Eye don't know
What is the difference between chalazion and hordeolum based on symptoms reported by the patient?
Chalazion: painless
Hordeolum: painful
Chalazion is on the eyelid (Meibomian gland) – resolves within 1 month; Hordeolum is on the lid margin (Zeis gland) – lasts 1-2 weeks
What presents with ear fullness, popping of ears, underwater feeling, intermittent sharp ear pain, fluctuating conductive hearing loss, and tinnitus?
Eustachian tube dysfunction
Most common location of anterior nasal epistaxis?
Kiesselbach's triangle
what is the tx for GAS pharyngitis?
kids = amoxicillin
adults = penicillin
could also use: 1st gen cephalosporin, azithromycin, clindamycin if PCN allergy
A mean corpuscular volume (MCV) of less than 80 cubic microns is a manifestation of which of the following diagnoses?
A. B12 deficiency anemia
B. Iron deficiency anemia
C. Folate deficiency anemia
D. Anemia of Chronic Disease
B. Iron deficiency anemia
- microcytic anemias: TICS are small
- MCV < 80
What is the leading cause of significant vision loss in people > 50 yo in the US?
Age-related Macular Degeneration
A 4-year-old girl who is brought to the clinic by her mother who states that the child has been complaining of progressively worsening ear pain and itchiness over the past week. Examination reveals left tragal tenderness and an edematous and closed canal. What is the most likely diagnosis?
Otitis externa
Most common pathogen associated with acute bacterial sinusitis in the adult population and what is the first line treatment?
strep pneumo
Augmentin
Describe the difference between leukoplakia and candida
Leukoplakia = Hyperkeratosis and dysplasia of the epithelium and mucous membranes
painless and cannot be rubbed/scraped off (unlike candidiasis)
Leukoplakia can progress into cancer, especially if redness is present (erythroplakia)
A 25 year-old female presents with fatigue. CBC results reveal the following: WBC: 6,300/microliter Hgb: 9.5 g/dl Hct: 28% MCV: 75 fL MCHC: 32 g/dl MCH: 24 pg Platelets: 550,000/mL Which of the following is the best treatment option for this patient? Bonus: what are common etiologies of this condition?
Ferrous sulfate
PO: most convenient BUT needs to be able to absorb it and tolerate it (sig GI SEs)
IV: quicker absorption; also indicated for malabsorption issues (celiac, hx of gastric bypass, etc.)
What are the symptoms of retinal detachment?
Increased floaters
Scotoma (curtain!) over visual field → loss of vision
Flashes of light
BPPV is diagnosed with what maneuver and treated with what maneuver?
Dix-Halpike is diagnostic
Epley is treatment
Note: Vertigo that changes with position and is without hearing loss, tinnitus, or ataxia
A 4-year-old boy presents with unilateral purulent, foul-smelling nasal discharge for three days. The child has no other respiratory symptoms. What is the most likely diagnosis?
nasal foreign body
A 6 yo unvaccinated child presents to clinic with high fever and sore throat sitting in the tripod position. His mother reports that he has been drooling and that his voice has sounded muffled. What is the most important first step if there is high suspicion for the most likely diagnosis?
Epiglottitis --> intubate immediately
Note: DO NOT examine oropharynx → could lead to respiratory arrest
On XR: “Thumbprint sign”
Tx: IV antibiotics to cover Hib: ceftriaxone → 10 days course PO abx
A 62-year-old male with a history of rheumatoid arthritis complains of weight loss, fatigue, and weakness. Iron studies reveal decreased serum iron, increased ferritin, and decreased TIBC. Peripheral blood smear shows normochromic RBCs. What's the most likely dx? What is the pathophys?
Dx = anemia of chronic disease
Pathophys: chronic inflammation --> increase in cytokines and hepcidin --> hides iron!
A 12 year old male presents to the clinic with complaint of a goopy and red right eye for the past 2 days. He states that this morning when he woke up, his eye was “glued shut”. On exam, there is yellow, purulent discharge coming from his eye. He wears contact, and he has had no symptoms of fever, cough, or upper respiratory symptoms. What is the most appropriate treatment for this patient?
bacterial conjunctivitis
Fluoroquinolone drops (cipro)
A 32 year-old female presents complaining of spiking fevers. She was seen four weeks ago with a complaint of left ear pain and was treated for otitis media. She continues to have symptoms, but now has pain behind the ear. On examination you note left post auricular tenderness and erythema. What is the treatment of choice in this patient?
Dx: Mastoiditis
Treatment of choice: IV ABX (ex: ceftriaxone, vancomycin)
Not to be taken lightly: Can result in life-threatening sequela, including meningitis, intracranial abscess, and venous sinus thrombosis.
A 13-year-old boy presents with clear fluid discharge from his nose for 2 days duration. This has also been associated with sneezing. On nasal exam, the mucosa and turbinates appear edematous and slightly bluish. He has swollen dark circles under his eyes and a transverse nasal crease. What is the first line treatment?
dx = allergic rhinitis
firstline tx = nasal corticosteroids
What is the tx for peritonsillar abscess?
Aspirate! (refer to ENT)
Abx: Augmentin or clindamycin
Rehydration
Which of the following is true regarding sickle cell anemia?
A. it is autosomal dominant inheritance pattern
B. sickle cell crisis is marked by low reticulocyte counts
C. most common in western European countries
D. hallmark symptoms are due to vaso-occlusive episodes and hemolysis
D. hallmark symptoms are due to vaso-occlusive episodes and hemolysis
Sickle cells lack elasticity and adhere to vascular endothelium, which disrupts microcirculation and causes vascular occlusion and subsequent tissue infarction.
A 65 yo female presents to the clinic with eye pain, headache, and photophobia for the past few hours. On exam, you see a cloudy cornea with a mid-dilated pupil that is not reactive to light. You use the tonometer and determine that the IOP is significantly elevated (> 30 mmHg). You decide that this is a medical emergency and make an urgent referral to an ophthalmologist. Which beta blocker can be used empirically until the patient sees the ophthalmologist?
Timolol drops
57 yo female with a six-day history of severe continuous dizziness associated with ataxia and right-sided hearing loss. She had an upper respiratory tract infection one week ago. What is the mostly likely diagnosis?
Dx = Labyrinthitis
Labyrinthitis is associated with CONTINUOUS vertigo along with hearing loss +/- tinnitus and is usually associated with an upper respiratory infection. This differentiates it from Meniere’s syndrome, which is EPISODIC and not typically associated with a viral infection.
Tx: Vestibular suppressants (meclizine) and antiemetics (ondansetron) to limit symptoms in the first 24 to 48 hours. Also, sudden onset of symptoms can get a 10 day course of prednisone.
A 34F presents with recurrent bouts of dizziness, tinnitus, and hearing loss. She states that the episodes are incapacitating and cause her to become nauseous and vomit. The attacks last about one hour and the symptoms disappear after a few days. The last two episodes were treated with meclizine (Antivert) and prochlorperazine (Compazine) at the emergency room. Audiologic testing reveals low-tone frequency hearing loss. What is the most appropriate long-term and least invasive management for this patient?
Dx = Meniere disease (vertigo = episodic, NOT continuous)
- pathophys: accumulation of fluid in the endolymphatic sac
Tx = Sodium restriction and diuretics
What is the Centor Criteria?
Likelihood of having GAS pharyngitis/next steps
Absence of cough, Temp > 100.4, anterior cervical lymphadenopathy, tonsillar exudates
0 = no swab
1-3 = swab and tx if positive
4 = may consider empiric tx w/ abx
A 26 yo female comes into the office with symptoms of fatigue as well as tingling in her lower extremities. Her medical history is insignificant, and she doesn’t take any medications. She follows a vegetarian diet and does not drink alcohol. You decide to get some labs, so you order a CBC with iron studies and homocysteine/MMA. The CBC shows the following:
RBC: normal
Hct: low
Hb: low
MCV: 110
WBC: normal
Ferritin: normal
Transferrin: normal
TIBC: normal
Homocysteine: elevated
MMA: elevated
What diagnosis is most likely in this patient?
Vitamin B12 deficiency
*Homocysteine is elevated in both folate and B12 deficiency anemia. MMA is only elevated in B12 deficiency anemia
*BONUS: AMS is found in B12 deficiency but not folate deficiency (12 yo's are kinda neurotic?)