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kelly's fam med AQ cases > 3 > Flashcards

3 Flashcards

1
Q

What are two signs for appendicitis

A

Psoas and obturator sign

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2
Q

Describe psoas sign

A

assive extension of patient’s thigh as s/he lies on his/her side with knees extended, or asking the patient to actively flex his/her thigh and hip causes abdominal pain, often indicative of appendicitis.

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3
Q

Describe obturator sign

A

Examiner has patient supine with right hip flexed to 90 degrees; takes patient’s right ankle in his right hand as he uses his left hand to externally/internally rotate patient’s hip by moving the knee back and forth. Elicitation of pain in the abdomen implies acute appendicitis.

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4
Q

Is the pain with duodenal ulcer relieved or worsened with food?

A

relieved, antiacids would also help

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5
Q

In what situations are plain abdominal films useful?

A

when suspect 1) acute intestinal obstruction or 2) free air from a perforated hollow viscus

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6
Q

When to order bnp?

A

primarily useful in distinguishing chronic obstructive pulmonary disease from congestive heart failure, especially in the evaluation of shortness of breath

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7
Q

What is the role of a HIDA scan if you suspect gallstones?

A

f the patient has typical symptoms of biliary colic but no visible stones on the gallbladder ultrasound, a HIDA scan might be obtained to look for gallbladder dysfunction and reproducible pain

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8
Q

When to get ERCP?

A

If there was jaundice and/or gallstone pancreatitis suggestive of a common duct stone (choledocholelithiasis)

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9
Q

terms used to describe primary skin lesions

A

macule, patch, papule, plaque, nodule, tumor, vesicle, bulla, pustule and wheal

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10
Q

What is a macule?

A

Flat and less than 1 cm in diameter.

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11
Q

What is a patch?

A

macule greater than 1 cm in diameter

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12
Q

Is a patch a big macule?

A

YES

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13
Q

What is a papule?

A

solid raised lesion that has distinct borders and is less than 1 cm in diameter

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14
Q

What is a plaque?

A

a solid, raised, flat-topped lesion greater than 1 cm in diameter. It is analogous to the geological formation, the plateau.

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15
Q

What is a nodule?

A

a raised solid lesion and may be in the epidermis, dermis or subcutaneous tissue.

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16
Q

What is a bulla?

A

a circumscribed fluid filled lesion that is greater than 1 cm in diameter.

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17
Q

What is a wheal?

A

an area of elevated edema in the upper epidermis.

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18
Q

What does it mean that skin exams are an I recommendation?

A

current evidence is insufficient to assess the balance of benefits and harms of a primary care clinician performing a whole body skin examination or a patient doing a skin self-examination for the early detection of skin cancers

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19
Q

Rash involvement in palms and soles is seen with what?

A

erythema multiforme, secondary syphilis and eczema

20
Q

Where do you typically see eczema?

A

behind the ears and on flexural areas

21
Q

Describe appearance of basal cell carcinoma

A

may be plaque-like or nodular with a waxy, translucent appearance, often with ulceration and/or telangiectasia.

22
Q

Describe typical appearance of psoriasis

A

usually bilateral and involves extensor surfaces of elbows and knees.

23
Q

What are common side effects of topical corticosteroids?

A

skin atrophy and hypopigmentation

24
Q

List two oral anti-fungals used for treatment of tinea caput and ungiuim

A

griseofulvin, itraconazole and terbinafine

25
Q

What is the diagnostic method of choice if there is a strong suspicion of malignant melanoma?

A

Excisional biopsy

26
Q

Is a shave biopsy possible in a macule or patch?

A

NO because they are both flat. Need raised lesion for a shave biopsy.

27
Q

What is the D in the ABCDEs of skin lesions?

A

Diameter greater than 6 mm

28
Q

What are some symptoms of prostatitis?

A

pain (in the perineum, lower abdomen, testicles and penis, and with ejaculation), bladder irritation, bladder outlet obstruction, and sometimes blood in the semen.

29
Q

What is necessary to evaluate when considering BPH?

A

A. Presence of classic lower urinary tract symptoms (LUTS).
B. Examination of prostate.
C. Urinalysis.
D. Serum prostate specific antigen (PSA).
E. Serum BUN and Creatinine

30
Q

What are complications of untreated BPH?

A

urinary tract infections
acute urinary retention
obstructive nephropathy

31
Q

What is a good first line treatment for BPH?

A

alpha-adrenergic antagonists (tamsulosin, alfuzosin, terazosin and doxazosin)

32
Q

When may combination treatment with an alpha-adrenergic antagonist and a 5-alpha-reductase inhibitor be desirable?

A

In men with severe symptoms, those with a large prostate (>40 g), and in those who do not get an adequate response to maximal dose monotherapy with an alpha-adrenergic antagonist

33
Q

Does BPH lead to prostate cancer?

A

NO

34
Q

What are the three kinds of primary HA?

A

Tension, cluster, and migraine

35
Q

What are serious causes of HA to rule out?

A

Meningitis
Brain tumor
Intracranial hemmorhage
Traumatic brain injury (concussion)

36
Q

Associated symptoms of migraine?

A

Often occur with nausea and vomiting, photophobia, or hyperacusis. May occur with aura.

37
Q

What are the number of migraines necessary for diagnosis?

A

5 episodes needed for diagnosis.

38
Q

What are associated symptoms of cluster headaches?

A

Associated with rhinorrhea, lacrimation, facial sweating, miosis, eyelid edema, conjunctival injection, and ptosis.

39
Q

What two questions are included in the GAD 2?

A

Feeling nervous, anxious, or on edge?

Not being able to stop or control worrying

40
Q

What are two things evaluated in the PHQ2?

A

Little interest or pleasure in doing things

Feeling down, depressed, or hopeless

41
Q

What are two groups of migraine-specific treatment?

A

Triptans and ergot alkaloids

42
Q

What are triptan side effects?

A

Dizziness, sleepiness, nausea, fatigue, paresthesia, throat tightness/closure, chest pressure.

43
Q

Potential side effects of ergot alkaloids?

A

MI, ventricular tachyarrhythmias, stroke, hypertension, nausea, vomiting, diarrhea, dry mouth, rash.

44
Q

What is a good non-specific treatment for HA?

A

Excedrin (acetaminophen/aspirin/caffeine)

45
Q

You wish to prescribe sumatriptan for a man with headaches. Which medication would concomitant use be dangerous with?

A

SSRI due to risk of serotonin syndrome

46
Q

Can metoprolol, propranolol, and timolol be used prophylactically against migraines?

A

YES

47
Q

In addition to beta-blockers which additional two groups of meds can be used prophylactically against migraines?

A

TCA (amitryptaline) and neurostabilizers (divalproex sodium, topiramate)

kelly's fam med AQ cases (10 decks)

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