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family med quiz Flashcards

1
Q

involuntary leg movements while sleeping

A

REM sleep behavior disorder

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2
Q

name causes of sleep problem in elderly people

A 
rem sleep behavior disorder, restless leg
hyperthyroidism (might be only symptom)
cardiopulmonary problem
substances & drugs
advanced sleep phase syndrome
pain
pruritis
GERD
depression, anxiety
sleep apnea
environment not conducive to sleep
disturbances to sleep wake cycle (jet lag, shift work)
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3
Q

Risk factors for completed suicide (name 4)

A

increased age
male
military service
previous attempts

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4
Q

which elderly people are more likely to commit suicide

A

widow/widower, live alone, poor health, often have recently seen primary care
lack confidante, stress

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5
Q

what does SIGECAPS stand for

A 
Sleep changes
Interest
Guilt/worthlessness
Energy
Concentration/cognition
Appetite
Psychomotor
Suicide
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6
Q

MDD criteria

A

5+/9 sigecaps with at least one being depressed mood or anhedonia lasting at least 2 weeks

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7
Q

how do you discern between depression and bereavement

A

bereavement: mood comes in waves/comes and goes can still feel moments of joy; more focused on the loved one; thoughts of death more focused on the loved one and possibly joining them. self esteem more preserved although might feel guilt about not doing enough

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8
Q

risk factors for late life depression

A 
female
low socioeconomic
pain
insomnia
functional impairment
cognitive impairment
widowed
living alone
poor health
social isolation
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9
Q

SAFE-T suicide screen

A

look for Risk factors: previous attempts, psych history, family history, symptoms like anhedonia impulsivity command hallucinations insomnia, stressors, changes in treatment and access to firearms

  • protective factors: internal and external
  • Suicide inquiry: Ideation/Plan/Behaviors/Intent/Ambivalence
  • Risk level
  • Document
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10
Q

PHQ-2

A

Over the past two weeks, have you often been bothered by either of the following problems?”

  1. Little interest or pleasure in doing things.
  2. Feeling down, depressed, hopeless
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11
Q

Side effects of SSRIs, SNRIs

A
  • headache
  • GI
  • sexual dysfunction
  • sleep disturbance
  • falls in elderly
less commonly
hyponatremia from SIADH
serotonin syndrome (lethargy, death, rhabdomyelosis, kidney failure, restlessness)
GI bleeds
maybe bone density?
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12
Q

Risky side effect of citalopram

A

QT prolongation (can lead to torsades de points)

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13
Q

risky side effect of escitalopram

A

QT prolongation (can lead to torsades de points)

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14
Q

risky side effect of TCAs

A

arrhythmia

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15
Q

________ are less likely than whites to have their depression identified

A

Latinx

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16
Q

heavy dependence of the ______ on the ______ increases risk of elder abuse

A

heavy dependence of the caregiver on the elder

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17
Q

2 main prongs of CBT-I

A

sleep restriction, sleep compression

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18
Q

name two benzodiazopene receptor agonists

A

zolpidem

eszopiclone

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19
Q

what TCA can be used as sleep aid

A

doxepin

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20
Q

orexen receptor antagonist used as sleep aid

A

suvorexant

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21
Q

fluvoxamine

A

luvox, SSRI

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22
Q

MOA of TCAs

A 
block NE and serotonin reuptake
can cause arrhythmias 
nortriptyline
amitriptyline
doxepin
clomipramine
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23
Q

Name 2 SNRIs

A

venlafaxine (effexor)

duloxetine (cymbalta)

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24
Q

MOA of bupropion

A

NE and dopamine reuptake inhibitor

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25
Q

MOA of mirtazipine

A

NE and serotonin reuptake inhibitor, antihistamine effects
low drug drug interaction potential
lotta appetite and weight increase

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26
Q

vilazodone

A

viibryd

serotonin partial agonist and reuptake inhibitor

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27
Q

SSRI approved for panic, OCD, PTSD

A

sertraline

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28
Q

pregnancy category D SSRI, short half life so likely to cause discontinuation symptoms

A

paroxetine (paxil)

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29
Q

SSRI used in OCD, often causes vomiting

A

fluvoxamine (luvox)

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30
Q

SSRI approved for GAD, causes prolonged QT

A

escitalopram

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31
Q

what labs should you get when evaluating someone for depression

A

TSH
CBC
CMP

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32
Q

name 3 medical conditions associated with depression

A

hypothyroidism
dementia
parkinsons

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33
Q

Who does the USPSTF say should be screened for chlamydia?

A
  • all sexually active women under 24

- sexually active women over 25 at increased risk

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34
Q

What 5 categories of things should you talk about at preconception convo?

A
  1. Genetic
    including folic acid supplementation. 400mcg for most ppl; 1mg for diabetics & epileptics; 4mg if previous neural tube defect
  2. Genetic screening (family hx - CF, tay sachs, sickle cell, connexin 26, thalessemia,
  3. Mom’s infectious disease status
    -GC, chlamydia
    -HIV
    -Hep B
    -preconception immunization: varicella, rubella
    -toxoplasmosis
    -CMV, parvovirus B19 (frequent handwashing)
  4. Environmental exposure
    -household/ substances & alcohol & tobacco
  5. Medical assessment : remember no ACE-I, no thiazides, no warfarin, no benzodiazepines, ARBS
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35
Q

Naegele’s rule for estimating due date

A

add 1 year
subtract 3 months
add one week

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36
Q

What does HEEEADSSS stand for

A 
Home
Eating
Exercise
Employment & Education
Activities
Drugs
Sexuality
Suicide/depression
Safety/violence
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37
Q

what labs at initial pregnancy appt

A 
HIV
CBC (anemia, nutritional deficiency)
HepBsurface ag
rubella immunity
blood typing
RPR
GC/chlamydia (don't think this is official answer)
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38
Q

labs for 1st trimester bleeding

A

hCG (should double every 48 hrs)
progesterone (<5 means ectopic, miscarriage)
trichomonas wet mount
CBC (check anemia - not that helpful in looking for infection as most preggers have mild leukocytosis)

remember Rh- moms always get Rhogam during bleeding episodes

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39
Q

management of inevitable abortion

A
  • expectant management
  • D&C
  • vaginal misoprostol
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40
Q

early pregnant woman with distended acute abdomen

A

think ruptured ectopic pregnancy

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41
Q

intrauterine contents cannot be seen on US until hCG is > ____ mIU/ml

A

1500

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42
Q

Drinking 1 drink per day for women or 2 drinks per day for men is called _______ alcohol use

A

moderate

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43
Q

define binge drinking

A

5+ drinks on one or more occaisions in last 30 days

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44
Q

heavy drinking is __ drinks on ___ days out last 30

A

5+, 5+

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45
Q

signs of alcohol use disorder

A

2 or more:
wanting to quit but not being able to
feeling guilt
feeling irritable about being questioned
keep drinking tho causing trouble with family or friends
keep drinking tho cause anxiety, depress
physical symptoms when alcohol wears off
tolerance
cravings
lot of time drinking, being sick from drinking
given up or cut back on other parts of life that are important
more than once gotten into dangerous situations

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46
Q

Name 2 PE tests for appendicitis

A

psoas sign

obtorator sign

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47
Q

Name 2 PE tests for appendicitis

A

psoas sign: Passive extension of patient’s thigh as s/he lies on his/her side with knees extended, or asking the patient to actively
flex his/her thigh and hip causes abdominal pain, often indicative of appendicitis.

obtorator sign: Examiner has patient supine with right hip flexed to 90 degrees; takes patient’s right ankle in his right hand as
he uses his left hand to externally/internally rotate patient’s hip by moving the knee back and forth. Elicitation of pain in the
abdomen implies acute appendicitis.

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48
Q

RUQ pain with N/V after heavy meal, no fever, lasts less than 8 hrs usually

A

biliary colic - due to stone in cystic duct that gets out of way. needs US, cholecystectomy if stones

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49
Q

If there is jaundice and/or gallstone pancreatitis suggestive of a common duct stone (choledocholelithiasis), what kind of imagining might you get?

A

ERCP

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50
Q

medication for alcohol use disorder

A

naltrexone, acamprosate

also CBT, MET, AA

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51
Q

what labs would you get for RUQ pain

A 
electrolytes bc of vomiting
LFTs
CBC - look for leukocytosis that might suggest infection, eg cholocystitis, and anemia due to internal bleed
amylase/lipase
UA - in case its renal colic
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52
Q

RUQ pain that is sharp, N/V, fever, doesn’t go away

A

acute cholecystitis - due to stone that doesnt dislodge from cystic duct
often after fatty meal
+/- Murphy’s sign
emergency cholectomy

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53
Q

nausea/vomiting, constant epigastric pain radiating to back, abdominal tenderness on exam

A

acute pancreatitis
often after alcohol
may be hard to differentiate biliary colic from gallstone pancreatitis
classic but rare signs are bruising over bellybutton, flank
*dehydration! coma! shock!
plural effusion risk
there may be jaundice if common bile duct obstruction!

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54
Q

abdominal distention, high pitched bowel sounds, lack of flatulence, diffuse colicky pain , n/v that helps pain

A

obstructed small bowel

maybe associated constipation

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55
Q 
mid epigastric pain or R or L UQ pain
maybe N/V
gets better with food and antacids
maybe bloating, early satiety
bloody emesis, tarry stools
A 
duodenal ulcer 
PPI for 4-6 weeks
stop nsaids, aspirin
if H pylori positive: H pylori eradication therapy = PPI + bismuth+ tetracycline + metronidazole for 2 weeks
complication: perforation
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56
Q

H pylori eradication therapy

A

PPI + bismuth subsalicylate + metronidazole + tetracycline for 2 weeks

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57
Q

malaise, RUQ pain, pruritis, N/V, anorexia, icterus, jaundice, insidious onset

A

hepatitis

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58
Q

menopause is ____months without a cycle

A

12

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59
Q

USPSTF mammography guidelines

A

every other year 50-74yo

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60
Q

symptoms and PE findings of atropic vaginitis

A

frequent UTI, uregency frequency, dyspareunia, vaginal itching, smoother vaginal mucosa and cervix
treat with estrogen cream or ring

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61
Q

Name risk factors for endometrial cancer

A 
unopposed estrogen therapy
tamoxifen (used for breast cancer)
nulliparity
early menarche
late menopause
obesity
anovulatory cycles
age
irregular cycles
(smoking weirdly decreases endometrial cancer risk)
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62
Q

when to use drugs to treat osteoposis

A

-2.5 t score

t score between -2.5 and -1 and hip fracture risk 3%

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63
Q

Hormone therapy for menopause

A

increases stroke and MI risk
after 3 years, increases breast cancer risk
obvi don’t use unopposed systemic estrogen
decreases osteoporeosis risk

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64
Q

Name 3 osteoporeosis bisphosphonate drugs

A

alendronate
ibandronate
zolendronic acid (yearly injection)

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65
Q

zoledronic acid

A

yearly injectable bisphosphonate

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66
Q

Name 3 non-bisphosphonate drugs that can be used to treat osteoporosis

A

calcitonin
parathyroid hormone (Forteo)
raloxifene

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67
Q

what medications besides HT can be used for menopause symptoms

A

SSRIs, SNRIs, gabapentin, clonidine

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68
Q

Name 5 tests for evaluation of post menopausal bleeding

A
  • TSH - make sure its not thyroid prob
  • CBC- anemia? thrombocytopenia?
  • endometrial biopsy (gold standard) but only after…
  • transvaginal ultrasound - look at thickness of endometrium to screen for endometrial cancer, also gives you some idea about fibroids, polyps or other uterine masses, ovary pathology
  • LH, FSH (elevation confirms menopause)
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69
Q

Differential for post menopausal uterine bleeding

A
  • cervical polyps: but you should know this is rare in post menopausal women; much more common in post partum, perimenopausal women
  • proliferative endometrium: especially in women with a lot of circulating estrogen – is she on HT?
  • endometrium hyperplasia: this is a premalignant condition and 25% go on to cancer!
  • endometrial cancer: 4th most common cause of cancer in women and 90% of women with have vaginal bleeding
  • hormone producing ovarian tumors: not common for ovarian tumors to cause vaginal bleeding but obvi need to consider it
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70
Q

symptoms of IBS

A

flatulence, bloating, mucus in stool, changes in consistancy and frequency, abdominal pain related to defecation, often feel better after pooping. worse with stress, diary, caffeine. can be brought on by bout of gastroenteritis.

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71
Q

mid epigastric pain in pt that smokes, drinks, uses nsaids. worse with spicy food and stress. Nausea. decreased appetite.

A

gastritis

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72
Q

associations of Gallbladder disease

A 
recently pregnant
uses OCPs
pain in RUQ, radiates to back, shoulder
fat, forty, fertile, female
eating fatty foods
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73
Q

a moderately severe to severe epigastric pain that often radiates to the back, and is
accompanied by nausea, vomiting and anorexia. There is usually a history of excessive alcohol use/abuse or a
family history of pancreatitis, although this can also be caused by gallstones, hypertriglyceridemia and other less
common causes.

A

pancreatitis

If suspicion is high, laboratory tests (lipase, amylase) and imaging (abdominal ultrasound or CT
scan) are needed to investigate further.

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74
Q

Cervical motion tenderness
Discharge
abdominal or pelvic pain, which is worse with sexual
intercourse or with activities such as running or jumping,
mild menstrual irregularities

A

PID
KOH/wet mount, naat
ceftriaxone + azithromycin

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75
Q

Patients present with divergent
symptoms ranging from no pain and normal menses, to intense pain and irregular or absent menses. A good
history, the physical exam and lab testing (always get a pregnanacy test if the patient has a uterus) are crucial for
this diagnosis. Imaging is also usually needed. You need the date of the patient’s last menstrual period (LMP), her
menstrual history, most recent intercourse dates, the types of contraception used currently and used in the past
/ever used, history of any vaginal or pelvic infections, and history of previous ectopic or normal pregnancies.

A

Ectopic pregnancy is a medical emergency. Early medical treatment reduces the need for surgery, but if the
fallopian tube is in danger of rupture, surgical intervention may be necessary. P

76
Q

modalities for diagnosing IBD

A

flexible sigmoidoscopy, endoscopy, barium enema, colonoscopy

77
Q

Centor criteria

A

fever
NO cough
cervical lymphadenopathy
tonsillar erythema or exudate

+1 point if under 15
0 points if 15-45
-1 point if over 45

if they are a kid and get 2 points, they get a strep test (and cx whether it’s positive or negative)
If they are an adult and get 3 points, they get a strep test

78
Q

what are 2 most common complications of flu

A

bacterial pneumonia

otitis media

79
Q

tx for streptococcal pneumonia

A

amoxicillin

80
Q

when is a kid considered overweight or obese?

A

overweight if 85-95 percentile of BMI

obese if >95 percentile BMI

81
Q

5-2-1-0 obesity prevention

A 
5 servings frutis and veg
2 hrs screen time
1 hr exercise
0 sugary drinks
family meals
healthy breakfast
kids self reg meals
82
Q

pulmonary findings that indicate consolidation

A 
crackles
tactile fremitis (increased)
egophony
whispered pectoriliquy 
dullness to percussion
83
Q

amantidine

A

give within first 48 hrs of flu

84
Q

rimantidine

A

give within first 48 hrs of flu

85
Q

zanamivir or oseltamivir

A

give w/in first 48 hrs of flu

86
Q

Can cause a low-grade fever, rhinorrhea, sneezing, nasal congestion and cough.
Last about one week.
Nasal discharge can begin as clear and gradually progress to colored, but that isn’t a predictor of bacterial
involvement.

A

URI

87
Q

Often starts as a viral illness and progresses to wheezing, cough, dyspnea, and cyanosis.
Infants require supportive treatment, including oxygen if hypoxic, while they are recovering.

A

Bronchiolitis

often caused by RSV

88
Q

crackles, fever >100.4, pleuritic chest pain, chills, cough, dyspnea, often no prodrome in children, often pleural effusion

A

strep pneumo pneumonia in children; treat with amoxicillin

89
Q

chills, fever, dry, nonproductive cough) and the

predominance of extrapulmonary symptoms, such as GI symptoms and arthralgias.

A

atypical pneumonia
viral, rsv, flu, varicella, measles, adenovirus, rhinovirus, parainfluenza, etc.
especially 4mo-5yo kids

90
Q

cough +/- purulent sputum for 5+ days maybe rhonchi (snoring sound from mucus) maybe wheezes maybe normal lung exam

A

acute bronchitis
usually viral
supportive treatment

91
Q 
upper and lower respiratory tract symptoms
*abruptt* onset
high fever 102-104
myalgia, malaise, fatigue, headache
rhonchi
A

flu

92
Q

fever, sore throat, and tender cervical lymphadenopathy .

A

Group a beta hemalytic steptococcal pharyngitis
with sandpaper rough macular rash–> scarlet fever
give penicillin V to prevent compliciations

93
Q

who should be screened for hyperlipidemia?

A

anyone over 20 if at increased risk – obesity, DM, fam hx, etc

94
Q

Clinicians should discuss aspirin chemoprevention with ____for primary prevention of myocardial infarction

A

men >50

95
Q

4 mechanisms of TIA or possible stroke

A

embolic - usually from heart (e.g. afib) or carotids (atherosclerosis)
thrombotic (MOST COMMON)
cardiogenic (decreased perfusion)
hemorrhagic

(hypercoagulobility, anemia, vasospasm)

96
Q

expressive and receptive aphasia plus facial weakness associated with stroke from…

A

MCA

97
Q

name 3 causes of facial asymmetry

A

bells palsy
stroke (think mca )
horner’s syndrome
(all CN VII)

98
Q

anticoagulation for high risk nonvalvular AF pts

A

warfarin or DOACs

dual clopidogrel and aspirin if they above won’t work. more bleeding risk

99
Q

primary stroke prevention for low risk AF pts

A

aspirin

100
Q

primary stroke prevention for AF with valve problems

A

warfarin!

101
Q

anticoagulation for stroke pt with AF

A

warfarin or doac. if they can’t take these, aspirin

102
Q

all patients with history of stroke or tia should be on _____ statin

A

high intensity
atorvastatin
rosuvastatin

103
Q

doacs

A

apixaban
dapigatran
edoxaban
rivaroxaban

104
Q

SPRINT trial BP goals for stroke pts

A

130/80

105
Q

Stroke work up

A 
MRI/CT
electrolytes &amp; renal function
cardiac markers -- troponin trend, BNP (elevated in left ventricular dysfunction)
CBC, PT, PTT
oxygen saturation
ECG
106
Q

DDx for lightheadedness with neuro focal findings

A 
stroke, tia
mi/cad
seizure
med side effect
afib
structural heart disease
hypertensive emergency
107
Q

elementary school admission vacc

A 
Three hepatitis B
Five DTaP
Four polio
Two MMR
Two varicella
108
Q

lead screening questions

A

Does your child live in or regularly visit a house or child care facility built before 1950?
Does your child live in or regularly visit a house or child care facility built before 1978 that is being or has recently been
renovated or remodeled (within the last six months)?
Does your child have a sibling or playmate who has or did have lead poisoning?

109
Q

fever, pharyngitis, and lymphadenopathy esp posterior cervical
palatal petechia
hs

A

monospot
EBV
rash with amoxicillin

110
Q

nspiratory stridor, “hot potato” (muffled) voice, dysphagia, and drooling.
Classically patients will be seated in a “tripod” position, leaning forwards and projecting the chin.
usually 1-6 yo

A

epiglottitis
very dangerous!
Hib
hospital!

111
Q

starts like common cold, but cough worsens, around for at least 14 days,

A

Pertussis

can be fatal in infants

112
Q

most common among teens
drooling and muffled (“hot potato”) voice.
Trismus occurs in two-thirds of patients and may help distinguish from tonsillitis.
complication of strep throat

A

Peritonsillar
abscess
Urgent surgical evaluation with drainage and antibiotic therapy are the mainstays of treatment

113
Q

fever, difficulty swallowing, neck or ear pain, muffled “hot potato”
voice, and unwillingness to move the neck. Patients typically appear ill.
Most common among young children ages 2 to 4, but can occur at other ages.

A

Retropharyngeal
abscess

can be life threatening need hospital. lateral neck film or ct

114
Q

barking cough, inspiratory stridor, and hoarse voice

A

viral croup
+/- steeple sign on x ray
make diagnosis clinically

115
Q 
a viral (or, less commonly, bacterial) infection of the inner ear causes inflammation of the
vestibular branch of the eighth cranial nerve.
A

vestibular neuritis

116
Q

infection affects both branches of the eighth cranial nerve resulting in tinnitus and/or
hearing loss as well as vertigo.

A

acute labarynthitis

117
Q

Dix-Hallpike manuever

A

confirm benign paroxysmal positional vertigo
nystagmus has fast component in direction of pathology
epley manuever = tx

118
Q

how to tx otitis media in kids <6 mo

A

antibiotics

119
Q

how to tx otitis media in kids 6mo - 2 yrs

A

cautious observation

120
Q

how to tx otitis media in kids > 2 yo

A

don’t need antibiotics if uncomplicated

121
Q

do you treat maxillary sinusitis with abx?

A

nope!

122
Q

symptomatic tx of URI

A

decongestant (such as pseudoephedrine) or saline nasal spray for congestion
acetaminophen for fever and pain
Physicians frequently recommend pushing fluids, though a recent Cochrane review found no studies investigating this
recommendation.
Echinacea has not been consistently demonstrated to improve symptoms of the common cold.
Vitamin C has shown mixed evidence in its ability to shorten the duration of the common cold. It may be worth a try for
some patients, but it can cause kidney stones.
Nasal ipratropium spray has been shown to slightly reduce rhinorrhea (runny nose) in the common cold, but not nasal
congestion (stuffy nose).

123
Q

tx for benign paroxysmal positional vertigo

A

epley manuever
vestibular rehabilitation
meds like meclizine, dimenhydrinate
antiemetics like metoclopramide, promethazine

124
Q

indications of central lesion causing vertigo

A

nyastagmus persists with fixed gaze, normal head thrust test

get imaging

125
Q

recent uri, vertigo, no hearing loss, nystagmus does not change direction with gaze

A

vestibular neuritis

126
Q

recent uri, vertigo, + hearing loss, nystagmus does not change direction with gaze

A

acute labarynthititis

127
Q

s acute onset vertigo that can be associated with nausea and vomiting and intact hearing
episodic

A

BPPV

128
Q

Episodes of unilateral hearing loss, tinnitus, and vertigo f

A

Mennieres disease

129
Q

Episodes of unilateral hearing loss, tinnitus, and vertigo

A

Mennieres disease

130
Q

HTN plus any kidney issues – what antihypertensive?

A

ACEi/ARB

131
Q

antihypertensive if history of stroke

A

acei

132
Q

older pt acute onset headache, nausea and/or vomiting

A

always suspect stroke
get non contrast CT, cbc to look for coagulopathy, blood glucose to look for hypoglycemia, UA, CXR ECG to look for heart probs

also need to consider subarachnoid hemorrhage

133
Q

sudden severe headache, middle to older age person, photophobia, nausea vomiting

A

wouldnt be migraine starting this late in life
think subarachnoid hemorrhage
get noncontrast CT but may be equivoqal –> lumbar puncture

134
Q

adrenal insufficiency with insufficient aldosterone would cause_____natremia dnd ______kalemia

A

hyponatremia and hyperkalemia

135
Q

Mammogram is the preferred imaging study for women over 35, while women younger than 35 should get ultrasound to evaluate a breast mass.

A

if a cystic mass found, probably not malignant. no further eval. If solid – biopsy.

136
Q

Enterobiasis

A 
aka pinworm
girls can get vulvovaginitis, uti
mebendazole
albendazole
treat whole household
wash bedding and clothing, clip fingernails
137
Q

when you see euvolemic hyponatremia always think …

A

SIADH
-hypotonicity (look at low plasma osmolality)
-inappropriately concentrated urine relative to hypotonic plasma
-normal renal function! kidneys are just fine
too much ADH (vasopressin) is causing body to hold on to free water in CD
causes:
1. cancer - especially small cell lung, pancreatic
2. CNS probs
3. drugs - antipsychotics, chlorpropamide, chemo
(remember that ppl with schizophrenia on antipsychotics might actually drink too much water –psychogenic polydipsia

138
Q

diabetes insipidus usually causes _____natremia
mechanism of central DI:
mecanism of nephrogenic DI

A

hypernatremia. Pt will pee a lot
central DI: not enough ADH production, often due to surgical trauma to hypothalamus or pituitary
nephrogenic DI: kidneys dont respond to ADH, usually inherited in kids, usually caused by drugs in adults like lithium

139
Q

tx for trichomonas or bacterial vaginitis

A

metronidazole

positive WHiff test for both

140
Q

tx for yeast infection

A

clotramazole

141
Q

post strep glomerulonephritis

A

the patient’s age (<7 years old)
dark brown colored urine (representing hematuria), and periorbital and peripheral edema.
There is also a latent period of around 10 days following pharyngitis before symptoms of glomerulonephritis occur, although for glomerulonephritis following streptococcal impetigo, the latent period can be as long as 3-4 weeks.
anti-streptolysin O titer,
RBC casts –When
you see casts in the urine sediment - whether WBC, RBC, or granular - you have glomerular disease. This is a useful pearl to remember – it’s only when cells get squeezed through the
glomerulus that they will form casts. Dysmorphic RBCs (especially acanthocytes) are also highly suggestive of glomerular disease. Patients with bleeding from sources other than the glomerulus
- such as a patient with renal stones, bladder cancer, or a urinary tract infection - should have RBCs with normal morphology, since those cells are not being squeezed from the glomerulus into
the collecting tubule. IgA nephropathy (answer A) is the most common cause of primary glomerulonephritis. The most common presentation is recurrent episodes of gross hematuria that occur
around 5 days after an upper respiratory infection.

142
Q

kid with hematuria, proteinuria, abdominal pain, palpabale purpura, arthralgia

A

henoch scholein
igA deposits in small vessels
provoked by meds, group a beta hemolytic strep, parvovirus B19, other infections, allergy
supportive care

143
Q

Hyperkalemia with EKG changes needs immediate treatment with

A

i.v. calcium to protect the heart

144
Q

classic ecg finding of hyperkalemia

A

peaked t wave

145
Q

markedly elevated blood pressure in an otherwise healthy young person and the presence of an
abdominal bruit

A

fibromuscular dysplasia

146
Q

hypertension, obesitymoon facies, a “buffalo hump,” purple striae, a

A

Cushings, most commonly from exogenous corticosteroids

147
Q

most common cause of syncope in young people is vasovagal but serious cardiac issues are…

A

wolf parkinson white (look for delta wave – radio ablation)
long or short QT
hypertrophic cardiomyopathy
valve disease

148
Q

Edrophonium test is to confirm…

A

mysthenia gravis 1) The key feature of MG is fatigable muscle weakness.
Patients will typically report that their symptoms worsen throughout the day. Oculobulbar myasthenia gravis is the most common type, resulting in the signs and symptoms presented in the
question stem: double vision, ptosis, dysarthria, and difficulty chewing. 2) Myasthenia gravis has a bimodal age distribution, so there are two classic groups of patients who get MG: young women
in their 20s or 30s with autoimmune disorders (RA, SLE, hyperthyroidism, etc.), and men in their 70s or 80s. 3) MG is caused by autoantibodies that bind to postsynaptic ACh receptors. A
commonly tested point is distinguishing myasthenia gravis from Lambert-Eaton syndrome, which is a paraneoplastic disorder (usually associated with small cell lung cancer) in which antibodies
are produced against the pre-synaptic Ca2+ channels. 4) The treatment of myasthenia gravis begins with anticholinesterase drugs like neostigmine or pyridostigmine, which increase the amount
of ACh in the synapse, overcoming the antibody blockade. Prednisone or other immunosuppressive drugs are also used, and i.v. Ig or plasmaphresis are used for refractory cases to more
directly target the responsible autoantibodies. 5) Myasthenia gravis almost always have some abnormality of the thymus: 75% will have thymic hyperplasia, and 15% will have an overt thymoma.
Since the disease is mediated by T cells, removal of the thymus can be curative in patients who fail medical therapy. Regardless, once the diagnosis of MG has been established, it is reasonable
to rule out thymoma via CT scan. If you answered B, a chest CT, you either recognized that this was a case of myasthenia gravis and were pursuing a thymoma, or you thought that this was a
case of Lambert-Eaton myasthenic syndrome and were looking for a small cell lung cancer. A chest CT will provide useful – and potentially even necessary – diagnostic and prognostic
information, but first you should confirm the initial diagnosis of myasthenia gravis with the edrophonium test or EMG

149
Q

fixed splitting of S2 in a child

A

think atrial septal defect
(normal s2 splitting is only on inspiration)
ASD leads to pulmonary tensions and eventually Eisenmenger syndrome where left to right shunt revereses

150
Q

midsystolic click followed by a late systolic murmur heard best at the apex of the heart

A

mitral valve prolapse

151
Q

PROVE tetralogy of fallot

A 
Pulmonary stenosis
Right ventricular hypertrophy
overarching aorta
ventricular septal defect
early cyanosis
152
Q

what do you give for acute COPD exacerbation

A

abx and systemic corticosteroids

153
Q

A useful mnemonic to remember the differential of microcytic anemias is “TAILS”

A 
Thalasemmia
Anemia of chronic disease
iron deficiency
lead poisoning
sideroblastic anemia

**Microcytic anemia/ iron deficient anemia in male is colorectal cancer until proven otherwise. First test is always endoscopy.

154
Q

increased LDH and decreased haptoglobin in setting of anemia suggests

A

hemolysis of RBCs

commonly tested cause: G6PD deficiency

155
Q

Extra” heart beat that originates in the left or right ventricle
Typically no P wave
Wide QRS complex, usually > 0.16 sec
Often followed by a compensatory pause

A

PVC

premature ventricular contraction

156
Q

pvc trigger

A 
htn
Ischemia/MI
Cardiomyopathy/HF
Anxiety, catecholamines
Stimulants (legal or illegal)
Electrolyte abnormalities (low K, Mag, high Ca)
Hyperthyroidism
157
Q

clinical significance PVC

A

high number” = more significant
Polymorphic = more significant
Even simple PVCs in otherwise healthy patients have shown association with increased all-cause mortality
Presence of PVCs, especially frequent or complex, associated with worse prognosis post-MI

158
Q

workup pvc

A

Labs: BMP, Mag, Ca, TSH
Holter monitor or event monitor
Echo
Stress test

159
Q

pvc tx

A

Treat the underlying cause
Beta blocker or calcium channel blocker
Antiarrhythmics
Catheter ablation

160
Q

afib

A

Rapid and irregular rhythm that originates in the atria
RR interval has no repetitive pattern (“irregularly irregular”)
No distinct P waves; will see fibrillatory waves, instead
Typical ventricular rate is from 90 – 170
Usually narrow QRS

161
Q

causes of afib

A 
Age
HTN and coronary disease
Structural heart disease
Alcohol (holiday heart syndrome)
Hyperthyroidism
Lung problems (COPD, PE)
Stimulants
MI
Hypoxia
162
Q

what are clinically significant effects of afib

A 
chf
mi
stroke
reduced ef
palpitations
163
Q

when should someone with afib be hospitalized

A 
Hemodynamically unstable
Treatment of underlying cause
Concern for ACS
Elderly
Unable to control rate
164
Q

afib workup

A 
Look for an underlying cause
EKG
Echo: LVH, atrial size, valves 
Electrolytes, TSH, CBC
Consider ischemia
165
Q

afib treatment

A

either rate or rhythm control

cha2ds2vas 2+ def anticoag

166
Q

cha2ds2vas

A 
chf
htn
age >75 2 pt
diabetes
stroke/tia hx 2 pt
vascular disease
age 64-75
sex (female)
1: maybe get anticoag
2: definitely anticoag
167
Q

supraventricular tachycardia

A

Fast rhythm originating in the atria
Narrow QRS
Rate from 120 - 220

168
Q

probs cause by SVT

A

hemodynamic instability
ischemia
HF
syncope

169
Q

immediate tx for SVT (name 4)

A

Vagal maneuvers
Adenosine 6 mg IVP, repeat 6 mg IVP 2 min later, 12 mg IVP 2 min later
IV Ca channel blocker (nondihydropyridine)
IV beta blocker

170
Q

long term management of SVT

A 
Self-termination with valsalva
“Pill in the pocket” 
B-blocker or nondihydropyridine
Other anti-arrythmics
Catheter ablation
171
Q

DSM def of insomnia

A

Difficulty initiating or maintaining sleep, or non-refreshing sleep
Impairment or distress
3x/week for one month

172
Q

sleep restriction goal 90% efficiency; relaxation and cognitive therapy; CBT-I superior to drugs in long term. benzos superior in short term

A

benzodiazapenes have reversible dementia risk

antihistamines have dementia risk

173
Q

moa of z drugs

A 
bind to GABA receptor 
benzodiazapene receptor agonists
zolpidem 
zaleplon
eszopiclone
*decrease sleep latency
174
Q

how does suvorexent work

A

orexen receptor antagonist, works in hypothalamus; blocks wakefulness but also reward pathway. can lead to depression

175
Q

non drug sleep approaches

A

keep sleep log
melatonin .3-.5 mg (** especially for delayed sleep phase disorder can move up sleep phase by 40 min)
light therapy
mindfulness based therapy for insomnia

176
Q

recommended melatonin dose

A

.3-.5mg

177
Q

USPSTF screening recs for sleep apnea

A

dont do it for everybody
-when indicated, Epsworth sleepiness sclare
STOP-BANG

178
Q

common co morbidities of osa

A

afib, obesity, depression, chf, htn, cad, dm, stroke

179
Q

diagnostic criteria for OSA

A

polysomnography, apnea-hypoanea index AHI

>15 AHI events in a night

180
Q

OSA treatment

A

*CPAP (oral devices are second line)
weight loss
positioning (poor compliance)
(conflicting evidence on whether osa tx actually lowers cardiovascular risk)

181
Q

creepy crawly sensation when resting, relieved with activity

A

RLS

182
Q

things that provoke RLS

A 
low iron, make sure ferritin >50
dopamin antagonists like neuroleptics, metoclopramide
SSRIs, 
TCAs
caffeine
lithium
antihistamines
183
Q

Name 4 drugs to treat RLS

A

carpadopa/levodopa
gabapentin
ropinirole
pramipexole

(all dopamine agonists)

184
Q

pramipexole

A

dopamine agonist used to treat RLS

185
Q

ropinirole

A

dopamine agonist used to treat RLS

186
Q

when to use low to mod dose statin for primary cvd prevention

A

1) they are aged 40 to 75 years;
2) they have 1 or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking);
and 3) they have a calculated 10-year risk of a cardiovascular event of 10% or greater.

family med quiz (1 decks)

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