6 Flashcards
What are common symptoms of the flu?
Myalgias, fever, sore throat, cough
What three groups are helpful in classifying “dizziness”?
Presyncope, dysequilibrium, vertigo
What is vertigo?
A sensation of the room spinning
What side effect can aminoglycosides cause?
Damage to inner ear - vertigo and hearing loss
What are the qualifications for orthostatic hypotension
Change in 20 of SBP or 10 in DBP with position
List 4 peripheral causes of vertigo?
BPPV, labrynthitis, vestibular neuritis, Meniere’s disease
A patient recently had a URI then comes in for vertigo. What is the likely cause?
Whether patient has hearing loss will help differentiate between vestibular neuritis (hearing intact) and labrynthitis (hearing loss)
While examining a patient with vertigo, they have nystagmus that does not resolve with fixation. Where is lesion?
Central. If nystagmus resolves with fixation of vision, lesion is peripheral (inner ear).
What is Meniere’s disease?
Episodes of unilateral hearing loss, tinnitus, and vertigo form the classic triad
What is acute labrynthitis?
occurs when an infection affects both branches of the eighth cranial nerve resulting in tinnitus and/or hearing loss as well as vertigo
What is the Dix-Hallpike maneuvre used to help diagnose?
BPPV
What can help relieve symptoms in someone with peripheral vertigo?
1) Diuretics
2) Epley maneuvers
3) Vestibular rehabilitation exercises
4) Vestibular suppressant medications (meclizine, dimenhydrinate, metoclopramide, promethazine)
A patient chronically uses NSAIDs for knee pain and now presents with abdominal pain that is relieved when eating. What is likely diagnosis?
peptic ulcer disease
Fever and LLQ pain. Likely cause?
Diverticulitis!
What two medications can contribute to PUD?
Aspirin and ibuprofen
What are the 4 main causes of PUD?
Medications (aspiring and ibuprofen)
Physiologic stress
H Pylori
Cigarette smoking
How can GERD easily be differentiated from PUD?
PUD symptoms likely to develop on empty stomach whereas GERD is worth with eating, leading to burning and regurgitation
Typical signs and symptoms of GERD:
asthma chronic cough dental enamel loss globus sensation hoarseness noncardiac chest pain recurrent laryngitis recurrent pharyngitis subglottic stenosis
When evaluating someone for dyspepsia, what alarm symptoms would motivate referral to GI for endoscopy?
Weight loss Onset of symptoms after 50 Dysphagia Odynophagia Hematemesis Hematochezia Early satiety Iron deficiency anemia Recurrent vomiting
Are cheliosis, brittle nails, pale palpebral mucosa and nailbeds signs of iron deficiency anemia?
YES
Can acanthosis nigricans be a sign of malignancy?
YES
What are some physical exam findings associated with hyperthyroidism?
warm skin, thinning hair, eyelid lag, brisk DTRs, or tachycardia
PPIs can affect the absorption of some drugs. List a few:
ampicillin, aspirin, iron, ketoconazole, methadone
What are some of the adverse effects of PPIs to watch out for?
community-acquired pneumonia, Clostridium difficile-associated diarrhea, osteoporotic fracture, anti-platelet agent inhibition, iron, magnesium, and vitamin B12 deficiencies.
Can you test someone for h pylori by urease breath test if they are on PPI?
NO, PPI disrupts sensitivity and would need to be stopped for 2 weeks before testing
What is the most convenient and affordable test for H pylori?
Serology
What is the first line “triple therapy” for h pylori?
PPI standard dose twice daily (esomeprazole is dosed once daily)
Amoxicillin 1 g twice daily
Clarithromycin 500 mg twice daily
What is the “quad therapy” for h pylori?
PPI standard dose once or twice daily (OR ranitidine 150 mg twice daily)
Metronidazole 250 mg four times daily
Tetracycline 500 mg four times daily
Bismuth subsalicylate 525 mg four times daily
What medication is in both the triple and quad therapy for h pylori?
PPI
What is the suggested duration of h pylori treatment?
10-14 days
You treat a patient for h pylori based on + serology testing but there sx don’t improve after full course of triple therapy. What do you do?
Urease breath test or fecal antigen test to determine if it is indeed hpylori and/or a resistant strain. If not h pylori than refer to GI.
What physical exam findings support diagnosis of lung consolidation?
Egogphany A to E Dullness to percussion Crackles Whispered pectoriloquy Tactile fremitus
What criteria do you refer to for strep testing?
Modified Centor Criteria
What are the modified centor criteria?
Tonsillar exudate or erythema Anterior cervical adenopathy Cough absent Fever present: Age 3 to 14 years: +1 point Age 15 to 45 years: 0 points Age over 45 years: -1 point
With what score should you consider testing strep in children?
2 Modified Centor Criteria
How do you collect sample for influenza?
Nasopharyngeal swab
What bug is largely involved in bacterial pneumonia?
strep pneumo
Patient presents with fever, sore throat, and tender cervical lymphadenopathy. What are you thinking?
GABS pharyngitis. Run rapid strep if child has Modified Centor Criteria > 3
What antivirals can be used to shorten influenza symptoms by 24 hours if given within 48 hours of onset of symptoms?
zanamivir, oseltamivir, amantadine, and rimantadine
What are the complications of pneumonia?
otitis media
lower respiratory tract infections including bronchitis and pneumonia
neurologic involvement (meningitis, guillan-barre, febrile seizures)
myositis
myocarditis
Which abx to use in uncomplicated pneumonia of child > 5 yrs old?
azithromycin, covers atypical pneumonia which has increased prevalence in this age group
3 mo to 5 y/o with uncomplicated pneumonia. What to treat with?
amoxicillin, covers strep pneumo which is most common offender in typical bacterial pneumonia of this age group
Do you look to BMIs for percentiles to determine whether child is normal weight, over weight, or obese?
percentile
What percentiles qualify a child as overweight?
85-95
A 10 year old boy has BMI at 97th percentile with no secondary complications. What do you recommend for weight at 2 month visit?
Maintain. If secondary complications, lose 1lb/month until less than 85th percentile
What does APGARS stand for and when do you take them?
Appearance, Pulse, Grimace, Activity, Respiration
At 1 and 5 minutes
When should newborns return to birthweight?
by 2 weeks
When do you expect a baby to roll over?
4 months
Describe course of colic
Symptoms typically begin around the age of two weeks, peak at about six weeks, and gradually improve over the next several weeks, with most infants free of symptoms by twelve weeks of life.
Nonbilious vomiting in an infant. What should you consider?
Pyloric stenosis. Palpate for olive shaped mass in abdomen + US, ultimately needs surgery
Which portion of alimentary canal is most often involved in intussception?
ileocolic
What is the Wessel rule of three for colic?
Unexplained paroxysmal bouts of fussing and crying that lasts at least three hours a day, at least three times a week, for longer than three weeks.
What would be included in your workup of fever in < 2 month old?
All fluids - blood, CSF, urine - sent to lab with cultures
How much should a 6 week old cry a day?
3 hours (2 week old should cry 2 hrs a day, 3 month old should cry 1 hour/day)
Is there an instrument designed just for post partum blues/depression?
YES Edinburgh Postnatal Depression Scale
What is time course of post-partum blues?
usually occurs soon after childbirth, often peaks around the fourth and fifth day, and subsides by around ten days
Family history of first degree relative with MI less than what age confers increased risk of CAD?
Myocardial infarction (MI) at a young age (male <55; female <65) in a first-degree relative does increase an individual’s risk for CAD.
What is the range of “elevated” blood pressure?
120-129/<80
What is the range of stage 1 HTN?
130-139/80-89
How is stage 2 HTN defined?
> 140/>90
Behavioral interventions for blood pressure control
Weight loss for those who are overweight or obese
A heart healthy diet, such as the DASH diet or Mediterranean diet.
Sodium restriction, or in those over 75 who are well nourished a trial of sodium restriction (sodium restriction may lead to decreased oral intake in older patients).
Potassium supplementation, particularly from diet (eg. tomatoes, avocados, green leafy vegetables, et al.)
Increased physical activity through a structured exercise program
Restriction of alcohol consumption to no more than 2 standard drinks per day for men or 1 standard drink per day for women and for all adults 65 years or older.
When should you initiative HTN treatment in someone with Stage 1 HTN (130-139/<80-89)?
When they also have 10 year ASCVD risk > 10%
A man is diagnosed with stage 2 HTN (>140/>90)and has no co-morbidities. What med to start?
ACE (Lisinopril etc)
ARB (Losartan etc.)
CCB (Nifedipine etc)
Thiazide (HCTZ, chlorthalidone, etc)
A patient has HTN and diabetes. Should you tailor BP meds to co-morbidities?
Not until DM has resulted in nephropathy
What two medications should be used in black patients with HTN?
CCB and thiazides
What type of ASCVD events mandate initiation of statin?
Acute coronary syndrome (MI or unstable angina)
Stroke or TIA felt to be atherosclerotic in origin
Peripheral vascular disease
What LDL cut-off mandates initiation of statin?
190
Among adults 40-75, what 10 year ASCVD risk mandates initiation of statin?
7.5 %
What are the two “high intensity” statins?
Atorvastatin
Rosuvastatin
How potent is simvastatin
Low-intensity
What is an abnormal ABI?
< 0.9
What is the USPSTF recommendation on aspirin use?
The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years
What exam findings support diagnosis of heart failure?
Crackles and dullness to percussion lung bases
PMI laterally displaced from the mid-clavicular line towards the axillary line
S3 from rapid ventricular filling or poor LV functioning
Enlarged liver, hepato-jugular reflux (distention of the jugular vein upon manual pressure on the liver), and distention and shifting dullness indicating ascites
Lower extremity edema and check pulses
Sacral edema
Besides an MI, what other disease processes can result in a new diagnosis of CHF?
Arrhythmia, ischemic cardiomyopathy, uncontrolled hypertension, MI can ALL result in CHF
How can afib lead to CHF?
inadequate filling of the left ventricle and subsequent heart failure.
What’s a quick way to determine if axis is correct on EKG?
upwards in I and AVF
What are XR findings of CHF?
Cardiomegaly (> 1/2 of thorax) Hilar fullness and central vascular congestion Pleurals effusions Cephalization of pulmonary vasculature Kerley B Lines
What is preserved EF?
> 45%
What lab test can help can help differentiate heart failure from non-cardiac conditions in patients with dyspnea?
BNP. If normal, effectively rules out cardiac etiology.
What medications have a role in systolic heart failure mgmt?
ACEi ARB Eplerenone Digoxin Loop diuretics (furosemide) Beta blockers (metoprolol succinate)
What in ankle clonus?
A series of abnormal alternating contractions and relaxations of the foot induced by sudden dorsiflexion of the foot. Its presence is suggestive of upper motor neuron pathology.
