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Medicine shelf > Ambulatory high yields: respiratory, GI, MSK > Flashcards

Ambulatory high yields: respiratory, GI, MSK Flashcards

1
Q

Should further investigate a cough once it has lasted how long?

A

> 1 month

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2
Q

4 MCCs of chronic cough in adults?

A

Smoking, GERD, asthma, post-nasal drip

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3
Q

3 indications for CXR for a cough?

A

Chronic cough (>8 wk), hemoptysis, if a pulmonary cause is suspected

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4
Q

Tx of post-nasal drip?

A

1st gen antihistamine/decongestant prep

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5
Q

MC presenting symptom of acute bronchitis?

A

Cough (with or w/o sputum)

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6
Q

MC route of spread of the common cold?

A

Hand to hand

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7
Q

Patient has a cold lasting 8 - 10 days or a cold that improves but then gets worse after a few days. What do you suspect?

A

Acute bacterial sinusitis

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8
Q

3 MCCs of acute bacterial sinusitis?

A

Strep pneumo, H. flu, anaerobes

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9
Q

MC sinuses involved in acute sinusitis?

A

Maxillary

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10
Q

Nasal stuffiness, purulent nasal DC, cough, pain over cheeks that mimics pain of dental caries?

A

Maxillary sinusitis

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11
Q

Nasal stuffiness, purulent nasal DC, cough, pain in lower forehead?

A

Frontal sinusitis

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12
Q

Nasal stuffiness, purulent nasal DC, cough, retro-orbital pain?

A

Ethmoid sinusitis

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13
Q

How long do Sx have to last to diagnose chronic sinusitis?

A

2-3 mo

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14
Q

Imaging test to do if sinusitis is complicated or may require surgery?

A

CT (coronal)

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15
Q

If acute sinusitis hasn’t improved after 2 weeks of proper treatment, what do you do next?

A

Sinus xray + penicillinase-resistant antibiotic

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16
Q

Sinusitis of which sinus is most likely to cause orbital cellulitis?

A

Ethmoid

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17
Q

Treatment of acute bacterial sinusitis?

A

Saline nasal spray (helps drainage) + decongestants (no more than 3-5 days) + Abx. Avoid anti-histamines unless patient also has allergies.

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18
Q

Name 2 decongestants

A

Pseudoephedrine, oxymetazoline

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19
Q

Patient with hoarseness, cough, and URI Sx. Dx?

A

Laryngitis

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20
Q

Why should patients with laryngitis rest their voices?

A

Avoid formation of vocal nodules

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21
Q

MCC of sore throat?

A

Virus

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22
Q

What can a throat culture tell you that a rapid strep test can’t?

A

Bacterial vs viral cause if non-streptococcal bacteria is the cause

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23
Q

How do you treat strep throat?

A

PN q10 days

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24
Q

Tx of strep in a PN-allergic patient?

A

Erythromycin

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25
Q

4 MCCs of dyspepsia/heartburn?

A

PUD, GERD, gastritis, nonulcer dyspepsia

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26
Q

How long do dyspepsia Sx need to be present to diagnose nonulcer dyspepsia?

A

> 4 wk. And you better have done an endoscopy!

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27
Q

Test of choice for eval of dyspepsia?

A

Endoscopy

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28
Q

7 major indications for endoscopy in dyspepsia?

A
  1. alarm sx 2. >45 yo w/ new dyspepsia 3. recurrent vomiting or evidence of GIB 4. signs of PUD complications 5. recurrent sx 6. no response to empiric therapy 7. evidence of systemic illness
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29
Q

GERD + dysphagia: most likely cause?

A

Peptic strictures

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30
Q

When do you do an endoscopy w/ Bx for suspected GERD?

A

if heartburn is refractory or is accompanied by dysphagia, odynophagia, or GIB.

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31
Q

Gold standard for Dx GERD?

A

24 hr pH monitoring of LE

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32
Q

How do you confirm dx of suspected peptic stricture?

A

EGD

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33
Q

Tx of peptic stricture?

A

Dilation

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34
Q

Who should be screened for Barretts and how?

A

Patients with symptomatic GERD for at least 5 years. Endoscopy w/ Bx.

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35
Q

What cytologic finding on bronch can diagnose aspiration of gastric contents (leading to recurrent PNA)?

A

Lipid-laden macrophages

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36
Q

Initial treatment of GERD?

A

Antacids + behavior mod

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37
Q

Fever + bloody diarrhea: 4 common orgs?

A

Campylobacter, shigella, salmonella, EHEC

38
Q

Diarrhea w/o fever or blood: 3 major groups of causes?

A

Viral, food poisoning, ETEC

39
Q

What workup is required in mild-mod diarrhea?

A

Assess vol status, abd exam, FOB. Nothing else!

40
Q

Major causes of diarrhea w/ fecal leukocytes?

A

Campylobacter, shigella, salmonella, EIEC, c diff

41
Q

MC acid base abnormality in severe diarrhea?

A

Metabolic acidosis and hypokalemia

42
Q

Empiric abx for patients with mod-severe diarrhea?

A

5 days of cipro

43
Q

If H&P suggest obstruction, what should you do next?

A

Abd xray

44
Q

4 major complications of chronic constipation?

A

Hemorrhoids, rectal prolapse, anal fissures, fecal impaction

45
Q

Myalgias, malaise, HA, watery diarrhea, ab pain, n/v for 2-3 days

A

Acute viral gastroenteritis

46
Q

Abd pain, diarrhea w/ fecal wbcs, n/v a day or two after eating chicken

A

Salmonella

47
Q

Diarrhea w/ fecal wbcs, abd pain, tenesmus, n/v lasting 4-5 days

A

Shigella

48
Q

Tx of shigella?

A

TMP-SMX

49
Q

Abd pain, n/v/d <6 hrs after a picnic?

A

Staph food poisoning

50
Q

HA, fever and fatigue–> diarrhea (w/ wbcs) and abd pain

A

Camplyobacter

51
Q

Tx of campylobacter?

A

Erythromycin

52
Q

Diarrhea and crampy abd pain lasting <24 hr

A

C. perfringens

53
Q

Traveler w/ watery diarrhea, nausea, abd pain lasting a few days

A

ETEC

54
Q

Very sick patient w/ bloody diarrhea. Hamburger.

A

EHEC

55
Q

Voluminous diarrhea, vomiting, abd pain in the third world

A

Vibrio cholerae

56
Q

How long do sx have to last to dx IBS?

A

3 mo

57
Q

MCC of gastroenteritis?

A

Enterobacter

58
Q

Bilious vomiting means obstruction is distal to what?

A

Ampulla of vater

59
Q

3 major causes of feculent vomit?

A

Distal intestinal obstruction, bacterial overgrowth, gastrocolic fistula

60
Q

First step in management of vomiting leading to dehydration?

A

IVF: 1/2NS w/ K

61
Q

Painless BRBPR in heroin abuser?

A

Internal hemorrhoids (opioid–>constipation–>straining)

62
Q

Sudden painful swelling emerging from anus?

A

External hemorrhois

63
Q

Tx for internal hemorrhoids?

A

Rubber band ligation

64
Q

Back pain that’s worse with sitting, driving, or lifting (forward flexion). Dx?

A

Disc herniation

65
Q

Leg pain on back extension. Worse w/ standing or walking; better with bending forward or sitting.

A

Spinal stenosis

66
Q

Acute bladder dysfxn + perineal/butt numbess

A

Cauda equina synd

67
Q

Suspect cauda equina syndrome… next best step?

A

STAT MRI

68
Q

MCC of acute neck pain?

A

Cervical strain

69
Q

Unilateral neck pain radiating to the arm in a dermatomal pattern. Dx?

A

Cervical radiculopathy

70
Q

You suspect cervical radiculopathy. What’s the best test to dx nerve root compression?

A

C spine MRI

71
Q

Old person who starts becoming unsteady and loses hand dexterity. What should you r/o and how?

A

Cervical myelopathy 2/2 cervical stenosis. C spine MRI

72
Q

Anterior knee pain that’s worse going up/down stairs

A

Patellofemoral syndrome

73
Q

Tx of patellofemoral synd?

A

PT for stretching/strengthening quads and hamstrings

74
Q

Recurrent knee effusions, tenderness along medial or lateral joint line, and positive mcmurray

A

Meniscal pathology

75
Q

Long jumper w/ pain at inferior pole of patella

A

Patellar tendinitis

76
Q

Pain along medial patella, “snapping” knee with walking, +/- intermittent effusion

A

Plica syndrome

77
Q

If you suspect ligamentous instability of knee or a meniscal tear, what’s the next best test?

A

MRI

78
Q

MC ligament injured in sprained ankle

A

ATFL

79
Q

Patient w/ suspected sprained ankle doesn’t require xrays if…

A

Can walk 4 steps at time of injury and at time of eval + no bony tenderness over distal 6 cm of either malleolus

80
Q

MCC of shoulder pain?

A

Supraspinatus tendinitis

81
Q

Weakness on shoulder aBduction. Next best test?

A

Shoulder MRI (weakness should make you think rotator cuff tear > tendinitis)

82
Q

Definitive treatment for impingement syndrome

A

Acromioplasty

83
Q

Best initial treatment for lateral epicondylitis?

A

Splinting the forearm w/ counterforce brace

84
Q

Pain in radial aspect of wrist. Reproduced if thumb is clenched in fist and wrist is ulnarly deviated. Dx?

A

De Quervain’s dz

85
Q

Spongy bag of fluid over the olecranon

A

Olecranon bursitis

86
Q

Lateral hip pain + pain on palpation of greater trochanter

A

Trochanteric bursitis

87
Q

Hip OA presents with pain in what site?

A

Groin

88
Q

Initial tx of carpal tunnel?

A

Night-time wrist splinting + NSAIDs

89
Q

1st line tx for pain of OA?

A

APAP

90
Q

4 general recommendations for patients w/ osteoporosis?

A

Daily Ca, daily vit D, weight-bearing exercise, stop smoking

91
Q

Gold standard for Dx of osteoporosis?

A

DEXA

92
Q

Indications for DEXA?

A

All women >64; postmenopausal women <65 and all men w/ RF for fracture

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