Musculoskeletal
Fluid-filled swelling caused by herniated synovial tissue surrounding tendon sheaths or joints
What is a ganglion cyst?
Indication for one-time abdominal aortic aneurysm screening
Men aged 65-75 years who have ever smoked
When should a patient with an atrial myxoma be referred for urgent surgical evaluation?
In patients with atrial myxoma and a central nervous system embolic event, urgent cardiac surgical evaluation and excision are indicated.
What are 3 treatment options for patients with community acquired pneumonia?
Amoxicillin, doxycycline, or a macrolide (if pneumococcal resistance <25%)
When are thrombolytics indicated for DVT/PE?
Consider for massive DVT leading to impaired venous drainage, severe edema, and acute limb ischemia
Massive PE and shock from low cardiac output
Anterior hip pain associated with glucocorticoid use, SLE, sickle cell anemia, or alcohol use disorder
What is osteonecrosis?
Age to begin osteoporosis screening in average-risk women
65 years
What are the indications for septal reduction surgery in a patient with hypertrophic cardiomyopathy?
Patients with hypertrophic cardiomyopathy who are receiving guideline-directed medical therapy but with New York Heart Association functional class III to IV heart failure symptoms or recurrent syncope believed to be related to left ventricular outflow tract (LVOT) obstruction and an LVOT gradient of 50 mm Hg (resting or provoked) or greater should be considered for septal reduction therapy.
Therapeutic drug class for invasive candidiasis without CNS or eye involvement
echinocandin (caspofungin, micafungin, or anidulafungin)
What are some dietary interventions to prevent calcium stone recurrence?
Reduce sodium, reduce animal protein, increase calcium, increase fluid, increase citrate, increase fruits and vegetables
Increasing calcium consumption leads to decreased oxalate absorption in the GI tract
Arm paresthesias/pain worsened with activity and arm elevation
What is neurogenic thoracic outlet syndrome?
Chlamydia and gonorrhea screening indication for women
All sexually active women ≤24 years of age
What is the size cut off for an ascending aortic aneurysm for surgical repair?
In patients with an ascending aorta or aortic root larger than 4.5 cm in diameter who require surgery for coronary artery disease or valve pathology, aortic repair should be performed at the time of cardiac surgery.
When an ascending aortic aneurysm due to degenerative disease exceeds 5.5 cm in diameter or has rapid growth (>0.5 cm/year), surgical repair is warranted to prevent the morbidity and mortality associated with rupture.
Antibiotics for osteomyelitis and retained orthopedic hardware?
Rifampin should be used in combination with another antistaphylococcal agent to manage Staphylococcus aureus infections in the setting of orthopedic hardware if the hardware cannot be removed. Little evidence is available to guide recommendations on therapy duration; 4 to 6 weeks of antibiotics is considered sufficient for acute infections, whereas longer courses may be required for chronic infections. In some circumstances, especially when hardware cannot be removed, indefinite suppressive therapy may be required. Relapse can occur many years after therapy completion.
What is the management of serotonin syndrome?
Elbow pain with flexion, paresthesia/numbness in 4th to 5th digits
What is ulnar nerve entrapment?
When should women of average risk undergo breast cancer screening and how frequently?
USPSTF: Shared decision making between 40-50 years; Every 2 years from 50-75
ACS: Annually from 45-55 and every 2 years from 55-75
ACOG: Shared decision making from 40-50; Every 1-2 years from 50-75
American college of Radiology: Annually 40-75
How is mild, moderate, and severe aortic stenosis defined on ECHO? How often do these patients need follow up ECHO?
Mild:
Transvalvular velocity: 2-2.9 m/s
Mean gradient: <20 mm Hg
Every 3-5 years
Moderate:
Transvalvular velocity: 3-3.9 m/s
Mean gradient: 20-39 mm Hg
Every 1-2 years
Severe:
Transvalvular velocity: 4 m/s or higher
Mean gradient: >40 mm Hg
Every 6-12 months
Treatment of choice for patients with isolated facial nerve palsy and positive enzyme immunoassay results for Lyme disease.
Doxycycline
What are some preventative therapies for migraines?
Topiramate, divalproex sodium, tricyclic antidepressants, beta blockers (propranolol)
Anterior knee pain after prolonged sitting, running, climbing
What is patellofemoral pain syndrome?
What are the recommendations for administration of pneumococcal vaccines (PCV 20, PCV15, and PPSV23)
Age 19-64:
PCV20 or combination of PCV 15 followed by PPSV 23
PPSV23 – DM, Heart dz, Liver dz, Lung dz, EtOH, Tobacco, CSF leaks
Both – Immunocompromised (CKD, HIV, asplenia, transplant, malignancy)
PCV15 followed by PPSV23 8 weeks later
Eligible patients who had received only PPSV23 previously should receive either PCV15 or PCV20. If given PCV15, there is no need for patients to receive the subsequent PPSV23 vaccination, having received it already in the past.
Age 65+:
PPSV20 alone or PCV 15 followed by PPSV 23 at least 1 year later
What are indications for ICD placement for primary prevention?
Select an ICD in the following scenarios:
Pyelonephritis indications for imaging
Fever lasting >72 hours, persistent bacteremia
What scores on MMSE define mild, moderate, or severe dementia?
Mild dementia is often associated with a MMSE score of 20 to 23, moderate dementia a score of 10 to 19, and severe dementia a score <10.
An MMSE score <24 is 87% sensitive and 82% specific for dementia; however, individuals with very mild dementia or those who are highly educated with dementia can have normal scores. One study showed that in individuals without cognitive dysfunction, the median MMSE score is 29 with >9 years of education and 26 with 5-8 years of education. Some experts suggest the cutoff for dementia be increased to a score of 27 in older individuals with a college education.