Family Med Flashcards
what meds can cause underactive bladder
CCBs, anticholinergics
location of piriformis tender point
7-10 cm medial and cephalad from the ipsilateral greater trochanter
microaneurysms are most commonly seen in what pts
diabetic
patients who are at increased risk for colon cancer, what is their screening
colonoscopy every 5 years starting at age 40 or 10 years younger than the earliest diagnosis in their family, whichevere cums first
with adenovirus conjuncitivitis what else would you see
treatment
associated pharyngitis, fever, malaise, preauricular LAD
hot compress, can use topical abx to stop 2ndary bacterial infection
H pylori
best diagnostic test
best eradication
diagnostic: serology
eradication: urea breath
conjunctivitis: watery discharge, mild foreighn body sensation and photophobia
viral
what seen in HTN retinopathy
cottow wool patches and A-V nicking
treatment of allergic conjunctivitis
ketorolac solution and cold compress and antihist
uterus is small and contracted and products of conception all gone from uterus and cervical os closed
complete abortion
what is memantine used for
dementia
NMDA receptor antagonist, that is neuroprotective
good for mod to severe alzheimers
can use in combo with donepezil or galantamine
usually excessive NMDA stimulation from ischemia can lead to excitotoxicity
the preferred test for TB infection in persons previosuly vaccinated with BCG is what
quantiferon-TB Gold test
which flu vaccine is recommended for pts with egg allergy
inactivated intramuscular vaccine IIV3 or IIV4
if pt has a first degree relative diagnosed with CRC at age over 60 then when should they get screened
every 10 years starting at age 40
diabetic retinopathy categories
non proliferative: cotton wool spots, intra retinal hemorrhages, macular edema
proliferative: neovascularization from VEGF
intermittent claudication or chronic lower extremity pain in young adult
claud with movement and palpable pedal pulses
popliteal artery entrapment
lip smacking and head jerking are classic for what
tardive dyskinesia
which hiv drugs should never be used for post exposure prohpylaxis
abacavir and nevirapine
chlamydial conjunctivitis caused by what serotypes and treatment
D and K
oral tetracycline, doxy, or erythromycin
also treat sex partners
if pt needs to be evaluated with endocopy for concern of brisk bleed or perforation upon initial eval then what test for h pylori
rapid urea breath test
anterior chapman point for the sinuses is where
posterior?
between clavicle and first rib
posterior is C2 articular pillar
what kind of conjunctivitis: bilateral itching, tearing, redness, strigny discharge and photohobia with foreign body sensation
treatment
allergic
cold compress, oral antihistamines, or topical antihist or anti-inflamm dropletws
UTI: motile gram neg rod with fruity odor
pseudomonas
what do you see in alport syndrome renal biopsy
basement membrane splitting
lesion of what causes left homonymous hemianopsia
right optic tract
wegner or goodpasture is in older pts
wegner
goodpasture is younger
treating incontinence
behavior mod first and exercises
then oxbutynin or tolterodine
neuromodulation of sacral nerve in severe cases
instrumental activiteis of daily living
phone, shop, food prep, housekeep, laundry, transportation, taking meds, finances
HIV prophylaxis post needle stick
NRTIs: tenofovir, emtricitabine
NNRTIs: efavirenz, delaviridine
common is : enofovir-emtricitanbine with raltegravir (integrase inhibitor)
alt: tenofovir-emtricitabine with ritonavir
when would biopsy be appropriate for initial testing in a pt with signs of peptic ulcer disesase
signs of bleed, anemia, early satiety, unexplained weight loss, dysphagia, odynophagia, recurrent vomiting, history of GI cancer, previous malignancy
how long should metformin be D/C after IV contrast
48 hours
most documented causes for miscarriages
maternal age
history of previous miscarriage
maternal smoking
step wise approach to diagnose galactorrhea
1) b-hcg to rule out pregnancy
2) check prolactin level
- if over 20 ng/mL then MRI of brain
3) if normal then check thyroid for hypothyroid
4) detailed review meds
what makes restless leg syndrome better
movement
diagnosing onychomycosis
treatment
AE of treatment
microscopic eval of toenail scrapings using KOH prep
terbinafine for 12 weeks
GI upset, rash, HA, hepatotox, prolonged QT, SJS
incontinence what should be done
bladder diary, exacerbating factors
UA to R/O UTI and a PSA in male pts
a creatinine of less than or equal to what with no AKI can use IV contrast
1.5 mg/dL
TG levels
normal
borderline high
high
very high
normal = <150 BH = 150-199 high = 200-499 severe = >500
after treatment of h pylori what is best test for eradication of bacteria
urea breath test 4 weeks post treatment
options with spontanesous abortion
expectant management and observation
medical managment with misoprostol
D and C
does PID increase risk of miscarriage
no only incrase risk infertility
confirmation of H pylori can best be achieved with what study in a pt without biopsy being neccessary
what pts?
pts under 55 and who do not have any red flag signs and sx
serologic study with test and treat method
detects IgG abs against h pylori antigens
very sensitive but not as specific bc titers may be elevated after eradication of infection
if positive then active infection in 50% of pts, so start triple therapy, then try serology after treatment and see if negative
small yellow, round spots with soft or hard borders spread unevenly in the retina as a result of normal aging but can be from macular degeneration
drusen
abrupt feeling of urination but cannot make toilet on time
urge incontinence
detrusor overactivity
treatment for goodpasture
plasma exchange, corticosteroids
functional incontinence
pt
causes
pt knows have to pee but physical or mental reasons cannot reach toilet
mental: confusion in dementia and delirium
physical: vision, dexterityh, mobility
other: anxiety/depression, hyperglycemia or HF fluid overload, UTI, preganancy, nocturia
most important risk factor to help AAA from growing
stop smoking
postvoid residual of over ___ mL indicates urinary retetion
do what next
200
if this is case then get renal US to rule out hydronephrosis
get PSA too
white ovoid lesions with irregular borders on retina
cotton wool patches
HTN
15 mm induration PPD test is positive on what people
all
ADLs
transfer, continence, toileting, bathing, dressing, feeding
sciatica vs piriformis syndrome pain location and cause
piriformis: pain in butt and hamstrings
- sitting too long or squatting
sciatica: causes pain in distal extremity as well
- injury
abx in human bite
augmentun
products of conception can be seen or palpated through the internal cervical os
inevitable abortion
allergic conjuncitivitis differs from viral how
similar with bilateral watery discharge but pruritus and a foreign body sensation are unique to allergic causes
mixed incontinence is a combo of what
stress and urge incontinence
who does overflow incontinenece occur in
pts who have blockage of bladder outlet like BPH or weakening of detrusor muscles
neuropathy from diabetes or MS too
in asx pt with a AAA under ____ can just monitor
3-4 cm monitor what
4-5.4 cm monitor what
5.5
3-4 cm monitor US Q 2yrs
4-5.4 cm monitor Q 6-12 months
what weird drug is used in parkinsons that is also antidepressent and good for dementia
selegeline
a family history of a father or brother before age ___ or in mother or sister before age ___ increase pt liklihood to get heart disease
men: 55
women: 65
ST depression in anterior leads and positive cardiac biomarkers including troponin
NSTEMI
good treatment for mild dementia
donepezil
most common cause of bacterial conjunctivitis and what are sx and tx
staph, strep, haem, morax. pseduo
rapid onset hyperemia, tearing with spread to other eye in less than 2 days with mucopurulent discharge and crusting
cipro, erythro, sulfacetamide
treatment of increased TGs if over 500 or under
over 500 then fibrates
under 500 statins
what antibodies can be positive in goodpasture
anti glomerular BM abs for sure
30% will have p-ANCA and c-ANCA too
AE selegeline
weight gain, anxiety, insomnia
moderate persistent asthma treatment
SABA and ICS + LABA
vaginal bleeding but no products of conceptions in the vagina and cervical os closed
threatened abortion
example: leaving a scalpel blade inside of the pt during a surgical procedure. what law thing
res ipsa loquitor or “the things speak for itself.”
what age for women is a risk factor for CAD
55
pt with CVA and residual R UE and R LE paresis presents with urinary incontinence. what type
functional incontinence
chapman point of ____ may be present with anypathology involving the retina or inner chamber of the ye
anterolateral humeral head
rapid onset of purulent copioius exudate in eye
what is cause and treatment bc bad thing can happen
bcaterial conjunctivitis from n gonorrhoeae
blindness possible
1 dose of 1 g IM ceftriaxone and topical therapy
a ___ can present as a left homonymous hemianopsia and headache in the absence of any focal motor deficits
acute cerebral vascular accident
normal BMI
overweight
obese class I class II class III
normal: 18.5-24.9
overweight: 25.0-29.9
class I: 30-34.9 class II: 35-39.9 class III: 40 and above
5 mm induration on PPD test indicates positive screen in what pts
HIV contact with TB person fibrotic change on chest radiograph organ transplant immunosuppressed
vaginal bleed and cramping pelvic pain and cervical os open and products of conception seen or palpated withhing cervical canal
incomplete abortion
involuntary contractions of major muscle groups characterized by torticollis, retrocollis, and oculogyric crisis
rapid in onset
dystonias
what meds can cause ED
SSRIs b-blockers and CCBs alpha blockers (finasteride) TCAs digoxin antihistamines
pseudomonnas UTI most commonly seen in what pts
foriegn body or obstruction of GU system
initial management of NSTEMI
which drugs show reduction in mortality
morphine, oxygen, nitroglycerin, aspirin, beta blocker, statin, clopidogrel, heparin
only aspirin and beta blockers reduce mortality
combo ICS and LABA
budesonide-formoterol
mometasone-formoterol
fluticasone-salmeterol
motor restlessness and inability to sit still, early and late in antipsychotic drug treatment
akathisia
alternative to colonoscopy
FOBT every year starting at age 50
sigmoidoscopy every 5 years starting at age 50
10 mm induration is apositive screen in what persons for PPD
recent (<5 yrs) immigrants from high prev countries
IV drug user
employee or resident at prison, military barrack, nursing home, hospitals, lab personall
under 4 or child
what antibodies in wegener granulomatosis
c anca only, not p-anca
treatment of CAP by age
under 60
-doxy, macrolide, moxifloxacin, levofloxacin, tigecycline
over 60
-augmentun, macrolides, fluoroquin, 2/3rd gen cephalosporins
which diuretics block urate excretion
thiazides and loop diuretics
what is the first line treatment for graves
methimazole
most common electrolyte abnormality in cushings
hypokalemia
what are some of the electrolyte abnormalities and lab values that hydrochlorothiazide cuases
hypokalemia, hyponatremia, hyperuricemia
side effects of simvastatin
myopathy, rhabdomyolysis, hepatotoxicity
primary ovarian failure
how to diagnose
sx
tx
FSH elevation in menopausal range on 2 occasions separated by at least 1 month
oligomenorrhea/amenorrhea and signs of estrogen deficiency
-vaginal dryness, itching, atrophy, hot flahses, decreased bone mineral density, etc
estrogen and progesterone replacement therapy
prolactinoma and estrogen
prolactinoma can cause of secondary ovarian failure
oligomen/amenorrhea, infertility, signs of estrogen deficiency
hip adductors
what nerve and roots
adductor brevis, longus, magnus
pectineus, gracilis, obturator externus
obturator nerve L2-L4
what is gluteus medius innervated by
superior gluteal nerve L4-S1
glutues maximus nerve and action
inferior gluteal nerve L4-S1
hip extensory
FEV1/FVC ratio in COPD
less than 0.7
what is treatment in pt with primary hyperparathyroidism with calcium under 12mg/.dL
over 12mg/dL
under: parathyroidectomy
over: preop treatment with saline, loops, IV bisphosphonates or calcimimetics (cinacalcet)
75 gram glucose tolerance test and BG measured after 2 hours drink is given what level indicates DM
200 or above
random blood glucose and typical sx of diabetes what level of BG would indicated DM
what if no sx
200 or above
no sx then wouldn’t indicate it
somatic symptom disorder
pain at 4 diff sites
2 GI sx
1 sexual
1 neuro sx
tx: freq office visits
analgesics
SSRIs
psychotherapy
