Ambulatory high yields: respiratory, GI, MSK Flashcards
Should further investigate a cough once it has lasted how long?
> 1 month
4 MCCs of chronic cough in adults?
Smoking, GERD, asthma, post-nasal drip
3 indications for CXR for a cough?
Chronic cough (>8 wk), hemoptysis, if a pulmonary cause is suspected
Tx of post-nasal drip?
1st gen antihistamine/decongestant prep
MC presenting symptom of acute bronchitis?
Cough (with or w/o sputum)
MC route of spread of the common cold?
Hand to hand
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?
Acute bacterial sinusitis
3 MCCs of acute bacterial sinusitis?
Strep pneumo, H. flu, anaerobes
MC sinuses involved in acute sinusitis?
Maxillary
Nasal stuffiness, purulent nasal DC, cough, pain over cheeks that mimics pain of dental caries?
Maxillary sinusitis
Nasal stuffiness, purulent nasal DC, cough, pain in lower forehead?
Frontal sinusitis
Nasal stuffiness, purulent nasal DC, cough, retro-orbital pain?
Ethmoid sinusitis
How long do Sx have to last to diagnose chronic sinusitis?
2-3 mo
Imaging test to do if sinusitis is complicated or may require surgery?
CT (coronal)
If acute sinusitis hasn’t improved after 2 weeks of proper treatment, what do you do next?
Sinus xray + penicillinase-resistant antibiotic
Sinusitis of which sinus is most likely to cause orbital cellulitis?
Ethmoid
Treatment of acute bacterial sinusitis?
Saline nasal spray (helps drainage) + decongestants (no more than 3-5 days) + Abx. Avoid anti-histamines unless patient also has allergies.
Name 2 decongestants
Pseudoephedrine, oxymetazoline
Patient with hoarseness, cough, and URI Sx. Dx?
Laryngitis
Why should patients with laryngitis rest their voices?
Avoid formation of vocal nodules
MCC of sore throat?
Virus
What can a throat culture tell you that a rapid strep test can’t?
Bacterial vs viral cause if non-streptococcal bacteria is the cause
How do you treat strep throat?
PN q10 days
Tx of strep in a PN-allergic patient?
Erythromycin
4 MCCs of dyspepsia/heartburn?
PUD, GERD, gastritis, nonulcer dyspepsia
How long do dyspepsia Sx need to be present to diagnose nonulcer dyspepsia?
> 4 wk. And you better have done an endoscopy!
Test of choice for eval of dyspepsia?
Endoscopy
7 major indications for endoscopy in dyspepsia?
- 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
GERD + dysphagia: most likely cause?
Peptic strictures
When do you do an endoscopy w/ Bx for suspected GERD?
if heartburn is refractory or is accompanied by dysphagia, odynophagia, or GIB.
Gold standard for Dx GERD?
24 hr pH monitoring of LE
How do you confirm dx of suspected peptic stricture?
EGD
Tx of peptic stricture?
Dilation
Who should be screened for Barretts and how?
Patients with symptomatic GERD for at least 5 years. Endoscopy w/ Bx.
What cytologic finding on bronch can diagnose aspiration of gastric contents (leading to recurrent PNA)?
Lipid-laden macrophages
Initial treatment of GERD?
Antacids + behavior mod
Fever + bloody diarrhea: 4 common orgs?
Campylobacter, shigella, salmonella, EHEC
Diarrhea w/o fever or blood: 3 major groups of causes?
Viral, food poisoning, ETEC
What workup is required in mild-mod diarrhea?
Assess vol status, abd exam, FOB. Nothing else!
Major causes of diarrhea w/ fecal leukocytes?
Campylobacter, shigella, salmonella, EIEC, c diff
MC acid base abnormality in severe diarrhea?
Metabolic acidosis and hypokalemia
Empiric abx for patients with mod-severe diarrhea?
5 days of cipro
If H&P suggest obstruction, what should you do next?
Abd xray
4 major complications of chronic constipation?
Hemorrhoids, rectal prolapse, anal fissures, fecal impaction
Myalgias, malaise, HA, watery diarrhea, ab pain, n/v for 2-3 days
Acute viral gastroenteritis
Abd pain, diarrhea w/ fecal wbcs, n/v a day or two after eating chicken
Salmonella
Diarrhea w/ fecal wbcs, abd pain, tenesmus, n/v lasting 4-5 days
Shigella
Tx of shigella?
TMP-SMX
Abd pain, n/v/d <6 hrs after a picnic?
Staph food poisoning
HA, fever and fatigue–> diarrhea (w/ wbcs) and abd pain
Camplyobacter
Tx of campylobacter?
Erythromycin
Diarrhea and crampy abd pain lasting <24 hr
C. perfringens
Traveler w/ watery diarrhea, nausea, abd pain lasting a few days
ETEC
Very sick patient w/ bloody diarrhea. Hamburger.
EHEC
Voluminous diarrhea, vomiting, abd pain in the third world
Vibrio cholerae
How long do sx have to last to dx IBS?
3 mo
MCC of gastroenteritis?
Enterobacter
Bilious vomiting means obstruction is distal to what?
Ampulla of vater
3 major causes of feculent vomit?
Distal intestinal obstruction, bacterial overgrowth, gastrocolic fistula
First step in management of vomiting leading to dehydration?
IVF: 1/2NS w/ K
Painless BRBPR in heroin abuser?
Internal hemorrhoids (opioid–>constipation–>straining)
Sudden painful swelling emerging from anus?
External hemorrhois
Tx for internal hemorrhoids?
Rubber band ligation
Back pain that’s worse with sitting, driving, or lifting (forward flexion). Dx?
Disc herniation
Leg pain on back extension. Worse w/ standing or walking; better with bending forward or sitting.
Spinal stenosis
Acute bladder dysfxn + perineal/butt numbess
Cauda equina synd
Suspect cauda equina syndrome… next best step?
STAT MRI
MCC of acute neck pain?
Cervical strain
Unilateral neck pain radiating to the arm in a dermatomal pattern. Dx?
Cervical radiculopathy
You suspect cervical radiculopathy. What’s the best test to dx nerve root compression?
C spine MRI
Old person who starts becoming unsteady and loses hand dexterity. What should you r/o and how?
Cervical myelopathy 2/2 cervical stenosis. C spine MRI
Anterior knee pain that’s worse going up/down stairs
Patellofemoral syndrome
Tx of patellofemoral synd?
PT for stretching/strengthening quads and hamstrings
Recurrent knee effusions, tenderness along medial or lateral joint line, and positive mcmurray
Meniscal pathology
Long jumper w/ pain at inferior pole of patella
Patellar tendinitis
Pain along medial patella, “snapping” knee with walking, +/- intermittent effusion
Plica syndrome
If you suspect ligamentous instability of knee or a meniscal tear, what’s the next best test?
MRI
MC ligament injured in sprained ankle
ATFL
Patient w/ suspected sprained ankle doesn’t require xrays if…
Can walk 4 steps at time of injury and at time of eval + no bony tenderness over distal 6 cm of either malleolus
MCC of shoulder pain?
Supraspinatus tendinitis
Weakness on shoulder aBduction. Next best test?
Shoulder MRI (weakness should make you think rotator cuff tear > tendinitis)
Definitive treatment for impingement syndrome
Acromioplasty
Best initial treatment for lateral epicondylitis?
Splinting the forearm w/ counterforce brace
Pain in radial aspect of wrist. Reproduced if thumb is clenched in fist and wrist is ulnarly deviated. Dx?
De Quervain’s dz
Spongy bag of fluid over the olecranon
Olecranon bursitis
Lateral hip pain + pain on palpation of greater trochanter
Trochanteric bursitis
Hip OA presents with pain in what site?
Groin
Initial tx of carpal tunnel?
Night-time wrist splinting + NSAIDs
1st line tx for pain of OA?
APAP
4 general recommendations for patients w/ osteoporosis?
Daily Ca, daily vit D, weight-bearing exercise, stop smoking
Gold standard for Dx of osteoporosis?
DEXA
Indications for DEXA?
All women >64; postmenopausal women <65 and all men w/ RF for fracture
