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Family Med > Ambulatory Medicine > Flashcards

Ambulatory Medicine Flashcards

1
Q

most common cause of secondary HTN in young women

A

OCPs

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2
Q

most common cause of secondary HTN

A

renal artery setnosis

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3
Q

main organs HTN causes damage to

A

heart
eyes
CNS
kidneys

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4
Q

Changes seen in the eyes due to HTN

A

AV knicking, cotton wool spots , papilledema (ominous finding)

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5
Q

BP meds C/I in pregnancy

A

Thiazides, ACEI , CCB, ARBs

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6
Q

safe meds for elevated BP in pregnancy

A

Beta blockers, hydralazine

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7
Q

biggests ADR of thiazide diuretics

A

Hypokalemia

hyperuricemia, hyperglycemia

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8
Q

secondary causes of hyperlipidemia

A

hypothyroidism, DM< cushing’s syndrome, nephrotic syndrome, ueremia

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9
Q

what lipid levels does alcohol increase?

A

TG and HDL levels

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10
Q

how do beta blockers affect cholesterol

A

Increase TGs and lower HDL

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11
Q

how do estrogens affects cholesterol levels

A

increase TG levles

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12
Q

LDL goal in all diabetic patients

A

<100

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13
Q

If a patient has CAD and DM what is the LDL goal?

A

<70

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14
Q

LDL goal w/ no eastblished CHD

A

<130

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15
Q

what needs to be monitored whil on statins?

A

AST and ALT

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16
Q

what cholesterol med should not be used in patients w/ DM

A

Niacin

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17
Q

how do fibrates (gemibrozil) affect cholesterol levels?

A

lower VLDL and TG

increase HDL

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18
Q

main ADR of bile acid resins?

A

GI side affects

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19
Q

C/I with sumatriptan

A 
CAD
pregnancy
uncontroll HTN
basilar artery migraine
hemiplegic migraine
use of MAO, SSRI or lithium
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20
Q

Prophylaxis for migraines

A

Amitriptyline propranolol

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21
Q

causes of chronic cough in adults

A

smoking
postnala drip
GERD
asthma

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22
Q

Antitussive therapy

A

Codeine
Dextromehorphan
Benzontate (Tessalon Pearles)

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23
Q

tx for common cold

A

hydration
rest and analgesics (aspirin, APAP, ibupforen)
cough suppressant
nasal decongestant (Neo-synphrine) for <3 days

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24
Q

If patient has a cold beyond 8-10 days or if cold symptoms improve then worsen after a few days what shoudl be considered?

A

aucte abcterial sinusitis

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25
Q

Sinusitits tx

A

Saline nasal sprays
Decongestatns (no more than 3-5 days)
amox, augmentin, bactrim, cefuroxime

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26
Q

most common cause of sore throat

A

viruses

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27
Q

Tx for strep throat

A

PCN for 10 days, erythromycin if allergic

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28
Q

indications for endoscopy w/ dyspepsia

A 
Weight loss, anemia, dysphagia
age >50
recurrent vomitting/ GI bleeding
dont respond to therapy
systemic illness
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29
Q

lifestyle modifications for dyspepsia

A

Avoid alcohol, caffeiene, acdic foods
stop smoking
raise head of bed

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30
Q

Med tx for dyspepsia

A

H2 blocker
sucralfate
PPI

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31
Q

most sensitive and specific test for GERD

A

24 pH monitoring of the lwoer esophagus

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32
Q

Fibrotic rings common in GERD that narrow the lumen and osbstruction the passage of food

A

peptic stricture

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33
Q

where the normal stratified squamous epithelium of the distal esophagus is replaced by columnar epithelium. Associated w/ risk of andocarcinoma

A

Barrett’s esophagus

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34
Q

if food poisoning causes diarrhea when will it occur?

A

within hours of the meal

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35
Q

Fever + bloody diarrhea could indicate what?

A

Shigella, campylobacter, slamonella , enterohemorrhagic E. Coli

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36
Q

diarrhea w/o fever or blood is associated w/ what?

A

Viruses- rotavirus, Norwalk virus, entero toxic E. Coli, food poisoning

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37
Q

how long is chronic diarrhea?

A

> 4 weeks

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38
Q

Most common med cause of diarrhea

A

abx

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39
Q

most common electrolyte and acid/base abnormlity w/ diarrhea are what?

A

metabolic acidosis

hypokalemia

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40
Q

when should you use abx w/ diarrhea

A

high fever, bloody stools (use quinolone)
stool crowth of a pthogenic oragnism
travelers diarrhea
c. diff (metronidazole)

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41
Q

Antidiarrheal agent that can be given w/ mild-moderate diarrhea. Don’t give to people w/ fever or blood

A

loperamide

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42
Q

Lab tests w/ constipation

A

TSH
serum calcium levels
CBC (suspect colon cancer)
electrolytes

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43
Q

Complications of chronic constipation

A

hemorrhoids
rectal prolapse
anal fissures
fecal impaction

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44
Q

lifestyle modificaitons for constipation

A

increase physical activity
eat high fiber foods
increase fluid intake

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45
Q

diarrhea that has abomdinal pain, possible fever, tenesmus, fecal luekocytes. Resolves within 4-5 days

A

Shigella

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46
Q

what exacerabtes IBS

A

stress and irritants in the intestinal lumen

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47
Q

most common cause of gastroenteritits

A

enterovirus

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48
Q

if there is bilous vomitus where is the obstruction?

A

Distal to ampulla of Vater

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49
Q

vomitting of undigested food indicated what?

A

esophageal problem, achalsia, stricture, diverticulum

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50
Q

what can projective vomiting indicate?

A

increased intracranial pressure or pyloric stenosis

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51
Q

most common electorlyte abnormality after severe vomitting

A

hypokalmeia w/ metabolic alkalosis

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52
Q

best fluid replacement to use w/ dehydration from vomiting

A

1/2 NS w/ K+ replacement

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53
Q

meds used to help w/ N/V

A

prochloperazone (comparzine)

promethazine (phenergan)

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54
Q

what type hemorrhoids are more painful

A

external

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55
Q

Risk factors for hemorrhoids

A 
constipation
pregnancy
portal HTN
obesity
prolonged sitting
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56
Q

when are extneral hemorrhoids painful?

A

when they are thromboses where there is painful swelling w/ ulceration, blood. Can do surgery on

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57
Q

non-med treatment for hemorrhoids

A 
sitz bath
ice packs
stool softeners
high fiber, high fluids diet
topical steroids
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58
Q

Surgical tx used for internal hemorrhoids

A

rubber band ligation

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59
Q

3 most common causes of LBP

A

musculoligamentous strain, degnerative disk disease, facet arthritits

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60
Q

factors that exacreabate disk herniation pain

A

Coughing/ sneezing

foreward flevsion

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61
Q

how long must LBP exist for it to be considered chronic

A

> 12 weeks

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62
Q

LBP + bladder dysfunction, saddle anesthesia

A

cauda equina syndrome

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63
Q

TX for cauda equina syndrome

A

surgical emergency. Need MRI ASAP

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64
Q

risk facto for chronic LBP

A

obesity, older age, sedentary work, physically strenuous work, low education, worker’s comp

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65
Q

patient has leg pain on back extension and pain worsense w/ standing or walking

A

spinal stenosis

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66
Q

foreward slippage of cephalad vertebrae on the caudal vertebra. Most common at L4-L5 and L5-S1. Often co-exists w/ spinal stenosis – neurogenic claudication

A

spondylolisthesis

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67
Q

Tx for lumbar disc ehrniation

A

anti-inflammatory meds, PT, epidural steroid injections.

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68
Q

when is spinal stenosis worse

A

when walking, relieved with sitting. foward flexion improves symptoms

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69
Q

what can multiple compressoin fractures in the spine lead to

A

kyphosis in the thoracic spine

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70
Q

At what spine level is the nerve for hip flexion

A

L2

71
Q

at what spine level is the nerve for ankle platna flexion

A

S1

72
Q

what what spine level is the nerve for knee extension

A

L3

73
Q

at what spine level is the nerve for great toe dorsiflexion

A

L5

74
Q

When should you get imaging for low back pain

A 
progressive neuro deficieits
osteoporosis or prolonged stoeroid use
constitutional symptoms (fever, weight loss)
IV drug use
recent trauma
75
Q

when can surgery be a good option for neck pain

A

with radicular arm symptoms

76
Q

what is the most common cause of cervical radiculopathy

A

cervical spondylosis (osteoarthritits) and disc herniation

77
Q

Best test to diagnose nerve root compression of neck

A

MRI of cervical spine

78
Q

Tx for cervical radiculopathy

A

NSAIDs, time, PT, epidural injections

79
Q

Neurologic dysfunction secondary to spinal cord compression in the cervical spine.

A

Cervical myelopathy

80
Q

earliest symptom of cervical myelopathy

A

gait disturbance , an have loss of hadn dexterity, bowel and bladder dysfunctiona re late findings

81
Q

treatment for cervical myelopathy

A

surgery to decompress the spinal cord

82
Q

Most common cause of knee pain in older patients

A

osteoarthritits

83
Q

if a patient presents with patellofemolar pain (anterior knee pain) how should it be treated?

A

PT to strength and stretch quads/ hamstrings

84
Q

syndrome typically seen in athletes w/ overuse injuries. Patients ahve pain along medial patella and feel snapping with walking and intermittent effusion.

A

Plica syndrome

85
Q

Tx for plica syndrome

A

PT, Anti-infalmmatories, steroid injections. Can do arthroscopic release of plica if that fails

86
Q

most common ankle ligametn injuired

A

ATFL- anterior talofibular ligament

87
Q

3 ligaments on the lateral side of the ankle

A

ATFL (anterior talofibular ligament)
calcenofibular ligament (CFL)
posterior talofibular ligament

88
Q

Are medial ligament (deltoid ligaments) injured in an ankle sprain?

A

No

89
Q

Tx for ankle sprain

A

RICE and PT

90
Q

What is the ATFL ligament located?

A

anterior tip of distal fibular

91
Q

what is the most common cause of shoulder pain

A

Supraspinatus (rotator cuff) tendinitits- impingement syndrome

92
Q

Where is pain w/ impingement syndrome

A

Subacromially on the lateral aspect of teh shoulder with arm in abduction

93
Q

Tx for impingement syndrome

A

PT, subacrominal steroid injection

94
Q

Caused by inflammation/ degeneration of the extensor tendons of the forearm which originates ont eh alteral epicondyle

A

Lateral epicondyliitits (“tennis elbow)

95
Q

What causes tennis elbow

A

excessie/ repetitive supination/ pronation

96
Q

Tx for lateral epicondylitits

A

spinting the forearm (counterforce brace) Don’t wrap the elbow itself!! PT often helpful

97
Q

pain distal to medial epicondyle htat is caused by overuse of the flexor pronator muscle. Exacerbated by wrist flexion

A

Medial epicondylitits (golfer’s elbow)

98
Q

Where does pain w/ hip osteoarthritits often present

A

groin pain

99
Q

Pain at the radial aspect fo the wrist (espeically w/ pinch gripping) in region of radial styloid. Common for pain to radiate to elbow or into thumb

A

De Quervain’s disease

100
Q

What causes De Quervain’s disease

A

Inflammation of the abductor pollicis longus and extensor pollicis brevis tendons

101
Q

What is the Finklestein’s test (for De Quervain’s disease)

A

have patient clench the thumb under the other fingers when making a first then ulnarly deviate the wrist.

102
Q

Tx for de Quervain’s disease

A

Thumb spica splint and NSAIDs. local cortisone injections can be helpful

103
Q

common cause of lateral hip pain. Greater tronachter is exquisitely painful on palpation

A

Trochanteric bursitits

104
Q

Tx for trochanteric bursitis

A

NSAIDs, activity modification. Local cortisone injections may be helpful

105
Q

caused by median nerve compression leading to numbness and pain in the mdian nerve distrubtion

A

Carpal tunnel syndrome

106
Q

Tap median nerve at wrist crease , will lead to paresthesias in the mdian nerve

A

Tinel’s sign

107
Q

Palmar flexion of teh wrost for 1 minutes causes paresthesias in the mdian nerve

A

PHalen’s test

108
Q

Definitive diagnosis of CTS

A

EMG and NCV

109
Q

TX for CTS

A

wrist splints worn at night during sleep to prevent wrist flexion, NSAIDs, local corticosteroidsteroid injections, surgical release

110
Q

degeneration of cartilage due to wear and tear and by hypertrophy of bone and articular margins

A

Osteoarthritits

111
Q

Risk factors for OA

A

age, obesity, excessive joint loading, trauma, altered joint anatomy, hemophilia

112
Q

X-ray findings in osteoarthritits

A

Joitn space narrowing, osteophytes, subchondral sclerosis, subchondral cysts

113
Q

Bony overgrowth and significant osteoarthritic chagnew at the PIP

A

Bouchard’s nodes

114
Q

Bony overgrowth and significant osteoarthritits changes at the DIP

A

Heberden’s nodes

115
Q

Tx for OA

A

avoid excessive use of joint
weight loss, PT
use canes or cruthces to reduce weight on joint
APAP is 1st line
cortisone injecitons (up to 3-4 per year)

116
Q

if a patient has left knee pain which hand should the cane be in?

A

right

117
Q

Causes of secondary osteoporosis

A

Excess steroid therapy/ Cushing’s syndrome, immobilization, hyerpthyroidism, long term heparin, hypogonadism in men, mit D deficiency

118
Q

mainstay of therapy for osteoporosis

A

Exercise program with calciu, Vit D

119
Q

fracture in distal radius usually due to fall on an outstretched hand

A

Colles fracture

120
Q

ostoepenia T score

A

_1.0 to -2.5

121
Q

t score less than or equal to -2.5

A

osteopororsis

122
Q

indications for DEXA

A

women 65, postmenopausal women <65 w/ one or more risk factors

123
Q

when should DEXa scan be repeated if normal

A

3-5 years

124
Q

labs to r/o secondary causes of osteopororisi

A

calcium, phosphorus, alkaline phosphatase, TSH, vit D, free PTH, creatinine, CBC

125
Q

bisphosphonate indications for osteopororsis

A

T score 2.5 or less of fragility fracture

126
Q

ADRs of oral bisphosphonates

A

reflux, esophageal irritation and ulceration

127
Q

most common causes of visual impairment in developed countries

A

diabetic retinopathy (65 years)
cataracts
glaucoma

128
Q

loss of central vision, blurred vision and scotoma.

A

Age- related macular degeneration

129
Q

risk factors for ARMD

A

female gender, causcasian race, smoking, HTN, family hx

130
Q

2 categories of ARMD

A

exudative (wet) and nonexudative (dry)

131
Q

what type of ARMD causes sudden visual lause due to leakage of serous fluid and blood as a result of abnormal vessel formation under the retina

A

exudative ARMD

132
Q

what type ARMD has rusen under the pigemnt epithelium and can be seen with an opthalmoscope

A

nonexudative ARMD (dry)

133
Q

Tx for chronic open angle glaucoma

A

Beta blocker, alpha agonist, carbonic anyhydrase inhibition

134
Q

Tx for acute angle closure glaucoma

A

Laer or surgical iridectomy

135
Q

most common organism for viral conjunctivitis

A

adenovirus

136
Q

most common cause of bacterial conjunctivitits

A

S. pneumoniaea

137
Q

Tx for bacterial conjuncitivits

A

Erythromycin, ciprofloxacin, sulfacetamide

138
Q

Sudden, transient monocular loss of vision due to emboliation of cholesterol plaque from teh carotid arterial system

A

amaurosis fugax

139
Q

Workup for amaurosis fugax

A

carotid US, cardiac work up (lipid profile, ECG)

140
Q

risk factors for OSA

A

obesity (espeicailly around neck), enlarge tonsils, uvula, nasal polyps, dviated septum, family hx, hypothyroidism

141
Q

Features of OSA

A

snoring, daytime sleepiness, intellectual function decreased, HTN, cardiac arrhythmias , morning headaches, polycythemia

142
Q

diagnosis of OSA

A

polysomnography

143
Q

Tx of mild to moderate OSA

A

weight loss, avoid alcohol and sedatives, avoid suprine position during sleep

144
Q

For severe OSA what is the tx

A

CPAP to present occlusion of the upper pharynx, resmoval of redudant tissue in the oropharynx , tracheostomy is last resort

145
Q

loss of muscle tone that generally occurs w/ intense emotional stimuli

A

cataplexy

146
Q

tx for narcolepsy

A

methylphenidate (Ritalin), planed naps during the day

147
Q

what causes conductive hearing loss

A

lesions in external or middle ear that interference w/ mechanical reception or amplification fo sound

148
Q

what causes sensorineural hearing loss

A

lesions in the cochlea or CN VIII (auditory branch)

149
Q

most common cause of conductive hearing loss

A

cerumen impaction

150
Q

bony outgrowths of external auditory canal related to repetitive exposure to cold water

A

Exostoses

151
Q

gradual, symmetric hearing loss accosiated w/ aginging

A

prebycusis

152
Q

drugs that can cause hearing loss

A

aminoglycoside abx, furosemic, cisplatin, quinidine

153
Q

sensorineural hearing loss, (U/L), pressure in ear, tinnitus, vertigo

A

Meniere’s disease

154
Q

Tx for meniere’s disease

A

for vertigo- dietary salt restriction and meclizine. hearing los is progressive

155
Q

tx for cerumen impaction

A

irrigation after several days of softening w/ carbamide peroxide, or triethanolamine

156
Q

for conductive hearing loss where will sound laterize on the Weber test

A

To the affected size

157
Q

In which type of hearing loss will the RInne test be abnormal

A

ocnductive loss

158
Q

In snesorinueral haering loss which side will the Weber test lateralize to?

A

The unaffected side

159
Q

what is the most common king of incontinence in eldelry patients

A

urge incontinence

160
Q

in women <70 what is the most common type of incontinence

A

stress in continence

161
Q

increase intra-abomdinal pressure (cough, laugh) causes urine loss

A

stress incontinence

162
Q

what causes urge incontinence

A

detrusor instability

163
Q

sudden urge to urinate, loss of large volumes of urine w/ small postvoid residual

A

urge incontinence

164
Q

management of urge incontinence

A

bladder training exercises. Meds include anticholinergic med (oxybutynin, TCAs (imipramine)

165
Q

managemetn of stress incontinence

A

Kegel exercises, estrogen replacement therapy, use of a pessary, surgery

166
Q

Who is overflow incontinence common in

A

patient w/ neurologic disorders- have inadequate bladder contractions

167
Q

Tx for overflow incontinence

A

intermittent self cath, cholinergic agents (bethanechol), alpha blockers to decrease sphincter resistance

168
Q

most common cause of fatigue

A

depression or anxiety

169
Q

risk factors for ED

A

HTN, smoking, hyperlipidemia, DM

170
Q

what causes wernicke’s encephalopathy (nystagmus, ataxia, ophthalmoplegia, confusion)

A

thiamine deficiency, seen in alcoholism

171
Q

partial agonist at the alpha4-beat-2 subunit of the nicotinic Ach receptor used for smoking cessation

A

Varenicline

172
Q

what vaccinations fo asplenic patients need

A

Hib vaccine, meningococcal and puneumococcal vaccines

173
Q

who should get the pneumococcal polysaccharide vaccine?

A

Adults >65, sickle cell disease, asplenia, chronic medical problems

174
Q

who should get the shingles vaccine?

A

adults >60

Family Med (3 decks)

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