Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Internal Medicine > Ambulatory > Flashcards

Ambulatory Flashcards

1
Q

Goal hyperlipidemia levels in general population and diabetic patients and diabetic plus CAD patients

A

General population
Total cholesterol: less than 200 (high is 240)
LDL: less than 130 (high is 160)
Triglycerides: less than 125 (high is 250)

Diabetic
LDL less than 100

Diabetic plus CAD
LDL less than 70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Tension headache treatment

A

Stress reduction possible depression or anxiety
NSAIDs, acetaminophen and aspirin
If don’t respond can use migraine drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cluster headache treatment

A

Acute attack:
Sumatriptan, O2 inhalation

Prophylaxis
Verapamil drug of choice
Ergotamine, methysergide, lithium and corticosteroids are alternatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pseudotumor cerebri diagnosis and treatment

A

Diagnosis:
Normal CSF, except increased CSF opening pressure
(tetracyclline or isotretenoin use)

Treatment:
Azetazolamide-1st line (can be with furosemide)
If have progressive vision loss: surgical intervention with optic nerve sheath decompression or lumbar peritoeal shunting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Migraine treatment

A

Acute attacks:
NSAIDs or acetaminophen for mild attacks
dihydroergotamine-sertonin agonist
Sumatriptan

Prophylaxiss
amitryptyline and propanolol (most effective)
verapamil, valproic acid and methysergide

NSAIDs for menstrual migraines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Treatment of postnasal drip

A

Fist generation antihistamine/decongestant

Allergic rhinitis: loratadine (long acting non-sedating oral antihistamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acute bronchitis treatment

A

Codeine for symptoms
Bronchodilators (albuterol)

Antibiotics are NOT indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Common cold treatment

A

Adequate hydration-loosens secretions and prevents airway obstruction
Rest and analgesics (aspirin, acetaminophen, and ibuprofen) for releif of malaise, headache, fever and aches
dextromehtorphan, codeine for cough suppression
antihistamines for rhinorrhea/sneezing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Diagnosis and treatment of acute sinusitis

A

Diagnosis
Cold for more than 8-10 days
purulent discharge from one of the turbinates
Impaired light transmission in maxillary sinuses
tenderness to palpation

Treatment:
Antibiotics and decongestants for 1-2 weeks
Saline nasal spray aids drainage
Decongestants: pseudoephdrine or oxymetazoline-facilitates sinus drainage and relieves congestion-no more than 3-5 days
antibiotics: amoxicillin-clavulanate, TMP/SMX, levofloxacin, moxifloxacin, and cefuroxime
Antihistamines: use sparingly because can increase secretion thickness

Chronic:
broad spectrum penicilinase resistant antibiotic
Refer to otolaryngologist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Diagnosis and treatment of sore throat

A

Diagnosis:
Throat culture: takes 24 hours but is most accurate
Rapid strep test: takes one hour
Mono suspicion: obtain appropriate blood tests (monospot)

Treatment:
strep throat: penicillin for 10 days
viral: symptomatic treatment
Mono: advise rest and acetaminophen/ibuprofen
Symptomatic treatment:
Acetaminophen or ibuprofen
gargling with warm salt water
Humidifier
Sucking on throat lozenges, hard candy, flavored frozen desserts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dyspepsia workup and treatment

A 
Dyspepsia
Typical GERD-acid support
NSAID use-discontinue
Neither-alarm symptoms or >55=endoscopy
no alarm symptoms and less than 55=H. Pylori test
\+H. Pylori test=treat H. pylori
-H. Pylori test=PPI for 4-6 weeks

Alarm symptoms: weight loss, bleeding, dysphagia, persistent vomiting, or early satiety

Also avoid alcohol, caffeine, stop smoking, raise head when sleeping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Diagnosis and treatment of GERD

A

Diagnosis
Endoscopy with biopsy-test of choice if heartburn refractory to treatment, accompanied by dysphagia, odynophagia or GI bleeding

Upper GI series (barium contrast study) if strictures/ulcerations suspected
24 pH monitoring is most sensitive and specific but normally unnecessary

Treatment:
Phase I: diet (avoid fatty foods, coffee, alcohol, OJ, chocolate, avoid large meals before bed time), sleep with trunk of body elevated, stop smoking
Antacids after meals and at bedtime
Phase II: add an H2 blocker
Phase III: switch to PPI
Phase IV: add promitility agent (metoclpramide or bethanechol)
Phase V: increase dose of PPI and/or H2 blocker
Phase VI: antireflux surgery if medical treatment does not work, respiratory problems due to aspiration, severe esophageal injury (nissen funcoplication)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Indications for diarrhea diagnostic studies

A 
Chronic diarrhea >4 weeks
severe illness or high fever
presence of blood in the stool
Severe abdominal pain
Immunodeficiency
Signs of volume depletion
Lab tests to order
Stool WBCs
Stool for ova and parasites
Stool culture
Stool for C. difficile culture and toxin
Stool for Giardia Ag (ELISA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Indications for hospitalization of diarrhea

A

dehydration
unable to tolerate or hold down PO fluids
Blood diarrhea
high fever, toxic appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treatment of acute diarrhea

A 
No complications: rehydrate and consider loperamide
monitor electrolytes (metabolic acidosis with hypokalemia)

Complications (blood diarrhea, high fever, severe diarrhea)-ciprofloxacin for 5 days or specific antibiotic for bug

If diarrhea lasts longer than expected: sigmoidoscopy with biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment of shigella diarrhea

A

TMP/SMX

17
Q

Treatment of campylobacter diarrhea

A

erythromycin

18
Q

Treatment of irritable bowel syndrome

A

diarrhea: diphenoxylate, loperamide
constipation: colace, psyllium, cisaride

Avoid dairy products and excessive caffeine

Tegasrod maleate (zelnorm) serotonin agonist works in women

19
Q

Treatment of nausea and vomiting

A

fluid replacement is first step: use 1/2 Normal saline with potassium replacement

Prochlorperazine (compazine) and promethazine (phenergan)
Liquid diet
Avoid large meals and fatty meals
Nasogastric suction may improve symptoms

Correct electrolytes: metabolic alkalosis with hypokalemia

20
Q

Treatment of hemorrhoids

A

painless BRBPR

General: 
Sitz bath
Ice packs
Stool softeners
High fiber and high fluid diet
topical steroids

Rubber band ligation for internal hemorrhoids

Surgery if do not respond to conservative methods-severe prolapse, strangulation, very large anal tags or fissure is present

21
Q

Goal for hypertension in general population vs diabetic

A

General population: less than 140/90

Diabetic: less than 135/85

22
Q

Most commonly injured ankle ligament

A

anterior talofibular ligament

23
Q

when are ankle radiographs not necessary

A

patient is able to walk four steps at the time of injury and at time of evaluation
No bony tenderness over distal 6 cm of either malleolus

24
Q

Diagnosis of osteoarthritis

A

Plain radiographs are the initial test-joint space narrowing, osteophytes, sclerosis at end plates, subchondral cysts
MRI is indicated if neurologic findings or before surgery

Treatment:
Avoid activities involving joint
Weight loss, physical therapy (swimming)
Use can or crutches

Acetaminophen is first line
then NSAIDs or celecoxib
intra-articular injections of corticosteroids
Viscosupplementation

Surgery for serious disability: total joint replacement

25
Q

Osteoporosis diagnosis and treatment

A

Diagnosis
DEXA scan: women >65, postemenopausal women less than 65 with 1+ risk factors, men with risk factors
If normal repeat in 3-5 years

Treatment:
Diet: 1200 g of calcium, 800 international units of Vitamin D
Smoking cessation
Reduce alcohol intake
weight bearing exercise

Pharmacological: postmenopausal women with T score less than 2.5 or fragility fracture, high risk postmenopausal women with score -1 to -2.5
Bisphosphonates: inhibit bone resorption-first line
PTH therapy: max of 24 months
Calcitonin: short term therapy

26
Q

Diagnosis and treatment of age related macular degeneration

A

Diagnosis: loss of central vision-peripheral vision preserved
Distortion of straight lines

Treatment
Exudative: sudden visual loss due to abnormal vessel formation (anti-VEGF inhibitors)-Ranibizumab
Nonexudative: atrophy and degneration of central retina-OTC vitamins antioxidant

27
Q

Open angle glaucoma diagnosis and treatment

A

Diagnosis: enlargment of optic cup (cupping)
Impaired outflow of aqueous humor
Painless increased IOP
Visual field loos sparing central vision

Tanometroy measures IOP
Opthalmoscopy
Gonioscopy: gold standard visualizes the anterior chamber
Visual field testing: monitors

Treatment
B blocker, a agonist, carbonic anyhydrase inhibitor, and or prostaglandin analog
Laser or surgical treatment if refractory

28
Q

Closed angle glaucoma diagnosis and treatment

A

Opthalmologic emergency can lead to irreversible vision loss
Red painful eye
Sudden decrease in visual acuity,, seeing halos
N and V
Pupil is dialted and nonreactive

Diagnosis
Tanometry-measures IOP
Opthalmoscopy
Gonioscopy: gold standard
Visual field testing

Treatment
Opthalmic consult
emergently lower IOP
Pilocarpine drops, IV acetazolamide and oral glycerin

Laser or surgical iridectomy is definitive

29
Q

Viral conjunctivitis diagnosis and treatment

A

watery discharge, pereauricular lymph node palpable, eye stuck shut

cold compress, strict hand washing, topical antibiotics possible

30
Q

Bacterial conjunctivitis diagnosis and treatment

A

Diagnosis: S. pneumo or gram - (gonorrhea)
Mucopurulent discharge with crusting
rapid onset

Treatment
Acute: erytormycin, ciprfloxacin (contacts), sulfacetamide
Hyperacute: one time dose of ceftriaxone IM (gonnococcal) and topical therapy

31
Q

Amaurosis Fugax

A

Transient monocular loss of vision
Embolization of cholesterol plaque from the carotid arterial system
Reperfusion established and vision returns

Diagnosis: carotid ultrasonography (duplex study of neck) and cardiac workup

32
Q

Diagnosis and treatment of obesity

A 
Diagnosis
BMI:
19.5-24.9 is normal
25-30 is overweight
30-40 is obese
40+ is morbidly obese

Treatment
Lifestyle modifications
Orilistat can be used for 4 years
Bariatric surgery if BMI over 40 (roux-en-Y bypass)

Internal Medicine (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions