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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
Cardinal features of Ménière disease?
Vertigo, tinnitus, and hearing loss. The vertigo & hearing loss are initially fluctuating.
26
Important ways to assess Central vs. Peripheral causes of vertigo?
- 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
27
Medications used to treat labyrinthitis, vestibular neuronitis, and BPV include what? (4)
Meclizine, Dimenhydrinate, Antiemetics, & Benzodiazepines
28
Vertigo -- causes of Peripheral vestibular disease?
``` Benign positional vertigo (BPV) Acute labyrinthitis Vestibular neuronitis Ménière disease Acoustic neuroma ```
29
Vertigo -- causes of Central vestibular disease?
Vertebrobasilar insufficiency or hemorrhage Multiple sclerosis Brain tumor (e.g., glioblastoma or metastatic disease)
30
BPV -- Tx?
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
Intracranial pain-sensitive | structures (i.e. that could cause headache)?
- Trigeminal - Glossopharyngeal - Vagus - First 3 CNs
32
MOA of primary abortive meds used in Migraine headache?
Serotonin receptor agonists
33
When should you consider Temporal arteritis as headache Dx?
In older patients who have pain on palpation of the Temporal Artery
34
Dx test useful for patients w/ suspected GERD who have normal endoscopy and have either atypical symptoms or are refractory to therapy?
Ambulatory esophageal pH monitoring
35
4 tests for H. pylori testing?
- 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
4 major causes of heartburn symptoms?
- GERD - Peptic ulcer disease - Gastritis - Nonulcer dyspepsia
37
Atypical symptoms of heartburn that should trigger a GI workup?
Dysphagia, early satiety, weight loss, or blood loss
38
H. pylori is a leading causative factor in _____ & _____
Peptic ulcer disease & Gastritis
39
Name 4 H2 blockers
Cimetidine, ranitidine, famotidine, nizatidine
40
Medication to treat dysmotility symptoms causing heartburn?
Metoclopropamide
41
2 most common causes of hematuria in patients < 20yrs?
- Glomerulonephritis | - Urinary Tract Infection
42
Most common causes of Hematuria in patients 20-40 yrs old?
UTI, stone, trauma, & neoplasm of the urinary tract
43
Most common causes of Hematuria in patients 40-60 yrs old?
1. Bladder carcinoma 2. Kidney stone 3. UTI 4. Renal carcinoma 5. BPH
44
Familial causes of hematuria?
- Benign familial hematuria - Sickle cell disease or trait - Polycystic kidney disease - Alport syndrome - Familial hypercalciuria
45
If Liver disease is suspected as cause of Jaundice, what 5 tests should be performed?
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
At what bilirubin level does jaundice become present?
Bilirubin > 2.0 to 2.5 mg/dL.
47
_____ accounts for up to 75% of the cases of jaundice in younger adults
Hepatitis
48
Drugs causing jaundice?
Acetaminophen, isoniazid, nitrofurantoin, methotrexate, sulfonamides, & phenytoin
49
Weight loss and painless jaundice are signs of _____.
Pancreatic cancer
50
Low serum albumin in a jaundiced patient suggests what?
It suggests a chronic process
51
The feeling of the knee giving way suggests what? | Locking of the knee?
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
Most likely Dx? | A sudden onset of severe knee pain and effusion in a middle aged man in the absence of trauma.
Gout
53
When are x-rays &/or MRIs indicated for knee pain?
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
Acute isolated knee pain with an effusion -- how to evaluate?
Should be evaluated w/ an Arthrocentesis
55
A knee injury usually responds to what?
Rest, ice, and NSAIDs
56
_____ usually improve the pain of inflammatory arthritis.
NSAIDs
57
Generalized vs. Regional Lymphadenopathy?
Generalized = enlargement of LNs in 3 or more noncontiguous areas Regional = swelling is limited to a specific region, such as cervical LNs
58
Viral gastroenteritis -- typical symptoms?
Nausea & vomiting accompanied by fever, watery diarrhea, & abdominal cramps
59
Common meds that cause nausea?
Macrolides, metronidazole, opiates, NSAIDs, estrogen, digitalis, theophylline, & chemo-agents
60
Commonly used centrally acting agents that help control nausea? Side effects?
Phenothiazines SEs include sedation & extrapyramidal symptoms, especially in children
61
Diagnostic criteria for Rheumatoid Arthritis?
- 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
Methotrexate -- SEs?
Bone marrow toxicity, Hepatitis, & Stomatitis
63
Hydroxychloroquine -- SEs?
Retinopathy
64
3 key issues in evaluating joint pain?
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
Morning stiffness that lasts more than 45 minutes suggests what?
An inflammatory arthritis
66
Monoarthritis -- dDx?
- Infection - Crystal-induced arthropathies (gout and pseudo gout) - Trauma - Osteo-arthritis
67
How does Rheumatoid Factor play into RA diagnosis?
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
First line of pharmacologic Tx of osteoarthritis?
Acetaminophen NSAIDs are effective but may have more side effects

3rd Year (Step 2) (44 decks)

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