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

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 fingers of psoriatic arthritis ...

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 fingers 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 proliferation of megakaryocytes in marrow, leading to nonreactive increased platlets? - ✔✔Essential Thrombocytosis Treatment for Essential Thrombocytosis? - ✔✔Hydroxyurea Myeloproliferative disorder characterized by proliferation of myeloid cells that are capable of differentiation? - ✔✔CML CML is assoicated with what? - ✔✔Philadelphia Chromosome t(9;22) Phases of CML? - ✔✔Chronic phase (Most common at presentation) Accelerated Ph