Family Medicine Boards Exam Study Guide – COMPLETE SOLUTION 2022/23

Family Medicine Boards Exam Study Guide – COMPLETE SOLUTION 2022/23 Document Content and Description Below Family Medicine Boards Exam Study Guide – COMPLETE SOLUTION 2022/23 Most common type of arthritis seen in psoriatic arthritis? - Oligoarticular artheritis Characteristic finding in the fing ers of psoriatic arthritis - Sausage Digits What is the early finding in allopurinol hypersensitivity syndrome? - Eosinophilia What antihypertensive is a good uricouric agent? - Losartan Where does pseudogout present on board exams in elderly women? - Wrist What antibody suggest sjogrens syndrome - SSA What connective tissue disease is assoicated with CREST syndrome? - Scleroderma What virus can cause mixed cryoglobulinemia, oligoarthritis, and secondary sjogrens - Hepatitis C How do you diagnose low T - Signs and Symptoms with two am testosterones < 300 Most common cause of osteomyelitis? - Staph A Most common cause of osteomyelitis in IV drug users? - Pseudomonas Most common cause of osteomyelitis in sickle cell patient? - SalmonellaWhat MEDD does a patient need a referral to pain management? - 90 What should all patients who are on chronic pain medication be on? - Senna or bisacodyl Over the counters a patient can take for sleep? - Melatonin or Valarian root Primary Prevention - Prevent disease (vaccines) Secondary prevention - early detection and treatment of disease Tertiary prevention - management of chronic disease How often should a female have cervical cancer screening? - Starting at age 21 q 3 years with pap smear until 30 then q 5 years with pap plus HPV until age 65 How often should a female have ovarian cancer screening? - She shouldn't How often should a female have breast cancer screening? - Starting at age 50 q 2 years until 74 When should you screen for AAA? - 65 years of age male who has ever smoked before At what age should you start to apply fluoride varnishes? - > 6 months of life if water is deficient When should you start to think about medications for BMI? - > 30 When should you start to think about surgery for BMI? - BMI > 40 BMI > 35 with comorbiditiesWhat is Marasmus - Total calorie malnutrition What is Kwashiorkor? - Protein Malnutrition How do you tell the difference between marasmus and kwashiorkor? - Kwashiorkor has edema and ascites with normal weight while marasmus has wasting Treatment of both marasmus and kwashiorkor? - 1 g protein /kg and 30 kcal/kg enterically Symptoms of B1 deficiency? - dry beriberi and wernicke korsakoff syndrome Wet beriberi- high output heart failure What is dry beriberi? - Wernicke korsakoff syndrome What is wet Beriberi? - High output heart failure Symptoms of B2 deficiency? - glossitis, cheilosis, and seborrheic dermatitis Symptoms of B3 deficiency? - Pellagra- dermatitis, diarrhea, and dementia Symptoms of B6 deficiency? - Peripheral neuropathy, anemia, and seizures Symptoms of Vitamin C deficiency? - Scurvy- poor wound healing, easy bruising and bleeding gums Symptoms of biotin deficiency? - myalgias, dysethesias, anorexia Symptoms of Vitamin A deficiency? - Night blindness, Bitot's spotsWhat are Bitots Spots? - Seen in Vitamin A Deficiency, white patches n the Conjunctivae Symptoms of Vitamin E deficiency? - Areflexia, peripheral neuropathy What herbals interact with Coumadin? - Garlic, Ginger, Gingko, Ginseng What is Garlic powder used for? - High Cholesterol What is Ginger root used for? - Motion Sickness What is horse chestnut used for? - Venous Insufficiency What is Saw Palmetto used for? - BPH What percent DEET should travelers use? - At least 20% When is Yellow Fever vaccine needed for travel? - Sub-Saharan africa, south america Most common bacterial cause of travelers diarrhea? - Enterotoxigenic E Coli Why dont we use Bismuth subsalicylate in children? - Reye Syndrome Drug of choice for malaria if no resistence? - Chloroquine phosphate Drugs of choice for malaria if resistence to Chloroquine - Doxycycline or malarone Drug of choice for P vivax malaria? - PrimaquineWhat exposures can cause silicosis? - Silica mining, sandblasting, masonry What exposures can cause asbestosis? - Textiles, shipbuilding, cement, insulation What exposures can cause Toxic organic dust syndrome? - Moldy Hay Post Exposure protocol for TB - Offer PPD now and then again at 12 weeks. > 5 mm is (+) Post Exposure protocol for Hepatitis A virus? - Immune globulin and first dose of Vaccine now Post Exposure protocol for Hepatitis B virus? - Offer Immune globulin and start vaccine Post exposure protocol for HIV? - start 4 week course of 2 drug regimen within 72 hours of exposure Types of Anthrax - Cutaneous Inhalation Pharyngeal and GI How do you diagnose Anthrax? - Gram Stain with culture, pcr treatment for cutaneous anthrax? - Ciprofloxacin or doxycycline What virus causes small pox? - Variola Virus Progression of skin findings in small pox? - Red spots on tongue or palpate Papules Vesicles all samePustules What is the difference between Non alcoholic fatty liver and Non alcoholic steatohepatitis? - NASH has ballooning of the cells, inflammation, and fibrosis What inheritance pattern is hemochromatosis? - Autosomal recessive What gene mutation is found in hemochromatosis? - HFE gene Who should you suspect alpha one anti trypsin deficiency disease in? - Early Onset emphysema with elevated liver enzymes Test to look for autoimmune hepatitis? - Anti-smooth muscle antibody and elevated IgG Pattern of Inheritance of Wilsons disease? - Autosomal recessive What extrahepatic things can cause elevated liver enzymes? - Thyroid Disorders and Celiac Sprue What is Scrofula? - Tuberculous Lymphadenitis of the cervical lymph nodes What is incidence? - Number of new cases What is prevalence? - Number of existing cases How do you calculate Sensitivity? - A/A+C How do you calculate Specificity? - D/B+D How do you calculate Positive predictive value? - A/A+BHow do you calculate Negative predictive value? - D/D+C How do you calculate positive likelihood ratio? - Sensitivity/(1-Specificity) How do you calculate negative likelihood ratio? - (1-Sensitivity)/Specificity How do you calculate Relative Risk? - A/(A+B)/C/(C+D) How do you calculate Odds Ratio? - (A*D)/(C*D) Type I Error? - The probability of detecting a difference when none exist Type II Error? - The probability to fail to detect a difference when one exist What causes wide splitting of S2? - RBBB, Pulmonic stenosis, PE, or Pulmonary HTN What causes Fixed splitting of S2? - Atrial septal defect What kind of block can cause a left axis deviation? - Left anterior fascicular block What kind of block can cause a right axis deviation? - Left Posterior fascicular block How to diagnose right ventricular hypertrophy? - R V1 + S V6 >11 mm R >S in V1 When does bradycardia need a pacemaker? - symptomatic, third degree heart block, > 3 second pause, or pulse < 40What is paroxysmal Atrial fibrillation? - last less than 7 days What is persistent atrial fibrillation? - Last more than 7 days What is permanent Atrial fibrillation? - Last more than a year What do you give patients for rate control when they have hypotension with atrial fibrillation with RVR? - Amiodarone What do you do if atrial fibrillation has been occuring for more than 48 hours? - Anticoagulate for 4 weeks then cardiovert then anticoagulate for 4 weeks most cardioversion What is monomorphic ventricular tachycardia assoicated with? - Myocardial scar What will you see on EKG with hyperkalemia? - Peaked T waves, wide PR, wide QRS, short QT What will you see on EKG with hypokalemia? - U waves, ST and T wave depression What will you see on EKG with hypercalcemia? - Short QT What will you see on EKG with hypocalcemia? - Long QT What will you see on EKG with hypermagnesemia? - Bradycardia What will you see on EKG with hypomagnesemia? - Long QT, PR, and QRS Indication for revascularization with stable angina? - 3 vessel disease two vessel with prominent LAD>50% stenosis of LAD Refractory symptoms Leads for inferior MI? - II, III, aVF leads for lateral MI? - I, aVL Leads for Septal MI? - V1-V3 Leads for Lateral MI? - V4-V6 Leads for Posterior MI? - V1-V2 depression Class A heart Failure? - High risk for heart failure without signs or symptoms and no structural damage Class B Heart Failure? - Structural heart disease without symptoms Class C Heart Failure? - Structural heart disease with symptoms Class D Heart Failure - Refractory Heart Failure despite medical Therapy Spironolactone confers mortality benefit in whom? - Class III and IV heart failure At what Creatinine should you not use Spironolactone? - Men > 2.5, Women > 2.0 What type of heart valve replacement would you pick for an elderly patient with < than 10 years of life expectancy? - Bioprosthetic valves because they dont require anticoagulants.What is dysphonia? - Voice impairment Most common cause of hoarseness? - Laryngitis What is chronic laryngitis? - Symptoms persist more than 3 weeks Irritant causes of chronic laryngitis? - Smoking, chronic vocal cord strain, reflux premalignant or malignant vocal fold lesions? - Laryngeal leukoplakia, dysphasia, SCC What can cause unilateral paralysis of vocal cord? - Recurrent laryngeal injury during thyroid or cardiothoracic surgery What can cause bilateral vocal cord paralysis? - Bilateral thyroid surgery or neck trauma What is presbylaryngis? - Age related vocal cord atrophy What is spasmodic dysphonia? - Episodic uncontrolled contraction of intrinsic muscles resulting in halting or strangled voice What is spasmodic dysphonia associated with? - Lack of breath control and stress What systemic diseases can cause hoarseness? - Inflammatory arthritis, SLE, hypothyroidism, acromegaly, sarcoidosis, and amyloidosis What should you do if dysphonia last more than two weeks? - Get laryngoscopy What should patient do if inhaled corticosteroids are causing dysphonia? - Gargling, rinsing mouth and using spacerCauses of aortic stenosis? - Rheumatic heart disease, bicuspid valve, senile calcific stenosis At what pressure gradient on echo is aortic stenosis symptomatic? - >40 mmHg When do you replace valve in aortic stenosis? - when they are symptomatic Causes of aortic insufficiency? - valve destruction by endocarditis or rheumatic heart disease, also dissection by marfan Describe murmor findings in Aortic insufficiency? - diastolic decresendo blowing at the base Treatment of aortic insufficiency? - afterload reduction with ACE inhibitor Replacement if symptoms or worsening symptoms Describe murmor in mitral valve stenosis? - diastolic aplical rumble after an opening snap Treatment of mitral valve stenosis? - balloon valvotomy if no regurg or thrombus Causes of mitral valve prolaspe? - idiopathic, marfan, ehlers- danlos, post MI Murmor of Mitral valve prolapse? - Midsystolic clic and murmur at the apex Murmor of mitral insufficiency? - holosystolic best at apex in left lateral decubitus Mneumonic for who needs prophylaxis for endocarditis? - HERT H: hole, E: Endocarditis (previously), R: repaired, T: transplantedWhat procedures need endocarditis prophylaxis? - Dental and respiratory procedures What do we give for endocarditis prophylaxis? - amoxicillin or cephalexin or clindamycin Inheritance of hypertrophic cardiomyopahty? - autosomal dominant Storage caues of restrictive cardiomyopathy? - hemochromatosis and Fabry disease Infectious causes of dilated cardiomyopathy? - viral, chagas, HIV, lyme Toxic causes of dilated Cardiomyopathy? - alcohol, cocaine, methamphetamine, chemo EKG findings in Hypertrophic cardiomyopathy? - LVH, prominent Q in II, III, and aVF Viruses that cause acute pericarditis? - HIV, coxsackie, Epstein-barr, CMV Most common causes of pericardial effusion? - idiopathic, infectious, malignancy, trauma, and post MI Causes of subacute tamponade? - neoplasm, pericarditis Becks triad for tamponade? - Elevated JVP, muffled heart sounds, and hypotension What is electrical alternans - QRS shifts from beath to beath What is pulsus paradoxus? - drop of systolic blood pressure by >10 mmHg during inspirationWhat can cause pulsus paradoxus? - Tamponade, constrictive pericarditis, asthma, and COPD ABI of < 0.9 indicates what? - >50% stenosis What ABI indicates ischemia? - <0.4 Who should be screened for diabetes? - Anyone with blood pressure >135/80 When should asa be used in diabetes for primary prevention? - When ASCVD risk is greater than 10% When should you screen for neuropathy in type 1 diabetes? - 5 years after diagnosis When should you screen for retinopathy in type 1 diabetes? - 5 years after diagnosis What are Kussmaul respirations? - Rapid deep breaths What Bicarbonate is indicative of metabolic acidosis? - < 15 mEq/L Types of ultra short acting insulin? - lispro, aspart, glulisine Types of long acting insulin? - glargine, and detemir With DKA when do you switch to subq insulin? - once the gap has closed When do you give Potassium in DKA? - When K is less than 4.5 How many Liters of fluid do you typically need when treating HONKC? - 6-10 LWhat do you give unconscious patients with hypoglycemia? - Glucagon 1 mg IM How do you diagnose Metabolic Syndrome? - 3 of following Waist circumference >40 men, >35 woman TG > 150 HDL < 40 in men, < 50 in women BP > 130/85 Fasting Glucose > 110 What hormones does the anterior pituitary secrete? - ACTH, TSH, FSH, LH, GH, and prolactin How big is a macroadenoma of the pituitary? - > 1 cm What is the most common macroadenoma? - nonfunctional What percentage of the population has a pituitary adenoma? - 10% What labs do you need to order for a pituitary adenoma? - Prolactin, insulin like growth factor-1, 24 hour urine for cortisol, ACTH, TSH, LH, FSH, and testosterone levels When can observation be an option for a pituitary adenoma? - < 20 mm and no symptoms What can cause decrease ADH leading to DI? - neurosurgery, trauma, tumor, ischemia, infiltrative diseases What causes nephrogenic DI? - CKD, hereditary, hypercalcemia, hypokalemia, and lithium toxicity Lab findings in DI? - Low urine osmolality with high serum osmolalityHow do you confirm DI? - Water deprivation test How do you differentiate between central and nephrogenic DI? - Give Desmopressin Next step once you diagnose central DI? - MRI of Sella turcica Treatment for Central DI? - Intranassal Desmopressin Treatment for peripheral DI? - Thiazide and amiloride Causes of SIADH? - CNS pathology or Drugs Which drugs can causes SIADH? - carbamazepine, SSRi, vincristine, haldoperidol, TCA, and amiodarone Lab findings with SIADH? - Low Na low plasma osmolality High urine osmolality >100 mOsm/kg Urine Na >40 mEq/L Treatment for SIADH? - Water restriction Salt administration if severe Causes of hypopituitarism? - INvasive, Infiltrative, infarction, Head injury, Immunologic, infectious, Empty Sella Syndrome Infiltrative cuases of hypopituitarism? - Sarcoidosis, hemochromatosis, histiocytosis XTypes of infarctions that can cause hypopituitarism? - Sheehan Syndrome and pituitary apoplexy What is Sheehan Syndrome? - Infarction that occurs postpartum presents with inability to lactate and amenorrhea What is pituitary apoplexy - Sudden hemorrhage Infectious causes of hypopituitarism? - TB, syphilis, and fungal What is primary empty sella syndrome? - Defect in the diaphragm sella leading to infiltration with CSF fluid? What is secondary Empty sella syndrome? - Enlargement of the sella by a mass that is removed by surgery What causes most cases of Growth hormone excess? - Pituitary adenoma (>99% of cases) How do you diagnose Growth hormone excess? - Insulin growth factor 1 Treatment of Growth Hormone Excess? - Transsphenoidal resection Drugs that are associated with hyperprolactinemia? - Dopaminergic drugs, estrogens, and SSRI What hormone stimulates prolactin secretion? - Thyroid releasing hormone What does increased prolactin do? - inhibits GnRH leading to decreased FSH and LH How do you treat prolactinoma? - Pharm: bromocriptine or cabergoline Surgical: Transphenoidal resectionMEN type 1 - Pancreatic, parathyroid, and pituitary tumors MEN II - medullary thyroid carcinoma, pheochromocytoma, parathyroid hyperplasia MEN III - medullary thyroid carcinoma, pheochromocytoma, and mucosal and GI neuromas What do you need to check lab wise with antithyroid medications? - CBC for agranulocytosis Cardiac complications of hyperthyroidism? - Increased contractility, CHF, arrhythmias (atrial fibrillation) What is the mechanism of graves opthalmopathy? - accumulation of hyaluronic acid Treatment for Graves opthalmopathy? - steroids and eye surgery Symptoms of thyroid storm? - fever, tachycardia, delirium, diarrhea, vomiting, and CHF Treatment of thyroid storm? - high dose prpranolol, PTU, steroids, and iodide Drugs that can cause hypothyrodism? - Amiodarone, lithium, interferon Exam findings of hypothyrodism? - delayed DTR, enlargment of tongue, hoarseness, and periorbital edema When do you treat subclinical hypothyrodism? - symptomatic or TSH >10 Treatment for myxedema coma? - IV T3 or T4Auto antibody for Hashimoto thyroiditis? - TPO What causes postpartum thyroiditis? - Lymphocytic infiltration What is the 90% mneumonic for thyroid nodules? - 90% of nodules are benign, 90% are cold, 90% are non malignant, 90% of malignancies present as a nodule Types of primary thyroid cancers? - papillary, follicular, medullary, and anaplastic Most common type of thyroid Cancer? - Papillary Aggressive type of thyroid cancer that goes to bone, lungs, and brain? - Follicular What type of thyroid cancer is assoicated with MEN 2 and 3? What does it secrete? - Medullary Calcitonin Red Flags for thyroid cancer? - male, age < 20 or >65, history of neck radiation, FH of thyroid cancer. What on physical exam findings are red flags for thyroid cancer? - Hard, Fixed, > 4 cm, symptoms of local invasion. Next step when you find thyroid nodule? - Get TSH Next step for thyroid nodule with low TSH? - Up take scan Next step for thyroid nodule with normal or high TSH - FNA biopsyDescribe Vitamin D Metabolism? - Ingest Vitamin D3 which is converted to 25-Vitamin D by liver. This goes to kidneys and is converted to active 1,25 vitamin D How can malignancy causes hypercalcemia? - Tumor release of PTH-related peptide 1,25 DHD production by tumor Local osteolytis from metastases What types of tumors produce PTH related peptide? - Breast, lung, renal cell, ovarian and bladder What type of tumor produces 1,25 DHD? - lymphomas What type of tumors caues osteolysis? - multiple myeloma and breast cancer What Vitamin Excess can cause hypercalcemia? - Excess Vitamin A and Vitamin D What labs should you order for hypercalcemia? - Repeat Ca with albumin, ionized Ca, PTH, and phosphate Why can we only use calcitonin for three days? - Tachyphylaxis Calcium, Phosphorus, PTH, PTHrP in PTH mediated hypercalcemia? - Caclium (increased) Phosphorus (decreased) PTH (increased) PTHrP (decreased) Calcium, Phosphorus, PTH, PTHrP in PTHrP mediated hypercalcemia? - Caclium (increased) Phosphorus (decreased)PTH (decreased) PTHrP (increasead) Calcium, Phosphorus, PTH, PTHrP in 1,25 vitamin D mediated hypercalcemia? - Caclium (increased) Phosphorus (increased )) PTH (decreased) PTHrP (decreased ) Calcium, Phosphorus, PTH, PTHrP in Vitamin D intoxication mediated hypercalcemia? - Caclium (increased) Phosphorus (increased ) PTH (decreased) PTHrP (decreased ) When are glucocortiocoids first line treatment for hypercalcemia? - Vitamin A or Vitamin D mediated Indications for surgery for hyperparathyroidism? - Age < 50 Calcium > 1mg/DL above normal osteoporosis Hypercalciuria Worsening renal function What syndrome is assoicated with pseudohypoparathyroidism? - Albright hereditary osteodystrophy What will you see with albright hereditary osteodystrophy? - short stature, round face, short neck, and bradydactylyWhat is Paget disease of the bone? - accelerated bone turnover most common fracture in paget disease? - vertebral crush fracture Treatment of paget disease? - Bisphosphonates What should be screened for osteoporosis? - >65 year old women or women at risk if >60 What part of the adrenal gland produces catecholamines? - Medulla What are the parts of the cortex and what do they produce? - Glomeruloa -( mineralocorticoids) Fasciculata- (cortisol) Reticularis- (androgens) What will you see lab wise for adrenal insufficiency? - HYponatremia and hyperkalemia How do you confirm Adrenal insufficiency? - early morning cortisol < 5 microgram/dL How do you distinguish primary from secondary adrenal insufficiency? - Primary has hyperpigmentation also and increase in ACTH What is Cushing Disease? - ACTH hypersecretion from the actual pituitary How do you confirm Cushing syndrome? - overnight dexamethasone suppression test shows am cortisol > 1.8 micrograms/dL Most common symptoms for hyperaldosteronism? - HTN with hypokalemiaHow do you treat pheochromocytoma? - phenoxybenzamine (first) then beta blocker for rate control then surgical removal. How do you rule out adrenal incidentaloma? - plasma metanephrines, dexamethasone suppresion test, plasma renin/aldosterone When do adrenal incidentaloma need resection? - Non functional and > 4 cm What is the difference between dysphagia and odynophagia? - odynophagia is pain with swallowing while dysphagia is the feeling of the food sticking Secondary cause of achalasia? - Chagas disease What does dysphagia for solids and liquids suggest? - motility disorder What is oropharyngeal dysphagia? - sensation of food getting stuck immediately upon swallowing Vital causes of esophagitis? - HSV, CMV, HIV Indications for EGD in patients with GERD? - failure to respond to therapy, bleeding, dysphagia, Most common surgical technique for GERD? - Nissen Fundoplication, and Hill repair What will you see on histology of barrett esophagus? - metaplasia where squamous epithelium is replaced with columnar How much does barrett's esophagus increase risk of esophageal adenocarcinoma? - 0.2% to 2.0% What is Gastropathy? - injury to the mucosa of the stomach with damage without inflammationCauses of gastropathy? - NSAIDS, alcohol, bile reflux, severe ilnness, and portal HTN Causes of acute gastritis? - H pylori or possibly CMV Types of chronic gastritis? - Type A TYpe B What is type A chronic gastritis? - in the fundus of the stomach is autoimmune against parietal cells and intrinsic factor What is type B chronic Gastritis? - Found in the antrum of the stomach, is caused by H Pylori Test of choice for H Pylori? - Biopsy urease test what can cause false negatives for H Pylori? - PPIs, H2 blockers, GI bleeding, antibiotics,a nd bismuth Alarm signs for Peptic ulcer disease? - Age > 45, weight loss, anemia, bleeding, vomiting, dysphagia, family history of gastric cancer Treatment for H PYlori? - PPI BID, clarithromycin and amoxicillin for 14 days What should you think of if Treatment fails for PUD? - H Pylori resistance, large ulcers, ZollingerEllison syndrome The other 10% of causes for acute diarrhea? - medications, toxin ingestions, and ischemia What should you think of with bloody diarrhea? - E Coli 0157:H7, shigella, campylobacter, and salmonellaWhat will stool cultures not look for? - Yersinia and aeromonas When do you get O and P for diarrhea? - If it last more than 2 weeks, traveled to developing countries, men who have sex with men, AIDS Fluid and electrolyte replacement cocktail? - 1/2 teaspoon of salt, 1/2 teaspoon of baking soda, and 4 tablespoons of sugar in 1 L of water What is chronic diarrhea? - last more than 4 weeks How do you calculate the stool osmotic gap? - 290- (2(Na+K)) When will stool osmotic gap be elevated? - Osmotic chronic diarrhea Gold standard for fat malabsorption? - Fecal fat collection over 72 hours. > 6 g/day Treatment for fat malabsorption? - Restrict long chain fatty acids to 40 g/day, need to supplement fat soluable vitamins (ADEK) What is the lactose tolerance test? - measure serum glucose in blood at time 0, 60, and 120 minutes after ingestion of 50 g of lactose. an Increase of glucose > 20 mg/dL is diagnostic What would be a positive lactose breath test - measure H2 at time 30 minutes after ingestion of 2 g/kg of lactose. An increase of >20 ppm is diagnostic Antibodies assoicated with Celiac Disease? - Antiendomysial IgA and Anti tissue transglutaminase What vaccine do you need to give Celiac Disease patients? Why? - Pneumococcal VaccineAssociated with hypersplenism What do the following resections of the colon cause? > 60 cm of terminal ileum >100 cm of ileum Ileocecal valve - A: IF bound vitamin B12 B: Bile salt and fat malabsorption C: Bacterial overgrowth What malabsorptions does bacterial overgrowth cause? - Carbohydrate, fat, B12 GOld standard to diagnosis of bacterial overgrowth? - Jejunal aspirate showing bacterial count >10^5 Extraintestinal manifestations is more assoicated with which IBS? - Ulcerative Colitis Antibody for Crohn's Disease? - ASCA Antibody for Ulcerative Colitis? - p-ANCA First line for Crohns' Disease that is in the Ileium? - Mesalamine Treatment of Crohns' when it is in the ileocolitis or colitis? - mesalamine or sulfasalazine Ulcerative colitis medication if proctitis? - 5-ASA suppositories Extraintestinal manifestations of ulcerative colitis? - uveitis, episcleritis, erythema nodosum, pyoderma gangrenosum, ankylosing spondylitis, sclerosing cholangitisPrimary symptoms of IBS? - discomfort, relief with defecation, change in frequency or form Antispasmodics for IBS? - dicyclomine or hyoscyamine Medications for constipation form of IBS? - lubiprostone, increase dietary fiber Medications for diarrhea form of IBS? - loperamide, diphenoxylate, atropine Patient education for constipation? - Increase fiber and fluid intake, go to bathrrom right after eating, regular physical activities How do you calculate the discriminant function? What is it used for? - (PT-control x 4.6 + T. Bili)= If > 32 then you need to give prednisolone In which common liver disease will you see the transaminases > 5000 - Ischemic hepatopathy What chromosome is HFE gene located on? - 6 What gene is involved with Wilson Disease? - ATP7B How do you diagnose wilson disease? - low copper and serum ceruloplasmin What do you treat autoimmunehepatitis with? - Azathioprine and prednisone What does primary biliary cirrhosis effect? - destruction of the intrahepatic bile ducs What antibody will be positive with primary biliary cirrhosis? - Antimitochondrial antibodiesWhat does primary sclerosing cholangitis effect? - biliary tract How do you diagnose primary sclerosing cholangitis? - ERCP (beads on a string) What physical exam findings are caused by portal hypertension? - esophageal varices splenomegaly Caput medusae Ascites Hemorrhoids Shifting dullnesss manes there is how much ascites fluid? - at least 1500 cc 90% of ascites patients will respond to what? - sodium restriction (less than 2 g) spironolactone (100 mg), and lasix 40 mg How do you diagnose SBP? - PMN count > 250 + culture of ascitic fluid Treatment of SBP? - third generation cephalosporin + IV albumin What causes hepatorenal syndrome? - intense renal vasoconstriction from failure of renal vasodilator synthesis What will you see with hepatorenal syndrome? - renal failure and < 500 mg/dL of proteinuria Hepatopulmonary syndrome is characterized by what? - liver disease, increased Alveolar-arterial O2 gradient, and intrapulmonary vascular dilation leading to right to left shuntWhat is platypnea? - shortness of breath What is orthodeoxia? - deoxygenation in the upright position How do you diagnose hepatopulmonary syndrome? - Contrast enhanced echo to look for pulmonary vascular dilation Treatment for hepatopulmonary syndrome? - methylene blue (inhibits NO2 vasodilation) Liver transplantation What all goes into Child-Pugh Score? - Encephalopathy? Bilirubin? Ascities? Albumin? INR? Goal for resting heart rate when giving beta blocke for esophageal varices? - 50 to 60 Risk factors for Gallstones? - Obesity, insulin resistance, rapid weight loss, and pregnancy How long after a fatty meal does acute cholecystitis pain resolve? - 12 hours Charcot Triad - Jaundice, fever, and right upper quadrant pain for acute cholangitis When is HIDA scan reliable for acute cholecystitis? - if bilirubin is < 5 mg/dL Mnemonic for acute pancreatitis causes? - I GET SMASHED idiopathic, gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion stings, hyperlipdema, ERCP, DrugsWhat all goes into Ranson Criteria? - Age WBC Glucose LDH AST Complications of pancreatitis? - infected pancreatic necrosis, pancreatic abscess, pseudocysts MNEUMONIC for causes of chronic pancreatitis? - TIGAR-O Toxic, idiopathic, genetic, autoimmune, recurrent, obstructive Classic triad of chronic pancreatitis? - Pancreatic calcifications, steotorrhea, and DM What causes the two types of esophageal cancer 1. SCC 2. Adenocarcinoma - 1. Chronic alcohol use and smoking 2. Barrett esophagus Most common type of Gastric Cancer? - Adenocarcinoma Endoscopy with biopsy should be performed on all patients with these findngs? - > 50 with dyspepsia that did not respond to acid suppression What inheritance is familial adenomatous polyposis? What is it characterized by? - Autosomal dominant > 100 colonic adenomatous polys by the age of 35Treatment for familial adenomatous polyposis? - colectomy by the age of 20 Inheritance of hereditary nonpolyposis colorectal cancer? What is it? - Autosomal dominant condition where the adenomas you do have ar emore likely to be high grade villous How do you make diagnosis of hepatocellular carcinoma? - alpha fetoprotein Liver CT scan Risk factors for pancreatic cancer? - age, obesity, tobacco use, abdominal radiation, family history Lab for pancreatic cancer? - CA 19-9 Petechiae and palpable purpura are associated with what cause of meningitis? - Meningococcal meningitis causes DIC Microorganisms and treatment for Meningitis in patient < 1 month of life? - Group B strep, E Coli, Listeria Ampicillin and cefotaxime (or gentamicin) Microorganisms and treatment for Meningitis in patient 1 month to 50 years of life? - S Pneumoniae, N meningitidis, H Flu Ceftriaxone + vancomcyinMicroorganisms and treatment for Meningitis in patient >50 years of age? - S pneumoniae, listeria Ceftriaxone + ampicillin + vancomcyin What does WBC, Glucose, Protein, and opening pressure do with bacterial meningitis? - WBC: PMN increased Glucose: Decreased Protein: increased Opening Pressure: increased What does WBC, Glucose, Protein, and opening pressure do with viral meningitis? - WBC: Increased Lympcytes Glucose: normal protein: normal Opening pressure: normal What does WBC, Glucose, Protein, and opening pressure do with fungal meningitis? - WBC: increased lympocytes Glucose: decreased Protein: increased Opening Pressure: increased Viral Meningitis causes in summer and fall? - echoviridae and coxsackievirus Viral meningitis causes in winter/spring? - Mumps Encephalitis assoicated with olfactory hallucination? - HSV Most common cuase of blindness worldwide? - untreated C. TrachomatisWhat age can you give OTC cold medications to kids? - >2 years of age What is zygomycosis? - Rare fungal infection in immunocompromised patients of zygoma. Presents with necrotic eschar and nasal mucosa What virus causes Herpangina? - Coxsackievirus What all goes into Centor Criteria? - T > 38.0 Tender cervical LAD absence of cough Pharyngotonsillar exudates When do you test pharyngitis for GAS and treat only if positive? - Centor 2-3 out of 4 Only drugs that have been shown to to prevent rheumatic fever? - penicillin or erythromycin What will you see on soft palate in Herpangina? - vesicular exanthem Most common cause of dental Caries? - streptococcus mutans What is ludwig angina? - infection of sublingual and submandibular spaces that can lead to obstruction of airway What is lemierre syndrome? - suppurative thrombophlebitis of the internal jugular vein What bug causes Lemierre syndrome? - Fusobacterium necrophorum Tender nodules on finger and toe pads associated with endocarditis? - Osler nodesNontender hemorrhagic macules on palms and soles associated with endocarditis? - Janeway lesions Reddish brown streaks in the proximal nail beds associated with endocarditis? - Splinter hemorrhages Retinal hemorrhages associated with endocarditis? - Roth spots Major criteria for Endocarditis? - + blood culture or + echocardiogram Minor Criteria for endocarditis? - IV drug use Fever Vascular phenomena Immunologic phenomena Microbiologic Evidence HACEK organisms? - Haemophilus, actinobacillus, cardiobacterium, eikenella, kingella Empirical therapy for naive valve endocarditis? - Vancomycin plus Ceftriaxone Empirical therapy for prosthetic valve endocarditis? - Vancomycin plus rifampin plus gentamicin Typical patient for myocarditis? - young healthy patient who recently had a viral URI Infectious causes of myocarditis? - coxsackievirus, HIV, influenza, lyme disease, Chgas disease How old does a patient need to be to get flu vaccine? - > 6 months of lifePneumonia associated with Ethanol abuse? - Klebsiella pneumonia Pneumonia associated with prolonged sore throat? - Chlamydia pneumoniae Pneumonia associated with livestock and elevated LFTs? - Q Fever Pneumonia associated with birds? - Chlamydia psittaci What makes up the Ghon complex? - Peripheral calcified nodule with hilar lymphadenopahty How do you rule out pulmonary TB? - 3 negative sputum cultures are negative for 8 weeks. When do you use antibiotics for infectious diarrhea? When would you not? - fever, tenesmus, bloody stool, fecal leukocytes Enterohemorrhagic E Coli, nontyphpoidal salmonella, aeromonas, yersinia Main risk of rotovirus vaccine? - intussusception HUS is a complication of what cause of diarrhe? - EHEC Guillain-Barre syndrome is a potential complication of what cause of diarrhea? - C jejuni When should you consult nephrology for CKD? - GFR < 30 mL What is stage 2 CKD? - GFR 89-60What is stage 3a CKD? - GFR 59-45 What is stage 3b CKD? - GFR 44-30 What is stage 4 CKD? - GFR 29-15 What in the history has a high likelihood ratio of palpitations being secondary to cardiac causes? - Palpitations at work or affecting sleep What positions make AVNRT symptoms worse? - standing or bending over Most common structural heart disease resulting in palpitations? - Mitral Valve prolapse Most cost effective approach to patients with infrequent episodes of palpitations? - Implantable loop monitors What percentage of beats can cause Ventricular premature contraction induced cardiomyopathoy? - 25% What structural abnormalities are SVT assoicated with? - Hypertrophic cardiomyopathy and ebstein anomaly When do risk of death increase with ventricular tachycardia? - lasting 4 beats What is Long QT in men? - 440 msec What is Long QT in women? - 460 msec What do you not want to give a patient with Long QT syndrome? - beta blockerHow do you diagnose Hepatitis A? - Anti-hepatitis A IgM What is the rate of virus acquisition by an infant from mom with Hepatitis B? - 90% Markers for acute hepatitis B? - HBsAg (+) Anti- HB core IgM Markers for Vaccine to Hepatitis B? - Anti-HB Surface What do you do for babies born to mothers of hepatitis B? - Should receive immunoglobulin and vaccine in first 24 hours of life What rate of Hep C patient become chronic? - 75% What organ is the most common for abscess development beside the skin? - Liver What do you call a liver abscess that is from bacterial invasion from biliary tree, portal vein or, hepatic artery? - Pyogenic liver abscess Common organisms for pyogenic liver abscess? - E Coli, Klebsiella pneumoniae, proteus vulgaris, Treatment of pyogenic liver abscess? - Third Geneeration Cephalosporin + flagyl How long do you give antibiotics for with pyogenic liver abscess? - Radiographic resolution likely 6- 12 weeks When do you drain pyogenic liver abscesses? - >5 cmWhat makes a + urine culture? - at least 10,000 colony forming units of a single organism What should you think of if patient has fever after 2-3 days of an appropriate antibiotic with UTI? - Perinephric abscess When can you conisder a UTI recurrent? - New symptoms > 2 weeks after resolution of symptoms When do you need to consider suppression for UTI? - 2 or more recurrences within a 6 month window Difference in WBC between noninflammatory, inflammatory, and septic arhritis? - Noninflammatory < 2000 Inflammatory < 50,000 Septic > 50,000 Mosquito borne infection that caues fever, hemolysis and meningoencephalitis? - Malaria Mosquito borne infection that can either cause breakbone fever or hemorrhagic fever with thrombocytopenia? - Dengue fever Mosquito borne infection that is usually self limited but can cause hepatitis and jaundice? - Yellow Fever Mosquito borne infection that causes encephalitis and peripheral neuropathy? - eastern equine or west nile In what areas do you see Babesiosis? - Coastal areas Where do you see colorado tick fever? - Western and northwestern USAWhere do you see human granulocytic anaplasmosis? - Japan, malaysia, and Eastern USA Where do you see Human monocytic Ehrlichiosis? - Japan, malaysia, and souther USA Where do you find aspergillus? - Soil Where do you find cryptococcus? - bird droppings Where do you find Coccidioides? - soil of southwesterns USA Where do you find blastomyces? - Great lakes What is a fever of unknown origin? - Temp > 38.3 for 3 weeks What is a fever of unknown origin likely to be? - Infectious Cancer Autoimmune What are angular cheilosis? - Fissures at the corner of the mouth What is koilonychia? - Spooning of the fingernails Esophageal webs and atrophic glossitis is what syndrome - Plummer vinson Target cells are associated with anemia caused by what? - Thalassemia TIBC is what in iron deficiency anemia and anemia of chronic disease? - High in Fe deficiency Low in chronic diseaseWhat causes sideroblastic anemia? - Defect in Heme biosynthesis in RBC precursors Causes of Sideroblastic anemia? - X linked or autosomal Acquired Acquired causes of Sideroblastic anemia? - Lead, INH, alcoholism, Cu defiency Medication to help with hereditary forms of sideroblasstic anemia? - pyridoxine How does Anemia of chronic disease lead to increase iron in macrophages? - Hepcidin produced by inflammation is a negative regulator of iron absorption Ways you can have hemolysis of RBC? - Trapped in the spleen, lysis in blood vessels, or antibodies What will you see lab wise for hemolytic anemia? - Increased Bilirubin Decreased haptoglobin Increased LDH Test for autoimmune hemolytic anemia? Treatment? - Direct coombs test (+) Tx: steroids, rituxan, splenectomy What etiologies are assoicated with microangiopathic hemolytic anemia? - TTP, DIC, Malignant HTN, HELLP How is G6PD deficiency inherited? - x linked recessiveWhat will you see on peripheral smear in G6PD deficiency anemia? - Heinz bodies or bite cells What is paroxysmal nocturnal hemoglobinuria? - increased RBC sensitivity to complement leads to episodes of intravascular hemolysis and hemoglobinuria What organism can lead to vitamin B12 deficiency? - Fish Tapeworm Pernicious anemia leads to increased risk of what? - Gastric cancer and carcinoid tumors What do you need to do before treating folate deficiency? - look for vitamin B12 deficiency What are thalassemias? - decreased production of globin chains either alpha or beta Who do you see alpha chain disorders in for thalassemia? - southeast asia and china Who do you see beta chain disorders for Thalassemia? - mediterranean Alleles for hydrops fetalis in alpha chain disorders? - Missing all 4 chains Alleles for hemoglobin H disease? - Missing 3 chains Alleles for Alpha thalassemia minor? - Missing two chains Alleles for alpha thalassemia carrier? - Missing one chain Sickle cell Crisis most commonly affects what? - Back and long bonesMost common cause of death in sickle cell patients is? - Pulmonary complications New pulmonary infiltrate with chest pain and fever in sickle cell patient should make you think of what? - Acute chest syndrome Features of TTP/HUS? - Fever Anemia Thrombocytopenia Renal Failure Neurologic abnormalities Treatment for TTP or HUS? - Urgent plasma exchange What is ITP? - autoimmune platelet disorder leading to decreased platelet production and clearance Acute treatment of ITP if plateltes <20,000? - corticosteroids What do antibodies in HITT go after? - heparin-platelet factor 4 Time period for HITT? - 5-10 days after exposure to heparin Treatment for HITT? - stop heparin and start argatroban or lepirudin When do you start warfarin with HITT? - when platelet count >100,000 for 3 months from thrombosis Inheritance of hemophilia A and B? - X linked recessive disorder Lab values for Hemophilia A and B? - Low factor 8 or 9increased PTT What can you give patients with mild hemophilia A? - Desmopression (increases the release of VIII from storage) Most common inherited bleeding disorder? - Von Willebrand Disease What is the only clotting factor not synthesized by the liver? - vWF Mode of inheritance for vWD? - autosomal dominant How do you diagnose vWD? - decreased plasma vWF activity Treatment for vWD? - Desmopressin-increases the release of vWF from endothelial storage What is DIC? - Consumptive coagulopathy that leads to bleeding and thrombosis Symptoms of DIC? - Bleeding, Thrombosis, and end organ damage How do you diagnose DIC? - Increased Fibrin, D-Dimer, PT/PTT Decreased Fibrinogen, platelets Treatment options for DIC? - Platelets if < 20,000 Cryoprecipitate Protein C Initial labs to order for clotting disorder? - cbc, PTT, Factor V leiden, Homocystein, anticardiolipid antibody, prothrombin 20210 mutationMost common inherited hypercoagulability in white patients? - Factor V Leiden Deficiency When should factor V leiden Deficient patient get anti coagulation? - Homozygotes How do you diagnosed antiphospholipid syndrome? - Thrombosis or pregnancy morbidity AND Anticardiolipid Antibody or lupus anticogulant Treatment for antiphospholipid syndrome? - LMWH then warfarin for 6 months for minimum of 6 months after first thrombotic event Most common transfusion reaction? - Febrile Non-Hemolytic Reactions Fever, hyperbilirubinemia within 2-10 days after transfusion? - Delayted hemolytic transfusion reaction Noncardiogenic pulmonary edema or ards 6 hours after transfusion? - Transfusion related acute lung injury Fever, chills, flank, red urine, hypotension and tachycardia within 24 hours of transfusion? - acute hemolytic transfusion reaction What patientss get anaphylaxis to transfusion? - IgA deficient patients. Caused by increased blood volume and viscosity, will lead to headaches, dizziness, tinnitus, and blurred vision? - Polycythemia vera Major Criteria to diagnose Polycythemia vera? - Hemoglobin > 18.5 and JAK2 mutation Treatment for Polycythemia vera? - Serial Phlebotomy, low Fe Diet, and hydroxyurea.Complications of POlycythemia Vera? - arterial or venous thrombosis Hemorrhage AML Clonal proliferative disorder of myeloid cells that leads to reactive bone marrow fibrosis? - Myelofibrosis Marked p