Fam Med - Uworld Flashcards
What to give in patient who is on chronic opioid therapy for pain (ie cancer)?
Naloxone - to prevent overdose - should be offered in every patient with chronic opioid therapy
Naltrexone - mechanism and when to use
An opioid antagonist => Treat opioid use disorder => start after patient has stopped opioid for 1-2wks
What intervention improves/prolonged survival rate of patient with COPD?
Stop smoking
Long-term supplemental O2 therapy (LTOT)
Treatment of choice for HTN due to ADPKD?
ACE inhibitors (lisinopril) due to their ability to inhibit the RAAS system
Management for lumbosacral radiculopathy (hernia after lifting heavy objects)
Activity modification (not bed rest)
First 1-2 weeks: NSAIDs
After 2 weeks: consider physical therapy, oral glucocorticoids
After 4-6 weeks: obtain MRI & assess for surgical indication
Test for suspected strabismus (ocular misalignment)?
Presents with eye deviation, asymmetric corneal light and red reflexes, and an abnormal cover test
First step in evaluation is a dilated funduscopic examination to assess for secondary causes, particularly retinoblastoma, an intraocular malignancy that can often be visualized on funduscopy as a nodular, cream-colored retinal mass
Eye exam for different eye conditions
Fluorescein stains epithelial defects of the eye, and drops are applied to the eye to evaluate for a corneal abrasion
Intraocular pressure is measured if funduscopic examination reveals optic nerve cupping indicative of glaucoma.
Visual evoked potential testing may be performed for optic neuritis
Additional meds for type 2 DM with obesity and cardiovascular disease comorbid? - 1st line is always metformin
Glucagon-like peptide-1 receptor agonists (GLP-1) and/or certain sodium-glucose co-transporter-2 inhibitors (SGLT2) can be added to decrease cardiovascular mortality, induce weight loss, and minimize the risk for hypoglycemia.
When imaging is indicated for nipple discharge?
When there is sign of pathologic discharge: unilateral, bloody, abnormal breast exam, lymphadenopathy, etc.
Physiology (bilateral, nonbloody, normal breast exam, etc.) => pregnancy test, TSH level, prolactin, etc. => but no imaging indicated
When is XRay indicated for ankle injury?
Indicated for patients with pain in the malleolar region in association with either
1) bony tenderness at the posterior margin or tip of the lateral or medial malleolus
or 2) inability to bear weight (4 steps)
Management for hand OA?
- stretching and strengthening exercises
- Topical nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, diclofenac)
- oral NSAIDs are also effective but carry a greater risk for toxicity (eg, peptic ulcer).
Tinea corporis - Appearance and and Rx
Superficial dermatophyte infection = slowly expanding, pruritic rash with a raised border and central clearing.
Transmitted by skin-to-skin contact, contact with animals, or via fomites.
The diagnosis = inspection - confirmed with potassium hydroxide of skin scrapings.
First-line treatment is a topical antifungal (eg, terbinafine, miconazole)
Diagnosis of diabetes neuropathy
DN can lead to renal complications
The diagnosis of DN is made in the setting of persistently (ie, >3 months) elevated levels of albuminuria (>30 mg/g).
The random urine albumin-to-creatinine ratio (UACR) is MOST SENSITIVE for detecting early elevations in albumin excretion
Should be screened at least annually, starting either at diagnosis (for type 2) or 5 years after diagnosis (for type 1).
How ovarian endometrioma showed on US?
Bimanual examination reveals left adnexal tenderness.
A unilocular mass with homogeneous, low-level echoes on US
CKD in children- MC, Symptoms, Next step,
MC: congenital urinary track abnormality (ie. Posterior Urethral Valve)
Symptoms: Fatigue, poor growth, HTN, bedwetting, urinary incontinence day and night, recurrent UTIs due to vesicoureteral reflux.
Next step: serum creatinine level – or renal US or cystourethrogram
Rx for psoriasis plaques
Topical vitamin D analogues
Squamous cell carcinoma (SCC) - symptoms, management
Symptoms: asymptomatic, not pruritic, present where solar damage
- SCC in situ => confined to the epidermis, well-demarcated, scaly, red macules or plaques
- Invasive SCC => nodules and ulcerations are typically seen
Management => biopsy => confirm Dx => imiquimod therapy (topical immune response modifier)
Blood glucose and meds (thiazide diuretics, ACEi, statin)
Thiazide and statin => raise blood glucose
ACEi => can increase insulin sensitivity => sometimes induce hypoglycemia
Asymptomatic bacteriuria (ASB)
General population = not treated
Pregnant =
- All are screened and treated at the initial prenatal visit due to the risk of acute pyelonephritis and complications (eg, preterm delivery, low birth weight)
- The most common pathogen is Escherichia coli.
- First-line antibiotics include cephalexin, amoxicillin-clavulanate, or nitrofurantoin.
Frozen shoulder - Adhesive capsulitis (AC)
Stiffness and pain in shoulder joint - gradual onset, 1-3 years
- caused by glenohumeral capsule contracture - risk increased with medical condition/procedure (stroke, mastectomy)
Management = Range of motion exercise - Adjunctive: NSAIDs or corticosteroid - Surgery
Usually self-limited
Iliotibial (IT) band syndrome
Poorly localized lateral knee pain
Usually happens in inexperienced runners => overused
Medial knee pain could be Pes anserinus pain syndrome, often termed pes anserine bursitis
Presbycusis (age-related hearing loss)
a bilateral, progressive, sensorineural hearing loss (SNHL).
=> related to cochlear hair cell loss and cochlear neuron degeneration
High frequency => affected first => difficulty understand higher speech voice (women, children)
Other associated symptoms: tinnitus (ringing buzzing), problem with speech discrimination in elderly (from background noise)
Meds can cause SNHL => aminoglycosides, loop diuretics
Earliest sign of nephropathy?
Albuminuria (urine albumin/creatinine ratio ≥30 mg/g)
Hypertension
Rx => ACE inhibitors (eg, lisinopril) or ARBs are indicated if either presents.
Sodium-glucose cotransporter-2 inhibitors (eg, dapagliflozin) => can slow nephropathy => use when cardiac comorbidity presents
Diabetic patients and when to give lipid-lowering meds
All diabetic patients ≥ 40y/o, regardless of baseline lipid level or < 40y/o with established ASCVD
=> start statin + modified lifestyle
