Board Examinations, Questions and answers. 2022 update. Graded A+

Document Content and Description Below

Question that I was able to remember  Basal Cell Cancer: Question description and the fact that it doesn’t have any tx (Hints: Waxy, pearly, telangiectasia, ulcer center lesion Basal cell- mos... t prevalent skin cancer, pearly domed nodule with overlying telangiectatic vessels, maybe plaque, maybe papule, may see central ulceration and crusting, deepest layer of the epidermis, Dx gold standard biopsy, TX chemo or immunotherapy  Actinic Keratosis: Question about description (Scaly red to yellow located in sun exposed area: precancerous Actinic keratosis- rough flat, dry, crusty, erythematous papules or plaques, scaly patch of red or brown skin caused by years of sun exposure, evolving carcinoma, precursor to squamous cell carcinoma, Dx biopsy, refer to dermatology, TX topical 5 fluoracil 5-FU, cryotherapy,  Melanoma question: Know ABCDE ABCDE- asymmetry, border is irregular, color variegation, diameter .6mm size greater than pencil eraser, elevation above skin level  Squamous cell- skin cancer develops in the outer layer of the skin, lower lip common location, nodule, indistinct margins, surface is firm, scaly, irregular, and may bleed easily, may metastasize  Postherpetic neuralgia PHN- prophylaxis is TCA-Elavil Shingles  Cellulitis- deep tissue, gram positive, gradual course over days, TX PCN, macrolide  Erysipelas-(strept infection)- acute onset, well demarcated and above the skin, TX pcn or macrolide  MRSA- TX Bactrim or tetracyclines  Papule – solid elevated mass up to 1 cm  Macule- flat small like a freckle  Vesicle – filled with serous fluid and less than 1 cm  Bullae- fluid filled and larger than 1 cm, can be found with 2nd degreeburns  Xerosis- dry skin, use petroleum-based product, not lotions  Psoriasis- pruritic erythematous plaque covered with fine silvery white scales, scalp and elbows TX topical steroids  Shingles- chicken pox, reactivation of varicella zoster virus involves single dermatome, less likely several dermatomes, finding prodrome- itching burning photophobia fever headache malaise, acute phase dermatomal rash 3-4 days, unilateral, pain, possible severe, macupapular rash progresses to vesicles then pustules 3-4 days, may appear for a week, convalescent phase- 2-3 week rash resolves, pain Dx viral culture, polymerase chain reaction PCR, TX acyclovir, zostrix cream, gabapentin amitriptyline Varicella: Chicken pox, starts on the FACE, spreads to trunk, arms and scalp. Prodrome of fever, pharyngitis, malaise., followed by 24, eruption of puritic vesicular lesions. Exanthem, erthematous puritic maculars develop to papules and fluid filled vesicles”drewdrops on a rose petal” Hairline and spread  Shingles: herpes zoster: varicella virus infection: elderly. One dermatone  Spider bite- TX abx on wound, cold packs nsaids  Dog bite- treat with analgesia (Tylenol, nsaids, Demerol), Augmentin/doxycycline/Bactrim, wound cleaning with soap and water, betadine, local anesthesia (lidocaine), irrigated with 2000ml normal saline, betadine, wound debridement, facial bites should be closed with sutures only, pack wound, tetanus immunization, antibiotic therapy,  Lyme disease- erythema migrans, (Borrelia burgdorferi) bulls eye rash, start within 72 hours of exposure, TX with doxycycline or amoxicillin, or azithromycin Dx two step test EIA and then western blot  Lupus- multisystem autoimmune disease, characterized by remission and exacerbations, affects organs, skin kidney, heart, and blood vessels, face butterfly rash, avoid sunlight exposure, photosensitivity TX refer to rheumatologist, topical and oral steroids, avoid sun and cover skin Less seen in Caucasians  Pityriasis rosea- exanthem, Christmas tree pattern rash, herald patch, normally on trunk, and limbs, oval erythematous-squamous scaly lesion. Pityriasis=bran, rosea=pink, last 5weeks  Anthrax-bacterial infection, from animals, spores inhaled, caused dark scabs difficult to breath. TX doxycycline/ fluoroquinolones (Cipro)  Tinea versicolor- trunk and extremities sun spots, lighten areas over darker skin  Tinea corporis-(ringworm) arms/legs or body, fungal, Tx: mupirocin ointment  Tinea cruris- jock itch  Tinea capitas- skin or scalp  Tinea pedis-athletes foot  Psoriasis- cause pitting in finger nails  Erthema Multiforme- Bulls Eye Rash.Infection. erythematous macule evolves into a papuleSX: skin, mouth lesions that ave pink-red center surrounded by pale ring border, can be painful and puritic. Hands. Bulla on lips vesicle filled large lesions, Causes:herpes simplex, or sulfa drugs.seborrhe  Subungal Hematoma tx: Make a hole and drain the blood  A subungual hematoma is a collection of blood (hematoma) underneath a toenail or fingernail (black toenail). It can be extremely painful for an injury of its size, although otherwise it is not a serious medical condition. TX make hole and drain the blood (trephination) Tx for moderate acne Moderate acne- TX oral abx + topical retinoid +/- benzoyl peroxide (tetracycline + tazarotene +/- Benz Pero Retin topical, oral tetracycline then Accutane (isotretinoin)  Left Ventricle Failure: SX; crackles bibasilar rales, cough, dyspnea, orthopnea,  Right Ventricle Failure: Jugular Vein Distention JVD) enlarged spleen, and liver, anorexia, nausea, abdominal px., lower extremity edema and cool. S3 gallop.  Know Systolic and Diastolic Murmur (MR. ASS & MS. ARD). Mr. ASS question was asked about heart murmur with high pitch holosystolic and the other one is mid systolic.  Systolic murmurs (audible between 1st and 2nd heart sound) MR/mitral regurg (high pitch), heard at mitral area- radiates to left axilla AS/aortic stenosis (medium pitch) heard at AORTA area- radiates to neck MVP/mitral valve prolapse (midsystolic click) heard at mitral area  Diastolic murmurs—ABNORMAL ASSOC WITH AORTIC/PULMONIC VALVES (audible between 2nd and 1st heart sound) AR/aortic regurg (high pitch) heard at AORTA area MS/mitral stenosis (low pitch with bell) heard at mitral area  Mitral area- 5th ICS midclavicular, apex, apical area, PMI, apical pulse  Aorta area- 2nd ICS to the right side of upper border of sternum,  Grade of murmurs 1. Barely audible, 2 faints but audible, 3 Moderately loud no thrill palpable, 4 LOUD WITH PALPABLE THRILL, 5 very loud stethoscopes off chest, thrill palpable, 6 audible without stethoscope thrill palpable  S1- closure of atrioventricular valves , state of systole  S2- closure of semilunar valves  S3- heard in pulmonic, sign of CHF, S3 gallop heard in pregnancy and thyrotoxicosis  S4 – heard in elderly not associated with heart disease, normal  Pulse deficit- apical/radial pulse taken at same time, find difference  Hypertrophic cardiomyopathy- causes sudden death in young athletes  Question about Grade III/VI Murmur: (Loud murmur easily heard) Mitral regurgitation: holosystolic murmur-apex radiates to left axilla, loud, does not increase in inspirations, S3, Pansystolic, pathologic  Coarctation of Aorta: Know that systolic BP on lower extremities is supposed to be higher compare to upper extremities. In COA case its vise versa. Look for weak radial and bounding femoral pulse Know the difference between Peripheral Arterial Disease and Chronic Venous Insufficiency. There was question about PAD and the answer was exercise by walking (Tx) Peripheral arterial disease-impedance of arterial blood flow in lower extremities ankle brachial index <.90, plaque develops in in vessels due to atherosclerosis, pain with exercise, relief with rest, lack of hair growth on lower extremities, gangrene toes TX check pedal pulses, ABI test, exercise by walking, lifestyle modifications -smoking cessation, antiplatelet, cool to touch. Chronic venous insufficiency- and varicose veins result from venous incompetence secondary to valvular dysfunction, low extremity edema, skin discoloration, ulceration, DVT/PE are complications warm to touch, TX light exercise, stockings, weight loss, elevate legs  Question about JVD causes? right side heart fx, causes HF, pulm HTN, tricuspid valve stenosis, superior vena cava obstruction, constrictive pericarditis, hypervolemia, cardiac tamponade  Know Bacterial endocarditis (There was a pt. with gradual onset of fever, hemorrhages on nail beds, painful raised red nodules) Osler’s nodes Endocarditis is an infection of the endocardium, which is the inner lining of your heart chambers and heart valves, Fever is the most common symptom of IE, it is often associated with chills, anorexia, and weight loss. Other common symptoms of IE include malaise, headache, myalgias, arthralgias, night sweats, abdominal pain, dyspnea, cough, and pleuritic pain [4]. Patients with IE associated with dental infection may report tooth pain or related symptoms. splenomegaly, Janeway lesions, which are red spots on the soles of your feet or the palms of your hands, Osler's nodes, which are red, tender spots under the skin of your fingers or toes, Petechiae which are tiny purple or red spots on the skin, whites of your eyes, or inside your mouth (gradual onset of fever, hemorrhages under nail beds, painful raised red nodules) Artificial heart valves. Germs are more likely to attach to an artificial (prosthetic) heart valve than to a normal heart valve. Risk factors- Congenital heart defects. If you were born with certain types of heart defects, such as an irregular heart or abnormal heart valves, your heart may be more susceptible to infection. A history of endocarditis. Endocarditis can damage heart tissue and valves, increasing the risk of a future heart infection. Damaged heart valves. Certain medical conditions, such as rheumatic fever or infection, can damage or scar one or more of your heart valves, A history of intravenous (IV) illegal drug use TX amoxicillin or macrolide RML CXR  Chronic bronchitis description and treatment= Chronic bronchitisproduction of sputum for at least 3 months annually for 2 consecutive years accompanied by cough, stage 1-SABA (albuterol) or SAAC(ipratropium) and/or low dose theophylline, <2 per month night awaking’s stage 2- SABA or SAAC, and LABA(salmeterol), rehabilitation, nightly awakenings 3-4 per month stage 3- SABA or SAAC, LABA, inhaled glucocorticoids(fluticasone), rehabilitation nighttime 1 per week stage 4- SABA or SAAC, LABA, inhaled glucocorticoids, rehabilitation, long term oxygen, surgical treatments  Hiv pt. PPD + (5mm)TB  Croup/Epiglottitis: Question about what condition would make you order Lateral X-ray of the neck. Options include: Drooling, Unable to do ROM of the neck / stiff neck. Croup=(hemophilus parainfluenzae) slow onset,viral respiratory infection characterized by cold symptoms, low fever, stridor, barking cough, and hoarseness, NO DROOLING,nasal flaring, abdominal breathing, use of accessory muscles, “steeple sign. Looks like a church steeple. Epiglottis=( Hemophilus influenza)RAPID ONSET,acute Bacterial infection of inflammation characterized by high fever, (104)stridor, , nasal flaring,sore throat, respiratory distress. drooling, Head tilted back to breath, abdominal breathing, use of accessory muscles, “thumb sign used to describe swelling of epiglottis seen on lateral radiograph of neck” Emergency, 02,ER,  Hyper and Hypothyroidism= Hyperthyroid- TSH is low <0.5 free t4, t3 is high,  Hypothyroid- elevated TSH >0.5 free t4, t3, low  Subclinical hypothyroid- slightly elevated TSH >5.0, t4 t3 normal DO NOT TREAT, RECHECK 6 MONTHS  Hyperthyroid- Graves’ disease-, elevated free t4, t3, goiter, palpitation, cardiovascular symptoms (AFIB), insomnia, menstrual irregularities, diaphoresis, heat intolerance, anxiety, night sweats, blurred vision, lid lag, photophobia, double vision, diarrhea, tremors, weight loss, exophthalmos (bulging eyes), soft hair and nails, (complications: thyroid storm (life threatening), HF, visual disturbance)long term effects- heart disease, osteoporosis, mental illness, infertility. Dx TSH, thyroid panel, antibody test TX PTU propylthiouracil,methimazole Tapazole, Radioactive iodine, RAI, BB for intial tachycardic, palpitations or tremors, anxiety (propranolol)  Hypothyroid- Hashimoto’s thyroiditis produces antibodies to destroy thyroid gland, lethargy, weight, gain, cold intolerance, constipation, heavy menses, myalgia, muscle cramps, headaches, weakness, dry skin, coarse hair, loss of lateral eyebrows, , alopecia, hoarseness, slight impairment of mental ability, depression, decreased libido, hypersomnia, thickened tongue, delayed deep tendon reflexes, middle aged woman, constipation, intolerance to cold, menstrual irregularities, memory loss, muscle cramps, coarse dry skin, hair loss, brittle nails, bradycardia, anemia, side effect swollen fingers, hyperlipidemia, complications osteoporosis/penia, mental retardation, myxedema coma, can lead to ovulation dysfunction and infertility. Hypothyroidism and PCOS normally include increased serum free testosterone, luteinizing hormone (LH), and high cholesterol. Dx tsh, tsh with t4, order TPO’s antibody test to confirm diagnosis, TX Synthroid 25- 50mcg, half for elderly recheck 6-8 weeks  Hypothyroid- elevated TSH >0.5 free t4, t3, low  Subclinical hypothyroid- slightly elevated TSH >5.0, t4 t3 normal DO NOT TREAT, RECHECK 6 MONTHS  Hyperthyroid- TSH is low <.5 t4, t3 is high  Dawn phenomenon- early morning increase in blood sugar between 2-8am  Cotton Wool spots: DM, microaneurysm due to neovascularization diabetic retinopathy, hard exudates, considered moderate retinopathy.  Metabolic syndrome: obesity, hypertension, hyperglycemia, and dyslipidemia( Insulin resistant syndrome) Diabetes Mellitus:type 2- Get on ASA. Risk factors:  HTN  Age>45  Family Hx  Inactivity  HTN (140/90)>  Women with PCOS  Hx vascular disease  Deliver big babies 9 plus pounds  Minority  A1C>5.7 3Ps=Polyuria, polyphagia, polydipsia with BS>200. For A1C 5.7-6.4%, less than 60 y.0. BMI>35,female hx of gestational DM start Metformin o  Question about AV nicking (Arterioles pressing on vein of the eye): Its HTN retinopathy, fundoscopy,HTN stiffens vessels, arteries indent and displaceveins, veins pulse., considered Mild retinopathy. Arterioles pressing on the vein of the eye.  Question causes of IOP  Rovsing sign : deep palpation over the LLQ with sudden unexpected release of pressure, this causes tenderness on the RLQ which a positive sign for appendicitis  McMurray test- knee pain and click, injury to medial meniscus, (Knee feels like locking up) Dx gold standard test for joint damage is the MRI (supine raise knee twisting knee inward/outward while extending in/out)  McMurray test- knee pain and click, injury to medial meniscus, (Knee feels like locking up) Dx gold standard test for joint damage is the MRI (supine raise knee twisting knee inward/outward while extending in/out)  Drawer sign test- for knee stability- positive anterior drawer sign test for ACL, the positive drawers sign test for PCL  Homans sign- lower leg pain on dorsiflexion of foot, assess for DVT  Cullen’s sign- edema and bruising of the subcutaneous tissue around the umbilicus  Grey-turners sign- bruising/bluish discoloration of the flank area that may indicate retroperitoneal hemorrhage  PSOAS- supine patient, patient uses resistance against examiners hand on straighten leg, side lying variation as well, test for pancreatitis/appendicitis  Obturator sign- right side lying patient, inward rotation of hip, test for pancreatitis/appendicitis  Finklestein test- to diagnose de quervains tenosynovitis in wrist pain, thumb side,  Dix-Hall pike test- tests benign positional vertigo (sitting twist head)  Tinel test- tapping wrist for carpal tunnel  Phalen’s test- upside down praying hands for carpal tunnel  Murphy sign - gall bladder test (hook during inspiration)  McBurney’s point- umbilicus to great trochanter, appendicitis test, knife hand technique, press and assess pain on rebound effect  Sprains:  Mild sprain:Grade 1: slight stretch, damage to ligament fiber, weight bearing, no instability to joint ambulation ok  Moderate sprain:partical thickness tear, presents with ecchymosis, mod swelling, px tender to palpate, wgt bearing painful, recovery 1-2 weeks  3rd degree severe rupture of ligaments, popping nosie, swelling pain unablity to walk. Recovery 1month+  Pt. with GERD and Barrett’s esophagus: Refer to Oncologist o Globus- feeling of foreign body in throat, lump in throat generally from GERD Question that I was able to remember  Basal Cell Cancer: Question description and the fact that it doesn’t have any tx (Hints: Waxy, pearly, telangiectasia, ulcer center lesion Basal cell- most prevalent skin cancer, pearly domed nodule with overlying telangiectatic vessels, maybe plaque, maybe papule, may see central ulceration and crusting, deepest layer of the epidermis, Dx gold standard biopsy, TX chemo or immunotherapy  Actinic Keratosis: Question about description (Scaly red to yellow located in sun exposed area: precancerous Actinic keratosis- rough flat, dry, crusty, erythematous papules or plaques, scaly patch of red or brown skin caused by years of sun exposure, evolving carcinoma, precursor to squamous cell carcinoma, Dx biopsy, refer to dermatology, TX topical 5 fluoracil 5-FU, cryotherapy,  Melanoma question: Know ABCDE ABCDE- asymmetry, border is irregular, color variegation, diameter .6mm size greater than pencil eraser, elevation above skin level  Squamous cell- skin cancer develops in the outer layer of the skin, lower lip common location, nodule, indistinct margins, surface is firm, scaly, irregular, and may bleed easily, may metastasize  Postherpetic neuralgia PHN- prophylaxis is TCA-Elavil Shingles  Cellulitis- deep tissue, gram positive, gradual course over days, TX PCN, macrolide  Erysipelas-(strept infection)- acute onset, well demarcated and above the skin, TX pcn or macrolide  MRSA- TX Bactrim or tetracyclines  Papule – solid elevated mass up to 1 cm  Macule- flat small like a freckle  Vesicle – filled with serous fluid and less than 1 cm  Bullae- fluid filled and larger than 1 cm, can be found with 2nd degreeburns  Xerosis- dry skin, use petroleum-based product, not lotions  Psoriasis- pruritic erythematous plaque covered with fine silvery white scales, scalp and elbows TX topical steroids  Shingles- chicken pox, reactivation of varicella zoster virus involves single dermatome, less likely several dermatomes, finding prodrome- itching burning photophobia fever headache malaise, acute phase dermatomal rash 3-4 days, unilateral, pain, possible severe, macupapular rash progresses to vesicles then pustules 3-4 days, may appear for a week, convalescent phase- 2-3 week rash resolves, pain Dx viral culture, polymerase chain reaction PCR, TX acyclovir, zostrix cream, gabapentin amitriptyline Varicella: Chicken pox, starts on the FACE, spreads to trunk, arms and scalp. Prodrome of fever, pharyngitis, malaise., followed by 24, eruption of puritic vesicular lesions. Exanthem, erthematous puritic maculars develop to papules and fluid filled vesicles”drewdrops on a rose petal” Hairline and spread  Shingles: herpes zoster: varicella virus infection: elderly. One dermatone  Spider bite- TX abx on wound, cold packs nsaids  Dog bite- treat with analgesia (Tylenol, nsaids, Demerol), Augmentin/doxycycline/Bactrim, wound cleaning with soap and water, betadine, local anesthesia (lidocaine), irrigated with 2000ml normal saline, betadine, wound debridement, facial bites should be closed with sutures only, pack wound, tetanus immunization, antibiotic therapy,  Lyme disease- erythema migrans, (Borrelia burgdorferi) bulls eye rash, start within 72 hours of exposure, TX with doxycycline or amoxicillin, or azithromycin Dx two step test EIA and then western blot  Lupus- multisystem autoimmune disease, characterized by remission and exacerbations, affects organs, skin kidney, heart, and blood vessels, face butterfly rash, avoid sunlight exposure, photosensitivity TX refer to rheumatologist, topical and oral steroids, avoid sun and cover skin Less seen in Caucasians  Pityriasis rosea- exanthem, Christmas tree pattern rash, herald patch, normally on trunk, and limbs, oval erythematous-squamous scaly lesion. Pityriasis=bran, rosea=pink, last 5weeks  Anthrax-bacterial infection, from animals, spores inhaled, caused dark scabs difficult to breath. TX doxycycline/ fluoroquinolones (Cipro)  Tinea versicolor- trunk and extremities sun spots, lighten areas over darker skin  Tinea corporis-(ringworm) arms/legs or body, fungal, Tx: mupirocin ointment  Tinea cruris- jock itch  Tinea capitas- skin or scalp  Tinea pedis-athletes foot  Psoriasis- cause pitting in finger nails  Erthema Multiforme- Bulls Eye Rash.Infection. erythematous macule evolves into a papuleSX: skin, mouth lesions that ave pink-red center surrounded by pale ring border, can be painful and puritic. Hands. Bulla on lips vesicle filled large lesions, Causes:herpes simplex, or sulfa drugs.seborrhe  Subungal Hematoma tx: Make a hole and drain the blood  A subungual hematoma is a collection of blood (hematoma) underneath a toenail or fingernail (black toenail). It can be extremely painful for an injury of its size, although otherwise it is not a serious medical condition. TX make hole and drain the blood (trephination) Tx for moderate acne Moderate acne- TX oral abx + topical retinoid +/- benzoyl peroxide (tetracycline + tazarotene +/- Benz Pero Retin topical, oral tetracycline then Accutane (isotretinoin)  Left Ventricle Failure: SX; crackles bibasilar rales, cough, dyspnea, orthopnea,  Right Ventricle Failure: Jugular Vein Distention JVD) enlarged spleen, and liver, anorexia, nausea, abdominal px., lower extremity edema and cool. S3 gallop.  Know Systolic and Diastolic Murmur (MR. ASS & MS. ARD). Mr. ASS question was asked about heart murmur with high pitch holosystolic and the other one is mid systolic.  Systolic murmurs (audible between 1st and 2nd heart sound) MR/mitral regurg (high pitch), heard at mitral area- radiates to left axilla AS/aortic stenosis (medium pitch) heard at AORTA area- radiates to neck MVP/mitral valve prolapse (midsystolic click) heard at mitral area  Diastolic murmurs—ABNORMAL ASSOC WITH AORTIC/PULMONIC VALVES (audible between 2nd and 1st heart sound) AR/aortic regurg (high pitch) heard at AORTA area MS/mitral stenosis (low pitch with bell) heard at mitral area  Mitral area- 5th ICS midclavicular, apex, apical area, PMI, apical pulse  Aorta area- 2nd ICS to the right side of upper border of sternum,  Grade of murmurs 1. Barely audible, 2 faints but audible, 3 Moderately loud no thrill palpable, 4 LOUD WITH PALPABLE THRILL, 5 very loud stethoscopes off chest, thrill palpable, 6 audible without stethoscope thrill palpable  S1- closure of atrioventricular valves , state of systole  S2- closure of semilunar valves  S3- heard in pulmonic, sign of CHF, S3 gallop heard in pregnancy and thyrotoxicosis  S4 – heard in elderly not associated with heart disease, normal  Pulse deficit- apical/radial pulse taken at same time, find difference  Hypertrophic cardiomyopathy- causes sudden death in young athletes  Question about Grade III/VI Murmur: (Loud murmur easily heard) Mitral regurgitation: holosystolic murmur-apex radiates to left axilla, loud, does not increase in inspirations, S3, Pansystolic, pathologic  Coarctation of Aorta: Know that systolic BP on lower extremities is supposed to be higher compare to upper extremities. In COA case its vise versa. Look for weak radial and bounding femoral pulse Know the difference between Peripheral Arterial Disease and Chronic Venous Insufficiency. There was question about PAD and the answer was exercise by walking (Tx) Peripheral arterial disease-impedance of arterial blood flow in lower extremities ankle brachial index <.90, plaque develops in in vessels due to atherosclerosis, pain with exercise, relief with rest, lack of hair growth on lower extremities, gangrene toes TX check pedal pulses, ABI test, exercise by walking, lifestyle modifications -smoking cessation, antiplatelet, cool to touch. Chronic venous insufficiency- and varicose veins result from venous incompetence secondary to valvular dysfunction, low extremity edema, skin discoloration, ulceration, DVT/PE are complications warm to touch, TX light exercise, stockings, weight loss, elevate legs  Question about JVD causes? right side heart fx, causes HF, pulm HTN, tricuspid valve stenosis, superior vena cava obstruction, constrictive pericarditis, hypervolemia, cardiac tamponade  Know Bacterial endocarditis (There was a pt. with gradual onset of fever, hemorrhages on nail beds, painful raised red nodules) Osler’s nodes Endocarditis is an infection of the endocardium, which is the inner lining of your heart chambers and heart valves, Fever is the most common symptom of IE, it is often associated with chills, anorexia, and weight loss. Other common symptoms of IE include malaise, headache, myalgias, arthralgias, night sweats, abdominal pain, dyspnea, cough, and pleuritic pain [4]. Patients with IE associated with dental infection may report tooth pain or related symptoms. splenomegaly, Janeway lesions, which are red spots on the soles of your feet or the palms of your hands, Osler's nodes, which are red, tender spots under the skin of your fingers or toes, Petechiae which are tiny purple or red spots on the skin, whites of your eyes, or inside your mouth (gradual onset of fever, hemorrhages under nail beds, painful raised red nodules) Artificial heart valves. Germs are more likely to attach to an artificial (prosthetic) heart valve than to a normal heart valve. Risk factors- Congenital heart defects. If you were born with certain types of heart defects, such as an irregular heart or abnormal heart valves, your heart may be more susceptible to infection. A history of endocarditis. Endocarditis can damage heart tissue and valves, increasing the risk of a future heart infection. Damaged heart valves. Certain medical conditions, such as rheumatic fever or infection, can damage or scar one or more of your heart valves, A history of intravenous (IV) illegal drug use TX amoxicillin or macrolide RML CXR  Chronic bronchitis description and treatment= Chronic bronchitisproduction of sputum for at least 3 months annually for 2 consecutive years accompanied by cough, stage 1-SABA (albuterol) or SAAC(ipratropium) and/or low dose theophylline, <2 per month night awaking’s stage 2- SABA or SAAC, and LABA(salmeterol), rehabilitation, nightly awakenings 3-4 per month stage 3- SABA or SAAC, LABA, inhaled glucocorticoids(fluticasone), rehabilitation nighttime 1 per week stage 4- SABA or SAAC, LABA, inhaled glucocorticoids, rehabilitation, long term oxygen, surgical treatments  Hiv pt. PPD + (5mm)TB  Croup/Epiglottitis: Question about what condition would make you order Lateral X-ray of the neck. Options include: Drooling, Unable to do ROM of the neck / stiff neck. Croup=(hemophilus parainfluenzae) slow onset,viral respiratory infection characterized by cold symptoms, low fever, stridor, barking cough, and hoarseness, NO DROOLING,nasal flaring, abdominal breathing, use of accessory muscles, “steeple sign. Looks like a church steeple. Epiglottis=( Hemophilus influenza)RAPID ONSET,acute Bacterial infection of inflammation characterized by high fever, (104)stridor, , nasal flaring,sore throat, respiratory distress. drooling, Head tilted back to breath, abdominal breathing, use of accessory muscles, “thumb sign used to describe swelling of epiglottis seen on lateral radiograph of neck” Emergency, 02,ER,  Hyper and Hypothyroidism= Hyperthyroid- TSH is low <0.5 free t4, t3 is high,  Hypothyroid- elevated TSH >0.5 free t4, t3, low  Subclinical hypothyroid- slightly elevated TSH >5.0, t4 t3 normal DO NOT TREAT, RECHECK 6 MONTHS  Hyperthyroid- Graves’ disease-, elevated free t4, t3, goiter, palpitation, cardiovascular symptoms (AFIB), insomnia, menstrual irregularities, diaphoresis, heat intolerance, anxiety, night sweats, blurred vision, lid lag, photophobia, double vision, diarrhea, tremors, weight loss, exophthalmos (bulging eyes), soft hair and nails, (complications: thyroid storm (life threatening), HF, visual disturbance)long term effects- heart disease, osteoporosis, mental illness, infertility. Dx TSH, thyroid panel, antibody test TX PTU propylthiouracil,methimazole Tapazole, Radioactive iodine, RAI, BB for intial tachycardic, palpitations or tremors, anxiety (propranolol)  Hypothyroid- Hashimoto’s thyroiditis produces antibodies to destroy thyroid gland, lethargy, weight, gain, cold intolerance, constipation, heavy menses, myalgia, muscle cramps, headaches, weakness, dry skin, coarse hair, loss of lateral eyebrows, , alopecia, hoarseness, slight impairment of mental ability, depression, decreased libido, hypersomnia, thickened tongue, delayed deep tendon reflexes, middle aged woman, constipation, intolerance to cold, menstrual irregularities, memory loss, muscle cramps, coarse dry skin, hair loss, brittle nails, bradycardia, anemia, side effect swollen fingers, hyperlipidemia, complications osteoporosis/penia, mental retardation, myxedema coma, can lead to ovulation dysfunction and infertility. Hypothyroidism and PCOS normally include increased serum free testosterone, luteinizing hormone (LH), and high cholesterol. Dx tsh, tsh with t4, order TPO’s antibody test to confirm diagnosis, TX Synthroid 25- 50mcg, half for elderly recheck 6-8 weeks  Hypothyroid- elevated TSH >0.5 free t4, t3, low  Subclinical hypothyroid- slightly elevated TSH >5.0, t4 t3 normal DO NOT TREAT, RECHECK 6 MONTHS  Hyperthyroid- TSH is low <.5 t4, t3 is high  Dawn phenomenon- early morning increase in blood sugar between 2-8am  Cotton Wool spots: DM, microaneurysm due to neovascularization diabetic retinopathy, hard exudates, considered moderate retinopathy.  Metabolic syndrome: obesity, hypertension, hyperglycemia, and dyslipidemia( Insulin resistant syndrome) Diabetes Mellitus:type 2- Get on ASA. Risk factors:  HTN  Age>45  Family Hx  Inactivity  HTN (140/90)>  Women with PCOS  Hx vascular disease  Deliver big babies 9 plus pounds  Minority  A1C>5.7 3Ps=Polyuria, polyphagia, polydipsia with BS>200. For A1C 5.7-6.4%, less than 60 y.0. BMI>35,female hx of gestational DM start Metformin o  Question about AV nicking (Arterioles pressing on vein of the eye): Its HTN retinopathy, fundoscopy,HTN stiffens vessels, arteries indent and displaceveins, veins pulse., considered Mild retinopathy. Arterioles pressing on the vein of the eye.  Question causes of IOP  Rovsing sign : deep palpation over the LLQ with sudden unexpected release of pressure, this causes tenderness on the RLQ which a positive sign for appendicitis  McMurray test- knee pain and click, injury to medial meniscus, (Knee feels like locking up) Dx gold standard test for joint damage is the MRI (supine raise knee twisting knee inward/outward while extending in/out)  McMurray test- knee pain and click, injury to medial meniscus, (Knee feels like locking up) Dx gold standard test for joint damage is the MRI (supine raise knee twisting knee inward/outward while extending in/out)  Drawer sign test- for knee stability- positive anterior drawer sign test for ACL, the positive drawers sign test for PCL  Homans sign- lower leg pain on dorsiflexion of foot, assess for DVT  Cullen’s sign- edema and bruising of the subcutaneous tissue around the umbilicus  Grey-turners sign- bruising/bluish discoloration of the flank area that may indicate retroperitoneal hemorrhage  PSOAS- supine patient, patient uses resistance against examiners hand on straighten leg, side lying variation as well, test for pancreatitis/appendicitis  Obturator sign- right side lying patient, inward rotation of hip, test for pancreatitis/appendicitis  Finklestein test- to diagnose de quervains tenosynovitis in wrist pain, thumb side,  Dix-Hall pike test- tests benign positional vertigo (sitting twist head)  Tinel test- tapping wrist for carpal tunnel  Phalen’s test- upside down praying hands for carpal tunnel  Murphy sign - gall bladder test (hook during inspiration)  McBurney’s point- umbilicus to great trochanter, appendicitis test, knife hand technique, press and assess pain on rebound effect  Sprains:  Mild sprain:Grade 1: slight stretch, damage to ligament fiber, weight bearing, no instability to joint ambulation ok  Moderate sprain:partical thickness tear, presents with ecchymosis, mod swelling, px tender to palpate, wgt bearing painful, recovery 1-2 weeks  3rd degree severe rupture of ligaments, popping nosie, swelling pain unablity to walk. Recovery 1month+  Pt. with GERD and Barrett’s esophagus: Refer to Oncologist o Globus- feeling of foreign body in throat, lump in throat generally from GERD [Show More]

Last updated: 2 years ago

Preview 1 out of 19 pages