continued family med notes qs Flashcards
criteria for non suicidal self injury
NSSI >5 days in the past year
-expects NSSI will solve problem/provide relieve
-experiences at least one of: negative thoughts immediately before NSSI, preoccupation with NSSI, frequent thougts of NSSI
-NSSI is related to clinically significant distress across different domains of function
-not in the context of psychosis, delerium, substance use
what is the recommended nap duration during shifts?
30 minutes or less
what two criteria suggest need for antibiotics during an ECOPD?
-increased purulence of sputum
-moderative - severe symptoms
having 1 moderate exacerbation of COPD in the last year puts you into what risk group?
mod/severe with low risk AECOPD
having 1+ SEVERE exacerbation, or 2+ MODERATE exacerbations of COPD in the last year puts you into what risk group?
high risk of AECOPD
what are the risk factors for pseudomonas infection in COPD patients?
FEV <35%, chronic steroids, constant purulent sputum
which patients with COPD should undergo pulmonary rehab?
those who remain dyspneic despite LAMA/LABA
first line antibiotics for a simple AECOPD
Amoxicillin
Doxycyline
Tretracycline
which COPD patients should be referred to resp? Name at least FIVE
- Unclear diagnosis
- Symptoms severe/disproportionate to spirometry
- Accelerated decrease of lung function
- Onset <40 yeras old
- Failure to respond to therapy
- Complex comorbidities
- Assessment for pulmonary rehab
- Home ox
- Surgical therapy assessments
Name 4 complications of COPD
skeletal muscle deconditioning, right heart failure, polycythemia, MDD
what is upper airway cough sydnrome?
coughing due to PND, cough receptor irritation, GERD, etc.
what are the two patterns of allergic rhinitis?
seasonal (reactions to pollen)
Perennial (dust, dust mites, animal dander, fungal spores)
name 5 types of rhinitis
-allergic rhinitis
-non allergic
-vasomotor
-food induced
-alcohol induced
-work related
-atrophic
Clinical features of allergic rhinitis
Allergic cause PLUS at least one of:: nasal congestion, rhinorrhea, itchy nose, sneezing
Investigations for allergic rhinitis
Do aeroallergen skin prick testing or IgE testing to confirm diagnosis
Do NOT routinely order food allergy testing
What advice to you provide to someone with seasonal allergic rhinitis?
Stay indoors during peak pollen times
Keep windows closed and use air purifiers
what can you prescribe for SEVERE rhinitis or +++ edema not improved with nasal meds?
oral corticosteroids 5-7 days
Name 3 different criteria for clinical anaphylaxis diagnosis?
- Acute onset (min-hour) involving skin & mucosal tissues & either resp, hypotension or end organ dysfunction
- Two system involvment including skin/mucosal, resp, hypotension, GI sx
- Hypotension secondary to allergic trigger
if someone is hypotensive due to anaphylaxis and is on a beta blcoker, what should you give?
glucagon
what medication is indicated for all HF patients regardless of EF?
SGLT2i
what medication should be considered in all patients with advanced (NYHA III or IV) heart failure with reEF?
hydralazine
first line treatment of alopecia areata
intralesional steroids
what investigations would you consider ordering in someone with statin induced myopathy?
-ALT, AST, bilirubin, alk phos
-if concern for rhabdo: creatinine, urine myoglobin
what should you monitor in someone with a statin induced myopathy?
monitor their CK until normal
how may hypothyroid change someones blood lipids?
-increased LDL
-increased triglycerides
what is the guideline for pediatric lipid screening?
screen children 2-10 once then based on risk from three
how is pediatric hyperlipidemia diagnosed?
avereage of two fasting lipid profiles 2-12 weeks apart
a child has initial blood screening showing abnormal lipid profile. What else should you order?
-repeat fasting lipids
-A1C
-FPG
-TSH
-ck
-LFTs
-urinalysis
what is the LDL target in someone who has LDL > 5 or FHL?
decrease by 50% or <2.5
what is the LDL target for someone with DM/CKD?
<2
what is the LDL target in someone with ASCVD?
<1.8
what lipid abnormalitiy is particularly associated with pancreatitis?
hypertriglyceridemia
does severe pancreatitis require antibiotics?
no
what patients with stable chest pain get a CCTA?
low-mod risk patients
which patients with stable chest pain get angiography?
those that are HIGH risk for CAD and diagnosis is unlcear
which patients with stable chest pain get exercise stress test?
No risk factors, and pretest likelihood > 10%
which patients get persantine echo/sestamibi for stable chest pain?
-if unable to exercise and no LBBB
