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Family med review > 1 > Flashcards

1 Flashcards

1
Q

Loss of elastic recoil is characteristic of what kind of COPD

A

emphysema

increased airway resistance is characteristic of bronchitis

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2
Q

what is the most common sx of emphysema

A 
dyspnea 
seen with hyperinflation 
barrel chest 
increase in AP diameter 
V/Q matched defects
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3
Q

sxs of chronic bronchitis

A 
productive cough 
wheezing 
rales 
rhonci 
peripheral edema 
cyanosis
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4
Q

increased CO2 is characteristic of chronic bronchitis or emphysema

A

chornic bronchitis

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5
Q

anything over this temp celicius is technically a fever

A

38

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6
Q

what is the presentation of PUD

A

dyspepsia that is worse at night
GIB
(MCC of upper GIB)

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7
Q

duodenal ulcers are better or worse with meals

A

better

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8
Q

MC type of Peptic ulcers

A

dueodenal (4x)

more common in younger pts

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9
Q

diagnostic test for PUD

A

endoscopy

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10
Q

what is gastritis

A

superficial inflammation / irritation of stomach mucosa with mucosal injury

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11
Q

CC of gastritis

A

. H. pylori MCC

NSAID / ASA / Alcohol 2nd MCC

less common Autoimmune / Pernicious anemia

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12
Q

MC presentation of gastritis

A

epigastric pain

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13
Q

MC virsu associated with gastroenteritis in adults

what is the most common virus in children

A

adults –>NORO

children–>ROTA

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14
Q

questions would want to ask if you suspect gastroenteritis

A

recent travel (e.coli)

recent anbx (C. Diff)

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15
Q

sxs of invasive gastroenteritis

A

increased fever
blood and fecal leukocytes
large bowel involvement

mimics acute appendicitis
initially watery

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16
Q

sxs of shigella

A 
lower abd pain
explosive watery diarrhea
mucoid
blood
febrile seizures
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17
Q

nonivasive gastroenteritis szs

A

vomiting
increase i voluminous stool
small bowel involvement

copious watery diarrhea “rice water”

grey, no fecal door/blood/pus

severe dehydration

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18
Q

Canned home foods is a RF for this gastroenteririts pathogen

A

C perfringens

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19
Q

pork and poultry are RF for these gastroenteririts pathogen

A

Salmonella

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20
Q

shellfish and gastroenteritis think this pathgen

A

V. Cholerae

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21
Q

picnic and egg salad think this gastroenteritis RF

A

S. auereus

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22
Q

DO NOT GIVE ANTIDIARRHEAL WITH this type of gastroenteririts

A

invasive (fever, blood, leukocytes large bowel involvement)

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23
Q

antiemetics that can be used for gastroenteririts include

A

5HT3 inihibitors

dopamine blockers like reglan (if not heart conditions)

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24
Q

anbx TX for shigella

A

Trimethoprim-sulfamethoxazole (Bactrim) 1st line if severe

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25
Q

anbx tx for vibrio

A

tetracyclines, FQ

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26
Q

C. diff tx

A

metro or vanco

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27
Q

Salmonella tx

A

FQ

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28
Q

constipation questions to ask

A

new onset after 50

opiate use

DM

hypothyroid

MS

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29
Q

Labs for constipation

A

CBC, CMP, TSH

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30
Q

Tx for constipation

A

bulk forming laxitices (metamucil)

increase fiber 20g

stool softner like sENNA

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31
Q

ROME criteria for constipation

A

less than 3 BM/ week
with straining

hard or lumpy

sensation of incomplete evacuation

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32
Q

acute pancreatitis causes

A

gallstones (40%)

ETOH (35%)

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33
Q

sxs of acute pancreatitis

A

epigastric boring pain that radiates to the back

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34
Q

PE of acute pancreatitis

A

tachy
necrotizing hemorrhagic

Cullen’s (periubilical ecchy)

Grey turner( flank ecchymosis)

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35
Q

Labs if you suspect acute pancreatitis

A 
increase tg
Increase lipase (more specific than amylase)

greater than 3x ULN of amylase

increase ALT: 3x suggest gallstone

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36
Q

dx test of choice for acute pancreatitis

A

abd CT

can rule out gallstones with abd U/S

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37
Q

Tx for acute pancreatitis

A

supportive
NPO]
IV

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38
Q

Ranson’s at admission

A

at admission

glucose >200
age>55
ldh>350
ast>250
wbc>16k
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39
Q

ranson’s w/in 48 hrs

A 
calcium <8
hct>10% fall
pO2<60 mmHG
BUN>1.8
HCO3<20
fluid sequestration> 6L
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40
Q

chronic pancreatits

A

ETOH 70%

idipathic 15%

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41
Q

triad of chronic pancreatitis

A

calcifications on plain ab =d xray
steatorrhea
DM

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42
Q

UC differs from crohn’s b/c

A

limited to colon
begin in rectum always and contiguous spread

mucosa and submucosa

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43
Q

UC sxs

A

LLQ colicky MC

bloody diarrhea hallmark
hematochezia

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44
Q

crohn’s dz differs from UC b/c

A

can be any segment of GI
MC terminal
transmural

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45
Q

crohn’s sxs

A

RLQ pain

apthous ulcers

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46
Q

Chron’s complications

A

B12 deficiency
fistual
perianal dz

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47
Q

skipped lesions and cobbles-atoning on colonscopy is associated with

A

chron’s

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48
Q

string sign

A

barium enema of chron’s

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49
Q

TX for IBD

A

5-ASA (oral mesalamine)
sulfasalazine (UC)

prednisone

immune modifying

anti tnf

50
Q

MC sx of diverticulitis

A

GIB and LLQ pain

51
Q

labs and diagnostics with diverticulitis

A

CT scan fat stranding and increased WBC

guiac +

52
Q

diverticulosis tx

A

high fiber

53
Q

diverticulitis tx

A

clear liquid diet abx (cipro or bactrim +falgyl)

54
Q

MCC of small bowel obstructions

A

post surgical adhesions

55
Q

HX of small bowel obstructions

A

Cramping abd pain

▪ Abd distention

▪ Vomiting

▪ Obstipation (no stool/passing gas)

56
Q

early small bowel obstruction expect

A

▪ hyperactive bowel
▪ high pitched tinkles
▪ visible peristalsis

57
Q

ABD XRAY in small bowel obstruction expect

A

Abd XR: air fluid levels in step ladder pattern, dilated bowel loops

58
Q

initial tx of SBO

A
  • aggressive fluid resuscitation (very dehydrated)
    • electrolyte repletion
    • NG tube (evacuate air & fluid)
59
Q

Four Cardinal signs of strangulated bowel:

A

1) fever
2) tachycardia
3) leukocytosis
4) localized abd tenderness

60
Q

Hep A symptoms

A

hepatomegaly
jaundice
RUQ pain

61
Q

HepA contagious until

A

1 week after jaundice

62
Q

HepA test

A

IgM anti HaV positive

63
Q

Gallstones in gallbladder, no inflammation

A

Cholelithiasis

64
Q

Cholelithiasis sxs

A

Biliary “colic” episodes
▪ abrupt RUQ/epigastric pain, nausea
▪ 30min to 1hr
▪ precipitated by fatty/large meals

65
Q

Cholelithiasis tx

A

Asymptomatic = observation

Symptomatic = elective cholecystectomy

66
Q

GB cystic duct obstruction by gallstone → inflammation / infection

A

Acute cholecystitis

67
Q

cholecystitis MC pathogens

A

E. coli MC

Klebsiella

Enterococci

68
Q

SXS and physical of cholecystitis

A

RUQ/epigastric pain

▪ precipitated by fatty/large meals

Physical exam:
▪ fever
▪ enlarged, palpable gallbladder

(+) Murphy’s: inspiratory arrest

(+) referred pain R-shoulder/scapular d/t phrenic nerve irritation

69
Q

eferred pain R-shoulder/scapular d/t phrenic nerve irritation

seen in cholecytitis is known as

A

Boas sign:

70
Q

dx tests of cholecystitis

A

Initial test → US

Gold standard → HIDA scan

↑ WBCs with left shift

71
Q

cholecystitis TX

A 
NPO, IVF, Abx (Ceftriaxone + Flagyl) → laparoscopic cholecystectomy 
for acute (within 72h) and chronic
72
Q

stone obstruct cystic duct)

A

stone obstruct cystic duct)

73
Q

stone obstruct cystic duct)

A

choledocholithiasis

74
Q

stone causing biliary tract infection)

A

stone causing biliary tract infection)

75
Q

Transient relaxation / incompetency of Lower esophageal sphincter

associated with what sxs

A

GERD

Heartburn (pyrosis) hallmark

Worse with supine (flat) position

regurgitation

dysphagia

76
Q

RF for GERD

A

Weight gain

Fatty food

Caffeinated or carbonated drinks

Alcohol, tobacco, drug use

77
Q

Lifestyle modifications

A

elevate head of bed 15cm (6 inch)

- avoid eating 2-3hr before bed
- avoid strong stimulants (coffee, alcohol, smoking)
- avoid fatty food, chocolate
- weight loss
78
Q

tx for GERD outside of lifestyle modifications

A

▪ H2RA (-tidine) then upper endoscopy

stage 3 use prazole PPI

79
Q

drugs that lower LES pressure and can casue GERD (6)

A 
Anticholinergic
▪ Antihistamine
▪ TCA
▪ CCB
▪ Progesterone
▪ Nitrates
80
Q

TX for IBS

A

smoking cessation, low
fat/unprocessed food
▪ Exercise, antibiotics, antispasmodics, peppermint oil, and probiotics appear to improve symptoms

81
Q

ESOPHAGITIS causes

A
  1. MCC GERD (Reflux)
    ▪ mechanical or functional abnl of LES
  2. Eosinophilic / atopic dz → esophagitis
  3. Pill induced esophagitis
    ▪ bisphosphonates
    ▪ NSAIDs
  4. Infectious cause in immunocompromised
    ▪ Candida
    ▪ CMV
    ▪ HSV
82
Q

esophagitis common sx

A

odynophagia -hallmark of infx

dysphagia

retrosternal CP

83
Q

dx test for esophagitis

A

upper endoscopy

84
Q

Achalasia

A

Loss of Auerbach’s plexus →
increased LES pressure

leads to lack of persitalsis

85
Q

dx test for achlasia

A

Double contrast barium swallow →
“Bird’s beak” appearance of LES

esphageal manometry

86
Q

tx for achlasia

A

botox injection
nitrates
CCB
LES

87
Q

test for suspected rotator cuff injury

A

▪ Hawkins: elbow/shoulder flexed with internal rotation
▪ Neer: pronated arm, pain with forward flex
▪ Jobes: pain with “empty can”

88
Q

questions for differentiating arthritis

A

when is it worse?

morning–> rheumatoid

later in the day–> osteo

89
Q

what is classically spared in rheumatoid arthtritis

A

DIP

90
Q

prodrome of constitutional sxs are classically seen in this form of arthritis

what are they

A

rheumatoid arthritis has prodrome

fever
fatigue
wt loss
anorexia

91
Q

what dx test do you need to confirm RA

A

ccp antibodies

can also look at rheumatoid factor
XRAY

92
Q

osteoarthritis dx tests

A

xray

93
Q

tx of osteoarhtritis

A

NSAIDS

elderly with bleeding risk –> actetome

94
Q

what is reactive arthritis

A

autoimmune response 1-4 s/p chlamydia

seen with conjunctivits or urethritis

95
Q

sinusitis -what is it

A

symptomatic inflammation of ≥1 paranasal sinuses of <4 weeks’ duration resulting from impaired drainage and retained secretions accompanied by obstruction, facial pain/pressure/fullness, or both. Because rhinitis and sinusitis usually coexist, “rhinosinusitis” is the preferred term.

96
Q

three important features of sinusitis

A

Inflammation and edema of the sinus mucosa

Obstruction of the sinus ostia

Impaired mucociliary clearance

97
Q

most cases of sinusitis are due to

A

vast majority of cases

(rhinovirus; influenza A and B; parainfluenza virus; respiratory syncytial; adeno-, corona-, and enteroviruses)

98
Q

bacterial sinusitis can be differentiated from viral how?

A

More likely if symptoms worsen within 5 to 6 days after initial improvement

No improvement within 10 days of symptom onset

> 3 to 4 days of fever >102°F and facial pain and purulent nasal discharge

99
Q

hx of sinusitis

A

Worsening of symptoms >5 to 6 days after initial improvement

Persistent symptoms for ≥10 days

Persistent purulent nasal discharge

Unilateral upper tooth or facial pain

Unilateral maxillary sinus tenderness

Fever

100
Q

associated sxs of sinusitis

A

Headache

Nasal congestion

Retro-orbital pain

Otalgia

Hyposomia

Halitosis

Chronic cough

101
Q

sxs with sinusitis requiring immediate attention

A

Visual disturbances, especially diplopia

Periorbital swelling or erythema

Altered mental status

102
Q

PE of sinusitis

A

Fever

Edema and erythema of nasal mucosa

Purulent discharge

Tenderness to palpation over sinus(es)

Pain localized to sinuses when bending forward

Transillumination of the sinuses may confirm fluid in sinuses (helpful if asymmetric; not helpful if symmetric exam).

103
Q

tx for sinusitis

A

Pseudoephedrine HCl

Phenylephrine nasal spray (limited use)

Oxymetazoline nasal spray (e.g., Afrin) (not to be used >3 days)

104
Q

when would you suspect strep throat

A

pharyngitis sxs with high fever

105
Q

viruses associated with pharyngitis

A

Rhinovirus

Adenovirus (associated with conjunctivitis)

Parainfluenza virus

Coxsackievirus (hand-foot-mouth disease)

Coronavirus

106
Q

sxs associated with pharyngitis

A

Sore throat

Difficulty swallowing (dysphagia) or pain on swallowing (odynophagia)

Cough (uncommon in GAS pharyngitis)

Hoarseness; “hot potato” voice

Fever

Anorexia

Chills

Malaise; fatigue

Headache

Dysuria and arthralgias (suggest gonococcal etiology)

Sick contacts with similar symptoms or confirmed diagnosis

107
Q

PE of pharyngitis

A

Enlarged tonsils with or without exudate

Pharyngeal erythema

Unilateral tonsillar swelling (“frog’s belly”) or uvular deviation (concern for peritonsillar abscess)

Trismus; stridor; drooling (concern for peritonsillar or retropharyngeal abscess)

Cervical adenopathy (anterior suggestive of GAS, posterior most commonly associated with infectious mononucleosis)

Fever (higher in bacterial infections)

Pharyngeal ulcers (CMV, HIV, Crohn, other autoimmune vasculitides)

Scarlet fever rash: Punctate erythematous macules with reddened flexor creases and circumoral pallor suggests streptococcal pharyngitis.

Tonsillar/soft palate petechiae and hepatosplenomegaly suggest infectious mononucleosis (EBV/CMV).

Gray oral pseudomembrane suggests diphtheria and occasionally infectious mononucleosis (EBV/CMV).

Characteristic erythematous-based clear vesicles suggest HSV or coxsackie A virus infection (herpangina).

Conjunctivitis suggests adenovirus.

108
Q

ddx of pharyngitis

A

Viral syndrome

Streptococcal infection

Allergic rhinitis/postnasal drip

GERD

Malignancy (lymphoma or squamous cell carcinoma)

Irritants/chemicals (detergent/caustic ingestion)

Atypical bacterial (e.g., gonococcal, chlamydial, syphilis, pertussis, diphtheria)

Oral candidiasis (patients typically complain mostly of dysphagia)

Epiglottitis (associated with stridor, drooling, and progressive respiratory distress)

109
Q

how to decide whether or not to test for stre

A

+1 point: tonsillar exudates

+1 point: tender anterior chain cervical adenopathy

+1 point: absence of cough

+1 point: fever by history

+1 point: age <15 years

0 point: age 15 to 45 years

−1 point: age >45 years+1 point: tonsillar exudates

+1 point: tender anterior chain cervical adenopathy

+1 point: absence of cough

+1 point: fever by history

+1 point: age <15 years

0 point: age 15 to 45 years

−1 point: age >45 years

110
Q

once you have your

A

If 4 points, positive predictive value of ~80%; treat empirically.

If 2 to 3 points, positive predictive value of ~50%, rapid strep antigen; treat if GAS-positive.

If 0 or 1 point, positive predictive value <20%; do not test; treat empirically with follow-up as needed.

111
Q

viral pharyngitis sxs that would not warrant testing for GAS

A

cough, rhinorrhea, hoarseness, oral ulcers, diarrhea, conjunctivitis, rash) (1)[A]

112
Q

tx for viral pharyngitis

A

Salt water gargles

Viscous lidocaine (2%) 5 to 10 mL PO q4h swish/spit

Acetaminophen 10 to 15 mg/kg/dose q4h PRN pain or fever (pediatric). In adults, do not exceed >3 g/day.

NSAIDs for pain or fever (more effective than acetaminophen for GAS pharyngitis)

Anesthetic lozenges

Cool-mist humidifier

Hydration (PO or IV)

113
Q

anbx for GAS

A

Antibiotics (particularly penicillin) are chosen primarily to prevent complications.

60–70% primary care visits by children with pharyngitis result in antibiotic prescriptions (4). Empiric therapy results in antibiotic overuse.

Treatment duration generally 10 days (1)[A]

Antibiotics do not reduce risk of poststreptococcal glomerulonephritis.

Antibiotics shorten duration of symptoms by approximately 16 hours (5).

Antibiotics may prevent pharyngitis/fever by day 3 (NNT 4 if GAS-positive, 6.5 if GAS-negative, 14.4 if untested) (5)[A].

114
Q

GAS COURSE

A

Streptococcal pharyngitis runs a 5- to 7-day course with peak fever at 2 to 3 days.

Symptoms will resolve spontaneously without treatment, but rheumatic complications are still possible.

115
Q

how long does influenza last

A

7 days, followed by additional days of cough and fatigue

116
Q

how long does URI last

A

3-14 days

117
Q

when would you not want to use HCTZ, Chlorthalidone

A

DM or gout

118
Q

presentation of arrhythmias

A 
▪ Palpitations MC
▪ dizzy
▪ lightheaded
▪ syncope
▪ SOB
119
Q

LDL target

A

LDL cholesterol levels should be less than 100 mg/dL. Levels of 100 to 129 mg/dL are acceptable for people with no health issues but may be of more concern for those with heart disease or heart disease risk factors. A reading of 130 to 159 mg/dL is borderline high and 160 to 189 mg/dL is high

120
Q

Triad of lupus

A

▪ joint pain (90%)
▪ fever
▪ malar “butterfly rash”

121
Q

cardiac ROS

A 
Chest pain?
• Palpitations?
• Dyspnea on exertion DOE? o SOB on exertion?
• Orthopnea?
o SOB when lying down?
• Paroxysmal nocturnal dyspnea PND?
o Do you awake in the middle of the
night and feel like you have to run
to the window to get air?
• Leg edema?
o Swelling in legs?
• Hx of cardiac problems? (HTN, MI, CHF,
rheumatic fever, heart murmur)?
o **Move to PMH if positive
• Ever had/last EKG?
o **Move to HM: Screening
• Ever had/last heart tests (echo, stress
tests)?
o **Move to HM: Screening
• Cardiac procedures (cath, stent)
o **Move to PMH: Surgeries if yes

Family med review (1 decks)

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