Family Medicine Pretest Flashcards I

Front 1

Hep B vaccine schedule

Back 1

birth
1-2 mo
6-18 mo

Front 2

Is vzv more effective in over 13 or under?

Back 2

under; therefore 2 doses requ'd if over 13, and given 4-8 wks apart

Front 3

is zoster more common among natural infected or immunized w/ vzv vaccine?

Back 3

naturally infected

Front 4

hep B vaccine for?

Back 4

nonimmune ppl at high risk:
men having sex w/men
sex workers
drug users
prison inmates
hemodialysis
households of carriers
h/c workers
endemic regions

Front 5

Hep A vaccine for?

Back 5

men having sex w/men
illegal drug users

Front 6

meningitis vaccine for?

Back 6

functional asplenic
travelers to endemic areas
college aged

Front 7

when not give rubella vaccine for woman?

Back 7

if preg
if planning to be preg in 4 wks.
give directly after delivery

Front 8

are Td booster shots req'd for clean minor wounds?

Back 8

no ; but for
contaminated or deep wounds, if last Td was given over 5 y/ago
if no vacc history or history unclear, give immunoglobulin also

Front 9

when start lipid screening?

Back 9

age 35 or younger if fam hx or other risk factors

Front 10

when start crc screening?

Back 10

age 50 or 10 y/ before age of death of family member from crc (ie if father died at 50, start at age 40)

Front 11

age to start mammogram screening?

Back 11

every 1-2 years starting at 40;
every 1 yr from 50 on

Front 12

when start cerv cxr screening (pap smears)? when discontinue?

Back 12

age 21 or 3 yrs after first sexual activity
discontinue at 70 or if had 3 documented normal smears and no abnormal findings in past 10 yrs

Front 13

major predictors of perioperative CV risk?

Back 13

severe heart valve disease
MI recent
unstable/severe angina
decompensated heart failure
high grade A/V block
symptomatic arrhythmias with underlying disease
SVT's w/ poorly controlled ventricular rate

Front 14

obesity causes what adverse post operative outcomes?

Back 14

Doesnt!
those that do include:
low fxnal capacity of lungs
type 2 DM
Hyperlipidemia
Congestive heart failure

Front 15

pre operative creatinine levels should be takenf or whom?

Back 15

surgery w/ high risk of bleeding
pt over 50
chance of hypotension
nephrotoxic meds given

Front 16

age for preoperative ECG to be done?

Back 16

men over 45
women over 55
(and for any underlying cv disease or disease related to CV ie DM, etc)

Front 17

m/c cause of death in international travelers?

Back 17

heart disease
then:
accidents,
etc

Front 18

recommended prophylaxis for traveler's diarrhea?

Back 18

NOT ab's but
cautionary measures
for TX, give cipro

Front 19

legally required vaccines for travelers?

Back 19

Yellow fever ( if going where it's endemic)
Polio (inactivated) if going where it's endemic

Front 20

yellow fever may cause?

Back 20

complications of encephalitis or syndrome resembling wild-type yellow fever...

Front 21

what vaccines do you not give to preggers or i/c pts?

Back 21

live ones:

Yoo Must not give:

Yellow fever
Oral Polio
Oral Typhoid
MMR

Front 22

if pt has contionuing elevated BP after starting combination oral contraceptives, what to do?

Back 22

stop OC's....bp should return to normal

Front 23

m/c reason for stopping OC's?

Back 23

irregular bleeding -
(but this usually stops after 3 months)

Front 24

progestin-only pill use?

Back 24

use for any pt with hx of dm, venous thrombosis, pulm embolism, obesity, or htn, bc these pills do NOT increase risk for TE..!
but must give w/NO hormone free period: contraception may be compromised if even 3 hr delay in taking pill!

Front 25

progesting-only pill and ectopic preg?

Back 25

think: like IUD:
lower overall rate of ectopic preg b/c lower rate of preg; but IF preg, higher risk of ectopic

Front 26

don't give IUD to whom?

Back 26

woman w/ multiple sexual partners

Front 27

what to give to woman over 35 smoker who wants contraception but cant have IUD b/c has multiple sexual partners?

Back 27

progestin-only pill or long-acting progestin form

Front 28

Does emergency contraception disrupt an already implanted pregnancy?

Back 28

no...also do not cause birth defects

Front 29

3 types of emergency contraception?

Back 29

Progestin only pill (levonorgesterol, one large dose)
Yuzpe method (2 large doses of e and p, 12 hrs apart; thought to be less effective as above)
Mifepristone = RU486 if given before implantation (but not approved in US b/c can ALSO disrupt implantation therefore is ALSO an abortifacient if given after / around implantation)

Front 30

what are contraindications to emergency contraception?

Back 30

none except: allergy/hypersensitivity to pill components

Front 31

Open or closed questions lead to most accurate info?

Back 31

open

Front 32

if pt is extremely angry, what should you say to him?

Back 32

"you seem furious"
is "better" thank
you seem a little angry (may make things worse)
??

Front 33

how to begin telling person bad news?

Back 33

say "I'm afraid I have some bad news for you"
helps them prepare for it rather tahn asking: what do you know about (HIV)? is essentially giving them the dx w/o letting them prepare.

Front 34

illnesses of native americans?

Back 34

Diabetes
Obesity
Suicide
Alcoholism

Front 35

what type illnesses are homeless children more likely to get than normal pop?

Back 35

acute ie ear infections

Front 36

what ethnicity is highest percent of uninsured?

Back 36

hispanics; 1/3 , and is growing

Front 37

uninsured have more or less chronic health conditions?

Back 37

less

Front 38

mental health disorders are dx'd more or less frequently in minorities?

Back 38

More, but have more misdiagnoses of mental health in minorities too due to inaccurate screening/ language barriers/ etc

Front 39

tx for uncomplicated UTI ? in pregger?

Back 39

ciproflox or tmp-smx
in pregger don't give!
give: cephalexin = first gen ceph

Front 40

3 principles of professionalism in medicine

Back 40

primacy of pt welfare
social justice
pt autonomy

Front 41

gingko is used to tx what alternatively?

Back 41

dementia

Front 42

st john's wort is used to tx what alternatively?

Back 42

depression

Front 43

saw palmetto is used to tx what alternatively?

Back 43

BPH - works as good as finesteride, but doesn't shrink its size

Front 44

what can st john's wort cause?

Back 44

serotonin syndrome if mixed w/ SSRI like paroxetine, etc

Front 45

what adverse effect can gingko biloba cause?

Back 45

antiplatelet and bleeding if taken with aspirin

Front 46

when should you ever use fentanyl patch in pt who hasn't yet tried opoids?

Back 46

never

Front 47

when to introduce patient-controlled opoid analgesics?

Back 47

only when pain is severe; b/c involves iv/ subq admin

Front 48

oalliatave tx for pain, not responsive to analgesics / nsaids?

Back 48

give morphine sulfate, immediate release, to detmn baseline need, then titrate for most effective dose or add sustained release after

Front 49

whats the specific limit to opoid use? what's more common, tolerance or addiction to opoids in terminal pts?

Back 49

there is none;
both are UNCOMMON...don't fear giving more opoids to terminal pt unless is a previous drug user.

Front 50

neruopathic pain relief ( ie dm neuropathy or vzv shingles long term px?)

Back 50

give anticonvulsants OR TCA's (amitryptiline) OR SNRI's (not ssri's)

Front 51

dyspnea due to cxr ie lung, may be txed with?

Back 51

opoids!

Front 52

excessive fatigue due to cxr may be tx'd with?

Back 52

psychostimulant ie methylphenidate
or steroids

Front 53

"most useful sx" to detmn depression in terminal cxr pt?

Back 53

anhedonia
other sx ie insomnia, fatigue may be due to meds or disease; sadness may be expected

Front 54

what's a better indication of impending death? delirium or decreased attention span?

Back 54

delirium is not, b/c can be caused by meds. decr attention span, decr oral intake, decr hearing, etc are.

Front 55

tx for death rattle (labored breathing before death)?
for pain before death?
for agitation/hallucinations before death?
for restlessness before death?

Back 55

atropine, scopolamine, or morphine
px = ketorolac
agitation/hallucinations = haloperidol, thorazine
restlessness= benzodiazepine

Front 56

tx for anal HPV warts in homosexual men?

Back 56

cytol screening for anal mucuosa dysplasia.
Not valcyclovir = tx for Herpes

Front 57

gay men have incr incidence of what cancer?

Back 57

anal = due to HPV infection, dysplasia, etc like cervical cxr

Front 58

what disease is more common among lesbians than heterosexuals?

Back 58

bact vaginosis.

Front 59

do lesbians have higher/lower rates of HIV than heterosexuals?

Back 59

higher

Front 60

br cxr rates among lesbians?

Back 60

same as that among heterosexuals

Front 61

transgender vs transsexual?

Back 61

transgender = anyone trying to cross gender line in a culture ( ie crossdressing, etc counts)
transsex = someone wishing to change sex and undergoing surgery for it

Front 62

elderly with bilat mild lower abd px, and fever...dx?

Back 62

acute appendicitis!
in elderly, only 20% present with classic signs

Front 63

renal calculi may radiate to where?

Back 63

shoulder (while gallstones = shoulder blade/scapula)

Front 64

which is more specific, lipase or amylase?

Back 64

lipase; if > 3x normal, is sens and specific

Front 65

tx of hpv benign veneral warts?

Back 65

aldara (imiquimod) = immune modulator

Front 66

ASCUS finding on pap smear...what next?

Back 66

either :
1) repeat 4-6 mo
then if + --> colposcopy
if - --> repeat in 4-6 mo --> if - go back to annual pap smearing
2) do HPV dna test: if + --> colp
3) proceed direclty to colp

Front 67

if ASCUS + LGIL, what next?

Back 67

colposcopy

Front 68

If Atypical Glandular Cells on pap smear, what next?

Back 68

check what origin - if endom = do endom biopsy; if endocerv, ok

Front 69

ice craving in woman?

Back 69

iron def

Front 70

things that inhibit iron absorption?

Back 70

basic materials like antacids, calcium,
tannins of tea, wine, and soy proteins

Front 71

distinguish iron def anemia from thalassemia?

Back 71

both have anemia, low MCV, but IDA has INCREASED RDW (mix of norm and microcytic) and low RBCs while Thal has LOW-NORM RDW and high RBC count

Front 72

glossitis seen in what anemias?

Back 72

macrocytic = folate or B12;
if also neurolog def, = B12

Front 73

only type of diet that can really cause vit B12 def outside of malabsorption, fish tapeworm, etc?

Back 73

vegan

Front 74

prevention of pain crisis in sickle cell? tx if crisis?

Back 74

maintain adequate O2 and hydration; for Tx, give analgesics and hydration too

Front 75

intensely itching papules in between fingers, toes, buttocks, elbows, waist area, genital area, and under the breasts in women

Back 75

scabies

Front 76

small bites on warm areas of body, ie areas covered by socks and shoes, behind the knees and around the groin are often trouble spots

Back 76

chigger bites

Front 77

diff b/w fibroadenmoas and breast cysts of fibrocystic changes?

Back 77

fibroadenomas arent usually tender

Front 78

which is more indic of cxr: breast discharge that's bloody or spontaneous discharge?

Back 78

spontaneous is worse, (but still workup a bloody discharge)

Front 79

BIRADS numbers after mammography mean what?

Back 79

0 = test incomplete
1, 2 = benign
3 = probably benign, need mammogram in 6 mo
4,5 = suggest cancerous = needs tissue sample

Front 80

cat bite = what common bacteria?

Back 80

pasteurella multicoda

Front 81

hot tub folliculitis = what bact?

Back 81

pseudomonas

Front 82

use benzoyl peroxide for what type acne?

Back 82

Inflammatory, not for just open/closed comedones = just use topical retinoids

Front 83

where does tinea cruris appear?

Back 83

groin

Front 84

diff b/w sx of asthma and PE in a young woman?

Back 84

pain is abrupt onset in PE

Front 85

what drugs must be stopped before stress test, and for how long?

Back 85

any BBlockers; for 4-5 halflives = 48 hrs

Front 86

if bronchodilator and antitussives don't work, how to tx acute bronchitis?

Back 86

inhaled CS's or oral tapered Cs's, NOT AB's

Front 87

tx of pertussis?

Back 87

azithro for 5 days...doesnt shorten course but prevents transmission

Front 88

vertigo vs disequilibrium sensattion?

Back 88

v = room spinning around pt
d = unsteadiness

Front 89

acoustic neuroma sx vs vestibular neuronitis vs benign positional vertigo vs Meniere's disease??

Back 89

an = starts w/unilat hearing loss and tinnitis, then gradual lfacial weakness, ataxia, and vertigo
vnitis=acute sever vertigo lasting days, then improving over weeks
bpv= v w/position changes only
Md= discrete attacks of vertigo for hours, + nauseas, vomiting, hearing loss, and tinnitis.

Front 90

what is one of the only causes of central vertigo?

Back 90

stroke

Front 91

tx for peripheral vertigo

Back 91

antihistamine ie diphenydramine or meclizine: suppress vagal response (anticholinergic effect)
then antiemetics if nausea, vomiting also

Front 92

BNP levels and CHF?

Back 92

if < 80pg/mL, can say w/ up to 99% certainty that CHF is NOT cause of sx

Front 93

when to get urine culture and when not to for symptomatic female?

Back 93

if urine dipstick is neg or inconclusive, then DO culture to confirm.
if dipstick is + or microscopic analysis is +, don't need to do culture, just tx

Front 94

tx for recurrent uti, that is susc to ab tx?

Back 94

give single dose ab's directly after sexual intercourse (85% of utis occur directly after intercourse)
if this doesn't work, give prophylactic single dose daily ab's for 3-6 mo

Front 95

recurrent dysuria + hematuria, small bladder capacity, urge to void on very small volume , ulceration and fissure on cystoscopy?

Back 95

interstitial cystitis ;

Front 96

cause of dysuria in female post menopausal? pre?

Back 96

post = bladder atrophy
pre = irritant ie caffeine, acid in urine;
if + hematuria = interstitial cystitis

Front 97

back px, fever, frequency, urgency in male?

Back 97

think acute bacterial prostatitis before pyelonephritis/cystitis or urethritis

Front 98

tx for TMJ?

Back 98

NSAIDS, rest from chewing, etc ;
if this doesn't work, refer to dentist for bite-guard

Front 99

reliable vs unreliable findigns for acute otitis media?

Back 99

reliable: bulging, impaired motility, opacity (loss of light reflex; indicating purulent effusion)

purulent discharge
unreliable: redness of tm (could be just due to crying)

Front 100

pathogen of otitis externa? tx?

Back 100

m/c caused by staph / strep. I f swimmer's ear, pseudomonas.

tx = topical AB's +/- flushing

Front 101

diabetic drugs that cause peripheral edema?

Back 101

rosiglitazone = insulin secretagogue

Front 102

is a disorder of adipose tissue distinguished by five characteristics: 1) it can be inherited; 2) it occurs almost exclusively in women; 3) it can occur in women of all sizes, from the seriously underweight to the morbidly obese; 3) it involves the excess deposit and expansion of fat cells in an unusual and particular pattern – bilateral, symmetrical and usually from the waist to a distinct line just above the ankles; and 4) unlike the “normal” fat of obesity, lthis fat cannot be lost through diet and exercise. Surgery is highly controversial, and in many cases, can make the condition worse.

Back 102

lipedema = SPARES the feet

Front 103

bilateral edema workup ina woman?

Back 103

other sx of chd -> echo
+ ascities --> chekc lft's
if not, check urine for albumin/protein...if increased = notic syndrom or ATN
doppler --> venous insufficiency
or if unilat : doppler --> DVT
if erythema --> cellulitis

Front 104

tx of unilateral edema w/o other sx of chf, no trauma, or inflammation?

Back 104

=venous insufficiency. does NOT respond to diuretics or AI's...tx: give pt elastic stockings

Front 105

what percent of 5 y/o's are bedwetters? family hx and enuresis?

Back 105

25%, decr 15 % every year after.
if 1 parent did it, 40% chance...
if 2 parents did it, 70% chance

Front 106

should motivational measures with neg consequences be used for bedwetting?

Back 106

no...positive reinforcements ok.

Front 107

if pt wets bed, what look for first?

Back 107

check for constipation...if tx, it often tx's the enuresis.

Front 108

const delay
vs
familial short stature
in bone age vs height age?

Back 108

in const delay, bone age = ht age, and both are < actual age
in familial shortness, bone age = chron age, while height age is behind

Front 109

growth curves for kids: const delay, familial shortness, ftt, and hypothyroidism differences?

Back 109

familial shortness = ht and wt drop off together.
const delay and ftt: wt drops off before ht.

Front 110

most common cause of fatigue in primary care? (this presents as fatigue w/o weakness or hypersleeping)

Back 110

depression...
thenk look for pregancy, sleep apnea, anemia, hypoth, etc..

Front 111

rash after mono was incorrectly txed with amp; amoxy for strep?

Back 111

due to having mono and tx, NOT a pen / amp -allergy!!

Front 112

55 y/o african american male w/ fatigue w/ no explanation...what is included in workup?

Back 112

age/gender appropriate CXR screening!!
ie prostate screenw ould be approporiate
??

Front 113

painless, significant bleeding in 2 y/o?

Back 113

meckel's (#1 cause of significant bleed in children

Front 114

family clinic tx of internal hemorrhoid? external that's thrombosed (bleeding, very painful, nodular)

Back 114

internal = rubber band ligation or sclerotherapy
external = excision, under local anasthesia

Front 115

cluster vs migraine vs tension?

Back 115

migraine = usually more assoc w/ nausea...also may have aura. 4 hrs - 3 days
cluster - rhinorrea, sweating., 15 mins - 3 hrs

tension = no nausea, no vomiting, = 3hrs - 7 days; MOST COMMON
both may be unilat, or

Front 116

migraine prevention? migraine tx?

Back 116

prevention: amitryptiline or Bblocker.
tx: nasal triptan, ergotamine tx

Front 117

what tx should you never give for migraine?

Back 117

narcotics...

Front 118

what is the only ca ch blocker that may help prophylactically against migraine?

Back 118

verapamil

Front 119

cluster hache tx?

Back 119

long term- nifedipine during sx
for acute sx: INHALED ergotamine or injected sumatriptan or lidocaine during sx...not oral meds b/c takes too long to kick in

Front 120

red flags for headache?
what to do if red flag?/

Back 120

don't respond to first line tx
getting worse and worse
sudden onset
don't fit clinical causes of hache
w/ neurol deficits

...if red flag, send for imaging

Front 121

medications that may cause hematuria?

Back 121

penicillins, sulfonamides, phenytoin, cp, anticoags, nitrofurantoin.
NSAIDS cause kid probs but not hematuria (but wouldnt nsaid-induced TIN cause hematuria?-->no, would cause fever, oliguria, rash, and ARF; pyelonephritis causing TIN would cause hematuria, though)

Front 122

painless hematuria = m/c presentation of what?

Back 122

bladder carcinoma!!

Front 123

nephrolithiasis vs urinary stones sx?

Back 123

n = no pain, just hematuria (stones are inside kids)
u stones = pain, hematuria, etc

Front 124

what is terminal hematuria?

Back 124

bleeding just at the end of micturition = bladder neck or prostatic urethral lesion, NOT renal/bladder/ or even lower urethral lesion as all these would bleed throughout micturition

Front 125

tx for pt w/ hematuria, but normal IVP and urinalysis/creatinine, and urine culture?

Back 125

just reassurance and periodic monitoring, unless over 40 = do cystoscopy or renal biopsy

Front 126

causes of urinary incontinence w/ age?

Back 126

total bladder contractiliy decreases w/ age (overflow incont)
invol bladder contractions increase with age (detrusor hyperactivity = urge incont = m/c incont in elderly)
increased urogenital atrophy = decreased internal urethral sphincter sensitivity

Front 127

does asx bacteriuria cause incontinence in elderly?

Back 127

no, but sx bacteriuria may , as well as diuretics, stool impaction, atrophic vaginitis as well

Front 128

m/c type of incont in elderly

Back 128

urge incont (detrusor hypractivity)

Front 129

therapy for incont if behav approach is ineffective? for urge inc? for stress inc?

Back 129

urge:
anticholinergics = urinary retention.
give oxybutynin (ditropan) or tolterodine
stress: pseudoephedrine
prostatitis: tmpsmx
prostatic hyperplasia: finasteride, terazosin (alpha blocker to shrink prostate)

Front 130

m/c cause of primary amenorrhea

Back 130

gonadal dysgenesis ie turners

Front 131

m/c cause of 2ndary amenorrhea?

Back 131

pregnancy, then PCOS, hypoth dysfxn ie anorrexia, rapid wt loss, rig exercise, then hypoth (causes incr prolactin) or hyperprolactinemia

Front 132

tx for primary dysmenorrhea?

Back 132

nsaids, then if doesnt work, 2nd line = OCP's

Front 133

meds that may cause hyperprolactinemia

Back 133

benzos, ssri's, tca's, phenothiazines, buspirone, sumatriptan, valproate, ergot deriv's, atenolol, verapamil, mdopa, estrogens, and contraceptives..!!!

Front 134

if woman found to have high testosterone and dhea, what next?

Back 134

check for blind pouch vagina or no uterus = testicular feminization. if not, :
CT scanning of adrenals and US of ovaries to rule out neoplasm

Front 135

when is secondary dysmennorhea normal

Back 135

is not...is usually pathological

Front 136

describe px of endometriosis?

Back 136

starts several days before menses, amay last entire cycle!

Front 137

sx of leiomyomas?

Back 137

usually asx...except for bloating, mass, and excess bleeding (menorrhagia/metorrhagia). NOT pain usually

Front 138

how do OCP's tx dysmenorrhea?

Back 138

cause endom hypoplasia, and suppress menstrual fluid vol and pg release,

Front 139

abrupt onset is more indic of delirium or dementia?

Back 139

deliriium

Front 140

hyperalert confusion is sign of what w/drawal?
psychomotor slowing?

Back 140

alcohol w/d
amphetamine w/d

Front 141

person has vomiting 1-2hrs post meal, with non-bilious food still undigested coming back up? dx? tx?

Back 141

gastroparesis
tx = metoclopramide = antiemetic AND gastroprokinetic

Front 142

abd obstruction has what finding on phys exam?

Back 142

hypERactive bowel sounds +/- distension proximal to obstr

Front 143

vomiting early in the morning before eating...think what?

Back 143

incr ic pressure ie meningitis, space occupying lesion;
uremia
alcohol w/d
pregnancy!

Front 144

phenothiazine- waht is it for?

Back 144

is antipsych (ie chlorpromazine) and antihistamine
use as antiemetic in low doses
causes drowsiness, dry mouth, and dizziness

Front 145

side effect of prokinetic drug metoclopramide?

Back 145

works on 5HT3 and D2 receptors;
extrapyrimidal s/e's include: tardive dysk, parkinsonism
in addition to diarrhea (is prokinetic!), drowsiness

Front 146

if suspect ectopic preg, what would be changed w/ menses?

Back 146

no menses / abnormal bleeding instead

Front 147

posterior cervical lad is usually signifying what?

Back 147

EBV mono

Front 148

GAS may be distinguished from viral infection by what changes?

Back 148

more intense course;
plus UVEAL EDEMA

Front 149

to CLEAR a pt from chronic GAS colonization, what AB's to use?

Back 149

oral respiratory quinolone or oral clindamycin

Front 150

only outside factor that has been proven to play a role in acne?

Back 150

stress

Front 151

use to tx acne?

Back 151

FIRST LINE: **RETINOID (keratolytic)

...benzoyl per, or topical AB's NOT first line;
oral AB's may work
OC's may work
topical CS's may help

Front 152

side effect of retinoid may be?

Back 152

worsening acne! if so, stop ;
other s/es = jt pain, dry skin

Front 153

acne rosacea often affect what other organ? how tx?

Back 153

eye involvment ie styes, blepharitis, corneal surface disease.
tx w/ oral tetracycline

Front 154

pharm for psoriasis?

Back 154

topical cs's
dovonex = calcipotriene, = vit D derived keratocyte proliferation inhibitor

Front 155

tx for pityriasas rosea?

Back 155

cs's, antihist's

Front 156

tx for hot tub folliculitis?

Back 156

no AB!s...is self-limiting

Front 157

sx's of primary HSV1 inf? 2ndary?

Back 157

primary = gingivostomatitis, w/wo perioral skin lesions, fever, malaise, tender lad
secondary = perioral , crusting vesicular lesions; LESS severe

Front 158

tx for genital herpes?

Back 158

either tx each outbreakor use chronic suppression ie : DAILY valcyclovir (valtrex)

Front 159

in whom should tx for shingles be given if after 72 hours post sx started?

Back 159

in over 50, I/C, or eye involvement, still give.

Front 160

what does antiviral for vzv zoster do?

Back 160

shortens dur, DECR's PAIN..

Front 161

tinea capitis tx?

Back 161

Griseofulvin

Front 162

palpable preauricular l/n and pink eye?

Back 162

viral (adenovirus) conjunctivitis - is hihgly contagious but self-limited

Front 163

what is contraindicated in conjunctivitis tx?

Back 163

cs's

Front 164

vzv zoster eye inf?

Back 164

oral valcyclovir + antiviral eye drops!

Front 165

tx for viral conjunctivitis (non vzv/herpes)

Back 165

supportive, cold compresses, lubrication drops

Front 166

only conj that is medical emergency?

Back 166

gonorrheal conj...can lead to corneal ulceration or perforation w/in 24 hrs!!

Front 167

tx for subconjunctival hemorrhages

Back 167

actually outpatient, supportive, no drugs. should subside in days- week

Front 168

what sx is more suggestive of serious problem in conjunctivitis?

Back 168

pain

Front 169

tx for bact conjunctivitis (2)?

Back 169

1) normally = strep/staph = tx w/ tmpsmx ointment 3xday for 3 days
2) if pt wears contact, is probably gram -, so use gentamicin ointment

Front 170

bugs causing: otitis media, bact conjunctivitis, or sinusitis?

Back 170

All = SAME and same order = Strep pneum, staph, h. influenzae (not-typed = vacc doesn't cover), and Moraxella Catarrhalis, then Pseudonomas

Front 171

sx to suspect gonococcal conjunctivitis? NSIM?

Back 171

wiping away purulent d/c and it immediately forms again.

ophth referral immediately

Front 172

red eye, boring eye pain, and surrounding headache?

Back 172

scleritis,associated w/ rheumatoid arthritis, wegeners granulomatosis

Front 173

acute eye px, decr vision, and redness, dilated pupil? same but constricted pupil?

Back 173

acute glaucoma
iritis

Front 174

most specific sx for rhinosinusitis?

Back 174

Not sinus pain or dental pain!!
duration > 10 days is MORE specific!

Front 175

m/c bug for chronic sinusitis?

Back 175

polymicrobial

Front 176

def of chronic sinusitis?tx?

Back 176

sx > 3 mo
tx = cipro or amoxi/clav for 2-3 wks

Front 177

best drug for nasal congestion?

Back 177

topical nasal steroids

Front 178

AC type IV-VI requires what therapy?
type I-III?

Back 178

surgery b/c is full dislocation = more than 50% separation of the joint with a posterior displacement of clavicle.
types I-III may be tx'd with sling immobilization, exercises, and pain management

Front 179

what is patellofemoral syndrome? tx?

Back 179

M/C injury to knee in under 40 y/o's!
due to biomechanical tracking of patella lateral to the vastus lateralis muscle. tx = strengthening of vastus MEDIALIS and stretching of hamstrings to improve biomechanics

Front 180

twisting of knee, + "pop" + swelling but can still bear weight?

Back 180

ACL tear

Front 181

direct force to knee and post drawer sign?

Back 181

PCL tear

Front 182

knee injury causing pain plus locking, catching, or giving way ?

Back 182

= meniscus injury

Front 183

knee instability + lateral/medial vallus/ valgus movement beyond expected?

Back 183

lat or med COLLATERAL LIGAMENT tear

Front 184

McMurray's test?

Back 184

tests for meniscus tear: flex and extend knee while int/ext rotating the tibia

Front 185

Ottawa ankle rules indicate xray for what findings?

Back 185

can't bear weight on ankle
bone tenderness over distal 6 cm of tibia, fibula, or malleoli
mid foot or navic tenderness
tenderness over prox 5th metatarsal

Front 186

ischemia may present as what in a diabetic?

Back 186

silent mi! think about sx of diaphoresis, syncope as possible sx of MI in diabetic

Front 187

when do tilt-table testing for syncope?

Back 187

After workup for cardiac syncope (ecg, holter, ) and orthostat BP's are all done and normal.
If tilt table is -, think psychogenic and do psych workup

Front 188

tx for vag candidiasis?

Back 188

topical -azoles

Front 189

m/c cause of recurrent vag candidiasis

Back 189

reinfection from partner

Front 190

strawberry cervix...plus yellow green frothy vag discharge?dx?

Back 190

trichomonas vaginalis

Front 191

moth-eaten cells (pseudo-clue cells) on vag saline prep?

Back 191

acid-base disturbance of vagina

Front 192

HPV genital inf...tx?

Back 192

imiquimod = imodulating agent to

Front 193

wheeze, slight cough, and mild fever in 18 mo old?

Back 193

acute viral resp tract infection!!!!!!!!!
ONLY blitis if pt also has breathlessness

Front 194

any ACUTE sob + tachypnea...what must you rule out?

Back 194

PE!!

Front 195

first episode of wheezing must get what in workup?

Back 195

CXRAY!!

Front 196

recurrent wheezing and vomiting after feeding in baby...dx?

Back 196

infant GERD

Front 197

test for asthma pt coming in for increased SOB despite using his asthma meds...

Back 197

peak flow testing - helps monitor status of lung fxn...pfts are good but require a pft lab

Front 198

decreased sexual interest..what lab test?

Back 198

FREE testosterone

Front 199

causes of EJAC dysfxn?

Back 199

any sympathetic system antag...ie b blocker, or alpha blockers (terazosin)

Front 200

tx for prem ejac? ejac dysfxn?

Back 200

use something that raises threshold for orgasm...fluoxetine...

Front 201

tx for erectile dysfx?

Back 201

alprostadil (PGE2)
sildenafil (viagara = pde inhibitor)

Front 202

tx for ejac dysfxn?

Back 202

sex therapy

Front 203

proven factors in substance abuse?

Back 203

GENDER - men
AGE - younger
EMPLOYMENT - unemployed
EDUCATION - less eduacated
MARITAL - single status

Front 204

most sensitive lab enzyme elevated in alcohol abuse?

Back 204

GGT

Front 205

alc abuse tx causing adverse rxn when pt drinks?

Back 205

disulfiram

Front 206

tx for alcohol abuse that reduces the 'reinforcing' effect of alcohol, not allowing ppl to get drunk?

Back 206

naltrexone ( is also a tx for opoid abuse b/c blocks ALL opoid receptors)

Front 207

intense hunger is sieen in w/drawal from what?

Back 207

amphetamines

Front 208

w/drawal causes irritability, anxiety, DEPRESSED mood, restlessness

Back 208

cigarrettes

Front 209

fastest nicotine releasing medication?

Back 209

nasal spray

Front 210

w/drawal is very little physiologic...- depression and extreme fatigue . psych craving

Back 210

think that movie...
cocaine

Front 211

opiate w/drawal sx? is it life-threatening?

Back 211

sweating, tearing, then restlessness, irritability, bone pain, nausea, DIARRHEA (think heroin = constip)...abd cramps,

Front 212

marijuana w/drwawal?

Back 212

not clinically significant

Front 213

drugs c/i'd in asthma pt?

Back 213

bblockers!!!
and
aspirin (blocks pg synth)

Front 214

joint aspirate in OA vs RA?

Back 214

both = 2-10k wbc's
but RA = >50% PMN's,
OA = <50% PMN's

Front 215

lupus joint involvement vs RA

Back 215

rarely as symmetrical as RA

Front 216

extraarticular involvement of RA?

Back 216

nodules all over, pulm interstit disease = cough, dyspnea, vasculitis, dry eyes, mouth, etc.

Front 217

tx for enviro factors of asthma?

Back 217

keep humidity under 50% in house;
enclose bed spring,mattress in covers,
wash bed covers w/ hot water,
remove carpeting

Front 218

if pt asthma is intolerant of s/e's of inhaled c/s's, what give?

Back 218

give pt leuk inhib instead...not LA b/c LA doesnt work well unless with inhaled CS

Front 219

m/c cause of lower back px in under 26 y/o's?

Back 219

spondylolisthesis

Front 220

eval of scoliosis in adolescent?

Back 220

if <20deg curve, follow w/ 6 mo xrays...if progressive changes, bracing may help...if >20 deg, refer to orthopedist. ANY curve to left--> send to MRI (90% are to right)

Front 221

positive straight leg raising test (px b/w30-60deg)?

Back 221

Is NOT back strain (should not have pos test)
but radicular px = nerve compression

Front 222

any back/joint px/injury not w/ normal xrays but not responsive to 6 wks of conservative tx...?

Back 222

MRI!!

Front 223

what NSIM if pt got in accident and now can't rotate head 45deg left or right?

Back 223

cervical spine xrays...

Front 224

first line tx for copd?

Back 224

ipratropium and short acting B2Ags

Front 225

give theophylline especially for what disease?

Back 225

cor pulmonale ( also increases heart fxn

Front 226

first lab change indicating CKD

Back 226

anemia...b/c erythropoetin prod drops after GFR drops lower than 60 (norm = 90); hyponat, hypokal, met acid, etc sets in when GFR drops lower than 30

Front 227

when is nephrology referral indicated? when is dialysis started

Back 227

stage III renal failure and below...
dialysis starts at <15 GFR

Front 228

poor prognosis in pt with Primary biliary cirrhosis?

Back 228

rising bilirubin levels

Front 229

hepatotoxic drugs?

Back 229

TAMALAN
Tca's
AntiDM drugs
Muscle relaxants
Antifungals
Lipid lowering (statins)
Anticonvulsants
NSAIDS!!!!!!

Front 230

m/c cause of death in cirrhosis?

Back 230

bleeding varices!!!!

Front 231

absolute c/i's to liver tplant?

Back 231

portal vn thrombosis,
severe medical illness
malignancy, hepatobiliary sepsis,
lack of pt understanding

Front 232

hepatojug reflex description if heart failure?

Back 232

heart cannot respond to incr venous return, so jug vein expands DURING and IMMEDIATELY AFTER right upper quad compressoin

Front 233

NYHA classes:

Back 233

I = no dsypnea on any activities
II = dsypnea on "ordinary" or "normal " activities
III = dyspnea on daily activities ie around house
IV dyspnea at rest and increased with any movement

Front 234

in what class heart failure pts should you give spironolactone?

Back 234

CLASS iii OR iv

Front 235

if have to add a second diuretic for volume overload heart failure, what should you add?

Back 235

metalozone = a thiazide

Front 236

who to give hydralazine or nitrates to in heart failure?

Back 236

PPL WHO CAN'T tolerate ACE I's or ARB's OR in blacks w/ stage III, IV

Front 237

bblockers to be given to and will decr morbidity in what classes?

Back 237

II-IV

Front 238

diff b/w dementia and delirium/depression on testing?

Back 238

testing = good effort w/ dementia (but wrong answers)
del and dep = poor effort on testing

Front 239

early signs of dementia? later signs?

Back 239

loss of conversational output; loss of memory; loss of calculating abilities and drawing...
late = loss of appropriate social behavior

Front 240

regular workup for suspected dementia?

Back 240

CBC, biochem, THYROID, B12, and MRI...
others if clinical presentation indicated include toxic screen, syphilis, HIV, CSF, etc

Front 241

3 drugs for alzheimer's?

Back 241

donepezil
galantamine
rivastigmine

may have behavioral / cognitive fxn increases, but do NOT slow the progresseion of neurodegeneration

Front 242

dementia of Lewy body type? what NOT to use in tx?

Back 242

= presents with parkinsonism signs and visual hallucinations.
thus, don't use antipsychotic to tx, b/c of long term neur. damage that it can cause

Front 243

how often to screen ppl for diabetes?

Back 243

start at 45, every 3 yrs, but start earlier if fam hx or high risk ethnicities, or previous abnormal labs, or woman w/hx of gest dm

Front 244

m/c cause of blindness in US?

Back 244

DM retinopathy

Front 245

dm retinopathy worsens w/ worsening what?

Back 245

HBA1c levels

Front 246

first line anit htn tx for diabetic pt?

Back 246

ACE Inh

Front 247

only diet that has been proven to improve glycemic control?

Back 247

high fiber

Front 248

what to give pt who needs more glycemic control but has renal failure?

Back 248

thiazolinediones-safe for renal failure pts.

Front 249

wt influences of two diabetic drugs?

Back 249

thiazolinediones (rosiglitazone) may cause edema and wt gain,
incretins ie exenatide cause wt loss

Front 250

onset of each insulin? peak of each?

Back 250

ONSET PEAK
aspart 15-30mins 30-60mins
reg 30-60 2-3hrs
lente or glargine 1-2 hrs 4-8*
ultralente 2-4 hrs 8-20hrs
*= glargine (lantus) has NO peak

Front 251

longest acting insulin?how long?

Back 251

ultralente =24-32 hrs

Front 252

if just adding insulin to dm type II's diet b/c need further control, how much to add?

Back 252

only add .1 u / kg / day

Front 253

metformin's side effect...when must stop metformin in pt?

Back 253

s/e = lactic acidosis.
stop if pt going under surgery or
getting any radiocontrast dye, b/c will predispose to developoing lactic acidosis

Front 254

what changes occur in lipid profile during fasting?

Back 254

fasting = lower TG's, which causes LDL to rise and therefore total Chol to rise (HDL doesn't change)
thus, LDL and total Chol is highest during fasting lipid profile

Front 255

smoking cessation will change what in lipid profile?

Back 255

incr hdl by 5-10mg/dL

Front 256

tx for flushing caused by niacin?

Back 256

give niacin with aspirin..!!

Front 257

which statins will cause less drug interactions?

Back 257

rosuvastatin (crestor),pravastatin, and fluvastatin

Front 258

how does omega 3 work?

Back 258

decreases TG secretion by the liver

Front 259

how do fibrates work? Niacin? Ezetemibe? bile acid sequestrant?

Back 259

upregulate LPL causing increased TG clearance by the liver
Niacin - reduces liver's release of VLDL
Ezet- decr chol absorpt in gut
Bile Acid Resin = cholestyramine = "Bar's Bile's" reabs in gut so stim's liver must USE more chol to make more (so slighly incr's TG's)

Front 260

what tests when for detecting HIV?

Back 260

if primary infection and suspect HIV, do HIV RNA quantitative test.
otherwise, if past primary inf stage, do ELISA first, then confirm w/ WESTERN BLOT

Front 261

how to tx HIV pt with PCP?

Back 261

give TMPSMX , AND give cs's if PaO2 drops to below 70.

Front 262

signs of secondary htn?

Back 262

abd /flank masses (POCD),
abd bruits (rasten)
tc/flushing/sweating (pheo)
pigmented striae (cushing's)
thyroid mass (hyperth)
absent fem pulses (coa of aorta)

Front 263

routine tests for newly dx'd htn pt?

Back 263

NOT thyroid...unless clinical eval indicates...
but :
Hb, Hct, K, creatinine, fasting glu, Ca, fasting lipid, urinalysis, resting ECG

Front 264

what has been shown to lower the bp the MOST?

Back 264

DASH diet = diet rich in fruits , vegges, in low in sat and total fat

Front 265

what htn drugs to give post-stroke pt?

Back 265

give combo of thiaz and captopril

Front 266

when do thallium scan?

Back 266

ie if pt who would normally do ecg stress test can't b/c he has baseline ecg abnormalities

Front 267

what is goal dose for beta blocker

Back 267

enough to reach hr of 50-60

Front 268

what disease may be associated w/osteoporeosis?

Back 268

Graves,
cushing's

Front 269

only absolute c/i's to estrogen therapy for osteoporosis in postmenopauslal woman?

Back 269

abnormal genital bleeding
pt hx of br cxr
pt hx of est dep cxr
hx of TEmbolism disorder

Front 270

pharm tx for acute Osteoporosis fracture iv VB fracture/ colles fracture? what other effect does this drug have?

Back 270

calcitonin
also has an analgesic effect!!!

Front 271

to prevent relapse, ho long should tx with antidep be started for?

Back 271

6-9 months continuously

Front 272

how to distinguish anorex from bulimia?

Back 272

anorexics always have control over eating, bulemics often express lack of control during binges
(binging may be seen in anorexia subtype, so is not indicative of bulimia only)

Front 273

major risk factor for ADHD?

Back 273

family hx of ADHD
(also OSA is a rf)

Front 274

do most kids w/ ADHD continue w/ sx into adulthood?

Back 274

up to 60% do

Front 275

painless enlargement of thyroid after giving birth, that starts w/hyperth then leads chronic hoth in 50% of cases...no markers pos for hashimotos?

Back 275

subacute painless lymphocytic thyroiditis

Front 276

thyroid swelling, painful, after viral inf?

Back 276

subacute granulomatous thyroiditis (M/C cause of painful thyroid gland)...does not usually lead to permanent hypothyroidism

Front 277

m/c cause of goiter in states, also has pain?

Back 277

hashimotos

Front 278

gradually increasing firm, nontender thyroid

Back 278

fibrous invasive thyroiditis

Front 279

elevated TSH, T4, and T3 ?

Back 279

think Thyroid resistance (at end organs, causing entire pathway to be stimulated to be elevated)

Front 280

what tests diffs grave's disease from OTHER hyperthyroid conditions?

Back 280

AB's to Thyroid receptor

Front 281

definitive dx for a "hot nodule" after radioisotope scan?

Back 281

do FNA