Exam 1 Flashcards
Cholesterol screening
Age 35 for men, 45 for women
Mammogram screening
Every 2 years from age 50-74
Bone mineral density screening
> 65 years old one time
Sports physical should be deferred if
Sudden death in family <50 years old, disabling cardiac disease <50 years, cardiomyopahty, long QT syndrome, arrhythmias
medical necessity
What was done (CPT) + why it was done (ICD10)
Payment for service is based on
work effect, practice expense, and malpractice expense
Level 2 CPT
Problem focused
Brief HPI
Perform and document 1-5 elements
Straightforward
Level 3 CPT
Expanded problem focused
Brief HPI and problem focused ROS
Perform and document at least 6 elements
Low complexity
Level 4 CPT
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
Level 5 CPT
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
Medicare eligibility
<65, disabled
Part A: hospital
Part B: outpatient
Sensitivity
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
Specificity
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
Medications for acute bronchoconstriction
beta 2 agonist, ipatropium, systemic steroids
Treatment of anaphylaxis
Epinephrine first line
H1 and H2 blockers second line (diphenhydramine)
Treatment of bites/stings
Local wound care, removal of stinger, ice patch, antihistamine for itchijng, topical steroids for inflammation, antibiotics for secondary infection, NSAIDs
Treatment for scabies/lice
Permethrin
Abx for Lyme disease
Doxycycline 100mg 2 tablets
S/S of allergies
Sclera erythema and injection, allergic shiners, swollen and pale turbinates, tonsillar enlargement
Neurogenic hypotension
Failure of pulse to increase with a decrease in BP
Symptoms occur with postural changes, prolonged standing, dehydration, alcohol, carb heavy meals, heat exposure
Treatment for hypotension in normotensive person
Fludrocortisone (volume expander)
Treatment for hypotension if hypertension when supine
Midodrine (sympathomimetic)
Treatment for hypotension if hypertension when standing
Pyridostigmine (cholinesterase inhibitor)
Most common cause of syncope
Vasovagal: vasodilation, bradycardia, paradoxical systemic hypotension
nonpainful, progressive loss of visual acuity, blurry and hazy vision with halos or glare with bright lights
Cataracts
Tx for cataracts
Surgery
Most common cause of blepharitis
Staph aureus
Treatment of blepharitis
Lid hygiene with warm compresses for 5-10 minutes
May apply thin layer of erythromycin or bacitracin gel
Acute onset of red eye with excessive watery discharge
Viral conjunctivitis
Thick purulent discharge in both eyes that are sticky and glued shut in the morning
Bacterial conjunctivitis
most common organisms in bacterial conjunctivitis
Staph aureus in adults
H. influenzae and strep pneumoniae in children
Treatment of bacterial conjunctivitis
Trimethoprim-polymyxin B or fluoroquinolone drops 4 times per day for 1 week
Itchy eyes with clear or stringy white discharge
Allergic conjunctivitis
Giant papillary conjunctivitis, cobblestone pattern of large bumps on eversion of upper lid
Vernal conjunctivitis
Epidemiology
study of health-related determinants and distribution/control of disease/health problems
Epidemic
outbreak limited in time + location (SARS in 2003) short duration (<2 weeks)
Pandemic
epidemic extending to entire community or large part of world (AIDS)
Endemic
remains persistent in area for long period of time (Hep B in China)
Epidemiologic triad
host, vector, environment, agent
Sudden onset eye pain, foreign body sensation, blurry vision, redness, tearing, light sensitivity
Corneal abrasion
Dx for corneal abrasion
Topical fluorescein dye
Epithelium repairs itself in 5 days
Seek emergency care with corneal abrasion if
RSVP (redness, sensitivity to light, vision changes, pain
Meds that can cause dry eye
Anticholinergic, antihistamines, TCAs, alpha blockers, antihypertensives, steroids
Unilateral or bilateral ear fullness or hearing loss, otalgia, itching, discomfort, tinnitus
Cerumen impaction
Conductive hearing loss causes
Impacted ceremun, infections of outer ear, tumors, fibrotic stenosis, TM perforation, scar tissue, barotrauma
Causes of sensorineural hearing loss
Inner ear infection, meniere disease, trauma, CN8 disorder
Gradual hearing loss with aging
Presbycusis
Meds that can cause ototoxicity
Aminoglycosides, antineoplastics, salicylates, furosemide, quinine
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
vestibular neuritis
Tx of vestibular neuritis
• 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
Chronic condition with 4 symptoms: dizziness, low frequency sensorineural hearing loss, tinnitus, feeling of fullness in affected ear
Meniere disease
Dx test
Sound will lateralize to UNAFFECTED ear in Weber test; AC>BC on Rinne test
Tx for Meniere
No cure– refer
Patients with unilateral sensorineural hearing loss and tinnitus should be tested for
syphilis and Lyme disease
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
OE
Tx OE
Topical ofloxacin or ciprofloxacin: safe for patients with nonintact TM
Aminoglycosides: Neomycin-Polymyxin B (TM must be intact)
rapid onset otalgia, worse in prone position; may have hearing loss, imbalanace, mild stuffiness, fullness or popping sensation in ear
OM
Tx of OM
Amoxicillin
Sneezing, rhinorrhea, and nasal and pharyngeal itching in relation to an allergen exposure
Allergic rhinitis
Tx allergic rhinitis
Intranasal steroids 1st line
2nd gen antihistamines + nasal decongestant 2nd line
Most common cause of bacterial sinusitis
strep pneumoniae, H. influenzae, or Moraxella catarrhalis
nasal congestion, purulent nasal discharge, headache worse when leaning forward, fever, fatigue, postnasal drip (Causes sore throat and coughing), yellow/green discharge
Sinusitis
Tx viral sinusitis
1st generation antihistamine, NSAID, decongenstant, cough suppressant
Tx for bacterial sinusitis
Augmentin 1st line
Doxy or azithromycin if penicilin allergy
DOC for dental abscess
Penicillin or clindamycin
Findings are always unilateral with tonsil typically displaced down and medially; uvula is edematous and displaced to opposite side; hot potato voice
Peritonsillar abscess
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
Strep pharyngitis
Tx for strep throat
Penicillin 500mg BID 10 days
Infectious until 24 hours after abx
Sudden onset sore throat, fever, malaise, cough, headache, fatigue, rhinitis, congestion, cough with sputum
viral pharyngitis
fatigue, headache, high fever, tonsillar hypertrophy, white to grat exudates, petechiae on palate and posterior cervical adenopathy
Mono
Examples of diagnostic tests
Amnio, cardiac cath, colposcopy, chest x ray
Patient swallowing a lot and bleeding nose
Posteriir epistaxis
send to ED
OE prophylaxis
Vinegar and alcohol in ear before swimming
DOC for recurrent OM or treatment failure with amoxicillin
Augmentin
Throbbing pain in eye, irregular pupil shape, marked phototobia, redness around iris
Iritis
Most common cause of sensorineural hearing loss
Presbycusis
Feeling of curtain coming down over eye
Retinal detachment
Absence of red reflex
Cataracts
Effective tx for tinnitus
CBT
How to relieve barotrauma of ears
Nasal steroids and oral decongestants
halos around lights, severe eye pain and redness
Acute angle-closure glaucoma
Decreased peripheral vision
Primary open angle glaucoma
Immediate goal of myringotomy/tube placement in child with recurrent OM
Removal of supporative and mucosal material releasing the pressure
Keratoconjunctivitis
Dry eye
Night vision impacted
Cataracts
Frequent prescription changes
Cataracts
3 components of evaluation and management guidelines
history, physical exam, medical decision making
When can you code by time
if >50% of visit was spent discussing options with patient
CBC can detect
Infection, anemia, clotting problems, blood cnancer, immune disorders
CMP can detect
kidney and bone disease, neurologic disorder, diabetes, kidney function, nutrition, liver injury, gallstones
Pathophys of anaphylaxis
Vasodilation, increased vascular permeability, increased HR, increased glandular secretions
Bronchoconstriction, coronary vasoconstriction, peripheral vasodilation
In kids with anaphylaxis, must consider
foreign body aspiraton, congenital alformation, SIDS, acute asthma, syncope, panic attack, pulmonary emboli
Lyme disease tx for kids
Amoxicillin
Medication for symptomatic bradycardia
Atropine 0.5mg IV every 3-5 minutes
Heart rhythms to refer immediately to ED
New onset A Fib, atrial flutter, VT, SVT
Precipitants of tachycardia
nicotine, exercise, stimulants, medications, anxiety, pregnancy, CAD, CHF, ischemia, electrolytes imbalances, toxins, infection, hypovolemia
Antihistamine of choice for food allergen
Oral diphenhydramine
Cardiac causes of syncope
mechanical or obstructive processes or arrhythmias
Neurologic causes of syncope
Autonomic failure, vasovagal, situational, carotid sinus hypersensitivity, TIA
Other causes of syncope
hypoglycemia, postprandial hypotension, psych causes
Physical exam for syncope
CV, neuro, fundoscopic, orthostatic hypotension
Leading cause of blindness worldwide
cataracts
Physical exam findings for cataracts
No injection, corneal opacification, pupils normal, absent or decreased light reflex
burning, foreign body sensation, tearing, phototobia, itching, redness, discharge, swollen erythematous eyelids worse in the morning
Blepharitis
If staph infection of blepharitis
tobramycin 0.3% 4 times per day
White, thick and ropy discharge from eye
Atopic conjunctivitis
What is contraindicated with corneal abrasion
Steroids and anesthetics
Epithelium of eye repairs itself in
5 days
dryness, foreign body sensation, burning/stinging, pain, itching, ocular fatigue, redness, light sensitivity
Dry eye syndrome
Long term tx of dry eye syndrome
Cyclosporine emulsion 0.05%
When can you not irrigate ears with fluid
ruptured ear drum, tympanostomy tubes or recent ear surgery
Risk factors for presbycusis
Genetics, medications, infection, exposure to smoke, high blood pressure, smoking, diabetes
Hearing in vestibular neuritis
Intact
What to rule out with meniere disease
AOM, acoustic neuroma, cerebellar tumors, diabetes, thyroid disease, teriary syphilis
Symptom relief of meniere disease
Meclizine and promethazine (antiemetic)
OME
Fluid present in middle ear without s/s of inflammation; TM gray; pain mild
Second line for allergic rhinitis
oral antihistamines (loratadine, cetrizine fexofenadine) Combine with nasal decongestant
Vasomotor rhinitis
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
Tx of thrush
Nystatin
Tx of oral herpes
Topical acyclovir or valacyclovir
