FAMILY MED ROSH BOOST EXAM 1

Treatment for fibroadenoma that increases in size or is symptomatic

excision performed to rule out malignant change and confirm the diagnosis.

bell palsy

acute paralysis of the facial nerve.

what are the most common causes of bells palsy

herpes simplex virus and herpes zoster

symptoms of bells palsy

-eyebrow, inability to close the eye, flattening of the nasolabial fold, and drooping of the affected corner of the mouth

-decreased tearing and loss of taste sensation

-ear pain or difficulty hearing. The

when should patients with bell palsy undergo imagining

slow recovery beyond three weeks, no improvement after four months, or facial twitching or spasm preceding the facial weakness

-Contrast-enhanced CT scan or magnetic resonance imaging of the brain, temporal bone, and parotid gland

treatment for bell palsy

Oral glucocorticoids, particularly prednisone, and antiviral therapy, such as valacyclovir, are started within the first three days

-artificial tears and an eye patch to avoid corneal abrasion or injury

mild intermittent asthma

peak flow measurement (≥ 80%), daytime symptoms (two times or less per week), and nighttime symptoms (< one per month).

symptoms of asthma

airway inflammation, bronchial hyperresponsiveness, and reversible airflow obstruction. Patients usually present with episodic wheezing, cough, dyspnea, or chest tightness

what is the mainstay rescue therapy for asthma

albuterol

what is the main stay treatment fr chronic persistent asthma

inhaled corticosteroids

Why are asthma symptoms worse at night?

Increased vagal tone and decreased airway secretions, thereby increasing symptoms of bronchoconstriction.

what is SMART therapy for children w ashtma age of 4

ICS-LABA

hereditary hemochromotosis

-increases intestinal iron absorption leading to iron overload in some individuals

symptoms of hemochromotosis

- fatigue and arthralgias

-dysrhythmias can occur with cardiac iron overload.

-Skin hyperpigmentation

what mutation is associaed w hemochromotosis

HFE

what labs suggest hemochromatosis

-elevated levels of serum iron and ferritin, as well as elevated liver function studie

what is the modality of choice in determining iron stores in hemochromatosis

MRI

what lifestyle modifications should be advised in hemochromatosis

-avoid alcohol

-ascorbic acid supplements

- consumption of raw seafood

pharmacotherapy for hemochromatosis

therapeutic phlebotomy

iron chelation if cant undergo phlebotomy

what are complications of hemochromatosis (4)

-hepatocellular carcinoma

-cirrhosis

-diabetes mellitus,

-cardiomyopathy

treatment for panic disorders

-Benzodiazepines (alprazolam or lorazepam)

-SSRIs (fluoxetine, paroxetine, or sertraline)

-SNRI (venlafaxine, duloxetine, desvenlafaxine, or milnacipran)

Recurrent unexpected panic attacks include Sxs such as

Palpitations

Shortness of breath

Chest pain

Dizziness

Depersonalization or derealization

Numbness or tingling

Fear of dying or losing control

what is the earliest indicator of acute infection of hepatitis b

hep b surface antigen

when is the hepatits b core antibody only created

The core antibody is only created when the actual live virus was presented to the patient's immune system.

what are symptoms of HEP B

present with right upper quadrant pain, constitutional symptoms, jaundice, and nausea. In addition to a positive hepatitis B surface antigen, patients are expected to have alanine aminotransferase (ALT) > aspartate aminotransferase (AST), indicating hepatic injury

complication of hep b

increased risk of developing hepatocellular carcinoma and should be screened annually for cirrhosis and hepatocellular carcinoma

How long must the hepatitis B surface antigen persist in order for hepatitis B infection to be considered chronic?

6 monthd

treatment for acute hepatitis

supportive care, antiviral therapy if severe or prolonged course or acute liver failure

treatment for chronic hepatitis

-decision to initiate antiviral therapy depends on various factors (e.g., presence of cirrhosis, ALT level, HBV DNA level)

-Antiviral Tx options include entecavir, tenofovir, interferon

pleuritis

acute inflammation of the parietal pleura, resulting in pain

symptoms of pleuritis

-localized, sharp, and transient, often aggravated by cough, sneezing, deep breathing, or movement

what is the most common pathogen associated with pleuritis

viral infections (influenza, parainfluenza, coxsackie, epstein-barr virus) or pneumonia (marked by tactile fremitus, egophony, percussive dullness, fever, pleural friction rub, whispered pectoriloquy, and crackles/rales)

what physical exam sign can suggest pleuritis

Pleural friction rub is a low-pitch harsh or grating noise heard when the lung pleura are rubbing together as seen in pleuritis

treatment for pleuritis

anti-inflammatory drugs (indomethacin)

symptoms of pulmonary embolism

sudden death and include dyspnea, pleuritic chest pain, unilateral swollen extremity, hypotension, tachycardia, hemoptysis, dysrhythmia, and syncope.

definitve diagnosis for pulmonary embolism

computed tomographic pulmonary angiography,

what is an appropriate first line diagnostic test to obtaun if CT is immediately unavailable for PE

bedside Doppler ultrasound of the swollen extremity

treatment for PE in hemodynamically unstable patietns

thrombolytic therapy or embolectomy may be necessary

treatment for PE in hemodynamically stable patients

hospitalized while anticoagulation with heparin or enoxaparin is initiated.

-warfarin is also begun and the patient discharged once the international normalized ratio is at therapeutic range (2.0 to 3.0).

how long should patients with PE be on anticoagulants

first-time = 3 months

Longer or indefinite anticoagulation may be necessary for patients with persistent risk factors for thrombus formation

chrons disease

transmural inflammation of the gastrointestinal tract

what deficiencies are associated with chrons disease

develop iron, vitamin B12, and vitamin D deficiencies

clinical manefestations of chrons disease

-crampy abdominal pain, fatigue, weight loss, and nonbloody diarrhea

-systemic manifestations, including arthritis, eye conditions ( uveitis, iritis), and skin disorders ( erythema nodosum, pyoderma gangrenosum). and mouth ulcers

how to diagnose chrons disease

-Colonoscopy with intubation of the terminal ileum

-Cobblestoning and skip lesions due to the transmural inflammatory pattern of disease are the most common finding.

first line treatment for mild active chrons

budesonide 4 weeks

Budesonide is preferred over other conventional glucocorticoids, such as prednisone, due to a more favorable side effect profile.

what is warranted initially in all patients presenting with chest pain

EKG

first line treatment for type 2 diabetes

oral biguanide agent metformin

human scabies

cutaneous infection caused by the Sarcoptes scabiei var. hominis mite

vercrowding, poverty, and natural disasters. In the United States, it is often seen in institutional settings such as correctional facilities, shelters for those without housing, long-term care facilities, and hospitals.

treatment for crusted scabies

permethrin daily for 7 days then twice weekly until cured, plus they should be given oral ivermectin

what is the most common form of community-acquired pneumonia.

strep pneumonia

rust colored sputum

what PE signs suggest pneumonia

-inspiratory crackles and bronchial breath sounds

-Consolidation is indicated by dullness to percussion, increased tactile fremitus, and positive egophony and whispered pectoriloquy.

first line abx regimens for outpatient CAO

amoxicillin, doxycycline, and a macrolide

what is a common endocrine disorder during pregnancy

hyperthyroidism

what are symptoms of graves disease (3)

-goiter

-infiltrative ophthalmopathy-proptosis with tearing and periorbital edema

-infiltrative dermopathy (pretibial myxedema)- raised, violaceous papules on the shins

what labs are associated with graves disease

-elevated T4

-decreased TSH

-thyroid-stimulating immunoglobulins.

-elevated antithyroperoxidase or antithyroglobulin antibodies and antinuclear antibodies

First-line treatment for symptoms of moderate to severe hyperthyroidism

beta-blocker, such as propranolol or metoprolol

what medication is contraindicated in treamtent for pregnant patients with hyperthyroidism

Atenolol is contraindicated in pregnant patients due to intrauterine growth restriction

treatment for hyperthyroidism in pregnancy-

1st trimester - PTU

2nd/3rd trimester - Methimazole

Cholangitis

Charcot triad of fever, jaundice, and abdominal pain that develops as a result of biliary duct obstruction and subsequent bacterial colonization

reynolds pentad

Charcot's triad plus shock and mental status changes, with suppurative ascending cholangitis

what does an abdominal US show in cholangitis

bile duct stone and bile duct dilation

treatment for cholangitis

Broad-spectrum antibiotics (piperacillin-tazobactam

-severe cholangitis require urgent biliary decompression (endoscopic sphincterotomy with stone extraction and stent placement)

what is both diagnostic and therapeutic for cholangitis

Endoscopic retrograde cholangiopancreatography

t: f bite wounds on the hands should be closed

should not be closed primarily but allowed to heal by secondary intention, and antibiotic prophylaxis is indicated

what is the most common pathogen in cat bites

Pasteurella multocida

treatment for cat bites

Augmentin 875 mg PO BID x 10-14 days

allergy to PCN- doxy, bactrim, or fluroquinolone

-tetanus prophylaxis if not UTD

treatment for manic episodes associated with bipolar

lithium or valproate,

treatment for bipolar I disorder who present during a depressive episode

olanzapine and fluoxetine

what is a potential complication following an endoscopic retrograde cholangiopancreatography procedure

pancreatitis

how to diangose pancreatitis

-abdominal ultrasound may show a diffusely enlarged hypoechoic pancreas with peripancreatic fluid

-Contrast-enhanced abdominal CT also shows focal or diffuse enlargement of the pancreas with consistent enhancement with contrast

treatment of pancreatitis

NG suction

NPO

IV rehydration

Obs

clinical manifestations of primary adrenal insufficency

-fatigue, reduced stamina, weakness, anorexia, and weight loss

- abdominal pain, nausea, and vomiting

-Arthralgias, myalgias, chest pain, back pain, leg pain, and headache

-craving for salt

acute adrenal crisis (Addisonian crisis)

ife-threatening emergency caused by insufficient cortisol that manifests with nausea, vomiting, fever, dehydration, and profound hypotension, which progresses to shock that does not fully respond to intravenous fluids and vasopressors

what is diagnostic of primary adrenal insufficiency,

-plasma cortisol < 3 mcg/dL drawn at 8 AM

-plasma adrenocorticotropic hormone level is > 200 pg/mL

what is used to diagnose primary adrenal insufficency

cosyntropin stimulation test

serum cortisol levels < 20 mcg/dL

primary treatment for adrenal insufficency

corticosteroid replacement therapy. Hydrocortisone

treatment for acute adrenal crisis

Intravenous hydrocortisone should be administered in high dose with saline infusion

ulcerative colitis

-chronic inflammation of the colon with presence of ulcers

-bloody diarrhea with tenesmus

how to diagnose ulcerative colitis

colonoscopy- continuous, circumferential inflammatory changes in the rectum.

treatment for ulcerative colitis

5-aminosalicylic acid

what does an xray show in osteoarthritis

joint space narrowing and with the presence of osteophyte and subchondral sclerosis

treatment for older patient with dementia and psychosis ue to a reversibel cause

Hospital admission, intravenous antibiotics, and oral risperdone

-antipsychotic medication should be continued for two weeks after resolution of symptoms and then slowly tapered.

what medication would increase the risk of urinary retention in a patient with benign prostatic hypertrophy in patient with psychosis

chlorpromazine

would also increase the risk of falls in an older patient, due to chlorpromazine's high potential for orthostatic hypotension and sedation

Which of the following organisms is the most common cause of bacterial sinusitis?

Streptococcus pneumoniae

what indicates bacterial sinusitis

persistent and not improving (≥ 10 days), worsening or double sickening (≥ 5-6 days); onset of severe symptoms: fever ≥ 39°C (102.2°F) and purulent nasal discharge (≥ 3-4 days at the beginning of illness)

what physical exam signs suggest bacterial sinusitits

-erythema or edema over the affected sinus, purulent drainage in the nose, pain exacerbation with sinus percussion, and maxillary tenderness

-Transillumination of the frontal and maxillary sinuses may show opacity

treatment for bacterial sinusitis

amoxicillin-clavulanate or doxycycline

what is initial preventative treatment for migraines

-tricyclic antidepressant (amitriptyline or nortriptyline)

-beta-blocker (such as propranolol)

- topiramate (cautioned in young women on estrogen-based oral contraceptives as it can decrease the serum concentration of estrogen and cause contraceptive failure)

abortive migraine treatment

-(NSAIDs, acetaminophen)

-oral triptan

Essential tremor, or “familial tremor,”

gradually progressive action tremor of the hands, head, voice, and, less frequently, the legs. It is the most common cause of action tremor

In patients with persistent tremor, initial monotherapy includes either

primidone or propranolol.

-cant use BB in pts with asthma, heart block, or type 1 diabetes

side effects of primidone

sedation, depression, anxiety, nausea, and vomiting

side effects of BB

lightheadedness, impotence, and bradycardia

how to diagnose trichomonas vaginalis

wet mount, which reveals Trichomonas vaginalis, a round-shaped organism with four anterior flagella that cause a characteristic jerky, spinning motion

symptoms of hyperprolactinemia

oligomenorrhea, amenorrhea, infertility, headache, hot flashes, and galactorrhea.+ decreased bone density

what symptoms of hyperprolactinemia are suggestive of an underlying pituitary tumor

Headache and temporal visual field loss

how to diagnose hyperprolactinemia

serum prolactin is > 20 ng/mL in men and postmenopausal woman and > 30 ng/mL in premenopausal women.

treatment for hyperprolactinemia

dopamine agonists - cabergoline, bromocriptine

surgical resection if possible-

Which of the following antituberculous therapeutic agents requires concomitant vitamin B6 supplementation if dietary intake is insufficient?

isonizad

What is the first step in the pathogenesis of otitis externa

Breakdown of the skin-cerumen barrie