CSE 1A Flashcards
What is the most common cause of acute pharyngitis?
Viruses like Epstein-Barr virus, Herpes simplex virus, influenza, etc
What is the most common thing you will see in pediatric patients?
Colds
What is lateral epicondylitis (aka tennis elbow)?
Inflammation of the common extensor tendon at the lateral aspect of the elbow; overuse injury
Pain in lateral epicondyle and in the forearm; pain with wrist extension
What ratio is used to assess COPD status?
FEV1/FVC
First line antibiotic of choice for the treatment of acute bacterial sinusitis?
Amoxicillin
What is sinusitis?
Inflammation of the mucosal lining of 1 or more of the paranasal sinuses
Is it okay to ask elderly patients if they have any sensory deficits?
Yes! Don’t assume they do, ask.
What is Carpal tunnel syndrome?
Overuse problem due to compression of the median nerve
Tingling, numbness, and pain in the median nerve distribution
Symptoms can be constant or intermittant, but most commonly occur at night
What four groups of drugs are used to manage symptoms of URIs?
- Antihistamines (H1 blocker)
- Decongestants (sympathomimetic amines)
- Antitussives
- Expectorants
Why is patient-doctor communication important?
Improved satisfaction, improved compliance, improved decision making, better health outcomes, decreased malpractice claims
What do Metoprolol (Toprol, Lopressor), carvedilol (CoReg), propanolol do?
Beta blockers (lower BP)
What inhaled corticosteroid is used in the treatment of COPD?
fluticasone
Is glucosamine sulfate safe? What is it efficacy comparable to?
Yes
NSAIDs
Four pharmacological interventions for COPD?
- Bronchodilators (beta agonists)
- Anticholinergics
- Inhaled steroids
- Combo of the above
Two instances where we care about colds?
- Complications like otitis media, sinusitis, asthma exacerbations, etc
- Preoperative evaluation for anesthesia (avoid elective anesthesia for 4-6 weeks after a URI)
Pertinent +/- for signs and symptoms associated with poor control or over control of CHF?
chest pain, dyspnea, orthopnea, lower extremity edema, sudden weight gain, low BP/fatigue from over medication, bradycardia from over medication
What drug interaction should you be concerned about in patient’s taking garlic supplements?
Blood thinners. Combination may increase bleeding tendency
What are somatoform disorders?
Variety of conditions presenting with physical/medical complaints that turn out to be “psychogenic”
Emotional distress is unconsciously, unknowingly transformed into physical distress (they’re not faking it - they’re unaware)
What two anticholinergics are used in the treatment of COPD?
ipratropium (Atrovent) and tiotropium (Spiriva)
Two categories of hypertension?
Essential hypertension & secondary hypertension
Who needs a Geriatrician?
- Frail elderly
- Patients with 5 or more chronic conditions (which is 20% of the Medicare population!)
- Residents of long term care facilities
What three non-pharmacologic things are used to treat high cholesterol?
- Fish oil (although can be prescribed now)
- Garlic
- the Mediterranean diet
What is the most common clinical problem in children? Second most common?
First: URI
Second: Otitis Media
What is critical for success with a new exercise program?
Accountability
So follow up with patients to see how they’re doing
What test is used for lateral epicondylitis/tennis elbow?
The middle finger test
Five domains of CAM?
- Energy therapy
- Mind-body interventions
- Manipulative and body-base interventions
- Alternative medical systems
- Biologically-based interventions
EMMA B (like the Spice Girl :D)
Drug class of sitagliptin (Januvia), linagliptin, saxagliptin and what do they do?
DPP4 inhibitors
Increase incretin levels which decreases glucagon release, increases insulin secretion, and delays gastric emptying
What is essential for teamwork?
Mutual Support/Task Assistance
The ability to anticipate the needs of other team members through knowledge of their tasks and repsonsibilities
What does Losartan do?
Block angiotensin II receptors (lowers BP)
Protective factors for Otitis Media?
breast feeding and immunizations
What does the upper respiratory tract include?
Nares, nasal cavity, pharynx, larynx
Five pharmacological targets for DM treatment?
- Increase insulin production
- Increase insulin sensitivity
- Reduce hepatic glucose production
- Reduce renal glucose absorption/increase excretion
- Modify the mediatiors of glucose regulation
Four pharmacological interventions for hypertension?
- Vasodilators - relax the pipe walls
- Diuretics - remove some of the fluid in the pipe
- Beta blockers - make the pump generate less force
- ACE1/ARBs - interfere with mediators of systems that increase BP
What age is a minor in most states?
Under 18
Does the National Center for Complementary and Alternative Medicine (NCCAM) apply just as rigorous research methods than the current standard in convention medicine?
Apparently yes. Sometimes even more rigorous
What should you save for the end of a pediatric physical exam?
Ears and mouth
What do amlodipine (Norvasc) and diltiazem (Cardizem) do?
Calcium channel blockers (vasodilators to lower BP)
What ages is Guardasil approved for? How many doses?
Three dose series for ages 9 - 26
(note: guidelines were recently updated but the lecturer said to know 9 to 26)
Is Echinacea safe?
Generally very safe, but concern over misidentification and contamination
Drug class of glipizide, glyburide, and glimepiride and what do they do?
Sulfonylureas
Increase insulin production
What is the physiologic importance of sinuses?
Primarily they warm, humidify, and filter air
Provide mucus to upper airways, lubricate, and clear viruses, bacteria and foreign material
What is the mechanism of action of antitussives?
They act on the cough control center in the medulla oblongata to suppress the cough reflex
Four pharmacological interventions for CHF?
- ACE1/ARB
- Beta blockers
- Aldosterone antagonist
- Diruretics
How often do you perform a pap smear for a woman over 30?
Every five years with HPV co-testing
Examples of diuretics used to treat CHF?
furosemide (Lasix) and bumetanide (Bumex)
Pertinent +/- signs and symptoms associated with poor control or over control of DM?
polydipsia, polyuria, blurred vision, hypoglycemia
What accounts for 30-50% of common colds?
Rhinoviruses - Picornavirus
What is quality improvement methodology?
F - Find opportunities for improvement
O - Organize team
C - Clarify process and problems
U - Understand process and root cause of problem
S - Select an improvement
P - Plan improvements and study to test improvements
D - Do (implement) the plan
S - Study the results
A - Act on the Finding
FOCUS PDSA
What is trochanteric bursitis?
Pain over the lateral aspect of the hip/greater trochanter
Normal range of motion but may be limited due to pain or tight IT band
(Note: more common in females)
What does FVC stand for?
forced vital capacity
What is trigger finger?
Overuse injury due to repetitive labor
Inflammation of the flexor tendon at the A1 pulley (possible catching/triggering)
What is the fastest growing elderly population?
People 85+
What is De Quervain’s Tenosynovitis?
An overuse injury - inflammation of the 1st dorsal compartment
Pain on the radial side and the base of the thumb
Common in females with young babies
What do enalapril (Vasotec), ramipril (Altace), and benazapril do?
ACE inhibitors (lowers BP)
What does FEV1 stand for?
forced expiratory volume in 1 second
How to evaluate CAM utility?
Is it safe?
Are there significant interactions?
Is it effective?
What does it cost?
E-CSI (effective, cost, safety, interactions)
Condition for which CAM is most frequently used among adults?
pain
What is the most important prescription you can write?
One for exercise
(according to lecture)
By participating in Tobacco Free Florida, patients more than ______ their chances of quitting
double
What comprises HEEADSSS?
Home
Education/Employment
Eating
Activities
Drugs
Sexuality
Suicide/depression
Safety
(also strengths, spirituality)
How is De Quervain’s Tenosynovitis treated?
Thumb splint, tylenol/NSAIDs, corticosteroid injection
What are activities of daily living (ADLs)?
Bathing, dressing, eating, using the toilet, gait
Most common CAM therapy used among adults?
Natural products
After an ankle sprain how long will it take to be back at 100%?
Six weeks
Is echinacea effective in reducing the duration and severity of a URI?
Yes, by 10-30%
Does vitamin C prevent a cold/URI?
No, but decreases duration by 1-1.5 days
(just don’t take more than 2000mg per day)
Four simple tests to assess elderly physical function in the clinic?
- gait speed (greater than 1m/s is good)
- chair rise (less than 15 second)
- Balance (hold for 10 seconds)
- Timed up and go (TUG - less than 13.5 seconds)
Drug class of pioglitazone and what does it do?
Thiazolidinediones
Increase insulin sensitivity
What is a SMART goal?
One that is specific, measurable, action-oriented, realistic and timely
Majority of suicides occur within ____ months of seeing a physician
Six
What is as strong or stronger of a risk factor as smoking?
Sedentary lifestyle
What safety concern has gotten Kava banned in several European countries?
potential for hepatic failure
What are topics of anticipatory guidance?
- Media (screen time, cyber bulling, social networking)
- Obesity
- Behavior
- Safety
MOBS
Pertinent +/- signs and symptoms associated with poor control or over control of COPD?
dyspnea, productive cough, fever/chills, wheezing, increased O2 use
What is acupuncture effective at treating?
Tension headaches, migraine prophylaxis, osteoarthritis, neck pain (note: probably effective at treating lower back pain)
What sign is pathognomic for Carpal tunnel syndrome?
The “flick sign” (ask the patient what they do when they wake up at night with numbness, if they demonstrate shaking their hand out or flicking it then its a positive flick sign)
What is St. John’s Wort effect in treating? What is its mechanism of action?
Mild to moderate depression
Mechanism is likely similar to that of an SSRI
Are over-the-counter medications effective at treating the common cold?
No. They can help ease symptoms but will not treat the underlying virus
What is the best expectorant?
Hydration
(note: expectorants loosen bronchial secretions so they can be eliminated when coughing)
Those with ADHD should show edivdence of symptoms before age what?
7
What does the Dietary Supplement Health and Education Act of 1994 say?
Efficacy testing not required prior to marketing; no standards required in manufacture; marketing claims don’t require FDA approval but claims must be substantiated if requested
Note: current products before the act didn’t have to prove safety to stay on the market. FDA had to prove unsafe to remove
What bacteria is responsible for most bacterial cases of pharyngitis?
Group A streptococcus
What helps identify issues before unfavorable outcomes occur (geriatrics lecture)?
Functional assessments
What are the current exercise guidelines?
At least 150 minutes a week of moderate intensity exercise or at least 75 minutes a week of vigorous exercise (20-60 mins per day)
Strengthening exercise at least two days a week for all major muscles
Drug class of canaglifozin (Invokana) and dapagliflozin and what do they do?
SGLT2 inhibitors
Reduce glucose reabsorption at the kidney/increase urinary glucose excretion
What is the treatment for carpal tunnel?
Volar splint at night and most of the day, home exercise program (OT/PT), corticosteroid injection, surgical release
What two beta agonists are used in the treatment of COPD?
albuterol (short-acting) and salmeterol (long-acting)
_______ predicts lack of change
Resistance
(The patient needs to talk about making the change themselves)
Three cardinal symptoms of COPD?
- Dyspnea
- Chronic Cough
- Sputum production
Most common natural products used by adults?
fish oil/omega 3
What does traditional Chinese medicine emphasize?
Proper balance of qi
What are instrumental ALDs?
Telephone use, travel, shopping, medication management, financial management
What are the four categories of prevention?
- Screening
- Immunization
- Chemoprevention
- Counseling
What is the mechanism of action of an antihistamine?
It is a competitive antagonist for the H-1 receptor
Antihistamines decrease nasopharyngeal secretions by blocking the H-1 receptor
Treatment for lateral epicondylitis?
Rest, ice, NSAID, counterforce strap, stretching/eccentric strengthening exercises
Avoid corticosteroid injections (maybe 1x okay)
Is Zinc safe?
Yes, as long as the daily limit of 40mg isn’t exceeded. Can cause copper deficiency, sideroblastic anemia, and anosmia (no smell)
When do you begin pap smears?
At age 21, regardless of when the patient started having sex
Delirium vs. Dementia: what’s the difference?
Delirium is an acute confusional state whereas dementia is long-term memory impairment
By how much can fish oil reduce triglycerides?
20-50%
What is quality healthcare?
“Doing the right thing, at the right time, in the right way, for the right person - and having the best possible results”
Is zinc effective at reducing the duration of a cold/URI?
Yes, by about 10-20%
What is acute otitis media?
Presence of fluid in the middle ear accompanied by acute signs of illness and signs or symptoms of middle ear inflammation
What is the SBAR framework for communication?
Situation
Background
Assessment
Recommendation/Request
What four things are confidential between teenaged patients & physician?
- Drugs
- STDs
- Contraceptives
- Anxiety/depression/suicide concerns
How long does a URI last?
7 to 9 miserable days
What is the common cold?
An acute, self-limiting viral infection of the upper respiratory tract involving, to a variable degree: sneezing, nasal congestion, rhinorrhea, sore throat, cough, low-grade fever, headache, and malaise
What is complementary alternative medicine (CAM)?
Group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine
Examples of beta blockers used to treat CHF?
Metoprolol (Toprol, Lopressor), and Carvedilol (CoReg)
What is the treatment for trigger finger?
Finger splint in extention/rest/NSAID, corticosteroid injection, surgical release
What is homeopathy?
Small doses of plant/animal extracts and minerals are used to stimulate the body’s defense mechanisms and healing processes in order to treat illness
Homeopaths believe the more dilute the remedy the greater its potency
Pertinent +/- signs and symptoms associated with poor control or over control of hypertension?
chest pain, dyspnea, headache, unilateral weakness, vision changes, lower extremity edema, fatigue, orthostatic hypotension/postural dizziness
(Recent or distant) activities are associated with lower mortality
Recent
(Start moving at any age!)
What is the 2 A’s and R Model?
What is just culture?
Shared accountability, supporting the organization of learning, shifts focus from severity/outcomes to choices/risks
What is CUS Terminology?
I am CONCERNED
I am UNCOMFORTABLE
This is a SAFETY issue
Risk factors for Otitis Media?
Less than two years old, male, smoke exposure, daycare exposure, and winter months
Examples of ACEI/ARBs used to treat CHF?
lisinopril, losartan
What is plantar fascitis?
Tightness and pain with the first step in the morning; some improvement but can intensify as the day ends
Tenderness at medial plantar calcaneal region
Clinical diagnosis
Three intervention recommendations for hypertension?
- Lifestyle improvements
- Continued monitoring
- Medications
Example of an aldosterone antagonist used to treat CHF?
Sprionolactone
What do free Tobacco Free Florida services provide a patient?
- Counseling
- Nictoine-replacement products (patches and/or gum/lozenges)
Can a dietary supplement claim that it can cure or prevent an illness?
No, but it may claim how it affects structure/function
Define quality improvement
Managing human performance using systemic, data-driven, integrated approach
What days are you most contagious when you have the common cold?
Days 2 and 3
How often do you perform a pap smear for a woman under 30?
Every three years
What does hydrochlorothiazide do?
Diuretic (lowers BP)
Three common causes of vaginal discharge?
- Candidasis (yeast infection)
- Bacterial Vaginosis
- Trichomoniasis
Drug class of exanatide and liraglutide (Victoza)?
incretin agonists/mimetics
Decrease glucagon release, increase insulin secretion, and delays gastric emptying
Drug class of Metformin and what does it do?
Biguanide
Decreases hepatic glucose production and enhances insulin sensitivity
What plant was nicknamed “intoxicating pepper”?
Kava
When are providers required to break consent?
When abuse is present or there is a risk of harm to self or others
What is gravida?
of live births
What is para? What is it subdivded into (gyn lecture)?
of births
FPAL: full-term, pre-term, abortion/miscarriage, live children
If a gyn resident says “G3P2012” about a patient, what does that mean?
3 pregnancies (G3)
2 full-term births, 0 pre-term births, 1 miscarriage/abortion, 2 living children (P2012)
Is Gardasil quadrivalent or 9-valent?
9-valent
HPV types 16 and 18 most frequency cause what?
cervical cancer
HPV types 6 and 11 most frequency cause what?
warts
What sinuses are present at birth?
Maxillary and ethmoid
What sinus is the last to develop?
The sphenoid around ages 8 to 10
Centor criteria for pharyngitis?
Fever
Anterior cervical lymphadenopathy
Tonsil exudate
No cough
