Case Files 7-12 (J) Flashcards
What is the single greatest cause of preventable death?
Tobacco use (no shit)
What are the “5 A’s” of tobacco cessation?
Ask about use
Advise to quit
Assess willingness
Assist
Arrange followup
What are the 2 non-nicotine pharmacological treatment adjuncts for smoking?
Buproprion (wellbutrin) and varenicline (chantix)
A pregnant woman wants to quit smoking, what can we prescribe her?
Both Buproprion (wellbutrin) and varenicline (chantix) are category C and considered safe in pregnancy. nicotine replacements are category D.
- Buproprion = antidepressant (helps with withdrawal symptoms and cravings)*
- Varenicline = nicotonic receptor partial agonist (decreases cravings and pleasurable effects)*
True or False: Most smokers fail quitting multiple times before finally quitting.
True
A 65yo female presents with worsening dyspnea, fatigue, dizziness, and palpitations. She has conjuctival pallor on PE. Most likely diagnosis?
Anemia.
A 65yo female presents with worsening dyspnea, fatigue, dizziness, and palpitations. She has conjuctival pallor on PE. Next Step?
CBC with RBC indices, and a reticulocyte count
A 65yo female presents with worsening dyspnea, fatigue, dizziness, and palpitations. She is demented and confused. On PE she has Glossitis, decreased vibratory senses, ataxia, paresthsia, and pearly gray hair at her temples. What is the most likely cause of her anemia?
Vitamin B12 deficiency. If she did not have the neurological defects it is suggestive of a folate deficiency
A 65yo female presents with worsening dyspnea, fatigue, dizziness, and palpitations. On PE she has Glossitis, koilonychias (spoon nails), and dysphagia. What is the most likely cause of her anemia?
Profound iron deficiency.
Causes of microcytic anemia?
Iron deficiency (most common), chronic disease, thalassemia, sideroblastic
Causes of macrocytic anemia?
B12 deficiency (most common), folate deficiency (most common) (yes they are both most common. deal with it), hypothyroid, Chemo, Liver disease, myelodysplastic syndrome
B12 and Folate are both needed to generate precursors for DNA and RNA division. Without them, RBCs grow (in preparation for chromosomal duplication) and stall because they cannot pair precursors to multiply…“stuck being big” = megaloblatic anemia
Causes of normocytic anemia?
renal failure, multiple myeloma, acute blood loss, hemolysis
How do you differentiate anemia due to low iron from chronic disease?
Low Iron: Low serum Iron, Low Transferrin, Low ferritin, High TIBC
Chronic Disease: Low/Normal serum iron, Low/normal transferrin, high/normal ferritin, Low TIBC
- Ferritin = storage form*
- Transferrin = carrier form (blood)*
- TIBC = blood test for iron (transferrin should normally be 1/3 saturated)*
What is the hemoglobin threshold for transfusion?
Less than 7
What is the most common cause of B12 deficiency?
Pernicious anemia (lack of intrinsic factor)
What is the most common cause of folate deficiency?
Alcohol abuse
What is a common cause of anemia in geriatric patients?
GI bleed.
A 40 yo male comes in complaining of nausea, vomiting, and diarrhea. on PE he has dry mucus membranes (or is found to have orthostatic hypotension). what is the appropriate next step?
fluid resuscitation. either NS or LR
what % of acute diarrhea is infections.
90%
“Doc! I just got back from Mexico and i cant stop shitting. what’s causing this?”
most likely enterotoxigenic E Coli
“Doc! I just got back from camping and i cant stop shitting. what’s causing this?”
most likely Giardia
“Doc! I just got back from the on base family day cook-out and i cant stop shitting. what’s causing this?”
6 hours ago? Staph Aureus
8-12 hours ago? Clostridium perfringens
12-14 hours ago? E coli
“Doc! I cant stop shitting. I think I ate some undercooked chicken.” what’s causing this?
most likely Salmonella or Shigella
“Doc! I cant stop shitting. I think I ate some undercooked hamburger.” what’s causing this?
enterohemorrhagic E. Coli
“Doc! I cant stop shitting. I think I ate some raw seafood.” what’s causing this?
Vibrio, Salmonella, or hepatitis A
Which patient groups with acute diarrhea require a workup? (hint most dont)
if they have a fever, bloody stools, or dehydration. Also kids, geriatrics, and immunocompromised patients.
What antibiotic is classically (as in on tests) associated with C. Diff?
Clindamycin
What is the best way to prevent the spread of diarrhea?
wash your nasty ass hands
“Hey doc im going to mexico this weekend, and I dont want to get diarrhea. What can I do?”
Avoid raw fruits and veggies, dont get ice or use tap water, Use bottled water to brush your teeth.
a patient has had acute diarrhea for >3 days and your sure that its bacterial. what antibiotics should you use?
Ciprofloxacin 500mg BID for 3 days (not to be used in pregnant women or children)
Azithromycin for pregnant women (single 1000mg dose) or children (10mg/kg daily x 3 days)
“hey doc my kid has diarrhea. We got a note saying that its going around at the day care. Whats causing this?
most likley rotavirus
Oh shit! Johnny has C.Diff! what do we treat him with?
Metronidazole (flagyl) or Vancomycin
When should a woman get BRCA tested?
-2 1st degree relatives with breast cancer -3 1st or 2nd degree relatives with breast cancer -breast AND ovarian cancer in 1st or 2nd degree relatives -a 1st degree relative with bilateral breast cancer - a male family member with breast cancer
At what age should we start screening for hypertension (men and women)?
18 (level A) for both
At what age should we start screening for lipid disorders (men and women)?
20 if high risk 35 for men 45 for women
When should women start getting routine mammograms?
FUCK THIS QUESTION! its every 1 or 2 years starting at age 40 or 50 depending on which guideline you look at.
tell me about cervical cancer screening
pap smears starting at age 21. every 3 years until age 30, then you start concurrent HPV testing and can go every 5 years.
how do you screen for osteoporosis? At what age do you start in women?
DEXA scan. 65
how much calcium and vitamin D should women over 50 take a day?
1200mg of calcium and 400-800 IU of vitamin D
what are the two most common side effects of bisphosphonates?
errosive esophagitis and gastritis
what are the risk factors for domestic violence?
Think about the show cops: young couples, low income, pregnant, divorced, with mental illness, and you know there is some kind of substance involved.
A 19yo sailor comes in for ankle pain saying he rolled it playing basketball. On PE his ankle is swollen but he can bear weight, and there is no focal tenderness or ligament laxity. What is his most likely diagnosis?
Ankle sprain
A 19yo sailor comes in for ankle pain saying he rolled it playing basketball. On PE his ankle is swollen but he can bear weight, and there is no focal tenderness or ligament laxity. What is the next step?
PRICE Protection Rest Ice Compression Elevation
What is the most commonly injured ankle ligament in an ankle sprain?
Anterior talofibular ligament (ATFL)
What are the Ottawa ankle rules?
only get x-rays if the patient is unable to bear weight, or has point tenderness over: the distal 6cm of the medial or lateral malleolus, base of the 5th metatarsal, or navicular bone
What is the difference between a sprain and a strain?
Sprain: ligament Strain: tendon/muscle (T is for tendon)
Matching: Test and Structure Empty Can test
Supraspinatus
Matching: Test and Structure external rotation
infraspinatus and teres minor
Matching: Test and Structure behind the back lift off test and/or internal rotation
subscapularis
Matching: Test and Structure hawkins
impingement
Matching: Test and Structure Anterior Drawer-ankle
ATFL
Matching: Test and Structure inversion of ankle
CFL
Matching: Test and Structure Squeeze test (squeeze the tib/fib together)
syndesmosis
Matching: Test and Structure Thompson squeeze test (squeeze the calf)
Achilles tendon
Matching: Test and Structure Lachman and anterior drawer
ACL
Matching: Test and Structure Valgus stress
MCL
Matching: Test and Structure Varus stres
LCL
What is the initial diagnostic imaging modality of choice for a patient with joint pain?
x ray
A patient comes in stating that they are still stiff and sore 4 weeks after getting a sprained ankle. What is the next step?
Refer to physical therapy. the most common cause of pain/stiffness in a join following a sprain is inadequate rehabilitation.
