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3rd Year (Step 2) > Family Med_Blueprints > Flashcards

Family Med_Blueprints Flashcards

1
Q

Treatment of choice for most patients with moderate-to-severe persistent allergic rhinitis?

A

Intranasal steroids

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2
Q

What is the first and definitive treatment for any allergic disorder?

A

Avoidance of the allergens

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3
Q

Indications for X-rays in ppl w/ back pain?

A 
Age >50
History of significant trauma
Neurologic deficit
Systemic symptoms
Chronic steroid use
Possible hereditary condition
History of drug or alcohol abuse
History of osteoporosis
Immunodeficient state
Pain persisting >6 weeks
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4
Q

Surgical treatments are indicated for patients w/ what kind(s) of back pain?

A
  • Cauda equina syndrome
  • Patients with intractable pain
  • Patients w/ worsening of neurologic deficits

**For patients with herniated disks not responding after 4-6 wks of conservative therapy, a diskectomy may be considered. For spinal stenosis, surgery may be of benefit to those who do not respond to conservative care & have disabling symptoms.

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5
Q

5 most common causes of EMERGENT chest pain?

A
  • MI
  • Unstable angina
  • Aortic dissection
  • PE
  • Pneumothorax
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6
Q

Cardiac chest pain that lasts more than ____ is most probably secondary to infarction.

A

30 minutes

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7
Q

What is Beck’s Triad?

A
  • Jugular venous distention
  • Muffled heart sounds
  • Decreased blood pressure

**indicates Cardiac Tamponade

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8
Q

What are some sgns of pneumothorax?

A
  • Hyperresonance to percussion
  • Tracheal deviation
  • Decreased breath sounds
  • Decreased tactile & vocal fremitus
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9
Q

A patient who presents w/ MI should be stabilized initially w/ what?

A

Oxygen, nitroglycerin, & morphine for pain control

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10
Q

Contraindications to thrombolytics?

A
  • Active internal bleeding
  • Hx of cerebrovascular
    disease
  • Recent surgery
  • Intracranial neoplasm
  • Arteriovenous malformation
  • Aneurysm
  • Bleeding diathesis
  • Severe uncontrolled HTN
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11
Q

Clinical definition of “constipation”?

A

< 3 stools per week

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12
Q

Common causes of constipation in the primary care setting?

A

Poor fluid intake and a lack of fiber

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13
Q

Constipation - indications for laboratory testing?

A
  • Refractory constipation
  • New onset of constipation
    in an older individual
  • Heme-positive stools
  • Situations in which the etiology is unclear or the clinical evaluation suggests underlying pathology
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14
Q

Types of laxatives?

A
  • Bulk-forming agents (Psyllium, Methylcellulose, Calcium Polycarbophil)
  • Osmotic laxatives (Lactulose, Magnesium, Sorbitol)
  • Stimulant laxatives (Bisacodyl, Senna, Casanthranol)
  • Stool softeners (Docusate sodium)
  • Suppositories & Enemas
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15
Q

Most likely diagnoses in immunocompetent patients with a persistent cough & a normal chest x-ray?

A

Occult bronchospasm, allergies, GERD, or a combination
of these
(Spirometry or an empiric trial
of bronchodilator therapy may be helpful)

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16
Q

Common cause of cough in patients with allergies or a recent viral URI?

A

Postnasal drip

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17
Q

Centrally acting antitussive medications include ____ & ____

A

Codeine & Dextromethorphan

Codeine = narcotic; binds opiate receptors & suppresses medullary cough center; SE = sedation

Dextromethorphan = non-narcotic

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18
Q

Diarrhea – definition?

A

Increase in stool weight to

more than 200 g/day

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19
Q

4 general causes of bloody diarrhea?

A
  • Bacterial infection
  • IBD
  • Ischemic colitis
  • Malignancy
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20
Q

Most common viral pathogens causing diarrhea? (3)

A

Norwalk virus, Rotavirus, & Enterovirus

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21
Q

Fluoroquinolones are active against what 3 causes of bloody diarrhea?

A

Salmonella, Shigella, Campylobacter, and E. coli

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22
Q

_____ is the antibiotic of choice for traveler’s diarrhea in children and pregnant women and for
areas in which quinolone-resistant campylobacter is endemic.

A

Azithromycin

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23
Q

Giardia diarrhea – Tx?

A

Metronidazole

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24
Q

How does Benign Positional Vertigo typically present?

A

BPV generally occurs as an isolated symptom; the vertigo is short-lived, recurrent, & associated with particular head movements.

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25
Q

Cardinal features of Ménière disease?

A

Vertigo, tinnitus, and hearing loss. The vertigo & hearing loss are initially fluctuating.

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26
Q

Important ways to assess Central vs. Peripheral causes of vertigo?

A
  • Presence of isolated vertigo w/ or w/out hearing loss – suggests Peripheral disease.
    Also, Peripheral causes of vertigo are usually acute & self-limited.
  • Associated brainstem or other neurologic symptoms – suggest a Central disease
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27
Q

Medications used to treat labyrinthitis, vestibular neuronitis, and BPV include what? (4)

A

Meclizine, Dimenhydrinate, Antiemetics, & Benzodiazepines

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28
Q

Vertigo – causes of Peripheral vestibular disease?

A 
Benign positional vertigo (BPV)
Acute labyrinthitis
Vestibular neuronitis
Ménière disease
Acoustic neuroma
29
Q

Vertigo – causes of Central vestibular disease?

A

Vertebrobasilar insufficiency or hemorrhage
Multiple sclerosis
Brain tumor (e.g., glioblastoma or metastatic disease)

30
Q

BPV – Tx?

A

Epley maneuver

(performed by rotating the patients through a series of positions in an attempt to relocate the debris in the semicircular canal into the vestibule of the labyrinth)
- success rate ~ 80%.

31
Q

Intracranial pain-sensitive

structures (i.e. that could cause headache)?

A
  • Trigeminal
  • Glossopharyngeal
  • Vagus
  • First 3 CNs
32
Q

MOA of primary abortive meds used in Migraine headache?

A

Serotonin receptor agonists

33
Q

When should you consider Temporal arteritis as headache Dx?

A

In older patients who have pain on palpation of the Temporal Artery

34
Q

Dx test useful for patients w/ suspected GERD who have normal endoscopy and have either atypical symptoms or are refractory to therapy?

A

Ambulatory esophageal pH monitoring

35
Q

4 tests for H. pylori testing?

A
  • Rapid urease test
    (analyzes tissue samples obtained via endoscopy for presence of urease)
  • Histologic staining
    (same as above, but slower & more expensive)
  • Serologic & Fecal antigen tests
    (noninvasive, inexpensive, & highly sensitive and specific (>90%). Positive test indicates only prior infection, NOT current; patients in 20s rarely positive, but >50% in 60s are positive)
  • Urea breath tests
    (patient ingests urea labeled w/ radioactive carbon. If H. pylori is
    present, urease hydrolyzes the urea & the patient exhales labeled CO2.
    S&S but expensive & slow)
36
Q

4 major causes of heartburn symptoms?

A
  • GERD
  • Peptic ulcer disease
  • Gastritis
  • Nonulcer dyspepsia
37
Q

Atypical symptoms of heartburn that should trigger a GI workup?

A

Dysphagia, early satiety, weight loss, or blood loss

38
Q

H. pylori is a leading causative factor in _____ & _____

A

Peptic ulcer disease & Gastritis

39
Q

Name 4 H2 blockers

A

Cimetidine, ranitidine, famotidine, nizatidine

40
Q

Medication to treat dysmotility symptoms causing heartburn?

A

Metoclopropamide

41
Q

2 most common causes of hematuria in patients < 20yrs?

A
  • Glomerulonephritis

- Urinary Tract Infection

42
Q

Most common causes of Hematuria in patients 20-40 yrs old?

A

UTI, stone, trauma, & neoplasm of the urinary tract

43
Q

Most common causes of Hematuria in patients 40-60 yrs old?

A
  1. Bladder carcinoma
  2. Kidney stone
  3. UTI
  4. Renal carcinoma
  5. BPH
44
Q

Familial causes of hematuria?

A
  • Benign familial hematuria
  • Sickle cell disease or trait
  • Polycystic kidney disease
  • Alport syndrome
  • Familial hypercalciuria
45
Q

If Liver disease is suspected as cause of Jaundice, what 5 tests should be performed?

A
  1. Hepatitis profile – Hepatitis A, B, & C
  2. Antimitochondrial antibody – Primary biliary cirrhosis
  3. Serum iron, transferrin saturation, and ferritin – Hemochromatosis
  4. Serum ceruloplasmin and urine copper levels – Wilson disease
  5. Antismooth muscle and antinuclear antibodies – Autoimmune Hepatitis
46
Q

At what bilirubin level does jaundice become present?

A

Bilirubin > 2.0 to 2.5 mg/dL.

47
Q

_____ accounts for up to 75% of the cases of jaundice in younger adults

A

Hepatitis

48
Q

Drugs causing jaundice?

A

Acetaminophen, isoniazid, nitrofurantoin, methotrexate, sulfonamides, & phenytoin

49
Q

Weight loss and painless jaundice are signs of _____.

A

Pancreatic cancer

50
Q

Low serum albumin in a jaundiced patient suggests what?

A

It suggests a chronic process

51
Q

The feeling of the knee giving way suggests what?

Locking of the knee?

A

The feeling of the knee giving way suggests damage to a ligament.

Locking of the knee is more consistent with a torn meniscus or loose body that becomes trapped.

52
Q

Most likely Dx?

A sudden onset of severe knee pain and effusion in a middle aged man in the absence of trauma.

A

Gout

53
Q

When are x-rays &/or MRIs indicated for knee pain?

A

Plain x-rays should be obtained in all patients who are thought to have a possible fracture.

MRI is used to diagnose rupture of the ACL and can often detect injury to the meniscus & collateral ligaments.

54
Q

Acute isolated knee pain with an effusion – how to evaluate?

A

Should be evaluated w/ an Arthrocentesis

55
Q

A knee injury usually responds to what?

A

Rest, ice, and NSAIDs

56
Q

_____ usually improve the pain of inflammatory arthritis.

A

NSAIDs

57
Q

Generalized vs. Regional Lymphadenopathy?

A

Generalized = enlargement of LNs in 3 or more noncontiguous
areas
Regional = swelling is limited to a specific region, such as cervical LNs

58
Q

Viral gastroenteritis – typical symptoms?

A

Nausea & vomiting accompanied by fever, watery diarrhea, & abdominal cramps

59
Q

Common meds that cause nausea?

A

Macrolides, metronidazole, opiates, NSAIDs, estrogen, digitalis, theophylline, & chemo-agents

60
Q

Commonly used centrally
acting agents that help control nausea?
Side effects?

A

Phenothiazines

SEs include sedation & extrapyramidal symptoms, especially in children

61
Q

Diagnostic criteria for Rheumatoid Arthritis?

A
  • Morning stiffness > than 1 hour
  • Arthritis in 3 or more joints
  • Involvement of the wrist, MCP, or PIP joints
  • Symmetric arthritis
  • Rheumatoid nodules
  • Positive rheumatoid factor
  • Bony erosions on hand or wrist films
    (Four or more criteria are needed for diagnosing rheumatoid arthritis)
62
Q

Methotrexate – SEs?

A

Bone marrow toxicity, Hepatitis, & Stomatitis

63
Q

Hydroxychloroquine – SEs?

A

Retinopathy

64
Q

3 key issues in evaluating joint pain?

A

1) Are the symptoms related to the joint or to the periarticular structures?
2) Is the problem monoarticular or polyarticular?
3) Is the process inflammatory or noninflammatory?

65
Q

Morning stiffness that lasts more than 45 minutes suggests what?

A

An inflammatory arthritis

66
Q

Monoarthritis – dDx?

A
  • Infection
  • Crystal-induced arthropathies (gout and pseudo gout)
  • Trauma
  • Osteo-arthritis
67
Q

How does Rheumatoid Factor play into RA diagnosis?

A

RA is a clinical diagnosis.

However, a rheumatoid factor is positive in about 85% of patients.
Generally, the higher the rheumatoid factor titer, the more likely the patient has RA.

68
Q

First line of pharmacologic Tx of osteoarthritis?

A

Acetaminophen

NSAIDs are effective but may have more side effects

3rd Year (Step 2) (44 decks)

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