Usmle Step 3 Ambulatory Medicine

Front 1

Define elevated intraocular pressure of glaucoma

Back 1

>20mmHg

Front 2

optic neuropathy caused by elevated intraocular pressure that results in progressive loss of peripheral vision

Back 2

glaucoma

Front 3

Define abnormal cup:disk ratio

Back 3

>50%

Front 4

Diagnosis of open-angle glaucoma

Back 4

losing peripheral vision, high intraocular pressures, abnormal cup-disc ratio

Front 5

phramacologic treatment of open-angle glaucoma

Back 5

nonselective B blockers (timolol, levobunolol), adrenergic agonists (E), cholinergic agonists (pilocarpine, carbachol), CAI (dorzolamide, brinzolamide)

Front 6

race predilection of glaucoma

Back 6

OAG - African-American; CAG - asians

Front 7

Symptoms of close-angle glaucoma

Back 7

eye pain, HA, nausea, conjunctival injection, halos around lights, fixed, mod dilated pupil, elevated intraocular pressure

Front 8

Treatment of CAG

Back 8

medical emergency, ophtha referral ASAP; topical pilocarpine (pupillary constriction), timolol and acetazolamide (decreases IOP), laser iridotomy

Front 9

age-related hearing loss

Back 9

presbycusis

Front 10

progressive fixation of the stapes, leading to bilateral progressive conductive hearing loss

Back 10

otosclerosis

Front 11

treatment of otosclerosis

Back 11

surgery with stapedectomy or stapedotomy, excellent results

Front 12

At what age does otosclerosis present?

Back 12

second or third decade of life, may advance in pregnancy

Front 13

How is Weber test performed?

Back 13

place vibrating tuning fork in middle of patient's forehead, ask in which ear it sounds louder

Front 14

How is Rinne test performed?

Back 14

place vibrating tuning fork agains mastoid and once no longer audible, reposition it near EAM

Front 15

Results of Weber test

Back 15

CHL - louder in affected ear; SNHL - louder in normal ear

Front 16

Results of Rinne test

Back 16

CHL - BC > AC; SNHL - AC > BC

Front 17

symptoms of allergic rhinitis

Back 17

congestion, rhinorrhea, sneezing, eye irritation, PND

Front 18

PE findings in allergic rhinitis

Back 18

edematous, pale mucosa

Front 19

usual environmental allergens causing allergic rhinitis

Back 19

pollens, animal dander, dust mites, mold spores

Front 20

How is allergic rhinitis diagnosed?

Back 20

usually clinical; skin testing, blood testing for specific IgE antibodies via RAST

Front 21

What is RAST?

Back 21

radioallergosorbent testing - blood test to look for specific IgE antibodies

Front 22

pharmacologic treatment of allergic rhinitis

Back 22

antihistamines, intranasal corticosteroids, sympathomimetics, intranasal anticholinergics, immunotherapy

Front 23

usual location of epistaxis (90% of cases)

Back 23

anterior nasal septum (at Kiesselbach's plexus)

Front 24

most common cause of epistaxis / other causes

Back 24

local trauma due to digital manipulation / dry mucosa, nasal septal deviation, uses of antiplatelets, bone abnormalities in the nares, rhinitis, bleeding diatheses

Front 25

treatment of nosebleeds

Back 25

direct pressure, topical nasal vasconstrictors; if still bleeding, cauterize with silver nitrate or insert nasal packing

Front 26

white patches or plaques in the oral mucosa that are considered precancerous

Back 26

oral leukoplakia

Front 27

How do you distinguish between leukoplakia and candida infection in the mouth?

Back 27

Leukoplakia cannot be removed by rubbing the mucosal surface

Front 28

risk factor for oral leukoplakia

Back 28

smokeless tobacco use

Front 29

leukoplakia represents these precancerous states

Back 29

dysplasia or early invasive SCC

Front 30

clinical pictuer of atopic dermatitis or eczema

Back 30

strong family history of atopy, early age of onset, high serum IgE and repeated skin infections; pruritic lichenified eruptions in certain areas

Front 31

usual location of eczema / atopic dermatitis

Back 31

face, neck, upper trunk, bends of elbows and knees

Front 32

aggravating factors for atopic dermatitis / eczema

Back 32

low humidity and winter

Front 33

treatment of atopic dermatitis

Back 33

topical creams (sparingly); skin moisturizer

Front 34

first-line steroid sparing agent for eczema

Back 34

tacrolimus ointment

Front 35

How does acute and chronic contact derm present?

Back 35

acute - vesicles, weeping erosions, crusting and excoriations; chronic - hyperkeratosis and lichenification

Front 36

treatment of contact derm

Back 36

avoid agent, cold compress and oatmeal baths; topical steroids; short course of oral steroids if large region involved

Front 37

Treatment of psoriasis - limited disease

Back 37

limited disease - topical steroids, occlusive dressings, topical Vit D, topical retinoids

Front 38

treatment of psoriasis - generalized disease

Back 38

UVB 3x per week, PUVA (if UVB not effective), methotrexate for severe cases

Front 39

when is psoriasis considered generalized?

Back 39

involves >30% of body

Front 40

what is PUVA?

Back 40

psoralen and UVA

Front 41

secondary causes of erythema nodosum

Back 41

sarcoidosis, IBD, infectious (streptococcus, coccidioidomycosis, TB)

Front 42

PE of erythema nodosum

Back 42

deep-seated, poorly demarcated, painful red nodules without ulceration on extensor surfaces of lower legs

Front 43

treatment of erythema nodosum

Back 43

treat underlying disease; usually self-limited, NSAIDs helpful, if persistent KI drops and CS may be beneficial

Front 44

PE findings in rosacea

Back 44

erythema and inflammatory papules mimicing acne that appears on the forehead, cheeks, nose and chin but occurs in 30-60 y/o

Front 45

thickened, lumpy skin on the nose due to sebaceous gland hyperplasia in rosacea

Back 45

rhinophyma

Front 46

How is rosacea differentiated from acne clinically?

Back 46

absence of comedones in rosacea

Front 47

initial treatment of rosacea

Back 47

goal is to control rather than cure; use mild cleansers, benzoyl peroxide, metronidazole topical +/- oral antibiotics

Front 48

oral antibiotics used in rosacea

Back 48

tetracycline, minocycline

Front 49

maintenance therapy for rosacea

Back 49

topical metronidazole OD; clonidine for flushing, surgical referral is rhinophyma not responding to treatment

Front 50

causative factors linked with erythema multiforme

Back 50

infectious agents (HSV, mycoplasma), drugs, CTDs, physical agents, RT, pregnancy, internal malignancies

Front 51

how does erythema multiforme present?

Back 51

sudden onset of rapidly progressive symetrical lesions, preceded by malaise, fever, itching, burning at site of future eruptions; target lesions at back of hands and palms, soles and limbs, but can be found anywhere; recur in crops for 2-3 weeks

Front 52

diagnosis of EM

Back 52

usually clinical; biopsy can help in certain cases

Front 53

treatment of EM

Back 53

mild cases treat with histamine blockers; if many target lesions present, prednisone x 1-3 weeks; unresponsive - Azathioprine, levamisole; if etio is HSV; maintenance acyclovir or valacyclovir can reduce recurrence of both

Front 54

rare autoimmune disease where blisters as formed as autoantibodies destroy intracellular adhesions between epithelial cells in the skin

Back 54

pemphigus

Front 55

gentle lateral traction on the skin separates the epidermis from the underlying tissue

Back 55

Nikolsky's sign

Front 56

diagnosis of pemhigus vulgaris

Back 56

skin biopsy - acantholysis, IF - antibodies in the epidermis

Front 57

treatment of pemphigus vulgaris

Back 57

corticosteroids and immunosuppression

Front 58

autoimmune disease with antibodies against basement membrane leading to subepidermal bullae

Back 58

bullous pemphigoid

Front 59

diagnosis of bullous pemphigoid

Back 59

clinical, confirm with IF and histopath

Front 60

treatment of bullous pemphigoid

Back 60

corticosteroids

Front 61

closed comedones

Back 61

whiteheads

Front 62

open comedones

Back 62

blackheads

Front 63

treatment of acne vulgaris

Back 63

topical antibiotics, oral antibiotics, isotretinoin

Front 64

topical antibiotics used in acne vulgaris

Back 64

erythromycin, benzoyl peroxide gels, topical retinoids

Front 65

oral antibiotics used in acne vulgaris

Back 65

minocycline, tetracycline

Front 66

diagnosis of herpes zoster

Back 66

clinical, giant cells on Tzanck smear of fluid

Front 67

treatment of herpes zoster

Back 67

pain antiviral treatment with acyclovir, valacyclovir or famciclovir if within 3 days (decreases duration of illness an doccurrence of postherpetic neuralgia)

Front 68

define erectile dysfunction

Back 68

inability to achieve or maintain an erection, sufficient to effect penetration and ejaculation

Front 69

prevalence of ED

Back 69

40% in 40 years old and 70% of 70 years old

Front 70

describe psychological form of ED

Back 70

sudden onset, unable to sustain or obtain erection; normal nocturnal penile tumescence

Front 71

endocrine causes of ED

Back 71

DM, hypothyroidism thyrotoxicosis, pituitary or gonadal disorders, increased prolactin

Front 72

neurologic causes of ED

Back 72

stroke, temporal lobe seizures, MS, spinal surgery, neuropathy

Front 73

drugs that cause ED

Back 73

alpha-blockers, clonidine, CNS depressants, anticholinergics, TCAs

Front 74

diagnostic tests to order for ED

Back 74

TSH, prolactin, testosterone, FBS

Front 75

treatment of ED

Back 75

PDE-5a inhibitors; testosterone for hypogonadism, behavioral treatment for depression / anxiety; vascular surgery if indicated

Front 76

MOA of PDE5a inhibitors

Back 76

inhibit cGMP-specific PDE 5a; improves relaxation of smooth muscle in the corpora cavernosa

Front 77

S/E of PDE5a inhibitors

Back 77

flushing, HA, decreased BP

Front 78

drugs that cannot be given with viagra

Back 78

nitrates or alpha-blockers

Front 79

symptoms of BPH

Back 79

frequency, urgency, nocturia, dec force and size of stream, incomplete emptying

Front 80

PSA values in BPH

Back 80

elevated in up to 50%, but not diagnostically useful

Front 81

treatment of BPH

Back 81

alpha-blockers, 5alpha reductase inhibitors; TURP, open procedure

Front 82

drugs to avoid in BPH

Back 82

anticholinergics, antihistamines, narcotics

Front 83

alpha blocker used in BPH

Back 83

terazosin

Front 84

5 alpha reductase inhibitor used in BPH

Back 84

finasteride

Front 85

when is open procedure indicated in BPH (instead of TURP)

Back 85

if gland size is >75g

Front 86

when is PSA useful

Back 86

marker to follow reponse to prostate CA treatment