Fall Final Flashcards
Normal lipid panel values
Cholesterol < 200
Triglycerides < 150
HDL 50
LDL < 100
Moderate Intensity statins
Lowers LDL 30-50%, use if LDL 70-189 or < 7.5% ASCVD
Atorvastatin 10-20 mg
Simvastatin 20-40mg
Rosuvastatin 5-10 mg
High Intensity statins
Lowers LDL >50%, use if LDL >190, or high clinical ASCVD >7.5%
Atorvastatin 40-80 mg
Rosuvastatin 20-40 mg
Diagnostics/lab work for statin therapy
Baseline LFTs and CK
Lipid panel 6-8 weeks after initiating therapy,
Only recheck CK if statin induced myopathy is suspicious
CHADS-2 score
CHF HTN Age >75 DM Stroke/TIA (+2)
0-nothing, ASA; 1 ASA or warfarin; >2 wafarin
Stemmer’s sign
Sign for lymphedema
Pinch skinfold at base of 2nd toe or middle finger
If you can’t, (+) sign for lymphedema
Risk for DVT
Pretest probability (1pt each): active cancer paralysis immobility > 3days vein tenderness limb swelling unilateral calf swelling pitting edema collateral superficial vein -2 for alternative diagnosis likely
< 1=low; 1-2=moderate; >3 high
Management: d-dimer for low risk
venography for moderate/high risk
Risk for PE
Pretest probability: S/S of DVT alternative explanation than PE HR > 100 Immobility within 4 weeks Prior VTE Hemoptysis malignancy
High >6; Mod 2-6; Low < 2
Mod/high risk= CTA
Bacterial Meningitis
S/S: fever, nuchal rigidity, altered sensorium, N/V, exaggerated DTR
Brudzinski and Kerning signs
LP: cloudy, high opening pressure >180, increased WBC (1-2k), total protein (100-500), decreased glucose < 40
Treat within 60 minutes, 3rd generation cephalosporin (Cefotaxime or Ceftriaxone plus Vancomycin)
Treatment of acute prostatitis
IV Fluoroquinolone
3rd generation cephalosporin (ceftazidime, rocephin)
S/S: rapid onset dysuria with indwelling catheter, tense/boggy/tender prostate
Treatment of UTI in pregnancy
Cephalexin 500 mg QID/BID
Nitrofurantoin 50 mg QID (avoid >36 weeks)
Ampicillin 500 mg QID
resistance 20-40% for ampicillin
Avoid sulfonamides and fluoroquinolone
Pyelonephritis use beta-lactam with/without amino glycoside
Treatment of urinary retention in BPH
Alpha blockers (-zosin) tamsuloin, alfuzosin
Second line option: 5-alpha reductase inhibitors- finasteride and dulasteride
Diagnosis of iron deficiency anemia
low MCV, low serum ferritin, low serum iron, high TIBC
Most common type of leukemia in older adults
CML
Significance of Auer rods
Seen in blasts of AML and high grade myeloproliferative syndromes
Distinguish pre-leukemia (excess blasts with Auer rods) from refractory anemia with excess blasts (no Auer rods)
Screening exams
Colonoscopy: age 50 q10 years, sigmoid q5 years
Skin: q3 years age 18-40, >40 annual
Breast: annual mammography >40
Cervical: PAP/HPV age 21 q3years, 30-65 PAP q5 years
NO specific guidelines for testicular, lung or prostate
Reed-Sternberg cell indicated
Hodgkin’s Lymphoma
Suicidal risk factors
Sex, Unsuccessful attempts, identified family hx, chronic illness, depression/drugs/drinking, age, lethal means
highest risk: elderly men with medical problems and no social support
Stages of COPD
COPD diagnosis: FEV1/FVC= < 0.7 FEV1: > 80% Mild 50-80% Mod 30-50% Severe < 30% Very Severe
Diagnosis of CAP
CURB-65 Confusion Urea > 7 RR >30 BP SBP 65
0-1= home trx; 2=hospital trx; >3= hospital or ICU
Diagnosis of HIV
ELISA test first, then Western blot to confirm
When to initiate Bactrim prophylaxis for CD4 counts
Initiate count < 200, discontinue when CD4 count > 200 for 3-6 months
Stages of CKD
by GFR ml/min, Stage:
1: >90
2: 60-89
3: 30-59
4: 15-29
5: < 15
Neph consult at stage 3
Earliest sign of kidney damage is proteinuria
Management of hyperkalemia
Kayexalate
1/2 amp of D50 with 10 unit regular insulin
10%calcium gluconate
Compartment syndrome
disproportionate pain, reduced sensation, passive extension of digits causes pain
Remove constricting materials (cast, splint)
Maintain limb at level of heart
Compartment pressure >40
6 P’s
Herberden’s and Bouchard’s nodes
Herberden’s: DIP joints
Bouchard’s: PIP joints
Felty’s syndrome
higher risk of infection
Triad of: RA, splenomegaly, neutropenia
Chronic vs. Acute glaucoma
Chronic: d/t age, nearsightedness, DM
S/S: painless, loss of visual fields, IOP 10-20, goal: improve flow or reduce aqeous (beta blockers)
Acute: due to blockage
S/S: severe pain, HA, blurry visions, halos around objects, decreased visual acuity, cloudy cornea
Trx: azetazolamide
Treatment of Herpes Zoster
Acyclovir 800mg QID for 7-10days
second line: Valacyclovir 1000mg BID for 7-10 days
Rule of 50: 50 hours or less since onset, >50 years of age, more than 50 lesions
Oral steroids not effective
Treatment of Varicella Zoster
Modest clinical benefit when administered within 24 hours of rash onset
Acyclovir 20 mg/kg for 5 days or 800 mg five times a day
Valacyclovir 20 mg/kg TID or 1 gram TID
Can do aluminum acetate soaks
Conditions that require referral to Dermatology
conditions beyond expertise, difficult cases, to biopsy suspicious lesions, life threatening conditions
sinusitis
S/S: pain/pressure worse when bending over, purulent/blood tinged nasal drainage, congest, fever, tender face
Amoxicillin- clavulanate 500 mg TID for 5-7 days
Second line: Augmentin, levofloxacin, moxifloxacin
Otitis media
inflammation of inner ear, throbbing pain, hearing loss, red tympanic membrane
Trx: Amoxicillin 500 mg q12h for 5-7 days
Otitis externa
decreased hearing, edema within ear canal
Trx: cortisporin otic, ciprofloxacin HC for 7 days
Conjunctivitis
red/swollen eyelid, EOM intact, foreign body feeling, drainage
Trx: plymyxin 1-2 drops q2-3h for 5-7 days
Allergic: symptomatic care, antihistamines
