or an event monitor?

answer

Holter monitor: 24 hours, detect an arrhythmia; patient keeps a log of symptoms Event monitor: can be carried for 30 days or more and are patient activated at the time of symptoms; event recroding ca nbe transmitted by telephone to a monitoring symptoms

question

When should invasive eletrophysiologic study should be considered?

answer

in syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

question

What are the three major risk factors for heart failure?

answer

hypertension, CAD, valvular heart disease

question

What is the preload?

answer

aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

question

What is afterload?

answer

the resistance against which the heart contracts and is clinically reflected by systolic blood pressure

question

What are signs of pulmonary congestion?

answer

orthopnea, paroxysmal nocturna dyspnea, rales, jugular venous distention, and edema

question

What the consequences of decreased cardiac output?

answer

-activation of the RAAS, increased levels of catecholamines, secretion of atrial natriuretic hormone -This leads to vasoconstriction, fluid retention, increased afterload, which further inhibits cardiac output -late changes are mycoardial and vascular remodeling and fibrosis

question

What are the consequences of diastolic dysfunction?

answer

-higher filling presure, pulmonary congestion, and decreasd cardiac return

question

What are symptoms are CHF?

answer

dyspnea, orthopnea, paroxysmal nocturnal dyspnea, nocturia, edema, weight gain, fatigue, chest pain, abdominal pain, anorexia, mental status changes

question

What are the physical exam signs of CHF?

answer

-jugular venous distension: elevated venous pressures -PMI is displaced laterally and downward: cardiomegaly -bibasilar rales -third and fourth heart sounds: fluid overloaded, stiff ventricles -murmurs: valvular pathology -hepatomegaly: right sided heart failure, venous congestion -lower extremity edema --> stasis dermatitis

question

How does CHF present on X-ray?

answer

-cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

question

How does systolic vs. diastolic heart failure present on the echocardiogram?

answer

systolic dysfunction- ejection fraction is reduced to less than 45% diastolic dysfunction- ejection fraction is preserved or high; use doppler techniques- abnormal flow across the mitral valve

question

What should blood work include for suspected heart failure?

answer

-CBC, UA, electrolytes, BUN, creatinine, albumin, TSH -BNP: elevated in CHF

question

What is the goal of CHF treatment? What drugs should be used?

answer

-reduce symptoms, prevent complications, improve survival -diuretics, ACE inhibitors (slow progression of heart failure, decrease the number of hospitalizations and decrease mortality), beta blockers (decrease mortality and sudden death), spironolactone, digoxin

question

Name the microorganism: folliculitis, cellulitis, furuncles (abscess/ boil), bullous impetigo and staphylococcal scaleded skin syndrome

answer

S. aureus- beta hemolytic streptococcus

question

Name the microorganism: impetigo, erysipelas, cellulitis, lymphangitis

answer

Streptococci

question

What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?

answer

HSV1: oral HSV2: genital -primary infection: transmitted by respiratory droplets or by direct contact with an active lesion or infected secretions -secondary phase: reactivation of the latent virus from dorsal root ganglia -grouped vesicles on an erythematous base and is uniform in size

question

Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution, starting at the trunk and spreading to the face and extremities. Lesions appear as a "dewdrop on a rose petal" with a thin-walled vesicle, clear fluid, and a red based. Appear as constellations of lesions in different stages at the same time. Can cause cutaneous reactivation of varicella typically involving the skin of a single dermatome

answer

Varicella virus

question

Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma

answer

HPV

question

Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation, scratching, or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored, dome shaped papules occurring on the face, trunk, axillae, and extremities in children and in the pubic and genital areas in adults

answer

molluscum contagiosum- pox virus

question

Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum), the hair and the nails

answer

dermatophytes i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

question

Name the diagnosis: live in the mouth, vaginal tract, and gut; produce budding spores, pseudohypahe (elongated cells), or true hypae

answer

Candida albicans

question

Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched, the mites can migrate to other areas such as the finger webs, wrists, extensor surfaces of the elbow and knees, axillae, breasts, waist, sides of hands and feet, ankles, penis, buttocks, scrotum ,and palms and soles of infants. Transmitted by direct skin contact with an infected patient.

answer

Scabies

question

What are the three types of lice?

answer

Pediculus humanus capitis- head louse P. humanus corporis- body louse Phthirus pubis- pubic or crab louse

question

Name the skin lesion: honey colored crusts

answer

Impetigo

question

Name the skin lesion: erythema, warmth, edema, pain, fever

answer

cellulitis

question

Name the skin lesion: pustule in association with a hair follice

answer

folliculitis

question

Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions

answer

furucnle

question

What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?

answer

Staphylococcal scalded skin syndrome

question

Name the skin lesion: small tumors of the skin that obscure normal skin lines, have a mosaic surface pattern, and may have thrombosed vessels appeairng as black dots on the surface

answer

Warts

question

What does the classic ring worm lesion have?

answer

a central clear area

question

How are fungal infections diagnosed?

answer

with a KOH wet mount preparation

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