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225 Cards in this Set
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- Back
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ceravix v guardasil |
ceravix: against 16 and 18 only guardasil: against 6, 11, 16, 18 usually up to 18 |
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when do you start mammograms? |
40 and every year after USPTF says 50 and every 2 years |
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what do you do for preventative visits |
risk factors imunizations screening test educaation |
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wht ECG changes suggest coronary artery disease |
horizontal ST eevation or downsloping ST (cardiac ischemia) convex ST elevation (injury) Q waves greater than 25% of succeeding R wave and lovger than 0.4 seconds (infarction) |
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what do you do for people at high risk for atherosclerotic coronary vascular disease (ASCVD) |
ASA and a moderate to high intensity statin |
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what are the steps of clinical problem solving? |
make diagnosis stage treat based on stage follow up treatment (so "next step" questions are basically confirm diagnosis, stage, or treat) |
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what is the difference between primary and secondary prevention |
primary prevention- prevent it before it happens ( lower LDL) secondary prevention- prevent a rep lapse (after MI lower LDL) |
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what are level A screening tests? |
CV diseases (HTN and lipid d/o)- because they are the leading cause of death of adult men and women HTN: all adults llipid profile: men over 35 and women over 45 (level B is men over 20 with increased risk) |
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who do you ultrasound for AAA's |
MEN 65-75 who have EVER smoked, NEVER suggested for women |
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who should get he pneumococal vaccine? (flu vaccine 6 months and older) |
single dose to people 65 and up younger if they're alcoholics or smokers, asthma, immune compromised, cochlear implants a one time booster 5 years later if they are immune compromised or a splenic or got before 65 |
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how much calcium/ vitamin D should a female get? |
1200 mg calcium, 4-800 D over 50 |
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screen for domestic violence in well woman exams. what are the risk factors? |
young, poor, prego, mental illness, substance abuse |
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what is calcitonin's role is osteoporosis? SE? |
TREAT (not prevent) SE: flushing, injection, site reaction nosebleeds if taken nasally (snort or inject calcitonin) |
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whats the role of estrogen in osteoporosis? |
PREVENTION SE: DVT, MI, PE, stroke |
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what is PTH (teriparatide) role in osteoporosis? |
TREATMENT SE: leg cramps, dizziness, transient hypercalcemia (takes calcium from bone into blood- paradoxical treatment) |
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what is used to TREAT AND PREVENT osteoporosis? |
Raloxifiene (SERM): cause hot flashes, weight gain, DVT/PE bisphosphonates (alendronates) |
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when do you do paps? |
age 21 or within 3 years of sex, every year for 3 years. after 3 normal ones increase interval (every 3 years) until 65 people with hysterectomies for cervical dysplasia need to get them every year still. if they had cervix removed for benign condition can stop |
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what does HEEADSSS stand for with kid intervviewsing |
Home education eating activities drugs sex suicide safety |
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who should get screened for chlamydia |
sexually active non pregnant OR pregnant 24 and younger- (under 24) older (25+) if pre go + increased risk |
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how do you find estimated delivery date |
LNMP +1 year -3 months +1 week |
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what do you screen for with a pre go? |
chlamydia if under 24, CBC rubella antibodies hep b SA type and screen RPR HIV |
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what do you do for first trimester bleeding? |
CBC, BHcG, progesterone, and wet mount for chlamydia. (culture probably won't grow anything) |
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who gets cervical polyps |
post and perimenopausal women |
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what are cause of post menopausal bleeding? |
cervical polyp endometrial proliferation (no increased risk for cancer) endometrial cancer proliferativ endometrium hormone producing ovarian cancer SSRI, anticoagulant, |
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risk factors for endometrial cancer? (estrogen) |
obesity HTN unopposed Estrogen smoking HELPS because smoking decreases estrogen exposure |
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what is TVUS good for? bad? |
+: thickness of the endometrium ( should be less than 4 mm) leiomyoma (fibroid) or focul uterine BAD FOR: endometrial polyps and submucosal fibroids |
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what can you give for hot flashes |
SSRI, clonidine, gabapentin, mind stuff |
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what causes primary dysmenorhea |
increasing prostaglandin |
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what will biopsy show for chronic PID? (not usually associated with mesnses) adenomyosis is symmetrical, diffusely boggy and movable uterus. pressure symptoms |
plasma cells endometriosis is pain and bleeding, pain with sex |
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what are the most common benign tumors of the uterus made of? |
uterine leiomyoma (fibroids) made of normal myometrial cells most common complaint is mennorhagia an pressure symptoms NO PAIN W SEX (difference between endometriosis) uterine fibroids- menorrhagia, usually not painful |
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whats the best thing to use for dysmenorrhagia from fibroids? |
progesterone releasing IUD- decreases uterus size ( not the size of the fibroid) good for people who want to have kids later depo provera affects fertility and can cause osteoporosis, weight gain. may take 9 months to wear off after last shot. no risk of venous throboembolism |
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what is an androgenic medicine with progesterone effects (lowers estrogen/inhibits ovulation, lowers HDL) but causes hirsutism and weight gain |
danazol- for PMS and endometriosis leuprolide gnrh- cause hot flashes anastrazol: post menopausal women treatment for breast cancer- aromatase inhibitor |
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how do you treat PMS? (bloating, breast tenderness, eating a lot, mood issues only around period... less severe than premenstrual dysmorphic d/o) |
SSRI for mood symptoms. OCP is for DYSmennorrhea- cramping |
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mennorhagia v metorhagia |
menorhagia- increased length and blood metor- irregular bleeding |
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what is considered HTN |
above 60 y/o 150/90, younger than 60 140/90 2 readings 1 week apart. if only 1 reading its just ELEVATED BP |
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what is the deal with thiazide dosing? (give to all except CKD) |
50 mg is no more efficacious than 25 mg start elderly on 6.25 or 12.5 mg because they may be more sensitive and have hypotensive episodes. and may cause incontinence also don't give to gout- they cause hyperuricemai |
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what do you order for essential HTN work up |
EKG, UA, glucose, HCT (anemia increaseses stroke or MI risk), K only, fasting lipid, Ca (can have vasoconstrictive effect, nephrolithiasis) |
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what is consideed elevated ACSV risk |
above 7.5% (treat hyper cholesterol) |
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whats the point of prescribing ASA |
in men 45-79 reuce risk of MI in women 55-79 - reduce risk of ischemic STROKE |
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ACE an ARB both reduce microalbunemia and cause heart remodeling effects. what different about ARB |
avoid ARBS in pre go less bradykinin production reduces MACROglobulinemia |
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low dose _____ lower mortality in CHF patients low doses and increase mortality from sudden cardiac death at high doses |
aldosterone antagonists/k sparing diuretics (spironolactone, eplerinone- k sparing agents) |
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who has the best BP |
native americans and mexicans. blacks have it the worst |
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when do you screen for hyperlipidemia |
women: above 45, men over 35 |
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what do you give to everyone to reduce chance of second MI whether they have HTN |
bblockers |
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what works synergistically with ACEs? |
thiazides (but may increase blood sugar) |
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what is first line for lowering ACSVCD and LDL cholesterol in DIABETICS? |
Atorvastatin (ace) |
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what is the most common cause of CHF? |
Ischemic cardio myopathy (CAD) from untreated HTN, hyperlipidemia, diabetes, smoking second most common cause of CHF is diastolic dysfxn from uncontrolled HTN |
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what is ST depressions (often downward sloping) with T-wave inversions in the lateral precordial leads? |
LVH with strain |
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very large S wave in V3 suggests? |
LVH |
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mainstay of systolic (and diastolic) CHF |
ACE (ARBS if aces can't be tolerated)- both decrease mortality also use digoxin (careful with renal ppl )- decrease hospitalizations and symptoms loops- be real careful with people with DIASTOLIC dysfunction, diuretics can worsen tat metoprolol- low and slow, initially can worsen HF- may lower preload. ONLY for COMPESATED hf (meaning fluid balance is okay)- if its Decompensated (fluid balance out of whack) don't use BBlockers Eperlerone-(like spironono- treats HTN or chronic heart failure after heart attack) decreased risk of death and hospitalization thalizidone (glizazones) and Ca blockers make CHF worse because increase peripheral edema |
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what does a nuclear stress test show? |
perfusion abnormalities- in coronary heart disease |
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how do you treat diastolic HF? |
not as well studied- want to lower BP and increase filling time: diuretics- avoid fluid over load (too much preload reduction can make it worse th) slow HR- (non dihydropene CCB diltiazam or blocker) |
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how do you treat HTN? |
thiazide, ACE/ARB if diabetic or have CKD- NEVER USE ACE IN BLACKS (even if they do have diabetes)- they're more likely to get angioedema BBlocker or ACE if they have CAD or have had a previous MI |
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what does alcohol actually REDUCE? |
BP |
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how do thiazides increase gout? |
thiazides can cause hyperuricemia |
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the 4 P's (pulsatile, palpation reproduces, pleuritic, positional, and stabbing) mean that chest pain is most likely NOT |
ACS |
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when do you use an exercise stress test? |
when pretest probability is high that the person has ACS |
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what are the main causes of palpitations? |
arrhythmias (ISMARTCHAP- afib) structural HD psychosomatic systemic causes (thyroid, anemia..) drugs (cushiness does not- random) |
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why is S3 vs S4 |
S3- dilated ventricle . CHF - volume overload n LV systolic dysfxn. may be normal S4- atria contracting- with uncontrolled HTN - stiff ventricle= decreases compliance= increases filling pressures= congestion |
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3 most frequent bugs for COPD exacerbations (increased sputum, or purulent sputum. |
pneumo, h influ, moral cat- same as OM/sinusitis if SEVERE:: think gram negatives - klebsiella and pseudomonis and do broader spectrum |
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joint infections |
acute MONO (shoulder, hip, knee)- bacterial CHRONIC mono: fungo or mycobac acute polyarticular: may be endocarditis or gonnococcal |
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who gets bacterial joint infections? |
people with RA- chronic inflammation + steroids = s aureus HIV: pneumo, salmonella, H influ IVDU: strep, staph, gram neg, pseudomonas |
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cellulitis vs septic joint |
cellulitis/bursitis or osteomyelitis- ROM is okay septic joint- very limited ROM 2/2 pain |
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how much folic acid should someone take? |
400-800 ug if low risk if have epilepsy or DM 1 mg previos NTD- 4mg |
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who should get US? |
without reliable dating criteria (in first tri accurate up to 1 week, 2nd tri 2 weeks...) discrepancy between measured and expected urterine growth twins chromosomal abnormalitis |
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when do you tripple/quad screen? (hCG, AFP, estrol, +inhibin A) |
15-20 weeks at 10-14 weeks, can do PAPP-A and hCG levels + fetal nuchal translucency for downs |
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when do you do amniocentesis or CVS? |
for women with higher risk for aneupoloidy- 35+, 32+ if twins, ... CVS- 10-12 weeks and theres a 1-1.5% abortion rate amnio_ 15 weeks and 0.5% chance of abonrtion |
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when are pregos screened for diabetes? who isnt' |
24-28 weeks with 1 hour 50 g glucose challenge over 135 is bad, 200 diagnostic. if between, go 3 hour glucose challenge after fasting younger than 25, normal pre go weight, no hx of abnormal glucose, no bad outcomes of pregnancies, no no issues..) |
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whats the difference between first and sec on gen antihistamines? |
second gen (fexofenadine) has fewer anticholinergic SE (dry eyes, mouth, can't pee, blurred vision) and doesn't cause sedation because no CNS first generation (diphenhydramine, chlorpheniramine, hydroxyzine) |
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common agents of bacterial conjunctivitis and how do you treat? epidemic keratoconjunctivitis (pinkeye) |
staph, strep, haemophilus, morax, pseudo sulfonamide 3x daily pink eye is usually adenovirus- local sulfonamide therapy might prevent secondary bacterial infection, hot compress, weak topical steroids. cipro, bactrim |
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how does buproprion work? |
NE and DA reuptake inhibitor (varenicline is a partial nictoniic receptro partial agonist- reduce cravings withdrawal symptoms, don't give to neuropsych people (depression, agitation..) may cause nausea, insomnia, abnormal vivid or strange dreams) don't give to epileptics, people with MAOiS within the last two weeks, eating disorders |
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what is the hgb level when you see conjunctival pallor |
9 less than 12 in women and 13 in men is considered anemia |
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b12 v folate v iron anemia |
b12 is glossitis, decreased positional and vibratory sense, ataxia, paresthsia, confusion, dementia, pearly gray hair at young age folate is that minus neurologic fe anemia is koilonychias, glossitis, dysphagia splenomegaly+anemia= thalessemia or cancer |
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What are causes of macrocytic anemai |
b12 (elevated MMA)- malabsorbtion (pernicious anemia= lack of IF) folate (high homocysteine)- alcoholics drugs liver disease hypothyroidism |
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causes of normocytic anemia |
/anemia of chronic inflammation- body stores are normal, but can't use fe in RE system renal insufficiency |
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how can you tell difference bw fe deficiency and ACD? |
TIBC is high in FE def, low in ACD serum ferritin is high in ACD and low in Fe def |
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how do you treat travelers diarrhea (usually treat those with IBD, renal disease, immune compromised..) |
quinelone (cipro- not if prego) or azithro if prego |
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how do you treat C diff? what is CONTRAindicated? |
treat C diff with METRO loperamide is contra indicated- it decreases frequency of BMs |
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what is the single most important prognosic factor for melanomas? |
thickness of the tumor (less than 1 mm thick is good) |
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what predisposes one to squamous cell cancer besides sun |
actinic keratosis (treat with 5-FU) and HPV of skin |
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whats most common of all cancers anyhow do they appear? |
basal cell pearly centra ulceration, or with multiple leganiectasias, bleed and itch SCC is usually irregular plaques or nodules with raised borders4f |
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what causes secondary hyperpara? tertiary? |
secondary- low blood calcium (dietary or low vitamin D) low albumin can look like low calcium because its bound to it tertiary- renal failure |
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5 areas of hypercalcemia |
PTH related (MEN1/2) malignancy (PTH-rP: solid lung, squamous cell, renal cell) (breast, prostate, MM= direct osteolysis) renal failure high bone turnover Vitamin D deficiency |
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what meds reduce urinary excretion of Ca nd in crease PTH secretion? |
thiazides |
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what causes increased bone resorbtion and increased protein binding of calcium- leading to hypercalcemia? |
adrenal insufficiency |
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how does tertiary hyperpara (renal failure) present ? |
hypOcalcemia, (2/2) hypERphos, low vitamin D --> leads to hyperplasia of parathyroid glands, increased PTH, eventually hypercalcemia |
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how can you tell hyperpara from familial hypocalciuric hypercalcemia (inappropriately high PTH- which remember can mean NORMAL PTH if they calcium is high. PTH should be LOW in that scenario) |
24 hour urine- FHH is low urine Ca. PTH is high urine Ca. |
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what is the leading cause of severe vision loss in the elder? |
age related macular degeneration (atrophy of cells in the central macular region of the retinal pigment piehtellium- loss of central vision) |
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whats the world leading cause of blindness |
age related cataracts- blinds (vs. mac degen is leading cause of SEVERE vision loss) (random thing- glaucoma has intraocular pressure, optic neuropathy defines the disease) |
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what is roseola? |
HHV6- (kids under 3) mild resp symptoms, high fever for 5 days fever goes away-> macpap rash that goes from trunk to limbs for 1-2 days, sparing face no treatment. rash goes away in 2 days vs. parvo/fifth disease: younger than 10 mild fever URI prodrome- fever AND rash on face for 1-2 days than lacy, itchy to trunk/extremeties 4-14 ays vs. chicken pox: crops THEN fever malaise and anorexia (super infection with strep and s auras) contagious until crust! |
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what is persistent wheezing that looks like asthma that doesn't respond to bronchodilators |
vocal cord dysfuncion |
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what is pneumonia breath sound? |
rales (wheezing- asthma, COPD, PE, CHF, upper airway cough syndrome/postnasal drip, foreign body, vocal cord dysfunction) |
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what is the duration of sinusitis symptoms that help distinguish acute bacterial sinusitis vs viral? |
10 days less than 10 days and NOT worsening is more likely viral |
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treatment for allergic rhinitis? |
ceterizine (oral antihistamine) and fluticasone |
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when do you do rapid strep (McIsac) |
1 point for each: under 15 febrile NO cough cervical lymph nodes tonsillar exudates 2-3= rapid strep 4= treat empirically and get culture (add 1 point for being over 45) |
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how do you treat OP bacterial pneumonia |
older: azithro younger than 7: amoxicillin |
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what rash usually starts as erythematous macpap eruptions that does NOT blanch? |
nieseria meningitis -petechiae may turn to purupra ADMIT and give amp and gent for less than 1 month olds, vanco and ceftriaxxone for adults THEN when its confined, start penicillin G |
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what is hyponatremia, low WBC, low platelet, elevated liver enzymes and rash? |
RMSF |
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what rash starts on forehead and moves down? face/neck moves down? |
forehead down: measles face/neck moves down: Rubella neck moves down: GAS scarlet fever vs rheumatic fever: GAS- erythema marginatum, small px (variola): all things in same stage roseola (HHV6): starts on trunk and spares face |
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when do you do imaging for LBP? |
after 4-6 weeks of treatment or earlier with red flag signs (high risk for fracture [osteoporosis, corticosteroids, systemic symptoms..], cancer, infections, cauda equine) |
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how much weight gain in pregnancy? |
normal BMI- 25-35 lbs overweight- limit wiegt gain 15-25 lbs obese- limit weight gain to 11-20 lbs |
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when do you test for gestational diabetes? |
1 hour glucose test at 24-48 weeks 1 fasting over 126 and 1 hr glucose over 130 |
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what is gestational hypertension? |
over 140/90 AFTER 20 weeks WITHOUT PROTEINURIA in previously normotensive person (before 20 weeks lasting after 12 weeks post partum its chronic hypertension) with protein urea (over .3 g/day) its preeclampsia, with seizures its eclampsia above 160/110 for 6 hours is severe. higher risk of small baby, abruption, |
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symptoms of severe preeclampsia |
severe RUQ pain, headache, visual changes, n//v, decreased urine output |
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if 1 hour glucose test is off (above 130), what do you do? |
3 hour glucose tolerance 2/4 have to be abnormal
fasting: over 95 1 hour: over 180 2 horu: over 155 3 hour: over 140 if gestational diabetes is there: increased risk for preeclampsia, macrosomia, birth trauma, hypoglycemia, hyperbili, hypocalcemai |
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how do you treat a GBS positive (check vag/rectal swab at 37 weeks) |
penicillin. if allergic, cefazolin |
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pruritic urticarial papules and plaques of pregnancy (PUPPP) prurigo of pregnancy pruritic folliculitis and what do you have to differentiate this from? |
women develop papulovesicular lesions on the trunk and extremities (PUPPP) generally appears as excoriated areas on the trunk or limbs (prugio) pruitic folliculitits : rash may be centered around hair follicles and have an associated pustular appearance make sure this isn't cholestasis of pregnancy (whole body itching) |
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what BC can you use post partum? |
copper containing IUD immediately progestin only OCP starting 6 weeks after both if exclusively breastfeeding (combined wills press milk production) progestin only BC have no increased bleeding issues, BP, and lipids |
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post partum blues v depression |
blues- 2 weeks of fluctuating mood depression- meets clinical criteria and within 4 weeks |
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what should weight be at 2 weeks? |
birth weight. may loose up to 10% in the first few days |
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what is the colic rules of 3 |
3 hours a day, 3 times a week for 3 weeks |
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what are the most common causes of post partum hemorrhage? |
4 T's Tone (uterine atony) Trauma Tissue (remains) Thrombin |
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what is Apgar score? |
taken at 1 and 5 minutes Appearance: pale- 0, blue limbs only-1, fine-2 Pulse: over 100- 2 grimace: flacid -0, flex- 1, sneeze/cough/pull away-2 Activity: stay flexed- 1, moving 2 Respirations: crying 2, slow irregular 1 under3- bad 3-6- bad over 7 is good |
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what is pre- eclampsia |
over 140/90 after the 20th week with .3g/day protein or 1+ in urine SEVERE pre- eclampsia: 160/110, 5g/24 hr, 3/4+ protein in urine and persistant RUQ pain, HELLP, HA, vision loss, sz, end organ damage |
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what is the baby monitor with contractions thing- normal rate, variability, reactive, reassuring, non reassuring |
fetal heart rate is 110-160 with MODERATE (6-25) variability no variability- less than 5 bpm marked variability: over 25 reactive: +15 for 15 seconds reassuring: moderate variability, mom feels movement, and a REACTIVE strip NON-reassuring: min, absent, or marked variability |
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how do you categorize the strips? |
1: normal (baseline 110-160, moderate variabiity) w/w/o acceerations NO LATE or VARIABLE (deep V) decelerations (there CAN be early decelerations- shows head compression) 3: no baseline variability AND less than 110 LATE or VARIABLE decelerations sinusidal 2: doesnt fit into others |
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how thick is a cervix usually? |
3 cm thick. first birth moms efface before dilation multiparous women cervix stays thick |
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what do you do to stop blood loss in prego |
give oxytocin to hurry the placental detachment massage uterus to constrict blood vessels in uterus clamp umbilical cord w/in 2 minutes |
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stages of labor? |
1st stage: latent: dilated less than 4 cm active: dilated 4-10 cm 2nd stage: fully dilated until birth 3rd stage: birth to placenta |
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what are primary causes of headaceh |
migraine (4-72 hours) dx 5 episodes tension (half hour- week) dx 10 episodes NOT worsened with physical activity cluster (15-180 minutes) dx 5 episodes |
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how do you diagnose a medication overuse rebound headache (have it when you wake up, aggravated by extortion, bilateral, |
over 15 headaches a month 3 months use of analgesic development or worsening of headache during overuse to treat: stop med |
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when do you image someone for headache complaints? |
atypical patterns, abnormalities on neuro exam high risk for abnormality results would alter management (increased frequency, new onset over 35, worse with valsalva, cancer or HIV, history of neuro signs, wakes them up from sleep |
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what are GAD-2 and PHQ-2 |
PHQ2- screen for depression (in the past 2 weeks) -feel less interest in things? -felt down, depressed, hopeless no to both is negative screen, yes to one is SIGECAPS GAD-2: screen for anxiety (in the past 2 weeks) feel nervous or anxious? not be able to stop worrying? 0, several days 1, half of days is 2, most days is 3. over 3 points is positive and do GAD7 |
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cerebellar ataxia |
heel-shin finger-nose romberg is vertibrobasilar ischemia |
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what are the main HA meds and their SE? |
triptans - seratonin syndrome, dizziness, nausea, don't give to hx of HD, stroke, uncontrolled HTN ergot alkaloids- MI, rash, arrythmias opiods are last last resort |
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if you get HA more than twice a week, you're at risk for rebound headaches from medication overuse. so you have to use prophylactic. what are prophylactic for migraine? |
anti-epileptics (divalex sodium, sodium valproate, BBlocker (metoprolol, Timolol, Propanolol) antidepressant: amitryptyline (TCA) and venlafaxine BBlockers: atenolol, nadolol |
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what is AF w RVR? |
presence of physiologic or non-physiologic Vtach caused by fever, myocarditis, pericarditis, volume contraction, thyrotoxicosis, endogenous catecholamines, and AV nodal dysfunction are causative. treatment: control rate: intravenous diltiazem, beta-blockers, or verapamil rhythm: cardioversion |
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what kind of heart block does vagal maneuver/carotid massage make worse? |
carotid massage makes mobitz type 1 AV (prolonging p-r, "group beating" WORSE. exercise and atropine improve type 1 Type 2: constant PR interval then dropped beat. Exercise and atropine make type 2 worse. Vagal maneuver (carotid massage) paradoxically improves type 2 non-conductedf p waves |
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Who do you screen for T2DM? |
people over 45 every 3-6 years if normal younger if obese and also have one of the following: inactive native american or black first degree relative with T1DM HTN HDL under 23 or dtrigs over 250 previously weird glucose gestational dm or delivering a baby over 9 lbs PCOS CV disease A1c over 5.7% (6.5 to diagnose) |
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where do you do monofilament foot exam? |
4 spots on the foot first 3rd and 5th meta tarsal big toe |
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how do you treat T2DM |
if A1c is over 6.5, lifestyle changes and metformin asses: if a1c >8, life style mod, metformin, and sulfonurea, glipizide, glimepiride, or insulin, detemir or glaring (basal), NPD reasses: if a1c is >8 still, lifestyle mod, met, basal insulin (detemir or glarine) . or add insulin if already on it. consider stoping sulfonurea to avoid hypoglycemia |
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what do you use to treat ppl with T2DM who can't take the GI SE of metformin or get hypoglycemic from sulfonurea? |
glitaozone and pia gliitazone (thiazadinediones) but they cause heart failure, edema, and bone fractures |
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how do you grade ankle sprains |
grade 1: stretching and/or small tear in ligament. mild tenderness, welling, slight/no functional loss, no instability/stretching/opening of joint w stress grade 2: incomplete tear and moderate functional impairment. tenderness, moderate pain, swelling, ecchymosis. some motor function loss and moderate instability. joint stretches with stress but still has definite stopping point grade 3: cmplete tear |
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when do you need imaging for ankle injuries? |
if theres pain on the posterior medial or lateral maleoli can't bear weight immediately or at presentation pain at base of 5th metatarsal or navicular and can't bear weight immediately or on presentation |
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what does the inversion stress test tell you? |
calcaneofubular ligament integrity/ the anterior drawer test does the anterior talofibular ligament cross e.g. test: high ankle sprain (syndesmotic injury) |
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what kind of exercises can reduce the likelihood of ankle reinjury? |
proprioceptive exercises |
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when do you X-ray a knee |
Age 55 or older Isolated tenderness of the patella (that is, no bone tenderness of the knee other than the patella). Tenderness at the head of the fibula. Inability to flex to 90 degrees. Inability to bear weight both immediately and in the emergency department (4 steps; unable to transfer weight twice onto each lower limb regardless of limping). |
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what is loefgroen syndrome? |
fever migratory polyarthralgias hilar adenopathy erythema nodosum |
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how do you treat guillan barre? (after URI.. symmetric ascending muscle weakness with absent or depressed DTRs)? |
IVIG or plasmapheresis |
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what do you do for ischemic stroke within 3.5-4 hours of symptom onset? after that? |
IV altepase before 4 hours has passed since symptom onset. after that ASA |
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when do you give PCV 13 THEN PSV23 in 6-12 months? |
those over 65 under 65 if they are at very high risk- CSF leak, coclear implant sickle cell, asplenia immunocompromised/CKD PSV23 alone if under 65 and have chronic heart lung or liver disease, DM, smoker, alcoholic |
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what raises suspicion for esophageal motility disorder? |
dysphagia, regurg, and/or chest pain precipitated by emotional stress. also alleviated with nitro |
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what causes hypercalcemia with HIGH PTH? |
primary and tertiary hyperpara (secondary is CKD- not activating vitamin D. PTH is super high and serum calcium is low to normal ) FHH lithium teriparatide with LOW PTH: malignancy, vitamin D toxicity, granulomatous diseases, HCTZ, theophyline, milk-alkali, thyrotoxicosis, vitamin A toxicidy, |
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what do you need to give all people started on EPO? |
iron- it uses up body's iron stores quick |
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whats the relationship with confidence intervals and p-vaues? |
confidence interval that crosses 1 at 95% has a p value less than .05 and IS statistically significant! if the confidence interval crosses 1 it is NOT significant |
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what does smaller sample size do to the power? |
smaller sample size= decrease power (ability to detect difference between exposed and unexposed) |
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chronic bronchitis vs bronchiectasis? |
bronchiectasis: irreversible dilation and destruction of airways from chronic inflammation= chronic cough and inadequate mucus clearance. more associated wit RECURRENT respiratory tract infections, and MUCOPURULNET sputum. crackles, ronchi, wheezing more common with bronchiectasis than bronchitis. CF, kartagener syndrome (dyenin arm of cilia f'd), necrotizing infection, allergic bronchopulmonary aspergillosis. emphysema: too much protease, not enough antiprotenase. protease ruins the elasticity and the grocery bags collapse and trap air. alpha 1 antitrypsin deficiency: PAN acinar. still produced in the liver- messing up folding so they stay in the endoplasmic reticulum. = cirrhosis PAS+ Pan acinar is smoker. |
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what disease has oligoclonal bands in the CSF? |
MS- urinary incontinence, urgency, hyperreflexia, impaired vibration and proprioception- high IgG (no incontinence and ascending paralysis in GB) |
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what maneuvers decrease preload?? |
valsalva (straining) standing from sitting nitro decreasing preload INCREASES murmer in hypertrophic cardiomyopathy |
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what maneuver increases after load and preload? |
squatting: makes hypertrophic cardiomyopathy (autosomal dominant) BETTER (as does hand grip and passive leg raise) |
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prolonged hypotension can lead to what in the kidney? |
ATN- muddy brown casts- ischemic |
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what give you WBC casts? |
intersitial nephritis and pyelonephritis (tubulointerstitial nephritis) |
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what gives fatty casts? broad and waxy casts? |
fatty- nephroTIC styndrome- (lost protein, put in fat) broad and waxy: chronic renal failure muddy brown: ATN (iscemic or toxic) |
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what is malignant otitis externs? |
granular things in the ear canal pseudomonas aeruginosa elderly, diabetic peole ear pain and drainage not responsive to topical meds MAY--> lead to osteomyelitis of the skull base and CN damage (facial droop) |
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how do you treat (empirically) meningitis? |
vanc and third gen cephaloosporin if they're over 50, do vanc, third cephalosporin ,and ampicillin (to cover listeria) if they're immunocompromised- vanc, amp, cefepime |
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who do you give cefepime to? |
meningitis in immunocmpromised (along with vanc and amp) and penetrating trauma to skull (increased risk) |
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what is hyposthenuria? |
can't concentrate urine- night time urination especialy n peole with SICKLE CELL DZ/TRAIT (from sicking in vasa rectae of inner medulla- messes with free water reabsorption) |
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what kidney dysfunction do you see with people who take asa and naproxen? (analgesic combination) |
chronic tubulointerstitial nephritis (WBC casts) and papillary necrosis |
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what are people with analgesic nephropathy more at risk for? |
premature aging, atherosclerotic vascular disease, urinary tract cancer |
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what gives you a loud S2 right sided heave pulsatile liver tricuspid regurg murmer? |
cor pulmonale |
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how does cor pulmonale show up on ECG? what is gold standard for diagnosis of cor pulmonale? |
partial or complete RBB, right deviation, RA enlargement right heart cath is gold standard: pulmonary HTN and no left heart disease |
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what gives UNILATERAL motor impairment WITHOUT sensory deficits (NO visual field abnormalities_ |
posterior limb of internal capsule (lacunar) |
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what gives you CONTRALATERAL somatosensory and MOTOR defecicit? eye deviates TOWARD infarct? homonymous hemianopia aphasia (dominant hemisphere) hemineglect (non dominent hemisphere) |
MCA occlusion |
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what gives contra SOMATOSENSORY and MOTOR defect (LE) ABULIA (no will or initiative) dyspraxia, emotional disturbances, urinary incontinence |
ACA occlusion |
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what brain lesion gives you alternate syndromes with ocntralateral hemiplegia and ipsilateral cranial nerve involvement possible ataxia? |
vertebrobasilar system lesion (brainstem) |
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what usually presents as gait ataxia and limb incoordination? cranial defects and hemiparesis not common? |
cerebellar infarct |
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when do you I&D a stye/ |
after 48 hours (its a staph abscess) |
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what is a granulomatous inflammation of the meibomian gland? |
chalaizon (inflamed) |
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what value varies with the pretest probability of a disease? |
NPV- high probability of disease has a LOW NPV |
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what do you do for first degree (PR interval over 0.2 seconds) heart block? |
with normal QRS--observe with widened QRS-- (conduction delay below AV node)- electrophys |
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how do you treat benign tremor? |
bblocker (prop) or primidone. |
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what heart drugs cause decrease in conduction velocity (lengthen QRS) and are "use dependent"= have to increase dosage/works better with time? |
class 1C and CCB (flecanimide and procanimide and V and D) |
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what causes skin ulceration, lytic bone lesions, and looks like anything on CXR in the lungs? |
blasto (looks like tb and histo- hits doesn't have cutaneous) |
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what IBD thing has dermatitis herpetiformis and how do you treat? |
dapsone. celiac- dermatitis herpetiformis pyoderma gangrenous: IBD (chrons) RA |
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what diabetes drug can cause weight gain and increased LDL? |
pioglitazone- increases insulin sensitivity |
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what diabetes drug is excreted 100% from the kidneys and therefore don't give with IV contrast. whats another random SE? |
metformin- lactic acidosis. may reduce B12 absorption |
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what does inspiratory stridor suggest? (v expiratory wheeze) |
upper airway obstruction (vs expiratory wheeze- lower airway) |
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how do you treat croup? tracheolaryngeobronchitis -parainfluenza virus -"steeple sign" -subglottid narrowing -noctournal cough |
humidified air h influ is epiglottis |
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when do you admit for bronchiolitis? -RSV -kids under 1 year -cough, coryza, upper airway sings |
hypoxia, prematurity, less than 3 months, and look toxic |
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whats epiglottis typically caused by? |
H influ in UNVACCINATED. in vaccinated its strep pyo, strep pneumo, staphaureus |
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what are classes of HF? |
1: just can't do hard exertion 2. can't do stairs/groceries 3. can't do ADL 4. symptoms at rest |
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how do you diagnose premature ovarian failure? |
2 elevated FSH one month away in a premenopausal female treat with cyclical hormonal therapy (estrogen and progesterone) |
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how do you treat primary hyperparathyroidism? |
parathyroidectomy if serum ca is under 12 if over 12 give loop with IV saline |
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what are cotton wool patches? |
"aka soft exudates" infarcted nerve fibers often seen with AV nicking in people with HTN dot hemorrhages and HARD exudates are diabetic retinopathy |
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what can be the result of normal aging or can be macular degeneration? |
drunsen- small yellow round spots unevenly all over the retina |
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what are hard exudates? (bright spots) |
DM or HTN |
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who gets micro aneurysms? |
DM |
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who gets roth spots? (retinal hemorrhages with pale white centers) |
bacterial endocarditis |
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how do you tell the difference between viral, bacterial, and allergic conjunctivitis? |
virlal- unilateral watery d/c allergic- b/l watery d/c and foreign body sensation and pruritus bacterial- mucopurulent d/c |
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how do you treat allergic conjunctivitis? |
toical NSAIDS over topical steroid |
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most common etiology of horners syndrome? |
carotid artery dissection |
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what is ipsilateral headache with contralateral hemianopsia? |
posterior cerebral stroke |
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large, esinophilic, polygonal cells with indistinct borders in thyroid are what? |
Hurtle cells- hashimotos |
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what thyroid cancer is solid masses of cells with vesicular nuclei? often with a lot of amyloid deposition and fibrosis |
medullary- MEN2a/b, calcitonin from parafolicular C tells |
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what tumors have psammoma bodies? |
PSAMM papillary thyroid carcinoma serous cystadenocarcinoma of the ovary adenocarcinoma of the endometrium meningioma mesothelioma |
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how do you post exposure prophylax hep A |
immunize( age 1-40) or immunoglobin(less than 1) (because hep A has a 2-6 week incubation period) |
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why might someone treated for h pylori and saw resolution of sx have a positive urea breath test? (to see eradication, serology to confirm infection) |
didn't stop antibiotics or PPI 2-4 weeks before testing (make sure you wait 2-4 weeks before you confirm eradication!) |
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non modifiable risk factors for CAD? |
age over 55 male first degree relative with coronary event before 55 female first degree relative with coronary event before 65 |
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whats considered contaminated urine specimen |
2 organisms less than 105 CFUs |
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when do you do incisional/punch biopsy? |
good for full thickness takes out a part of the lesion |
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when do you excisional biopsy? |
strong suspicion for melanoma |
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what are the risk factors for recurrence of cutaneous squamous cell carcinoma? |
bigger then 2 cm or deeper than 4 mm on the ear or lip hx of radiation hx of local recurrence rapid growth perineural invasion infiltrate deep or peripheral margins |
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when do you use radiation for skin cancer? |
when its on face and neck and not extremities. they ulcerate because the radiation killed blood supply and if you get any kin dog injury it can't heal. too susceptible out there |
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how do you treat actinic keratosis |
5-FU topical |
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when do you do a PSA? |
when men with life expectancy over 10 years. usually when considering treatment with 5 alpha reductase inhibitor- finasteride and dutasteride (take a year to prevent acute urinary retention and reduce need for surgery- for larger prostates) |
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whats first line for BPPH? |
behavior modifications alpha adrenergic antagonist: tamulosin, alfuzosoin, terazosni, doxazosin 5alpha reductase (finasteride if hypertensive) |
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what OTC meds should patients with BPPH avoid? |
decongestannts and antihistamines (antipara= sympathetic= hold urine=make it harder to go) |
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whats the difference between parkinsons demential and dementia with lewy bodies? |
(dementia- progressive, aware. delerium- acute, fluctuating, hallucinations unaware) parkinsons is parkinsons first then dementia. LBD is parkinsons signs and dementia appearing a the same time. more common than parkinsons dementia . |
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activities of daily living vs instrumental activities of daily living |
ADL: bathing, feeding, toileting, transferring, continence, dressing IADL: phone, shopping, transportation, bills, cooking, meds |
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what do you use mini cog for? (tell them 2 objects and have them repeat. then draw the clock at a time .) |
dementia 3- nml 0- dementia (not diagnostic) 1 or 2- if clock is right its nothing. if clock is wrong its suggestive |
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what are 2 pre requisites for IV contrast? |
cr less than 1.5 no evidence of acute kidney injury |
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what is mixed in continence? |
stress and urge |
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what should you test kids under 7 with nasal polyps for? |
CF associated with asa indued asthma |
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small cell lung carcinoma para neoplastic syndromes |
eaton lambert (destruction of presynaptic calcium channels) SIADH or ACTH (lung loves adrenal) |
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whipples disease |
chronic steatorrhea weight loss arthralgia dementia dx: foamy macrophages on jejunal biopsy tx: tmp-smx (tropheryma whippelii) long term penicillin G first 14 days then tmpSMx long term after |
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MS v GB |
MS: inflammatory dz of myelin sheath oligoclonal bands, LP shows large increase in gamma globulin optic neuritis can mimic hyperkalemia (paresthesias) tx: steroids, IFNb GB: autoimmune demyelinating tx: plasmapheresis/IVIG, dx: EMG, LP everything normal besides increased protein (normal pressure) and yellowish STEROIDS MAKE GB WORSE |
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wilsons |
decreased ceruloplasmin, increased urinary copper give penicillamine/ treantine (copper chelators) messes up LIVER- increased ammonia supplement zinc- decrease iron absorption inGI |
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epididymitis |
under 35- treat nies/chlam over 35- ecoli/ coliform positive phren sign rules out torsion |
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management for ADPCKD |
no treatment, only treat symptoms controll BP(ACE/ARB) |
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entameobic histolyics vs bactericiodes vs klebsiella (hepatic cysts) |
trophozoite invvades, cyst form infects. in stool most common amebic hepatic cyst tx: metronidazole bacteriodes: pyogenic liver abscess klebsiella: most cases of hepatic liver abscess. DM and preexisting biliary tract infections and preexisting fatty liver dz |
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side effect of burproption? |
seizures insomnia weight loss sweating, ppl with SE of cardiotocicity should avoid citalopram TCA: orthostatic hypotension |
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most common cause of pneumonia is CF? |
pseudomonas staph areas h influ |
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when do you get fulminant hepatitis? |
viral hepatitis acetaminophen intox bud chiari autoimmune heptitis |
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what TCA (inhibit NE and serotonin reuptake) has anticholinergic side effects? |
nortryptiline- post herpetic neuralgia (anticholinergic SE are no sweat, hot, blurry vision, dry mouth, vasodilation, confusion |
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wide gait stance= |
ataxia romberg tests proprioception, vestibular function, and vision. when patient has ataxia and you knock vision out and they sway, it means theres loss of proprioception. with ataxia and no sway, the issue is a localized cerebellum issue. cerebellum chapman point is corracoid process |
