Absence of dysuria decreases the likelihood

There is insufficient evidence to recommend for ir against prostate cancer screening

Induration of 5mm is positive for hiv patients, cos there is an increased risk of
progression from latent to active tb. Some high risk individuals (homeless of IV drug
users) should be tested abually
Posotive pap smear, do a colposcopy(kinda like a biopsy under microscope of the
affected area)
Oral contraceptives can cause increased BP in some people
For pertussis give azithromycin for 5 days of eruthromycin for 14 days
The Hib vaccine does not reduce the rate of otitis media as most cases are cases
are caused by non typable H.influenza
Strongest predisposing factor in the development of asthma is history of atopy.
Only drug therapy that has been shown to improve the natural history of COPD
progresson is supplemental oxygen in those pAtients that re hypoxemic.
In dementia you get good effort with testing but wrong answers
Donepezil has no effect on the progression of neurodegeneration
Naltrexone reduces the reinforcing effects of alcohol
Elastic stockings for patients with chronic venous insufficiency cos it helps in venous
return
Someone who has a coronary disease risk factor less than 10% for the next
10yearfs has an LDL tresatment goal less thnan or equal to 160mg/DL
Atypical angina occurs when the patient experiences pain that has the quality and
characteristics of angina or occurs with exertion but not both
After a cat bite to the hand hospitalization is indicated. Outpatient antibiotic therpy
with amoxicillin/clavulanic acid is the treatment of choice if the patient is not
hospitalized (5days for prevention, 10 days for treatment).
Fibrocystic change=bilateral multifocal mass
In a patient with poor functional capacity noninvasive testing is recommended
before surgery.
Thrombosed external hemmorhoids(distal to the dentate line) do excision with local
anesthesia. It eliminated pain and recurrence for external use rubber band ligation
snd sclerotherapy but drainage increases risk of recurrence and can lead to
infection of the retained clot.
Peptic ulcer disease presentation=gnawing abdominal pain in upper right quadrant
associated with sensation of hunger,(also history of alcohol abuse and dark stools
to go with it. NSAIDS are also the second most common cause.

Peptic ulcer Disease

waking at night with upper abdominal pain or upper abdominal pain that improves with eating. The pain is
often described as a burning or dull ache. Other symptoms include belching, vomiting, weight loss,
or poor appetite. About a third of older people have no symptoms.[1] Complications may
includebleeding, perforation, and blockage of the stomach. Bleeding occurs in as many as 15% of people.
[3]

Common causes include the bacteria Helicobacter pylori and non-steroidal anti-inflammatory
drugs (NSAIDs)

-current level of orientation helps differentiate delirium frim dementia cos in

dementia level of consciousness is not clouded.
Molluscum contagiosum-poxvirus through skin to skin contact. In adults they are
sexually transmitted disease
Viral gastgroenteritis( involving nausea and vomiting to nme few symptoms) by
(Norwalk,reovirus, adenovirus, usually self resolve within 5 days. Oral rehydration is
indicated as long as there is no signs of severe dehydration. There is no role for
antibiotic therapy.
Principle of primacy of patient welfare: deals with doing no harm
Early disseminated disease is treated with oral antibiotics(amoxicillin or
doxycyclinez0 for 14 to 21 days.
Rocky mountain spotted fever is treated with chloramphenicol
Tularemia is treated with streptomycin intramuscularly
Screen men for lipid disorders at age 35 even in the absence of other risk factors
In acute gout corticosteroids can provide quick relief but should be reserved if initial
therapy fails,
Opiates may control pain but will not lead to resolution of the inflammation.
Benzo withdrawal is similar to alcohol and is associated with hypertension,
tachycardia and possibly seizures.
Opiate withdrawal=lacrimtion,rhinotthea,yawning,diaphoresis.
Negative hpv testing=patient is low risk and you can repeat the test in 1year.
Event duration and irregular heart beat are some things that make something or
cardia etiology

Posterior cervical adenopathy should always point to infectious mononucleosis

e.g 2% of people with strep throat actually test negativeusing this test=False
negative
ectopic pregnancy=colicky and may radiate to shoulder, also there is nausea
loose stools without bleeding/ diarrhea=acute viral diarrhea, patients encouraged to
eat potatoes, rice, wheat, noodles, crackers, bananas, yogurt, boiled veggies and
soup.
When evaluating primary
amenorrhea in patients with normal secondary sexual characteristics and
a normal initial laboratory evaluation (pregnancy test, TSH assessment,
and prolactin level), it is appropriate to perform a progestin challenge
test. When there is no withdrawal bleeding, it either indicates inadequate
estrogen production or an outflow tract obstruction. An estrogen-progestin
challenge can differentiate between the two. No withdrawal bleeding after
an estrogen-progestin challenge indicates an outflow tract obstruction or
an anatomic defect
topical treatments for warts with liquid nitrogen to prevent recurrence.
Imiquimod =anogenital warts
Laser therapy is effective but leaves open wounds that heal by secondary intention and
should be reserved for warts resistant to other treatment modalities.
Bleomycin=terminal digital necrosis
Adenovirus=mot common cause of conjunctivitis
D-dimer =tells is dvt or PE(pulmonary embolism or not, if negative you aight
Doppler flow studies are used to verify dvt
IBS=abdominal pain or discomfort associated with defecation.if present for at least 12 weeks
and includes 1. Relieved by defecation, onset is associated with a change in stool frequency
or onset is associated with a change in the form or appearance of stool.
Testicular torsion=emergent surgical referral cos after 12 hrs only 20% chance of saving the
testes.there will also be no cremasteric reflex. Also if pain is relieved upon elevation of the
testicle when the patient is supine prehn sign is positive, this does not happen in testicular
torsion.
CHF=always start with diuretics
ASCUS(atypical squamous cells of undetermined origin
+pap test reportin ASCUS=and no hpv testing available=repeat the pap test in 4 to 6
months or do colposcopy.
If you do colposcopy and nothing found repeat it after 12 months then after that go back to
normal schedule
Cervical cancer screening evry 3 years for women who have ever had sex and have a cervix,
start at age 21 or 3 years after the onset of sexual activity.

When pap smear shows atypical glandular cells and are reported to be of
endometrial origin= do endometrial biopsy
Signs of severe malnutrition=hypotension and severe bradycardia
HBsAg=indicates either chronic or acute infection. IGM anti-HBc=acute infection,
HBeAg=correlates with replication
Single dose antibiotics therapy after sexual intercourse for women with rexurrent
UTIs, symptoms usually develop within 24hrs of sexual intercourse. If that doesnt
help daily does antibiotics prophylaxis for 3-6months.
Fatigue less =physical cause(infections,endocrine imbalances, cardiovascular
disease, anemia, or medication).
Fatigue 3months=psychological fatigue(depression, anxiety, stress, adjustment
reaction).
Physiological fatigue= because of overwork, lack of sleep, or a defined physical
stressor like pregnancy.
Chronic fatigue syndromes and chronic idiopathic fatigue-require more than 6
months of symptoms.
Spinal stenosis= CT scan
Spine radiographs=after injuries
MRI=anatomical assessment of disk herniation or spinal cord abnormalities
EMG=radiculopathy
Radiculopathy=A disease of the root of a nerve, such as from a pinched nerve or a tumor.
Quadrivalent HPV vaccination=highly immunogenic, safe and well tolerated in
females ages 9-26
To be most effective give before a female becomes sexually active.
It can be given to pregnant women, immunocompromised
Decongestants and diet pills may cause urinary retention if they include alpha
agonists.
Antihistamines can cause urinary retention or functional incontinence.
Patients are more likekly to make behavioral changes if they are given several
options for change from which to choose.
When the history , physical examination and lmited evaluaton are negative, it is
appropriate to reassure the patient with palpitations and continue observation
Iliotibial band syndrome=most common cause of lateral knee pain in an
athlete(common in athletes who do repetitive ne flexion activities like long distance

runners and cyclists.(pain or ache in lateral aspect of the knee that worsens with
acticity.
Patellofemoral pain syndrome= diffuse knee pain and a positive patellar grind test
No need to treat kids with group A Beta hemolytic streptococcus, cos it doesnt
spread
For mild acne combination therapy (with topical antibiotics, benzoyl peroxide gel,
and topical retinoids.
Combined oral contraceptives side effects: hair growth, male pattern baldness,
nausea, breast tenderness, fluid retention. Weight gain. Main side effect why people
stop it is irregular bleeding.
Atopic dermatitis: flexure surfaces often affected, pruritis may be severe.
Post voidal residual less than 50m is normal. A post voidal residual greater than 200
ml indicates inadequate bladder emptying and is consistent with overflow
incontinence.
Patients with amenorrhea and elevated testosterone and DHEA-s levels meet CT
scanning of the adrenal glands and ultrasound of the ovaries to rule out neoplasm
80% of ovarian masses in girls younger than 15 years are malignant. Cos of this any
adnexal madd should be evaluated by transvaginal ultrasound and referral for
surgical removal, in women of child bearing age its just a cyst. Ultrasound is the
best first test.
Influenza vaccine: for all persons aged 6 months and older.
Minimum age for LAIV is 2 years
Minimum age for TIV is 6months
Practitioners should administer 2 doses of vaccine (separated by at least 4 weeks)
to children between the ages of 6months and 8 years who are receiving the
seasonal influenza vaccine for the first time, or who were vaccinated for the first
time during the previous influenza season but only received one dose.
Prevalence=probability of having a disease at a specific point in time and is
obtained by dividing the number of people with the disease by the number of
people in the study.
Recent coronary revascularization is a risk factor for poor perioperative outcomes.
Ginko biloba=dementia
Garlic=prevents heart disease
St johns worts=depression
Saw palmetto=used in treatment of benign prostatic hypertrophy
Bee pollen=increase energy

Alpha blockers=urethral sphincter relaxation and can cause urinary leakage but not
urgency
Calcium channel blockers=urinary retention
b-blocker inhibit bladder relaxation and therefore can cause urinary
leakage and urgency
Glabellar reflex (also known as the "glabellar tap sign") (Glabella) is a primitive reflex. It is elicited
by repetitive tapping on the forehead. Subjects blink in response to the first several taps. If the
blinking persists, this is known as Myerson's sign and is abnormal and a sign of frontal release; it is
often seen in people who have Parkinson's disease.[
upper endoscopy=for acute upper gi bleed

red cell scans=better to locate bleeding sources in the lower GI tract

when the results of a pap smer re reported as atypical glandula cells the physician should proceed to colposcopy

colposcopy=uses endocervical ampling

lewy body deentia=dont use antipsychotics cos it can cause long term neurological damage

thalassemia minor=low hemoglobin and mcv but elevated rbc count and normal RDW

if a mother I positive baby should receive hep b immune globulin within 7 days, vaccine within, 12 hrs, at 1 month and 2 months and at 6 months

paroxysmal supraventricular tach-rapid and irregular

most important component in diagnosis of asthma is history

naproxen=edema

selegiline=reduce mortality and morbidity of parkinsons, carbidopa and levodopa only do symptomatic relief

fish oil=has omega 3 fatty acids=decreases secretion of triglycerides by the liver

Primary amenorrhea
is defined as the absence of menses at age 16 in the presence of normalsecondary sex
characteristics, or absence of menses at age 14 in the absence
of secondary sex characteristics. It is usually the result of a genetic or
anatomic abnormality. Gonadal dysgenesis is the most common cause
of primary amenorrhea, responsible for about 50% of the cases. The most
well-known type is Turner syndrome (45 XO). Hypothalamic failure is
often a result of anorexia nervosa, excessive exercise, chronic or systemic
illness, and severe stress, and results from a suppression of hypothalamic
gonadotropin-releasing hormone (GnRH) secretion. Pituitary failure may
result from inadequate GnRH stimulation and is often associated with a
history of head trauma, shock, infiltrative processes, pituitary adenoma, or
craniopharyngioma. These patients will often display deficiency of other
pituitary hormones as well. Polycystic ovarian syndrome may cause primary
amenorrhea, but is generally associated with normal breast development.
Constitutional delay of puberty, although common in boys, is an
uncommon cause of amenorrhea in girls, but clinically is very hard to distinguish
from other more common causes.
Ace inhibitor plus arb=reduces hospitalization but not mortality
b-blockers=treat angina

when the results of a pap test are ASCUS and the patient Is postmenopausal and not taking any
estrogen therapy repeat pap test after one week (while the patient is on 4 week therapyof vaginal
estrogen cream).
mrcp(mahnetic resonance cholangiopancreatography)=if obstruction is still considered likely after a negative ultrasound or ct.

but normally when obstruction is suspected ultrasound or ct is the appropriate initial test

if the bile ducts are not dilated but the likelihood of obstruction is low the patient should be evaluated for hepatocllulat or cholestatuc liver disase

edema,swollen uvula=group a hemolytic strep

one point is given for each of the following characteristics, 1.tonsilar exudates, tender cervival adenopathy, fever, lack of cough. all 4 you should treat without prforming lab test

hot nodules are benign e.g edenoma

anal fissure= after passing hard stool, ache or spasm that resolves after a couple of hours

all healthy children 24-59 months who have not completed their primary immunization for pcv7 be given one dose of pcv7

normal schedule=2,4,6, and 12 to 15 months

Transvestites dress as another gender but have not considered surgery, vs transsexuals

x-linked recessive trait affect more males than females and x-linked dominant affects more females than males

in autosomal recessive trait, of unaffected parents have an affected child, there is a 25% risk that each offspring from those parents will be affected

Tdap vaccine should be administered to patients 65 years and older who have close contact with an infant aged less than 12 months. the tdap vaccine should be administered regardless of the interval since most
recent td containing vaccine.

pneumococcal polysaccharide vaccine=every 5 years

intranasal influenza should only be used in healthy adults younger than the age of 50

Cluster headache=nifedipine for prophylaxis, also prednisone,indomethacin, and lithium. ergotamine only for acute stage mot prophylaxis,

migranes=verapamil for prophylaxis other calcium channel blockers cant do it, other calcium blockers can help suppress cluster headache tho

beets=cause pseudohematuria

endometriosis=pain before and during menses=due MRI

impetig0=erythematous lesions that are golden crusted when disrupted=due to staph areus, and usually infect nares

pyelonephritis=have fever

interstitial cystitis=more chronic and not associated with back pain

acute bacterial cystitis=frequency,hematuria,dysuria and back pain

nausea and vomiting before eating in morning=pregnancy, uremia, alcohol withdrawal and increased intracranial pressure

gastroparesis and pancreatitis=nausea after esting

cholelithiasis=nausea and vomiting and pain after eating fatty foods

signs of inflammation e.g erythema with edema point towards cellulitis=treat with antibiotics

pain from renal caluli=radiates to shoulder

murphys sign=cholecystitis

hepatitis and gallstones=right upper quadrant tenderness but no murphy sign

Acamprosate=most effective for alcohol relapse prevention,ir works on gamma aminobytyric acid gaba and glutamine nt which are important for alcohols effect on the brain, and their effect appear to be greater and
longer lasting than naltrexone.

Arterial blood measurements should only be obtained if the FREV1 is found to be less than 50% predicted

serum creatinine can be can be normal in elderly people with chronic renal insufficiency becos they generally have less muscle mass therefor the best indicator of renal failure is GFR

use of alarm for nocturnal enuresis cos frequent awakening has a low compliance barrier

viral infections account for 70% to 80% of acute infectious diarrhea with rotavirus being the most frequent cause

tularemia=pain and ulceration at the bite site

lyme disease=slowly spreading anular lesions

RMSF= red macules on peripheral extremities that become purpuric and confluent(e.g pink spots on ectremities that coalesce)

Tdap=is recommended for adults aged 19 to 64 to replace the next booster dose of tetanus

HBsAG=indicated acute or chronic infection, if a patient was in recovery phase their HBsAG would be negative

positivity of IgM anti HBc indicates early infection

upper endoscopy fails to reveal GERD in 36% to 50% of patients with GERD by a ph probe, EGD(esophagogastroduodenoscopy) shoud be performed if bleeding, weight loss or dysphagia is present.

pinpint pupils=narcotic excess

atopic dermatitis=flexor surfaces are often involved

imiquimod=immunomodulating agent approved to treat HPV, acyclovir=treats herpetic infection(

Topical anti-tumor medication

It can treat genital warts. It can also treat rough, raised areas of heavily sun-exposed skin (actinic keratoses) and skin cancer (basal
cell carcinoma).
b-blockers=erectile dysfunction

ssri for Premature ejaculation

rheumatoid arthritisis symmetrical vs osteoarthritis

b-blockers=inhibit the adverse effects of sympathethic nervous system activation in heart failure patients, they can slo reduce symptoms, improve quality of life and reduce mortality.

herpes zoster=for adults 60years or older regardless if they had an epidode of herpes zoster before or not.

cardiac complications are the most lethal presurgical complicatons

dysmenorrhea=(

painful menstruation, typically involving abdominal cramps.)=primary dysmenorrhea is caused by the release of
prostaglandins from the endometrium at the time of menstruation so give NSAIDS for remedy.
The diagnosis of diabetes
may be made by two separate random glucose measurements more than
200 mg/dL with classic signs of diabetes (polydipsia, polyuria, polyphagia,
weight loss), a fasting glucose greater than 126 mg/dL, or a glucose reading
greater than 200 mg/dL 2 hours after a 75-g glucose load.
Bigunides=metformin
Oral therapy for type 2
diabetes can be complicated. No evidence supports changing sulfonylureas
when one is not adequately controlling glucose levels. Biguanides act to
decrease glucose output from the liver, and can decrease hemoglobin A 1C by
1.5% to 2%. However, biguanides should not be used if creatinine is higher
than 1.5 mg/dL. Meglitinides increase insulin secretion and should only be
taken before meals. They can reduce the hemoglobin A 1C by 0.5% to 2% and
are most valuable if fasting sugar is adequate, but postprandial sugars are
high. Since they increase insulin levels, they are more effective when used
in combination with a medication that has a different mechanism of action.
They are excreted in the liver, therefore are safe in renal failure. Thiazolidinediones
decrease insulin resistance and are an excellent choice for those
with insulin insensitivity. -Glucosidase inhibitors inhibit the absorption of
carbohydrates in the gut and can decrease the hemoglobin A 1C by 0.7% to
1%. They should be avoided if creatinine more than 2.0 mg/dL
Chronic constipation=psyllium=bulk forming agents