Common symptoms

Question 1

Difference between acute, persistent, chronic and subacute cough

Answer 1

Acute- less than 3 weeks
Persistent- 3 to 8 weeks
Chronic- >8weeks
Subacute- post infectious cough for 3 to 8 weeks

Question 2

when cough lasts more than 3-6 wks what imaging should be done

Answer 2

chest radiography

Question 3

cough lasting more than 3 weeks what is considered

Answer 3

pertussis

Question 4

If ACE inhibitor, respiratory infection, and radiography abnormals are absent what should be expected

Answer 4

post nasal drip, GERD, Asthma

Question 5

Dyspnea with persistant cough check for

Answer 5

HF, anemia, chronic lung disease

Question 6

Patient with acute cough abnormal vital signs, chest dullness (on percussion) with egophony what are next two studies to perform

Answer 6

C-reactive protein (Positive if >30mg/dL) and chest xray

Question 7

Persistant cough, no ACE-I or postinfection, what would you check? how would you check? what if that test is negative?

Answer 7

Suspect pertussis
check with polymerase chain reaction
negative PCR suspect asthma, GERD, post nasal drip

Question 8

Step 1 therapy for asthma

Answer 8

beta 2 agonist

Question 9

step 1 therapy for GERD

Answer 9

PPI

Question 10

STEP 1 therapy for post nasal drip

Answer 10

therapy for allergy and chornic sinusitis

Question 11

Early treatment of pertussis

Answer 11

macrolide antibiotics

Question 12

Pertussis for more than 7-10 days treatment

Answer 12

Tdap, macrolide antibiotics for those at risk (wont help cough)

Question 13

what is the difference in reflex cough and persistant cough symdromes

Answer 13

Reflex cough is when someone sees something they jsut cough

persistant cough syndromes deals with vagus/laryngeal nerve dysfunction

Question 14

When to refer patient with cough

Answer 14

1) failure of tx to control persistent or chronic cough
2) recurrent symptoms (oto, pulm, gas)
3) adults needing Tdap FOR cocooning of at risk kids

Question 15

How to diagnose pneumonia

Answer 15

CXR, blood levels of procalcitonin and C-reactive protein

Question 16

Hemoptysis essential inquires

Answer 16

1) fever cough lower respiratory tract infecoin
2) smoking history
3) nasopharyngeal or gastric bleed
4) cxr, cbc, INR

Question 17

Diagnostics tests for hemoptysis

Answer 17

CXR, cbc, renal function test, urinalysis, coagulation studies

Question 18

young obese patient with hyperlipidemia, and smoking with chest pain, EKG depressed ST, expect

Answer 18

Acute coronary syndrome

Question 19

Patient with chest pain, you do a TIMI and Goldman score and Troponin T, then you discharge patient why

Answer 19

TIMI 1 or less
Goldman score 1 or less
Troponin T in normal

Question 20

Patient with chest pain, you do a TIMI and HEART score and Troponin I, then you discharge patient why

Answer 20

TIMI 1 or less
Heart was 3 or less
Troponin was normal

Question 21

75y Patient comes in with palpitations, syncope, has abnormal ECG, hematocrit less than 30%, SOB, RR24, Hx of HF, should they be admitted

Answer 21

yes

Question 22

Treatment of lower extremity edema do to venous insufficiency without comorbid HF includes

Answer 22

leg elevation
compression therapy
ambulatory
NO DIURETICS ( may damage kidneys)

Question 23

normal celcius body temp range

Answer 23

36.7 (36to 37.4)

Question 24

neuroleptic malignant syndrome and serotonin syndrom cause what to occur body temp

Answer 24

hyperthermic

Question 25

treatment of neuroleptic malignant syndrome

Answer 25

dantrolene in combo with bromocriptine or levodopa

Question 26

treatment of serotonin syndrome

Answer 26

cyproheptadine or cholrpromazine , with benzodiazepine

Question 27

patient comes in with dilated pupils, sweating, diarrhea for days, shivering, headache, and confusion. reports starting new medication for mood. What would be expected, how would you treat

Answer 27

expect serotonin syndrome | treat with cyproheptadine (or chlorpromazine) and benzodiazepine

Question 28

Three common findings of weight loss of 5% over 6-12month period

Answer 28

1) cancer (30%) 2) GI disorders (15%) 3) dementia/depression

Question 29

First tests to run when significant weight loss is seen

Answer 29

cbc, tsh, urinalysis, fecal occult blood, serological test (hiv), cxr, upper gi

Question 30

when weight loss is seen, a second phase of tests to run

Answer 30

gastrointestinal (for malabsorption) and cancer screening (colonoscopy may not be adequate for symptom of weight loss only)

Question 31

When weight loss is seen along with anorexia nervosa, depression, or dementia what should be considered

Answer 31

psychological consult

Question 32

how many percentage of weight loss cases can go without specific cause

Answer 32

15-25%

Question 33

When initiating nutrition back to some one who had significant weight loss intake goal should be

Answer 33

30 to 40 kcal/kg/d

Question 34

3 common types of categories of treatment for weight loss include

Answer 34

1) appetite stimulants 2) growth hormone 3) anticatabolic agents

Question 35

appetite stimulant medications include

Answer 35

``` corticosteroids, dronabinol, progestational agents, and serotonin antagonists ```

Question 36

anticatabolic agents for treatment of weight loss include

Answer 36

hydrazine sulfate, omega 3 fatty acid, pentoxifylline, and thalidamide

Question 37

Patients with significant weight lose should be referred when

Answer 37

1) caused by malabsorption 2) anorexia nervosa or bulimia 3) persistent nutrition deficit despite adequate supplementation

Question 38

Patients with significant weight loss should be admitted when

Answer 38

1) cachexia 2nd to psych disorder 2) severe protein deficient (kwarshiorkor or marasmus) 3) severe vitamin deficient 4) electrolyte fluid replacement

Question 39

After physical assessment labs to be used for chronic fatigue diagnosis are

Answer 39

``` cbc chemistry erythrocyte sedimentation rate antinuclear antibodies urinalysis TB Lyme serology serum cortisol rheumatoid factor immunoglobin levels Hiv antibodies ```

Question 40

An acute headache seen in someone who is >50 or HIV positive, especially with mental or neuro abnormals on exam requires what type of imaging

Answer 40

neuroimaging

Question 41

Patients that have acute onset of headache and are 40 or older, have neck pain or stiffness, limited neck flexion, witnessed loss of consciousness, onset during exercise, thunderclap headache should be evaluated for

Answer 41

subarachnoid hemorrhage

Question 42

If suspicion of subarachnoid hemorrhage what diagnosis tests should be done

Answer 42

CT noncontrast then CT with contrast then lumbar puncture then angiography

Question 43

urinalysis is most helpful in presentation of

Answer 43

atypical cystitis

Question 44

patient with complaints of dysuria and severe flank pain what is likely considered? requires what type of imaging

Answer 44

kidney infection, hydronephrosis, >use renal ultrasound or ct scanning or nephrothiasis > CT helical scanner

Question 45

Academy of pediatrics committe on drugs states what antibiotics are safe during breast feeding

Answer 45

``` ciprofloxicin ofloxicin trimethoprim-sulfamethoxazole(unless G6PD deficient) amoxicillin nitrofurantoin ```