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Family Med > Case Files > Flashcards

Case Files Flashcards

1
Q

who is the influenza vaccine recommended for?

A

Every adult >50 years, health care workers, chornic CV, pulmonary, reanl or metabloic dsiease

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2
Q

Who gets a 1 time revaccination after 5 years of the pneumococcal polysaccharide vaccine?

A

chronic kidney, hepatic disease, immunodeficiency or asplenia

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3
Q

who is Hep A vacciene recommended for?

A

chronic liver dz, use clotting factors, IV drugs, men who have sex w/ men, travel to countries where hep A is endemic

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4
Q

when should lipid screening happen

A

men >35 years old and women >45 years old

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5
Q

Who is screening for AAA recommended for?

A

men aged 65-75 who ahve ever smoked

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6
Q

mainstay of meds w/ COPD exacerbations

A

oxygen, bronchodilators, steroids

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7
Q

In COPD the FEV1/FVC is less than what?

A

0.7

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8
Q

when is O2 therapy recommended w/ COPD

A

PaO2 <88% at rest . needs to be worn at least 15 hours a day

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9
Q

steroid dose recommended w/ COPD exacerbation

A

40 mg prednisone for 10-14 days

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10
Q

Condition of joint pain and inflammation due to calcium

pyrophosphate dehydrate crystals in the joints, which can be diagnosed by

noting rod-shaped, rhomboid, weakly positive birefringence by crystal analysis.

A

Pseudogout

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11
Q

major finding w/ a septic joint

A

very limited ROM due to pain

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12
Q

morning joint stiffness, involves 3 or more joint and have x ray chagnes such as erosions or decalcifications

A

rehumatoid arthritis

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13
Q

Tx for septic joint

A

Surgery for drainage than IV abx

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14
Q

tx for infectious diarrhea

A

cipro for adults

azithromycin for children/ pregnant women

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15
Q

when should women be screened for lipid disorders?

A

age 45

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16
Q

a stectching or tearing injury of a ligament

A

sprain

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17
Q

a stretching or tearing injury of a muscle or tendon

A

strain

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18
Q

pain with internal rotation when the arm is flexed to 90 degrees with the elbow bent to 90 degrees

A

Hawkin’s impingmenet (subacrominal impingement)

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19
Q

examiner pulls forward on patient’s heel while stabilizing lower leg w/ other hand

A

anterio rdrawer. if abnormal suggests anterior talofibular ligament injury

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20
Q

Examiner inverts ankle with one hand while stabilizing the lower leg w/ the other

A

inversion stress test. abnormal or clunk suggests tear of calcaneofibular ligament

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21
Q

Examiner compresses tibia/ fibula at midcalf

A

Pain at anterior anle joint (below where squeeezing) suggests syndesmotic injury

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22
Q

ottawa knee rules (for knee x ray)

A 
>55 years old
2- isoalted patella tenderness
3- tenderness of head of fibula
4- inability to flex knee to 90 degress
5- inability to bear weight for four steps immendaitely and in the exam room
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23
Q

most important risk factor for skin cancer devleopment

A

exposure to ultraviolet radiation

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24
Q

most common skin cancer

A

basal cell carcinoma

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25
Q

Present as pearly papules often w/ central ulceration/ multiple telangiectasias

A

basal cell carcinoma

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26
Q

irregularly shaped plaques or nodules w/ raised borders that are often scaly, ulcerated and bleed easily

A

squamous cell carincoma

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27
Q

what in the urinary sediment is suggestive of renal glomerular disease

A

red cell casts and dysmorphic red blood cells

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28
Q

presence of hemamaturia and what suggests interstitial nephritits

A

eosinophils

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29
Q

most common cause of hyperthyroidism

A

Graves dz (autoimmune)

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30
Q

definitive treatment for hyperthyroidism

A

radioactive iodine

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31
Q

Thyroid storm treatment

A

Beta blockers
high doses of PTU
hydrocortisone or prevent adrenal crisis

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32
Q

most common cause of hypothyroidism

A

Hashimoto thyroiditis

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33
Q

most sensitive and sepcific test for thyroid nodules to determien malignancy

A

FNA

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34
Q

if a person has hypercalcemi with a suppressed PTH waht should you immediately think of

A

malignancy

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35
Q

leading cause of blindness worldwide

A

cataracts

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36
Q

hypomagnesemia can incfease the incidence of what type of v-tach?

A

torsade de pointes

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37
Q

what can chest pain plus unequal carotid pulses of unequal UE pulses

A

aortic dissection

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38
Q

sharp pain that radiates to the trapezius, increaes w/ respiration and decreases when sitting forward

A

pericarditits

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39
Q

sudden onset of pleuritic pain, tachycardia, tachypnea, hypoxemia

A

PE

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40
Q

how to treat high K+ in patients with chronic kidney diesase?

A

Polystyrene sulfonate (Kayexalate)

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41
Q

what causes occasionally emesis w/ CKD?

A

high levels of urea and other toxins

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42
Q

Most common casues of CKD

A

HTN, DM, glomerulonephritits

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43
Q

GFR of 30-59 indicated what stage?

A

Satege 3

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44
Q

Stage 5 of CKD

A

GFR <15

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45
Q

Drugs that can affect kidney function

A

NSAIDs, aminoglycosides at full strength, radiographic contrast material

46
Q

are small kidneys good or bad with CKD

A

Bad, reflect irresversible disease. shoudl rarely be bsiopsied

47
Q

best tx for outpatient PID

A

IM ceftriaxone and oral doxycycline

48
Q

Diverticulitits tx

A

bowel rest, quinolone _ metronidazole may need surgery

49
Q

which IBD is a risk factor for colon cancer?

A

Ulcerative colitits

50
Q

most common cause of community acquired pneumo?

A

Steptococcus pneumoniae (pneumococcus) then H flu then moraxella catarrhalis

51
Q

who are atypical pneumo organisms (Mycoplasma, chlaymdia, legionella) more common in

A

the young and the old

52
Q

how do atypical pneumos typically appear on x-ray

A

bilateral, diffuse infiltrates

53
Q

who is the pneumococcal vaccine recommended for

A

all persons >65 years old

54
Q

what is a common cause of pneumonia after a person has had flux

A

S aureus

55
Q

2 years of low mood. less acute but longer in duraiton than major depression.

A

dysthymic disorder

56
Q

main causes of CHF

A

CAD or HTN

57
Q

main meds for CHF

A

furosemide
ACEI
Beta blockers (decrease preload and afterload)

58
Q

CHF when there is a dilated left ventricle with impaired

contractility.

A

systolic dysfunction

59
Q

S/S of Right sided HF

A

Venous congestion, N/V, bloating, abomdinal pain, fluid retention, peripheral edema, JVD

60
Q

LEft sided CHF manifestations

A

Pulmonary congestion (DOE), wheezing, cough, tachypnea , S3 gallops rythm

61
Q

elevation in what lab indicate CHF

A

BNP

62
Q

a BNP greater than what is consisitent with a diagnosis of CHF

A

110-500

63
Q

one of the earliest chest x-ray findings in CHF

A

cephalization of the pulmonary vasculature

64
Q

gold standard of diagnostics for CHF

A

echocardiography

65
Q

first line therapy in patients w/ CHF and reduced LV function

A

ACEI

66
Q

benefits for ACEI in CHF

A

reduces preload, afterload, improves cardiac output, inhibits tissue renin-angiotensin systems

67
Q

When are ACEI contraindicated?

A

pregnancy, HPOTN, hyperkalemia, B/ renal artery stenosis , caution w/ renal insufficiency

68
Q

when are BB indicated/ w CHF

A

NYHA class II or III or w/ CAD

69
Q

when should the aldosterone antagonist spironolactone be considered w/ CHF

A

Class III and IV

70
Q

ADR of spironolactone

A

hyperkalemia

71
Q

medication used in diastolic dysfunction as they promote increased cardiac output by lower HR which allows for more ventricular filling time

A

Nondihydropyridine calcium channel blockers (diltiazem, verapamil)

72
Q

we should you recheck lipids after starting a statin?

A

6 weeks

73
Q

what try fracture is a sign of abuse?

A

corner or “bucket handle” fractures of metaphysis of long bones, sprial fracture, scauplar fracture, spinious process, sternal fractures

74
Q

5 Ws of post op fever

A 
Wind (pneumo)
Water (UTI)
Wound (SSI)
Walk (DVT)
Wonder drugs (drug fever
75
Q

alarm features w/ abominal pain and bowel changes that suggest underlying pathology

A 
weight loss
fever
melena
blood in stool
excessive diarrhea
older age
anemia
family xh of colon cancer, IBD
76
Q

antispasmodics that can be used for IBS

A

dicyclomine and hyoscyamine

77
Q

tx for constipation predominant IBS

A

intake fiber

78
Q

tx for diarrhea predominant IBS

A

loperamide

79
Q

At risk drinking

A

Men >14 drinks / week >4 per occasin

Women >7 drinks per week >3 for occassion

80
Q

most common valvular heart defect in the US

A

mitral valve prolapse

81
Q

caused by a cardiac source of the arrhyth-
mia that is not in the ventricle. This category includes atrial fibrillation, atrial

flutter, focal atrial tachycardia, multifocal atrial tachycardia (MAT), and AV

nodal reentrant tachycardia.

A

supraventricular tachycardia

82
Q

most common of all arrhythmias, becomes more common w/ older age and cardiomyopathy

A

A-fib

83
Q

arrhythmia found w COPD

A

MAT (multifocal atrial tachycardia)

84
Q

caused by an accessory track between the atria and ven-

tricles that conducts electrical impulses in addition to the AV node.

A

Wolf Parkinson White (WPW)

85
Q

classic finding on a ECG w/ WPW.

A

slurring on teh upstroke of the QRS complex (delta wave)

86
Q

ion channel disorder that is most common in Asian males. On an ECG, it presents as ST-segment elevation in leads V1
, and it too can cause dangerous arrhythmias that result in death.

A

Brudaga syndrome

87
Q

dysfunction of the SA node that leads to bradycardia and can cause fatigue and syncope. Patients, however,
can also have a tachycardia-bradycardia variety of sick sinus syndrome in

which they also experience supraventricular tachycardia with its associated

symptoms of palpitations and angina pectoris.

A

sick sinus syndrome

88
Q

patients w/ long QT interval syndrome are at most risk for waht

A

ventricular arrhythmias and sudden cardiac death

89
Q

Cause of long QT syndrome

A

mutations in multiple genes, can have an autosomal dominant pattern , more common in females

90
Q

most common cause of sudden cardiac death in adolescents in the US

A

hypertrophic cardiomyopathy

91
Q

what makes the murmur w/ hypertrophic cardiomyopathy louder?

A

valsalva manuever

92
Q

Gold standard for diagnoseis of hyertrophy cardiomyopathy

A

thickened intraventricular septum

93
Q

noncardiac causes of palpitations

A

anemia, electrolyte disturbances, hyperthryoidism or hypothyroidism, hypoglycemia, hypovolemia, fever, pheo, vasovagal syncope

94
Q

who should not get exercise stress tests?

A

patient w/ suspected hypertrophic cardiomyopathy or severe aortic stenosis

95
Q

non pharm tx for SVT

A

carotid massage, valsalv menuever, cold applications to the face

96
Q

Pharm tx for episode of SVT

A

IV adenosine

97
Q

tx for chronic a-fib

A

beta blockers or CCB to keep HR below 100, warfarin

98
Q

most common causes of ventricular arrhythmias

A

ischemia

99
Q

most common cause of palpiattions

A

primary rhythm disturbances

100
Q

most common bacteria from fist injuries

A

Eikenella

101
Q

single most important risk factor for stroke

A

HTN

102
Q

if a patient has stroke that affects the middle cerebral artery what will they experience

A

aphasia (dominant hemisphere), C/L hemiparesis, sensory loss, spatial neglect.

103
Q

When the anterior cerebral artery is affected what symptoms will the patient have?

A

Foot and leg deficiets more than arm. Cognitive and personality changes

104
Q

A stroke that affects the vertebrobasilar stokre what are the symptoms

A

include motor or sensory loss in all four limbs, crossed signs, disconjugate gaze, nystagmus, dysarthria, and dysphagia.

105
Q

If the cerebellum is affected w/ a stroke what symptoms will there be

A

Ipsilateral limb ataxia

106
Q

initital imaging of choice for stroke

A

CT scan of brain w/o contrast (helps r/o intracrnail hemorrhage, tumors, abscesses)

107
Q

when is carotid endartectomy indicated?

A

carotid stenosis >70% , symptomatic patients w/ 50-70% stenosis

108
Q

alarm symptoms w/ dyspepsia which warrant an early upper GI endoscopy

A 
weight loss
progressive dyphagia
recurrent vomitting
GI bleeing
family Hx of cancer
109
Q

preferred non-invasive office test for H pylorie

A

stool antigen testing (need to not have had PPIs for at laeast 2 weeks before )

110
Q

can serologic testing for H pylori distinguish between acute and treated infections

A

No

111
Q

gold standard for H Pylori testing

A

endoscopy w/ biopsy testing

112
Q

tx for RMSF

A

doxycycline

Family Med (3 decks)

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