Family Med Clerkship Flashcards
Changes to potassium for these medications?
- ACE inhibitors
- ARBs
- Chlorthalidone and HCTZ (diuretics)
- Amlodipine
- and 2. : Hyperkalemia is a known side effect of ACE inhibitors and angiotensin receptor blockers such as olmesartan.
— The risk of hyperkalemia is increased with chronic kidney disease, diabetes mellitus, moderately severe to severe heart failure, NSAID use, and older adults. - Chlorthalidone and hydrochlorothiazide can cause hypokalemia
- amlodipine have no significant effect on potassium levels.
Treatment of
functional constipation
Daily use of polyethylene
glycol (PEG) solution has been found to be more effective than lactulose, senna, or magnesium hydroxide
in head-to-head studies.
–another 1st line drug is psyllium
In what age range is acne abnormal and prompt endocrine laboratory testing for possible systemic disease
- mid childhood
acne can happen in infants (6-12 months) and then starting preadolescent (8 or 9 years)
- Elevated BP
- Spontaneously low potassium level
- Possibly persistent HTN despite use of medication
- what could be causing HTN?
Primary hyperaldosteronism
- This can be evaluated by checking a serum renin activity level and a serum aldosterone concentration and determining the aldosterone/renin ratio. Primary hyperaldosteronism typically presents with a very low serum renin activity level and an elevated serum aldosterone concentration
What typical infections can cause erythema nodosum (painful, subcutaneous, nonulcerated, erythematous nodules)?
- coccidioidomycosis (valley fever)
- Streptococcal infection
- Tuberculosis
What is a infection that is associated with IV drug users + fever
Infectious endocarditis
- first step is blood cultures to check for bacteremia
Define
1. Psychogenic tremor
2. Physiologic tremor
3. Essential tremor
- characterized by an abrupt onset, spontaneous remission, changing characteristics,
and extinction with distraction. - Enhanced physiologic
tremor is a postural tremor of low amplitude exacerbated by medication. There is usually a history of
caffeine use or anxiety. - Essential tremor have symmetric, fine tremors that may involve the hands, wrists, head,
voice, or lower extremities. This may improve with ingestion of small amounts of alcohol. There is no
specific diagnostic test but the tremor is treated with propranolol or primidone
Pregnant people should receive a dose of Tdap between (Blank A) and (Blank B) weeks gestation to protect against pertussis, Tdap is the best choice for this patient.
Pregnant people should receive a dose of Tdap between 27 and 36 weeks gestation to protect against pertussis, Tdap is the best choice for this patient.
Treatment for
1. gonorrhea positive only
2. When you don’t know if its either gonorrhea or chlamydia
For gonorrhea only infection: First-line therapy is one dose of ceftriaxone
Patients presenting with an unknown cause of urethritis should be prescribed a combination of one dose of ceftriaxone and doxycycline
—> Azithromycin as a single dose, may be used as an alternative to doxycycline for treatment of chlamydial infection
What is the Rotterdam 2003 criteria most widely used diagnostic criteria for PCOS
The Rotterdam 2003 criteria are the most widely used diagnostic criteria for PCOS
Require the presence of two out of the following three features:
—oligomenorrhea, hyperandrogenism, and the presence of polycystic ovaries on ultrasonography.
When the first two of these criteria are clearly met, ultrasonography to establish the presence of polycystic ovaries is not required.
CHA2DS2-VASc score of atleast 2 + Afib indicates what medications should be given for anticoagulation?
Anticoagulation with either a direct oral anticoagulant (DOAC) such as apixaban OR a vitamin K antagonist such as warfarin is recommended in patients with atrial fibrillation who have a CHA2DS2-VASc score 2.
Aspirin monotherapy is considered an ineffective antithrombotic strategy and inferior to a DOAC or warfarin for preventing thromboembolic events in patients with atrial fibrillation. Adding aspirin therapy to warfarin does not confer extra benefit and increases the risk of major bleeding.
Which one of the following is the most common radiologic finding in early pulmonary sarcoidosis?
The most common finding is bilateral hilar adenopathy alone (stage 1). Other findings, which usually develop over time, include infiltrates and, in some patients, ultimately fibrosis.
The American Academy of Pediatrics recommends annual blood pressure screening at what age
The American Academy of Pediatrics recommends annual blood pressure screening at well child checks beginning at 3 years of age. This recommendation does not differ for children who have a strong family history of hypertension.
triptan medications are contraindicated in patients with what kinds of conditions
Because of their vasoconstricting properties, triptan medications are contraindicated in patients with established coronary artery disease, cerebrovascular disease, or peripheral vascular disease; patients with uncontrolled or multiple cardiovascular risk factors; and patients with certain high-risk migraine syndromes, including basilar and hemiplegic migraines.
Triptan use for the treatment of migraine headaches would not be contraindicated with a history of depression with psychotic features, poorly controlled diabetes mellitus, hypertension requiring two medications, or stage 4 chronic kidney disease.
35-year-old female at 36 weeks gestation presents to your office. She reports that for the past few days she has had itching of her palms and soles that has been quite bothersome. She has tried moisturizer with no improvement. A physical examination is unremarkable with no rashes, erythema, or warmth of the palm and soles. The patient otherwise feels well.
What is the most likely cause?
Intrahepatic cholestasis of pregnancy (ICP) presents with pruritus of the palms and soles with or without jaundice along with an elevation in serum bile acid concentrations. ICP, which is most common in the late second and/or third trimester, can cause significant risk to the fetus, including fetal death, and is therefore treated aggressively with ursodeoxycholic acid and often early delivery
What medication can be used alongside treatment for PTSD to diminish sleep disturbance
Prazosin is an effective augmenting therapy for patients with PTSD and sleep disturbance
Tumor Lysis Syndrome
what happens to
–uric acid levels
–calcium levels
–potassium levels
–phosphate levels
- The breakdown of nucleic acids releases large amounts of uric acid and leads to acute kidney failure, which limits clearance of potassium, phosphorus, and uric acid. This leads to
–hyperuricemia
–secondary hypocalcemia
–hyperkalemia
–hyperphosphatemia.
It can result in acute renal failure, arrhythmia, seizure, and sudden death. While tumor lysis syndrome has been reported with many cancer types, it is more common with acute leukemia and high-grade lymphomas
- When is cardiac stress testing indicated
- What about contraindicated
- cardiac stress testing is indicated when there is an intermediate probability of acute coronary syndrome. Also indicated in a preoperative assessment when surgery is at least a moderate risk and the patient cannot reach 4 METs of exertion (climbing a single flight of stairs) without cardiac symptoms.
- Cardiac stress testing is contraindicated after a recent stroke or TIA and in patients with severe symptomatic aortic stenosis.
Differentiate between ASA I, ASA II, ASA III, ASA IV, ASA V, ASA VI
ASA I - normal healthy patient
ASA II - patient with mild systemic dx (smoker, social alcohol drinker, pregnancy, obesity BMI 30-40, well controlled HTN, mild lung disease)
ASA III - A patient with severe systemic disease
ASA IV - A patient with severe systemic disease that is a constant threat to life
ASA V - A moribund patient who is not expected to survive without the operation
ASA VI - A declared brain-dead patient whose organs are being removed for donor purposes
- All patients who are having major surgery should be offered preoperative lab testing including what two things?
CBC and renal function testing
What is the recommended treatment for metatarsal stress fractures
The recommended treatment for metatarsal stress fractures is
1. No weight bearing for a few days, possibly using a posterior splint
2. Transitioning to a walking boot or short leg cast
3. Then a rigid-soled shoe in 4–6 weeks
What is next step lab after getting a dipstick urinalysis when trying to differentiate between serious illness from benign causes of proteinuria
- spot protein/creatinine ratio is reliable test for ruling out proteinuria
–if persistent proteinuria occurs then a specialist referral, blood analysis, and ultrasound can be done
Antipsychotics (such as quetiapine) are frequently used for tx of Behavioral and psychological symptoms of dementia include delusions, hallucinations, aggression, and
agitation.
–How should this medication be managed if symptoms have stabilized or pt has not responded
For patients who have been taking antipsychotics for 3 months and whose symptoms have
stabilized, or for patients who have not responded to an adequate trial of an antipsychotic, it is
recommended that the drug be tapered slowly (SOR B).
What risk factors increase 30 day mortality for patients with community acquired pneumonia?
- increased respiratory rate 30/min
- Hypotension
- Confusion or disorientation
- BUN level 20 mg/dL
- age > 65 years
- male sex
- Heart failure or COPD
what is megestrol for?
appetite stimulant
- not recommended in older adults due to potential harmful side effects and a lack of evidence supporting improved outcomes for the treatment of cachexia in the geriatric population
What condition shows erythematous patches with slightly elevated scaly borders + rash on the back has a “Christmas tree” pattern
- for what population is this condition dangerous for and why
Pityriasis rosea is associated with an increased rate of
spontaneous abortion in the first 15 weeks of gestation.
Diarrhea that develops in patients with ileal Crohn’s disease or following ileal resection is usually due to…
Due to increased amounts of bile acid remaining in the stool. This affects colonic secretion and motility and various protein factors in the gut, resulting in the development of bile acid diarrhea (BAD).
–a therapeutic trial with a bile acid sequestrant such as cholestyramine is most often used for both the diagnosis and treatment of BAD
What is the most accurate and appropriate maneuver to detect an anterior cruciate ligament tear?
Lachman test is the most accurate test for an anterior cruciate ligament (ACL) tear (SOR A). The Lachman test has higher validity based on a sensitivity of 68% for partial ruptures and 96% for complete ruptures.
What type of drug is donepezil?
- what does it do?
- This is an cholinesterase inhibitor. Increases risk of bradycardia or heart block in patients with or without underlying cardiac conduction abnormalities due to vagotonic effect on the SA and AV nodes.
- used to treat symptoms of alzheimers disease like memory loss and confusion
What is the appropriate treatment for viral bronchiolitis?
Supportive therapy, including
adequate hydration, is recommended for treatment
– symptoms include runny nose, fever, stuffy nose, loss of appetite and cough are the first signs of the infection. Symptoms may worsen after a few days and may include wheezing, shortness of breath, and worsening of the cough
- spironolactone/eplerenone MOA
- ACE inhibitors MOA
- ARBs MOA
- competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule
2.prevent an enzyme in the body from making angiotensin 2, a substance that narrows blood vessels - The ARBs’ mechanism of action, selective inhibition of angiotensin II by competitive antagonism of the angiotensin II receptors
Aldosterone MOA
- Aldosterone stimulates the secretion of K+ into the tubular lumen.
- Aldosterone stimulates Na+ and water reabsorption from the gut, salivary and sweat glands in exchange for K+.
- Aldosterone stimulates secretion of H+ via the H+/ATPase in the intercalated cells of the cortical collecting tubules.
The first step in the evaluation of nonmassive hemoptysis is …
The first step in the evaluation of nonmassive hemoptysis is to obtain a chest radiograph
– If this is normal and there is a high risk of malignancy (patient age 40 years or older with at least a 30-pack year smoking history), chest CT should be ordered. Bronchoscopy should also be considered in the workup of high-risk
patients.
What does sarcoidosis usually present with on chest radiograph?
- Among patients with sarcoidosis, 75–90% will present with mediastinal and hilar lymphadenopathy.
What are significant risk factors for esophageal adenocarcinoma?
gastroesophageal reflux and obesity are the main risk factors.
The diagnostic cutoff point for type 2 diabetes is a
– fasting plasma glucose level of (BLANK A)
– a hemoglobin A1c of (BLANK B)
The diagnostic cutoff point for type 2 diabetes is a
– fasting plasma glucose level 126 mg/dL
– a hemoglobin A1c 6.5%.
The diagnosis requires confirmation by repeat testing or by obtaining both a fasting glucose level and hemoglobin A1c.
Immune (idiopathic) thrombocytopenic purpura
1. what is this
2. how is it treated?
- Acquired immune-mediated disorder defined as isolated thrombocytopenia not found to have another cause.
- Treatment is usually restricted to severe
thrombocytopenic cases (platelet count <50,000/mm3) unless there is evidence of acute bleeding. Corticosteroids are considered the first-line therapy (SOR C)
What drug can help improve antidepressant-related sexual arousal dysfunction (SOR B)
- Bupropion
Bupropion is used to treat depression and to prevent depression in patients with seasonal affective disorder (SAD), which is sometimes called winter depression. It is also used as part of a support program to help people stop smoking.
What antihypertensive medication should be given for patients with chronic kidney disease (CKD) and proteinuria
JNC 8 advises more intensive blood pressure control in patients with chronic kidney disease (CKD) and proteinuria.
This is most often achieved with combination therapy, with either an
1. ACE inhibitor or an angiotensin receptor blocker (ARB)
2. PLUS either a thiazide diuretic or a calcium channel blocker.
- Glipizide, glyburide, and glimepiride
-What type of medication are these? - MOA?
- sulfonylureas
- stimulate release of insulin from pancreatic beta cells and thereby lower blood glucose concentrations. Only useful in patients with some beta cell function
- what infants need vitamin D supplementation
- When should vitamin D supplementation start
- Breastfeeding does not provide adequate levels of vitamin D. Exclusive formula feeding probably provides adequate levels of vitamin D, but infants who consume less than 1 liter of formula per day need supplementation with 400 IU of vitamin D daily.
- Vitamin D supplementation should be started within the first 2 months of life.
What are the three major risk factors for curve progression of idiopathic scoliosis
- the magnitude of the curve at presentation
- the potential for future growth
- female sex.
The Cobb angle is based on spine radiology that quantifies the magnitude of the scoliosis curve. If the Cobb angle is 20° there is a high risk that the curve will progress and that the patient may need treatment
Reminder: Scoliosis typically does not cause pain
The evidence shows that the risk of an opioid overdose increases at the threshold of (BLANK) MME/day.
50 MME/day.
- It is therefore recommended by the CDC that a prescription for naloxone be ordered when an opioid dosage reaches 50 MME/day, which is a high dosage. In general one should avoid prescribing 90 MME/day because of the substantially higher risk of an overdose at this dosage level.
What is Charcot neuroarthropathy?
an inflammatory condition that occurs in obese patients with peripheral neuropathy and ultimately leads to foot deformities (the classic rocker-bottom foot) and resultant ulcerations and infections. Its clinical appearance can easily be initially mistaken for cellulitis. However, the absence of tenderness and other signs of infection such as fever, an elevated WBC count, and inflammatory markers is not consistent with cellulitis. Radiography is an appropriate initial imaging modality but the results are often interpreted as normal early in the disease process. MRI is the modality
of choice for a definitive diagnosis and may demonstrate periarticular bone marrow edema, adjacent soft-tissue edema, joint effusion, and microtrabecular or stress fractures.
The treatment of acute Charcot neuroarthropathy is immobilization with total contact casting, which increases the total surface area of contact to the entire lower extremity, distributing pressure away from
the foot. Immobilization is typically required for at least 3–4 months but in some cases may be needed for up to 12 months
(BLANK A) should be started for
all patients with PAD regardless of their LDL-cholesterol levels (SOR A).
Statins should be started for all patients with PAD regardless of their LDL-cholesterol levels (SOR A). High-intensity statins should be used if tolerated.
- Elevated BP is defined as…
- Stage I hypertension
- Stage II hypertension
- systolic pressure of 120–129 mm Hg and a diastolic pressure <80 mm Hg.
- A blood pressure of 130–139/80–89 mm Hg
- A systolic pressure 140 mm Hg or a diastolic pressure 90 mm Hg
- What is the goal fasting blood glucose for patients with gestational diabetes?
- goal 2-hour postprandial glucose level is??
- goal 1-hour postprandial glucose level is??
- <95 mg/dL
- goal 2-hour postprandial glucose level is <120 mg/dL
- goal 1-hour postprandial glucose level is <140 mg/dL
What should you immediately administer to someone with a STEMI
Along with initiating the hospital’s protocol for myocardial infarction, immediate
treatment should
— include dual antiplatelet therapy with a 325-mg dose of nonenteric aspirin, a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor)
— and an anticoagulant (unfractionated heparin or bivalirudin).
What antidepressants have helped with IBS symptoms
– SSRIs used in these trials included citalopram, fluoxetine, and paroxetine, and tricyclic antidepressants included amitriptyline, desipramine, and imipramine.
–Exercise, probiotics, antibiotics, antispasmodics, antidepressants, psychological treatments, and peppermint oil all have evidence that they may improve IBS symptoms (SOR B)
- What is the preferred agent for preventing acute mountain sickness (AMS)
- What is the first-line treatment for acute mountain sickness of any severity
- Acetazolamide is the preferred agent for preventing acute mountain sickness (AMS). Multiple trials have demonstrated its efficacy in preventing AMS.
- Dexamethasone is a first-line treatment for acute mountain sickness of any severity but is a second-line drug for prevention because of its side-effect profile.
When dual antiplatelet therapy is needed for more than a year what should be used instead
(Blank) or (Blank) in addition to aspirin
For dual antiplatelet therapy that continues beyond a year
–either ticagrelor, 60 mg twice daily
–or clopidogrel, 75 mg daily, is recommended in addition to aspirin.
FDA issued a warning that systemic (BLANK) can increase the occurrence of aortic dissections or ruptures.
FDA issued a warning that systemic fluoroquinolones can increase the occurrence of aortic dissections or ruptures.
Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy
– How is this treated?
The clinical presentation and laboratory studies can mirror acute coronary syndrome and should be treated similarly. Once symptoms and cardiac abnormalities resolve, treatment is no longer indicated and may be withdrawn if there are no signs of coronary disease.
Med treatment of acute coronary syndrome
a diuretic, ACE inhibitor, and -blocker are indicated.
Who should be screened for syphilis infection? (USPSTF)
-Asymptomatic, nonpregnant adults
and adolescents who are at increased risk be screened for syphilis infection
–Factors associated with increased prevalence rates for syphilis in the United States include a history of incarceration or commercial sex work, living in the southern or western United States, residing in a major metropolitan area, African-American ethnicity, and being a male younger than 29 years of age. The risk for syphilis infection is highest among men who have sex with men and among persons who are HIV-positive.
What values are most useful predictors of severity of pancreatitis
Hematocrit, BUN, and creatinine levels are the most useful predictors of the severity of pancreatitis, reflecting the degree of intravascular volume depletion
