Ambulatory Objectives

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Ambulatory Objectives
2010-08-23 21:17:52
ambulatory medicine

Review for EOR ambulatory medicine exam
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  1. An internal hordeola is caused by what?
    Inflammation and infection of a meibomian gland, with abcess formation in that gland
  2. An external hordeola is caused by what?
    Inflammation and infection of the glands of Moll or Zeis, with abscess formation in those glands
  3. What is the treatment for hordeolum?
    • a) Warm compresses several times a day for 48 hours
    • b) Topical abx if secondary infection develops
    • c) I&D if indicated
  4. What is a chalazion?
    Relatively painless, indurated lesion deep from palpebral margin, often secondary to a chronic inflammation of an internal hordeolum of the meibomian gland. Insidious onset, minimal irritation, can be pruritic and erythematous. Tx: warm compress, refer to optho for elective excision.
  5. Why would an entropion form?
    Secondary to scar tissue or a spasm of the obicularis oculi muscles
  6. Why would an ectropion form?
    Secondary to advanced age, trauma, infection, or palsy of facial nerve.
  7. Treatment for entropion and ectropion?
  8. Presentation of viral conjunctivitis
    Acute onset of unilateral or bilateral erythema of the conjunctiva, copious watery discharge, and ipsilateral tender preauricular lymphadenopathy
  9. Tx of viral conjunctivitis
    Eye lavage with normal saline twice a day for 7-14 days; vasocontrictor-antihistamine drops might help; opthalmic sulfonamide drops may prevent secondary bacterial infection but not routinely prescribed.
  10. Natural history of bacterial conjunctivitis (common pathogens), why is it treated?
    Self-limiting, but secondary keratitis can develop
  11. Natural history of bacterial conjunctivitis caused by Chlamydia or gonorrhea (rare)
    Severe conjunctivitis and keratitis with development of permanent visual impairment
  12. Tx for bacterial conjunctivitis (for common and rare pathogens)?
    • common: topical abx
    • rare: may also require systemic antibiotics
  13. What causes a pinguecula?
    Chronic actinic exposure, repeated trauma, and dry and windy conditions
  14. What is a pterygium?
    Slowly growing thickening of the bulbar conjunctiva, highly vascular, triangular mass grows from nasal side toward cornea
  15. What does papilledema look like?
    The disc appears swollen, and the margins are blurred, with an obliteration of the vessels
  16. What is the most common cause of sensorineural hearing loss and what is its treatment?
    Presbycusis, may or may not be helped by hearing aids
  17. Treatment for Meniere's disease?
    Diuretics and salt restriction (due to distention of endolymphatic comaprtment of inner ear), surgery if sx progress
  18. Drugs that might cause hearing loss
    NECKS: neomycin, ethacrynic acid, chloramphenicol, kanamycin, streptomycin
  19. Bullae on otoscopic exam of otitis media suggest what?
    Mycoplasmal infection
  20. Inadequate tx of OM may lead to?
  21. Treatment for an acute attack of vertigo? mild vertigo? Severe vertigo? Chronic vertigo?
    • Acute: diazepam, maybe bed rest
    • Mild: Meclizine, cyclizine, dimenhydrinate
    • Severe: scopolamine
    • Chronic: moving about
  22. Treatment of barotrauma
    after removal of offending agent: decongestants, autoinflation, myringotomy
  23. Most common type of skin cancer?
    basal cell
  24. Treatment of apthous ulcers
    non-specific; symptomatic tx: topical steroids, anti-inflammatories
  25. A lateral soft-tissue neck radiograph reveals a thumb-like projection (the classic thumb sign) in a patient who presents with abrupt onset of high fever, difficulty swallowing, sore throat and drooling. What is the dx?
  26. Most common site of epistaxis
    Kiesselbach's plexus on the anterior aspect of the nose
  27. Posterior epistaxis source
    Woodruff's plexus
  28. Epistaxis patient: if there is blood in the posterior pharynx, where is the source of bleeding?
    Woodruff's plexus, posterior
  29. Polysaccharide pneumococcal vaccine should be given to patients with what disease and why?
    Sickle cell, they are functionally asplenic, and therefore require the vaccine to prevent invasive disease
  30. AFP is a tumor marker for which cancer?
    Recurrence of hepatocellular carcinoma
  31. CEA is a tumor marker for which cancer?
    Recurrence of colon carcinoma
  32. CA 19-9 is a tumor marker for which cancer?
    recurrence of pancreatic carcinoma
  33. CA-125 is a tumor marker for which cancer?
    recurrence of ovarian cancer
  34. A grade III/VI diastolic murmur heard best at the apex without radiation
    Mitral stenosis. Grade 3- heard all over precordium
  35. Grade IV/VI systolic ejection murmur heard best at the base with radiation to the left clavicle
    Pulmonic stenosis, grade 4 is loud with palpable thrill
  36. Grade II/VI systolic murmur heard best at the apex preceded by a click and without radiation
    Mitral valve prolapse, grade 2 is soft
  37. Grade IV/VI systolic murmur heard best at apex with radiation to the L axilla
    Mitral regurgitation, grade 4 is loud with palpable thrill
  38. What is TIPS?
    Transjugular Intrahepatic Portosystemic Shunt: placement of stent in order to shunt blood away from the portal vein into the hepatic vein to bypass liver parenchyma.
  39. What is the main complication of TIPS?
    Encephalopathy from the accumulation of toxic substances in the brain since the liver no longer acts as a filter
  40. What is Budd-Chiari syndrome?
    Thrombosis of the hepatic vein (not a common complications of TIPS)
  41. Limitation of lumbar flexibility and tight hamstring muscles
  42. Reduced lumbar lordosis and sacral kyphosis
  43. Lumbar muscle spasm, positive straight leg test
    Herniated disc
  44. Which lab abnormalities characterize acute adrenal insufficiency?
    Hyponatremia and hyperkalemia, eosinophilia and lymphocytosis, hypoglycemia
  45. Gonococcal conjunctivits tx, no corneal involvement, with corneal involvement
    • none: single 1g IM dose of ceftriaxone
    • with: 5 days of IM ceftriaxone
  46. CxR associations:
    indistinct heart border looking like "ground glass"
    irregular opacities ranging from reticular pattern to nodular pattern
    calcification of the hilar nodes with an "eggshell" pattern
    Patchy fibrosis
    • indistinct heart border looking like "ground glass": asbestosis
    • irregular opacities ranging from reticular pattern to nodular pattern: coal miner
    • calcification of the hilar nodes with an "eggshell" pattern: silicosis
    • Patchy fibrosis: farmer's lung, from spores produces hypersensitivity pneumonitis
  47. In which disease is the following present: anti-endomysial antibodies
    celiac sprue
  48. In which disease is the following present: anti-mitochondrial antibodies
    hypothyroid disease and other autoimmune processes
  49. In which dz is the following present: anti-glomerular basement membrane antibodies
  50. In which disease is the following present: anti-phospholipid antibodies
  51. Tx for enterbiasis
    pinworms- Mebendazole (Vermox)
  52. Granulomas and inflammation of alveoli, small bronchi and small blood vessels
  53. inflammation and destruction of the structural components of the bronchial wall
  54. increased permeability of the alveolar-capillary membrane and diffuse alveolar damage
  55. edema of the airways with eosinophils, neutrophils, and lymphocytes
  56. Outpatient treatment of CAP
    doxycycline, macrolides like azithromycin or clarithromycin, and fluoroquinolones
  57. What is the gold standard test for the evaluation of patients with malabsorption of the intestine?
    Stool fecal fat
  58. Fever, pharyngitis, "sandpaper rash" over face, neck, trunk, and extremities
    Scarlet fever
  59. Round of oval maculopapular lesions that begin on the neck or face and spread to the extremities
  60. High fever with few symptoms, followed by appearance of a macular rash over the trunk and neck
  61. generally asymptomatic, red papules on the face that coalesce to give a "slapped cheek" appearance
    erythema infectiosum (Fifth Disease)
  62. typical cause of kernicterus in a newborn
    ABO/Rh incompatibility
  63. which drug causes teeth discoloration in infants?
  64. What sign is positive when the supine patient notes pain with flexion of the hip against resistance?
  65. What sign is positive when the patient experiences abrupt cessation of deep breathing with palpation of the gallbladder?
    Murphy's sign
  66. What sign is positive when the patient experiences RLQ pain with deep palpation of the LLQ?
    Rovsing's sign
  67. What sign is positive when the supine patient experiences pain when the R leg is flexed at the hip and knee and the hip is externally and internally rotated?
    Obturator sign
  68. What are the degradation products that result from the metabolism of epinephrine and norepinephrine?
    Metaneprine and normetanephrine
  69. What does the Schilling test assess?
    Pernicious anemia
  70. Distended neck veins and cold clammy skin in a patient with recent stab wound in the chest
    pericardial tamponade
  71. Jones criteria for rheumatic fever
    • Major- MECCS: Migratory polyarthralgia, Erythema marginatum, Chorea, Carditis, subcutaneous nodules
    • Minor- PRAEFH: Prolonged PR interval, Rising titer of antistrep Abs, Arthralgia, Elevated ESR & CRP, Fever, Hx of acute RH
  72. What is the difference between the morning stiffness seen in RA vs. that seen in OA?
    • RA: lasts longer than 1 hr
    • OA: lasts less than 15 mins
  73. Match: RA and OA
    cervical spondylosis
    C1-C2 subluxation
    • cervical spondylosis: OA
    • C1-C2 subluxation: RA
  74. What are Herberden's nodes?
    bony enlargements of the DIP joints, seen in OA
  75. 7 yo boy with enuresis- which drug used to treat?
    Desmopressin (DDVAP)
  76. Tx for sleep terrors?
    Lorazepam (Ativan)
  77. Tx of pediatric overactive bladder
    Hyoscyamine (Levsin)
  78. As part of long-term tx of DM type I pt, HgbA1C level should be maintained at?
    between 6-7%
  79. What is the rapid test for mono?
    Heterophil antibody test
  80. What is the tx for EBV
    Acetaminophen, supportive treatment
  81. What type of injury causes pain over the posterior tibialis muscle body?
    Shin splint
  82. What is Osgood-Schlatter disease?
    injury occurring at insertion of the patellar tendon on the tibial tuberosity in a younger age group
  83. most common cause of chronic anterior knee pain, more commonly seen in females
    Patellofemoral pain syndrome
  84. In what situation would you see clue cells?
    Gardnerella vaginalis
  85. Describe the vaginal d/c in Gardnerella vaginalis infections.
    Grayish, unpleasant, fishy odor
  86. Mobile flagellated protozoa on a normal saline preparation
  87. Trichomonas presentation
    dysuria, vulvovaginal pruritis, frothy clear to white d/c
  88. Rho-GAM indications
    unsensitized Rh-negative patient who has had a spontaneous or induced abortion, ectopic pregnancy, or at the time of amniocentesis. Also indicated at 28 weeks gestation and within 72 hours of delivery of an Rh-positive infant
  89. Which animal is the major cause of human rabies in the US?
  90. onset of mid-lower abd pain, spasmodic, cramping that radiates to the back or inner thighs1-2 years after onset of menarche. begins on day 1 or 2 of menstruation.
    primary dysmenorrhea
  91. pain that starts 1-2 weeks before onset of menses and is relieved at the onset of menstrual flow or shortly thereafter
  92. Therapeutic agent for acute influenza?
    Zanamivir (Relenza)
  93. responsible for acid secretion and intrinsic factor
    Parietal cells
  94. responsible for secretion of proteolytic proenzymes pepsinogen I and II
    Chief cells
  95. secrete mucous and pepsinogen II
    mucous cells
  96. which cells secrete gastrin?
  97. Which drug is associated with macular damage, rash, and diarrhea?
  98. Blood being put back into the R side of the body with increased jugular pulsation in the neck, along with a palpable venous pulse in the liver
    tricuspid insufficiency
  99. A palpable cord is commonly found in patients with _?
  100. A complication of UC, presents with diarrhea, fever, tachycardia, and leukocytosis
    Toxic megacolon
  101. Stasis dermatitis and LE edema is commonly seen in patients with _?
    Venous insufficiency
  102. A sign of acute ischemia secondary to arterial embolism
  103. common in children 1-2 years of age, presents with crampy abdominal pain, vomiting and currant jelly stool
  104. Plethora (ruddy complexion), engorged retinal veins, splenomegaly, increased Hgb and Hct
    Polycythemia vera
  105. Cheilosis in?
    Iron deficiency anemia
  106. What is an early manifestation of Alzheimer's disease?
    Memory deficit
  107. Important measure in the prevention of epiglottitis?
    H. influenza vaccine
  108. What is the initial appropriate IV drug therapy for a patient in status epilepticus?
    Lorazepam (Ativan)
  109. What is the diagnostic test for Cushing's?
    Dexamethasone suppression test
  110. Presentation of mesenteric ischemia
    Severe abdominal pain, often refractory to analgesics; severe pain, with gradually increasing intensity, combined with a relatively normal abdominal exam.
  111. What does finger-to-nose testing measure?
    Cerebellar function
  112. What test is the single most useful in diagnosing multiple sclerosis?
  113. A patient with an upper motor lesion would exhibit _?
  114. What is Hirschsprung's disease?
    It is due to failure in the cephalocaudal migration of the parasympathetic myenteric nerve cells into the distal bowel. The aganglionic bowel produces functional obstruction because the bowel fails to relax in response to distention.
  115. What is Wilson's disease?
    A protein deficiency that impairs copper excretion, which results in copper toxicity and oxidant damage.
  116. Behavioral problems, trouble concentration, sunflower cataracts, Kayser-fleischer rings, hepatitis, autonomic disurbances, movement disorders
    Wilson disease
  117. What type of headache is strictly unilateral orbital, supraorbital, or temporal pain lasting 15-180 minutes, explosive excruciating pain, one attack every other day to eight attacks per day?
    Cluster headache
  118. Mean age occurrence for glioblastoma
    56-60 years
  119. A first seizure during adulthood is always suggestive of _.
    A brain tumor
  120. Which disorder typically presents as quadraplegia and pseudobulbar palsy, sometimes confusion, dysarthria, and/or disturbance of conjugate gaze
    central pontine myelinolysis
  121. Predisposing factors include underlying medical illness or nutritional deficiency, most cases are associated with rapid correction of hyponatremia or with hyperosmolar states.
    Central pontine myelinolysis
  122. Most common initial presenting symptom of primary biliary cirrhosis?
  123. Hypoadrenalism is characterized by what lab abnormalities?
    Hyperkalemia, hyponatremia, and hypoglycemia
  124. The most accurate measurement of adequate thyroxine replacement in a hypothyroid patient is
  125. Indications for insertion of IVC filter (2)
    • 1. active bleeding that precludes anticoagulation
    • 2. recurrent venous thrombosis despite intensive anticoagulation
  126. sudden change in mental status with fever and tachycardia out of proportion to fever, and GI, cardiac, or CNS symptoms
    Thyroid Storm
  127. Hypertension, low T waves, hypernatremia, hypokalemia, low plasma rennin levels, female, 30-50 years old
  128. First-line drugs for painful nephropathy
    Antidepressants: tricyclics, SNRIs; anti-epileptics
  129. cutaneous flushing, diarrhea, and bronchoconstriction
    carcinoid syndrome
  130. mainstay of treatment for inflammatory bowel disease
    sulfasalazine and other 5-ASA agents
  131. on x-ray: bilateral hilar adenopathy and diffuse reticular infiltrates
  132. Which class of drugs have been proven to lower mortality and should be instituted for all patients having an MI (unless contraindications exist)?
    beta blockers
  133. carotid pulse with quick upstroke and wide pulse pressure
    aortic stenosis
  134. leading cause of chronic renal failure
    diabetes mellitus
  135. What is the most consistent physical examination finding associated with a hydrocele?
    Non-tender scrotal mass that transilluminates
  136. What is the most common hypercoaguable state?
    Factor V Leiden
  137. source of fibrinogen, factor VIII, and vWF. Ideal for supplying fibrinogen to the volume-sensitive patient
  138. In the treatment of hyponatremia without the presence of seizures, plasma sodium should be raised no more than...?
    0.5 to 1 mEq/L/hour
  139. When examining urine sediment, what might indicate contamination?
    squamous epithelial cells
  140. angina at rest with a cyclic pattern, episodes more common in the early morning hours
    Prinzmetal's (variant) angina
  141. Initial therapy of idiopathic thrombocytopenia purpura
  142. what valve is a common site of endocarditis in IV drug users?
  143. What is the treatment of choice for polycythemia vera?
  144. a gram-negative intracellular diplococcus transmitted during sex. highest incidence in 15-29 year-olds
    Nisseria gonorrhoeae
  145. incubation period of nisseria gonorrhoeae
    2-8 days after exposure
  146. men experience burning on urination, serous or milky discharge, then 1-3 days later the urethral pain is more pronounced and the d/c becomes yellow, creamy, profuse, and occasionally tinged with blood
    Nisseria gonorrhoeae
  147. natural hx: may progress to involve prostate, epididymus and periurethral glands with acute, painful inflammation; may progress to chronic infection resulting in prostatitis and urethral strictures
    Nisseria gonorrhoeae
  148. women often experience no sx, or may develop dysuria, urinary frequency and urgency, and a purulent urethral d/c. vaginitis and cervicitis are common
  149. a cause of PID and infertility, as well as perpetual transmission of the pathogen
    asymptomatic gonorrhea
  150. gonococcal bactermia is associated with
    peripheral skin lesions or septic arthritis of the knee, ankle, or wrist
  151. In a patient with gonorrheal conjunctivitis, there is purulent, copious d/c, usually unilateral. It is caused by direct inoculation. If it is not treated adequately, what is the patient at risk for?
    global rupture
  152. Current tx of choice for gonorrhea
    IM ceftriaxone or oral cefixime
  153. All partners of gonorrhea patients must be treated. Concurrent tx against what organism is also recommended?
    Chlamydia sp.
  154. caused by Chlamydia, starts with a vesicular or ulcerative lesion. Spreads to lymph nodes causing inguinal buboes, may fuse and break down, resulting in multiple draining sinuses and scarring. Anorectal disease causes tenesmus, d/c, and fistulae
    Lymphgranuloma venereum
  155. In males, what is the most common cause of postgonoccal urethritis?
    chlamydia sp.
  156. this d/c is less painful than gonococcal urethritis, and usually is watery
    chlamydia sp
  157. females- sx of chlamydia infection
    often asymptomatic, may develop cervicitis, salpingitis, or PID
  158. leading cause of infertility
  159. The gram stain for chlamydia will be _
  160. What tests will help confirm the presence of chlamydia?
    Complement fixation test, immunofluorescence, ELISA, or DNA probes
  161. Tx of chlamydia, tx of chlamydia in pregnant women
    Azithromycin, doxycycline, erythromycin; erythromycin for pregnant women
  162. a flagellated protozoan that infects the vagina, Skene's gland, and lower urinary tract of females and the GU tract of males
    Trichomonas sp.
  163. STD that produces pruritis, and a malodorous, frothy yellow-green d/c, diffuse vaginal erythema, and red macular lesions on the cervix
  164. lab findings in trichomonas
    wet mount reveals motile flagellates
  165. tx for trichomonas
    Metronidazole, in a single 2-g dose, may need to be repeated if infection does not clear. Treat partners.
  166. invades the cutaneous and mucosal epithelium, proliferate and cause warts. local growths commonly regress, but it persists and lesions frequently recur
  167. What causes the most common, benign epithelial tumor of the larynx?
    HPV serotype 11
  168. HPV types 6 and 11 cause lesions in the squamous epithelium of the external genitalia and perianal area. What are these lesions called?
    condylomata acuminata
  169. Which virus(es) is/are implicated in intraepithelial cervical dysplasia, neoplasia, and invasive carcinoma?
    HPV 16, 18, and others
  170. For which HPV types is a vaccine available?
    6, 11, 16, 18
  171. Hyperplastic prickle cells with excess keratin are found where?
    in skin warts
  172. Where might you see koilocytotic or vacuolated squamous epithelial cells in clumps?
    on a Pap smear- indicated cervical warts
  173. Humans are its only resevoir. Transmission is via close contact and inoculation into the mucosal surface or through cracks in the skin. It is inactivated at room temperature or by drying. What is it?
  174. Which HSV type is transmitted through sexual contact or from the mother's genital tract during delivery?
    HSV type 2
  175. Where does HSV remain latent in the human body? Specifically where for each type?
    in the dorsal root ganglia, HSV1: trigeminal nerve, HSV2: sacral root ganglia
  176. Constitutional sx are unlikely in the recurrence of this lesion. Its recurrence is heralded by burning or stinging. Neuralgia may also occur.
  177. Where is the typical location of HSV 1 recurrence?
    vermillion border
  178. Where is the typical location for recurrence of HSV type 2?
    the genital area, including the penile shaft, labia, perianal area, and buttocks
  179. How often does HSV1 recur? When is maximum shedding? How long will recurrences last?
    Recurs twice a year, maximum shedding during first 24 hours of recurrence, number of episodes decreases with time
  180. How many episodes of recurrence will a patient with HSV2 have?
    50% will have 10-20 per year
  181. multinucleated giant cells on a Tzanck smear, antibodies identified in the serum by PCR techniques
  182. tx for hsv? tx for patients with frequent outbreaks? how to treat keratitis?
    local wound care and supportive tx with antivirals; foscarnet for immunocompromised, trifluridine for keratitis
  183. grayish-white vaginal d/c, presence of vaginal epithelial clue cells, vaginal pH higher than 4.5, positive "whiff" test, decreased numbers of lactobacilli, increased bacteria count, consisting mainly of short rods observed on wet mount
    bacterial vaginosis
  184. What is the most frequent cause of vaginal discharge in the U.S.?
    Bacterial vaginosis
  185. previously called nonspecific vaginitis or Gardnerella vaginitis
    bacterial vaginosis
  186. Why is vaginal pH increased in bacterial vaginosis? What is responsible for the characteristic fishy odor?
    The decline in lactobacilli, which produce lactic acid, a key component in the maintenance of the normally low vaginal pH, results in increased vaginal pH. That increase in pH allows for the overgrowth of anaerobic bacteria, which apparently coat epithelial cells ("clue cells") and produce a grayish-white vaginal discharge. The metabolites from anaerobic bacteria are rich in amines responsible for the characteristic fishy odor.
  187. What are the Amsel criteria?
    P.W.D.C. According to these criteria, bacterial vaginosis is present if three of the following findings are present: (1) elevated vaginal pH (>4.5), (2) positive amine odor when vaginal fluid is mixed with 10% potassium hydroxide (KOH)—the so-called "whiff" test, (3) presence of clue cells (squamous epithelial cells covered with adherent bacteria) in a saline (wet mount) preparation of the vaginal fluid, and (4) homogenous vaginal discharge.
  188. tx for bacterial vaginosis
    metronidazole or clindamycin
  189. What accounts for most cases of SBO?
    intra-abdominal adhesions related to prior abdominal surgery
  190. How do you confirm a diagnosis of SBO?
    abdominal series
  191. What finding on x-ray is most specific for SBO?
    the triad of dilated small bowel loops (>3 cm in diameter), air-fluid levels seen on upright films, and a paucity of air in the colon
  192. edematous, expanding, erythematous, warm plaque with or without vesicles of bullae; lower leg frequently involved; pain chills and fever are commonly present; septicemia may develop
  193. common pathogens of cellulitis
    gram + cocci, especially group A beta-hemolytic strepto cocci and S. aureus
  194. in healthy persons, what is the most common portal of entry for lower leg cullulitis?
    toe web intertrigo with fissuring
  195. mild cases of cellulitis tx
    dicloxacillin or cephalexin
  196. in the tx of acne, antibiotics are combined with what to decrease antimicrobial resistance?
    benzoyl peroxide
  197. Hearing is mediated by which CN?
  198. an atypical antipsychotic drug, 5HT receptor antagonist, reduced incidence of extrapyrimidal side effects compared to the classical neuroleptics, possibly greater efficacy for reducing the negative sx of schizophrenia, also high affinity for dopamine receptors
    Clozapine (Clozaril)
  199. What BP finding on PE will you find in a patient with coarctation of the aorta?
    BP greater in UE than in LE
  200. Naphazoline is a _ and is used for _
    vasoconstrictor (anti-histamine and mast-cell stabilizer), allergic conjunctivitis
  201. What test specifically visualizes the eighth nerve (acoustic and balance nerve)?
    MRI with gadolinium
  202. In infants over the age of 6 mos, a practicioner will want to screen for strabismus in order to prevent what?
  203. What part of the eye provides central vision acuity?
    the macula
  204. What anti-psychotic drug is associated with increased mortality in elderly patients with dementia-related psychosis?
  205. used for Psychotic disorders (schizophrenia),* dementia of the elderly, bipolar disorder, mania, Tourette disorder, autism
  206. Rhinosinusitis can damage the olfactory _
  207. What medication used in the treatment of CAD is associated with tolerance?
  208. What heart murmur is likely to radiate into the axilla
    Mitral insufficiency (regurgitation) (backflow points to axilla)
  209. A patient presents within 1 hour of ingested 30 tablets of diazepam (valium). what is the most appropriate treatment?
    gastric lavage
  210. In children, tympanostomy tube placement has been proven to _.
    Improve hearing
  211. Which class of drugs is considered to be the standard therapy in the management of chronic heart failure in an asymptomatic patient?
    ACE inhibitors
  212. In an alcoholic, what will you find on assessment of the MCV?
    Increased MCV
  213. Lyme is caused by what kind of organism?
  214. Treatment of Lyme disease in men and non-pregnant women
    • D.A.C.E.
    • 1. Doxycycline
    • 2. Amoxicillin
    • 3. cefuroxime axetil
    • 4. erythromycin
  215. For children, what is the treatment for Lyme disease?
    • 1. Amoxicillin
    • 2. Erythromycin or cefuroxime if penicillin allergy
  216. MRSA tx: for an abcess; for outpatients; infection with hemolytic streptococci; hospitalized patients?
    Surgical drainage of any abscesses should be performed. For those in whom outpatient treatment is appropriate, TMP-SMZ, doxycycline, minocycline, and clindamycin are all appropriate agents. However, treatment failure may result from inducible clindamycin resistance. If infection with -hemolytic streptococci is considered likely, cephalexin may be added. Hospitalized patients may be treated with vancomycin or linezolid.
  217. what is HAART?
    It is the combination of at least three ARV drugs that attack different parts of HIV or stop the virus from entering blood cells
  218. If a patient with TIA is presenting with weakness and heaviness of the contralateral arm, leg, or face, singly or in any combination, where is the lesion?
    carotid territory
  219. If a patient with TIA presents with transient monocular blindness (amaurosis fugax), where is the lesion?
    ophthalmic artery (the first branch of the internal carotid artery)
  220. treatment for early ectopic pregnancy in a stable patient
  221. Initial treatment of choice in a 10-week pregnant patient for hyperthyroidism?
  222. A dendritic ulcer is noted on fluorescein staining. What is the diagnosis?
    Viral keratitis: HSV is a common cause
  223. Which bones are most commonly affected in an adult patient with osteomyelitis?
    Vertebral spine
  224. Asymptomatic patient with elevated serum calcium. next test to order?
    Serum albumin- 50% of Ca is bound to it
  225. Kussmaul's sign is most often caused by what?
    severe R-sided heart failure, frequent in patients with constrictive pericarditis or RV infarction
  226. How is the diagnosis of cystic fibrosis confirmed?
    elevated sweat chloride test or demonstration of a genotype consistent with cystic fibrosis
  227. In infants the eyes should move in parallel without deviation by the age of _.
    6 mos
  228. Lung findings in emphysema
    midline trachea, diffuse hyperresonant to percussion, decreased tactile fremitus, distant heart sounds due to hyperinflation of the lungs
  229. What are the surgical indications for chronic pancreatitis?
    severe pain refractory to analgesics and alcohol abstinence
  230. If a woman has a normal 28-day cycle what tissue and hormonal phase occurs during the last 14 days?
    Secretory luteal phase under the influence of estrogen and progesterone
  231. on peripheral blood smear: lymphocytosis, atypical large lymphocytes, darker-staining, vacuolated, foamy cytoplasm, dark chromatin in the nuclus
  232. a history of cryptorchidism repaired after age 2, predisposes the patient to what?
    testicular cancer
  233. Rhabdomyolysis is a serious complication of seizures and hyperthermia related to drug abuse. What test would best help manage a patient with these sx?
    Serum creatinine kinase
  234. Which gout medication helps to increase the excretion of uric acid and is also not effective in patients with chronic renal disease?
  235. Which gout drug is best to lower serum urate in overproducers, stone formers, and patients with advanced renal failure?
  236. A gout drug, xanthine oxidase inhibitor used to prevent the formation of uric acid
  237. What drug is used for patients who have tophaceous deposits in the skin and is used in the acute rather than the chronic setting of gout?
  238. What will you see on EKG of a patient with acute pericarditis?
    diffuse ST segment elevation
  239. When does the Moro reflex start to disappear?
    5-6 mos of age
  240. When does the grasp reflex start to disappear?
    2-3 mos of age
  241. When does the tonic neck reflex begin to disappear?
    6-7 mos
  242. The injection of hyaluronic acid has been approved for treatment of patients with what conditions?
    OA and RA
  243. a fracture along the length of the radius with injury to the distal radioulnar joint
  244. fracture of the proximal ulna with anterior dislocation of the radial head
  245. fracture of the distal radius with dorsal displacement of the radial head
  246. fracture of the distal radius with ventral displacement of the radial head
  247. DM type 2 patient- neovascularization on optho exam. What is it and what is the most likley complication?
    Proliferative retinopathy, vitreous hemorrhage
  248. characterized by a medium-pitched, mid-systolic murmur that decreases with squatting and increases with straining
    hypertrophic cardiomyopathy
  249. When patients with active severed IBD use antidiarrheals, what might happen?
    toxic megacolon
  250. Methotrexate is used to treat Crohn's. What might be a serious consequence?
    Bone marrow suppression
  251. long-term use of steroids may have what affect on the eye?
  252. pain is noted on straightening the knee after flexing both the hip and the knee- what sign is this?
  253. children rising to stand by rolling over prone and pushing off the floor with arms while legs remain extended- what sign and what condition is this seen in?
    Gower's, muscular dystrophy
  254. What area of the abdomen will pain from the bladder, uterus, or colon go?
  255. Where will pain from the stomach, duodenum, or pancreas go
  256. pain from the small intestine, appendix, or proximal colon causes pain where
  257. Adverse effects of thiazides
    hypokalemia, hypercalcemia, hyponatremia
  258. Treatment for chronic bacterial prostatitis
    fluoroquinolones or bactrim- they penetrate the prostate
  259. narrow complex tachycardia, short P-R interval, delta wave on EKG? What is treatment?
    WPW, radiofrequency catheter ablation- no digoxin or CCB
  260. Enlargement of mucus glands and goblet cell hypertrophy in the large airways results in what?
    chronic bronchitis
  261. destruction of the gas-exchanging structures in the lung
  262. abnormal absorption of sodium and reduced rate of chloride secretion leads to thickening of the mucus and increase in adhesion of the mucus in what condition?
    cystic fibrosis
  263. A single revaccination for a person over age 65 is recommended if it has been more than how many years since he received his first vaccination?
  264. For an osteoporotic fracture, what treatment has the potential to cause analgesia of the fracture site with its use?