AAFP - Primary Care Flashcards
In which patients should you suspect pneumonia, and what is the best management for a 15 month old patient wit these signs?
Fever, cyanosis, and abnormal respiratory findings on physical exam (children in day care are at risk)
If child is not toxic appearing, dehydrated or hypoxemic, give oral high-dose amox with close outpatient f/u
What is the appropriate treatment for midshaft posteromedial tibial stress fracture? (patient can walk without pain)
Air stirrup leg brace (aircast - pneumatic stirrup)
Casting NOT recommended
What does low TSH in a patient with primary HoThyr receiving synthroid suggest? What should be done?
Indicates overreplacement, reduce dose slightly and repeat TSH levels in 2-3 months
What determines progression to multiple myeloma in a patient diagnosis of MGUS?
Signs of end organ damage
What is low dose estrogen OCP protective against?
Ovarian cancer
Main S/S of polymyalgia rheumatica, and treatment?
Pain and stiff over shoulders and pelvic girdle, fever, night sweats high ESR
Responds dramatically to steroids
What is the hallmark biochemical feature of refeeding syndrome?
Hypophosphatemia
Indication for steroids in mono?
Signs of acute airway obstruction
Which medications should be avoided in WPW syndrome? What can be given for cardio version ?
Any meds that block conduction through AV node should NOT be given (adenosine, digoxin, calcium channel blockers like verapamil)
Procainamide or Amiodarone
What is the most important intervention to prevent spread of MRSA in nursing home?
Strict hand washing by all visitors and staff of the patient
In which situations should metformin be withheld?
When there may be a temporary decrease in renal function that may cause lactic acidosis - I.e. IV contrast like during CTA
In which situations should metformin be withheld?
When there may be a temporary decrease in renal function that may cause lactic acidosis - I.e. IV contrast like during CTA
Risk of Welbutrin in preggos?
Spontaneous abortion
What is sterile pyuria and dysuria in young female most suggestive of?
Chlamydja and gohnorrea or HSV
What is the indication for 3 year follow up of colonoscopy?
3 or more tubular adenomas
What is the primary treatment for symptomatic mitral valve prolapse?
Beta-blockers, eliminate caffeine and etoh,
What is the treatment of altitude illness?
Acetazolamide, and dexamethasone for those with sulfa allergies
Which drugs most likely cause interstitial nephritis?
Abx, mostly penicillins, cephalosporins, and sulfonamides,
What is the most common cause of erythema multiforme?
Hypersensitivity reaction to HSV
What are the signs of pyogenic tenosynovitis and how do you treat?
Pain, swelling, resistance to passive extension
Prevent spread in early stages with Abx and splinting, late stage tx requires surgery drainage + Abx
What is a contraindication to using pioglitazone?
can cause fluid retention and therefore would not be a good choice for a patient with cardiomyopathy.
What drugs should not be combined with sitagliptin initially?
Sulfonylureas
What is scombroid poisoning?
pseudoallergic condition resulting from consumption of improperly stored scombroid fish such as tuna, mackerel, wahoo, and bonito.
What is POTS and how do you treat?
Postural Orthostatic tachycardia syndrome, sudden tachy on standing (usually develops after viral illness, and associated with chronic fatigue),
adequate fluid and salt intake, followed by the initiation of regular aerobic exercise combined with lower-extremity strength training, and then the use of β-blockers.
What initial tests should be done for an elderly patient with diabetes and decreased physical activity, who is about to undergo a vascular surgery procedure?
Non-invasive testing to determine risk of MI, via dipyridamole-thallium scan
Coronary angio if abnormalities found
What are the potential problems associated with long term omeprazole therapy?
Increased risk of community-acquired pneumonia and Clostridium difficile colitis, acutely decrease the absorption of vitamin B 12 , and it decreases calcium absorption, leading to an increased risk of hip fracture.
What needs to be done for women over 35 years of age who experience abnormal vaginal bleeding?
endometrial assessment (via biopsy), to exclude endometrial hyperplasia or cancer
What should pharmacotherapy with SSRIs be augmented with for treatment resistant depression?
Lithium or low-dose T3
How should a patient presenting with cervical radiculopathy be managed?
respond well to NSAIDs without surgery
What is intertrigo and erythrasma?
Intertrigo is inflammation of skinfolds caused by skin-on-skin friction.
Erythrasma is caused by Corynebacterium minutissimum and presents as small reddish-brown macules that may coalesce into larger patches with sharp borders.
How would you manage a thrombosed external hemorrhoid in the first 24 hours?
Thrombectomy under local
What is a contributing factor to patellofemoral pain syndrome?
INadequate hip abductor strength
What may be contraindications to prescribing Trazadone?
May cause sedation and orthostatic HoTN
What should be given to a child with an asthma attack who has already received albuterol and corticosteroids and is still having breathing issues?
Magnesium sulfate IV
Which hypoglycemic agent is best to use in patients with chronic kidney disease?
Glipizide
How can you differentiate the symptoms of spinal stenosis vs. herniated disk?
In SS - Pain is relieved by sitting and aggravated by standing, whereas the opposite is true for pain from a herniated disk (better with standing worse with sitting aka flexed)
What increases success of voiding trial in an elderly post-op pt with urinary incontinence?
Initiate alpha-blocker (Flomax-tamsulosin) with catheter insertion
Which cardiac arrhythmia is associated with methadone use?
QT prolongation –> Torsades de Pointes
What is the most sensitive test to do if suspecting genital HSV infection?
Viral PCR test
What is the treatment for low-risk patients presenting with a-fib?
Aspirin 81-325 mg
What is the appropriate therapy for venous ulcers?
Pentoxifylline is effective when used with compression therapy for venous ulcers
What is the most worrisome early sign of anaphylaxis?
Pruritus around the mouth and on the palms of the hands and soles of the feet
What is the most common cause of abnormal liver enzymes in the developed world>
Non-alcoholic fatty liver disease
What should you suspect in patients suffering from a critical illness with an exaggerated inflammatory response?
Cortisol deficiency, give corticosteroids
Which drug is least likely to produce dangerous side effects in an elderly patient with low back pain?
Lidoderm - lidocaine patch, low systemic absorption
What is the appropriate management of chronic neck pain?
Complete cervical spine series followed by MRI if neurological signs present
What is the centor criteria?
most reliable clinical predictors of streptococcal pharyngitis - tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough, and history of fever (3/4 test and treat if +, 4/4 treat)
What is the best treatment for recurrent migraines for children
Propranalol
What is the most common cause of abnormal liver enzymes in the developed world>
Non-alcoholic fatty liver disease
What should you suspect in patients suffering from a critical illness with an exaggerated inflammatory response?
Cortisol deficiency, give corticosteroids
Which drug is least likely to produce dangerous side effects in an elderly patient with low back pain?
Lidoderm - lidocaine patch, low systemic absorption
What is the appropriate management of chronic neck pain?
Complete cervical spine series followed by MRI if neurological signs present
What is the centor criteria?
most reliable clinical predictors of streptococcal pharyngitis - (3/4 needed) tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough, and history of fever
What is the best treatment for recurrent migraines for children
Propranalol
What NSAID should be avoided in elderly patients and why?
Indomethacin due to high rates of adverse CNS effects
Best medication to treat nausea in pregnant women?
Doxylamine and vitamin B6
What is the treatment of Rosacea?
avoidance of precipitating factors and use of sunscreen. Oral metronidazole, doxycycline, or tetracycline also can be used, especially if there are ocular symptoms.
How does lichen planus appear and how do you treat?
violaceous flat-topped papules, usually 3–6 mm in size
high-potency topical corticosteroids such as clobetaso
Which should be considered in a patient being treated with appropriate antibiotics for complicated UTI who has persistent fever and flank pain?
Get CT abdomen to look for peri nephric abscess
What is the preferred imaging modality when suspecting septic arthritis?
Ultrasonography to detect effusions etc.
What is the female athlete truant and what evaluations may need to be done in such patients?
amenorrhea for 6 months, disordered eating, and/or a history of a stress fracture resulting from minimal trauma
May require evaluation for pregnancy, progestin challenge of suspecting secondary amenorrhea and bone scan for fracture
What should be given for persistent vfib along with CPR and defibrillation?
vasopressor, which can be either epinephrine or vasopressin.
What are the Radiographic features of a benign pulmonary nodule?
diameter
What is fibromyalgia syndrome and how do you best treat?
Depression, pain and sleep disturbance in patients with fibromyalgia
TCA and duloxetine
What is the best management for foot problems in elderly patient (e.g. Bunyons, ulcers, Hammer toes etc.)?
Palliative care, like special shoes and pads
What is the best ppx Abx for travelers diarrhea?
Rifaximin
What are patients in end stage renal failure who receive gadolinium enhanced MRI at risk for?
gadolinium-associated nephrogenic systemic fibrosis
What are the markers of gestational diabetes and how do you best treat?
Fasting glucose >100 and post meal >140
Try diet and exercise, if still problem, add A combination of intermediate-acting insulin (e.g., NPH) and a short-acting insulin (e.g., lispro) twice daily
What is a side effect of geodon and what can exacerbate this?
QT prolongation, which can worsen with Abx like Clarithromycin, anti arrhythmics, and TCAs
What should be given to a patient with STEMI being evaluated for reperfusion therapy?
Oral clipidogrel and chew 162-325mg Aspirin
What is the greatest risk factor for developing T2DM?
Gestational diabetes
What is a Dupuytren’s contracture?
Changes in the palmar fascia, with progressive thickening and nodule formation that can progress to contracture of associated finger (commonly 4th finger, pitting or dimpling over nodule)
What medications can cause acute dystonic reaction, and how do you best treat?
any agent that blocks dopamine, including prochlorperazine, metoclopramide, and typical neuroleptic agents such as haloperidol. The acute treatment of choice is diphenhydramine or benztropine
Which classes of diabetes medications acts primarily by stimulating pancreatic insulin secretion?
Sulfonylureas and meglitinides stimulate pancreatic insulin secretion (like Glipizide)
What is the best treatment for isolated hirsutism in premenopausal females?
Androgen inhibitors like spirinolactone along with OCPs
What are the most likely signs of retinal detachment?
patient complaining of flashes of light and a visual field defect
