Anemia + Asthma + CVD + MSK + Joint Flashcards
1
Q
Correct definition about anemia is:
A
- decrease in O2 carrying capacity
- decrease in RBC
- decrease in getting rid CO2
2
Q
Most common cause of anemia
A
IDA
3
Q
How do drugs, acohol, and tobacco cause anemia?
A
Affect Stomach lining causing nutritional anemia
4
Q
What cardiovascular complication is seen with anemia?
A
Ejection systolic murmur\ S3 gallop
5
Q
What are the most important labs in anemia
A
CBC and smear
6
Q
Best lab tool in IDA is:
A
Ferritin
7
Q
Name high MCV + Normal RDW
A
- folic & B12
- Hypothyroidism
- Drug-induced anticonvulsants.
- MDS
- BM failure
8
Q
Name low MCV + high RDW
A
- active hemolysis with brisk reticulocytosis
9
Q
Name Normal MCV + Normal RDW
A
- Chronic disease
- Hemorrhage
- Inflammation (acute)
- Malignancy
- Transient erytheroblastopenia childhood.
10
Q
Name Normal MCV + high RDW
A
- Hemolytic anemia (sickle cell\ G6pd\ membrane\ microangiopathies like DIC & HUS\ immune)
11
Q
Name low MCV + Normal RDW
A
- Sideroblastic anemia
- Lead poisoning
- IDA
- Thalassemia trait
- Chronic disease
12
Q
Name low MCV + high RDW
A
- Thalassemia (HBS-SB)
- HBC & HBE.
13
Q
What will you order if you see low Hg and MCV
A
Lead level - Iron profile - Electrophoresis.
14
Q
What will you order if you see low Hg and normal MCV
A
- electrophersis
- Coomb
- Osmotic fragility
- enzyme assays
- other diseases.
15
Q
What will you order if you see low Hg and high MCV
A
- B12\folic\thyroid screen
- BM aspiration
- hemolysis
16
Q
Normal MCV values is
A
80-100
17
Q
Low:
- MCV
- Iron
- Ferritin
- TIBC
Is:
A
Anemia of chronic diseases
18
Q
Low: - MCV - Iron - Ferritin High - TIBC
Is:
A
IDA
19
Q
Low: - MCV High - Iron - Ferritin
Is:
A
Thalassemia
20
Q
What is the role of mentezer index?
A
Identify thalassemia:
- MCV\RBC < 13
- Iron levels >30
21
Q
Less than (13, 12,11) is mild anemia in …. & … & …..
A
1- male
2- nonpregnant women
3- pregnant women..
22
Q
Is ferritin always right to diagnose IDA?
A
No because it might increase in some cases in reactions
Even if increased, check for TIBC and iron
23
Q
Common risk factors for IDA
A
- increased intrauterine bleeding
- celiac
- NSAID
- Hpylori or peptic ulcer
24
Q
When should we suspect malignancy in IDA?
A
- men
- post menapausal
- RF
- elderly
25
Iron therapy is:
120 elemental iron for 3m
26
How to take iron supplements
Empty stomach, No PPI or calcium, vit D
27
Falsly elevated A1c is due to:
IDA
28
AAP recommends screening for IDA at
1 year
29
UPSTSF VS AAFP\CDC for pregnancy screening of IDA is:
USPSTF: not sufficent data
| But rest recommend it
30
What happens with
| 1- 2 - 3 - and 4 deletions of Hemoglobin A
1: nothing
2: nothing except in pregnancy\illness
3: HBH “splenomegaly & avoid oxidative”
4: hydrops fetalis “not surviving”
31
What is the major drug that should be avoided in G6pd?
Nitrofuritoin for UTI > cause hemolysis
32
If b12 is boarderline low, order:
Homocystine +methylmalonoic
33
Risk factors for future episodes of asthma attacks.
- pregnancy
- use ICS, oral steroid, high use of inhaler
- comorbidities - psychological
- exposure to allergens - eosinphilia
- low FEV1 - ICU admission
34
Most common ICS medication
Budsonide
Fluticasone
Ciclosonide
35
Most common reliever combination therapy is:
- Sertride: salmeterol + fluticasone
| - Simbicort: Formeterol + Budsonide
36
Explain the initiation process of asthma treatment:
1: >20 no RF
2: >20 yes RF - 16 to 19
3: <16
4: <16 severe go for referral.
37
Explain the maintainace process of asthma treatment
- Maintain: >20 for 3 months.
| - Step up: <19
38
How is step 3 different in child <5 than adults?
instead of laba+ICS we double dose the ICS
| “Due to fear of bronchospam)
39
When to step down asthma treatment?
When pts is controlled after 3 months and we can find a minimum therapy to maintain good control
40
What do you recommend patients with adverse effect of medications?
- change medics or decrease dose\frequency
- anti-fungal therapy for severe thrush
- wash mouth after use
- use spacer
41
How to evaluate moderate asthma acute attack
Full sentence, agitated alert, may\not use accessory.
- RR:20-30
- HR:<120
- SaO2: >92
- PEFR: 50-70%
42
How to treat moderate asthma?
```
1- O2 to keep saturation
2- nebulization or MDI of salbutamol
3- oral prednisone STAT
4- discharge & Start on step 3
5- close follow up
```
43
How to treat severe and life-threatning asthma
```
1- O2
2- Salbutamol nebulizer
3- oral prednisone or 100-200 IV hydrocortisone
4- ipratropium
5- referral
```
44
Pediatric assessment score for acute asthma attack
- scalene muscle contraction
- suprasternal retraction
- air entry
- O2 sat.
45
A child with acute asthma attack and pram 1-3, how to manage
1- O2
2- Salbutamol Q20 for 2 doses
3- ipratropium or oral steroid
4- reassess
46
What test is used to confirm bronchial asthma?
Spirometery with reversibility test
47
A patient with known asthma present with acute presentation, what could be the cause other than asthma?
- Viral infection
- pnemonia
- smoke
- exercise
- rhinosinusitis
- GERD
- Obesity
- B-blocker, asprin & NSAID usage.
- sleep disorders
48
What are the findings in asthma examination
- bilateral expiratory wheez
| - high pitch
49
Reversibility improvement in spriometery with bronchodilator is:
FEV1 (12%) + 200ml
50
When to preform spiromentery in children?
At 6 years
51
How to diagnose child with asthma?
More than 3 attacks of SOB or Wheeze in one season with more than 2 weeks of cough
52
How to diagnose child below 6 years with asthma
```
Wheeze of >3 episodes
+
(1 major) Atopy , Family hx, skin test
+
(2 minor) Eosinophilia, food allergy
```
53
How much is the recommended physical activity?
- 150\w of moderate
| - 75\w of vigorous
54
When do we start screening men for dyslipidemia?
- No risk: 35
| - Risk: 20
55
When do women start screening men for dyslipidemia?
- No risk: 45
| - Risk: 20
56
When are men and women are at similar risk for dyslipidemia?
- post\early menapause
| - premature ovarian failure
57
What are the secondary causes of dyslipidemia?
- Diet: anorexia - high fat diet
- Medications: Steroid - diuretics - amiodarone.
- Medical conditions: hypothyroidism - pregnancy - nephrotic syndrome
58
Name high intensity statin agents:
| and how much it decreases?
- Atorvastatin 40-50
- Rosuvstatin 20-40
(50%)
59
Name moderate intensity statin agents:
- Atorva 10-20
- Rosuva 5-10
- Simva 20-40
30-49%
60
Name low intensity statin agents:
Simvastatin 10mg
61
When to start patients aged 0-19 on statin?
When they have hypercholestermia in the family
62
When to start patients aged 20-39 on statin
- family history
- premature ASCVD
- LDL >160
63
Normal population to start statin:
Above 40
64
What is the cut-off point for diabetes starting high intensity statin?
20% or LDL >190
65
When to consider CAC?
Between 5-<7.5
Anything from 1 and above favors statin
If >100 initiate immidiatly
66
What are the risk enhancers for ASCVD risk score:
- family history of premature
- LDL >160
- women condition
- metabolic syndrome
- ethnicity
- inflammatory disease
- kidney diseases
- elevated CRP- LpA-ApoB
- nephorpathy, retinopathy, neuropathy.
67
How to differentiate myalgia, myositis, rhabdomyolysis in statin therapy?
- Myalgia: Normal CK
- Rhabdomylsis: CK<10x ULN
- Myositis: more than ULN
68
In which group of population do you expect to see myalgia?
Young - female - thin - athletes - alcohol - drugs on liver metabolism
69
Statin works primary on:
| Liver - kidney
Liver
70
When to stop statin therapy?
- If ALT\AST is elevated 3x ULN
| - Before 3m of conception & in breast-feeding.
71
After statin therapy [initiation], when to repeat lipid profile test?
And for [maintenance]
- After 1m - 3m.
| - After 3-12m
72
Statin intolerance is common in:
- Old
- Female
- Hypothyroidism
- Alcoholic
- Hemorrhagic stroke
73
What are the baseline laboratory investigations for statin therapy?
[TSH - BHCG - Liver\renal function - CK - Hb1c - vitamin D]
74
Do you stop statins if the GFR is below <30?
You only stop rousvastatin, but the rest decrease their doses.
75
What are the side effects of gum and lozange in smoking cessation therapy?
Hiccups and dyspepsia (avoid food\drinks)
76
When to initiate aspirin therapy?
Age 40-70 with no previous risk of bleeding and ASCVD of >20%
77
Most important risk enhancers for ASCVD are:
- LDL>160
| - Family Hx of premature ASCVD
78
What is your next step when you see your patient with BP >160\100
Look for target oran damage.
79
When can you immediately diagnose patients w\HTN without any further testing?
- Hypertensive emergency
- Asymptomatic severe HTN >180\120
- target organ damage.
80
Differences between left and right arm in BP measurement is due to:
Subclavian stenosis (PVD)
81
Postural hypotension measurment should be in:
1- elderly >65
2- DM
3- dizziness
82
Hypertension in African American is:
- earlier
- Severer
- commoner
83
Elevated systolic BP is usually attributed to which cause?
Age
84
Major categories of OTC medications to be avoided in HTN?
- NSAIDs
- OCP
- Antacids
- Decongestants
- Corticosteroids
- antidepressants & atypical antipsychotics
85
A patient presents with [HTN + Hypokalemia + Metabolic alkalosis]
Is suspected to have:
Primary aldosteronism
86
Endocrine disorders that may cause secondary HTN are
- Hyper & hypothyroidism
- Hyperparathyroidism
- Cushing
- Pheochromocytoma
- primary aldosteronism
87
When to screen for HTN annually and when to screen semi-annually?
- annually: anyone above 18
| - Semiannually: anyone with risk factor (prehypertensive - obese)
88
Typical findings in HTN fundoscopy examinations?
- Cotton wool spots
- arteriolar narrowing\nicking
- hemorrhage
- papillodema.
89
Initial tests in newly diagnosed HTN:
- electrolyte & creatinine
- urinalysis
- glucose
- TSH
- lipid
- ECG + ASCVD.
90
Who should you start antihypertensive medications with
1- stage I: w\ [ASCVD 10% - DM - Kidney - 65 - CVD]
| 2- stage 2: any patient.
91
Drug of choice for black patient with HTN?
Thiazide or CCB
92
Drug of choice in renal impairment w\HTN:
ACE or ARB
93
Drug of choice in HF w\HTN:
B-blocker
94
Compelling indications for HTN in
- Angina
- Afib\flutter
- CKD
- B-blocker\CCB
- B-blocker\CCB “non-hydro”
- ACE\ARB
95
Favorable indications for HTN in
- BPH
- tremor\Hyperthyroidism
- Migrane
- osteoprosis
- raynoids
- Alpha blocker
- B-blocker
- B-blocker
- Thiazide
- CCB
96
antihypertensive Medications that are contraindicated in
| - Bronchospastic disease:
- B-blocker
97
antihypertensive Medications that are contraindicated in
- Liver disease:
Methyldopa
98
antihypertensive Medications that are contraindicated in
| - pregnancy:
ARBs or ACE
99
antihypertensive Medications that are contraindicated in
- Heart block
B-blocker
100
antihypertensive Medications that are contraindicated in
- Gout:
Thiazide diuretics
101
antihypertensive Medications that are contraindicated in
- Hyperkalemia
Aldosterone antagonist
102
antihypertensive Medications that are contraindicated in
- Hyponatermia
Thiazide
103
antihypertensive Medications that are contraindicated in
- renovascular disease
ACE and arb
104
Most common combination therapy is:
ACE\ARB + CCB
105
In which group of patients would you IMMEDIATELY start combination therapy?
+20 Systolic\+10 diastolic of their goal BP.
106
When do you switch amoldipine (Dihydropyridine) to verapmil\diltizam (non-Dihydropyridine)
Leg swelling
107
What is drug resistant HTN?
[3 HTN medics] one of them is Diuretic.
108
Function of the rotator cuff:
| SITS
Supra: Abduction
Infraspinatus: external rotation
Teres minor: External rotation
Subscapularis: internal rotation.
109
Posterior vs anterior shoulder dislocation:
Posterior: inability to external rotation
Anterior: inability to internal rotation
110
Scapular winging is due to
Serratus anterior muscle injury + Thoracic nerve.
111
Throwing atheletes are common to develop:
Labrum injury (cluncking shoulder in above head motion)
112
The test for all ranges of motion
Apley scratch test
113
Rotator cuff tests are:
- Resisted external rotation
- Drop arm
- empty can test
114
Impingement tests are:
Hawkins & neer
115
Explain Hawkin’s - Neer test:
- Flexion -flexion - internal rotation
| - internal rotation - flexion
116
How to test for biceps tendinitis:
- Speed’s: Resist shoulder flexion after 30
| - yargson’s: flexion + Resist pronation.
117
To test for anterior shoulder laxity:
Apprehension test
118
Sulcus sign indicate:
| And is caused usually by which action?
Inferior shoulder instability.
| Holding heavy object
119
- Overuse of shoulder
- worse w\overhead
- Night time pain
this is typical presentation of:
This is treated by:
- Impingement
| - conservative > corticosteroid injection > surgery (MRI)
120
- old patient
- Fall in overstretched hand (trauma)
- Pain in lateral shoulder
- weakness w\external rotation
this is typical presentation of:
This is treated by:
Rotator cuff tear
| - Surgery (unless not candidates)> rehab.
121
- Old + DM
- Acute shoulder pain + no trauma
- decrease in ROM (active\passive)
this is typical presentation of:
This is treated by:
Adhesive capsulitis
- conservative (2y)> surgery
122
- Young - Fall on his shoulder
- Can’t Abduct\Flex arm
- Palpable coracoid process
- Maintain arm on external rotation
this is typical presentation of:
This is treated by:
Anterior shoulder dislocation
- Surgery if prone to recur (Athletes\military)\No surgery if not prone
123
- Numbness in first 3 fingers
- worse w\working
this is typical presentation of:
This is treated by:
Carpal tunnel
| - splinting\corticosteroid\physio\yoga \theraputic US > surgery if indicated.
124
- pain in dorsal of radial wrist
- Painful ulnar deviation
- worse w\working
this is typical presentation of:
This is treated by:
Dequiverian tensinovitis
- Ice\Analgesic\Spica splinting > corticosteroid injection
125
- catching of thumb
- can flex thumb
- palpable nodule in MCP joint
this is typical presentation of:
This is treated by:
Trigger finger
- NSAID\injection at flexor tendon sheath > surgery.
126
- Unilateral
- worse w\moving
- stiffness <30min
- old\obese
- effusion
- pain in knee joint in medial side
- crepitus\buckling
this is typical presentation of:
Osteoarthritis
127
- back pain after heavy lifting
- no neurological deficit
this is typical presentation of:
MSK back pain
128
Fall on outstretched arm usually causes which type of shoulder dislocation?
Posterior shoulder dislocation
129
The core component for shoulder instability physiotherapy
Rotator cuff strengthening + scapular stabilization
130
Best 2 tests to confirm Carpal tunnel?
1st: flick sign> pain relief w\shaking wrist
2nd: carpal compression
131
In which patient will you only diagnose carpal tunnel clinically and not preform any further testing or surgical recommendation?
- pain is mild
| - pain is associated w\pregnancy
132
Which muscles are affected in dequevarian tenosynovitis?
- Abd pollices longus
| - Extensory pollices brevis
133
Spica splinting VS nocturnal splinting indications in MSK injuries:
- Spica: Dequervian tenosynovitis
| - Nocturnal: Carpal tunnel
134
Name associated clinical findings of osteoarthritis in the knees:
Baker’s cyst + Varus\vulgus
135
Name associated clinical findings of osteoarthritis in the hands:
Heberden\Bouchard
136
Name associated clinical findings of osteoarthritis in the shoulder and hips:
- shoulder: external rotation limitation
| - Hip: internal rotation limitation
137
What are the radiographic findings in osteoarthritis?
Joint narrowing - subchondral sclerosis - osteophytes
138
An important advise you need to give your patients with acute low back due to MSK is to:
Continue with life activity.
139
Oligoarthrtis is defined as
2-4
140
Most common site for gout
1st metatarso - ankle
141
If patient has joint pain\swelling and is known for IV drug abuse, you might suspect?
Septic arthritis by staph.
142
Patient on diuretic is at high risk of developing attacks followed by resolution.
Gout
143
In any patient with 1 joint effusion, next step is to:
Arthrocentesis
144
In any patient with joint pain and trauma, next step is to:
X-ray
145
WBC in gout - osteoarthritis - septic arthritis:
- >2000
- 200-2000
- >50,000
146
Synovial fluid in gout vs psudogout:
- gout: monosodium ureate crystal (needle shaped -ve bifergnce) + poly neutrophils
- psudogout: calcium pyrophosphate & +ve, biferengent, rhomboid
147
In septic arthritis, synovial fluid analysis should include:
Gram stain
148
Gout is more common in
| M/f
Male
149
Characterstics of gout
- tophi
- increased ureate levels (not always and no necessary in acute attacks)
- pain and eryhtema and joint space narrowing
150
Role of plasma ureate
Increase likelihood of gout
151
What is first line treatment for gout
NSAID
152
Prophylaxis of gout is
Allopuranol
153
What are the indications of prophylaxis in gout?
- tophi
- joint destruction
- nephorlithasis
- recurrent 2-3/y
- patient preference
154
Old man with minor (injury) develops joint swelling/pain/low grade fever reduced
Is likely to be:
Psudogout
155
The most common causes for acute monoarthritis in elderly is:
Psudogout
156
First line treatment in psudogout?
Intra-articular steroid injection
157
Septic arthritis is due to
(Trauma - no trauma)
(Associated w/disease - not associated)
(Most prominent symptom is)
- No trauma
- associated
- decrease ROM
158
Diff between psudogout and septic arthritis
- septic could be associated with fever.
| - psudo: associated with trauma
159
Spetic arthritis is usually due to
| Gram (positive - negative) cocci
Positive
160
Treatment of choice for septic arthritis is
AB emperic before results of culture
161
What are the risk factors for septic arthritis?
- old
- immunosuppressed
- OA/RA
- infection spread (hematogeous - contagous)
- prosthesis
- low socioeconmic
- ticks
162
Gout is more common in
| M/f
Male
163
Characterstics of gout
- tophi
- increased ureate levels (not always and no necessary in acute attacks)
- pain and eryhtema and joint space narrowing
164
Role of plasma ureate
Increase likelihood of gout
165
What is first line treatment for gout
NSAID
166
Prophylaxis of gout is
Allopuranol
167
What are the indications of prophylaxis in gout?
- tophi
- joint destruction
- nephorlithasis
- recurrent 2-3/y
- patient preference
168
Old man with minor (injury) develops joint swelling/pain/low grade fever reduced
Is likely to be:
Psudogout
169
The most common causes for acute monoarthritis in elderly is:
Psudogout
170
First line treatment in psudogout?
Intra-articular steroid injection
171
Septic arthritis is due to
(Trauma - no trauma)
(Associated w/disease - not associated)
(Most prominent symptom is)
- No trauma
- associated
- decrease ROM
172
Diff between psudogout and septic arthritis
- septic could be associated with fever.
| - psudo: associated with trauma
173
Spetic arthritis is usually due to
| Gram (positive - negative) cocci
Positive
174
Treatment of choice for septic arthritis is
AB emperic before results of culture
175
What are the risk factors for septic arthritis?
- old
- immunosuppressed
- OA/RA
- infection spread (hematogeous - contagous)
- prosthesis
- low socioeconmic
- ticks
176
Your ddx for a monoarthrtitis would be
- hemorthrosis
- septic arthritis
- gout\psudogout
- osteoarthritis
177
In patient with history of warfarin, and acute non-traumatic injury and a very swollen\warm knee is most likely to have
Hemathrosis
178
Name examples of symmetrical and non-symmetrical polyarthritis:
- Symmetrical: RA\SLE
| - Non: OA\ psoriatic arthritis
179
What kind of joints is usually affected in SLE (small - medium - large)?
Small to medium
180
Name inflammatory diseases that are assocaited with oligoarthritis:
Psoriatic
| Ankylosing
181
What are the systemic features of RA?
- Uveitis
- pneumonitis
- nodules
- fever
182
differentiate between RA and OA affecting Interphalangeal joints
RA: PIP
OA: DIP
183
What are the systemic features of SLE?
- malar rash
- oral ulcer
- pleurisy
184
What are the systemic features of AS?
- uveitis
| - pneumonitis
185
Lab test for RA:
- Specific: Anti-ccp
| - RF
186
Lab test for vasculitis:
- ESR >50
- ANCA
- Biposy
187
Lab tests for SLE:
- specific: Antismith
- C3\C4
- Anti- DsDNA
188
Lab test for AS:
HLA B27
189
Sacroilitis can present in which inflammatory joint diseases?
- psoriatic arthritis
| - Ankylosing spondylitis
190
An important role in family medicine when dealing with RA diagnosis:
Is to diagnose early and treat early to avoid irreversible damage
191
To manage patients with RA:
1- NSAID & steroid injection or oral
| 2- refer to rhumatology to presrcribe DMARDs “methotrexate”
192
Polymylagia rhumatica affect which joint?
Hip and shoulder girdles
193
Criteria for AS diagnosis:
Back pain in 20 +
- morning stiffness relieved by exercise
- alternating buttock pain
- pain relieved by NSAID
- waking at night due to pain
- extrarticular: enthisitis\ uveitis\ fatigue
194
Patient with Ankylosing spondylitis have
| Kyphosis - lordosis
Kyphosis & decreased flexion
195
In psoriatic arthritis
| which is usually first (psoriasis or arthritis)?
Usually psoriasis but can be either way
