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Family Medicine Acute Problems > Acute Problems > Flashcards

Acute Problems Flashcards

1
Q

What is temporal arteritis?

A

Temporal arteritis is a condition in which the temporal arteries, which supply blood to the head and brain, become inflamed or damaged.

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2
Q

What other symptoms are accompanying an URI?>

A
  1. kind of cough
  2. sick contacts
  3. confounding illness
  4. Treatment
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3
Q

Symptoms of viral infection on exam

A
  1. Nares-erythema, blue or boggy
  2. Oropharynx-watch for exudate/erythema
  3. Lymphadenopathy
  4. Pulmonary exam-URI vs pna
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4
Q

Flu vs common cold

A

Flu-myalgia
cold- sore throat
flu-fever, headache, fatigue, cough
Cold-sore throat, sneezing nasal congestion

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5
Q

How is common cold treated?

A
  1. antipyretic/analgesics
  2. children no medicine effective
  3. nasal suction
  4. guaifenesin, mucolytic
    5.
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6
Q

When is it appropriate to treat a URI with antibiotic therapy?

A

avoid broad spectrum ABT treat for 10 days

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7
Q

How is Group A strep URI treated

A

PCN 10 day course

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8
Q

Treating EBV with amoxicillin is associate dwith what?

A

Rash

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9
Q

Which of the following is most likely the main indication for antibiotic treatment in children with group A Streptococcus pharyngitis?

A

Prevention of rheumatic fever

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10
Q

Symptoms of whiplash

A
  1. History of acute injury
  2. neck pain, reduced mobility, occipital headache
  3. imaging demonstrates no changes
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11
Q

What is cervical radiculopathy

A

The clinical description of when a nerve root in the cervical spine becomes inflamed or damaged, resulting in a change in neurological function.

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12
Q

Symptoms of cervical radiculopathy.

A

Neurological deficits, such as numbness, altered reflexes, or weakness, may radiate anywhere from the neck into the shoulder, arm, hand, or fingers

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13
Q

Causes of cervical radiculopathy?

A

Radiculopathy may be caused by trauma either acute disc damage or exacerbation of degenerative disease

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14
Q

What is Spurling’s test

A

Reproduction of radiculopathy when the examiner rotates the patient’s neck to the ipsilateral side and extends it applying gentle downward pressure

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15
Q

What is the definition of ipsilateral?

A

belonging to or occurring on the same side of the body.

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16
Q

How is acute neck injury managed?

A
  1. APAP
  2. NSAID’s
  3. Muscle relaxants
  4. Tramadol
  5. Opiates
  6. PT
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17
Q

How long can whiplash last

A

about half of whip lash patients will continue to have neck pain at one year

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18
Q

What are key diagnoses to rule out when assessing a patient for back pain?

A
  1. Cauda equina syndrome
  2. metastatic cancer
  3. epidural abscess
  4. vertebral osteomyelitis
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19
Q

How is acute back pain managed in family medicine

A
  1. Analgesics

2. PT

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20
Q

What percentage of acute back pain becomes chronic?

A

20 percent

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21
Q

a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine

A

Spinal stenosis

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22
Q

If treatment is not working and the patient has decreased functioning when treating LBP, is imaging a next step

A
  1. yes if treatment has been effective
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23
Q

If analgesics and PT have failed what is the next best step in treating LBP

A
  1. Epidural glucocorticoid injection
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24
Q

How long does epidural injection for back pain last

A

3 months or less

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25
Q

What is the annual limit for steroid injections for LBP

A

6 annual limit for injections for LBP

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26
Q

Are glucocorticoid injections helpful for spinal stenosis?

A

not effective

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27
Q

What are the major causes of shoulder pain to consider?

A
  1. Rotator cuff tendonitis
  2. Adhesive capsulitis
  3. acromioclavicular joint disease
  4. Biceps tendonitis
  5. Glenohumeral arthritis instability
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28
Q

What shoulder disorder is more common among patients with diabetes and hypothyroidism?

A

Adhesive capsulitis

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29
Q

If the pain in the shoulder is located anterior/superior what is the likely cause or diagnosis?

A

AC joint disease

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30
Q

If the patient has pain with overhead activity what is the likely diagnosis?

A

Rotator cuff disorders

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31
Q

If the patient has pain with the Hawkin’s test what is the likely cause of the pain?

A

Rotator cuff

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32
Q

What is the likely diagnosis if a patient has positive pain with the empty can test?

A

supraspinatus tear

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33
Q

If a patient has positive pain during the cross body abduction test what is the likely cause of the pain?

A

AC joint disease is a possibility

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34
Q

If a patient has pain during the external rotation test what is the likely cause of the pain

A

Infraspinatus tendon pathology

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35
Q

During the speed test if a patient has pain what is a possible diagnosis?

A

Biceps tendonitis

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36
Q

If the patient has pain with the cross body abduction test what is the likely cause of pain?

A

AC joint disease

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37
Q

How is shoulder pain managed?

A 
Modification of activity
Analgesics
Cortico steroids
Physical Therapy
Surgical referral
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38
Q

How did the injury occur

A
  1. Direct blow
  2. foot planted
  3. Previous injury
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39
Q

How is the knee assessed for injury?

A
  1. Inspection
  2. ROM
  3. Palpate pain, warmth, effusion
  4. Patellofemoral syndrome, crepitus on quad contraction
  5. Assess cruciate/collateral ligaments
  6. Meniscal testing with poor sensitivity
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40
Q

When the patient has a suspected meniscal tear what should the provider do to correctly confirm diagnosis?

A

MRI

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41
Q

The Thessaly test is useful for diagnosis an injury to the?

A

Menisci

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42
Q

Which of the following conditions is characterized by pain around or behind the patella resulting from chronic overuse and is largely a diagnosis of exclusion?

A

Patellofemoral pain

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43
Q

Anterior knee pain what type of injury would the provider consider?

A
  1. Patellar tendonitis jumpers knee

2. Patellofemoral syndrome

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44
Q

What type of injury should be suspected if the patients knee pain located medially on the knee?

A
  1. MCI sprain
  2. Medial meniscal tear
  3. Pes amserine bursitis
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45
Q

Lateral knee pain or injury could be related to?

A
  1. Lateral meniscal tear

2. iliotibial band syndrome

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46
Q

Patellar subluxation is more common in male or female

A

female

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47
Q

Tibial apophysitis (Osgood-Schlatter disease)

A
  1. Pain over the tibial tuberosity in adolescent s/p recent growth spurt, worse with squatting, stairs, quad strain
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48
Q

This in just is actually a hip injury which can be avascular necrosis, which can present as knee pain.

A

Slipped capital femoral epiphysis can result in referred knee pain

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49
Q

IT band syndrome

A
  1. Pain is worse with stairs

2. TIP lateral epicondyle 3 cm above joint line

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50
Q

Meniscal tear twisting motion with foot planted can be acute or chronic may present with:

A
  1. Effusion

2. MRI for diagnosis

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51
Q

What is patellofemoral syndrome?

A
  1. Stiff when standing
  2. Most common diagnosis in anterior knee pain among athletes
  3. Pain with climbing stairs
  4. J sign lateral patellar tracking as knee extended from 90 degrees flexion to full extension.
  5. Recommend PT
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52
Q

How is osteoarthritis treated

A
  1. Exercise therapy
  2. weight loss
  3. APAP
  4. Glucosamine/chondroitin
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53
Q

How are ankle sprains treated?

A
  1. Early mobilization
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54
Q

Achilles tendonitis

A
  1. Avoid hill workouts

2. PT

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55
Q

How is Peroneal tendonitis treated?

A
  1. Lateral heel wedges, ankle taping may not help healing
  2. Commitment to PT, ROM strengthening
  3. Surgical repair
56
Q

How is Plantar Facititis treated

A
  1. Stretching’s
  2. Deep myofascial massage
  3. analgesic
  4. Ice massage
    OTC orthotics: Injection triamcinolone long acting synthetic corticosteroid, superior to dry needling, lidocaine alone.
    Severe: extra corporeal shock wave therapy or fasciotomy
57
Q

Which of the following is the most appropriate management of chronic midportion Achilles tendinopathy

A
  1. Eccentric calf strengthening
58
Q

Causes of hand and wrist pain?

A
  1. Osteoarthritis
  2. RA
  3. Tendonitis
  4. Fracture/sprain
  5. Overuse injuries
59
Q

What is De Quervains tenosynovitis

A
  1. Radial pain limited to 1st extensor compartment
  2. History of over use not necessary
  3. Inflammation of the extensor pollicis brevis and abductor pollicis logus
  4. Finkelsteins test with good sensitivity/specificity
60
Q

What is the treatment for De Quervains tenosynovitis?

A
  1. Splinting
  2. Rest
  3. can go straight to injection
61
Q

Carpal Tunnel Syndrome

A

Palmar’s surface

can involve entire hand motor and sensory does not involve dorsum of the hand

62
Q

Tapping over the median nerve elicits tingling or pain is called the what sign for diagnosis of Carpal tunnel syndrome?

A

Tinel sign

63
Q

Tingling in the median nerve distribution with flexion for diagnosing carpal tunnel syndrome?

A

Phalen sign

64
Q

Full compression of the carpal tunnel to elicit symptoms is what kind of test for carpal tunnel?

A

Compression test

65
Q

What is the treatment for carpal tunnel syndrome?

A
  1. Avoid overuse
  2. Splinting (2-8) monitor for reduced ROM
  3. Corticosteroids for short term use
  4. Injection with triamcinolone acetonide 20 mg
  5. Resistant cases surgery
66
Q

Fracture that occurs after a fall with an outstretched hand

A

Scaphoid Fracture of the wrist

67
Q

What are complications of a scaphoid fratucture

A
  1. Non union
  2. Avascular necrosis
  3. Arthritis
  4. Mal union
68
Q

de Quervain tenosynovitis is inflammation of which of the following structures?

A

Extensor pollicis brevis and abductor pollicis longus tendons

69
Q

A 32-year-old man is brought into the emergency department because of pain in his right wrist after he fell onto his outstretched arm with his wrist in dorsiflexion. On physical examination, he has tenderness in the anatomical snuffbox. Neurovascular examination is unremarkable. An X-ray shows no abnormal findings. Which of the following is the most appropriate next step in management

A

Immobilization and X-ray in 10 days

70
Q

Which provocative test is used to diagnose de Quervain’s tenosynovitis?

A

Finkelsteins test

71
Q

Which of the following is the most appropriate step in management of a patient with a clinical diagnosis of carpal tunnel syndrome that has caused no sensory deficits and has not disrupted sleep or daily function?

72
Q

What the are three separate categories of abdominal pain

A
  1. Upper GI
  2. Lower GI
  3. Non Gi
73
Q

What are common upper GI causes of pain?

A
  1. GERD
  2. Gastritis
  3. Gastric Duodenal ulcer
  4. Biliary colic
  5. Pancreatitis
  6. Malignancy
74
Q

What are common causes of main Lower GI

A
  1. Functional bowel d/o
  2. Inflammatory bowel disease
  3. Diverticulosis
  4. Mechanical obstruction
  5. Malignancy
  6. appendicitis
75
Q

What are non GI disorders?

A
  1. Kidney stores
  2. Reproductive d/o
  3. Malignancy
76
Q

What are demographic factors related to upper GI pain

A
  1. Age
  2. Sex
  3. ETOH
  4. Smoking
  5. Caffeine
77
Q

Past medical history of abdominal pain

A
  1. what caused pain in the past
  2. surgical history
  3. medications
78
Q

What labs should be ordered for abdominal pain?

A
  1. Liver and kidney
  2. CBC may not be helpful
  3. try to focus labs evaluation cholestasis, pancreatitis
    uranalysis
79
Q

For diagnosing and assessing abdominal pain what imaging films would be most helpful?

A
  1. Plain films limited to bowel obstruction/perforation
  2. U/S less complications, superior for biliary tract and reproductive imaging
  3. general screening exam: colonoscopy, cervical cancer screening
80
Q

Which of the following is not a known risk factor for gastropathy/gastritis?

A

Chronic opiate use

81
Q

What does Hematochezia mean?

A

passage of fresh blood from the anus usually in stool or mixed with stool

82
Q

What is the difference between Hematochezia and Melena?

A

Hematochezia is fresh frank blood where as Melena is dark and tarry stools

83
Q

What is a maculopapular rash?

A
  1. Can be raised or flat skin lesions the name is a blend of the words macule which are flat discolored skin lesions and papule which are small bumps.
84
Q

More of a generalized rash

A

Atopic dermatitis

85
Q

How is dermatitis treated?

A
  1. Avoidance of triggers
  2. Treat dyshidrosis
  3. topical corticosteroids
  4. Emollients
86
Q

What the difference between a fungal rash and a contact dermatitis?

A
  1. Fungal rashes have maculopapular erythema with central clearing and scale.
  2. Feet hands, intertriginous areas large people
87
Q

How are fungal rashes treated?

A
  1. OTC products to reduce moisture-prevention

2. Topical antifungals

88
Q

Which of the following best describes the clinical presentation of allergic contact dermatitis?

A

Well-demarcated, pruritic, eczematous eruption localized to the area of skin that comes in contact with the allergen

89
Q

Why must cellulitis be monitored closely?

A
  1. Cellulitis can develop into necrotizing faciitis
90
Q

What should clinicians look for when assessing for atopic dermatitis?

A
  1. Scaling and lichenification with pruritus
  2. often in children linked with family history of atopy
  3. 30% of children with AD eventually develop asthma
  4. Distribution: flexor surfaces, neck, forehead, behind ears.
91
Q

How is atomic dermatitis treated in children?

A
  1. Low heat showers gentle or no soaps
  2. Emollients
  3. Topical corticosteroids
  4. Topical calcineum inhibitors
92
Q

What causes 5th disease

A

Parvovirus B19

93
Q

Children with the slapped cheek appearance have what disease?

A

5ths disease a viral exanthem

Fishnet pattern, lace appearance over the body

94
Q

What is the classic pattern of Roseola

A
  1. Fever for a few days

2. Followed by a maculopapular rash central to peripheral spread

95
Q

When assessing for Nummular Eczema what should the clinician be aware of?

A
  1. 2 to 10 cm erythematous plaques with scale and sharp border.
  2. Distribution: dorsal hands and feet: extensor surfaces of limbs
96
Q

What is the treatment for Nummular Eczema?

A
  1. Moisturizers
  2. Topical corticosteroids
  3. Dermatology referral
97
Q

What will the clinician assess when diagnosing Pityriasis Rosea?

A
  1. Round or oval salmon colored patches 5 to 10 mm
  2. Christmas tree pattern on back may find prominent herald patch
  3. Limited duration without severe pruritis usually no intervention beyond reassurance.
98
Q

How is psoriasis treated and managed?

A
  1. Topical corticosteroids for less than 5% skin involvement
  2. Larger area refer to derm
  3. Topical calcineurin
99
Q

What are classic symptoms of PID?

A
  1. Cervical motion tenderness
  2. Mucopurulent cervical discharge
  3. lack of leukocytosis on wet mount
100
Q

Treatment of PID should be?

A
  1. Parenteral treatment
  2. Cefotetan or cefoxitin plus doxycycline
  3. Clindamycin and gentamycin
  4. IM ceftriaxone with oral doxycycline or flagyl
101
Q

What should be done with patients who have persistent ovarian cyst?

A
  1. Gyn referral

2. CA-125

102
Q

What is the most common type of kidney stone found?

A
  1. Calcium oxalate
103
Q

What is the work up for kidney stone

A
  1. U/A

2. U/S or CT

104
Q

What medications promote stone formation?

A
  1. Bactrim, Amoxicillin, Quinolones
  2. Sulfonylureas
  3. Potassium sparing diuretics
  4. Laxatives
105
Q

How are kidney stones managed?

A
  1. Hydration 2 ltiers per 24 hours

2. pain management antispasmodics, calcium channel blockers may hasten stone passage by 5-7 days

106
Q

What are symptoms of prostatitis?

A
  1. Pain peaks at 20-40 years and over 70 years
  2. E coli most common organism
  3. pain may be suprapubic, rectal, perineal
  4. dull or sharp pain
  5. Digital rectal exam for symptomatic patients
  6. urine culture may be negative
  7. STD testing high risk <35 years of age
107
Q

How is prostatitis treated?

A
  1. Ceftriaxone IM x 1 then doxycycline for 10 days

2. Quinoline ( or TMP-SMX x 10-14 days)

108
Q

Which of the following is the most common cause of struvite kidney stones?

109
Q

What are first line ABT for treatment of UTI?

A
  1. Bactrim x 3 days
  2. Macrodantin x 5 days
  3. Fosfomycin x 1 dose
  4. Fluoroquinolones
110
Q

UTI in children 2 to 24 months what should the clinician be aware of?

A
  1. defined by abnormal UA plus at least 50 CFU/ml
  2. Renal and bladder U/s should be performed
  3. VCUG not necessary after first UTI
111
Q

How are UTI’s managed in young children?

A

Oral ABT 7-14 days

112
Q

A voiding cystourethrogram (VCUG) in children primarily evaluates which of the following?

A

Vesicoureteral reflux

113
Q

Most common causes of chest pain in primary care are?

A
  1. Chest wall pain/costochondritis

2. GERD

114
Q

What type of pain accompanies acute MI

A
  1. Radaites to both arms/neck/jaw
  2. New 3rd heart sound
  3. hypotension
115
Q

What types of chest pain are more common and cause chest wall pain?

A
  1. Stinging sharp pain
  2. reproducible pain on palpation
  3. Muscle tension
116
Q

What symptoms accompany Gerd

A
  1. burning retrosternal pain

2. better with PPI or antacid

117
Q

What is Wells Criteria used for?

A
  1. Evaluate risk of DVT and PE symptoms
118
Q

What symptoms of a Thoracic Aortic Aneurysm?

A
  1. Tearing pain that goes through to back

2. brachial BP difference

119
Q

What are symptoms of a tension headache?

A
  1. Bilateral mild to moderate pressure in the head
  2. less aggravated with physical activity
  3. Absence of N/V photo and phonophobia
  4. look for connection to stress/anxiety
120
Q

What is the acronym for assessing migraine headaches?

A
  1. POUND pusatile
  2. On for 4 to 72 hours
  3. unilateral location
  4. Nausea/Vomiting
  5. Disability
121
Q

What is the acronym for assessing migraine headaches?

A
  1. POUND pulsatile
  2. On for 4 to 72 hours
  3. unilateral location
  4. Nausea/Vomiting
  5. Disability
122
Q

Prevention of tension type headaches can be treated with?

A
  1. Amitriptyline 1-=75 mg nightly
  2. Relaxation/biofeedback
  3. psychotherapy
  4. acupuncture
123
Q

Most common medication used for migraines?

124
Q

Triptans should be avoided in patients with the following:

A
  1. CVD

2. multiple risk factors pts taking SSRI’s

125
Q

What medications can be used to treat migraines proph?

A
  1. Beta blockers
  2. TCA’s
  3. Topiramate
  4. Divalproex
  5. Gabapentin
  6. Ca-channel blockers
126
Q

How is dizziness assessed in patients?

A
  1. Orthostatic b/p
  2. Hallpike diagnostic BPPV
  3. Cranial Romberg gait
  4. Cardiac exam
127
Q

What blood work for diagnosing dizziness?

A
  1. Anemia
  2. Thyroid
  3. BMP
128
Q

How is Meniere’s disease treated?

A
  1. Salt restriction
  2. Diuretics such as triamterene/hctz
    chlorothiazide
129
Q

How is vestibular neuritis treated?

A

Methy-lprednisone taper over 3 weeks

130
Q

How is vestibular neuritis treated?

A

Methyl-prednisone taper over 3 weeks

131
Q

Which of the following is the classic triad of Meniere’s disease?

A

Episodic vertigo, tinnitus, hearing loss

132
Q

Which of the following drug classes is best avoided in patients with asthma?

A

Non selective beta blockers

133
Q

Which of the following signs is LEAST consistent with heart failure?

A

Finger clubbing

134
Q

Which of the following symptoms is most specific to heart failure

135
Q

Diagnostic work up for shortness of breath

A
  1. CXR
  2. EKG
  3. Spirometry with bronchodilator
    Labs:
  4. CBC, CMP, BNP, ntBNP
  5. Possible D-Dimer
  6. Echo
  7. Chest CT
  8. Cardiac stress test

Family Medicine Acute Problems (1 decks)

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