AAFP Flashcards
kid has proteinuria, what should next step to evaluate be?
protein/creatinine ratio to determine if true proteinuria
what can cause benign proteinuria?
exercise
what should you do for adult with dementia who has been on antipsychotic and is now stable?
taper them off
what should you do for patient traveling to country with high TB rate?
test before and test 8 weeks after the trip
what advice can you give someone who is worried about contracting travelers diarrhea?
azithromycin if they start to experience diarrhea while traveling
what can you give for motion sickness?
transdermal scopolamine
what is pityriasis rosea associated with in pregnancy?
spontaneous abortion
what should first lab in primary care workup of infertility be?
luteal phase progesterone
a patient with ileal crohns that is having diarrhea, is likely caused by what?
bile acid increased in poop
how do you treat diarrhea in patient with ileal crohns?
cholestyramine
what treatment improved quality of life from tinnitus?
CBT
if a kid has lice can they go to school?
yes
what is first step in work up of hemoptysis?
Chest radiograph to rule out obvious lesions
kid has newlydiagnosed HTN, what should you check?
BMP, lipids, and urinalysis
what is an eval that should be done yearly in patients with asymptomatic sarcoidosis?
ocular
what four drugs increase life expectancy after an ACS event?
aspirin, ACE inhib, beta block, statin
what angle is worrisome in scoliosis?
20 degree Cobb angle
when should you prescribe naloxone?
if morphine equivalent is 50+
what are levels of phosphorus and PTH in patients with CKD?
high phos and high PTH
why is phosphate high in CKD?
because cannot be excreted well
what is fasting blood glucose goal in gesttional DM?
<95
what NSAID is not associated with cardiovascular risk?
naproxen
why do NSAIDs increase risk of cardiovascular issues?
elevate BP due to salt and water retention
if patient is on high dose steroids, what should they receive to help prevent osteoporosis?
bisphosphonate
what should be done for scaphoid fracture?
thumb spica splint and follow up in 2 weeks
patient with a stemi should receive what before cath?
anti platelet and anticoagulatn
how long should aspiring and clopidogrel be continued after stint placement?
at least a year
what should be measured to determine severity of pancreatitis?
hematocrit, BUN and creatinine because will show volume depletion
if patient with sickle cell develops diabetes, how should you monitor sugar control?
fructosamine level
what is first line therapy of dequervians tenosynovitis?
thumb splint and NSAIDs for 1-4 weeks
what is most common cause of HTN in pre adolescents?
interstitial kidney diseases
if HTN in pre adolescent, what should be done to work up?
renal US
which seizure med increases risk of kidney stones?
topiramate
what is treatment of non displaced 5th metatarsal fracture?
compressive dressing with activity and weight bearing as tolerated
what is the rule about HPV vaccines?
if given one before 15 then only need two, if first is after 15 then need 3
if patient with a fib cannot tolerate anticoagulation, are they a candidate for ablation?
no because have to be anticoag before and after surgery
what is an indication to ablate a fib?
if a fib is refractory to medical treatment
what is first line abx rx for cat bite?
augmentin
what is leading cause of human death worldwide?
ischemic heart diseas
what is considered stage 1 sarcoidosis?
asymptomatic with hilar lymphadenopathy
what is course of stage 1 sarcoid?
typically self resolves
what should be done for patient with stage 1 sarcoid?
repeat imaging in 6 months at follow up
what is treatment of wollf parkinson white?
ablation
up to what age should kids get two flu doses if it is their first?
8 years, can be either quad or tri
what is a FABER test? when is it positive?
flexion, abduction and external rotation. Positive with SI joint dysfxn
how long should patient be anticoagulated after having a DVT/PE?
3 months
what decreases hospitalizations in patients with COPD?
written self management plans for smoking cessation
what happens to levels of TSH and t4 in pregnancy?
tsh low and T4 elevated
how often should breast cancer survivor have mammogram?
no more than yearly
where should injection be placed for patient with rotator cuff tendonitis?
subacromial space
what abx are given to patients with really bad CAP in ICU?
ceftriaxone or ampicillin with a macrolide
aside from abx what else should be given to patient with bad CAP in ICU?
steroids
will thyroid uptake radioactive iodine in postpartum thyoiditis?
NO only in graves disease
aside from classic migraine meds, what other medication can help abort a migraine if patient cannot get rid of it with triptans?
IM promethazine (anti nausea meds), metoclopramide works too
what should be done for a solar lentigene that is growing oddly?
biopsy
what should patients at high risk of preeclampsia be on after 12weeks gestation?
baby aspirin
what imaging is preferred for calcaneal stress fracture?
MRI
a patient with asymptomatic carotid artery stenosis should be on what? and should have what imaging done?
statin, yearly US
what is rx of eosinophilic esophagitis?
oral suspension steroids
what is rx of head lice?
topical permethrin
aside from permethrin what else should be done to prevent head lice worsening/spreading?
wash everything in hot water or seal in plastic bag
a non solid ground glass appearance of lung lesion is concerning for what?
lung cancer
what antidepressant can be tried for insomnia?
doxepin
what Z drug is best for insomnia?
eszopiclone
what two diabetes classes promote weight loss?
SGLT2 inhibitors and GLP1 agonist
what imaging modality should be used if worried about mesenteric ischemia?
CT angio
what is management of dislocated shoulder?
immobilization for 1+ week
what should patient with shoulder dislocation do while they are immbolized? why?
gentle ROM exercises to limit risk of adhesive capsulitis
what are first two options for rate control in a fib?
beta blocker and calcium channel blocker (diltiazem/verapamil)
what is contraindication to using beta blocker in patient with a fib?
COPD
in females, what is greatest risk factor for developing DM?
GDM, then obesity
define subclinical hypothyroidism
normal T4 with high TSH
what should be done for subclinical hypothyroidism?
re measure tsh in a couple months
what bug causes cellulitis after puncture through rubber?
pseudomonas
what abx for puncture wound through rubber that has caused cellulitis?
ciprofloxacin
what length of time does a firm mobile non tender lymph node become worrisome for cancer?
beyond 4-6 weeks
if patient below 50 has family history of breast cancer, what should initial step be to assess for risk?
familial risk stratification
when do you start mammos?
50 years
what should you do for patient with hypoechoic testicle mass?
refer to urology
when should overweight patients be screened for DM?
40 years to 70 years,
what is microscopic colitis? who gets it?
elderly adults, leads to secretory watery diarrhea that is intermittent
what changes to meals should patients make after bariatric surgery?
no water with meals or before/after for 15 minutes
what should patients have monitored after bariatric surgery? how often?
bone density every 2 years
what can cause pseuodhyponatremia?
extreme hyperlipidemia
what imaging modality for suspected nephrolithiasis?
low dose helical CT
patient with history of gastric bypass has iron deficiency anemia, what should you do?
give IV iron replacement because cannot absorb iron well with bypass history
if patient is taking oxy and you want to know if it is in their system and UDS is negative, what can you do?
get chromatography
what opiates show up on UDS?
heroin, codeine and morphine
HHV6 is known as what? what does rash look like?
roseola infantum…rash is maculopapular on trunk and extremities
at what age should females with AUB be evaluated for endometrial cancer?
45+
what is a jones fracture?
proximal fifth metatarsal metadiaphyseal fracture
what should be rx of jones fracture?
surgical repair
what should be done if patient found to have normal appearing ovarian cyst on imaging and is asymptomatic?
repeat imaging in 2-3 menstrual cycles
patient with ear tubes has ear drainage and low fever, what should you give?
ciprodex
what pleural fluid to serum fluid ratio of LDH indicated exudative pleural effusion?
o.6 and above
what pleural protein to serum protein ratio suggests exudative?
0.5 and higher
what should be given to patient in septic shock who has low pressures for their pressures?
norepinephrine
what is rx of polymyalgia rheumatica?
low dose steroids
name three abx you can give for prophylaxis against N men
azithromycin, rifampin, ceftriaxone, ciprofloxacin
what fasting glucose level indicates DM?
over 126
what non fasting glucose level suggests DM In symptomatic patient?
over 200
what 2 hour glucose test glucose level suggests DM?
greater than 200
what two dietary changes are made for patients with cirrhosis?
lower sodium and increase protein
patients age 65+ with DM have an a1c goal of what?
7-8
patients with history of STEMI and a fib should be on what for anticoag?
warfarin, clopidogrel and aspirin
what are probiotics good at preventing in kids?
diarrhea associated with abx
what is the test to confirm legionnaires disease?
urine antigen test
what is a contraindication to fibrinolytic therapy?
ischemic stroke in last 3 months
a patient has sudden onset of sensorineural hearing loss without a specific cause, what should you give them?
prednisone
what drug should patients with HCM be on?
metoprolol
if kid has shoulder pain, what is an unlikely cause that is common in adults?
rotator cuff injury
kids with shoulder pain might have what issue?
little league shoulder
what is little league shoulder?
repetitive use injury to humeral growth plate
what is imaging for little league shoulder?
x ray
what is internal tibial rotation? who gets it?
when feet turn in..kids get it
what is rx for internal tibial rotation?
nothing.resolved itself by age 5
what can you measure if you are unsure if patient has infection that needs abx?
calcitonin…if elevated then likely bacterial
what supplement should not be taken with aspirin?
ginko balboa
what is location for best emergency airway?
cricothyroid membrane
if patient has secon TB test positive and first negative, what is diagnosis?
latent TB
what cause of pneumonia can occur in babies less than 4 months of age that causes prolonged cough and illness but is non toxic?
chlamydia
who should get abx prophylaxis before dental work?
those with fake heart valves
patient with severe hypertriglycidemia should be on what med? why?
fenofibrate, helps prevent pancreatitis
dupuytrens disease is associated with what?
DM
what is rx for dupuytrens?
steroid injections every few months
in primary hyperparathyroidism, what are levels of PTH, Ca, phosphorus and alk phos?
PTH and Ca high, phosphorus low, alk phos high
patients with unstable angina who elect for conservative treatment should receive what two drugs?
clopidogrel and aspirin
what is a rash that looks like tinea but isnt?
granuloma annulare
what type of immobilazation for boxer fracture?
ulnar splint
what is most common cause of erythema multiforme?
HSV
what imaging should be done for patients with hematuria of unknown origin?
CT urography and cytoscopy
what should be given for cocaine induced angina?
benzo
patient with vesicles on eye lid likely has what? what should be done?
HSV, refer to optho and give valtrex
what is most common cause of new hyperglycemia in patient who has been stable with DM for years>
renal disease
if a patient has chest pain and ECG and troponins are normal, what is first imaging to do?
CXR
when should clavicle fracture be operated on?
if patient older and fracture is displaced or comminuted
what is rx of postpartum urinary retention?
self cath
what is dosing limit of morphine?
NO limit
when do growing pains happen a lot?
in sleep after day of exercise
what should you clean a pressure ulcer with?
tap water
what is preferred and second abx options for dental procedures?
amox and clinda
carbamazapine can cause what electrolyte issue?
hyponatremia
what can you add to topical steroids for psoriasis??
topical calcipotriene
what can contribute to age related macular degeneration?
smoking
what is failure rate of cOCP?
9%
what is the delirium diagnosis tool?
CAM, confusion assessment method
what is direct observation therapy used for? why?
TB rx, to decrease drug resistance
what age should kids get screened for lipid issues
9-11
if patient having hallucinations, what can worsen the situation?
restraints
if patient has reaction to PB requiring epi pen, what should they do next even if symptoms resolved?
go to ED because at risk of biphasic reaction
what two abx should patient with SCD who is having acute chest syndrome be on?
3rd gen ceph and azithromycin
what lab for vitamin d deficiency diagnosis?
25-hydroxyvitamin D level
what can you give to help with hirsutism and contraception in patients with PCOS?
combined OCP
what disease can cause decrease in absorption of levothyroxine?
H pylori gastritis
if old patient has frequent falls and is on anticoag for a fib, what should be done to meds, why?
no changes, benefit outweight risk
what is drug name for LMWH?
enoxaparin
what anticoag should patient with cancer and DVT get?
enoxaparin
what is glucose goal in patient with DM who has sepsis/
less than 180
what is rx for opthalmopathy from graves?
methimazole
what to use for hyperthyroid?
beta block and methimazole
what is more effective for lateral epicondylitis, modified activity or bracing?
modifying activity
moms with penicillin allergy should get what for GBS intrapartum?
cephzolin
what is first line therapy to induce remission of an IBD?
corticosteroids
what meds should not be given to someone with cirrhosis? why?
NSAIDs, can induce hepatorenal syndrome
shipyard and construction workers are at increased risk of what lung disease?
asbestos
what heart med is contraindicated in heart failure?
verapamil
which sulfonyurea is worst at causing hypoglycemia?
glyburide>glipizinde
what med for osteoporosis helps with bone health and pain from a fracture?
calcitonin salmno
what injury is extracorperal shock therapy used for
tendinitis of shoulder rotator cuff
what is first line rx for HTN in pregnancy?
labetalol
what is most common cause of acute infective endocarditis?
staph A
what is treatment of hypoactive sex desire disorder?
topical testosterone
what is treatment of painful thrombosed hemorrhoid?45
eliptical excision of it
when do you screen asymptomatic individuals with no risk factors for DM?
45+
what type of RBC abnormality occurs in myelodysplastic syndromes?
macrocytic anemia
fracture of finger around the DIP joint should be treated with what?
splint in extended position for 8 weeks
what is first line rx for urge incontinence?
bladder training
what is a very short acting anti depressant for elderly with short life expectancy?
methylphenidate
what abx for pulmonary infection by anaerobe?
clindmycin
what is main difference between heat stroke and exhaustion?
if patient has any CNS issues…includes confusion
what type of stroke should you get immediate neurosurgery consult with?
cerebellar hemorrhage
patient with endometrial hyperplasia without atypia should get what for therapy
progesterone to induce bleeding
what is rule about treating newborn for potential varicells infection?
if baby born within 5 days of mom getting it then they get IVIG and acyclovir, if born beyond 5 days then observation onlu
in addition to azithromycin, what other abx can be given for travelers diarrhea?
ciprofloxacin
what is primary indication for joint replacement
intractable pain
what can be used to prevent opioid constipation?
miralax
should you combine an ACE and ARB?
NO can cause high creatinine and increase risk of dialysis
most common cause of secondary hypertension in middle aged?
primary hyperaldo…look for low K+
in addition to clozapine, what other psych med has increased risk of agranulocytosis?
carbamazapine
what is first line rx for mild dementia?
donepezil
what can be used for rx for sever dementia?
memantine
patients with scheduled bypass surgery who are taking aspirin and clopidogrel should be advised to do what with meds before surgery?
continue aspiring and stop clopidogrel 5 days before
what age should testicle be taken from abdomen?
6-12 months
what should you do if infant only has one descended testicle?
refer to urology
a quick drop in sodium or correction of hypernatremia can lead to what?
cerebral edem
a quick correction of hyponatremia can lead to what?
osmotic demyelination syndrome
what is most accurate way to do natural family planning?
monitor cervical mucus
what is most common cause of still birth after 22 weeks?
placental disease
what is treatment of atopic dermatitis flare up?
topical corticosteroids
what should be used as rx of depression from bipolar II?
lithium or depakote
what imaging should be done if volvulus is suspected?
upper GI series
what abx is given orally for c diff and which is given IV?
oral vanc
IV flagyl
when is therapeutic ultrasound contraindicated
?
if being used on active growth plates
what is first line rx of SVT for long term therapy?
ablation
what is therapy for SVT in acute setting?
adenosin
what are the two respiratory requirements for ARDS?
high PEEP and low TV
what is recommended to screen for in kids with T1DM?
hypothyroid and celiacs
what is imaging for septic arthritis of hip in a kid?
x ray then US
two drugs known for drug induced lupus
procainamide and hydralazine
what can patient deveop if they have metal in their eye>? what must be done?
rust ring…optho must take it out
what do you give child that is exposed to hep a?
vaccine if unvaccinated
what is abx prophylaxis for ortho procedures?
cephazolin
how long after standing should BP be measured if obtaining orthostatics?
3 minutes
patient with hypothyroid has normal TSH but still haveing hypothyroid sx, what should you do?
nothing…evaluate for other causes
what is preferred rx of tinea capitis?
oral griseofulvin
what is rx of a rectal fissure?
topical nitro
what type of issue with heart can you give atropine for?
symptomatic bradycardia
what oral abx for rosacea
doxy
what should you put on clean surgical site following excision?
petrolatum jelly
what is target uric acid level in gout?
5-6.0
if patient does not want cpr etc and has defib in what should be done?
deactivated the defibrillator
when should antibiotic time outs occur in the hospital?
every 48 hours
how long should patients be on systemic roids for COPD flare?
5 days, even if IV
what are symptoms of RMSF
fever, rash, vomiting, headache, myalgias
what does rash look like in RMSF and where is it located?
pink maculopapular on hands/feet and anywhere else on body EXCEPT face
what opioid should be avoided in patient with CKD?
morphine becasue metabolites are toxic
should patients age 70+ have caroti d stent or endarterectomy?
endarterectomy
what is rx for hypotension from adrenal insufficiency?
hydrocortisone
