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NMS Family Medicine


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How to treat rhinitis medicamentosa
stop offending agent and start inhaled/oral corticosteroids to wean off of steroids
who gets anterior epistaxis? how is it treated?
young people with chronic nosebleeds, treat by cauterizing with silver nitrate
who gets posterior epistaxis? how to treat
elderly, hypertensives. Pt. needs referral to ENT
Of the following, which is a risk factor in developing Otitis Media:
Tonsillar hypertrophy
Adenoidal hypertrophy
Adenoidal hypertrophy
What percent chance of developing otitis media is associated with:
RSV - 33%
Adeno/Inf. - 28%
What precent of otitis media bugs are PCN/Amox resistant?
How long can a middle ear effusion take to resolve following otitis media?
up to 16 weeks
What other anomaly is found in half of people with coarctation?
Bicuspid aortic valve
What are the top 3 valvular abnormalities caused by Rheumatic Fever?
1. MR
2. AS
3. AS+MS
What is the most common problem that Mitral Stenosis causes?
Systemic embolus due to left atrial enlargement.
What is the mortality rate associated with a first heart attack?
Patients with unstable angina have a __% chance of MI in 2 years.
What drugs are good to treat prinzmetal's angina? what is a poor choice to treat it?
Calcium channel blocker and ACE inhibitor. Beta blockers are a poor choice because they may aggrivate small vessel spasm
What is a good test to differentiate Paroxysmal Atrial Tachycardia with block from AVNRT?
Vagal maneuvers (carotid sinus massage/valsalva) cause an AV node block. Since supraventricular tachycardias occur independent of the AV node, there will be no response. So, PAT with block will not be slowed while AVNRT could be converted with a vagal maneuver.
PAT can be due to toxicity from what drug?
55 year old woman who is unable to lie flat because of SOB. No edema. 50% EF. what drug treatment is best?
This woman has LV CHF with Diastolic dysfxn (EF>40%). This is best treated with a Calcium channed blocker because of their anti-ischemic actions, preload reduction, BP control, LVH regression potential, and HR control which allows increased coronary filling during prolonged diastolic relaxation.
What is systolic dysfunction defined as (2 things) and what drug is best used to treat it?
EF < 40%, dilated heart. Digoxin + a thiazide is best to treat a symptomatic (orthopnea, neck veins, edema) person with CHF. ACE inhibitors work well also
Name 3 drug classes used to slow down A-fib with RVR
Digoxin, Beta Blocker, Calcium channel blocker
When should patients be anticoagulated before A-fib conversion?
when they have had A-fib for > 2 days
Is LVH a characteristic of diastolic or systolic dysfunction?
Why are calcium channel blockers and beta blockers relatively contraindicated in systolic dysfunction?
they have negative inotropism
What are some characteristics of systolic dysfunction
1. Reduced EF
2. Increased end diastolic pressure
3. Increased resistance to flow
Name one other cause of a systemic embolism besides Afib.
Would you suspect embolism or thrombosis in a patient with Afib, MS, LAE, Claudication
Embolism in AF, MS, LAE
Thrombosis in Claudication
What is the earliest sign and most sensitive indicator of chronic occlusive disease?
ABI < .9
What causes a descending (2) vs. ascending (2) AAA?
Descending - atherosclerosis, trauma (rarely)
Ascending - cystic medial necrosis, syphilis
How does the caliber, length and flow rate of vessels affect 5 year patency rates of baloon angioplasties?
High flow rate, larger caliber, and occluded segment < 3cm are assiated with higher patency rates
How much does treatment of DVT with anticoagulants decrease the risk of PE?
by 50%
How do you treat a superficial thrombophlebitis with no extension to deep venous systems?
Heat + NSAIDS (excision not indicated)
What sign is most consistent with a hemorrhagic stroke?
severe headache
What complication has the greatest morbidity in patients with subarachnoid hemorrhage? how can it be treated?
Vasospasm - treat with a calcium channel blocker
What is reflex sympathetic dystrophy?
syndrome of burning pains, tenderness, vasomotor skin changes, hyperesthesia, and edema usually to a hand or foot following trauma, peripheral nerve injury, or stroke
What is a major side effect of Ticlopidine when used in a patient with a recent ischemic stroke?
What is the stroke risk in a male with 70% carotid stenosis? How much does a carotid endarterectomy decrease the risk?
2% per year. Endarterectomy will reduce risk by 53%
How does a chronic subdural hematoma usually present?
headache or confusion, patients don't usually present with neuro defecits
What is the post traumatic hematoma that can appear anytime within 24 hours of the trauma?
A musical murmur in childhood that usually disappears by puberty
Still's murmur
Most common congenital heart defect
What two populations are normal pulmonary flow murmurs heard in?
3rd trimester and adolescents
What is a jugular venous hum?
A buzz like noise heard throughout the cardiac cycle in some kids. It is produced by cerebral blood flow hitting the right angle at the innominate vein. There is no clinical siginificance
Harsh murmur at the 2nd left intercostal space that ratiates to the back
How can the severity of PS be evaluated on physical exam?
degree of RVH
What physical exam finding best correlates with the severity of AS?
Palpable thrill in the suprasternal notch
How is a PDA treated in newborns?
A PDA should be given 48 hours of observation to close on its own, after that indomethacin can be used. If indomethacin is not successful, surgical ligation can be used
How should a carotid bruit in a child be treated?
No treatment, they aren't a big deal
When is a PVC concerning in children?
when they occur in couplets or triplets, they are more likely to go into vtach
What are the two heart defects that cause cyanosis in infancy and when are they usually cyanotic?
Transposition - becomes cyanotic withn the first few days of life after the ductus arteriosus closes

Tetralogy - more likely to be cyanotic within the first few weeks of life
What is the largest risk factor for HTN?
What percent of newly diagnosied HTN is secondary?
Primary aldosteronism is due to an adenoma ____% of the time (rather than idiopathic hyperplasia)
When and how much does CrCl begin to decrease in life?
CrCl falls by 1ml/min/1.73m2/year beginning at age 30-35
What is an acceptable range of microalbuminuria:
- in HTN?
- in DM?
HTN - 200-500 mg/24hrs
DMII - 30-300 mg/24hrs
What is the rate of renal decline once PCKD begins to affect renal function
CrCl declines by half every 36 months
What is the blood pressure target for:
- Non African americans/non diabetics?
- African americans/diabetics?
non AA/non DM - < 130/80
AA/DM - < 125/75
What meds does HTN in the elderly typically respond to and which don't they respond to?
Typically, HTN in the elderly is less sensitive to beta blockers and more sensitive to diuretics.
New onset diastolic HTN in the elderly suggests what?
It suggests changing physiology such as reovascular processes (renal artery obs. chronic GN, or nephrosclerosis) and high renin states.
How does HTN and treatment differ between high renin, low renin, and normal renin?
High renin (10% of HTN)- These patients will respond better to beta blockers and ACE inhibitors

Low renin (30-40% of HTN)- lower than normal renin activity for a given salt intake leads to "salt sensitive" HTN. These patients can best be treated with thiazied diuretics.

Normal renin - (55% of HTN) These patients respond to both families of drugs, and often better when diuretics are combined.
How can hyperinsulinemia increase vascular tone (4)?
1) Promotes Na+ retention
2) Promotes hypertrophy or hyperplasia of vascular smooth muscle
3) modifying ion transport leading to an increase in intracellular Ca++
4) Sympathetic activation
What are the side effects of HCTZ (4) and at what dose do they usually occur?
> 25 mg/day
1) hyperlipidemia
2) hyperuricemia
3) hypokalemia
4) carbohydrate intolerance
How does the efficacy of HCTZ change with age/race?
HCTZ is effective in the majority of african americans / elderly populations. HCTZ is effective in only 30-40% of caucasians
List the four leading causes of ESRD.
Diabetic nephropathy
Hypertensive nephropathy
Chronic GN
What percent of pts. is a thiazide used as a first line drug effective?
Differentiate between broca's and wernicke's aphasia and the location of the lesion in each.
Broca's - lesion in the lower posterior frontal lobe and presents with good comprehension but non-fluent effortful speech often associated with Right hemiparesis.
Wernicke's aphasia - Posterior/Superior frontal lobe. Presents with poor comprehension, abundant, fluid, well articulated speech that makes no sense.
How does a sensory defect affect Alzheimer's disease
Alzheimer's disease is exacerbated in the presence of another sensory defect.
How does Parkinson's disease usually begin?
unilateral tremor
What are some autonomic dysfunctions associated with Parkinson's?
Orthostatic hypotension, constipation, and impotence.
Tacrine - use? major side effect?
Tacrine is a cholinesterase inhibitor used to treat Alzheimer's and its major side effect is elevation of serum transaminases.
Benztropine. Mech? use?
anticholinergic used to reduce the tremor in PD
What are two drugs that reduce the rigidity associated with Parkinson's Disesae?
Levodopa and Amantidine
What are two drugs that can treat absence seizures? when do absence seizurs usually stop occurring?
Valproic acid and ethosuximide. Absence seizures usually resolve around adolescence.
What are two firstline treatments for generalized or focal seizures?
Phenytoin and phenobarbitol
What are 3 pulmonary bugs that can complicate a viral infection?
Strep pneumo, H flu, Staph aureus
What virus is most likely to cause pneumonia?
What is the criteria for a fluid to be considered an exudate?
Pleural fluid : serum protein > .5
Pleural fluid : serum LDH >.6
What does retrosternal airspace suggest in CXR?
What drug is the first line agent to treat COPD?
Ipratropium bromide is preferred over corticosteroids, beta agonists, and theophylline because of a better side effect profile.
Most bronchiolitis cases are caused by ___?
What viral infection can lead to asthma later in life if a child is infected multiple times?
What 2 bugs are responsible for the majority of respiratory infections from birth to 3 months?
Chlamydia trachomatis and GBS
What 2 bugs are suspected in lobar pneumonia in a 4 year old? Which one causes a monoarticular arthritis?
H flu and S. pneumo. H flu causes the arthritis.
(treat with ceftriaxone)
What is the best empiric treatment of URI in a 3 month - 5 year old
Erythromycin because of its effectiveness against S. pneumo, Chlamydia pneumoniae, and Mycoplasma
What causes croup, what is the peak age range, and what is the hospitalization rate for kids?
3 months - 6 years
<10% hospitalization rates
Muffled speech, drooling, stridor, and agitation with the child's head held in a sniffing position.
Diagnostic Xray sign?
Thumb sign on lateral neck CXR
Treat with ceftriaxone or ampicillin
What are the indications for adding a daily anti-inflammatory to an asthmatic
Use of beta agonist >3x/week
- 20% variance in twice daily peak flows
- < 80% of predicted peak flow
- < 80% of patient's peak flow history
Differentiate the etiologies of the following causes of dysphagia:
-difficulty swallowing solids and liquids
-rapidly progressing dysphagia with weight loss
-slowly progressing dysphagia over months to years
-Intermittent acute sx or
-esophageal motor disorder
-esophageal cancer
-benign stricture
-esophageal ring
-ulcerative esophagitis
What is the best treatment for GERD?
PPI's (esp. omeprazole) are the most potent and reliably successful therapy in treating GERD
What are some risk factors for esophageal carcinoma?
(race, sex, other Ca, health conditions, social hx)
Nasopharyngeal Ca
Long standing achalasia
Tylosis (hyperkeratosis)
Alcohol use
What percent of chest pain is caused by GI?
What NSAID has the most ulcerogenic properties?
What is the average 5 year recurrence rate of Crohn's after surgical treatment?
What percent of patients with diverticulosis will develop diverticulitis?
What are three diseases known to be associated with UC?
Pyoderma gangrenosum, Cholangitis, arthropathies
What bug is responsible:
1. incubation 6-48 hours, 33% of all bacterially caused food poisoning
2. incubation 3-6 hours, vomiting/diarrhea, sx last 24-48 hours. ham, pork, canned beef, cream filled pastry
3. incubation 8-24 hours, lasts &l
1. Salmonella
2. Staph aureus
3. C. pergringens
4. Vibrio parahaemolyticus
5. B. cereus
does the obturator sign suggest appendicitis or hernia
What is the most common cause of bowel obstruction in the first two years of life and what are some presenting signs (5)?
Intussusception which presents as colicky abd pain, currant jelly stools, reflex vomiting, leukocytosis, and a palpable mass
What does a first degree relative of CCA or adenomatous polyp do to your chance of getting colon cancer
It raises it from 2.5% to 7-7.5%
An elevated GGT in the presence of normal AlkPhos is _____ until proven otherwise
What is the most specific diagnostic criterion for PBC?
_____ is associated with 60% of patients who have PSC
recent history of jaundice and fever, no h/o alcohol use, homosexuality, or IVDA.

Negative GB ultrasound, negative hepatitis screen,

elevated ALT, AST, Alk Phos, and Tbili and conjugated bili


Resolution wi
Primary Sclerosing Cholangitis - confirmed by ERCP
What are the three diseases included under Autoimmune liver disease?
Autoimmune hepatitis - involves the parenchyma rather than the collecting system. 75% of cases. Treatment with steroids is effective

PSC, PBC are the other two
Ascites with a serum albumin:peritoneal fluid albumin ratio of 1:1 suggests what etiology?
What should you suspect in a cirrhotic patient with fever and abdominal pain? What two tests should be ordered?
Spontaneous Bacterial Peritonitis. Order a diagnostic peritoneal tap and CBC
Which hepatitis is most dangerous in pregnancy?
Hep E
How do you treat acute bacterial prostatitis
2 week course of Fluroquinolones
What bacteria produces struvite stones?
The urea splitting organisms which is usually proteus, but can also be ureaplasma
How does a patient with hemorrhagic cystitis present?
Dysuria, frequency, urgency prior to or with the hematuria
When is the only time when males are more likely to get UTIs than females?
during the first year of life, uncircumsized males are more likely to get UTIs
What study would be most likely to demonstrate VUR in a child?
Radionuclide cystogram
What is the most common urinart tract abnormality in kids?
How is a 3 year old with newly diagnosed VUR treated?
With prophylactic ABX because most cases will resolve within a year
What is the most common presenting sign of pyelo?
What type of amenorrhea will respond to a methylprogesterone challenge?
Anovulatory cycle - this condition involves appropriate estrogen priming of the endometrium, but no egg release and thus no progesterone phase and no menstruation
Define Asherman's syndrome
an obstruction to uterine outflow usually due to fibrous tissue development in response to infxn, endometrial instrumentation, or therapeutic abotion
What is the underlying problem when a patient fails to respond to a progesin challenge, but does respond to a reproduction of the estrogen/progestin cycle.
This would rule out uterine obstruction and would likely be an absence of estrogen stimulation of the uterus
Will PCOS patitents bleed in response to progesterone withdrawl? What are PCOS patients at risk for?
PCOS patients have amenorrhea secondary to anovulatory cycles, so they will respond to progesterone withdrawl. Their unopposed estrogen stimulation poses a risk for endometrial hyperplasia
What are women with hypothalamic amenorrhea at increased risk for?
What level of FSH confirms the dx of ovarian failure (usually d/t menopause)? What step is taken at this point?
>20 IU, begin HRT
What is the change found most often after surgical rather than natural menopause?
Loss of libido is more in a surgical hysterectomy
What is the most significant predicted benefit of HRT?
50% reduction in CAD
When is ERT contraindicated?
When the uterus is present
What should be done if a patient is still experiencing uterine bleeding after 6 months of HRT?
Endometrial Bx since postmenapausal bleeding is the hallmark for endometrial carcinoma
What percent of patients with unilateral bloody nipple discharge will end up having cancer?
What age range does the largest percentage of breast cancer occur?
List the percentages that occur in each age group.
>65 years old (>50%)
50-65 (25%)
<50 (25%)
What is the most common cause of complaint of breast pain?
What is the size limit for lumpectomy + radiation?
5 cm
Orchitis due to mumps spreads to the testes by what route?
Hematogenous spread is the usual route by which viruses spread to produce orchitis
What testicular abnormality is often associated with infertility?
Varicocele - a varicosity of veins in the pampiniform plexus
What condition is a contraindication to the use of a vacuum device to achieve an erection?
Sickle Cell
What is an important side effect of papavrine?
What are the top two cancer deaths in men?
Lung and Prostate
When should annual PSA/DRE begin in asymptomatic AA men?
What type of cancer is most common associated with cryptochordism? Does surgically descending the testical decrease cancer risk?
Seminoma - descending does not reduce risk of cancer, but it allows for earlier detection
What test is the best to confirm testicular torsion?
Testicular scintillation scan
What are two sexual changes that are not considered normal in elderly men
Testicular atrophy and decrease in libido
What cervical nerve roots are most affected by cervical disc herniation and spondylosis?
C6, C7
What physical exam finding would lead most strongly to the diagnosis of cervical radiculopathy?
Atrophy of hand/arm muscles
What is the preferred imaging modality to evaluate cervical radiculopathy?
C-spine xrays (not MRI)
Pain experienced upon active abduction at the shoulder is indicitive of what?
Rotator cuff tendonitis
What fracture is seen in anterior dislocations of the humerus?
posterolateral humeral head fracture
A positive Finklestein's test is indicitive of what?
De Queverian's tenosynovitis
What is the general rule to determine if a humerus fracture requires ORIF?
>45 degrees of displacement or a fx through pathologic bone
A football player who develops hip pain after being tackled and has pain with rotation and lateral bending of the trunk would most likely have an injury to what part of the hip?
Iliac Crest (hip pointer)
Differentiate between Osgood Schlatter and Patellofemoral Instability
Osgood Schlatter - pain at the tibial tubercle

Patellofemoral - Pain in activities where the knee is flexed. No jointline or patella tenderness
What additional injury is likely to be found with an acl tear?
MCL tear
How does tibial stress syndrome usually present? What is a risk factor?
Posteromedial tibial pain lasting 1-2 hours after resuming a running program. A risk factor is a flat foot. If the pain does not improve after 1-2 hours, evaluation for a stress fx is required
The most commonly sprained ligament in the ankle
Anterior talofibular ligament
How does treatment of a sprain with an avulsion fracture differ from treatment of a sprain
They are treated the same
What movement is painful in a patient with a fracture of the posterior process of the talus?
Plantar flexion
What location (1st - 5th) of a metatarsal stress fracture requires more aggressive management?
The 5th metatarsal, it is more likely to become a complete fx with non union
What are the top 3 most common underlying factors in recurrent otitis media?
Atopic Constitution
Adenoid hypertrophy
Congenital palatal deformity
How does passive motion affect OA?
It exacerbates it.
What are some signs of ehlers Danlos syndrome?
Hyperextensibility of joints, soft stretchy skin, open gaping wounds, easy bruisability. Patients can also develop arthralgias from overuse aggrivated by loose joint capsules.
RA postinactivity swelling lasts a minimum of ____ minutes
How long does RA remain monoarticular?
up to 5 years
What is the first line agent for OA?
What are 3 typical xray findings in OA?
Joint space narrowing
Bone Spurs
Subchondral new bone formation
Subperiosteal bone resorption is indicative of what? Where is this best visualized?
HyperPTH - best seen in radiographs of the fingers where, on the radial side of the phalanyx, the cortex has undergone resorption
Calcification of hyaline and fibrous cartilage is indicative of what?
What 3 things can precipitate Gout (2 drugs, 1 IV agent)
Aspirin, Thiazides, IV dye
Between Gout and Psuedogout, which is limited to the weight bearing joints? Which is more likely to be polyarticular?
Gout is limited to weight bearing joints
Pseudogout can be polyarticular
Why is aspirin not a good choice for patients with an acute gout attack?
ASA in low doses decreases renal uric acid excretion. All other NSAIDs are excellent first line agents
Why is Colchicine not a good choice for Acute gout attack?
because it may cause diarrhea, nausea, and emesis before an effective dose can be achieved
Developmental dysplasia of the hip has a family hx in ___% of cases. What screening tool should be used in these kids?
20% have a fhx, use ultrasonographic screening
What is the age cutoff of nonsurgical treatment of developmental dislocation of the hip?
6 months
With respect to delayed development of the hip, what percentage of the time is:
Left hip alone affected?
Both hips affected?
Right hip alone affected?

Is it more common in females or males?
Left hip - 60%
Both hips - 20%
Right hip 20%
Females are more common
Legg-Calves-Perthes disease is characterized by what?
Avascular necrosis of the femoral head
What is the most significant risk factor in postchlamydial infectious arthriris?
H/O multiple sex partners
What injury would you suspect from a patient who is repeatedly kneeling throughout the day?
Prepatellar bursitis
At what age range could you expect Osgood Schlatter disease to remit?
When the tubercle fuses between 9 and 15 years old
In patients with hip pain, what tests are necessary to rule out Legg-Calves-Perthes disease or a slipped femoral capital epiphysis?
serial X-rays
What patter of ANA is most specific for SLE?
Rim or peripheral pattern
What Ab is most commonly associated with neonatal lupus?
Anti SS-A (anti ro)
What antibodies correlate most specifically with Limited Systemic Sclerosis?
What cancers are most commonly associated with dermatomyositis?
Lung (most common), Stomach, Breast, ovary
Decribe the classic presentation of dermatomyositis.
Proximal muscle weakness, violaceous plaques on the dorsal aspect of interphalangeal joints, edema and violaceous coloring of upper eyelids.
What are some blood tests that are elevated in polymyositis, how is a definitive dx established?
Elevated LDH, CPK, SGOT. An open muscle bx is req'd for dx.
What antibody tests are most specific for Sjrogrens syndrome?
Anti SS-A and SS-B (ro and la)
What are two findings (one clinical and one serologic) needed to dx mixed CTD?
Clinical evidence of more than 2 CTDs and elevation of anti-RNP
How is Henoch-Schonlein purpura started?
Viral respiratory infection
Claudication, Angina, cold extremities in a young adult woman
Takayasu's arteritis
How long does it last?
How is it treated?
What age range?
Lasts 6-9 months and is treated by moderate amounts of glucocorticoids
Over 50 years old
What percent of Behcet's patients have ocular manifestations?
What gender is it most common?
What age range?
Triad of sx?
Middle age
Triad includes clinical dz in:
upper resp (nose bleeds, sinusitis)
lower resp (hemoptysis)
Define Grade I, II, and III concussions and when the patient can return to activity
Grade I - Confusion, no amnesia. Return to normal activity in 20 min if sx are absent
Grade II - Confusion with Amnesia. Return to play in 1 week if sx absent
Grade III - LOC. Take to hospital, may return to conditioning after 1 asymptomatic week, return to play 1 month after 2 asymptomatic weeks
what is the official definition of AIDS?
When are HIV patients more likely to get thrush?
200-500, also more likely to get diarrhea and weight loss
When are HIV patients more likely to get sebhorrea and folliculitis?
What is the only fluid excreted by the body that contains a significant amount of HIV virus?
Vaginal secretions
What health maintenance is necessary in HIV pts with:
CD4 < 500?
CD4 < 200?
CD4 50-75?
<500: Check CD4/Viral load every 3 months
<200: PCP prophylaxis
50-75: Mycobacterium avium prophylaxis
What AIDS patient population is more likely to develop Kaposi's sarcoma? What is the effect of treatment?
Homosexual men are most likely and treatment only helps cosmetically by diminishing the size of the lesions.
What HIV drug can cause pancreatitis?
How does treatment of TB change with HIV infected patietns
INH treatment time doubles from 6 months to 1 year
What are the likely organisms responsible for the following symptoms in an HIV patient:
1) 2 day h/o Occipital HA, fever, malaise in pt. with AIDS
2) Space occupying lesion with focal neuro defecits
3) retinitis, visual disturbance
1) Cryptococcus
2) Toxo
3) CMV
4) Mycobacterium
What 3 opportunistic infections are seen in CD4<200?
PCP, Kaposi, CMV retinitis
What test allows legoinnaire's disease to be distinguished from other pneumonitidies?
elevated CK
What is the indicated treatment for Legionnaire's disease?
Erythromycin with Rifampin. Other macrolides or sulfamethoxazole can also be used.
What is the minimum exposure time to a tick in order to be exposed to lyme disease?
24 hours
Describe stage 1, 2 and 3 of lyme disease. When does each stage begin?
Stage 1 - erythema chronicum migrans (lasts 7 days)
Stage 2 - dermal, CNS, MS systemic symptoms, begins 30 days after exposure
Stage 3 - First degree AV block among some stage 2 symptoms
What is the largest risk factor for TB?
What are the incubation periods of the following:
Lyme dz?
RMSF - 4 days
Lyme - 7 days
What is the estimated prevalence (in millions) of DM in the US? What percent is undiagnosed?
10-20 million, 50% are undiagnosed
What HLA types are associated with DM I?
DR3, DR4
How many calories per gram are carbohydrates, protein, and fat? What percent of each is recommended in a diet?
55% Carbs: 4 cal/gram
15% Protein: 4 cal/gram
<33% Fat: 8 cal/gram
How many units per kg are usually req'd in a diabetic?
.5-1 U/kg
What is the recommended protein intake for diabetics to prevent renal failure? (in g/kg/day)
.75 g/kg/day
What is the most sensitive diagnostic indicator of diabetic peripheral neuropathy? (found on PE)
Loss of ankle jerk
What type of DM is Gestational diabetes most similar to? What causes it? When is an appropriate time to test women for it?
most like type II, placental lactogen causes it and is at its highest during the beginning of the 3rd trimester of pregnancy, so testing should be done between 24-28 weeks.
What is the treatment for gestational diabetes?
Insulin therapy
What is the general rule for approximating Creatinine clearance in people? (without using a formula)
For young adults, the CrCl is usually around 100, and subtract 1 ml/hr for every year over 20.
What clinical scenario is direct measurement of free T3 (as opposed to calculation) most appropriate?
T3 toxicosis - because T4 is normal in this situation
What is the cause of the widened palpebral fissures in thyrotoxicosis?
elevated catecholamine state
How can you differentiate endogenous thryotoxicosis from exogenous thyrotoxicosis?

Name 1 way on PE and one lab value
Endogenous thyrotoxicosis will have a palpable thyroid and will have a decreased I123 uptake.
What drug is best suited to give rapid relief of thryotoxicosis?
Non selective beta blocker
What is the first lab abnormality to appear in hypothyroidism
increasing TSH
What is the most common type of hypothyroidism in the US?
Post ablative hypothyroidism due to surgery or radioiodine therapy
How long does treatment of hypothyroidism with levothyroxine take to achieve full effect?
1 month
What type of thyroid cancer results from childhood irradiation to the neck?
How much stronger is Dexamethasone than Prednisone?
How will Primary vs Secondary adrenal insufficiency differ in response to ACTH?
Primary - No change, since defect is in the adrenals
Secondary - Adrenals will be stimulated since defect is lack of ACTH secretion
What is a positive dexamethosone suppression test?
>50% suppression of 17-hydroxycorticosteroid in the overnight suppression test
What is suspected when there is no response to low dose dexa suppression test but a response to high dose
Cushing's disease - Pituitary tumor secreting ACTH
What effect does primary aldosteronism have on renin?
low renin due to the effect of hypervolemia and sodium retention
What is the best way to test for pheo?
24 hour urine catecholamine and metanephrine levels. VMA is not nearly as sensitive
What is the most common type of CAH?
21 alpha hydroxylase deficiency
After infancy, children grow about ___ inches per year.
2" per year, but it occurs in spurts
What would elevated FSH indicate in the setting of delayed or failed puberty?
a primary failure or primary gonadal failure as the cause.
What age ranges does puberty occur in boys and girls?
Girls: 8-13
Boys: 8-14
What are the Tanner stages for Boys?
I: no pubic hair, preadolescent genitalia
II: scant, slightly pigmented pubic hair, scrotum enlarged
III: small amt. of darker, coarser, curling pubic hair, longer penis, larger testes
IV: adult type pubic hair but less quantity, glans widened, testes approaching adult size, scrotum pigmented
V: pubic hair spread to thighs, adult genitalia
What are the tanner stages for girls?
I: no pubic hair, preadolescent breasts (elevation of papilla only)
II: Sparse, long straight, slightly pigmented hair on labia, visible or palpable breast buds, increased areolar diameter.
III: small amt of darker, coarser, curlier hair spreading over mons pubis,enlargement of breast and areola with no separation of coutours
IV: Adult type, coarse, curly, pubic hair covering less area than adult, breast and papilla no separated by coutour
V: pubic hair forming inverted triangle, adult contoured breast with projection of the papilla only, areola more pigmented
What is the definition of delayed puberty?
The continued absence of secondary sex characteristics by age 14 for boys and 12 for girls. Treatment is necessary to develop secondary sex characteristics and prevent short stature
What hormone would you use to treat central precocious puberty in a male?
At what age does Atopic dermatitis appear on cheeks?
At what age does Atopic Dermatitis usually remit?
Usually by age 20
What drug is a good choice for long time (30 hours) control of asthma symptoms?
Salmeterol (B2 agonist)
What is the peak age range for seasonal allergies?
What is the measure of ability to diagnose presence of disease
What is the measure of the ability to be truly negative in the absence of disease?
What is the max diastolic BP in hypertensive patients going to surgery?
What is the minimum time after a heart attack that a patient must wait for elective surgery?
3 months
What values of the following labs indicate severe malnourishment?
Pre Albumin?
Albumin < 2.0
Transferrin < 100
Pre Albumin < 7
Lymphocytes < 1000
What delay is required for elective surgery following stabilization of CHF?
1 week
What age should you begin to order:
BUN/CR - >50
Lytes/CXR - >60
Urinalysis/Alb - >65
EKG - Women >50 Men >35
What screen is used for appropriate lung function to go to surgery?
FEV1 > 2L
What is the one class of hypertensive meds that hypertensive patients must stop prior to surgery?
Diuretics - to prevent hypokalemia
How long should the following blood thinners be stopped prior to surgery, and when can the patient begin to take them again after surgery?

Aspirin - Stop 1 week prior
Restart 48 hours post
Ticlopidine - Stop 2 weeks pre
Restart 48 hours post
Warfarin - Stop 3-5 days pre
Restart 3-5 days post
What is an ideal TC:HDL ratio for a man?
How many calories per day does a very low calorie diet contain and who should go on it?
800 kcal per day for 12-16 weeks. Pts who are >30% overweight
What are the two effects of a fibrate on cholesterol?
Decrease TG
Raise HDL

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