Content 2 Flashcards
1
Q
Most common site of OA
A
Distal interphalangeal joint
2
Q
Peak age of RA
A
20-40 years
3
Q
40% of deaths in RA due to
A
CV causes: stroke
4
Q
Initial dx tests for RA
A
ANA, ESR, CRP, ACPA, RF
5
Q
Most sensitive lab marker for SLE
A
ANA
6
Q
Risk factors when on biologics
A
Increased risk of infection
-Get immunized!
7
Q
Meniscal tear
A
Popping sound
McMurray + Apley test are positive
Squatting and kneeling are impossible
Consider aspiration if no improvement after 2-4 weeks of RICE
Consider arthroscopy if no improvement in 4-6 weeks
8
Q
Acroparesthesia
A
Awakening at night with numbness/burning in fingers
Carpal tunnel
9
Q
Sarcoidosis
A
Inflammatory condition that results in production of noncaseating granulomas, predominantly in lungs, lymph nodes, eyes, skin
Fever, fatigue, anorexia, arthralgias, dyspnea on exertion, cough, chest pain, rash, color change and nodules under skin, blurred vision, eye pain, sensitivity to light, red eyes
Dx: biopsy of bronchial
10
Q
Tx sarcoidosis
A
Mild: NSAIDS
Steroids are mainstay of tx
Other: hydroxychloroquine, methotrexate, azathioprine, infliximab
11
Q
Risk factors for low back pain
A
Increasing age, overactivity, overweight, obese, spinal stenosis, scoliosis
12
Q
most common cause of lower back pain
A
Lumbosacral strain
-Sx: stiffness, spasm, decreased ROM, sitting increases pain
13
Q
Risk factors for lumbar radiculopathy
A
Smoking, DM, spinal infection, obesity, male, increased age
14
Q
Most common site for lumbar disk herniation
A
L4-L5, L5-S1
15
Q
Cause of sciatica
A
Herniated disk, spinal stenosis, compression fracture
16
Q
Most common site for cervical disk lesion
A
C6-C7
17
Q
Reiter syndrome
A
Reactive arthritis
Acute nonpurulent arthritis complicating an infection elsewhere in the body
Requires 2+ of following: asymmetrical oligoarthritis, dactylitis (sausage shaped finger), enthesitis (toe or heel pain), cervicitis, prostatitis, acute diarrhea, conjunctivitis, urethritis
-Usually seen days to weeks following acute bacterial diarrhea caused by shigella, salmonella, campylobacter or chlamydia
-HLA B27+
-Tx: NSAIDs, steroids, TNF blockers (etanercept or inflximab), steroid injections
18
Q
Osteoporosis screening
A
> 65 with DEXA scan
19
Q
Long term use of biphosphonates can cause
A
Atypical femoral fractures
20
Q
Tendinosis
A
Degradation of tendon’s collagen due to overuse
-NSAIDs and steroids my inhibit repair
21
Q
most common sites of tendonitis
A
Rotator cuff, elbow, biceps, wrist, heel
22
Q
Benefits of vitamin D
A
Minimizes abnormal cell proliferation, increases insulin secretion, immunomodulaes and increases renin
-Need 3000-5000IU per day
23
Q
Drugs that are Vitamin D depleting
A
Phenytoin and phenobarb
24
Q
Hormonally active form of Vitamin D
A
1,25-Dihydroxyvitamin D
25
Preferred blood test for Vitamin D
Serum 25-hydroxyvitamin D
| -Preferred minimum: 34-40
26
Raynaud's
Paroxysmal digital vasoconstriction that results in bilateral symmetrical pallor or cyanosis
- Tobacco exacerbates
- Dihydropyridine CCB and ACEI can be used as tx for vasodilator effect
27
Secondary Raynaud's
Due to atherosclerosis, collagen vascular disease, scleroderma
28
Vessel most commonly affected by varicose veins
Saphenous vein
29
Virchow triad
Hypercoagulability, Stasis/turbulence, endothelial injury
30
Risk factors for superficial thrombophlebitis
Local trauma, prolonged travel or rest, varicose veins, history of estrogen use, pregnancy, 6 weeks postpartum
Tx: warm packs, compression hose, NSAIDs, ambulation
31
1st line dx for DVT
Compression duplex ultrasound
32
If healthy person has DVT, what labs to do
Protein S and C, antithrombin III, fibrinogen, lupus anticoag, factor V Leiden, prothrombin mutation
33
Direct thrombin inhibitors
Dabigatran
| Caution with renal dysfx
34
Direct factor Xa inhibitors
Rivaroxaban
35
Risk factors for arterial occlusive disease
DM, htn, hyperlipidemia, tobacco use
36
Claudication
Caused by inability of diseases vessel to vasodilate during activity
37
First line dx for arterial occlusive disease
Doppler US
38
Tx arterial occlusive disease
Aspirin, Beta blockers, statins, DM meds, clopidogrel
39
Earliest sign of chronic venous insufficiency
Lower extremity edema
| -Develops into thin, shiny, atrophic skin with brown pigmentation
40
insulin resistance is correlated with
Gout, PCOS, acanthosis nigricans, LGA, prothrombotic state
41
FBG screening
Recommended every 3 years >45 years
42
A1C test best measures glucose control in the past
28-42 days
43
Short acting, rapid onset insulin
Lispro, Aspart, Glulisine
15-30 mins onset
1-2 hour peak
3-6 hour duration
44
Short acting, regular insulin
Humulin R, Novolin R
30 min-1 hour onset
2-3 hour peak
4-6 hour duration
45
Intermediate insulin
Humulin N, Novolin N
1-2 hour onset
6-14 hour peak
16-24 hour duration
46
Long acting insulin
Glargine (Lantus), Detemir
1 hour onset
No peak
12-24 hour duration
47
Pre-diabetes labs
FBG 100-125
Random glucose 140-199
A1C 5.7-6.4
48
Most common drug combo for type 2 DM
Metformin + Sulfonylurea
49
Metformin
Improves insulin mediated glucose uptake and fibrinolysis
SE: GI distress, rare lactic acidosis
CI: renal impairment, HF, age >80
D/C day of surgery or radicontrast use
50
Sulfonylureas
Glipizide, glyburide, glimepiride
Increases insulin release
Less effective after many years of use
51
Thiazolidinediones
Glitazone
Increases insulin sensitizing in muscles
Rare risk of hepatic toxicity: monitor ALT
Risk of edema: CI in HF
Do not use with insulin or nitrates
52
GLP1 agonist
Exanatide, Liraglutide
Stimulates insulin production in response to increased plasma glucose; inhibits postprandial glucagon release; slows gastric emptying
SE: N/V
CI: Gastroperesis
53
DPP4 inhibitor
Gliptin
Increases levels of incretin; increases release of insulin and decreases glucagon
Monitor for pancreatitis
54
SGLT2 inhibitor
-Flozin
| Decreases renal glucose threshold by increasing urinary glucose excretion
55
Alpha glucosidase inhibitors
Acarbose
Decreased intestinal carb absorption by decreasing postprandial absorption
CI: IBD, impaired renal function
56
Somogyi effect
Insulin induced hypoglycemia triggers excess secretion of glucagon and cortisol, leading to hyperglycemia in the morning
-Decrease night time dose of insulin
57
Dawn phenomeon
Decreased insulin sensitivity between 5 and 8am due to spikes in growth hormone causing hyperglycemia
-Increase insulin at night
58
Metabolic syndrome
```
Central obesity
Triglycerides >150
HDL <35 men and <39 women
BP >140/90
Microalbuminuria
```
59
Exertional heat stroke
Illness has been triggered by exercise in a warm environment that adds to thermal load produced by muscular contraction
60
Non-exertional heat stroke
Extreme temp >10 degrees more than is typical for 3 days
| -Affects infants and elderly
61
Risk factors for heat stroke
TCAs, beta blockers, vasoconstrictors
| -Negate body's natural attempts to decrease core temperature (increasing CO and vasodilation)
62
Early heat stroke sx
Increased HR, pounding HA, difficulty breathing
63
Labs in heat stroke
Increase in CK, hyperkalemia, transient polycythemia due to volume constriction, hyponatremia, stress induced leukocytosis
64
Most serious complication of heat stroke
Rhabdo
65
Orlistat
Take with meals
Decreases dietary fat absorption by 30%
SE: loose stools
66
Meds that can cause weight gain
Atypical antipsychotics, some antiepileptics, steroids
67
Meds that can cause thyroid disorder
Iodide, amiodarone, lithium, interferon alpha, IL2
68
Menstrual changes in thyroid disorders
Hyper: amenorrhea
Hypo: menorrhagia
69
Most helpful test to confirm abnormal TSH
Free T4
70
Most common cause of hypothyroid
Hashimotos thyroiditis
Diffusely enlarged, firm thyroid with fine nodules, neck pain and tightness
-TPO antibodies present
71
Most common cause of hyperthyroid
Graves
| Diffuse enlargement of thyroid, exopthalmos, nervousness, tachycardia, heat intolerance
72
Recommended testing interval when adjusting thyroid meds
6-8 weeks
73
How much can you decrease LDL with diet alone
5-10%
74
4 target groups for statin benefits
Clinical ASCVD
LDL >190
DM and LDL 70-189
10 year risk >7.5%
75
High intensity statins
Atorvastatin 40-80
| Rosuvastatin 20-40
76
Moderate intensity statins
Simvastatin 20-40
Atorvastatin 10-20
Pravastatin 40-80
Rosuvastatin 5-10
77
Cortisol effects
Maintains glucose control, decreases immune response, helps body respond to stress
78
Aldosterone effects
Regulates Na/K balance
79
Addison disease
Adrenal insufficiency
Do not produce enough cortisol or aldosterone
Sx: chronic diarrhea, N/V, loss of appetite, patchy skin, muscle weakness, fatigue, slow movements, hypoglycemia, decreased BP, fainting, salt craving
Tx: steroids and Na
80
Cushing syndrome
Increased cortisol
Most common cause: long term steroid use
Weight gain + fatty tissue deposits (buffalo hump and moon face), striae, thinning skin, slow healing of cuts, fatigue, anxiety, depression, glucose intolerance, hirsutism
-For endogenous causes, surgery is primary tx choice
81
Cushing disease
Due to benign tumor on pituitary gland overproducing ACTH
82
Pre-renal azotemia due to
Hypoperfused kidneys due to dehydration, acute blood loss, decreased CO, burns
83
Post-renal azotemia due to
obstruction to urine flow
| -Uncommon
84
Labs in renal failure
hyperkalemia, hypercalcemia, hypernatremia
| EPO decreased--leads to normocytic, normochromic anemia with decreased reticulocyte count
85
Glomerulonephritis
inflammation of the glomeruli in the kidneys
Sx: pink or cola colored urine due to hematuria, foamy urine due to proteinuria, htn, edema, anemia
-UA shows RBC and RBC casts, WBC and increased protein
-Kidney biopsy needed to confirm dx
-Tx: antihypertensives, antimicrobials if infection suspected, steroids
86
Pyelonephritis sx
Back pain, fever, N/V
87
Hemorrhage cystitis
Large quantities of visible blood in the urine due to infection, radiation or chemo
- Irritative voiding sx reported
- Adenovirus is a common cause and is self limiting
88
UA in UTI
Leukocyte esterase, nitrities, protein, blood
Nitrite + leukocyte esterase = G-
>10^5 CFU dx for UTI
89
Topical estrogen and UTI
Can restore natural flora and decrease UTI risk
90
UTI prophylaxis
>2 UTI within 6 months or >3 UTI within 12 months
| Daily Bactrim for prophylaxis
91
Risk factors for bladder cancer
Smoking, family history, male, arsenic exposure, cyclophosphamide, pioglitazone
-Sx: gross, painless hematuria, irritative voiding sx without fever
92
Urge incontinence
Overactive bladder
Most common form of incontinence in elderly
Tx: toilet training, decrease fluid intake; anticholinergics--oxybutynin, tolterodine, solifenacin succinate, farifenacin, fesoterodine
Alt meds: mirabegron, botulinum toxin
93
Stress incontinence
Weakness of pelvic floor and urethral muscles
Most common form in women
Loss of urine while coughing, sneezing and exercising
Tx: kegal exercises
94
Risk factors for kidney stones
Men, family history, poor fluid intake, dehydration, increased protein and sodium and sugar diets, overweight
95
Meds that increase risk of kidney stones
Diuretics, antacids, indinavir, topiramate
96
Meds for kidney stones
Alpha 1 blocker can be used to relax the muscles in the ureter to pass the stone
97
Anemia sx
Usually only occur when hgb <10
Fatigue, HA, decreased exercise tolerance, poor school performance, learning difficulties
-Early sytolic murmur may occur
98
Anisocytosis
Variation in RBC size
| Increased if <15%
99
Poikilocytosis
Variation in RBC shape
100
Normal body response to anemia
Reticulocytosis
101
Iron deficiency anemia labs
Early: decreased hgb, htc, total RBC, RDW >15%, decreased ferritin
102
Typical adult dose of Fe
50-60mg BID 3-6 months
103
What increases absorption of Fe
Vitamin C
104
Folic acid deficiecy
Increased homocysteine and normal MMA
Tx: 1mg/day
Levels usually return to normal in 1 month
105
Vit B12 deficiency
IM 100mcg monthly or PO 1000mcg/day
Usually resolves in 2 months
If neuro issues >6 months, most likely permanent
106
Epi dosage for anaphylaxis
0.3-0.5mg adult or 0.01mg/kg child
Give in vastus lateralis (lateral thigh)
Repeat every 5-15 minutes up to 3 injections
107
Alcohol withdrawal
Typically starts 12 hours after last drink and peaks at 24-48 hours
Sx: anxiety, depression, fatigue, irritability, jumpiness, mood swings, nightmares
Delirium tremens most serious presentation
Tx: benzodiazepines, beta blockers or clonidine for the tremors
108
How to taper benzos
Decrease dose by 25% per week
109
Opioid withdrawal
Htn, tachy, diarrhea, nausea, temp dysregulation, fever, papillary dilation, restlessness, myalgia, rhinorrhea
-Not life threatening
Tx: clonidine decreases sx
110
Persistent depressive disorder
Low level of depression for at least 2 years in adults or 1 year in children
111
Adjustment disorder
Grief >1-3 months
| Tx: same as major depression
112
Lethal dose of TCA
2 week supply in 1 dose
113
Lethal dose of SSR
2 month supply in 1 dose
114
SE SSRI
HA, nausea, diarrhea
| Usually resolve in 2-6 weeks after use
115
If ED occurs with SSRI
Switch to Wellbutrin, SNRI or TCA
116
SE wellbutrin
HA, dry mouth, nausea, weight loss, insomnia
117
Conditions that can mimic GAD
Thyrotoxicosis, alcohol withdrawal, abuse of sympathomimetic drugs (caffeine, amphetamines, cocaine)
118
Benzos with lowest abuse potential
Hydrophilic (lorazapam) and long half life
119
Effects of progesterone in BC
Decrease ovulation by decreasing LH, thickening endocervical mucus, hampering implantation by endometrial atrophy
120
Effects of estrogen in BC
Ovulation inhibited by decreasing FSH and LH, and altering endometrial cell structure
121
Benefits of COC
Decreased rates of benign breast tumors, dysmenorrhea, menstrual volume by 60%, endometrial, ovarian and colon CA, PID rates, acne, hirsutism, cysts
122
Which BC methods do not interfere with AED drugs
Depo Provera and Nexplanon
123
Patch and ring BC
Patch replace every week
Ring replace every 3 weeks
Increased risk of blood clots
124
how long should you use depo
<2 years due to decreasing bone density
125
Vilpristal
Ella
Progesterone agonist/antagonist--direct inhibitory effect on follicular development and ovum release
Can be used up to 5 days after unprotected sex
126
Hormones in perimenopause
Estrogen normal and FSH elevated
127
Avoid hormonal therapy in women with
Hx of CV disease, breast CA, uterine CA, VTE or active liver disease
128
Alternartives to decrease hot flashes if HT CI
Low dose SSRI, SNRI, gabapentin
129
Absolute CI to HT
Unexplained vaginal bleeding, acute liver disease, thrombotic disease, endometrial CA, breast CA
130
Most common STI
Chlamydia
- Sx: vaginal discharge, dysuria, dyspareunia, post coital bleeding
- Incubation period 7-14 days
- Friable cervix and mucopurulent discharge
- Screen all women <25
- Tx: Azithromycin 1 dose
- Re-screen in 3 months
131
Gonorrhea
incubation period 1-5 days
Sx: dysuria with milky to purulent discharge
-Tx: IM ceftriaxone and PO azithromycin
132
Genital Herpes
HHV 2
Painful ulcerated lesion and inguinal lymphadenopathy + thin, profuse discharge sometimes
-Suppressive therapy decreases frequency of recurrence by 70-80%
133
PID
Endometritis, salpingitis, oophoritis
- Sx: lower abdominal pain, abnormal vaginal discharge, dyspareunia, fever, GI upset, abnormal vaginal bleeding
- Cervical motion tenderness, uterine tenderness, adnexal tenderness
- Increased ESR + CRP, Leukocytosis with neutrophilia
- Tubal thickening with or without free pelvic fluid
- Tx: Ceftriaxone IM + doxy for 2 weeks with or without flagyl
134
Primary syphilis
Painless genital ulcer with clean base and indurated margins and localized lymphadenopathy
Tx: Benzathine Penicillin IM
135
Secondary syphilis
Maculopaular rash involving palms and soles, generalized lymphadenopathy, low fever, malaise, arthralgia, myalgia
136
Tertiary syphilis
Gumma, aortic insufficiency, aortic aneurysm, seizures
137
Presbycusis
Progressive symmetric, high frequency, age related sensory hearing loss likely caused by cochlear deterioration
- Speech discrimination usually primary problem
- Limited ability to understand content of speech when in noisy environment
138
Presbyopia
Problems with close vision
| May have perception of washed out colors, difficulty seeing under low illumination, increased sensitivity to glare
139
Macular degeneration
Leading cause of blindness
Loss of central vision
Hx of smoking and excessive sun exposure
140
Pharmacokinetics
Absorption, distribution, biotransformation (metabolism), excretion
141
Pharmacodynamics
What the drug does to the body
| Does not change over lifetime
142
Age related changes in regards to pharmacokinetics
Increased 1/2 life of drug, decreased gastric acid production, decreased GI blood flow, decreased gastric motility, decreased gastric emptying, decreased GI surface area, decreased hepatic blood flow and function of enzymes, decreased albumin, decreased GFR and lean muscle mass
143
Risks of long term PPI use
Decreased absorption of iron, vitamin B12, etc.
Increased fractures due to decreased Ca absorption
Increased pneumonia and C. Diff
144
Tx urge incontinence in elderly
Tolterodine or soliferiacin or mirabegron
| -Oxybutynin has systemic effects
145
Potentially treartable causes of urinary incontinence
DIAPPERS
| Delirium, infection, atrophic vaginitis, pharm, psych, excessive urine output, restricted mobility, stool impaction
146
Risk factors for pressure ulcers
High levels of moisture, increased age, decreased BP, smoking, increased body temp, lack sensory perception, weight loss, incontinence, dehydration
147
Most common causes of delirium
DELIRIUMS
Drugs, emotional, low PO2, infection, retention of urine, ictal state, under nutrition, metabolic, myocardial problems, subdural hematoma
148
Tx dementia
Cholinesterase inhibitors: donepezil, tacrine, rivastigmine, galantamine, memantine
149
Pseudodementia
Dementia syndrome with severe depression
150
Stages of human pregnancy
Fertilization: zygote
Up to 2 weeks: blastocyst
2-8 weeks: embryo
8-12 weeks to term: fetus
151
Hegar sign
Softening of uterine isthmus
152
Goodell sign
Softening of vaginal portion of cervix
153
Chadwick sign
Blue violet vaginal color
154
When is uterine fundus at umbilicus
20 weeks
155
Recommended daily intake of iron when pregnant
1000-1300mg
156
Quad screen includes
AFP, HcG, Inhibin A, unconjugated estriol levels
157
Increased AFP can be due to
open neural tube defects, fetal nephrosis, cystic hydroma, fetal GI obstruction, omphalocele, IUGR, multiple fetus, fetal demise
158
Decreased AFP can be due to
Trisomy 21 and 18
159
Inhibin A
Produced by placenta
| Increased in down syndrome
160
Classic teratogenic period
Between 31 and 81 days following LMP
161
What stage of pregnancy is bronchospasm worse for women with asthma
Between 29 and 36 weeks
162
NSAIDs in pregnancy can cause
premature closure of ductus arteriosus
163
Which SSRI is cat D
Paroxetine
164
Cat B abx
Amoxicillin, cephalexin, cefpodoxime, cefixime, augmentin, nitrofurantoin (Avoid after 36 weeks)
165
Pre-eclampsia risk factors
>40, <16, first pregnancy with new partner, DM, collagen vascular disease, htn, family hx, multiple gestation
166
HELLP
Pre-eclampsia
Increased LFT
Decreased platelets
Eclampsia
167
Classic ectopic pregnancy triad
Abdominal pain, vaginal bleeding, adnexal mass
| Tx: methotrexate or salpingostomy
