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Step Up To Medicine DF > Ambulatory Section > Flashcards

Ambulatory Section Flashcards

1
Q

DD for headache

A

VOMIT

Vascular: hemorrahge, hematoma, temporal arteritis

Other: malignant HTN, pseudotumor cerebri, postlumbar puncture, pheo

Meds: nitrates, alcohol withdrawal, chronic analgesics

Infection: meningitis, encephalitis, abscess, sinusitis, herpes zoster, fever

Tumor

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2
Q

2ndary causes of hyperlipidemia

A

PM REC
(M: GET Bent)

Pregnancy
Meds: Glucocorticoids, Estrogens, Thiazides, B-blockers

Renal dz: nephrotic syndrome and uremia
Endocrine: DM, cushing, hypothyroid
Chronic liver disease

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3
Q

recommendations for statin therapy

A

1) anyone with LDL 190 or above
2) 40-75 and DM and LDL over 70
3) ASCVD present
4) 40-75 no DM but 10 yr risk ASCVD 10% or higher

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4
Q

treatment for tension headache

A

find casual factor like depression or anxiety

then nsaids and acetaminophen and asa

migraine meds if severe

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5
Q

first line treatment for cluster headache

A

oxygen and triptan

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6
Q

prophylaxis for cluster headache

A

most responsive of all HA types

1) verapamil
2) ergotamine, methysergide, lithium, prednisone alternatives

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7
Q

treatment for migraines

A

NSAIDs, tylenol if mild,
DHE or triptan if don’t work

Sumatriptin

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8
Q

DHE MOA, use, and contraindications

A

5HT-1 agonist

terminate pain migraine

contraindications in: CAD, pregnancy, TIAs, PAD, sepsis

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9
Q

sumatriptin MOA and contraindications

A

5HT1 receptor agonist

contraindications: CAD, pregnancy, uncontrolled HTN, basilar artery migraine, hemiplegic migraine, MAOI, SSRI or lithium use

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10
Q

prophylaxis for migraine

A

consider in pts with weekly episodes that interfere with activities

TCAs and B-Blockers (propranolol most effective)

alt: verapimil, valproic acid, methysergide

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11
Q

menstrual migraine and treatment

A

occurs btwn 2 days before menstruation and the last day of menses

treatment: normal migraine and estrogen

prophylaxis is NSAID

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12
Q

acute cough length vs chronic

A

less than 3 = acute

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13
Q

patient who had migraine headache and no meds work. probably what

A

porbably not a migraine HA

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14
Q

treatment for acute bronchitis

A

bronchodilators and cough suppressants

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15
Q

which sinusitis may mimic pain of dental caries

A

maxillary sinusitis

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16
Q

chronic sinusitis last how long

A

2-3 months

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17
Q

pts with history of multiple sinus infections and courses of abx are at risk for infection with what

A

S aureus and gram negative rods

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18
Q

if pt has cold for longer than how many days then think bacterial sinusitis

A

8-10 days

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19
Q

antibiotics for sinusitis

A

augmentun, bactrim, levo/moxiflox, cefuroxime

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20
Q

treatment for chronic sinusitis

A

penicillinase resistant abx

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21
Q

laryngitis most commonly caused by what

A

virus

possible m cat or h influe

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22
Q

centor criteria, how many points for abx automatically

A

4 or more

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23
Q

centor criteria, how many points for culture

A

2,3

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24
Q

treatment for strep

alternative for allergy

A

PCN 10 days

erythromycin if pt allergic to PCN

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25
Q

initial treatment of GERD

A

behavior mod, antacids and H2 blocker

then PPI if above fails

surgery last resort

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26
Q

important parts of history in pts with diarrhea

A 
is there blood
fever, abdominal pain, vomit?
sick contacts?
travel outside US?
linked to certain foods?
medical problems?
recent changes in meds?
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27
Q

acute diarrhea and h and P shows complications then what is next

A

microscopic exam of stool for WBCs

positive then check for C diff
-if neg and diarrhea persist longer than expected can do flex sigmoid with bx

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28
Q

indications for diagnostic studeis in diarrhea

A 
chornic 
severe illness or high fever
blood in stool
severe abdominal pain
ICP
volume depletion
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29
Q

what tests to order if ordering for diarrhea

A 
CBC
stool sample (check for leukocytes)
ova and parasites
c diff culture and toxic
giardia antigen
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30
Q

abx in what diarrhea

A

infectious diarrhea, decrease illness by 24 hours

cipro

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31
Q

abx in diarrhea when

A

high fever, bloody stools, severe
stool culture grows pathogenic organism
traveler’s diarrhea
C diff infection

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32
Q

causes of constipation

A 
diet (lack fiber)
meds (lanticholinerg, CCBs, iron, narcotics)
IBS
obstruction
ileus
hemorrhoids, fissures
endocrine: hypothyroid, hypercalcemia, hypokalemia, uremia, dehydration
neuromuscular disorders
hirschsprung
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33
Q

the most common electrolyte/acid base abnormality seen with severe diarrhea is what

A

metabolic acidosis and hypokalemia

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34
Q

endocrine causes of constipation

A

hypothyroid, hypokalemia, hypercalcemia

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35
Q

diagnosing constipation

A

think labs for TSH, calcium, CBC (CRC suspected) electrolytes (obstruction suspected)

always r/o obstruction, may need abdominal films and flex sig

rectal exam

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36
Q

how long should sx be present for IBS to be diagnosed

A

3 months

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37
Q

Rome III diagnostic criteria for IBS

A

recurrent abdominal pain/discomfort 3 days or more per month in last 3 months and 2 or more of the following:

1) pain/discomfort improves with pooping
2) sx onset associated with change in freq of stool
3) sx onset associated with change in form of stool

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38
Q

treatment of IBS

A

diet and lifestyle change if mild

diarrhea: diphenoxylate, loperamide
constipation: psyllium, cisapride, colace
abdominal pain: antispasmodics
-pinaverium, trimebutine, cimetropium/dicyclomine, antidepressants, firaximin

39
Q

treatment for hyperemesis gravidarum

A

promethazine

40
Q

treatment for hemorrhoids

A 
sitz baths
ice pack
stool softener
high fiber 
topical steroids

band ligation for internal hemorrhoids
surgical if conservative methods do not work

41
Q

nonexudative ARMD or dry mac dengen cause and sx

tx

A

atrophy and degen of central retina

yellow white deposits called drusen form

vitamins

42
Q

tx for wet ARMD

A

(ranibizumab) anti-VEGF inhibitors maybe photocoag

43
Q

chronic open angle glaucoma treatment

A

a agonist
b blocker

carbonic anhydrase inhib
prostaglandin analogue

44
Q

acute angle closure glaucoma treatment

A

emergency

timolol, brimonidine, pilocarpine, prednisolone drops
IV acetazolamide
oral mannitol

laser or surgery is definitive treatment

45
Q

keratoconjunctivitis sicca is another name for what

A

dry eye

46
Q

blepharitis associated with what infection

A

staphylococcus

47
Q

scleritis is associated with what disease

sx
pain with what
tx

A

RA

eye pain, severe and deep

pain on palpation of eyeball

systemic corticosteroids

48
Q

acute anterior uveitis associated with what disesaes

A

sarcoid, ankylosing spondylitis, reiter syndrome and IBD

49
Q

dendritic ulcer on the cornea that is usually unilateral and can result in irreversible vision loss if untreated

what is treatment

A

Herpes simplex keratitis

topical gancyclovir gel
oral acyclovir or valcylovir if cannot tolerate topical therapy

50
Q

bacterial conjunctivitis most commonly caused by what

A

S aureus in adults

51
Q

chlamydial conjunctivitis

trachoma (serotypes A,B,C)

inclusion conjunctivitis (D and K)

A

trachoma: most common cause of blindness

D and K: genital hand eye contact with STI

52
Q

allergic conjunctivitis bilateral or unilateral?

A

bilateral usually

53
Q

bacterial conjunctivitis treatment

A

erythromycin, cipro, sulfacetamide

SEC

54
Q

hyperacute gonoccoccal conjunctivitis treatment

A

ceftriaxone 1g IM and topical therapy

55
Q

chlamydial conjunctivitis treatment

A

oral tetra, doxy, erythromycin for 2 weeks

56
Q

sudden transient loss of vision in one or both eyes

what should oyou order

A

amaurosis fugax

carotid ultraounorgraphy and cardiac workup

57
Q

causes of transient monocular vision loss

A

carotid artery disease, cardioembolic phenom, giant cell arteritis, and more

58
Q

treatment for obstructive sleep apnea

A

behavior mod

positive airway pressure therapy

if severe then continuous positive airway pressure
uvolopalatopharyngoplasty
tracheosteomy is last result

59
Q

treatment for narcolepsy

A

modafinil
methylphenidate
or amphetamines

60
Q

conductive hearing loss

A

lesions in external or middle ear

61
Q

conducitve hearing loss from external canal causes

A

cerumen impaction
otitis externa
exostoses (bony outgrowths from exposure to cold water)

62
Q

middle ear conductive hearing loss

A

middle ear effusion, otitis media, allergic rhinitis

otosclerosis (AD condition)
neoplasm, malformations of ear

63
Q

sensorineural hearing loss causes

A

presbycusis (aging), high freq hearing loss and discrimination difficulty

noise induced hearing loss: hair cells of corti damaged

Infection
drug induced
torch infection
meniere disease
CNS causes
64
Q

meniere disease

treatment for vertigo

A

unilateral hearing loss
tinnitus, vertigo, pressure

salt restriction and meclizine for vertigo

65
Q

CNS causes of sensorineural hearing loss

A

acoustic neruomas, meningitis, syphilis, meningioma

66
Q

obstruction to urine flow like BPH, prostate cancer, strictirues, severe constipation cause what kind of incontinence

A

overflow

67
Q

nocturnal wetting in what incontinence

A

urge and overflow

68
Q

diagnoses of incontinence

A

UA to r/o infection and hematuria

postvoid cath
-normal is less than 50 mL, if greater than may be obstruction or hypotonic bladder

urine culture

renal fnct studies with glucose

69
Q

differential diagnosis of fatigue

A 
psychiatric
endocrine
hematologic/oncologic
metabolic
infectious
cardiopulmonary
meds (clonidine, methyldopa)
chronic fatigue syndrome
70
Q

lab workup with fatigue

A 
CBC
TSH
glucose
BMP (electrolyte abnormalities)
UA, BUN/CR
LFT
71
Q

chronic fatigue syndrome

A

fatigue over 6 months not due to medical or psychiatric disorder

A) new or definite fatigue not alleviated by rest
and
B) 4 or more of following sx for at least 6 months
1) decreased short term mem or conentration
2) muscle pain
3) sore throat
4) tender LAD
5) unrefreshing sleep
6) joint pain
7) HAs
8) post exertional malaise for over 24 hours

72
Q

treatment for chronic fatigue syndrome

A

behavioral therapy
antidepressants (if depression too)
NSAIDs for pain

73
Q

most important risk factor for ED

A

atherosclerosis risk factors

74
Q

diagnosing ED

A

DRE, neuro exam, assess for PAD

labs: CBC, chem, glucose, lipids, T levels, prolactin, thyroid

consider vascular testing

psychogenic posible

75
Q

CAGE questions

A

Cut down
annoyed
guilty
eye opener

76
Q

which is reversible with alcohol problems wernicke or korsafoff

A

wernicke

77
Q

screening for hyperipidemia yrs

A

measure nonfasting total cholesterol and HDL every 5 years

78
Q

average risk pts 50-75 yrs old CRC screen

A

colonoscopy q10 yrs
flex sig q5 yrs and fecal occult blood test q3yrs
fecal occult every year

79
Q

screening for someone with family history of CRC or adenomatous polyps in first degree relative

A

colonscopy at age 40 or 10 years younger than the youngest case in family
-if normal repeat in 3-5 years

80
Q

families with FAP, what testing

A

genetic testing at age 10

colectomy if positive needs to be considered
if not positive then colonosopy every 1-2 yrs at puberty

81
Q

families with hereditary nonpolyposis CRC testing

A

genetic testing at age 21

if positive then colonoscopy q2 yrs until 40 then every year after

82
Q

patients with UC screening

A

8 years after diagnosis get colonoscopy then every year after

83
Q

age for high risk adults to get low dose CT of chest when screening for lung cancer

A

55-80

84
Q

when can you D/C pap screens

A

at age 65 with 3 consec neg paps or 2 neg pap with neg HPV testing within last 10 yrs and most recent test within last 5 years

85
Q

ovarian cancer screening rec

A

none

86
Q

all sexually active women under age what should be screened for chlam and gon

A

24

87
Q

hep C screen rec

A

pts at risk and one time screen in pts born btwn 1945-1965

88
Q

what pts screen for hep B

A

at risk

injection drug useres, MSM, hemodialyiss

89
Q

DM screen

A

BMI at or over 25 and one risk factor for diabetes

test every three years

adults without risk factors start at age 45

90
Q

pneumococcal polysaccharide PPSV23 and PCV13 vaccine schedule

A

adults over 65 get PPSV23

age 19-64 with ICP, asplenia, kidney disease, CSF leak, or cochlear implants get PCV13 then PPSV23 8 weeks later

adults with chronic problems like COPD and DM get PPSV23 before 65

91
Q

Tdap primary series

A

1, 1-2 months, 6-12 months

92
Q

booster of tdap

A

booster every 10 years Td

people over 19 should have 1 booster of Tdap instead of Td

93
Q

varicella zoster vaccine

A

adults over 60

94
Q

hepatitis B primary schedule

A

0, 1, 6 months

Step Up To Medicine DF (2 decks)

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