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Primary Care 1 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Cholesterol screening

A

Age 35 for men, 45 for women

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2
Q

Mammogram screening

A

Every 2 years from age 50-74

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3
Q

Bone mineral density screening

A

> 65 years old one time

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4
Q

Sports physical should be deferred if

A

Sudden death in family <50 years old, disabling cardiac disease <50 years, cardiomyopahty, long QT syndrome, arrhythmias

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5
Q

medical necessity

A

What was done (CPT) + why it was done (ICD10)

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6
Q

Payment for service is based on

A

work effect, practice expense, and malpractice expense

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7
Q

Level 2 CPT

A

Problem focused
Brief HPI
Perform and document 1-5 elements
Straightforward

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8
Q

Level 3 CPT

A

Expanded problem focused
Brief HPI and problem focused ROS
Perform and document at least 6 elements
Low complexity

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9
Q

Level 4 CPT

A

Detailed
Extensive HPI, ROS and pertinent family and social history
Perform and document at least 2 elements from 6 areas or 12 elements from 2+ areas
Moderate complexity

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10
Q

Level 5 CPT

A

Comprehensive
Comprehensive history, extended HPI, extended ROS, complete ROS, complete family and social history
Perform and document at least 2 elements from 9 areas
High complexity

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11
Q

Medicare eligibility

A

<65, disabled
Part A: hospital
Part B: outpatient

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12
Q

Sensitivity

A

Ability to detect true positives; ability to detect a disease
SnNout: if low probability of disease, you want to rule it out and so would use a sensitive test

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13
Q

Specificity

A

Ability to detect true negatives; ability to detect absence of disease
SpPin: if high probability of disease, rule it in and use a specific test

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14
Q

Medications for acute bronchoconstriction

A

beta 2 agonist, ipatropium, systemic steroids

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15
Q

Treatment of anaphylaxis

A

Epinephrine first line

H1 and H2 blockers second line (diphenhydramine)

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16
Q

Treatment of bites/stings

A

Local wound care, removal of stinger, ice patch, antihistamine for itchijng, topical steroids for inflammation, antibiotics for secondary infection, NSAIDs

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17
Q

Treatment for scabies/lice

A

Permethrin

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18
Q

Abx for Lyme disease

A

Doxycycline 100mg 2 tablets

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19
Q

S/S of allergies

A

Sclera erythema and injection, allergic shiners, swollen and pale turbinates, tonsillar enlargement

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20
Q

Neurogenic hypotension

A

Failure of pulse to increase with a decrease in BP

Symptoms occur with postural changes, prolonged standing, dehydration, alcohol, carb heavy meals, heat exposure

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21
Q

Treatment for hypotension in normotensive person

A

Fludrocortisone (volume expander)

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22
Q

Treatment for hypotension if hypertension when supine

A

Midodrine (sympathomimetic)

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23
Q

Treatment for hypotension if hypertension when standing

A

Pyridostigmine (cholinesterase inhibitor)

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24
Q

Most common cause of syncope

A

Vasovagal: vasodilation, bradycardia, paradoxical systemic hypotension

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25
Q

nonpainful, progressive loss of visual acuity, blurry and hazy vision with halos or glare with bright lights

A

Cataracts

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26
Q

Tx for cataracts

A

Surgery

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27
Q

Most common cause of blepharitis

A

Staph aureus

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28
Q

Treatment of blepharitis

A

Lid hygiene with warm compresses for 5-10 minutes

May apply thin layer of erythromycin or bacitracin gel

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29
Q

Acute onset of red eye with excessive watery discharge

A

Viral conjunctivitis

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30
Q

Thick purulent discharge in both eyes that are sticky and glued shut in the morning

A

Bacterial conjunctivitis

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31
Q

most common organisms in bacterial conjunctivitis

A

Staph aureus in adults

H. influenzae and strep pneumoniae in children

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32
Q

Treatment of bacterial conjunctivitis

A

Trimethoprim-polymyxin B or fluoroquinolone drops 4 times per day for 1 week

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33
Q

Itchy eyes with clear or stringy white discharge

A

Allergic conjunctivitis

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34
Q

Giant papillary conjunctivitis, cobblestone pattern of large bumps on eversion of upper lid

A

Vernal conjunctivitis

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35
Q

Epidemiology

A

study of health-related determinants and distribution/control of disease/health problems

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36
Q

Epidemic

A 
outbreak limited in time + location (SARS in 2003)
short duration (<2 weeks)
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37
Q

Pandemic

A

epidemic extending to entire community or large part of world (AIDS)

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38
Q

Endemic

A

remains persistent in area for long period of time (Hep B in China)

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39
Q

Epidemiologic triad

A

host, vector, environment, agent

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40
Q

Sudden onset eye pain, foreign body sensation, blurry vision, redness, tearing, light sensitivity

A

Corneal abrasion

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41
Q

Dx for corneal abrasion

A

Topical fluorescein dye

Epithelium repairs itself in 5 days

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42
Q

Seek emergency care with corneal abrasion if

A

RSVP (redness, sensitivity to light, vision changes, pain

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43
Q

Meds that can cause dry eye

A

Anticholinergic, antihistamines, TCAs, alpha blockers, antihypertensives, steroids

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44
Q

Unilateral or bilateral ear fullness or hearing loss, otalgia, itching, discomfort, tinnitus

A

Cerumen impaction

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45
Q

Conductive hearing loss causes

A

Impacted ceremun, infections of outer ear, tumors, fibrotic stenosis, TM perforation, scar tissue, barotrauma

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46
Q

Causes of sensorineural hearing loss

A

Inner ear infection, meniere disease, trauma, CN8 disorder

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47
Q

Gradual hearing loss with aging

A

Presbycusis

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48
Q

Meds that can cause ototoxicity

A

Aminoglycosides, antineoplastics, salicylates, furosemide, quinine

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49
Q

Brief severe vertigo, nausea, vomiting, disequilibrium lasting a few days followed by vertigo and disequilibrium with rapid head movement that may last weeks to months; hearing intact

A

vestibular neuritis

50
Q

Tx of vestibular neuritis

A

• Anticholinergics and antihistamines first line
o Meclizine 25-50mg every 6 hours is commonly used
• Benzodiazepines reserved for patients who cannot take drugs with anticholinergic effects
• Can start steroids during acute phase of vertigo—methylprednisone once daily for 22 days beginning with 100mg and tapering down every 3 days

51
Q

Chronic condition with 4 symptoms: dizziness, low frequency sensorineural hearing loss, tinnitus, feeling of fullness in affected ear

A

Meniere disease

52
Q

Dx test

A

Sound will lateralize to UNAFFECTED ear in Weber test; AC>BC on Rinne test

53
Q

Tx for Meniere

A

No cure– refer

54
Q

Patients with unilateral sensorineural hearing loss and tinnitus should be tested for

A

syphilis and Lyme disease

55
Q

pain in affected ear developing over 48 hours, feeling of fullness and itching, pain on palpation of tragus and repositioning auricle; canal erythematous and edematous; canal filled with debris and sloughed tissue

A

OE

56
Q

Tx OE

A

 Topical ofloxacin or ciprofloxacin: safe for patients with nonintact TM
 Aminoglycosides: Neomycin-Polymyxin B (TM must be intact)

57
Q

rapid onset otalgia, worse in prone position; may have hearing loss, imbalanace, mild stuffiness, fullness or popping sensation in ear

A

OM

58
Q

Tx of OM

A

Amoxicillin

59
Q

Sneezing, rhinorrhea, and nasal and pharyngeal itching in relation to an allergen exposure

A

Allergic rhinitis

60
Q

Tx allergic rhinitis

A

Intranasal steroids 1st line

2nd gen antihistamines + nasal decongestant 2nd line

61
Q

Most common cause of bacterial sinusitis

A

strep pneumoniae, H. influenzae, or Moraxella catarrhalis

62
Q

nasal congestion, purulent nasal discharge, headache worse when leaning forward, fever, fatigue, postnasal drip (Causes sore throat and coughing), yellow/green discharge

A

Sinusitis

63
Q

Tx viral sinusitis

A

1st generation antihistamine, NSAID, decongenstant, cough suppressant

64
Q

Tx for bacterial sinusitis

A

Augmentin 1st line

Doxy or azithromycin if penicilin allergy

65
Q

DOC for dental abscess

A

Penicillin or clindamycin

66
Q

Findings are always unilateral with tonsil typically displaced down and medially; uvula is edematous and displaced to opposite side; hot potato voice

A

Peritonsillar abscess

67
Q

marked erythema of throat and tonsils, patchy and discrete white or yellowish exudate, pharyngeal petechiae, tender anterior cervical adenopathy; may have scarlet fever rash and strawberry tongue

A

Strep pharyngitis

68
Q

Tx for strep throat

A

Penicillin 500mg BID 10 days

Infectious until 24 hours after abx

69
Q

Sudden onset sore throat, fever, malaise, cough, headache, fatigue, rhinitis, congestion, cough with sputum

A

viral pharyngitis

70
Q

fatigue, headache, high fever, tonsillar hypertrophy, white to grat exudates, petechiae on palate and posterior cervical adenopathy

A

Mono

71
Q

Examples of diagnostic tests

A

Amnio, cardiac cath, colposcopy, chest x ray

72
Q

Patient swallowing a lot and bleeding nose

A

Posteriir epistaxis

send to ED

73
Q

OE prophylaxis

A

Vinegar and alcohol in ear before swimming

74
Q

DOC for recurrent OM or treatment failure with amoxicillin

A

Augmentin

75
Q

Throbbing pain in eye, irregular pupil shape, marked phototobia, redness around iris

A

Iritis

76
Q

Most common cause of sensorineural hearing loss

A

Presbycusis

77
Q

Feeling of curtain coming down over eye

A

Retinal detachment

78
Q

Absence of red reflex

A

Cataracts

79
Q

Effective tx for tinnitus

A

CBT

80
Q

How to relieve barotrauma of ears

A

Nasal steroids and oral decongestants

81
Q

halos around lights, severe eye pain and redness

A

Acute angle-closure glaucoma

82
Q

Decreased peripheral vision

A

Primary open angle glaucoma

83
Q

Immediate goal of myringotomy/tube placement in child with recurrent OM

A

Removal of supporative and mucosal material releasing the pressure

84
Q

Keratoconjunctivitis

A

Dry eye

85
Q

Night vision impacted

A

Cataracts

86
Q

Frequent prescription changes

A

Cataracts

87
Q

3 components of evaluation and management guidelines

A

history, physical exam, medical decision making

88
Q

When can you code by time

A

if >50% of visit was spent discussing options with patient

89
Q

CBC can detect

A

Infection, anemia, clotting problems, blood cnancer, immune disorders

90
Q

CMP can detect

A

kidney and bone disease, neurologic disorder, diabetes, kidney function, nutrition, liver injury, gallstones

91
Q

Pathophys of anaphylaxis

A

Vasodilation, increased vascular permeability, increased HR, increased glandular secretions
Bronchoconstriction, coronary vasoconstriction, peripheral vasodilation

92
Q

In kids with anaphylaxis, must consider

A

foreign body aspiraton, congenital alformation, SIDS, acute asthma, syncope, panic attack, pulmonary emboli

93
Q

Lyme disease tx for kids

A

Amoxicillin

94
Q

Medication for symptomatic bradycardia

A

Atropine 0.5mg IV every 3-5 minutes

95
Q

Heart rhythms to refer immediately to ED

A

New onset A Fib, atrial flutter, VT, SVT

96
Q

Precipitants of tachycardia

A

nicotine, exercise, stimulants, medications, anxiety, pregnancy, CAD, CHF, ischemia, electrolytes imbalances, toxins, infection, hypovolemia

97
Q

Antihistamine of choice for food allergen

A

Oral diphenhydramine

98
Q

Cardiac causes of syncope

A

mechanical or obstructive processes or arrhythmias

99
Q

Neurologic causes of syncope

A

Autonomic failure, vasovagal, situational, carotid sinus hypersensitivity, TIA

100
Q

Other causes of syncope

A

hypoglycemia, postprandial hypotension, psych causes

101
Q

Physical exam for syncope

A

CV, neuro, fundoscopic, orthostatic hypotension

102
Q

Leading cause of blindness worldwide

A

cataracts

103
Q

Physical exam findings for cataracts

A

No injection, corneal opacification, pupils normal, absent or decreased light reflex

104
Q

burning, foreign body sensation, tearing, phototobia, itching, redness, discharge, swollen erythematous eyelids worse in the morning

A

Blepharitis

105
Q

If staph infection of blepharitis

A

tobramycin 0.3% 4 times per day

106
Q

White, thick and ropy discharge from eye

A

Atopic conjunctivitis

107
Q

What is contraindicated with corneal abrasion

A

Steroids and anesthetics

108
Q

Epithelium of eye repairs itself in

A

5 days

109
Q

dryness, foreign body sensation, burning/stinging, pain, itching, ocular fatigue, redness, light sensitivity

A

Dry eye syndrome

110
Q

Long term tx of dry eye syndrome

A

Cyclosporine emulsion 0.05%

111
Q

When can you not irrigate ears with fluid

A

ruptured ear drum, tympanostomy tubes or recent ear surgery

112
Q

Risk factors for presbycusis

A

Genetics, medications, infection, exposure to smoke, high blood pressure, smoking, diabetes

113
Q

Hearing in vestibular neuritis

A

Intact

114
Q

What to rule out with meniere disease

A

AOM, acoustic neuroma, cerebellar tumors, diabetes, thyroid disease, teriary syphilis

115
Q

Symptom relief of meniere disease

A

Meclizine and promethazine (antiemetic)

116
Q

OME

A

Fluid present in middle ear without s/s of inflammation; TM gray; pain mild

117
Q

Second line for allergic rhinitis

A 
oral antihistamines (loratadine, cetrizine fexofenadine)
Combine with nasal decongestant
118
Q

Vasomotor rhinitis

A

Nonallergic, noninfectious cause of perennial nasal congestion and rhinorrhea; no itchiness of eyes and nose or sneezing
Occurs in response to environmental triggers such as cold air ,strong smells, irritants, change in weathr
Does not respond to antihistamine

119
Q

Tx of thrush

A

Nystatin

120
Q

Tx of oral herpes

A

Topical acyclovir or valacyclovir

Primary Care 1 (3 decks)

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