Ambulatory Section Flashcards
DD for headache
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
2ndary causes of hyperlipidemia
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
recommendations for statin therapy
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
treatment for tension headache
find casual factor like depression or anxiety
then nsaids and acetaminophen and asa
migraine meds if severe
first line treatment for cluster headache
oxygen and triptan
prophylaxis for cluster headache
most responsive of all HA types
1) verapamil
2) ergotamine, methysergide, lithium, prednisone alternatives
treatment for migraines
NSAIDs, tylenol if mild,
DHE or triptan if don’t work
Sumatriptin
DHE MOA, use, and contraindications
5HT-1 agonist
terminate pain migraine
contraindications in: CAD, pregnancy, TIAs, PAD, sepsis
sumatriptin MOA and contraindications
5HT1 receptor agonist
contraindications: CAD, pregnancy, uncontrolled HTN, basilar artery migraine, hemiplegic migraine, MAOI, SSRI or lithium use
prophylaxis for migraine
consider in pts with weekly episodes that interfere with activities
TCAs and B-Blockers (propranolol most effective)
alt: verapimil, valproic acid, methysergide
menstrual migraine and treatment
occurs btwn 2 days before menstruation and the last day of menses
treatment: normal migraine and estrogen
prophylaxis is NSAID
acute cough length vs chronic
less than 3 = acute
patient who had migraine headache and no meds work. probably what
porbably not a migraine HA
treatment for acute bronchitis
bronchodilators and cough suppressants
which sinusitis may mimic pain of dental caries
maxillary sinusitis
chronic sinusitis last how long
2-3 months
pts with history of multiple sinus infections and courses of abx are at risk for infection with what
S aureus and gram negative rods
if pt has cold for longer than how many days then think bacterial sinusitis
8-10 days
antibiotics for sinusitis
augmentun, bactrim, levo/moxiflox, cefuroxime
treatment for chronic sinusitis
penicillinase resistant abx
laryngitis most commonly caused by what
virus
possible m cat or h influe
centor criteria, how many points for abx automatically
4 or more
centor criteria, how many points for culture
2,3
treatment for strep
alternative for allergy
PCN 10 days
erythromycin if pt allergic to PCN
initial treatment of GERD
behavior mod, antacids and H2 blocker
then PPI if above fails
surgery last resort
important parts of history in pts with diarrhea
is there blood fever, abdominal pain, vomit? sick contacts? travel outside US? linked to certain foods? medical problems? recent changes in meds?
acute diarrhea and h and P shows complications then what is next
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
indications for diagnostic studeis in diarrhea
chornic severe illness or high fever blood in stool severe abdominal pain ICP volume depletion
what tests to order if ordering for diarrhea
CBC stool sample (check for leukocytes) ova and parasites c diff culture and toxic giardia antigen
abx in what diarrhea
infectious diarrhea, decrease illness by 24 hours
cipro
abx in diarrhea when
high fever, bloody stools, severe
stool culture grows pathogenic organism
traveler’s diarrhea
C diff infection
causes of constipation
diet (lack fiber) meds (lanticholinerg, CCBs, iron, narcotics) IBS obstruction ileus hemorrhoids, fissures endocrine: hypothyroid, hypercalcemia, hypokalemia, uremia, dehydration neuromuscular disorders hirschsprung
the most common electrolyte/acid base abnormality seen with severe diarrhea is what
metabolic acidosis and hypokalemia
endocrine causes of constipation
hypothyroid, hypokalemia, hypercalcemia
diagnosing constipation
think labs for TSH, calcium, CBC (CRC suspected) electrolytes (obstruction suspected)
always r/o obstruction, may need abdominal films and flex sig
rectal exam
how long should sx be present for IBS to be diagnosed
3 months
Rome III diagnostic criteria for IBS
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
treatment of IBS
diet and lifestyle change if mild
diarrhea: diphenoxylate, loperamide
constipation: psyllium, cisapride, colace
abdominal pain: antispasmodics
-pinaverium, trimebutine, cimetropium/dicyclomine, antidepressants, firaximin
treatment for hyperemesis gravidarum
promethazine
treatment for hemorrhoids
sitz baths ice pack stool softener high fiber topical steroids
band ligation for internal hemorrhoids
surgical if conservative methods do not work
nonexudative ARMD or dry mac dengen cause and sx
tx
atrophy and degen of central retina
yellow white deposits called drusen form
vitamins
tx for wet ARMD
(ranibizumab) anti-VEGF inhibitors maybe photocoag
chronic open angle glaucoma treatment
a agonist
b blocker
carbonic anhydrase inhib
prostaglandin analogue
acute angle closure glaucoma treatment
emergency
timolol, brimonidine, pilocarpine, prednisolone drops
IV acetazolamide
oral mannitol
laser or surgery is definitive treatment
keratoconjunctivitis sicca is another name for what
dry eye
blepharitis associated with what infection
staphylococcus
scleritis is associated with what disease
sx
pain with what
tx
RA
eye pain, severe and deep
pain on palpation of eyeball
systemic corticosteroids
acute anterior uveitis associated with what disesaes
sarcoid, ankylosing spondylitis, reiter syndrome and IBD
dendritic ulcer on the cornea that is usually unilateral and can result in irreversible vision loss if untreated
what is treatment
Herpes simplex keratitis
topical gancyclovir gel
oral acyclovir or valcylovir if cannot tolerate topical therapy
bacterial conjunctivitis most commonly caused by what
S aureus in adults
chlamydial conjunctivitis
trachoma (serotypes A,B,C)
inclusion conjunctivitis (D and K)
trachoma: most common cause of blindness
D and K: genital hand eye contact with STI
allergic conjunctivitis bilateral or unilateral?
bilateral usually
bacterial conjunctivitis treatment
erythromycin, cipro, sulfacetamide
SEC
hyperacute gonoccoccal conjunctivitis treatment
ceftriaxone 1g IM and topical therapy
chlamydial conjunctivitis treatment
oral tetra, doxy, erythromycin for 2 weeks
sudden transient loss of vision in one or both eyes
what should oyou order
amaurosis fugax
carotid ultraounorgraphy and cardiac workup
causes of transient monocular vision loss
carotid artery disease, cardioembolic phenom, giant cell arteritis, and more
treatment for obstructive sleep apnea
behavior mod
positive airway pressure therapy
if severe then continuous positive airway pressure
uvolopalatopharyngoplasty
tracheosteomy is last result
treatment for narcolepsy
modafinil
methylphenidate
or amphetamines
conductive hearing loss
lesions in external or middle ear
conducitve hearing loss from external canal causes
cerumen impaction
otitis externa
exostoses (bony outgrowths from exposure to cold water)
middle ear conductive hearing loss
middle ear effusion, otitis media, allergic rhinitis
otosclerosis (AD condition)
neoplasm, malformations of ear
sensorineural hearing loss causes
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
meniere disease
treatment for vertigo
unilateral hearing loss
tinnitus, vertigo, pressure
salt restriction and meclizine for vertigo
CNS causes of sensorineural hearing loss
acoustic neruomas, meningitis, syphilis, meningioma
obstruction to urine flow like BPH, prostate cancer, strictirues, severe constipation cause what kind of incontinence
overflow
nocturnal wetting in what incontinence
urge and overflow
diagnoses of incontinence
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
differential diagnosis of fatigue
psychiatric endocrine hematologic/oncologic metabolic infectious cardiopulmonary meds (clonidine, methyldopa) chronic fatigue syndrome
lab workup with fatigue
CBC TSH glucose BMP (electrolyte abnormalities) UA, BUN/CR LFT
chronic fatigue syndrome
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
treatment for chronic fatigue syndrome
behavioral therapy
antidepressants (if depression too)
NSAIDs for pain
most important risk factor for ED
atherosclerosis risk factors
diagnosing ED
DRE, neuro exam, assess for PAD
labs: CBC, chem, glucose, lipids, T levels, prolactin, thyroid
consider vascular testing
psychogenic posible
CAGE questions
Cut down
annoyed
guilty
eye opener
which is reversible with alcohol problems wernicke or korsafoff
wernicke
screening for hyperipidemia yrs
measure nonfasting total cholesterol and HDL every 5 years
average risk pts 50-75 yrs old CRC screen
colonoscopy q10 yrs
flex sig q5 yrs and fecal occult blood test q3yrs
fecal occult every year
screening for someone with family history of CRC or adenomatous polyps in first degree relative
colonscopy at age 40 or 10 years younger than the youngest case in family
-if normal repeat in 3-5 years
families with FAP, what testing
genetic testing at age 10
colectomy if positive needs to be considered
if not positive then colonosopy every 1-2 yrs at puberty
families with hereditary nonpolyposis CRC testing
genetic testing at age 21
if positive then colonoscopy q2 yrs until 40 then every year after
patients with UC screening
8 years after diagnosis get colonoscopy then every year after
age for high risk adults to get low dose CT of chest when screening for lung cancer
55-80
when can you D/C pap screens
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
ovarian cancer screening rec
none
all sexually active women under age what should be screened for chlam and gon
24
hep C screen rec
pts at risk and one time screen in pts born btwn 1945-1965
what pts screen for hep B
at risk
injection drug useres, MSM, hemodialyiss
DM screen
BMI at or over 25 and one risk factor for diabetes
test every three years
adults without risk factors start at age 45
pneumococcal polysaccharide PPSV23 and PCV13 vaccine schedule
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
Tdap primary series
1, 1-2 months, 6-12 months
booster of tdap
booster every 10 years Td
people over 19 should have 1 booster of Tdap instead of Td
varicella zoster vaccine
adults over 60
hepatitis B primary schedule
0, 1, 6 months
