Step 3- Ambulatory

zms2187's version from 2015-09-09 02:02

Section 1

Question Answer
Glaucoma tx non-selective topical beta blockers (imolol), adrenergic agonists (epi), cholinergic agonists (pilocarpine, carbachol), CA inhibitors
Tx closed angle glaucoma topical pilocarpine to constrict pupil, timolol and acetazolamide to decrease IOP, laser iridotomy. Systemic tx--> mannitol and acetazolamide
Anti-virals for influenzaoseltamivir or zanamivir are used prophylactically or to tx infection (within 48hrs of exposure)
Complications of influenzapna (usually strep pneumo), myositis, rhabdo, CNS involvement, myocarditis, pericarditis
progressive fixation of stapesotosclerosis (causes conductive hearing loss, starts in 20s-30s, worse in pregnancy), tx is stapedotomy
Weber test interpretationhold tuning fork on forehead- if conductive hearing loss sound will be louder in affected ear, if sensorineural then normal ear will have louder sound
Rinne test interpretationplace vibrating tuning fork on pt mastoid bone and once no longer audible, reposition near ext meatus. if conductive loss then bone conduction is audible longer than air, if sensorineural then should still be able to hear fork (air conduction audible > bone)
Epistaxis txdirect pressure and topical nasal vasoconstrictors (phenylephrine or oxymetazoline). If bleed doesn't stop cauterize w/silver nitrate or insert nasal packing + abx to prevent TSS.
Removable white patches on tonguecandida (precancerous lesions cannot be removed)
tx eczemamoisturize, use topical steroids sparingly and only for flares. Tacrolimus ointment if severe
Tx psoriasistopical steroids for limited dz, if generalized (>30% of body) try UVB light exposure 3x/week, methotrexate also possibility
Rosacea txmild cleansers first, if persistent oral abx (tetracycline) + tretinoin cream. For flushing can do clonidine or alpha blockers

Section 2

Question Answer
Causes of erythema multiformeinfxn (HSV, mycoplasma), CTD, drugs, radiotherapy, pregnancy, internal malignancies
Lesions of erythema multiformerapidly progressive symmetrical lesions- target lesions and papules usually on back of hands and on palms/soles/limbs but can be anywhere. Lesions recur in crops for 2-3 weeks
Tx erythema multiformemild cases symptomatic tx w/anti-histamine, if many target lesions can do prednisone. Alternatives are azathioprine or levamisole
Auto-antibodies that destroy intracellular adhesions between epithelial cellspemphigus vulgaris
Antibodies against basement membranebullous pemphigoid
pemphigus vulgaris vs bullous pemphigoid, which has + nikolskysvulgaris
Tx of pemphigus vulgaris vs bullous pemphigoidvulgaris--> corticosteroids and immunosuppresive agents, bullous topical steroids
Tx of zosterif started w/in 72 hours of rash onset acyclovir/valtrex can decrease duration of illness and decrease occurence of post-herpetic neuralgia. Steroids NOT recommended
Annular marginated plaques with a thin scale and a clear center, what dx?Tinea corporis (tx griseo, itraconazole, clotrimazole cream)
Drugs that cause EDbeta blockers, clonidine, SSRIs, anti-cholinergics, opiates, TCAs
Common labs to order when working up EDTSH, prolactin, testosterone, fasting glucose (check for DM)

Section 3

Question Answer
Frequency of papsyearly starting at age 21 or within 3 years of starting sexual activity. If 3 normal results then can be spaced out to every 3 years
Mammogramsevery 2 years between age 50-74, before 50 then screening should be a discussion between pt/doc
Colon cancer screeningevery 10 years c-scope/5y flex sig/yearly hemoccult. If first degree relative has colon cancer start screening age 40 or 10y younger than relative dx
HLD screeningscreen males >35y and females >45y
DM screeningscreen all adults w/BMI >25 and 1+ risk factors for DM (family hx, physical inactivity, htn, hld, PCOS). otherwise screening starts at age 45 if no risk factors
osteoporosis screeningstart at age 65 w/dexa scan