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Family Medicine > Family Medicine 1 > Flashcards

Family Medicine 1 Flashcards

1
Q

coracoid process ant or post to acromioclavicular joint?

A

ant

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2
Q

which articulates w clavicle, coracoid or acromion

A

acromion

acromioclavicular joint

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3
Q

apley scratch test

A

reach hand to spine
over shoulder - abduct/ext r - most reach down to C7
under shoulder - abduct/int r - most reach up to T7

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4
Q

roughly what are the normal limits of full shoulder range of motion

A 
flex 180
abduct 180
ext rot 90
int rot 90
apley over down to c7
apley under up to t7
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5
Q

empty can jobe test

A

flex humerus
int rot shoulder
pronate forearm
upward against resistance

pain suggests impingement (rotator cuff muscles under coracocromial arch) , tendinitis, tear

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6
Q

empty can test aka

A

jobe test

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7
Q

jobe test aka

A

empty can test

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8
Q

coracoacromio arch formed by

A

coracoacromial ligament

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9
Q

neers test

A

empty can position with passive motion 90-180 flexion

pain suggests impingement (rotator cuff muscles under coracocromial arch) , tendinitis, tear

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10
Q

empty can test vs neer test

A

resisted vs passive

shoulder
flex to 90
internally rotate
pronate forearm
elbow straight

pain suggests impingement (rotator cuff muscles under coracocromial arch) , tendinitis, tear

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11
Q

hawkins-kennedy test

A 
shoulder
ff 90
int rot
bend elbow
passive further int rot

drives greater humeral tuberosity under coracoacromial arch, impinging supraspinatus tendon

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12
Q

rotator cuff tendons

A 
sits
supraspinatus
infraspinatus
teres minor
subscapularis
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13
Q

speeds test

A

shoulder
ff 90
supinate
resist downwards force

pain suggests biceps tendon or rotator cuff pathology

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14
Q

yergason test

A

shoulder
flex Elbow to 90
forearm neutral
passively flex elbow and supinate simultaneously

pain/snapping suggests bicipital tendonitis, tear/laxity of transverse humeral ligament (secures long head of biceps tendon into bicipital groove - long biceps snaps over lesser tuberosity)

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15
Q

long vs short head biceps tendon relative position

A

long head from supraglenoid tuberosity laterally thru bicipital groove between humeral tuberosities like pulley
short head more anterior and medial from coracoid

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16
Q

resisted external rotation of shoulder tests…

A 
infraspinatus (more w shoulder neutral)
teres minor (more w shoulder abducted 90)
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17
Q

posterior liftoff test

A

arm behind back elbow at 90 push away against resistance

tests subscapularis

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18
Q

internal rotators of the shoulder

A

Latissimus Dorsi
Pectoralis Major
Subscapularis
Teres Major

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19
Q

shoulder ROM tests

A 
flex
aduct
int rot
ext rot
apley scratch
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20
Q

rotator cuff tests

A 
empty can / jobe
resisted ext rot
resisted int rot
post liftoff
neer
hawkins-kennedy
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21
Q

biceps tests

A

speed

yergason

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22
Q

load and shift test

A

stabilize scap and acromion
shift glenohumeral joint
^50% shift is severely abnorm

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23
Q

sulcus sign

A

stabilize scap and ac joint
inf traction down on arm

sulcus appears inf to acromion suggests glenohumeral laxity

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24
Q

apprehension test

A

shoulder
abduct to 90
flex elbow to 90
externally rotate backward

patient apprehensive if feels risk for anterior dislocation

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25
Q

what is the “dislocation position” of the shoulder

A

abduct to 90
flex elbow to 90
externally rotate backward
push forward

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26
Q

relocation test

A

anterior force on glenohumeral joint relieves apprehension test

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27
Q

surprise test

A

release relocation test (release anterior force on apprehension/crank position) see if shoulder anteriorly dislocates

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28
Q

crank test aka

A 
apprehension test
shoulder
abduct to 90
flex elbow to 90
externally rotate backward

patient apprehensive if feels risk for anterior

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29
Q

shoulder instability tests

A 
load and shift
sulcus sign
anterior apprehension/crank
relocation
surprise
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30
Q

obrien test

A

like empty can position but some adduction ~30

resist downward pressure w wrist pronated (positive if painful labral tear) and supinated (no pain with labral tear)

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31
Q

shoulder pain provocation test

A

crank position (90 abduct, 90 flex elbow)
pain worse w pronation than supination
all the single ladies

for labral tear

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32
Q

shoulder labral tests

A

obrien

pain provocation all the single ladies

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33
Q

all the single ladies test aka

A

shoulder pain provocation test
crank position (90 abduct, 90 flex elbow)
pain worse w pronation than supination

for labral tear

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34
Q

spurling test

A

patient side-flexes neck
if no pain, doc flexes a bit further

for cervical rediculopathy

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35
Q

scapular winging suggests

A

serratus anterior weakness

long thoracic nerve damage

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36
Q

ottowa knee rules

A

knee xr only needed if one of these

  • age ^55
  • isolated patellar tenderness (not elswehere in knee)
  • fibular head tenderness
  • can’t flex to 90
  • can’t bear weight 4 steps (limp ok)
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37
Q

define binge drinking

A 
BAC .08
usually
5 drinks M
4 drinks F
in v2hrs
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38
Q

define heavy drinking

A

5+ drinks on same occasion 5+/30 past days

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39
Q

% gen pop experience severe headache
% v6yo
% ^16yo

A

~20
v5 (rare, extra concerning in kid)
^25 (common in adults

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40
Q

gender presominance of severe headaches

A

M v12yo

F ^12yo (post puberty)

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41
Q

cluster headache falls under a larger headache category called

A

trigeminal autonomic cephalalgia

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42
Q

scientific name for headache

A

cephalalgia

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43
Q

cephalalgia means

A

headache

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44
Q

mnemonic for characterizing pain

A 
old carts
Onset
Location
Duration
Character
Aggravating/alleviating
Radiation
Timing
Severity
Prior
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45
Q

pediatric blood pressure reference range of normal is adjusted for

A

age and height

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46
Q

common behavioral change strategies for conservative mgmt of headache syndrome

A 
hydration
dec caffeine
adequate good sleep
adequate exercise
limit stress
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47
Q

typical duration of migraine wo aura

A

4-72 hr adult

2-72 hr peds

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48
Q

common sympx assoc w migraine

A

nausea vomiting

photophobia phonophobia

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49
Q

typical duration of migraine aura

A

5-60 min

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50
Q

tf

migraine aura can consist of aphasia

A

t

can consist of lots of things

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51
Q

routine ladder of migraine pharm mgmt

A

motrin (nsaid ibuprofen)
tylenol (acetaminophen)
triptans
dhe dihydroergotamine if intractible

prochlorperazine
metoclopramide for n/v

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52
Q

Motrin ibuprofen moa

A

Reversibly -| cox1 and 2
v prostaglandin precursors
antipyretic, analgesic, antiinflam

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53
Q

reversibly -| cox1 and 2
v prostaglandin precursors
antipyretic, analgesic, antiinflam

name that drug

A

nsaids (Motrin ibuprofen)

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54
Q

Motrin generic

A

ibuprofen nsaid

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55
Q

Tylenol generic

A

acetaminophen

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56
Q

Tylenol acetaminophen moa

A 
Reversibly -| cox in cns
v prostaglandin precursors
analgesic not antiinflam
inactivated peripherally
antipyretic by -| hypothalamic temp center
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57
Q

Compazine generic

A

prochlorperazine

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58
Q

prochlorperazine moa

A
  • | mesolimbic D1 D2 including chemoreceptor zone (antipsychotic (1st gen) antiemetic… anxiolytic)
  • |a
  • |AchR
  • |hypothalamic and hypophyseal hormone release
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59
Q

metochlopramide moa

A

–| D
-| 5ht serotonin R in chemoreceptor CNS brain
potentiates response to Ach in upper GI for motility w/o secretions… also inc LES tone

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60
Q

dhe

dihydroergotamine moa

A
  • | a

vasoconstricts

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61
Q 
tf
triptans
nsaids
coffee
can all cause med overuse headache
A

T

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62
Q

acute migraine therapies work best when

A

administered ASAP at first aura or symptoms

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63
Q

vitamin you can try supplementing in peds migraine

and SE of this supplement

A

B2

orange urine

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64
Q

typical peds tension headache duration

A

30min - 7 days

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65
Q

tf

there is no n/v assoc w tension headache

A

t

a diagnostic criteria

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66
Q

tf

there is no photo or phonophobia w tension headache

A

fish

there can be one or none but not both

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67
Q

peds migraine ppx ladder

A

amitryptiline best studied
propanalol
topiramate

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68
Q

diathesis

A

~predisposition basically

“hereditary or constitutional predisposition to a disease or other disorder”

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69
Q

what FH puts pt at risk for breast cancer

A

1st degree relative

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70
Q

does the USPSTF recommend breast self exams

A

no (2016)

just increases number of biopsies

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71
Q

does USPSTF recommend clinical breast exams

A

no - insufficient evidence.. but do in pt w symptoms

but ACS does, q3 for 20-40, q1 ^40yo

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72
Q

bmi formula

A

kg/m^2

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73
Q

for what body types is BMI not a good estimate of obesity

A

extremes of
height
and
muscle mass

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74
Q

BMI categories

A 
underweight v18.5
normal v25
overweight v30
moderate obesity v35
severe v40
very severe (morbid) ^40
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75
Q

another body measure other than BMI assoc w risk of HTN, DM, HLD, CHD

A

waist circumference
^88cm 35 in F
^102c, 40in M

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76
Q

visual inspection for __ in breast exam

A 
skin changes
erythema
retractions
dimpling
nipple changes
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77
Q

maneuver to accentuate skin retraction or dimpling of brest

A

ask pt to lift hands overhead

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78
Q

breast exam starts sitting up or lying down

A

sitting up for inspection

lying down with hands over head for palpation

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79
Q

perform a clinical breast exam

A

pt sit up
lower gown to waist
inspect for skin changes (erythema, retractions, dimpling, nipple changes… asymmetry), lift hands over head to accentuate

lie down for palpation in vertical strips lateral to medial

palpate axillary and supraclavicular nodes

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80
Q

perform a pelvic speculum exam

A

table to 30-45
heels in stirrups adjusted
cover to knees
slide down to edge, let knees fall to side

inspect
palpate labia maj and min

warm and lubricated speculum (warm water or minimal gel away from tip – distorts cytology)
peace sign to spread introitus below, inert spec at 45 down, rotate horizontal, continue to insert until handle at perineum
open to visualize cervix

inspect vag wall and cerv
spatula 720, brush 180, get squamo-columnar junction

withdraw, clear cervix, close, withdraw rotating 45

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81
Q

tf

bimanual exam to screen for ovarian cancer

A

f
not to screen
to eval symptomatic pt

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82
Q

preform a pelvic bimanual exam

A

lub index and middle non dom gloved hand
palpate cervix for tenderness and motion
use dom hand not gloved to palp uterus, ovaries (difficult in obese or tense woman)

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83
Q

describe a normal bimanual exam

A

cervix freely moveable nontender
uterus normal size and position
ovaries not palpable (maybe palpable in slender woman)

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84
Q

cervical cancer screening guidelines

A

21-29yo q3y
30-65yo q5y if cotested for HPV, or q3 if cytology alone – stop after 65 if normal last 3 paps + cyt or last 2 paps + hpv

more freq if immunosuppresed, HIV, CIN hx, DES exposure in utero diethylstilbestrol

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85
Q

what is a total hysterectomy

A

remove uterus and cervix

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86
Q

what is a salpingoopherectomy

A 
remove
fallopian tubes (salpinx)
and ovaries
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87
Q

risks for cervical cancer

A 
early sex
multiple partners
immunosuppressed
smoking
DES in utero
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88
Q

tf

smoking is independently correlated w 4x inc risk of cervical cancer

A

t

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89
Q

possible pap results

A 
normal
LSIL low grade squamous epithelial cell
HSIL high grade
AGUS atyp glandular cell of undetermined sig
ASCUS atyp squam cell undetermined sig
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90
Q

reflex f/u to ASCUS pap

A

HPV PCR using pap cells

atyp squam cell undet sig

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91
Q

sensitive test means few…

A 
false negatives
(detects positive disease well)
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92
Q

specific test means few…

A 
false positives
(detects negative disease well)
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93
Q

this test to screen these pts for lung cancer

A

low-dose CT

55-80yo w 30py smoking hx

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94
Q

tf

screen routinely for ovarian cancer

A

f

don’t screen asymptomatic women’s ovaries USPSTF

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95
Q

key was that USPSTF differs from specialist society guidelines

A

USPSTF is strictly evidence-based

societies introduce expert opinion as well (and therefore bias)

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96
Q

screening mammo USPSTF guidelines

A

q2y 50-74yo

can start early depending on pt context

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97
Q

key breast lump hx

A 
location
how noticed
how long
nip disch
change size (menstural?)
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98
Q

describe breast lump

A 
number
firmness
mobility
size
borders
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99
Q

next diagnostic step cystic vs solid breast lump

A

fna cyst
vs
mammo solid

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100
Q

imaging to determine cystic from solid breast mass

A

us

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101
Q

causes of nip disch

A

preg
excessive stim

prolactinoma
brca
hormonal imbalance
trauma
abscess
meds (antidep, antipsych, antihtn, opiates)
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102
Q

workup nip disch

A

mammo
us
ductogram
bx

imaging

prolactin lvl for milky

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103
Q

what age group has more false negatives mammo

A

young
denser breasts
harder to find abnorms

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104
Q

tf

mammo involves radiation

A

t

but negligible amount modernly

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105
Q

when is breast MRI indicated

A

screen if ^20% lifetime risk (gene testing, pedigree, radiation for hodgkin)
further dx of brca dx
w contrast for implants – mammo difficult

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106
Q

indications for breast US

A

eval abnorms

not for aymptx screening

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107
Q

tf

breast us used for screening

A

f
eval abnorms
not for asympx screen

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108
Q

brca risks

A 
FH
prolongued E v12 ^45yo, late first preg
genes BRCA 1 or 2
age
female
inc breast density
DHE in utero
radiation
obesity
excess alcohol
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109
Q

is high or low breast density a risk for brca

A

high density

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110
Q

dec brca risk assoc

A 
late menarche
early menopause
early preg
high parity
SERMs NSAIDs ASA
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111
Q

what dietary intervention prevents brca

A

dec alc

that’s it

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112
Q

avg age, range menopause

A

51 (40-60)

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113
Q

confirm menopause

A

no menstuation 12 consec mos

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114
Q

duration of perimenopause

A

2-8 yrs

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115
Q

perimenopauseal sympx

A

irregular menst
hot flashes
vaginal dryness
mood swings

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116
Q

how long do perimenopausal hot flashes last

A

30sec-10min

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117
Q

most common mood swing perimenopause

A

depression

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118
Q

calcium for women

A

1000mg pre menopause
1200mg postmenopause

ideally thru 3-4 servings dairy

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119
Q

inc calcium intake risks…

A

atherosclerosis

kidney stones

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120
Q

osteoporosis screening USPSTF 2016

A

^65 DEXA dual energy xr absorptiometry

v65 use fx risk tool, screen equivalent risk to 65 yo women no risks (9.3% in 10 years)

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121
Q

OP risks

A 
vE (eraly menopause)
sedentary
prev adult fx
FH OP fx
smoking
white
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122
Q

tf

black is risk for OP

A

f

white

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123
Q

tf

obesity is risk for OP

A

f
obesity high E actually protective

but inc risk for OA

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124
Q

tf

best to limit both saturated and trans fats

A

t
but sat worse
pack together

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125
Q

recommendation for healthy breakfast

A

whole grain
fruit
dairy or lean protein

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126
Q

6 stages of change

A 
precontemplation
contemplation
preparation
action
maintenance
relapse
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127
Q

when is mammo’s earliest detection relative to brca sympx?

A

1-2 years prior to mass palpable

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128
Q

USPSTF when to screen for DM

vs ADA

A

htn ^ 135/80

BMI ^25

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129
Q

tf

cluster ha rare in peds

A

t

1/10,000

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130
Q

what route of admin of triptans is most effective in peds

A

intranasal or dissolving tablet
preferred to po tablet
(possibly due to migraine assoc w GI absorptive issues…)

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131
Q

combined OCPs are CI in what kind of migraine

A

migraine w aura (estrogen is a problem..)

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132
Q

rhinosinusitis on diff for what kind of h/a syndrome

A

cluster headache

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133
Q

Flonase
generic
moa
use

A

fluticasone
corticosteroid nasal spray - antiinflammatory
allergic rhinitis

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134
Q 
tf
eye strain (refractive error) is a common cause of primary headache syndrome
A

f
evidence not good
maybe triggers, but not a Cause…
don’t hang your hat on it

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135
Q

tf

obesity is a risk factor for breast cancer

A

t

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136
Q

Gardasil is a vaccination against

A

HPV

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137
Q

HPV vaccination approved for ages

A

9-26

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138
Q

HPV vaccination names, strain coverage, how many shots, recommended age, approved age

A

Gardasil 6 11 16 18
Cervarix 16 18 31 45
3 shots both
recommended for females 11-18 ideally before sexual debut but approved for M & F 9-26 regardless of sexual activity

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139
Q

tf

sexual activity is a contraindication to HPV vaccination

A

f

optimally before or shortly after debut, but not a CI

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140
Q

4 letter mnemonic for preventive visits

A 
RISE
risk immunize screen ed
risk factors
immunizations
screening tests
education
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141
Q

6 most freq causes of death for 55 yo M in no order

A 
cancer
heart disease
injury
Dm
chronic lung
chronic liver
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142
Q

tf

travel history is important to obtain when working up an adult for CV disease

A

f

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143
Q

guidelines for freq of ASCVD risk factor assessment in pts free of ASCVD

A

q6-7 yrs in adult 20-79yo free of ASCVD

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144
Q

tf

recommendation for an annual preventive visit and physical exam is evidence-based

A

f
no RCTs
but 65% primary care agrees annual physical is necessary

periodic exams, not necessarily annually, for younger healthy adults, is reasonable – pts w chronic illness should also schedule periodic PREVENTIVE visits, not just disease management

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145
Q

tf

heart auscultation and routine labs are recommended for annual well-exams

A

tf
no evidence
but pts expect
physicians often provide

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146
Q

info for pt who does not wear seatbelt

A

don’t want to preach, but
MVA common cause of death
restraints can save life
can be a good driver and get hit by a bad driver
most accidents occur within 25 miles of home – frequent territory

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147
Q

three C’s of addiction

A

compulsion
control lacked
continue despite adversity

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148
Q

5 a’s of counseling behavior change

A 
ask about the behavior
assess interest
advise - give options
assist motivation
arrange f/u
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149
Q

wellbutrin generic moa

A

buproprion
blocks NE and D reuptake
(antidepressant)
NuDoprion

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150
Q

zyban generic moa

A

buproprion
blocks NE and D reuptake
(antidepressant)
NuDoprion

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151
Q

budeprion generic moa

A

buproprion
blocks NE and D reuptake
(antidepressant)
NuDoprion

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152
Q

3 antidepressants commercial for buproprion used for smoking cessation

A

wellbutrin, zyban, budeprion
block NE and D reuptake
(antidepressant)
NuDoprion

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153
Q

Chantix generic moa

A

varenicline
partial neuronal a4 B2 receptor agonist that blocks nicotine stim of mesolimbic dopaminergic pathway, less dopa stim than nicotine, decreased craving and withdrawal

some S (serotonin) agonism of unknown sig as well

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154
Q

2 common oral pharm aids for smoking cessation

A

buproprion (wellbutrin = zyban = budeprion) NE D reup antag

verenicline (Chantix) partial nicotinic agonist

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155
Q

how helpful are oral meds such as buproprion (wellbutrin zyban budeprion) and varenicline (Chantix) for smoking cessation?

A

1.5-3x success of placebo for 12 month quit rate

fyi 2-3% quit rate wo med intervention

meds best in combo w group or on-on-one problem solving skills, social support, relaxation techniques etc

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156
Q

1st line pharm for smoking cessation

A

budoprion

varenicline has more SEs and reserved for budoprion failure or specific request

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157
Q

good types of questions to assess alcohol misuse, beyond quantifying

A 
CAGE
felt need to Cut down?
Annoyed at critics?
Guilty feelings ever?
Eye opener ever?

diff folks diff susceptibility to alcoholism. best advice, don’t do it

also
friends fam ever express concern?
ever miss work because drinking?

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158
Q

is a glass of red wine good for you?

A

speculative
cultural studies confounded by lifestyle, exercise, diet, etc

mod alcohol known to raise HDL, but exercise or niacin (B3) can do that better

alc and resveratol may reduce platelet stickiness, but aspirin can do that better

research merited, consumption not recommended now, especially if taking other meds

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159
Q

mnemonic for dietary assessment

A

WAVE

weight, activity, variety (pyramid/groups), excess - salt, sugar (carbs), fat, cholesterol

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160
Q

tf

important to include sat and sun in food diary

A

t

often eat different on weekends

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161
Q

casual 3 q screen for intimate partner violence

f/u w 4q screen if concern

A

tell me about living situation
how are you getting along
do you feel safe at home

SAFE
Stress/safe do you feel
Afraid/abused have you ever
Friends/fam are they aware/supportive
Emergency plan do you have one, place to go, resources
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162
Q

2016 USA adult obesity rate

A

25%

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163
Q

BMI is used clinically as a surrogate for

A

% body fat

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164
Q

high total body fat is a risk for

A

DM
HTN
DLD dislipidemia
CVD

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165
Q

what body fat distribution is higher risk for CAD

A

abdominal

so measure waist and waist/hip circumference ratio

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166
Q

physical exam findings of dyslipidemia

A
  • corneal arcus aka arcus senilis = ch dep in corneal stroma anterior to border of iris, white, gray, or blue, opaque
  • xanthelasma =ch dep in skin typ around eye
  • acanthosis nigracans = hyperpig of skin typ body folds
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167
Q

pe findings of atherosclerosis

A

carotid bruit

dec peripheral pulse

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168
Q

mnemonic for suspicious skin lesions

A 
ABCDE
assym
border irreg
color non-uniform
diam ^6mm
evolution
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169
Q

tf

zoster vaccine recommended for elderly

A

t

one does at 60yo

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170
Q

are varicella and zoster the same thing?

A

f
varicella = chicken pox kids
zoster = herpes zoster = shingles elderly

both caused by varicella-zoster virus

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171
Q

vaccines CI in immunocompromise, close contacts, and pregnant women

A

live attenuated ones
VZV
MMR
OPV (oral polio vacc)

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172
Q

strategy for keeping up with literature in family med

A

follow guidelines

read up on changes, see if you agree

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173
Q

USPSTF grading system

A 
A - substantial benefit
B - high certainty of moderate-substantial benefit
C - benefit negligible
D - No benefit or risks outweigh benefit
I - insufficient evidence

A & B recommended

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174
Q

sti screen for sexually active men

A

HIV
syphilis
chlamydia
gonorrhea

consider hep B and C

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175
Q

tf

genital herpes screen routine for sexually active male

A

f

only if symptomatic

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176
Q

opt-out HIV testing recommended by

A

the CDC

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177
Q

tf

HIV testing requires informed consent

A

tf
only in some states
otherwise opt-out – tell pt it is routine and do it unless they refuse it

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178
Q

USPSTF grade for PSA screening

A

D - harms outweigh benefit
in average risk male
no demonstrated reduction in prostate ca deaths;
ED, bowel and bladder incont, false positive psych effect

societies suggest informed decision w doc

large RCT US and EU pending

one study suggested 1 prevented death takes 1055 screens and 37 treated cancers

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179
Q

patient practical concerns w colonoscopy

A 
laxative prep
ride home (sedated)
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180
Q

CRC screen guide

A

50-75 yo
w
FOBT
sigmoidoscopy or colonoscopy

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181
Q

reasonable to check fasting lipids in adults over 21 how often

A

q4-6y

fasting = 8 hours after last meal

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182
Q

when to screen well adult for OSA

A

obese

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183
Q

when to screen well adult for CKD

A

htn

with BMP

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184
Q

when to screen well adult for DM

A

age 45

or overweight BMI ^25

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185
Q

interpret EKG

A 
RRAHI
rate
rhythm segments intervals
axis r wave progress
Q waves STD STE IT
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186
Q

tf

can consider exercise stress test in asymptomatic male

A 
t
^45yo plus one of
DLD
HTN
smoking
FH early CAD

good prognosticinfo

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187
Q

ischemia EKG

A

STD

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188
Q

acute MI EKG

A

STE

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189
Q

prior infarct EKG

A

q wave
^ 25% R wave
^ 0.04 seconds

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190
Q

ischemia vs
acute MI vs
prior MI
on ekg

A

STD
STE
Q waves

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191
Q

instructions for buproprion smoking cess

A 
set quit date
start bup 1 week prior
1 qd 3 days, then 1bid morn and eve
stop smoking on date
add nicotine gum for bad cravings
after 2 mos on pills, gradually stop

1800 quit now
smokefree.gov
try partnering up

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192
Q

how to handle “door handle” situation

A

quickly assess whether issue is life-threatening or requiring early follow-up. If not, at least ask a brief question to acknowledge the concern. Can have appropriate conversation at next visit.

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193
Q

patient has one or two v1cm tubular adenoma polyps with low-grade dysplasia on colonoscopy, recommend fu

A

colonoscopy in 5-10 years

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194
Q

what is a “small” polyp on colonoscopy

A

v1cm

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195
Q

manage high risk for ASCVD

A

asa 81mg

statin med-high dose

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196
Q

tf

location is a predictive factor for melanoma

A 
f
ABCDE
assym
border irreg
color not same throughout
diameter ^6mm
evolving changing
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197
Q

chloraseptic sore throat spray generic and moa

A

phenol

depresses cutaneous receptors – local anesthesia

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198
Q

metaxalone moa

A

general depression of CNS

centrally acting muscle relaxant

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199
Q

metolazone class moa

A

thiazide diuretic
inhib distal tub na k resorb
leads to h secretion in cd I think

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200
Q

elidel generic moa uses

A

pimecrolimus
topical calcineurin inhibitor
(blocks proinflammatory cytokine transcription)
atopic dermatitis
off label lichen planus, psoriasis, vitiligo

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201
Q

triamcinolone topical moa uses

A

corticosteroid-responsive dermatoses
topical corticosteroid
induces PLA2 inhibitory proteins and thus inhibs release of AA and multiple inflammatory mediators kinins, histamines, pg.
antiinflam, aintipuritic, vasoconstrictive

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202
Q

ivermecitn use

A

antihelminthic

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203
Q

phymatous

A

sebaceous gland overgrowth

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204
Q

what is rosacea

A

skin disorder of various manifestations primarily localized over central face
4 types – erythematotelangiectatic, papulopustular, phymatous, ocular

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205
Q

centor criteria

A 
tonsilar exudates
tender anterior cervical LAN
fever by history
absence of cough
modified - +1 age 3-14, -1 age ^45

likelihood of GAS group A strep inc w number of criteria (v3 unlikely GAS and should not get abx or dx testing)
Big study of 200,000, 1 crit 7% GAS, 2 21%, 3 38%, 4 57% GAS

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206
Q

Afrin generic moa

A

oxymetazoline

stims a, vasoconstriction

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207
Q

% presenting acute pharyngitis that gets abx for GAS vs % presenting acute pharyngitis that is GAS

A

70%

5-15%

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208
Q

RADT in context of strep

A

rapid antigen detecting test

rapid strep test

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209
Q

tessalon generic moa and use

A

benzonatate
antitussive
via topical anesthesia of airway stretch receptors

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210
Q

mucinex generic use moa

A

guaifenesin
expectorant +- antitussive
via hydration and decreased viscosity of resp mucus facilitating clearance but maintaining sol lyer for ciliary clearance

also inhib cough reflex hypersensitivity in URTI prob via sputum volum barrier to cough receptors

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211
Q

spell the word for frequent loose stool

A

diarrhea

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212
Q

augmentin generic

A

amoxicillin clavalunate

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213
Q

what is a neti pot

A

container to use home saltwater solution to drain in one nostril out the other ew

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214
Q

valium generic class

A

diazepam

benzodiazepine

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215
Q

Percocet generic

A

oxycodone acetaminophen

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216
Q

medicalese for breast pain

A

mastalgia

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217
Q

tf

it is common for brca to cause breast pain

A

f

uncommon, unless inflammatory breast cancer – visually obvious

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218
Q

1st line tx mastalgia

A

analgesics

supportive bra

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219
Q

7 causes of non-cyclical mastalgia

A 
large pendulous
diet lifestyle nonspecific
post MP HRT
ductal ectasia
mastitis
inflammatory brca
hidradentitis suppurativa (acne inversa, occlusive follicular)
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220
Q

ductal ectasia
define
sx
tx

A

distended subareolar ducts due to inflammation not infection

  • fev local pain tenderness from lipid penetration of duct wall
  • Tylenol, ibuprof advil motrin prn, maybe try abx, sg and option but rarely necessary
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221
Q

how long pre bedtime to avoid alc and caffeine for good sleep

A

4-6 hours

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222
Q

how common is sleep apnea in the elderly

A

20-70%

common

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223
Q

breif definition rem sleep behavior disorder

A

sleep enactment behaviors from loss of REM atonia

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224
Q

what demo w hyperthyroidism frequently do not present w typical sx tachycardia weight loss and may require lab studies to detect the problem

A

elderly

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225
Q

advanced sleep phase syndrome define

typical demo

A

circadian rhythm progresses forward till drowsy 6-7pm waking 3-4am

common in elderly

226
Q

tf

alc is an effective sleep aid

A

tf

initial sleep-inducing, few hours later stimulant/wake-up effect as levels fall

227
Q

how to regulate diet for sleep hygiene

A

avoid heavy, spicy, sugary foods 4-6 hours before bedtime

a light milk or banana snack before bed may help (tryptophan)

228
Q

tf

exercise helps deepen sleep

A

tf
can
but careful, within 2 hours of bed can impair sleep

229
Q

what to do if can’t sleep

A

if can’t sleep in 15-20 min or wake up and can’t get back to sleep in 15-20 min
leave bedroom
tryptophan snack milk banana
quiet reading, bath, other quiet, not challenging

230
Q

Ambien generic moa use

A

zolpidem
BZD1/GABA receptor agonist (not BZD class)
sedative hypnotic
(not anxiolytic, myorelaxant, anticonvulsant… BZD2 for those)

insomnia

231
Q

define cognitive restructuring

A

psychotherapeutic learning to id and dispute irrational or maladaptive thoughts (cognitive distortions) eg splitting magical thinking over-generalization, magnification, emotional reasoning

232
Q

define emotional reasoning

A

cognitive distortion in which person concludes that their emotional reaction proves something is true – amplifies other cognitive distortions

233
Q

define magnification type cognitive distortion

A

mountain of molehill
over-reactive
histrionic

234
Q

sleep restriction vs
sleep compression
therapy for insomnia

A

restrict in-bed time to recent average sleep time, no more. As sleep efficiency inc q5d can inc in-bed time by 15-20min till optimal sleep time

dec time in bed gradually to match total sleep time

235
Q

safest most efficacious hypnotic drugs for elderly insomnia

A 
zolpidem Ambien (non-BZD)
melatonin-r agonists

antihist, antidep, anticonv, antipsych BEERS more risk than bene in elderly

236
Q

common insomnia causes

A 
environment not conducive
drugs alc caf
osa
parasomnias (restles leg, periodic leg, rem sleep behavior)
sleep-wake disturb jetlag night shift
psych anx dep
CP CHF COPD asthma
pain pruritus
GERD
hyperthy
adv sleep phase synd
237
Q

tylenol pm generic moa uses

A

acetaminophen
diphenhydramine
-competitive H1 antagonist GI blood vessels resp tract… anticholinergic and sedative too

occasional insomnia
allergies
antitussive
motion sickness
parkinsonism
common cold rhinitis/snz
238
Q

% US w hypothyroid

A

5%

239
Q

tf
htn
asthma
associated w depression

A

f

not more than genpop

240
Q

% Parkinson disease that gets depression sx

A

60%

241
Q

quick assessment of cognitive skill in pt w dimentia

A

mini cog > mmse

-orientation, mem, attn., naming, commands, write sentence, copy shape)

242
Q

define hematochezia

A

brbpr
bright red blood per rectum

vs melena

243
Q

gender more likely to attempt suicide

A

F

244
Q

gender more likely to complete suicide

A

M

245
Q

how do we know that physicians need to proactively ask about suicidal ideations in elderly?

A

75% of elderly suicides visited a PCP within the preceding month

246
Q

tf

poverty is a risk factor for suicide

A

f
not by itself
rich folks get suicidal all the time

247
Q

tf

ethnic minority is a risk for suicide

A

f
just no
but low socioeconomic status a risk for depression

248
Q

MDD diagnostic criteria

A 
5/9 sigecaps nearly every day ^2wks
sleep insom hypersom
interest anhedonia
guilt inappropriate worthless
energy down fatigue
concentration down
appetite change
psychomotor retardation
suicidal ideation recurrent or attempt

^ 2 mos grief loss

249
Q 
female
isolation
widowed divorced separated
low socioec
chronic disease
uncontrolled pain
insomnia
functional impairment
cognitive impairment
risks for...
A

depression

250
Q

tf

bringing up suicide topic may increase suicidality

A

f

allows opportunity to intervene

251
Q

mnemonic for assessing suicide risk

and intervention needed

A 
SAD PERSONS
sex male
age v19 ^45
depression
previous attempt
ethanol/substance abuse
rational think impaired psychosis etc
social support lack
organized plan
no sig other
sickness

4-6 outpt tx, 7-10 hospitalize

252
Q

6 SSRIs generic and comm

A 
citalopram Celexa
escitalopram Lexapro
fluoxetine Prozac
fluvoxamine Luvox
paroxetine Paxil
sertraline Zoloft
253
Q

TCA moa

4 generic and comm

A 
snri
nortriptyline Pamelor
amitriptyline
clomipramine Anafranil
doxepin Sinequan
254
Q

MAOI moa

2 generic and comm

A

block sn catab
phenelzine Nardil
tranylcypromine Parnate

255
Q

2 SNRIs generic comm

A

venlafaxine Effexor

Duloxetine Cymbalta

256
Q

4 classes of antidepressants

A 
SSRIs
TCAs
MAOIs
SNRIs
some random others
257
Q

common SEs of SSRIs SNRIs

A 
headaches
sleep disturbance drowsy vs insom
GI naus vom
serotonin syndrome (leth, restles, hypertonic, rhabdo, renal failure, death risk)
GI bleeding
SIADH - hyponatremiasex dysfunc
falls in elderly
cit escit can cause QT prolong but not usually symptomatic
258
Q

antidepressant class known to cause arrhythmias

A

TCAs

notrip amitrip clomip doxep

259
Q

tf

ssris snris cause arthralgias

A

f

but depressed often complain of arthralgias

260
Q

optimal approach to mgmt. major depresson

A 
biopsychosocial
bio psycho social
pharm ssri or snri (9-12 mos initial, 2-3y recurrent, continuous multiple recurrences or elderly)
psychother CBT or interpersonal
 id stressors, exercise

combo med and counsel best

ECT safe and effective, for psychotic depression or refractory nonpsychotic depression

261
Q

how do antidepressants cause drug-drug interactions

A

through p450 system

262
Q

ssri preg cat D

A

Paxil paroxetine
evidence of human fetal risk

most other ssris are preg cat C no human evidence but animal evidence however can use if benefit may outweigh risk

263
Q

antidepressant discontinuation syndrome

A 
20% pts after abrupt discont after at least 6 wks on, more likely w longer
flu-like sx
insom
naus
imbalance
sens disturb
hyperarousal

mild 1-2 wks, rapid extinguish w restart antidep

264
Q

screen for medical causes of depression

A

CBC - anemia, vit defic
CMP - e-, renal, hepatic
TSH - hypothyroid

optional:
ESR - rheum
EKG - certain drugs eg TCAs QT prolong

265
Q

common drug classes that can cause depression as SE

A 
cv drugs
chemo
antiPD
antipsychotic
antianxiety/sedatives
anticonvulsant
antiinflam / antiinfect
stimulants
hormones
others others others`
266
Q

model for eliciting pt perspective on illness

A

ESFT
Explanatory model of illness from pt perspective
Social and financial barriers to adherence
Fears and concerns about illness or recommended treatment
Therapeutic contracting and playback

267
Q

tf

immigrant Hispanics higher rates of depression than US-born hispanics

A

f
US born higher rates – comparable to other ethnic groups

Immigrants lower rates

268
Q

define sandwich generation

A

caring for both parents and children

269
Q

tf

dementia is a risk factor for abuse

A

t

270
Q

tf

elder’s dependency is a risk for abuse

A

f

but Caregiver’s dependence on elder Is a risk

271
Q

onset of effect of SSRI

A

perhaps as soon as 1 wk, full effects not till about 2 mos

272
Q

adherence rate of elderly to antidepressant med

A

50%

so discuss challenges to adherence up front, answer questions, educate, etc

273
Q 
how do these differ in grief vs depression
guilt
thoughts of death
worthlessness
psychomotor retard
functional impairment
hallucinations
A

guilt - just actions taken or not at time of death
thoughts of death - just better of dead or wishing died with other
worthlessness - morbid preoccupation in MDD
psychomotor retard - marked in MDD
functional impairment - marked and prolongued in MDD
hallucinations - just voice/image of deceased

274
Q

tf

suicidal behaviors increase with age

A

f
behaviors don’t
but completions do
increase w age

275
Q

most common means of suicide in elderly

A

medication od

276
Q

what etiologies of depression fatigue does CBC screen for

A

anemia

nutrition deficiencies

277
Q

define “fully weight-bearing” eg in acute ankle inj pt

A

can take 4 steps independently

278
Q

tf

hearing a snap or tear is diagnostically significant in an acute ankle injury

A

f
acute knee
not acute ankle

279
Q

6 p’s of limb threatening injury

A 
pain
pallor
pulseless
paresthesia
perishing cold (inability to reg own body temp)
paralysis
280
Q

how long post injury can acute pain and swelling limit physical exam?

A

48 hours

281
Q

tf

acute ankle injury is one of most common MSK injuries in athletes and sedentary

A

T

20% of all sports injuries

282
Q

this comprises 20% of all sports injuries in the US

A

acute ankle injury

283
Q

next on diff after lateral ankle sprain?

A

peroneal tendon tear

also due to inversion injury often occurs w lat ank sprain

284
Q 
peroneus muscles and tendons
origin
course
insertion
function
nerve
a
compartments
A

peroneus aka fibularis

  • longus: fibular head, along fib, tendon post lat malleolus across bottom of foot to 1st cune and 1st met
  • brevis: mid and dist 2/3 fib, joins long tendon post lat malle insert lat tuberosity of prox 5th met
  • tertius: dist med fib joins ext pol longus tendon along dorsum to dorsal prox 5th met

long brev lat comp sup fib/pero n fib a evert plantarflex

tert ant comp deep fib n ant tib a evert dorsiflex

285
Q

peroneal in the leg aka

A

fubular

286
Q

diff fibular fracture from lat ankle sprain or peroneal tendon tear

A

more inability to walk, more pain, more deformity, xr

287
Q

big concern w talar dome fx

A

avascular necrosis from interruption of blood supply – can miss on first xr repeat imaging if sx persist

288
Q

instability in acute ankle sprain suggests…

maneuvers to test…

A

ATFL + CFL tears
PTFL is strongest lateral lig and rarely injured in inversion sprain

anterior drawer ATFL
inversion stress CFL

289
Q

medial ligament of ankle aka

A 
deltoid ligament 4 parts
PTTL
TCL
TNL
ATTL
290
Q

what stabilizes medial ankle

A

DL (PTTL TCL TNL ATTL)

bony mortise

291
Q

define mortise

A

recess cut into a part (mortise) to receive a corresponding projection (tenon)

aka the ankle joint

292
Q

factors in grading ankle sprain

A 
lig tear
loss of function
pain severity
swelling severity
ecchymosis
weight bearing
293
Q

grade ankle sprain

A

I - stretch/small tear, mild tend swell, slight to no funct imp, no instability
II - incomplete tear, mod funct imp, mod tend swell ecchymosis, mildmod instability
III - complete tear, severe swell (^4cm) ecchymosis, no weight bear, instability (no definite stopping point)

294
Q

% ankle injuries to ed turn out to be significant fractures

A

15%

295
Q

indications to image acute ankle or foot

A

ottowa rules (evidence based)
ankle xr if malleolar pain And one:
-bone tend post edge lat malle (med or lat)
-non-weight bearing immediate and ED

foot xr if midfoot pain And one:

  • bone tend prox 5th met or navicular
  • non-weight bearing immediate and ED
296
Q

how sensitive are the ottowa rules

A

97-100%
for adults 18 and up
recently for 5 and up too

297
Q

name midfoot bones

A

navicular w 3 wise cuneiforms distal

cuboid the retard laterally

298
Q

test for high ankle sprain

A

cross leg test

tests tib-fib syndesposis… AITFL PITFL

299
Q

tf

ankle sprains can take as long as fractures to heal

A

t

300
Q

RICE for most MSK injuries stands for

A

rest
ice
elevation
compression

also ibuprofen with food (NSAIDS > placebo)

301
Q

how long to Rice in ankle sprain

A

72 hours or less
may help with reduction of swelling and healing, then stretch, move, use
-too much rest dec ROM, persistent pain, swelling, chronic instability

302
Q

best ankle support for sprain

A

aircast - semirigid for flex ext but limited inv ev

better than tape, elastic wrape

soft lace-up brace less support but good for mild w prev sprain or returning to sports

303
Q

what exercises in particular help reduce reinjury of ankle

A

proprioceptive exercises

304
Q

in for referral of acute ankle from fam med

A 
fx disloc sublux
tendon rupt
syndesmotic inj
nv comp
wound pene
locking
sx disproport to traum
unclear dx
305
Q

rule out vaginal infection

A

pelvic exam and wet prep

306
Q

what is a vaginal wet prep

A

vaginal discharge observed w wet mount microscopy

307
Q

tf

in young f w typical sx of LUTI an no signs of UUTI you want + LE and + nitrates in UA before give abx

A

f

can treat empirically, uncomplicated UTIs common in young F

308
Q

demo for acute achilles tendon rupture

A

middle-aged males

weekend warriors

309
Q

how does acute achilles tendon rupture present differently from lateral ankle sprain

A

no inversion or trauma

e.g. middle-aged weekend warrior lands on ball of foot after taking shot, hears pop and immediate posterior pain

310
Q

next step in mgmt. when compartment syndrome suspected

A

emergent fasciotomy
(maybe manometry if not so so concerning…)
DON’T WAIT can lose limb to ischemia

311
Q

what has more weight in treating for UTI, constellation of sx or UA

A

constellation of sx

empiric tmp/smx 1tab bid 3d

312
Q

cv causes of palpitations

A

arrhythmia
cardiomyopathy
hypovolemia

313
Q

psych causes of palpitations

A

anxiety

panic attack

314
Q

medication causes of palpitations

A

caffeine
stimulants
theophylline
albuterol

315
Q

substance causes of palpitations

A

tobacco
caffeine
alcohol intox or withdraw
cocaine

316
Q

endocrine causes of palpitations

A

hyperthy
pheo
hypogly

317
Q

hematologic causes of palpitations

A

anemia

318
Q

infectious causes of palpitations

A

febrile illness

319
Q

heart beating
fast vs
hard

likely etiologies

A

fast more likely path (espec irregular) - anxiety, arrhythmia… but most folks w arrhythmia don’t complain of palps

hard - strong emotion, caffeine or other stimulant

320
Q

tf

most folks w arrhythmia complain of palpitations

A

f
most do not
more anxiety (fast) or emotion/stimulant (hard)… but arrhythmia prob if irregular
but KEEP ON DIFFERENTIAL for fast

321
Q

2 quickest q’s to screen for depression

A

bothered by feeling
down depressed hopless?
little interest or pleasure in doing things?

0 not at all 1 several days 2 more than half the days 3 nearly every day
score 0-6 w ppv 0 15% 6 79%

that’s PHQ-2, if 2+ complete full PHQ-9

322
Q

PHQ in context of PHQ2 or PHQ9 stands for

A

patient health questionnaire - for MDD

323
Q

diff hyperthyroid from anxiety

as cause of palpitations

A

both
tachy, tremulous, irritable, weak, fatige

hyperthy only
weight loss change stools (freq loose) change menses (light)

324
Q

pts w anemia severe enough to cause tachycardia typically also report…

A

positional diziness

325
Q

assoc signs and sx that suggest intoxication as cause of palpitations

A

dilated pupils
inc energy
inc bp
erratic behavior

326
Q

tf

constipation is a sx of hyperthyroid

A

f

freq loose stools

327
Q

tf heavy periods are a sx of hyperthyroid

A

f

lighter periods

328
Q

hyperthyroid
7 common sx
4 less common but possible

A 
heat intol
tachyc
fatig
weight los
tremor
sweating
exertional dyspnea

depression hyperreflexia freq loose stool light periods

329
Q

lid lag

A

eyelid lags to adjust to eye movement eg look down have to blink to get eyelid down too
sign of hyperthyroidism

330
Q

how does hyperthyroidism cause dyspnea

A

inc catab inc O2 consumption

331
Q

7 causes of goiter

A 
lack of idoine (#1 cause ww)
hypothy (e.g. hashimoto)
hyperthy (e.g. graves)
nodules
thyroid ca
pregnancy (slight enlargement)
thyroiditis (tender or nontender)
332
Q

tendon in gentle ___ to elicit reflex

A

gentle extension (stretched slightly)

333
Q

most common cause of hyperthyroidism in adults and children

A

toxic diffuse goiter (graves) - 60-80% majority
5% toxic nodular goiter
less thyroiditis, excess iodine (diet, amiodarone) causing thyroiditis

334
Q

toxic diffuse goiter
aka
pathogenesis
findings

A 
graves
ai ab to TSH-R
stims excess TH synth and release
hyperthyroidism
exopthalmos
pretibial myxedema (dep of hyaluronic acid in dermis and sub-cu)
335
Q

multi vs solitary nodular goiter demos freq

A

multi common ^40yo usually asymptomatic only 5% ca

single younger e.g. iodine deficiency

336
Q

thyroiditis pathogenesis

A

viral illness, pregnancy, excess iodine (diet med amiodarone)
inflamed thyroid hormone leaks out

337
Q

main objective in eval thyroid nodules

red flags

A 
exclude malig (US and FNA)
(5% malig)

M, v20 ^65yo, rapid growth, dysphag neck pain hoarse (local invasion), hx rad to head neck, fh thy ca polyposis (gardener’s - FAP var AD gi polyps, osteomas, skin soft tiss benign tumors)

338
Q

Gardener syndrome

A

FAP familial adenomatous polyposis variant
AD
GI polyps, osteomas, skin soft tiss tumors

339
Q

FAP familial adenomatous polyposis variant
AD
GI polyps, osteomas, skin soft tiss tumors

A

Gardener syndrome

340
Q

causes of tender vs nontender thyroiditis

A

tender
infarct radiation trauma

nontender
ai med idiopathic fibrotic

341
Q

drugs of drug-induced thyroiditis

A

amiodarone
IFN-a
IL-2
Li+

342
Q

tf

thyroiditis always causes hyperthyroidism

A

f

eu hyper or hypo

343
Q

how is radioactive iodine uptake affected in thyroiditis

A

usually reduced uptake

but can be eu hyper hypo thyroid

344
Q

tf

TSH is usually sufficient to dx hyperthyroid or hypothyroid

A

t

but if primary pit path does not reflect circulating th so need to get T4 as well

345
Q

TSH mildly elevated (5-10)
serum free T4 normal
dx

A

subclinical hypothyroidism

346
Q

TSH normal
free T4 increased
dx

A

pit adenoma or

TH resistance

347
Q

TSH inc
free T4 dec
dx

A

hypothyroidism

348
Q

TSH dec
free T4 inc
dx

A

hyperthyroidism

349
Q

TSH dec
free T4 dec
dx

A

central pit hypothyroidism

aka TSH or TRH deficiency

350
Q

TSH dec
free T4 normal
T3 inc
dx

A

T3 toxicosis

351
Q

TSH dec T4 inc, sx of hyperthy

next step?

A

propanalol (BB) for sx relief
radioactive I uptake test and scan (inc graves hot nodule, dec thyroiditis cold nodule)
antithyrotropin releasing abs (graves)

352
Q

normal RAIU

A

radioactive iodine uptake

15-30% ingested dose

353
Q

difference between TRAb vs TPOAb in graves vs hashimoto

A

TRAb anti thyrotropin (receptor) releasing antibody
97%sn 99%sp for graves

TPOAb anti TPO ab
elevated in 90% hashimoto 75% graves

354
Q

when to get thyroid US

A

thryoid nodules
enlargement

NOT hyperthyroid – RAIU TRAb for that

355
Q

why RAIU inc in graves

A

synth more th need more i

356
Q

TRAb stands for

signifies

A

anti thyrotropin releasing antibiody

ab against TSH receptor stims TH synth and release

357
Q

gender predom
age predom
graves

A

F 5-10x
(AI duh) - stress, high I intake, recent preg
40-60yo
anti thyrotropin releasing antibiody
ab against TSH receptor stims TH synth and release

358
Q

most common manifestations of graves opthalmopathy are

A

eyelid retraction

exopthalmos

359
Q

primary sx of eye manifestations of graves, when they occur, are related to

A

corneal irritation from eyelid retraction

360
Q

tf

eye signs and sx of graves always bilateral

A

f
Mostly bilateral
but can be unilateral

361
Q

tf

tx of hyperthyroidism improves eye manifestations of graves

A

f
does not cure eyes
some worsen after radioactive iodine… ppx w oral steroids after tx

362
Q

tf

more than 50% graves pts have clinically sig eye problems

A

f
50% eye involv on MRI
only 20-30% clinically relevant

363
Q

graves

mgmt

A

1st line (but pt pref.. euro med, us radio)
methimazole blocks ox of i and thereby T4 T3
1% agranulocytosis watch out
some improv 1 mo, 3 mos to full effect
stay on, dose fluctuates so freq bloodwork to check

2nd line
oral RAI - localized
few se… possible slight vasc mort or thy ca (preg breast feed CI absolute - damage to fetal infant thyroid – no preg 6 mos post tx no fathering 4 mos post tx)… stay away from v3yo kids and pregs 21 days post tx… flush toilet 2x excrete urine and sweat
eventual thyroid supplement w 1-2x/y bloodwork for dosing, but easy to manage usually

3rd line - sx

364
Q

methimazole moa

A

blocks oxidation of iodine and thereby T4 T3

365
Q

RAI radioactive iodine
tx
f/u

A

preg test
1m from v3yo preggos 21 days post dose
avoid in general don’t share bathrooms urine stool excr
transient soreness of neck or worsening sx resolve few days, some worsening eye sx

f/u remove propanolol if prescribed, q2-3mos blood draws till level stabilizes then q6mos+, alert to hypothy sx (weight gain cold intol pedal edema heavy periods fatigue) as will need supplementation at some point

366
Q

common hypothyroid sx

A 
fatigue
cold intol
weight gain
pedal edema
heavy periods
367
Q

thryoxine aka

A

T4

368
Q

start thyroid replacement

A

typical starting dose levothyroxine 1.5-1.8 mcg/kg
inc dose slowly, repeat TSH 6 wks
when TSH stable can check 1-2x annually

369
Q

tf

gynecomastia is seen in graves

A

t
10-40% pts
inc sex hormone binding globulins we think

370
Q

what % hyperthyroidism due to nodules

A

5%

usually asymptomatic

371
Q

tf

most thyroid nodules are asymptomatic

A

t

372
Q

tf

PaO2 is impacted in blood loss

A

f

373
Q

tf

platelet count is impacted in blood loss

A

f

374
Q

tf

LDH is elevated in gi blood loss anemia

A

f

elevated in hemolytic anemia

375
Q

symptomatic hyperglycemia =

A

polyuria

polydipsia

376
Q

relevant hx in diabetic

A 
age and characteristics at onset
-polyu polyd, dka, hhs, retinopathy on exam
tx prev current response
nutrition exercise
DM education
hypergly hypogly episodes awareness
microvasc compx retinop nephrop neurop
-sensory, foot lesions, ans dysfunc sexual gastroparesis
psychosocial depression
dental
377
Q

diabetic exam and labs

A 
bp
dilated eye exam
foot exam
a1c
ldl
urine screen for nephropathy
378
Q

tf

DM 1 and 2 both cause the same end damage and complications

A

t

379
Q

organs to think about in DM

A

blood vessels

eyes heart brain nerves sensation autonomics

380
Q

diabetics __ times more likely to suffer heart disease or stroke

A

2-4 times

381
Q

tf

diabetes considered equivalent risk to prev MI

A

t
2-4 times more likely to have heart disease
worse outcomes after MI

382
Q

most common cause of blindness among adults of working age

A

diabetes

383
Q

prevalence of retinopathy in DM

A

40% pts requiring insulin

25% on oral agents

384
Q

how long w DM does retinopathy dev

A

15 years
all T1DM
67% T2DM

385
Q

tf

by the time vision is affected in DM substantial retinal damage may have already occurred

A

t

386
Q

classifications of neuropathy

A 
focal
diffuse
sensory
motor
autonomic
387
Q

prevalence of neuropathy in DM

define

A

loss of ankle jerk reflex
7% 1 year
50% 25 years

for both T1 and T2 DM

388
Q

% DM develop diabetic nephropathy

A

20-40%

389
Q

most common cause of ESRD

A

DM

44% of cases in 2005

390
Q

what type of DM more often develops
DKA
vs
HHS

A

T1DM - DKA
T2DM - HHS… but DKA possible when B cells exhausted insulin deficient eg elderly w longstanding T2DM acutely ill w pneumonia

391
Q

HHS vs DKA which is life-threatening requiring prompt mgmt

A

both

392
Q

mortality rate w HHS vs DKA

A

HHS 15% but up to 30% w serious infection

DKA 2% u65yo up to 22% ^65yo

393
Q

tf

HHS in T2DM causes metabolic acidosis

A

f
pH ^7.3

DKA causes met ac

394
Q

plasma glucose levels in HHS vs DKA

A

^600 HHS

~250 DKA

395
Q

ketones in HHS vs DKA

A

absent or mild HHS

ketosis DKA

396
Q

physical findings in HHS

A

severe dehydration
-excess 9L fluid deficit w serum osmolality ^320mOsm/kg

fluid replacement is key

397
Q

most common cause of HHS in T2DM

and some other ones

A

infection aka pna uti w dec fluid intake

also stroke MI PE

398
Q

who to screen for DM

A

ADA
overweight or obese + 1 other risk factor
or 45 yo regardless
q3 years afterward if 1st negative

USPSTF
sustained bp ^135/80 (B)
insufficient evidence if normotensive (I)

399
Q

routine dx of DM

A
  • randome gluc 200mg/dl + sx polyu polyd unexplained weight loss etc
  • fasting gluc 126 repeat unless obvious sx
  • hba1c 6.5 repeat unless obvious sx
  • OGTT more sns more spec than fasting but difficult and poorly reproducible, not recommended for routine clinical use
400
Q

% US pop w DM in 2011
raw US total w DM
% ^20yo w DM
% ^65yo w DM

A

8%
26 Million (19dxd 7undxd)
11%
26%

401
Q

racial/ethnic risk factors for DM

A

native americans
african americans
latin americans
pacific islanders

402
Q

dx prediabetes aka

why important to ID

A

impaired fasting glucose
fasting gluc 100-126
OGGT 2h 140-200

end-organ damage already occurring
can delay or prevent progression w lifestyle mod (lesser degree w medicine)

403
Q

DM risk reduction in prediabetics after
intensive lifestyle mod
vs
info and metformin

A

58% risk reduction (11 year delay)
vs
31% risk reduction

404
Q

5 biggies on physical exam for diabetes

A 
eyes
thyroid (dz can contribute to DM, HLD)
heart
lungs
feet
405
Q

tx diabetic retinopathy

A

laser photocoagulation
slows progression
does not restore lost vision

406
Q

fundascopic findings in diabetic retinopathy

A

retinal hemorrhages (partial obstruction and infarct)
cotton wool spots (prior infarct)
microaneurysms (vascular dilation)
neovascularization = proliferative retinopathy = very bad

407
Q

JNC 7 and 8 HTN classes

A

v120/80 normo
v140/90 pre
v160/100 stage 1 HTN
^160/100 stage 2 HTN

408
Q

diabetic foot exam

A

inspect color hair loss scaling
inspect abrasions calluses ulcers infection
inspect bony abnorms
inspect footwear abnorm wear patterns and sizing
sense touch monofilament pinprick vibratory temp changes
pulses dorsalis pedis post tibial
achilles reflex

409
Q

monofilament exam for DM

A

start by demonstrated on pt arm, observe buckling, sensation
close eyes
say now when feels pressure
test big toe 1st 3rd 5th metatarsal heads randomly on both feet

410
Q

vibratory sns exam for DM

A

toe
then wrist, compare
can also compare sides

411
Q

what to consider for abnorm vib or sense exam in DM

A

protective footwear

in addition to meds and lifestyle

412
Q

hba1c represents

A

4-12 wk plasma gluc conc (via hb glycoscylation)

413
Q

how often to get HbA1c in DM

A

2x/y pt stable meeting a1c goal v7

4x/y pt therapy changing or not meeting goal

414
Q

why
how often
and how
to screen for diabetic nephropathy in DM

A

assess renal insuff, possible need to adjust renally excreted drugs to avoid tox (eg met ac from metformin)

annually

spot urine alb/cr ratio for microalbuminuria
serum cr and calculated GFR for monitor/stage CKD

415
Q

when to get fingerstick glucose for DM in family med

A

if pt acutely complaining of hypergly or hypogly sx

not useful for assessing glycemic control… a1c for that

416
Q

SE to monitor in metformin

A

tox from progressing renal insufficiency altering appropriate dose

B12 deficiency (unknown cause.. just data)

417
Q

when to order TSH screen in DM

A

T1DM wo TSH in past year
new dx DLD
F ^50yo

418
Q

tf

fasting lipid profile is important to obtain in DM family med

A

t

DLD common in DM

419
Q

normal serum cholesterol

A

v200 mg/dl

420
Q

normal fasting glucose

A

74-100 mg/dl

421
Q

normal TSH

A

.4-4.2 microIU/ml

422
Q

tf

controlling glucose as close to normal 4-6% a1c as possible has evidence of improving CVD outcomes that matter to pts

A

f
prevents microvascular retinopathy nephropathy
unclear if macrovascular benefit
(so goal is close to or less than 7% and tailor to pt aviod hypoglycemia and weight gain)
but lowering blood pressure v140/90 does macrovasc MI stroke mortality benefit

423
Q

leading cause of death in DM

A

ASCVD

424
Q

when to give statin in DM

what intensity

A

mod-intense statin for DM age 40-75

high-intense statin for DM age 40-75 and 7.5% 10 year ASCVD risk score

^21yo w LDL ^190 with or without DM

425
Q

when to consider aspirin for DM

A

same as non DM
hx CVD
inc risk (men^50 F^60 w +1 other risk)

(dec chance MI or stroke should outweigh inc chance of GI bleed)

426
Q

baby aspirin
dose
alternative if allergic

A

81mg aspirin

75mg clopidogrel

427
Q

ADA algorithm for mgmt of T2DM

A

at dx a1c^6.5 = lifestyle + metformin
at assessment a1c^8 = add sulfonylurea (glyburide glipizide glemipiride) or basal insulin (insulin glargine [Lantus] insulin detemir [Levemir]) on intermediate-acting insulin (NPH)
at reassessment a1c^8 = add insulin if not already or intensify insulin; consider discont sulfonylurea to avoid hypoglycemia

then time to explore other tx options

428
Q

tf

initiation of insulin should be viewed as a failure by physician or pt

A

f
course of disease that b cells function dec
that would be setting up for failure
can create barrier to insulin initiation

429
Q

tf

dental care is important in DM

A

t
inc gluc in saliva
immunosuppression
periodontal disease can inc heart disease

430
Q

vaccs for DM

A

flu like urbody else
pneumococcus for everyone, revacc if neprhotic, CKD, immunocompromise and at age 65 if last more than 5 years ago
Hep B for DM HIV other immunocompromise liver dz

431
Q

yearly dilated retinal exam sensitive for detecting

A

retinal thickening from
macular edema or
early neovascularization

432
Q

when to get optho consult for dilated retinal exam in DM

A

annually starting 5y post dx for T1DM
annually starting at time of dx for T2DM
(20% already getting retinopathy)

433
Q

factors that contribute to hyperglycemia

A 
overeating
missed med
dehydration
infection
illness
stress
434
Q

dx DM by OGTT

A

^200 2h post 75g glucose load

435
Q

blurry vision in DM due to…

A

macular edema

436
Q

transient dark spots in vision in DM due to…

A

retinal vessel hemorrhage

437
Q

tf

glaucoma more likely in people w DM

A

t
40% more likely
assoc w nausea headache narrow vision halos around lights

438
Q

AMS ddx in T2DM

A

HHS - dehydration gluc ^600 phv7.0
korsakoff syndrome - thiamine def alcoholic malnutrition
stroke - FND

439
Q

1st line antihtn in DM

goal bp JNC8

A

ACEI renoprotective

v140/90

440
Q

of htn dm obesity smoking

which causes the most deaths in us

A

smoking
single greatest contributor to death in US
450,000 annual premature smoking and 2nd hand smoke deaths
(lung cancer, MI, COPD)

300,000 Obesity (dec life expect mean6y R2-20y)
213,000 DM (CVD CKD)
20,000 HTN (uncontrolled dec LE 20y) (CAD, hypertensive cardiomyopathy, CVD, CKD)

441
Q

key difference between leg swelling from
cellulitis lymphedema DVT
vs
venous insufficiency PAD

A

unilateral
vs
bilateral

442
Q

tf
lymphedema can be unilateral
but
venous insufficiency is usually bilateral

A

t

443
Q

tf

cellulitis always has fever

A

f

can be localized w/o fever

444
Q

general diff b/tw strep and staph cellulitis

A

strep small breaks of skin

staph large wounds ulcers abscesses

445
Q

tf

DVT is palpable

A

tf

sometimes cord of thrombosed vein palpable

446
Q

Homan’s sign

A

pain on passive dorsiflexion foot
classic sign of DVT
but low predictive value - msk inj, cellulitis, venous insuff too

447
Q

PAD what area does it describe

A

anything distal to arch of aorta

448
Q

ankle brachial index consistent w PAD

A

v0.9

449
Q

greatest modifiable risk factor for PAD

A

cigarette smoking

odds inc 1.4 q10cigs/day

450
Q

rate of PAD in DM

A

half of pts w DM 20+ ys

usually below knees

451
Q

how is d-dimer used in context of dvt

A

best to r/o dvt if pretest probability low
eg by Well’s criteria
-ca w/in 6 mos
-paralysis paresis -immobilization
-bed ridden 3 days recently (within 4 wks)
-entire leg swollen
-calf swelling ^3cm measured 10cm below tibial tuberosity vs contralat
-pitting edema
-collateral superficial (not varicose) veins
-alternative dx not more likely

low prob 0, mod prob 1-2, hi prob 3+

452
Q

DVT

reflex cxr?

A

f

not without respiratory sx

453
Q

precedes diabetic foot ulcer

A

pressure callus

454
Q

grade diabetic foot ulcer by wegner system

and manage each

A

1 - skin - outpt deb care pres rel
2 - soft tissue - outpt deb care pres rel
3 - bone/abscess - eval osteomy PAD hospit
4 - forefoot gangrene - hosp, sg consx
5 - extensive gangrene - hosp, sg consx

455
Q

% PE from DVT VTE

A

95%

456
Q

deaths due to PE occur in what timeframe

A

within 1-2 hours usually

457
Q

to treat DVT on outpt basis

A 
pt must
hemodynamically stable
good kidney function
low bleed risk
stable supportive home env
access to daily INR monitoring
458
Q

tf

pt must not be on home O2 for outpt dvt mgmt

A

f

can be on home O2

459
Q

tf

pt must not be diabetic for outpt dvt mgmt

A

f

can be diabetic

460
Q

goals of DVT therapy

treat

A

stop clot
resolve clot
prevent clot

heparin or LMWH

461
Q

advantages of LMWH vs unfractionated heparin

A 
LMWH
longer t1/2 so qd or bid sq
no lab monitoring
less thrombocytopenia
dosing fixed
can use outpt
462
Q

tf

dosing is fixed w heparin

A

f

that’s LMWH

463
Q

tf

lab monitoring is required with heparin

A

t

but not w LMWH

464
Q

tf

heparin may be used in outpt

A

f

LMWH can

465
Q

how is heparin administered

A

iv

“heparin drip”

466
Q

dose warfarin in an adult

A

5-10mg qd

titrate to INR 2-3 q3-7d

467
Q

how long to anticoagulate first idiopathic (unprovoked) DVT VTE PE in low risk pt

A

6 months at least

468
Q

how long to anticoagulate first DVT/PE provoked by sx or transient factor

what if bleeding risk is moderate?

A

3 mos

still 3 mos
for low to mod bleed risk

469
Q

how long to anticoagulate first DVT/PE unprovoked

A

6+ mos if low mod bleed risk

3 mos if bleed risk high

470
Q

how long to anticoagulate first DVT/PE if assoc w active ca

A

6+ mos

471
Q

what does it mean that LMWH dosing is fixed

A

once adjusted for body weight,

no further adjusting based on lab monitoring

472
Q

tf

fixed dosing means everyone gets same dose

A

f
same dose/body weight
and then no adjusting based on labs necessary

473
Q

how are pts w inherited coagulation disorders managed diff from others after first DVT/PE

A

indefinite anticoagulation

474
Q

when to screen for inherited thrombophilia

A

1st thrombosis v50yo wo risk factor IDd
FH VTE
recurrent thrombosis
thrombosis in unusual vascular beds

475
Q

tf

colon cancer is a risk of obesity

A

t

476
Q

tf

gallbladder dz is a risk of obesity

A

t

477
Q

tf

stroke is a risk of obesity

A

t

478
Q

how many days for warfarin to reach steady state

A

5-7 days

t1/2 40 hours…. x4 = 6.6 days

479
Q

when to check INR after starting?

A

~3 days
before steady state (5-7 days… t1/2 40 hours)
to make sure not supratherapeutic
but if subtherapeutic give more time

480
Q

INR 11

what to do re warfarin regimen?

A

stop
give vit K 5mg orally to reduce INR (if INR^9)

significant bleed risk

481
Q

what to do if warfarin INR supratherapeutic but not bleeding

A

5-9 no other bleed risk factors omit 1-2 doses
5-9 w other bleed risk factors omit 1-2 doses
—and give oral vit K 1-2.5mg)
9-20 omit several doses, give oral vit K 3-5mg
—monitor repeat K prn restart warf when down
^20 treat as bleed refer to ED

482
Q

what to bridge to warfarin

when to stop bridge

A

UFH LMWH fondaparinux

5 days And INR therapeutic ^24h

483
Q

when can steroid injections help OA

A

when there is joint inflammation

484
Q

when to start screening for htn per USPSTF 2016

A

age 18

485
Q

define htn

A

140/90 v60yo

150/90 ^60yo

486
Q

end-organ damage in htn

A 
stroke TIA
retinopathy
LVH angina MI HF
CKD
PAD
487
Q

how does smoking contribute to CV disease

A

inc BP

interacts w CV drugs

488
Q

what recreational drugs commonly affect bp

A

cocaine ketamine
narcotic withdrawal
smoking
alcohol

489
Q

renal CV risk factors

A

microalbuminuria

GFR v60

490
Q

how does stress contribute to bp

A

stim release of NE and AT II

491
Q

tf

hx glaucoma is essential info in new htn dx

A

f

492
Q

% US htn
essential (primary, idiopathic)
vs
secondary (identifiable cause)

A

95-98% essential

493
Q

dx htn

A 
2 elevated measurements 5 min apart
one each arm (r/o aortic anomaly)
two or more visits
not ill
beware whitecoat htn, get home measurements maybs
494
Q

standardized BP measurement

A

seated quietly w back supported 5+ min
arm supported at heart level
cuff bladder length 80+% arm circ
width cuff 40+% arm circ

495
Q

tf

for standardized BP measurement most adults should get adult-sized cuff

A

f
most adults now fat
may require xl or thigh-sized cuff

496
Q

funduscopic findings to watch for in htn

which is a hypertensive emergency

A 
a-v nicking
cotton wool spots (infarct)
flame hemorrhage
exudates (fatty dep)
papilledema (htn emergency)
497
Q

panniculus

A

fat jelly rolls

498
Q

medical for fat jelly roles

A

panniculus

499
Q

manage htn in adult

^18yo

A 
LIFESTYLE +
non-black v60yo
-ACEI ARB CCB or thiazide goal v140/90
black v60yo
-CCB or thiazide goal v140/90
^60yo
-ACEI ARB CCB or thiazide goal v150/90
w CKD
-ACEI or ARB goal v140/90
w DM
-ACEI ARB CCB or thiazide goal v140/90
500
Q

tf

can consider BB AB loop hydralazine (vasodilator) clonidine (central a2 agonist) for initial mgmt of htn

A

f
ACEI ARB CCB or thiazide initial mgmt.

BB AB worse outcomes in studies
loops, vasodilators, central a2ag not sufficient data

501
Q

tf

CKD or DM elevates the target BP in htn mgmt

A 
f
just age (v60y 140/90 ^60y 150/90)
502
Q

most cost-effective antihtn drug

A

hydrochlorothiazide HCTZ $4.30/mo

503
Q

joint dz to watch for w thiazide diuretic

A

gout (hyperuricemia)

504
Q

hydrochlorothiazide is what class of drug

A

thiazide diuretic antihtn

505
Q

how does age influence urinary incontinence

A 
dec bladder capacity
dec awareness to void
dec detrusor and pelvic floor muscle strength
incomplete emptying
atrophic urethra changes
506
Q

tf

50mg HCTZ dec BP m and m more than 25mg

A

f

not per evidence

507
Q

starting dose for HCTZ in elderly

A

6.25-12.5mg low does avoid hypotension

most other adults can start at 25mg

508
Q

when is HCTZ not the antihtn of choice

A

in CKD

ACEI ARB

509
Q

second best prognostic factor for death in all people

A

LVH
all people with or without htn

(age is #1 duh)

510
Q

labs to get at dx of htn

A 
EKG for arrhythmia IHD LVH
UA for protein glucose alb/cr raio
blood glucose
hematocrit for low can make ischemia risk
K+ ele for CI to ACEI ARB KSD
----- cushing hyperaldo
Cr
9-12h fasting lipid panel for metabolic syndrome
serum Ca for nephrolithiasis hyperPTH
511
Q

antihtns that cause hyperkalemia

A

ACEI ARB KSD

512
Q

lifestyle mod to dec BP most

A

weight loss

513
Q

fascia lata of the thigh

A

deep fascia of thigh
encloses thigh muscles
separates with intermuscular septa
thickened laterally into IT band

514
Q

IT band

A

iliotibial band / tract
fibrous thickening of latral aspect of fascia lata
associated with muscles that extend abduct externally rotate hip and laterally stabilize knee
origin anterolat iliac tub
imsert lat tib gerdy cond w glut max and tens fasc lat

515
Q

normal fasting glucose range

A

65-100

516
Q

normal plasma sodium

A

135-145

517
Q

normal plasma K

A

3.5-5

518
Q

normal plasma Cl

A

95-105

519
Q

normal BUN

A

7-21

520
Q

normal Cr

A

.8-1.3

521
Q

normal total cholesterol

A

120-200

522
Q

normal triglycerides

A

70-150

523
Q

normal HDL

A

45-100

524
Q

normal LDL

A

v100

525
Q

normal lipid panel

A

T CH 120-200
TAG 70-150
HDL 45-100
LDL v100

526
Q

tf

two arms needed for HTN monitoring

A

f
not for monitoring
but for SCREENING for HTN and aortic anom

527
Q

what is considered an “elevated” 10 year ASCVD risk

A

^7.5%

528
Q

in 2016, on what do we base cholesterol management

A

ASCVD risk score

pooled data from large cohort studies

529
Q

USPTF aspirin recommendation

A

start in
men 45-79 to reduce MI
women 55-79 to reduce ischemic stroke

530
Q 
tf
according to JNC8
you can manage htn by
maximizing 1 med before starting another or
starting another before 1st maxed
starting 2 at the same time
A

t
all acceptable
but maximize double combo before starting 3rd

531
Q

tf

doses of HCTZ above 25mg demonstrate improvement in BP and morb mort

A

f

25mg max useful dose per evidence

532
Q

what to watch for in HCTZ pts

A

hyponatremia

gout

533
Q

tf

BBs mask hypoglycemic strokes so avoid in DM pts

A

f

evidence not there in real world clinical situations

534
Q

antihtn med to avoid in asthmatics

A

BB

535
Q

to check before starting BB

A

EKG

pulse

536
Q

BBs especially good antihtn in context of

A

tachyarrhythmia/fib
migraine
essential tremor
periop htn

537
Q

tf

avoid BB in heart block

A

tish

3rd degree heart block

538
Q

what degree is complete heart block

A

3rd degree

539
Q

to watch in ACEI

A

K Na Cr (Cr up 35% allowed)
bradykinin cough in 15-20%
angioedema
avoid in pregnancy

540
Q

first line antihtn in DM and kidney disease

A

ACEI

541
Q

antihtn w heart remodeling effects

A

ACEI ARB

542
Q

antihtn reduce albuminuria

A

ACEI ARB

543
Q

to watch in ARB

A

avoid in pregnancy

544
Q

tf

ARB causes bradykinin cough in 15-20%

A

f

ARB much less so than ACEI

545
Q

antihtn potentially useful in raynauds

A

CCBs

546
Q

to watch in CCB

A 
leg edema (15-30%)
CI short acting CCBs in essential htn and rug emerg
547
Q

to watch in aldo antag

A

hyperkalemia
avoid in K^5 prior to start
(goes for K sparing diuretics too)

548
Q

a-blocker use as antihtn

A

only as adjunct for refractory bp

possibly BPH but not first line

549
Q

tf

prev and sev of htn is inc in AAs

A

t

550
Q

special antihtn consideratin in AAs

A

less responsive to BB ACEI ARB
and more (2-4x) angioedema from ACEI
so prefer CCB and diuretics
unless CKD or 3rd or 4th line needed

551
Q

ethnic groups w lowest BP control rates

A

mexican american

native american

552
Q

when to consider referral to specialist for htn

A

can consider when
lifestyle mods appropriately adjusted and
not controlled to goal after 2 meds maxed
or CHF htnnephropathy or other end-organ damage

553
Q

tf

htn = elevated blood pressure

A

f
htn is a diagnosis that requires 2 separate readings ^140/90 at least 1 wk apart

elevated bp is what you call one high read

554
Q

preferred antihtn if known CAD or previous MI

A

BB thiazide

555
Q

pt drinks 1-2 beers 5 days/week

will alc chess improve bp?

A

f
mod alc actually improves bp 2-4mmhg

but don’t encourage non-drinker to drink… could get problematic

556
Q

DASH diet stands for

A

dietary approaches to stop hypertension

NIH-sponsored

557
Q

tf

avoid ACEI in AAs, even those w DM

A

t
htn in AAs may not be ATII dependent
as it is in others
and AAs 2-4x more angioedema w ACEI

558
Q

mnemonic for symptom characterization

A 
OPQRSTA
onset
provocation palliation
wuality
radiation
severity
temporal elements
associated sx
559
Q

where can anginal pain radiate

A

neck throat jaw teeth

UE shoulder

560
Q

tf

wide radiation of chest pain increases chances it is MI related

A

t

Family Medicine (2 decks)

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