7 Flashcards
What is on your differential for adult with chronic fatigue?
Anemia Occult malignancy Sleep apnea Depression CAD
What are the two questions of PHQ2?
(1) “Little interest or pleasure in doing things.”
(2) “Feeling down, depressed, or hopeless.”
List some signs/symptoms of liver disease
abdominal distension, jaundice, or light-colored stools
When and who to screen for lung cancer?
55-80 years who have a 30 pack-year smoking history and who currently smoke (or have quit within the past 15 years)
A patient comes in with bright red blood per rectum. What’s on your differential?
Hemerrhoids Fissure colorectal carcinoma colon polyps bleeding diverticuli
What’s a reasonable iron deficiency treatment?
ferrous sulfate 325 mg three times daily
docusate sodium 100 mg twice daily as needed for constipation
If you opt for flex sigmoidoscopy for colorectal CA screening how often does that need to be done?
5 years
A patient screens for colorectal CA with a FIT test and it is normal. When should it be repeated?
FIT repeated every year
What are the common sites of colorectal CA metastasis?
pelvic lymph nodes, liver and lung
What does HELLP syndrome stand for?
Hemolysis, Elevated Liver enzyme, Low Platelets
What are the core symptoms of ADHD?
Inattention
Hyperactivity
Impulsivity
You start a child on methylphenidate for ADHD. What are three common side effects with this medication?
Appetite suppression
Insomnia
Decrease in growth velocity
What is slipped capital femoral epiphysis ?
Think obese patient in puberty with pain in hip or knee. involves the displacement of the femoral head from the femoral neck through the physeal plate
What fasting blood glucose is diagnostic of diabetes?
> 126
A blood pressure cuff that is too ______ can result in falsely elevated bp.
TOO SMALL
Dry cough worse at night. What is on your ddx?
Asthma
What would tracheal deviation from midline suggest?
Tracheal deviation from midline - think mediastinal mass, pneumothorax, FB aspiration
When do you hear crackles?
alveolar or small airway conditions - pneumonia, pulmonary edema, bronchitis, interstitial disease
Hear stridor (high-pitched inspiratory sound), think what?
croup, inhaled foreign body with partial obstruction, and laryngomalacia
What is the role of Peak Expiratory Flow (PEF) in asthma?
Short-term monitoring
Managing exacerbations at home and in ED
Daily long-term monitoring of asthma-particularly in moderate to severe asthma
What are roth’s spots?
retinal hemorrhages with pale centers, typically seen in bacterial endocarditis
What are the criteria for metabolic syndrome?
central obesity Hypertension* Hypertriglyceridemia* Low HDL cholesterol* Impaired fasting glucose*
What is pre-diabetes A1C range?
5.7-6.4
Who would benefit from a statin?
Current ASCVD
LDL cholesterol > 190 mg/dL
Diabetes (type 1 or 2) age 40-75 years
Estimated 10-year ASCVD risk by Pooled Cohort Equations > 7.5%.
What 10 year ASCVD risk would qualify someone for a statin?
7.5%
What are some secondary causes of dyslipidemia?
Diabetes Hypothyroidism Medications - thiazides, beta blockers, estrogens, protease inhibitors Acute hepatitis Nephrotic syndrome Cholestatic or obstructive liver disease
What agent is most effective in increasing HDL?
Nicotinic acid (niacin, or vitamin B3)
What are two labs that should be drawn prior to initiation of a statin?
LFTs and CK, as liver dysfunction and myopathy can result as side effects
A patient is told to limit salt intake to help HTN. What is suggested limit?
2,400 mg per day
What caloric deficit is needed to lose one pound?
3,500
Who qualifies for bariatric surgery?
BMI > 40 or BMI > 35 with sever comorbid conditions
What noradrenergic appetite suppressants can function as aids in weight loss?
Phentermine
Diethylpropion
Pendimetrazine
Benzphetamine
This medication is a GI lipase inhibitor preventing fat absorption and is used to aid in weight loss.
Orlistat
What are some cardiac etiologies of chest pain?
variant angina MI aortic dissection cocaine induced valvular heart disease pericarditis myocarditis cardiac syndrome x non-ischemic cardiomyopathy
What are EKG findings of pericarditis?
diffuse ST elevations
What respiratory diseases can manifest as chest pain?
PE
pleurisy
pneumothorax
pneumonia
Patient has palpitations, lightheadedness and syncope. What’s on your ddx?
Ventricular tachycardia
What are the three criteria for typical angina?
Substernal chest discomfort with a characteristic duration and features
Exertional in nature
Relief with rest or nitroglycerin
What is atypical angina and who has it?
Patients who have diabetes, women, and the elderly are more likely to present with atypical features. Occasionally they will present with only weakness or shortness of breath on exertion. Those symptom are considered “anginal equivalents”.
Who should be on aspirin for prevention of CVD?
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 year
How can anemia contribute to myocardial ischemia?
by decreasing oxygen carrying capacity
Why check thyroid in someone with cardiac disease?
hyperthyroidism increases oxygen demand of the heart while hypothyroidism adversely effects lipids
What are the criteria of TYPICAL angina?
Substernal chest discomfort with a characteristic duration and features
Exertional in nature
Relief with rest or nitroglycerin
What are Q waves in an EKG pathologic for?
previous ischemic injury to heart
What drugs are the mainstay of anti-anginal treatment?
CCB, BB and nitrates
How do BB relieve sx of angina?
decrease myocardial oxygen consumption by slowing heart rate and decreasing blood pressure
How do CCB relieve angina sx?
dilation of coronary arteries and increase coronary blood flow while also decreasing myocardial oxygen consumption
This medication dilates both arteries and veins, but mostly veins. It is used in angina to reduce preload and effectively work of heart
Nitrates
Side effects of ACEi?
cough, renal dysfunction, angioedema, hyperkalemia
How does HCTZ affect K levels?
LOWERS, while ACEi INCREASED K+ leves
Side effects of HCTZ?
dehydration, hyponatremia, hypokalemia, renal dysfunction, increases serum uric acid which may precipitate gouty attack
A patient has history of gout and uncontrolled HTN. You’d like to add BP medication to regimen. Which should you avoid?
Avoid HCTZ as it can increase serum uric acid level and thus precipitate gout attacks
Hypotension, bradycardia, and heart block are all side effects of what anti-anginal medication?
Metoprolol
Side effects of aspirin?
gastritis, peptic ulcer disease, bleeding (especially when used with clopidogrel)
Statin side effect?
Myalgias, liver dysfunction, and in rare cases rhabdomyolysis - check LFTs and CK before initiating medication
What is the time up and go test?
Sit in the chair with your back to the chair and your arms resting in your lap.
Without using your arms, stand up from the chair and walk 10 ft. (3m).
Turn around, walk back to the chair, and sit down again.
What time for the TUG test is indicative of impaired mobility?
> 30 seconds to sit up from chair, walk ten feet, return and sit down
You suspect a TIA, what quick exam should you do?
Neuro (fascial tone and sensation, cerebellar testing with gait, balance and repetitive movements, gross visual fields, proprioception, MSE and motor strength)
Cardio (auscultate heart, carotids and get EKG)
This is one of the most sensitive tests for upper extremity weakness.
Pronator drift
What are the four types of stroke?
Embolic
Thrombotic
Cardiogenic
Hemorrhagic
What is a thrombotic stroke?
Native clot within the intracranial vasculature
How does a cardiogenic stroke work?
Secondary to a decrease in cerebral perfusion caused by decreased cardiac output (e.g.: anginal event associated with coronary artery disease), severe hypotension, or hypoxemia related to severe anemia or poor oxygen saturation
If considering IV tPa, how quickly must you act?
Within 3 hrs. Must first rule out hemorrhagic stroke with brain CT.
You want to provide intra-arterial therapy to a patient with embolic stroke. What is your time window?
6 hours
When does troponin increase and how long does it hang around following ischemic cardiac event?
Increase within 4-6 hours and around until day 10
What medications can correct AF through rate control?
intravenous diltiazem, beta-blockers, or verapamil
What symptoms do you expect in someone who is right handed and has a right parietal brain infarct?
left hemiplegia
May attempt to read while holding books upside down
Inattention to areas of a room
may also not recognize their functional impairments
Left facial weakness
What results from stroke in brainstem?
respiratory impairment and affect vital functions of blood pressure, heartbeat and consciousness.
What is the target INR range?
2-3
What is the role of the CHADS 2 score?
provide calculated guidance to help weigh the benefits and risks of anticoagulation.
What is apraxia
Loss of the ability to carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements.
What are Instrumental Acts of Daily Living (IADLs)?
are not necessary for fundamental functioning, but enable the individual to live independently within a community (light house work, preparing meals etc.)
