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139 Cards in this Set

  • Front
  • Back
When should you vaccinate a pregnant woman against MMR?
Immediately after delivery
Minimum age to vaccinate against influenza?
6 months
What is the maximum recommended age for HPV vaccine?
26+
When should you start screening a chronic smoker for lung cancer by CT or CXR?
Never
At what age should routine mammograms be recommended?
50
What cardiac evalulation should be done for an obese type 2 DM prior to invasive surgery?
Noninvasive stress test
What antibiotic should be used for prophylaxis against traveler's diarrhea?
NONE
What should you recommend to a woman who has elevated BP secondary to OCP?
Switch to barrier method
What is your recommendation to a woman who missed an OCP pill and had sex in the past 5 days vs greater than 5 days ago?
Less than 5 days: emergency contraception; greater: double pill
Best way to motivate someone to stop smoking?
Provide evidence of positive results of stopping
What should a physician do when treatment is futile?
Stop treatment, let patient die
What drug is great at relieving dyspnea?
Opiates
How should you treat fatigue in a person with end stage cancer?
Methylphenidate
What is a reliable sign that death is imminent in a terminal patient?
Decreased communication
What medication is good for treating a death rattle?
Atropine
Guideline for alcohol intake in men, women, and elderly?
Mne: 14 per week, no more than 4 per occasion; women: 7 per week, no more than 3 per occasion; elderly: 1 per day
What quality of pain is most likely to suggest a need for emergent evaluation?
Rapid onset
What are alarm symptoms that indicate upper endoscopy?
Dysphagia, odynophagia, weight loss, bleeding, vomiting
What is the initial test for cholecystitits? Choledocholithiasis?
Ultrasound; ERCP
Is alcohol abuse or gallstones the most common cause of pancreatitis?
Gallstones
Patient has atypical squamous cells of undetermined significance and a positive HPV; next step of management?
Colposcopy
What is the treatment for early Lyme? Late lyme?
Doxycycline 14-21 days; ceftriaxone IV 2-3 weeks
What bug tends to have a distribution located at waist, on wrists, and in between fingers?
Scabies
What is the likely distribution of flea bites vs bedbugs?
Fleas: clusters of 3 on legs; bedbugs: upper body
Deep cat bite to hand; management?
Hospitalization
How do you differentiate a fibroadenoma from fibrocystic change?
Adenoma is painless; fibrocystic painful on palpation
Solid nonmobile breast mass with a negative mammogram; management?
Ultrasound and biopsy
What ECG feature is most suggestive of acute MI?
ST elevation > 1 mm
Best laxative to use for chronic constipation?
Psyllium (bulk forming)
Best laxative to use for acute constipation?
Bisacodyl (motility)
Most common cause of chronic cough in nonsmokers? Smokers?
Postnasal drip from allergic rhinitis ; chronic bronchitis
Best treatment for postbronchitis cough?
Oral steroid taper
What is the Dix-Hallpike manuever used to determine? What are the two result types?
Central vs peripheral vertigo cause (stroke vs bpv); if nystagmus is immediate and change in direction with mild sx it is STROKE, if nystagmus is delayed onest by 3-10 seconds with same directiona nd severe symptoms it's peripehral (BPV)
Most likely dx in a woman with back pain, urinary frequency, hematuria, dysuria, no fever?
Acute bacterial cystitis
When do you nee dto do a urine culture in simple cystitis?
When dipstick is negative
Woman has recurrent UTIs after sex; tx?
Single dose antibiotic after sex
Acute onset urinary frequency, urgency, moderate bnack pain in a male; febrile and acutiely illw ith no penile discharge; dx?
Acute prostatitis
Initial treatment for TMJ?
NSAIDs
What are common medications that cause peripheral edema?
NSAIDs, beta blockers, CCBs
Bilateral edema in patient with noraml heart and liver; dx?
Nephrotic syndroem; do urinalysis
23 y/o woman presents with fatigue, lack of energy/tiredness but no hypersomnolence or weakness; dx?
Depression
How do you treat external vs internal hemrrhoids?
Internal: banding; external: excision
What antidepressant can be used for migraine prophylaxis?
TCA
What drug is used for cluster headache prophylaxis?
CCBs
Bilateral headache that lasts several days, pressure around forehead, not sensitive to sound; dx? Tx?
Tension headache; NSAID
Painless hematuria in an adult; dx?
Bladder cancer
Best drug for middle of the night insomnia?
Zaleplon
Asymptomatic bacturia in elderly woman; management?
Do nothing
Urge to void folowed by involuntary los sof urine; dx?
Urge incontinence (common in elderly)
Treatrment of choice for urge incontinence?
Oxybutynin (anticholinergic)
Treatment of choice for stress incontinence?
Muscle strengthing; alpha agonsits (pseudoephedrine)
What antihypertensive medication causes urinary urgency? Just leakage?
Urgency = beta blockers; leakage = alpha blockers
When should you do MRCP?
Choledocholithiasis with negative ultrasound
14 y/o female with no seondary sexual development; dx?
Gonadal dysgenesis
Female with elevated DHEA and testosterone; next step in management?
Ultrasound of ovaries, CT of adrenals
Hyperalert confusion is a withdrawal symptom from what drug?
Alcohol
Should you do a CT or MRI for a spinal disc herniation?
MRI
When should you get a C-spine radiography?
After any major MVA, regardless of symptoms
Neck compression test (pt turns head toward side of pain while tester exerts downward pressure) that displays only discomfort; dx?
Mechanical neck pain
What is Spurling test produces sx in uppe rextremity?
Nerve root injury
What differentiates PSVT from Afib?
Rapid and regular vs rapid and irregular rates
32 y/o woman with skipped heart beats and normal ECG; next step in management?
Reassurance
What imaginag test is most sensitive for endometriosis?
MRI > ultrasound
Patient has recurrent pharynigits and positive strep test; thought to be colonized; but is currently assymptomatic; tx?
Do nothing, carrier state doesn't have need for treatment
Four features of strep pharyngitis screen?
Tonsillar exudates, anterior cervical LAD, lack of cough, fever
Most common cause of epididymitis in a sexually active young adult? Monogomous older adult?
C. trach vs gram negatives (enterobacter)
Does not washing your face aggravate acne?
No
Treatment of mild acne? Moderate acne? Severe acne?
Mild: antibiotics, benzoyl, retiniods (all topical); moderate: oral antibiotics, topical retinoids/benz; severe: oral isotretinoin
What medication should be discontinued when a patient starts isotretinoin? Why?
Tetracyclines; both cause pseudotumor cerebri
Best treatment for severe rosacea?
Oral antibiotics
How do you differentiate a keratoacanthoma from basal cell carcinoma?
Keratoacanthoma occurs over weeks, basal cell is very slow growing
Best treatment for localized psoriasis? Generalized psoriasis?
Local: topical steroids; systemic: methotrexate/retinoids
Most common cause of impetigo in a child?
S. aureus > GAS
Treatment of hot tub folliculitis?
Reassurance and follow up; self limited
Pt with bacterial conjunctivitis fails topical cipro treatment; next step?'
Oral TMP-SMX for MRSA
A cyclist presents with lateral knee pain; dx?
Illeotibial band syndrome
Pt has twisting injury of knee, a pop, and immediate effusion but can still bear weight; dx?
ACL tear
When should you get an X-ray for an ankle sprain?
Patient unable to walk, tenderness over malleoli and tibi/afibula, tenderness over 5th metertasral; midfoot tenderness
Best initial test for a patient with syncope?
ECG
When should you do a tilt table test in syncope workup?
Negative ECG, 24 hour holter mointoring
What is the only Parkinson's drug that delays progression rather than provide purely symptomatic relief?
Selegiline
Most common cause of rhinorrhea, low grade fever, and wheezing in an infant?
Viral URI
Patient has first episode of wheezing; best initial test?
CXR
Most sensitive and specific tests for alcohol abuse?
Sensitive: GGT: specific: mcv
22 y/o man has low back pain, no traumatic event, no pain w/ movement, no radiation; dx?
Spondylolithesis
Person with seizure disorder and unstable angina wants to quit smoking; best therapy?
Varencicline (buprpropion contraindicated for seizures, nicotine patch contraindicated for unstable angia)
Pt has asthma symptoms 4 times a week; what type of asthma is this?
Mild
Most common cause of back pain in patients younger than 26?
Spondylolisthesis
Before going to opiods, what should you add to NSAIDs for chronic low back pain?
TCAs
Best test to detect renal insufficiency?
Lower GFR
First sign of chronic renal failure?
Anemia
Patient is having pain despite long acting opiods; next step?
Don't increase dose, switch to new opiod
First like treatment of CHF
are ACE inhibitors
What is the effect of donepezil on the progression of Alzheimer's?
no effect
What is the lowest blood pressure at which ACE-I can be used w/ diabetics?
100
Does exercise or weight loss have a greater effect on HDL levels?
Exercise
What is post exposure prophylaxis for HIV need stick?
At least 2 drugs + immediate testing for HIV antibodies
How often should women with HIV be screened w/ PAP smears?
Every 6 months
What is the initial therapy for a patient with stage I vs II HTN?
I: HCTZ; I: two drug therapy (HCTZ + ACE)
Patient has newly diagnosed HTN, best next test to perform?
ECG
What diuretic combination lowers stroke risk?
ACE + HCTZ
What osteporosis tx has anaglesic effects/
Calcitonin
Drug of choice for PTSD?
SSRIs
What blood tests should be done before DX of ADHD?
TSH, serum lead, blood chemistry
What are the two most common sx of hyperthyroidism?
Tachycardia, fatigue
Safest stimulatant laxative?
Senna
Chlorine resistant organisms?
Cryptosporidium, Giardia, entamoeba
20 year old w/ fatigue, weightloss, fever, diarrhea for 2 months, palpable RLQ mass; dx?
Croh'ns disease
22 year old female, weight loss, mild abdominal pain, significant diarrhea of 2months duration; anemia; dx?
Celiac disease
Common non-gastric presentations of Celiac disease?
Anemia, osteporosis
Most likely complication after gastric bypass surgery?
Iron and B12 deficeincy
Painful vesicular rash in a wrestler; dx?
Herpes gladitorum
What's the difference between urge and stress incontinence?
Stress: due to positional movement/cough/sneeze; urge: lack of desire to urinate, become distended
Woman with temperature instability 24 hours after treatment for pyelo; what do you do?
Continue current treatment until 72 hours; then check for obstruction/abscess
Female w/ dysuria nad pyuria in presence of negative culture for uropathegens; dx? Tx?
Urethral syndrome due to chlamydia/ureaplasm; tx w/ doxycycline/levofloxacin
Elevated LDL levels are associated with what thyroid condition?
Hypothyroidism
What antidiabetic medication is contraindicated w/ gastroparesis?
Exenatide
When should women be screened for gestational diabetes?
24-28 weeks
What should you do with hypothyroidism associated with infection/major surgery?
Monitor; follow up after recovery (likely not true hypothyroid)
What are indications for cardiac resynchronization therapy with CHF?
At maximum medical therapy with ejection fraction <30%, LV ED diameter > 55, QRS > 130 msec
What is the benefit of omega-3 fat?
Decreased sudden cardiac death
Gudeline for screening abdominal aortic aneurysms?
Male 65-75 who have ever smoked
What anticoagulant should have dosage reduction w/ renal failure?
Enoxaparin
What does new onset LBBB indicate?
LAD occlusion; indication for thrombolytic therapy
Recent MI with new onset LBBB
Thrombolytic therapy (LAD occlusion)
Significant predictor of peri/intraoperative arrhythmia?
CHF, vetnricular ectopy, hx of smoking
At what size do you operate on AAA?
5.5 cm
Contraindications for beta blockers in heart failure?
Hemodynamic instability, heart block, bradycardia, and severe asthma
What drug is contraindicated with cocaine induced arrhythmias?
Beta blockers (exacerbate vasoconstriction)
What condition is contraindicated w/ cilostazol?
CHF
Presentation of a periplymphatic fistula; cause?
Vertigo not associated w/ nausea, vomiting, or positional changes that is aggravated by sneezing/coughing; caused by barotrauma (scuba diving)
Discrete, round, yellow-white despits in the retina; dx?
Macular degeneration
Leading cause of blindness over age 65?
Age-related macular degeneraiton
Tarsal coalition
is the fusion of two or more tarsal bones. It occurs in mid-to late adolescence and is bilateral in 50% of those affected. Pain occurs around the ankle, and there is decreased range of motion of the hindfoot and pain on foot inversion on examination.
Os trigonum
Results from non-ossification of cartilage. It usually is unilateral and causes palpable tenderness of the heel.
Sever’s apophysitis
is inflammation of the calcaneal apophysis, and causes pain in the heel.
Plantar fasciitis
causes tenderness over the anteromedial heel.
Navicular stress fractures
are tender over the dorsomedial navicular.
What can aggravate the pain of lumbar spinal stenosis?
Walking downhill, spine extension