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Family Medicine > Case Files in Family Medicine > Flashcards

Case Files in Family Medicine Flashcards

1
Q

Pregnancy category C

A

Animal studies have shown adverse fetal effects and there are no adequate studies in humans
OR
no animal studies have been conducted and there are no adequate studies in humans

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2
Q

Pregnancy category D

A

Human studies have shown potential adverse fetal effects; however, the benefits of therapy may outweigh the potential risks

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3
Q

Five A’s of tobacco cessation counselling

A

ASK the patient at each visit about tobacco use
ADVISE to quit through clear personalized messages.
ASSESS willingness to quit
ASSIST to quit
ARRANGE follow up and support

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4
Q

5 Rs motivation to quit strategy

A 
RELEVANCE
RISKS
REWARDS
ROADBLOCKS
REPETITION
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5
Q

Bupropion (Zyban) Mechanism

A

(non-nicotine, For smoking cessation)

Blocks uptake of norepinephrine and/or dopamine

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6
Q

Bupropion (Zyban) contraindications

A

(non-nicotine, For smoking cessation)
Contraindicated in patients with eating disorders,MAO inhibitor use in the last 2 weeks, or a history of seizure disorder.

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7
Q

Bupoprion (Zyban) regimen

A

(non-nicotine, For smoking cessation)
-start 1-2 weeks before quit date
-150 mg for 3 days then 150 mg twice/day.
7-12 week course usual, can be used up to 6 months

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8
Q

True/False: Bupropion (Zyban) can be used either alone or in combination with nicotine-based treatments

A

(non-nicotine, For smoking cessation)

True

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9
Q

Bupropion (Zyban side effects

A

(non-nicotine, For smoking cessation)

Insomnia and dry mouth

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10
Q

Varenicline (Chantix) mechanism

A

(non-nicotine, for smoking cessation)
Nicotinic receptor partial agonist that may reduce cravings and withdrawal symptoms as well as block some of the binding of nicotine from cigarettes

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11
Q

True/false: Varenicline (Chantix) can be used in conjunction with nicotine based treatments.

A

(non-nicotine, for smoking cessation)

False: While this may be true, it has not been studied with nicotine supplementation

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12
Q

Varenicline (Chantix) regimen

A

(non-nicotine, for smoking cessation)

  • Start 1 week before quit date
  • dose: 0.5 mg/day for 3 days, then 0.5 mg 2x/day for 4 days, then 1 mg/day for up to 6 months.
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13
Q

When would you decrease dosage in a patient on Varenicline (Chantix)?

A

(non-nicotine, for smoking cessation)

When they are on hemodialysis or have a creatinine clearance

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14
Q

What symptoms are Varenicline (Chantix) associated with?

A

(non-nicotine, for smoking cessation)

  • Neuropsychiatric symptoms like changes in behavior, agitation, depression, suicidal thoughts
  • therefore, should be used cautiously in anyone with psychiatric disorder history
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15
Q

Varenicline (Chantix) side effects

A

(non-nicotine, for smoking cessation)

Nausea, trouble sleeping, and abnormal, vivid, or strange dreams

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16
Q

4mg Nicotine gum is for who?

A

Those who smoke more than 25 cigs/day (2mg for less)

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17
Q

Which nicotine replacement product has the highest peak nicotine level and therefore highest dependency potential?

A

nasal inhaler

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18
Q

The nicotine inhaler, nasal spray, patch, and gum are pregnancy category ____ drugs

A

D (use when benefits outweigh potential risks)

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19
Q

Buproprion and Varenicline are pregnancy category ______ meds

A

C (have not been studied, should only be used if absolutely necessary.

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20
Q

What tests are necessary when testing for anemia?

A

CBC with peripheral smear, reticulocyte count, iron studies, B12, folic acid

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21
Q

Anemia definition

A

hemoglobin level

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22
Q

What population has the highest rates of anemia?

A

non-hispanic blacks. lowest is non-hispanic whites

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23
Q

Anemia symptoms

A

fatigue, weakness, dyspnea

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24
Q

What symptom is a reliable sign for anemia and commonly present in patients with hemoglobin

A

Conjuctival pallor

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25
Q

______ deficiency causes neurologic deficits. __________ deficiency does not

A

Vitamin B12

Folate

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26
Q

Characteristics of iron deficiency anemia

A

Serum Iron: Low
TIBC: High
Transferrin saturation: Low
Serum Ferritin: Low

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27
Q

In the elderly, iron deficiency anemia is commonly caused by ____________

A

chronic GI blood loss

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28
Q

Anemia with a high MCV is usually indicative of what?

A

Folate or B12 deficiency

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29
Q

Elevated MMA (Methylmalonic acid) confirms what deficiency?

A

B12 deficiency

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30
Q

Elevated homocysteine levels indicate what type of deficiency?

A

folate deficiency

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31
Q

Folate deficiency anemia is usually seen in ________

A

alcoholics

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32
Q

B12 deficiency anemia is usually seen in _____________

A

pernicious anemia, malabsorption, veganism, history of gastrectomy

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33
Q

What happens in anemia of chronic inflammation with regards to the body’s iron stores?

A

The body’s iron stores (measured by serum ferritin) are normal, but the capability of using the stored iron in the reticuloendothelial system becomes decreased. (high ferritin helps differentiate form iron deficiency)

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34
Q

A hemoglobin less than ____________ is indicative for transfusion, and so is a co-morbid condition.

A

7 g/dL

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35
Q

Acute Diarrhea

A

Diarrhea present for less than 2-week duration

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36
Q

Chronic Diarrhea

A

Diarrhea lasting long than 4 weeks

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37
Q

Subacute diarrhea

A

Lasts between 2 and 4 weeks

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38
Q

What organisms can be found in undercooked chicken?

A

Salmonella and Shigella

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39
Q

What normally causes traveller’s diarrhea during travel to mexico?

A

Entertoxigenic E. Coli

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40
Q

What commonly causes diarrhea in campers?

A

Giardia

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41
Q

What commonly causes diarrhea and is found in mayonnaise?

A

Staph aureus and Salmonella

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42
Q

What organism is commonly found in undercooked hamburger?

A

Enterohemhorragic E Coli

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43
Q

Raw seafood may harbor what organisms?

A

Vibrio, Salmonella, Hep A

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44
Q

Illness within 6 hours of eating a salad with mayonnaise indicates?

A

Staph aureus

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45
Q

Illness with 8-12 hours of eating a salad with mayonnaise indicates?

A

Clostridium perfringes (12-14 = E coli)

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46
Q

Daycare settings commonly transmit what?

A

Rotavirus, Shigella, Giardia

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47
Q

When antibiotics are indicated, what do you use?

A
  • Quinolone antibiotics (commonly ciprofloxacin 500mg twice daily) are given for 1-3 days
  • Azithromycin (1000-mg single does in adults or 10mg/kg daily for 3 days in children) Can be used in pregnant women
  • Rifaximin (200mg 3 times/day for 3 days). Not effective when blood is in stool.
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48
Q

What are the primary sinopulmonary respiratory pathogens?

A

Strep pneumo
H influenzae
Moraxella catarrhalis

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49
Q

What are the primary oropharyngeal flora?

A

Staph Aureus
GAS (GBS in neonates)
Anaerobes

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50
Q

Best drug for retrophayngeal abscess and typical oropharyngeal flora?

A

Clindamycin

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51
Q

Dog bite treatment

A

Augmentin (“Dog” mentin)

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52
Q

Primary gut pathogens?

A

GNR (Klebsiella, E. Coli, Enterobacter), enterococcus, anaerobes

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53
Q

Best drug for primary gut pathogens?

A

Zosyn (piperacillin/tazobactam)

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54
Q

Cellulitus common causes

A

Staph and GABHS

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55
Q

Common MSK pathogens?

A

MSSA and MRSA most common, GABHS, Kingella, Lyme, Hib, GBS, Gonhorreae

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56
Q

The upper urinary tract can be imaged with what?

A

Either intravenous pyelogram (IVP) or computed tomography (CT) scan

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57
Q

The Lower urinary tract is most commonly evaluated by ____________

A

cytoscopy (an endoscopic procedure)

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58
Q

The incidence of cancer presenting as asymptomatic microscopic hematuria is ____________

A

low

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59
Q

What three etiologies is hematuria divided into?

A

Glomerular, renal (nonglomerular), and urologic

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60
Q

What is the difference between glomerular and renal heamaturia?

A

Glomerular is associated with significant proteinuria, erythrocyte casts, and dysmorphic RBCs. Renal hematuria is secondary to tubulointerstitial, renovascular, and metabolic disorders. It has significant proteinuria as well but without the dysmorphic RBCs or erythrocyte casts.

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61
Q

Routine screening of hematuria is/is not recommmended

A

is not

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62
Q

The initial finding of hematuria by the dipstick method should be confirmed by _______________

A

microscopic evaluation of the urinary sediment

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63
Q

Evaluation of the urinary sediment can distinguish between _______ and _______

A

glomerular disease and interstitial nephritis

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64
Q

What work up is required if hematuria resolves with treatment of UTI?

A

none

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65
Q

Further work up of idenitified thyroid nodules is indicated because the incidence of malignancy in solitary modules is ______

A

5-6%

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66
Q

Functional adenomas that present with hyperthyroidism are ______ malignant

A

rarely

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67
Q

Nonfunctioning nodules measuring greater than 1 cm by examination or ultrasonography do/do not require biopsy.

A

Do

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68
Q

What are the signs the could confirm rupture of placental membranes?

A
  • Visualization of amniotic fluid leaking form the cervix
  • The presence of pooling amniotic fluid in the posterior vaginal fornix
  • Demonstration of a pH above 6.5 in fluid collected from the vagina using Nitrazine paper
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69
Q

What is the baseline fetal heart rate?

A

140 bpm

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70
Q

What is the ideal contraction interval?

A

Every 3 minutes

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71
Q

What is the recommended antibiotic prophylaxis for GBS colonization during labor?

A
  • IV Penicillin 5 million units loading dose followed by 2.5 million units IV every 4 hours
  • Alternative IV ampicillin, cephalothin, erythromycin, clindamycin, vancomycin
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72
Q

What is the first stage of labor?

A

onset of labor until the cervix is completely dilated. can be divided into latent phase (contractions become stronger, longer lasting, and more coordinated) and active phase (starts at 3-4cm dilation, when the rate of cervical dilation is at a maximum

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73
Q

What is the second stage of labor?

A

complete cervical dilation (10cm) through the delivery of the fetus

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74
Q

What is the third stage of labor?

A

Begins after delivery of baby and ends with the delivery of the placenta and membranes

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75
Q

normal fetal heart rate

A

110-160 bpm

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76
Q

What is short term (beat-to-beat) variability?

A

Change in fetal heart rate from one beat to the next. (N 6-25)

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77
Q

What is long term variability?

A

Waviness of baseline fetal heart rate of 1 minute (3-5 cycles/minute)

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78
Q

Which type of deceleration in fetal heart rate coincides with a contraction?

A

Early (compression of fetal head)

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79
Q

What is a late deceleration a sign of?

A

uteroplacental insufficiency

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80
Q

Four cardinal movements fetal head goes through during birth

A
  • flexion
  • internal rotation
  • Extension
  • External rotation
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81
Q

Overweight definition

A

BMI =25 to 29.9 kg/m2

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82
Q

Obesity definition

A

BMI > 30

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83
Q

Obesity screening

A

Recommended by USPSTF. Measure height, weight, calculate BMI. Measure waste circumference in those with BMI between 25 and 35 kg/m2

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84
Q

What waist circumference indicates increased cardiometabolic risk?

A

> 40 in men and >35 in women

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85
Q

What tests can you perform on obese patients?

A

Fasting glucose, Fasting lipid, TSH, Liver enzyme

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86
Q

who qualifies for bariatric surgery?

A

Patients with BMI > 40 or patients with BMI > 35 and significant commorbidities.

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87
Q

Treatment for thyroid storm?

A

3 Ps propanolol PTU and ……idk

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88
Q

Normal TSG for thyroid nodule next step?

A

Fine needle aspiration (FNA) (adenoma)

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89
Q

Low TSH for thyroid nodule next step?

A

Radio uptake scan
Hot = benign/ablation
Cold = malignant, FNA

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90
Q

What is the screening recommendation for hyperlipidemia?

A

Grade A: Men 35 and odler
Grade B: Men 20-35
Grade A: women 45+
Women 20-45 = B

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91
Q

LDL goals:

A
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92
Q

Statins mechanism

A

HMG-CoA reductase inhibitor

  • Increases LDL receptor synthesis
  • decreases LDL
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93
Q

Bile acid sequestrant mechs

A

decrease LDL by forcing liver to consume cholesterol

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94
Q

Primary prevention

A

Intervention designed to prevent a disease before it occurs

Example: statin to reduce LDL to lower risk of CAD.

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95
Q

Secondary prevention

A

An intervention intended to reduce the recurrence of exacerbation of a disease
Example: use of a statin after a person has had a MI to reduce the risk of a second heart attack

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96
Q

Effective screening criteria

A

“PASS-C AI” - “I want an AI to do my stupid PASS-C assignment.”

  • Prevalence high
  • Asymptomatic time frame
  • Sensitivity adequate
  • Specificity adequate
  • Cost effective
  • Acceptable to patients
  • Intervention available to reduce morbidity/mortality
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97
Q

USPSTF Grade A

A

Provide service - High certainty that net benefit of intervention is substantial

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98
Q

USPSTF Grade B

A

Provide service - High certainty that net benefit of intervention is moderate
or
moderate certainty that the net benefit is moderate to substantial

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99
Q

USPSTF Grade C

A

Offer to provide service if additional considerations encourage

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100
Q

USPSTF Grade D

A

Discourage service- Moderate certainty that there is no net benefit or that harms outweigh benefits

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101
Q

USPSTF Grade I

A

If offered, inform patients on uncertainty of benefit/harm balance - insufficient evidence or poor quality evidence that benefit/harm balance merits recommendation

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102
Q

Adult CVD screening recommendations

A

Level A:
-hypertension - BP measurement
-lipid disorders (M35+/F40+ y.o./at risk 20+) - non-fasting total cholesterol and HDL or fasting lipid panels that include LDL.
Level B:
-AAA for those who have smoked (M65-75 y.o.)
Level C:
none
Level D:
-AAA for women, regardless of smoking status
-Coronary artery disease screening in low risk adults (Level I for high risk)
-peripheral arterial disease in asymptomatic adults

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103
Q

Adult cancer screening recommendations

A 
Level A:
-Colorectal cancer (M and F 50+) - Fecal occult blood testing using guaiac cards on 3 consecutive bowel movements (annual), flexible sigmoidoscopy (every 3-5 years), or colonoscopy (every 10 years).  +sigmoidoscopy or FOBT leads to colonoscopy.
Level B:
None
Level C: 
None
Level D: 
-Bladder, testicular, pancreatic cancer
Level I:
-prostate cancer with DRE or PSA.
-Lung cancer
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104
Q

Adult obesity screening recommendations

A 
Level A:
-Identify/promote tobacco use cessation 
Level B:
-BMI (all adults)
-Type 2 diabetes (adults with hypertension/Hyperlipidemia)
-Depression
-alcohol abuse/prevention
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105
Q

Pneumoccocal Polysaccharide recomendations

A

Recommended as single does for all 65+ y.o. adults
AND
65- adults who are alcoholics or smokers, or have chronic diseases/immunodeficiency

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106
Q

Hep B vaccine recommendations

A 
"everything involving a needle (penis counts as needle for MSM and promiscuos)"
Give to those at high risk of exposure:
health-care workers
Those exposed to blood
dialysis patients
IV drug users
promiscuous people or people w/ STDs
MSM (aka gay)
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107
Q

Hep A vaccine recommendations

A

Chronic liver disease people/all Hep B stuff

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108
Q

Varicella vaccination recommendations

A

-unreliable immunization history

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109
Q

Meningococcal vaccine recommendations

A

“West pointers (college/military/travel) and immunocompromised (asplenia/complement def)”

  • college dormitory
  • military recruits
  • asplenia
  • travel to countries where disease is endemic
  • complement deficiencies
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110
Q

First line treatment for rhinosinusitis

A

Amoxicillin and trimethoprim/sulfamethoxazole for 10-14 days

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111
Q

Second line treatment for rhinosinusitis

A

Augmentin, 2nd/3rd gen cephalosporins, fluoroquniolones, macrolides

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112
Q

What therapy do you give to a patient when you suspect angina pectoris?

A 
MONA therapy:
Morphine
Oxygen
Nitroglycerin
Aspirin
(B adrenergic antagonist too)
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113
Q

All patients who rule in for myocardial infarction should receive what?

A

aspirin and an antithrombotic treatment (heparin)

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114
Q

Ne York Heart Association functional classification of angina

A

Class I: Angina only with unusual strenuous activity
Class II: Angina with slightly more prolonged or slightly more vigorous activities than usual
Class III: Angina with usual daily activity
Class IV: Angina at rest

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115
Q

What does the combination of nitroglycerin and a B-adrenergic antoagnoist due for a myocardial infacrtion?

A

Reduces risk of subsequent myocardial infarction

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116
Q

Risk factors for MI

A

Diabetes, dyslipidemia, age, hypertension, tobacco abuse, family history of premature CAD, male gender, postmenopausal status, left ventricular hypertrophy, homocystinemia

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117
Q

Pericarditis symptoms

A

Sharp pain rather than dull,aching pressure. Pain exacerbated by inspiration, global ST-segment elevation on ECG

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118
Q

ESRD

A

The irreversible loss of kidney function such that the patient is permanently dependent on renal replacement therapy (Dialysis or transplantation). Also defined as a GFR of less than 15 mL/min

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119
Q

What are the 3 most common etiologies of CKD?

A

Diabetes, hypertension, and glomerulonephritis

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120
Q

What is normal GFR?

A

90 and 120 mL/min

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121
Q

Stage 1 CKD

A

A GFR more than 90 mL/min in the presence of signs of kidney disease, such as proteinuria, hematuria, or abnormal renal structure

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122
Q

Stage 2 CKD

A

GFR from 60-89

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123
Q

Stage 3 CKD

A

GFR from 30-59

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124
Q

Stage 4 CKD

A

GFR 15-29

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125
Q

Stage 5 CKD

A

GFR less than 15 mL/min

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126
Q

How should all patients with CKD be evaluated?

A

Renal imaging and microscopic evaluation of urine

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127
Q

Goals of treatment for CKD

A

BP less than 130/80 and protein excretion less than 500 to 10000 mg/d

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128
Q

What is the most important measure in the prevention of end-stage renal disease?

A

Glycemic control

Tight glycemic control can prevent the microvascular complications of diabetes such as diabetic nephropathy.

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129
Q

First line treatment for CKD signs?

A

ACE inhibitor or ARB

can also use dilitiazem, verapamil, or B-blockers

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130
Q

A history of recent antibiotic use may predispose to a __________ vaginitis

A

Candida

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131
Q

Women with diabetes mellitus are more prone to developing _______ infections

A

yeast

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132
Q

Vulvovaginal candidiasis

A
  • Thick, whitish discharge that has no odor
  • patient complains of priuritus
  • physical exam: vaginal area is edematous with erythema present
  • discharge has pH between 4.0 and 5.0
  • Wet mount of KOH shows budding yeast or pseudohyphae
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133
Q

Vulvovaginal candidiasis treatment

A
  • fluconazole 150mg for simple

- more serious 10-14 days

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134
Q

Trichimoniasis

A
  • STD
  • Risk factors: Multiple sexual partners, pregnancy, menopause
  • Copious amounts of a thin, frothy, green, yellow, or gray malodorous vaginal discharge
  • “Strawberry cervix”
  • wet mount demonstrates motile trichimonads
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135
Q

Trichimoniasis treatment

A

oral metronidazole, given in a single, 2-g oral dose or 1-week regimen of 500 mg twice a dayto patient and partner. Screen partner and for other STDs

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136
Q

Bacterial vaginosis BV

A
  • overgrowth of anaerobic G vaginalis associated with mulitple sexual partners
  • Diagnosis based on 3 of 4 criteria:
    1. a thin, homogenous vaginal discharge
    2. vaginal pH more than 4.5
    3. Positive KOH “whiff” test
    4. The presence of clue cells on wet mount prep
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137
Q

Bacterial vaginosis BV treatment

A

oral/topical preparations of metronidazole pr clindamycin

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138
Q

Mucopurulent cervicitis

A
  • Characterized by purulent or mucopurulent discharge from endocervix
  • test for N. gonorrheae or Chlamydia
  • Gold diagnostic standard is culture of cervical discharge
  • Treat Gonnorheae with 125 mg ceftriaxone intramuscularly.
  • Quinolones resisted and NOT recommended
  • Doxycyline 100mg orally 2/day or a 1-g azithromycin for Chlamydia
  • Treat partners
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139
Q

PID presenting symptoms

A

Lower abdominal tenderness with both adnexal and cervical motion tenderness without other explanaiton of illness

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140
Q

Hematochezia

A

Bright red blood visible in the stool

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141
Q

What is criticial in intial evaluation of unstable patients with GI bleeding?

A

ABC’s (airway, breathing, circulation)

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142
Q

The test of choice for the determination of the source of lower GI bleeding is _________________

A

colonoscopy

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143
Q

Ulcerative collitis

A

continuous inflammation of the large bowel, starting from rectum and extending proximally

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144
Q

Crohn’s disease

A

Areas of focal inlfammation, can occur anywhere in GI tract

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145
Q

Crohn’s disease and Ulcerative collitis can cause _______ in joints

A

arthritis

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146
Q

Who is colon cancer screening recommended for?

A

All patients over the age of 50 and at risk individuals who are younger

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147
Q

What is the gold standard for diagnosis of pneumonia?

A

Presence of an infiltrate on chest x-ray

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148
Q

Pneumonitis

A

Inflammation of the lungs from a variety of noninfectious causes such as cheicals, blood, radiation, and autoimmune processes

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149
Q

Community-acquired pneumonia

A
  • People who are not in a hosptial
  • Strep pneumoniae (acute onset, rust-sptutm, fever, shaking, chilss, lobar infiltrate)
  • Haemophilus influnenzae (seen in patients iwth underlying COPD)
  • Moraxella catarrhalis, mycoplasma, Chlamydia, Legionella: Atypical
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150
Q

Atypical pneumonia

A

Moraxella catarrhalis, mycoplasma, Chlamydia, Legionella: Atypical and some viruses

  • Very yung and older patient
  • Bilateral, diffuse infiltrates
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151
Q

Fun fact about legionella pneumonia

A

Causes diarrhea as well

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152
Q

recommended epmpiric therapy for pneumonia

A 
a macrolide (calrithromycin or azithromycin) or doxycycline
-fluoroquinolone (new) or blactam and inhibitor combination in areas of high macrolider resistance
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153
Q

Who is pneumococcal vaccine recommended for?

A

All persons aged 65 years and older, all adults with Cardiopulmonary diease, cigarrette smokers, and all immunocompromised persons.

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154
Q

Depression diagnosis

A 
Symptoms for depression must include at least 5 of the 9 following symptoms, must occur during the same 2-week period, must represent a change from previous functioning, and must include either depresssed mood or loss of interest or pleasure:
S leep changes: increase during day or decreased sleep at night
I nterest (loss): of interest in activities that used to interest them
G uilt (worthless):  depressed elderly tend to devalue themselves

E nergy (lack): common presenting symptom (fatigue)

C ognition/C oncentration: reduced cognition &/or difficulty concentrating
A ppetite (wt. loss); usually declined, occasionally increased
P sychomotor: agitation (anxiety) or retardations (lethargic)
S uicide/death preocp.

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155
Q

When should a diagnosis of depression be considered?

A

When a patient presents with multiple unrelated physical symptoms

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156
Q

What are the SSRIs?

A

First Person Shooter, FaCE = FPS FACE

  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Fluvoxaminee (Luvox)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
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157
Q

What are the SNRIs

A

Venlaxafine (Effexor)
Duloxetine (Cymbalata)
Mirtazapine (Remeron)
Desvenlafaxine (Pristiq)

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158
Q

What are the Atypical antidepressants?

A

Buproprion
Amoxapine
Trazodone

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159
Q

What are the MAOi inhibitors?

A

Phenelezine
Tranylcypromine
Selegiline

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160
Q

How do TCAs work?

A

Affect reuptake of norepinephrine and serotonin

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161
Q

How do MAOIs work?

A

increased amounts of serotonin and NE released during nerve stimulation

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162
Q

All patients with depression should be quesitoned about ______

A

mania (Antidepressants can exacerbate manic episode and uncover bipolar disorder)

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163
Q

Maternal benefits of breast feeding

A
  • more rapid return of uterine tone with reduced bleeding and quicker return to nonpregnant size
  • body weight stabilizaiton more rapid
  • reduced incidence of ovarian and breast cancer
  • convinience/cost
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164
Q

Lochia

A

Yellow-white discharge, consisting of blood cells, decidual cells, and fibrinous products, that occurs following delivery

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165
Q

In women who are not breast-feeding, menstruation usually restarts by what time?

A

Third post partum month (longer in those who are breast feeding

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166
Q

“Four Ts” of postpartum hemorrhage

A
  • Tone: Uterine atony
  • Trauma: Cervical, vaginal, or perineal lacerations; uterine inversion
  • Tissue: Retained placenta or membranes
  • Thrombin: Coagulopathies
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167
Q

What is the initial management of uterine atony after ABCs?

A

IV administration of oxytocin and binmanual uterine massage

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168
Q

What is given in uterine atony of oxytocin and massage fail? What are other options?

A 
Methylergonovine (Contraindicated in patients with hypertension)
Prostaglandin F2 (hemabate) is next.  Another option is misoprostol (Cytotec)
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169
Q

Postpartum fever, especially if associated with uterine tenderness and foul-smelling lochia, is often a sign of _______

A

endometritis

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170
Q

When does “baby blues” typically resolve?

A

10th post-partum day

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171
Q

When is the onset of postpartum depression?

A

at least 4 weeks post partum, but up to a year. Same symptoms as major depression

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172
Q

First line therapy for post-partum depression?

A

SSRIs (saffe in breast feeding)

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173
Q

Contraindications to breast-feeding

A
  • HIV
  • Acute, active HepB
  • Breast reduction surgery with nipple transplant
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174
Q

Most women resume sexual activity by _______ months post partum

A

3

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175
Q

In breast-feeding women, what type of contraception is preferred?

A

progestin only (mini pill)

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176
Q

how long is it recommended to wait before starting oral contraceptives?

A

6 weeks (same for depo-provera)

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177
Q

Non-breastfeeding women should wait ______ weeks after delivery to start combined OCPs

A

3

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178
Q

What is the first priority in managing congestive heart failure?

A

optimizing oxygen exchange by administering oxygen via nasal cannula, dilating pulmonary vasculature, and decreasing cardiac preload and afterload.

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179
Q

Most cases of CHF are caused by what?

A

CAD or hypertension, so serial cardiac enzymes right away are important

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180
Q

What can be administered to reduce anxiety induced catecholamine release that causes tachycardia and increased PV resistance in CHF? What is the preffered diuretic?

A
  • morphine sulfate acts as an anxiolyitc and vasodilator
  • Furosemide (Lasix) is the diuretic of choice because its a diuretic that has immediate vasodilatory action on bronchial vasculature.
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181
Q

What medications decrease preload and afterlaod in CHF?

A

ACE inihbitors and B-Blockers

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182
Q

What does the sputum of the cough from CHF look like?

A

pink, forthy sputum

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183
Q

Framingham Heart Study CHF diagnostic criteria

A
  • Must have two major OR one major and 2 minor
  • Major: paroxsysmal nocturnal dyspnea, JVD, rales, cardiomegaly, pulmonary edema, S3 gallop, central venous pressure greater than 16 cm H20, circulation time of 25 seconds, hepatojugular reflex, weight loss of 4.5 kg over 5 days of treatment.
  • Minor: bilateral ankle edema, nocturnal cough, dyspnea on exertion, hepatomegaly, pleural effusions, decreased vital capacity by one-third of max, and tachycardia
184
Q

First priority in CHF patient

A

ABCs, starting see a trend here?

185
Q

What are the initial tests for a suspected CHF patient?

A

blood tests (for anemia and infection), radiographic studies, electrocardiography, echocardiography

186
Q

Neurohumoral responses to a failing heart result in _______ and _______ retention and ______ excretion

A

water, sodium retention and pottassium excretion

187
Q

BNP can be used to assist in diagnosis of ____

A

CHF (BNP>500 pg/mL

188
Q

_______________________________ is the gold-standard diagnostic modality in the presence of CHF

A

Echocardiography

189
Q

Initial management of CHF patient

A
  • ABCs!
  • supplemental oxygen (possibly with CPAP or BiPAP or mechanical
  • IV access obtained and cardiac/pulse oximetry monitors
190
Q

Initial CHF outpatient sodium intake reduction

A

2 to 4 g/d restriciton

191
Q

____________________ should be considered first line therapy in patients with CHF and reduced left ventricular function

A

ACE inhibitors

192
Q

The administration of ______________________, especially in high doses, can worsen acute CHF symptoms. initial doses should be slow and titrated over several weeks

A

B-Blockers

193
Q

What type of medication is contraindicated in CHF?

A

calcium channel blockers, with exception of mlodipine (Norvasc).

194
Q

What type of calcium channel blockers can be used in diastolic dysfunction CHF?

A

nondihydropyridine calcium channel blockers (Diltiazem, verapamil)

195
Q

One last thing about CHF:

A

cardiac resynchronizaiton therapy

196
Q

Sexually active, symptomatic, and high risk females should be screened for _______ and ______ by urine nucleic acid amplification

A

Gonorrhea and Chlamydia

197
Q

Describe the murmur of hypertrophic cardiomyopathy

A

Best heard along the left sternal border and accentuates with activities that decrease cardiac preload and end-diastolic volume of the left ventricle. Standing or straining with a Valsalva manuever would increase the murmmur. 3/6 systolic murmur is indicative, or any diastolic murmur

198
Q

Gonorrhea and Chlamydia screening test?

A

Urine for nucleic acid amplification

199
Q

Prehypertension

A

Blood Pressure between 120 and 139 mm Hg systolic and 80 and 89 mm Hg diastolic

200
Q

Which is a greater risk for cardiovascular disease complications: systolic or diastolic?

A

Systolic

201
Q

For persons with diabetes or kidney disease, the goal BP is to achieve what?

A

below 130/80

202
Q

Stage 1 hypertension

A

Systolic: 140-159
Diastolic: 90-99

203
Q

Stage 2 Hypertension

A

Systolic: >160
Diastolic: >100

204
Q

What is the first line primary treatment of hypertension?

A

Thiazide diuretics

205
Q

what is the treatment for a stage 2 hypertension/someone who is above the recommended goal by less than or equal to 20/10 mm Hg?

A

Combination therapy with two medications

206
Q

What is the most common cause of hypertension in pediatric patients? What tests should be ordered?

A

Renal parenchymal disease.

Order urinalysis, urine culture, and renal ultrasonography for all children presenting with hypertension

207
Q

“Sausage shaped mass”, “Currant Jelly”

A

Intussusception

208
Q

“Olive shaped mass”, “double track sign”, waves across abdomen moments before emesis

A

Pyloric stenosis

209
Q

When intussusception is suspected, what are the first steps?

A

IV fluid stabilization, surgery consultation, plain film of the abdomen to rule out perforation.

210
Q

What test is diagnostic and therapeutic for intussusception?

A

barium enema

211
Q

What is the differential diagnosis for intestinal obstruction?

A

Hypertrophic pyloric stenosis, malrotation with volvulus/obstruction, foreign-body ingestion, and poisoning.

212
Q

What is the most common cause of GI obstruction in infants?

A

Hypertrophic pyloric stenosis

213
Q

If malrotation is suspected, what is the test of choice?

A

Upper GI series

214
Q

Lab studies/screening for suspected dementia

A
  • “Anything that can alter mental status” Blood count, electrolytes, glucose, calcium, liver function tests, folate, B12, TSH.
  • Syphilis screening for tertiary syphilis
  • CT or MRI
  • Depression
215
Q

What is the most widely used tool in screening for dementia?

A

Folstein Mini-Mental status exam (MMSE) has 87% sensitivity and 82% specifcity

216
Q

What is “pseudodementia”?

A

Depression in the elderly that mimicks dementia

217
Q

Medications used in treatment of Alzheimer’s dementia

A 
Donepezil
Galantamine
Rivastagmine
Tacrine
NMDA antoginist
Memantine
"DONE GALloping Near The RIVer, mah man (MEMAN)"
218
Q

Which type of dementia has a sudden onset and progresses in a stepwise fashion?

A

Vascular dementia

219
Q

What type of dementia presents with vivid hallucinations, fluctuation in cognition, and often parkinsonian extrapyramidal signs and postural instability?

A

Lewy Body

220
Q

What is delirium?

A

Acute change in mental status characterized by fluctuations in levels of consciousness.

221
Q

What is caused by normal pressure hydrocephalus in the elderly?

A

Triad: dementia, incontinence, gait disturbance

222
Q

Pharmacotherapy can be used in obesity patients with a BMI over __________

A

30 (or 27 with comorbid conditions)

223
Q

For obesity, only ________ is approved for long-term use of up to 2 years by the US food and drug administration

A

orlistat (inhibits absorption of dietary fat)

224
Q

aside from orlistat, all obesity medications are __________

A

anorexiants (increase satiety and satiation by affecting the monoamine oxidase system in the hypothalamus)

225
Q

Weight loss medications not called orlistat

A 
"Do PPD"
Dextroamphetamine
Phendimetrazine
Diethylproprion
Phentermine
226
Q

What type of patient is a potential candidate for bariatric surgery?

A

Patients with a BMI greater than 40 who have failed diet and exercise (with or without drug therapy), or greater than 35 with comorbid conditions

227
Q

Migraine headache diagnostic criteria

A

moderate to severe headache with pulsating quality, unilateral location, nausea and/or vomiting; photophobia, phonophobia, worsening with activity, multiple attacks lasting 3-4 days, absence of history or physical exam findings.

228
Q

Common migraine triggers

A

Menses, fatigue, hunger, stress

229
Q

Tension headache

A

pericranial muscle tenderness and a description of bilateral bandlike distribution of pain

230
Q

Cluster headache

A

Unilateral headaches that may have a high male predominance, can be located in the orbital, supraorbital, or temporal region. Deep, excruciating pain lasting from 15 minutes to 3 hours. Usually episodic, but can be chronic.

231
Q

What figures increase the likelihood of finding an abnormality on an imaging test for headache?

A

rapidly increasing headache frequency or a history of either lack of coordination, focal neurologic symptoms, or headache awakening the patient from sleep.

232
Q

What drugs can be used for migraine headache prevention?

A

amitryptiline, propranolol, timolol, divalproex

233
Q

What is initial pharmacologic therapy for atension headache?

A

Aspirin, acetaminophen, NSAIDs

234
Q

Cluster headache treatment

A

O2 at 6 mL/min (100%), triptans, dihydroergotamine, verapamil, lithium, divalproex, ergotamine, prednisone.

235
Q

Someone with known CHD or a CHD equivalent has a greater than _________ risk of having another CHD. These people will have the lowest cholesterol targets.

A

20% in 10 years

236
Q

In terms of lipids, the main risk factor for CHD is _______

A

LDL

237
Q

What are the guidelines on lipid screening?

A

Every adult over the age of 20 every 5 years, Can be fasting lipid panel or nonfasting total HDL cholesterol with subsequent fasting lipid panel if HDL200

238
Q

What are the 5 factors that determine the LDL in an individual?

A
  1. Cigarette smoking
  2. Hypertension (BP>140/90 or on antihypertensives)
  3. Low HDL
  4. Age >45 for men, >55 years for women
  5. Family history of premature CHD (male first dgree relative
239
Q

What is the LDL goal for risk category “CHD or CHD equivalent”? When should medication be considered?

A

LDL should be less than 100. Medication should be considered when LDL >130

240
Q

What is the LDL goal for patients with 2 or more risk factors? When should medication be considered?

A

LDL goal is less than 130. Medication should be considered when LDL >160 for 10 year risk between 10%-20% and >190 for 10 year risk between 0% and 9%

241
Q

What is the LDL goal for patients with 0-1 risk factors? When should medication be considered?

A

LDL goal is less than 160. Medication should be considered when LDL is greater than 190

242
Q

What is the LDL goal for patients who have a CHD and multiple risk factors?

A

LDL goal is less than 70

243
Q

What are the secondary causes of dyslipidemia?

A

Diabetes, hypothyroidism, obstructive liver disease, and chronic renal failure

244
Q

What is the cornerstone for all treatments for hyperlipidemia? What specific guidelines are given for fat and cholesterol intake?

A

Therapeutic lifestyle changes. Specific recommendations include a reduction of saturated fat to less than 7% of total calories and an intake of less than 200 mg/d of cholesterol?

245
Q

The first line pharmacotherapy for LDL cholesterol reduction is __________

A

a statin

246
Q

What are the USPSTF’s recommendations regarding intimate partner violence?

A

All clinicians should be alert to physical and behavioral signs and symptoms associated with abuse and neglect, and direct questions about abuse are justifiable due to high levels of undetected abuse in women

247
Q

Neglect is a form of __________

A

child abuse

248
Q

hip pathology will frequently present with pain where?

A

Groin, thigh, or even knee

249
Q

What is an antalgic gait?

A

Gait that occurs when the stance phase of gait is shortened, usually because of pain during weight bearing.

250
Q

____________ is the most sensitive marker of hip pathology in children, followed by __________

A

Restricted internal rotation, lack of abduction

251
Q

Common causes of limping in infants and toddlers

A

arthritis, fractures, and complications of congenital hip dysplasia

252
Q

How will children wit ha septic hip joint lay?

A

with their hip flexed, abducted, and externally rotated.

253
Q

Definitive diagnosis of septic arthritis comes from

A

aspiration of the joint

254
Q

How does undiagnosed congenital dysplasia of the hip present?

A

painless lump that is present form the time the child learns to walk

255
Q

What will septic joint aspirate look like?

A

A septic joint will have purulent aspirate with a WBC greater than 50,0000/uL

256
Q

What will transient synovitis joint aspirate look like?

A

Transient wynovitis will have a clear/ellow aspirate with lower WBC (

257
Q

What is Legg-Calce-Perthes?

A

Disease of avascular necrosis of the femoral head that typically occurs in children aged 4-8 years

258
Q

What type of hip injury is common in overweight adolescent boys?

A

Slipped capital femoral epiphysis (treatment is surgical pinning of the neck) Can complicate to avascular necrosis of the hip

259
Q

Drug fever

A

Fever that coincides with the administration of a particular drug and cannot be otherwise explained by clnicial and laboratory findings.

260
Q

Malignant hyperthermia

A

A rare autosomal disorder characterized by a fever greater than 104 (40C) tachycardia, metabolic acidosis, rhabdomyolysis, and calcium accumulation in skeletal muscle leading to rigidity. May occur up to 24 hours after exposure to anesthetic agents halothane and succinylcholine.

261
Q

Surgical Sight infection (SSI)

A

infection that occurs in the site of surgery within 30 days of an operative procedure or 1 year of implants.

262
Q

The “5Ws” pneumonic for posteroperative fever causes

A
  • Wind: pneumonia
  • Water: UTI
  • Wound: (SSI)
  • walk: DVT
  • wonder drugs: (Drug fever)
263
Q

What are two important infectious etiologies to keep in mind if fever occurs within 36 hours postlaparotomy?

A
  1. Bowel injury with leakage of GI contents into peritoneum
  2. Invasive soft-tissue wound infection caused by invasive streptococci and clostridium species.
    (TSS from staph aureus possible but less likely)
264
Q

Homan sign

A

Pain in the calf on foot dorsiflexion

265
Q

Bronchiolitis

A
  • The most common acute cause of wheezing in children younger than 2 years of age, especially in infants who are 1-3 months old.
  • It is a viral infection causing nonspecific inflammation of the small airways and peaks during the winter months.
  • RSV accounts for 70% of cases
266
Q

What is the progression of Cronchiolitis?

A
  • Initially, the child develops rhinorrhea and wheezing followed by low grade fever.
  • dyspnea eventually occurs, and fever
267
Q

When is supplemental oxygen recommended for patients with bronchiolitis?

A

if SpO2

268
Q

What is the most common cause of airway obstruction in children aged 6 months to 6 years?

A

Croup

269
Q

What is Croup?

A

It is a viral infection of the subglottic region or the larynx that produces the characteristic barking cough, hoarseness, stridor, and different degrees of respiratory distress that are more severe at night.

270
Q

When does croup usually occur?

A

Fall and winter

271
Q

A croup score > ____ indicates severe croup

A

8

272
Q

Moderate croup (westley socre 3-7) requires what?

A

epinephrine and other additional measures

273
Q

What are the current cornerstones in treatment of croup?

A

Inhaled corticosteroids and epinephrine

274
Q

What is Epiglottitis?

A

A bacterial infection of the supraglottic tissue and surrounding areas that causes rapidly progressive airway obstruction

275
Q

What vaccine has caused epiglottitis rates to go down?

A

Hib

276
Q

Epiglottitis visible on X-ray is called _________

A

thumb sign

277
Q

Irritable bowel syndrome (IBS)

A

A functional GI disorder characterized by chronic abdominal pain and altered bowel habits

278
Q

Lubirprostone (amitizia)

A

Pharmacologic agent that selectively activates intestinal chloride channels and increases fluid secretion is FDA approved for IBS in women with constipation, but has a side effect of nausea in a significant number of patients

279
Q

In patients with typical features of IBS, what testing is recommended?

A

CBC and stool hemoccult.

280
Q

IBS treatment for abdominal pain: Antispasmotics

A

dicyclomine and hysocycamine

281
Q

IBS treatment for abdominal pain: TCAs

A

Amitryptiline

282
Q

IBS treatment for abdominal pain: SSRIs

A

These can be used. Just remember that

283
Q

IBS treatment for abdominal pain: antibiotics

A

Rifaximin

284
Q

IBS treatment for Constipation: Natural

A

Fiber (Psyllium)

285
Q

IBS treatment for diarrhea

A

loperamide and alosetron for 6 months of symptoms

286
Q

Classic triad of ectopic pregnancy

A

Missed menses, pain, and bleeding

287
Q

Most common sign of uterine rupture

A

Fetal distress with prolonged, variable, or late decelerations and bradycardia is the most common, and often only, sign of uterine rupture.

288
Q

Treatments for opiod addiction

A

Methadone (long acting synthetic opiod), buprenorphine (parital opiod receptor agonist), naltrexone (long acting opiod antagonist)

289
Q

Treatments for tobbacco addiction

A

Niotine replacement therapies (gums, patch, spray, lozenges), Buproprion (blocks norepinephrine reuptake), varenicicline (partial nicotinic agonist

290
Q

Alcohol addiciton treatment

A
  • Naltrexone
  • Acamprosate (Acts on GABA and glutamate pathway
  • Disulfiram (makes you sick with acetaldehyde
  • Topiramate (probably does GABA and glutamate)
  • Chlordiazepoxide, diazepam, lorazepam (benzos)
  • Atenolol, propanolol (improve withdrawal symptoms)
  • Clonidine (alpha antagonist)
291
Q

Stimulant addiction treatment

A
  • methylphenidate, amantidine (dopamine antagonists(
  • Propanolol
  • Despiramine, buprpion (antidepressants)
292
Q

What is the treatment for acute opiod intoxication?

A

IV naloxone

293
Q

Long QT syndrome

A

caused by mutations in multiple genes and is autosomal dominant, seen more commonly in females

294
Q

Lab screening tests for noncardiac causes of palps

A

CBC, chemistry panel, TSH

295
Q

A _______ Should be done prior to cardioversion for chronic atrial fibrillation in order to rule out presence of a thrombus that might dislodge

A

Transesophogeal echocardiogram (TEE)

296
Q

Treatment for atrial fib?

A

Beta blockers (slow hear rate below 100) and anticoagulation with warfarin

297
Q

What is the most common cause of palpiations?

A

Primary rhythm disturbance

298
Q

The presence of delta waves on an ECG indicate what?

A

Wolff-Parkinson White (WPW) syndrome, AKA the presence of an accessory track that can be ablated by an electrophysiologist

299
Q

What is a PVC?

A

Premature ventricular contraction

300
Q

What is the confirmatory test for hypertrophic cardiomyopathy?

A

echocardiogram

301
Q

What is appropriate in a patient with frequent (daily) palpitations?

A

A 24-72 hour Holter Monitor. A 30 day event monitor is a better test for someone with infrequent episodes

302
Q

What are the charateristics of the hypertrophic cardiomyopathy murmur?

A

A systolic heart murmur that increases in intensity with Valsalva maneuver

303
Q

Hymenoptera

A

Insect order that causes allergic reactions

304
Q

How do you treat local insect sting reactions?

A

Ice, antihistamines, NSAId for pain relief. Tetanus prophylaxis needed in those not yet vaccinated or boosted.

305
Q

Delayed reaction to insect bite

A

Larrge area (>10cm) of redness and warmth. not infectious, will not respond to antibiotics. Best treated with oral steroids. Tetanus prophylaxis must be updated if necessary.

306
Q

Treatment of Anaphylaxis

A
  • ABC assessment (intubate if necessary), fluid rescussitation of 10-20 mg/kg ASAP.
  • Subcutaneous of intramuscular injection of 0.3 - 0.5 mL of 1:1000 solution of epinephrine given ASAP and repeated in 10-15 minutes if needed
307
Q

Treatment of animal bite

A
  • ABCs
  • Local cleaning of the wound(s) with soap and water, irrigation with saline, and debridement of devitalized tissue should take place ASAP.
  • update tetanus vaccination as needed
  • contact animal control authorities for guidance regarding rabies vaccination
308
Q

What is the current guidance for dog and cat bites?

A

Oral Augmentin prophylaxis for 5-7 days for patients with moderate to severe wounds from dog/cat/human. When cellulitis is present, do 7-14 days.

309
Q

What organism is most common in human bite injuries?

A

Eikenella corrodens

310
Q

What is the first diagnostic test in a suspected stroke patient?

A

CT without contrast to rule out hemorrhages

MRI can come later

311
Q

What are immediate precautionary treatments for suspected stroke patients?

A

ABC, Aspirin within 48 hours, DVT prophylaxis. No anticoagulation

312
Q

Transient ischemic attack (TIA)

A

A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without infarction.

313
Q

Transient symptoms with infarction (TSI)

A

A transient episode of neurologic dysfunction associated with irreversible ischemic brain injury

314
Q

What assessment can be used to identify patients at high risk of ischemic stroke in the first 7 days after TIA

A

ABCD2 score:

  • A: Age > 60 years (1 point)
  • B: Blood pressure elevation (S>140 d>90) (1 Point)
  • C: Clinical features (Unilateral weakness = 2 points, isolated speech disturbance = 1 point, other = 0)
  • D: Duration (>60 min = 2 points, 10-59 min = 1 point,
315
Q

____________ is the single most important risk factor for stroke

A

Hypertension

316
Q

What is a crucial distinction to make when a stroke is diagnosed?

A

Differentiate between acute and hemorrhagic stroke

317
Q

A _________ should be done in all stroke patients in order to detect acute myocardial infarctions

A

12-lead ECG

318
Q

When would you administer recombinant tissue-type plasminogen activator (rtTPA)?

A

if the patient can be treated within 3 hours of the onset of ischemic stroke and the patient has no contraindications, like anticoagulant medications, MI, recent surgery, trauma

319
Q

When a subarachnoid hemorrhage is suspected but not seen on CT, a _________ is indicated for diagnosis

A

lumbar puncture

320
Q

Patients with a history of symptomatic cerebrovascular disease should be treated to an LDL goal of less than _______

A

100 mg/dL

321
Q

If a patient has an ischemic stroke, ___________ will be a good management option

A

early mobilization of the patient

322
Q

_______ is good initial pharmacotherapy for stroke patients with no detected sources of embolism

A

aspirin or clopidogrel (anti-platelet)

323
Q

Be aware that ___________ can mimic stroke symptoms

A

hypoglycemia

324
Q

Treatment of __________ should be cautious in stroke patients

A

Hypertensions

325
Q

“ground glass” lung appearance on x-ray in suspected HIV patient

A

P. Jiroveci

326
Q

Postexposure treatment of healthcare workers exposed to HIV includes what?

A

immediate and careful cleanming of the exposure/puncture sight with postexposure prophylactic (PEP) treatment with anti-retroviral therapy. (start within 2 hours)

327
Q

Stages of AIDS

A

Stages of AIDS determined by CD4 count
1: >500
2: 20-499
3:

328
Q

The standard screening test for HIV infection is ________

A

Detection of HIV antibodies using ELISA (enzyme-linked immunosorbent assay)

329
Q

AIDS screening test samples that are repeatedly positive on ELISA must be confirmed with __________

A

Western Blot testing (electrophoresis that detects antibodies to HIV antigens of specific molecular weights)

330
Q

___________ vaccines are contraindicated in AIDS patients and their close contacts

A

Live virus

331
Q

P. jirovecci prophylaxis?

A

TMP-SMX when CD4

332
Q

Mycobacterium avium-intracellulaire prophylaxis recommendation

A

CD4

333
Q

Varicella vaccine is ________ in HIV patients

A

contraindicated (live vaccine)

334
Q

conjugated bilirubin is excreted in the __________, while unconjugated bilirubin is bound to albumin and exempted from glomerular filtration

A

urine

335
Q

A biliary obstruction leads to ___________ bilirubinemia

A

conjugated

336
Q

What is Gilbert Syndrome?

A

Congential reduction of conjugation of bilirubin in the liver due to autosomal recessive gene involved in glucoronidation.

337
Q

What type of bilirubinemia is caused by Hep A?

A

Conjugated

338
Q

Hep A diagnosis

A

conjugatred bilirubinemia, elevated hepatic transaminases, and serology.

339
Q

HBsAg

A

Hepatitis B surface antigen. present in both acute and chronic infections. It’s presence is associated with contagiousness to tohers. Typically becomes detectable in 1-10 weeks following HBV exposure and disappears in 4-6 months in those who recover. Persistent detection of HBsAg after 6 months indicaters chronic infection.

340
Q

HBeAg

A

Hepatitis e antigen. Marker for HBV replication and infectivity. patients with HBeAg are 100 times more infectious than those lacking it.

341
Q

Anti-HBs

A

Antibody to the surface antigen in the absence of HBSaG is seen in resolved infections and is the serologic marker produced after HBV vaccination

342
Q

anti-HBcAg IgM

A

diagnostic of acute infection. Only serological maker detectable during the window period.

343
Q

A negligible level of HBsAg with a negative anti-HBcAg IgM is diagnostic of ________

A

chronic HBV infection

344
Q

Hepatitis D requires what to thrive?

A

coinfection of Hep B because HepD uses the viral envelope of HepB to infect the host.

345
Q

What happens to levels of liver enzyme markers in alcohol abuse?

A

Transaminase levels from alcohol abuse typically show the aspartate aminotransferase (AST) being elevated out of proportion to the Alanine aminotransferase (ALT), a ratio of 2 or greater

346
Q

HCV effects?

A

Cirrhosis and edema

347
Q

All pregnant women should be screened for what hep B thingy?

A

HBsAg. If positive, treat newborn with Hep B immunoglobulin (HBIg) and vaccination

348
Q

__________ is one of the greatest risks for developing cirrhosis in Hep C patients

A

alcohol abuse

349
Q

Asymptomatic chronic bilirubin elevation is a sign of

A

gilbert syndrome

350
Q

The acute onset of painless jaundice in a patient older than age 50 years should prompt an examination for ___________

A

pancreatic cancer

351
Q

Primary diagnostic tool for CHF

A

The most useful diagnostic tool for evaluating patients with heart failure is two-dimensional echocardiography with Doppler to assess left ventricular ejection fraction (LVEF), left ventricular size, ventricular compliance, wall thickness, and valve function. The test should be performed during the initial evaluation.

352
Q

Recommended intial cardiac study for palps?

A

It is recommended to start the evaluation for cardiac causes with an EKG, which will assess the baseline rhythm and screen for signs of chamber enlargement, previous myocardial infarction, conduction disturbances, and a prolonged QT interval.

353
Q

ST-segment depression

A

ischemia

354
Q

Treat systolic hypertension in the elderly with

A

Thiazide diuretics. Thiazide diuretics may also improve osteoporosis, and would be the most cost-effective and useful agent in this instance.

355
Q

The ankle-brachial index (ABI)

A

The ankle-brachial index (ABI) is an inexpensive, sensitive screening tool and is the most appropriate first test for peripheral vascular occlusive disease (PVOD). The ABI is the ratio of systolic blood pressure measured in the ankle to systolic pressure using the standard brachial measurement. A ratio of 0.9-1.2 is considered normal.

356
Q

Which cardiovascular parameter increases with normal aging?

A

Blood pressure

357
Q

What changes does the heart undergo in normal aging?

A

As the body ages, the measured left ventricular ejection fraction, heart rate variability, and maximum heart rate trend downward, the walls of the major aorta and major arteries stiffen, and the vasodilator capacity of most smaller vessels is reduced (SOR A). The arterial wall changes increase peripheral resistance and result in an increase in blood pressure.

358
Q

Which drug class is preferred for treating hypertension in patients who also have diabetes mellitus?

A

ACE inhibitors

359
Q

Slipped capital femoral epiphysis

A

Slipped capital femoral epiphysis is the most common hip disorder between the ages of 8 and 15 and is more common in boys and overweight or obese children. It presents with limping and pain, and limited internal rotation of the hip is noted on physical examination.

360
Q

For high risk of colorectal cancer patients (1st degree relative or 2 second degree relatives have it before age 60), what are the screening recommendations?

A

They should start colon cancer screening at age 40, or 10 years before the earliest age at which an affected relative was diagnosed (whichever comes first) and be rescreened every 5 years.

361
Q

Who should early diagnostic upper GI endoscopy be considered for?

A

Patients with new-onset dyspepsia who are older than 55 years or who may have symptoms that may be associated with upper GI malignancy.

362
Q

What testing should be done for patients with epigastric pain and no alarm symptoms?

A

H pylori, by IgG serology rather than 13-C urea breath test or stool antigen test, is recommended due to its low cost and ease of collection. Urea or stool antigen testing used to confirm a positive result.

363
Q

How do H2 blockers work?

A

Competative antagonists of histamine binding to gastric parietal H2 receptors, which prevent activation of the pathway that mediates release of acid into the gastric lumen

364
Q

How do PPIs work?

A

Suppress gastric acid production by irreversibly inhibiting H+K+ATPase proton pump in gastric parietal cells

365
Q

Gastric ulcers are more common in _________ users

A

NSAID

366
Q

Classic PUD (peptic ulcer disease) symptoms

A

Epigastric abdominal pain that is improved with ingestion of food, or pain that develops a few hours after eating. Nocturnal symptoms also common. Gradual onset of symptoms.

367
Q

What is the gold standard for diagnosis for H pylori?

A

endoscopy with biopsy testing

368
Q

Urea breath tests detects _______

A

Active h pylori infection

369
Q

Serologic testing for anti-H pylori antibodies cannot distinguish between what?

A

Active and resolved infections

370
Q

Which bloody stool patients should undergo a colonoscopy regardless of endoscopy findings?

A

Patients over 50

371
Q

Roseola

A
  • HHV-6
  • 1-2 week incubation, mild fever, rash after fever goes away. Starts on trunk, spreads rapidly. Dissapear after 2 days. no treatment
372
Q

Varicella

A

chicken pox,
rash, malaise, fever, anorexia.
-Papules or vesicles on an erythematous base (dew drops on rose petal).
-vaccination at 12-18 months with booster at age 4-6 years

373
Q

fifth disease

A
  • Parvovirus B-19
  • AKA erythema infectiosum
  • mild fever and upper respiratory symptoms followed by rash lasting 4-14 days. Starts on face, goes down. “slapped cheek” appearance.
374
Q

Meningococcemia rash

A

Starts as erythematous maculopapular eruption that does not blanch with compression which prgroesses to form petechiae.

375
Q

Menigococcemia immediate treatment

A

Empirical. do not wait for lumbar puncture. Ampicillin + gentamicin for children or vancomycin and ceftriaxone for adults. Penicillin for meningococcal meningitis.

376
Q

Page 477

A

watch those sketchies

377
Q

Acromegaly

A

A condition that results from excessive production of growth hormone by a pituitary adenoma. May cause menstrual irregularities and breast discharge

378
Q

Duct Ectasia

A

Inflammation of a mammary duct below the nipple, which can lead to duct obstruction, a tender mass, and duct discharge

379
Q

Intraductal papilloma

A

A benign tumor growth into a mammary duct, often with a resultant palpable small mass and duct discharge.

380
Q

The identification of a new breast solid mass particularly in women older than 35 years should prompt __________

A

Triple assessment, which includes a clinical breast examination, imaging (mammography), and pathology assessment either by core biopsy or surgical excision.

381
Q

For women younger than 35 years of age, suspected lesion characteristic of fibroadenoma or fibrocystic changes can be assess by ___________

A

ultrasonography

382
Q

When is surgery indicated on a breast mass?

A

It is indicated if sterotactic biopsies show atypical ductal hyperplasia

383
Q

Is breast pain a common complication of breast cancer?

A

No

384
Q

What 3 categories can breast pain be split up into?

A
  1. Cyclic mastalgia: diffuse, ilateral, often radiating to axilla and arm and related to menstrual cycle. resolves with menses
  2. Noncyclic mastalgia: continuous or intermittent, but not associated with the menstrual cycle. More commonly unilateral and more prevalent in postmenopausal women.
  3. Extra-mammary pain is breast pain secondary to another etiology. This is often chest wall pain, but sometimes, the underlying cause may be difficult to determine
385
Q

What is the FDA approved treatment for breast pain?

A
  • Danazol (but expensive)

- Others include tamoxifen, torpemiphene, and bromocriptine.

386
Q

Nipple discharge is usually caused by a __________ process

A

benign

387
Q

What type of nipple discharge is more likely to represent a pathologic process?

A

Discharge that is spontaneous, persistent, from a single duct, associated with a mass, and occurs in women over 40 years of age is more likely to represent a pathologic process.

388
Q

What is the treatment for most unilateral, spontaneous, or bloody nipple discharges?

A

Surgical excision of the terminal duct

389
Q

What is the treatment of choice for most patients with hyperprolactinemic disorders?

A

Dopamine agonists (bromocriptine if infertility is involved).

390
Q

Amenorrhea

A

Absence of menstrual bleeding for 6 months or more without pregnancy

391
Q

Menometrorrhagia

A

Heavy menstrual flow or prolonged duration of flow occurring at regular intervals

392
Q

Monorrhagia

A

Excessive menstrual flow, or prolonged duration (>7 d)occurring at regular intervals

393
Q

Metrorrhagia

A

Bleeding occurring at irregular intervals

394
Q

Asherman syndrome

A

Scarring within the uterine cavity caused by trauma for uterine curettage.

395
Q

Risk factors for endometrial carcinoma

A

History of anovulatory menstrual cycles, obesity, nulliparity, age older than 35, the use of tamoxifen, or of unopposed exogenous estrogen

396
Q

Dysfunctional uterine bleeding age of concern?

A

> 35

397
Q

Nonketotic hyperosmolar syndrome

A

Occurs in type II diabetics when blood sugar levels become highlyelevated, often approaching 1000 mg/dL..This elevates the serum osmolarity, giving the patient a large fluid deficit (up to 9 L).

398
Q

What causes gestational diabetes?

A

increased insulin resistance caused by elevated chorionic somatomammotropin, progesterone, and estrogens all of which act as insulin antagonists.

399
Q

Maternal complications of gestational diabetes

A

DKA, hyperglycemia, increased UTI risk, increased pregnancy induced hypertension/preeclampsia, and retinopathy.

400
Q

Fetal effects of gestational diabetes

A

Congential malformation, macrosomia, polycythemia, hydramnios.

401
Q

Gestational diabetes screening

A

50-g 1 hour glucose challenege test (GCT) administered to high risk pregnant women at intitial visit and rescreened at 24-28 wks. Greater than 130 mg/DL leads to 100g 3 hour test. Diagnosis made with greater than 2 positive results

402
Q

Diabetes diagnosis: fasting glucose greater than

A

126 mg/dL

403
Q

Diabetes diagnosis: 2 hour pasma glucose or _____ or more after 75 mg glucose load

A

200 mg/dL

404
Q

Diabetes diagnosis: HA1C of _____ or greater

A

6.5%

405
Q

Diabeetes diagnosis:: Random glucose of ______ or more along with classic symptoms

A

200 mg/dL

406
Q

Metformin disadvantages

A

GI side effects, contraindiacted in patients with renal insufficiency

407
Q

Sulfonylurea disadvantages

A

Weight gain, hypoglycemia

408
Q

TZDs for diabetes disadvantages

A

fluid retention, CHF, weight gain, MI risk

409
Q

Metformin mechanism

A

Biguanides act on liver to decrease output during gluconeogenesis. Secondary actions include increased insulin sensitivity in the liver and muscle and hypothesized decrease in intestinal absorption of glucose

410
Q

Metformin contraindicatoins?

A

Creatinine of greater than 1.5/1.4 in men/women

411
Q

Principal action of thiazolidinediones (TZDs)

A

improving insulin sensitivity in muscle and adipose tissue. Secondary actions are decreased hepatic gluconeogenesis and increased peripheral glucose utilization

412
Q

Exenatide

A

GLP-1 agonist, incretin mimetic. Synthetic peptide that stimulates insulin releasse

413
Q

DPP-4 inhibitors

A

Gliptins. Inhibit GLP-1 and GIP and decrease glucose production in liver

414
Q

BP goal in diabetes ptients?

A

Less than 130/80

415
Q

Creatinine clearance

A

((140-age) x (ideal body weight in kg) x (0.85 for women))/(72xserum creatinine)

416
Q

Max bed rest for back pain?

A

2 days

417
Q

Length of time herniated disk can be treated conservatively before imaging is of benefit?

A

MRI4 weeks

418
Q

Cauda equina syndrome should be immediately evaluated by ____

A

MRI

419
Q

Age by which a child should use single words?

A

Most children will say “mama/dada” indiscriminately by 9 months of age and use two other words by 12 months of age. No single words by 16 are a red flag of autisim spectrum disorder

420
Q

Impairments for autism diagnosis

A
  • Social interaction: deficient nonverbal behavior, peer relationships, spontaneous seeking of relatedness with others
  • Communication: Spoken language development, conversation, play
  • Restricted, repetative, and stereotyped patterns of behavior, interests, and activites
421
Q

When shoud all children be screened with the Modified Checklist for Autism in Toddlers (M-CHAT)?

A

18- and 24-month visits

422
Q

What do you do when a child has a positive autism screening or demonstrates 2+ risk factors?

A
  • Refer the child for comprehensive ASD evaluation
  • Refer child to early intervention/early childhood education services
  • Obtain an audiologic evaluation
423
Q

Chorea

A

Unpredictable, involunatry, irregular, brief movement that is jerky, writhing, or flowing

424
Q

Hyperkinesias

A

Movement disorders characterized by extra or exaggerated

425
Q

hypokinesias

A

movement disorders characterized by overall slowness of movement (bradykinesia), lack of movement (akinesia), or difficulty in initiating movement

426
Q

Are laboratory and radiologic testing useful in diagnosis of movement disorders?

A

nope!

427
Q

What happens in Parkinson’s?

A

Neurons and dopamine are lost from the substantia nigra (part of basal ganglia) and intra-cytoplasmic inclusions (lewy bodies) proliferate. Dopamine depletion in the substantia nigra ultimately leads to increased inhibition of the thalamus and decreased excitation of the motor cortex.

428
Q

Cardinal physical signs of Parkinson’s

A

Distal resting tremor, rigidity, bradykinesia, postural instability, and assymetric onset

429
Q

First line treatment for parkinsons?

A

Levodopa for motor impairment, dopamine agonists such as pramipexole and ropinirole to lower risk of motor complications, and MAO-B inhibitors.

430
Q

First line treatment for Tourrette’s?

A

Clonidine helps iwth comorbind ADHD and OCD

431
Q

Huntington disease is inherited in an ______ pattern

A

AD

432
Q

Haloperidol helps in what tic disorder?

A

Tourrette’s

433
Q

Too much levodopa causes _____

A

Dyskinesia

434
Q

Intermittent asthma

A
  • Symptoms 2x per week
  • Night time awakenings 2 times per month
  • Short acting B agonist used less than 2 days per week
435
Q

Mild asthma

A
  • symptoms more than 2 days/week
  • nighttime awakenings 3-4x/month
  • B agonist used greater than 2 days/week
  • Minor limitation of normal acitvity
436
Q

Moderate asthma

A
  • Daily symptoms
  • nighttime awakenings greater than 1x/week but not nightly
  • daily use of B agonist
  • Some limitation of normal activity
  • FEV 60-80, FEV/FVC 75-80
437
Q

Severe asthma

A
  • Symptoms throughuought day
  • Nighttime awakenings 7x/week
  • B agonist used several times/day
  • Normal activity extremely limited
  • FEV less than 60, FEV/FVC less than 75
438
Q

Asthma diagnostic studies

A
  • accurate spirometry 5 yrs or older at time of diagnosis.
  • Allergy testin
  • Chest radiography
439
Q

Treatment for asthma always begins with _______

A

education and counseling, environmental controls, and management of coexisting conditions

440
Q

Treatment for AFib?

A

Rate and coagulation

Ventricular rate control with a calcium channel blocker or beta-blocker, and warfarin for anticoagulation

441
Q

Preeclampsia criteria

A

The criteria for severe preeclampsia specify a blood pressure of 160/110 mm Hg or above on two occasions, 6 hours apart. Other criteria include proteinuria above 5 g/24 hr, thrombocytopenia with a platelet count

442
Q

How is osteoporosis diagnosed?

A

Central DEX T score of -2.5 or more of the hip, femoral neck, and lumbar spine is the standard radiographic diagnostic test.

443
Q

What is the agent of choice for osteoporosis?

A

Oral bisphosphonates, like alendronate, risendronate, and ibandronate, which inhibit osteoclastic activity and therefore have anti-resorptive properties.

444
Q

Best SERM for osteoporosis

A

Raloxifene, also decreases risk of breast cancer

445
Q

Teriparatide

A

Recombinant human parathyroid hormone that causes bone density growth through its effect on osteoblasts.

446
Q

Denosumab

A

Used for osteoporosis, prevents osteoclast differentiation and limits bone turnover.

447
Q

Who does the USPSTF recommend osteoporosis screening for?

A

Women 65+ years old without previous known fractures or secondary causes of osteoporosis. Tey also recommend routine screening for women

448
Q

Delayed gastric emptying in diabetic patient can be caused by

A

exenatide

449
Q

Gabapentin is a good drug for relieving _______ pain

A

neuropathic

450
Q

Patients using narcotics should be considered for additional prescription of _______

A

A stool softener. Constipation is a common side effect of narcotic use

451
Q

In older people, __________ is the most common cause of lower extremity swelling

A

Chronic venous insufficiency

452
Q

Lower leg swelling differential

A
  • Venous insufficiency
  • Pulmonary hypertension
  • CHF
453
Q

Venous edema

A

An excess of low viscosity, protein poor interstitial fluid resulting in pitting in affected area of the body

454
Q

lymphedema

A

An excess of protein rich interstitial fluid within the skin and subcutaneous tissue. Primary forms are rare and often genetically related. Secondary lymphedema is more common and often related to previous malignancies, surgery, radiation, and infections.

455
Q

Lipidema

A

A form of fat maldistribution that can appear to be leg swelling with foot sparing

456
Q

Myxedema

A

A dermal edema secondary to increased deposition of connective tissue components (mucopolysaccharides) seen in various forms of thyroid disease

Family Medicine (2 decks)

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