Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

LMCC > Family medicine > Flashcards

Family medicine Flashcards

0
Q

Radiculopathy
L5
S1

A

L5-radiates buttock to lateral calf

S1- radiates to posterior calf, to heels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Back pain red flags

A 
Bowel or bladder dysfunction 
Anesthesia (saddle) 
Constitutional symptoms 
K-chronic disease 
P- parasthesia 
A- age>50 
I- IV drug use 
N-neuromuscular deficit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

History for cough and sputum, shortness of breath

A
  • course of events
  • cough (acute vs chronic), worse with position(orthopnea?)/season/night, relieving factors
  • sputum- color, quantity, quality, frequency
  • Hemoptysis- quantity, frequency
  • SOB- onset, provoking factors (exercise), quantity (frequency), relieving factors, severity
  • wheezing?
  • chest pain, palpitations, ankle swelling
  • fever, Chills, malaise, fatigue
  • sick contacts, travel, occupation
  • smoking, alcohol
  • allergies
  • PMHx, history of COPD, heart disease
  • medications
  • family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Physical exam for cough and sputum

A

Vitals
Respiratory Exam: inspection, percussion, lung sounds, include clubbing
Cardio: heart sounds, pulses, pedal edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Admission criteria for pneumonia

A 
CURB 65
Confusion 
urea> 7
RR> 30 
BP<90 systolic or <60 diastolic 
Age>65
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatment for pneumonia-outpatient

A

In healthy individuals with no abx use in last 3 months
1. Macrolide: azithromycin, clarithromycin, erythromycin
OR
2. Doxycycline

If there are comorbidities (chronic heart, lung, liver, renal disease, diabetes)

  1. Fluoroquinolone: moxifloxacin, gemifloxacin, levofloxacin OR
  2. Beta-lactam (high dose amox, amox clav), alternative agents (ceftriaxone, cefuroxime) AND a macrolide (azithromycin, clarithromycin, erythromycin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Treatment of outpatient with comorbidities such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs; or use of antimicrobials within the previous three months

A

A respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg])
OR
A beta-lactam (first-line agents: high-dose amoxicillin, amoxicillin-clavulanate; alternative agents: ceftriaxone, cefpodoxime, or cefuroxime) PLUS a macrolide (azithromycin, clarithromycin, or erythromycin)*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In patient treatment of pneumonia inpatient- non ICU

A
  1. Fluoroquinolone (moxi, gemifloxacin, levofloxacin)
    OR
    2.An antipneumococcal beta-lactam (preferred agents: cefotaxime, ceftriaxone, or ampicillin-sulbactam; or ertapenem for selected patients) AND a macrolide (azithromycin, clarithromycin, or erythromycin)*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pneumonia treatment for patient in ICU

A

An antipneumococcal beta-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) PLUS azithromycin

OR
An antipneumococcal beta-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) PLUS a respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg])

OR
For penicillin-allergic patients, a respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]) PLUS aztreonam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment of pneumonia if MRSA is a concern

A

Add vancomycin or linezolid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment for pneumonia and pseudomonas coverage

A

Pip tazo and tobra

An antipneumococcal, antipseudomonal beta-lactam (piperacillin-tazobactam, cefepime, imipenem, or meropenem) PLUS either ciprofloxacin or levofloxacin (750 mg)
OR
The above beta-lactam PLUS an aminoglycoside PLUS azithromycin
OR
The above beta-lactam PLUS an aminoglycoside PLUS a respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]); for penicillin-allergic patients, substitute aztreonam for above beta-lactam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Differential for lymphadenopathy

A
  1. infectious: EBV, HIV, syphillis, TB
  2. autoimmune: sarcoidosis, lupus
  3. Cancer: lymphoma, leukemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Physical exam for cervical adenopathy

A 
vitals- fever? weight?
Oral pharynx 
Check other lymph nodes: neck, axillary, supra and infraclavicular lymph node, groin 
Abdominal exam for masses 
Rashes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

History and Physical exam for cervical adenopathy

A 
vitals- fever? weight?
Oral pharynx 
Check other lymph nodes: neck, axillary, supra and infraclavicular lymph node, groin, painful? 
Abdominal exam for masses 
MSK- bone pain? 
Rashes
Viral prodrome?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Differential diagnosis for macrocytic anemia

A

Poor nutrition: Alcoholism, poverty, vitaminB deficiency
Malabsorption
Medication: alcohol, anticonvulsant, antifolates
Increased need: pregnancy, hemolysis, hemodialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Investigations for macrocytic anemia

A

CBC, diff, blood smear
Lytes, creat, urea
INR, PTT
Folate, serum B12, RBC folate, serum ferritin
Schillings test
Barium enema if pernicious anemia is suspected (associated with bowel cancers)
GGT, AST, ALT, alk phos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

History for patient with Afib and sub therapeutic digoxin level

A
  1. Symptoms of Afib: sudden fatigue, palpitations, general weakness, light headedness, symptoms of TIA/stroke
  2. Symptoms of CHF: ankle edema, SOB, orthopnea, PND, cough, wheeze, hemoptysis
  3. medication compliance: memory? side effects?
  4. medication side effects/overdose: anorexia, nausea, vomiting, bradycardia, visual effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CHF/Afib and digoxin counseling

A
  • explain how digoxin works (increase force of contraction)
  • discuss reasons for not taking medication
  • discuss symptoms of overdose
  • arrange follow up plan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

60 year old with hypercalcemia

Symptoms of hypercalcemia

A

Bones, Stones, Moans, Groans

  1. Bones- pain, arthralgia, muscle weakness
  2. Stones- renal colic/ nephrolithiasis
  3. Moans: emotional lability, fatigue
  4. Abdominal groans: pain, nausea, vomiting, constipation, ileus, polyuria, polydipsia, nocturia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

History for hypercalcemia

A
  • onset/duration of bones/stones/moans/groans
  • malignancy symptoms: weight loss, night sweat, fatigue
  • orthostatic hypotension (Addison’s)
  • Hyperthyroid symptoms: heat intolerance, tachycardia
  • Diet: milk, calcium supplements, antacids

Basic info:

  • meds, allergies, alcohol, smoking, drugs
  • pmhx: reflux, gastritis, PUD
  • Fhx: multiple endocrine neoplasia
  • review of systems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Physical exam for hypercalcemia

A
  • trousseau’ sign- inflate BP cuff, leave for 1-2 min, distal arm goes into flexion, tetani
  • signs of addison: bronze skin, orthostatic hypotension
  • Cushing’s sign: moon facies, striae, buffalo hump
  • signs of hypothyroidism, myxedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Differential diagnosis for hypercalcemia

A

PTH mediated: familial (MEN, FHH- familial hypocallciuric hypercalcemia), primary hyperparathyroidism, renal failure

PTH-independent
malignancy- PTHrp, bone mets, vitD intoxication, hyperthyroidism, adrenal insufficiency, immobilization, TPN, milk alkali syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Investigations for hypercalcemia

A
  • albumin
  • ionized calcium
  • PTH
  • vitamin D
  • urinary calcium
  • TSH
  • PTHrp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Obesity Counseling

A
  • check for hypothyroid symptoms
  • emphasize health benefits- blood pressure, heart disease, diabetes
  • discuss strategies tried and why it didn’t work
  • balanced diet- 3 meals no snacks
  • fats should be <20% of caloric intake
  • involvement of family
  • group support
  • increased activity- start with 1 hour of walking
  • arrange for followup
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Warning signs of abusive relationships

A
  • restrictions on going out
  • not allowed to see certain people
  • social isolation
  • threats
  • verbal abuse
  • cycles of violence/remorse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Risk factors for abusive relationships

A
  • social isolation
  • poverty
  • substance abuse
  • partner’s parents had abusive relationships
  • personality disorder
  • mental illness
  • pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

History for abusive relationships

A
  • events: triggers
  • objects used as weapons
  • injuries
  • history of previous episodes of violence
  • were patient’s parents in an abusive relationship?
  • is partner controlling?
  • is violence increasing in severity?
  • are there children?
  • are children abused?
  • do partners have alcohol abuse?
  • is money a problem?
  • are they open to couples counselling?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Physical abuse counselling

A
  1. physical abuse is criminal assault
  2. tends to increase unless couple seeks therapy or relationship ends
  3. Can be reflected in future behaviour of children
  4. Child abuse has to be reported
  5. Spousal abuse is criminal act but not reportable
  6. Should not return if there is a risk to safety
  7. Exit plan should be developed to ensure patient safety- alternative living arrangement, seek help of friends and family
  8. Document evidence of abuse
  9. Patient can seek a restraining order
  10. Discuss therapy for anger management, couple’s therapy
  11. Social worker referral
  12. Arrange follow up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

History for fever of unknown origin (3 weeks of fever)

A

Basic info: PMHx, PSHx, allergies, meds, vaccinations, smoking, alcohol, drugs, sexual hx

  • specifically for PMHx: cardiac, plum, DM, HTN, thyroid, cancer, HIV, TB
  • FMHx: cancer, familial mediterannean fever
  • how high is the fever? everyday?
  • associated symptoms: headache, sinus pain, sore throat, cough, abdo pain, diarrhea, pain with urination, change in urination
  • cancer symptoms: weight loss, height sweats, chills, lymph node swelling, appetite
  • travel, sick contacts, farm visits, pets at home
  • tests done so far? treatments so far?
  • what changed today that brought you to clinic?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

DDx for fever of unknown origin

A
  • infectious
  • neoplastic
  • connective tissue diseases/autoimmune
  • endocrine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Investigations for fever of unknown origin

A 
CBC, lytes, Ca, Mg, PO4
TSH 
LDH, ESR, CRP 
RF, ANA 
UA, culture 
Blood culture 
CXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

60 year old male with claudication

-5 risk factors for peripheral vascular disease

A
  1. HTN
  2. Diabetes
  3. Smoking
  4. Hypercholesterolemia
  5. CAD, CVD, ESRD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Investigations for peripheral vascular disease

A
  1. Dopplers with ankle-brachial index

2. Angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

History of Smoking cessation

A

-Basic info, name, age, occupation, PMHx, PSHx, Meds, Allergies, alcohol, drugs

  • Smoking history: how much ? how often? time of day? gain from smoking? concerns about smoking? interest in quitting? previous attempts and with what? other people who smoke in family/friends?
  • dependence? preoccupation? loss of control over use

-Resp symptoms: SOB, cough? asthma? COPD? HTN?

35
Q

Smoking cessation counselling

A
  • Physical component: withdrawal symptoms
  • Environmental factors: social, habits

-Benefits of smoking cessation: single most preventable cause of death; can prevent lung cancer, COPD, CAD, GI cancer, lung infections , better energy

  • Set date
  • Practical points: remove ashtrays, lighters, increase exercise, consider using patch/gums, self-reward for eating goals, support from family and friends, alternate activities with friends

-don’t give up, some people have to try >5 times before quitting

36
Q

Aids in smoking cessation

A
  1. Nicotine patch- decreases cravings, dose not give “highs” of nicotine. Can not smoke while on patch, can not use during pregnancy. 4-12 week treatments
  2. Zyban/buproprion. Can not be used in ppl with seizure disorder, alcoholism, eating disorder, pregnancy . Continues to smoke for 1st week of treatment then stop. Side effects: dry mouth, weight gain, headache
37
Q

Physical exam for a 30 year old with 6 weeks of epistaxis, petechiae, easy bruising, normal CBC except for plts of 20.

A

HEENT: bled in nose, mouth, gums, cervical lymphadenopathy

Chest: Inspection- skin, Percuss lung fields for effusions, consolidations, Ascultate the lung fields anterior and posterior, compress sternum and rib cage for pain
CVS: heart sounds
Abdo: bowel sounds, percuss liver/spleen, palpate for enlargement of sleen and liver , lymph nodes
Skin: petechiae, hair falling out, nails, palm

38
Q

4 things on history suggestive of ITP

A
  1. remitting-relapsing course
  2. mild fevers, viral prodrame
  3. splenic discomfort due to mild enlargement
  4. bleeding after low dose of NSAID
39
Q

Investigations for low platelets/ITP

A
  1. blood smear
  2. INR/PTT for hemophilia
  3. serum urea/creat for HUS
  4. serum platelet associated IgG
40
Q

68 yo M with difficulty swallowing. Take a history

A

Basic info: occupation, PHMx, PSHx, meds, allergies, smoking, alcohol, drugs

  • Difficulty swallowing: when did it start? getting worse? liquids/solids/both? things that make it better/worse
  • GI symptoms: hx of reflux, ulcer, hiatal hernia, hematemasis, black stool, abdominal pain, vomiting, chest pain? (if intermittent- esophageal spasm?)
  • cancer symptoms: weight loss, fatigue, fever, night sweats
41
Q 
Types of dysphagia 
1. 
2. 
3.
4. 
5.
A
  1. Oropharyngeal dysphagia
    -diff transferring food from mouth to esophagus, nasal regurgitation
    -nasal regurgitation
    -can be from bulbar stroke, timor, ALS, cricopharyngeal incoordination (failure of UES to relax with swallowing)
    -Zenker’s diverticulum
    2.Esophageal dysphagia
    -food stuck further down
    -lower esophageal web?, heart burn, carcinoma, scleroderma, esophageal spasm, achalasia
  2. Mechanical obstruction
    -problem worse with solids
    -tumor, stricture from GERD, trauma
  3. Neuromuscular dysfunction
    -problem is worse with liquids
    -achalasia, stroke, motor neuro disease, myasthenia gravis, muscular dystrophy
  4. Globus hystericus
    sensation of lump in throat- anxiety related?
42
Q

Esophageal cancer

  • findings on barium enema
  • further investigations
A
  • barium enema: string sign
  • endoscopy with biopsy, CXR for mediastinal involvement, CT chest, for staging
  • LFT
  • Abdo US for mets
43
Q

Differential for hypertension in 23 year old (160/100)

A
  1. Hyperthyroid
  2. Coart
  3. White coat hypertension
  4. Primary hypertension
  5. Athersclerosis
  6. Cushing’s
44
Q

Physical exam for hypertension

A

HEENT:

  • head for moon face
  • eyes- for proptosis, fundoscopy for retinopathy of hypertension, damage to retinal arterioles, exudates, papiplledema
  • buffalo hump
  • thyroid gland

Resp:
CVS:
-BP in 4 limbs
-pulses, radial, femoral, pedal, radial/femoral delays,
-PMI, thrills, heaves,
-Auscultation for heart sounds, murmur, carotid bruits
-JVP
-Abdo: truncal obesity, hepatosplenomegaly, renal artery bruit
-Skin: dry vs sweaty, nails

45
Q

Investigations for hypertension

A
  • Repeat BP 3x over next 6 months
  • urine analysis
  • CBC, creatinine, fasting glucose, lipids, TSH
  • 12 lead ecg
  • renal U/S
46
Q

Initial management plan for hypertension

A
  • smoking cessation
  • alcohol restriction
  • salt restriction
  • healthy diet
  • weight reduction if BMI >25 (1 hr 3-4x/wk)
47
Q

History for 21 yo F with bloody diarrhea, abdominal cramps, dizzy and weak

A

Basic info: name, age, occupation, PMHx, PSHx, FMHx (Crohn’s, UC, polyposis)

  • onset, duration, frequency of diarrhea
  • appearance of stools: streaks, vs mixed with stools
  • melena vs BRBPR
  • abdo pain: PQRST
  • other abdo symptoms: heart burn, peptic ulcer, reflux, hiatal hernia
  • extra-intestinal manifestations of IBD: iritis, arthritis, mouth ulcers, anal ulcers, skin lesions, kidney stones, infectious diarrhea
  • recent travel, new foods, antibiotics, sick contacts
  • gyne hx: pelvic pain, vaginal discharge, vaginal bleeding
48
Q

Physical exam for bloody diarrhea

A
  • vitals
  • HEENT: eyes, oral ulcers
  • Resp: tachypnea
  • CVS: pulses
  • Abdo: bowel soundsx4 quadrants, inspection- distension, masses, palpation- superficial/deep, rebound tenderness?, hepatomegaly, splenomegaly
  • skin:rash
49
Q

Investigations for bloody diarrhea

A

CBC
Stool culture, O+P, C.diff
G+C scope
Type and cross for 4 units

50
Q

Ddx for bloody diarrhea

A
  1. Gastroenteritis
  2. Bleeding peptic ulcer
  3. Inflammatory bowel disease
51
Q

Middle aged woman with systolic ejection murmur radiating to carotids

A

Describe murmur

  • systolic vs diastolic, grade /6
  • where it’s heard the loudest
  • where the sound radiates
  • pitch
  • quality
  • contour: cresendo, decresendo
52
Q

Cause of systolic murmur in adults

A

Aortic stenosis: loudest over aortic area, radiates to clavicle/carotids, systole, harsh- crescendo/decresendo
Mitral regurgitaion: loudest over apex, occurs in systole, radiates to axilla, blowing and plateau

53
Q

Innocent murmurs

A 
are <3/6 
peak early in systole
heard better at the aortic and pulmonary areas 
no clicks or heaves 
ECG and CXR are normal
54
Q

Back pain- differential

A
  1. Degenerative- mechanical (muscle stain, spasm), spinal stenosis(congenital, osteophyte, central disc)
  2. Cauda Equina
  3. Neoplastic (primary or metastatic)
  4. Trauma (fraction- compression)
  5. Spondyloarthropathy- ankylosing spondylitis
  6. Discitis
  7. Osteomyelitis
  8. Referred: aorta (AAA), renal (pyelo, nephrolithiasi), pancreatitis
  9. Malingering
55
Q

Lower back pain red flags

A 
BACKPAIN 
Bowel or bladder dysfunction 
Age > 50 
Constitutional symptoms/malignancy- night sweats, fever, weight loss 
K- chronic disease
Paresthesias
Anesthesia
IV drug user 
Neuromotor deficits
56
Q

Disc herniation

A

L4/L5-> causes compression of L5 root

  • pain from buttock to lateral calf
  • lateral calf pain
  • numbness of the medial, dorsum of foot
  • ankle dorsiflexion weakness

L5/S1- S1 compression

  • radiation down leg to heel
  • posterior calf pain
  • lateral foot numbness
  • ankle plantar flexion weakness (decreased ankle jerk)
57
Q

Back pain history

A

Description

  • location, radiation, quality, duration, frequency, intensity, circumstances, aggravating, relieving factors
  • worse with standing and walking, better while bending and sitting- think of spinal stenosis
  • morning stiffness?
  • previous episodes?
  • previous investigations, treatment
  • other pain in buttock, legs? joint pain?
  • eye pain/change in vision (uveitis)?
  • limitations to function? activities of daily living
  • improving? worsening?

-Red flags: bowel/urinary incontinence/retention, sexual dysfunction, age>50, constitutional symptoms (fever, night sweats, weight loss), chronic disease, parasthesia (numbness), anesthesia, IV drug use, neuro symptoms (weakness)

58
Q

Signs of cauda equina

A

surgical priority if subactue
emergency surgery if acute

  • saddle anesthesia (perineal numbness)
  • decreased anal tone
  • impotence
  • urinary retention
  • bowel incontinence
59
Q

Physical exam for back pain

A

inspection:
- posture
- gait
- toe/heel, walk on heels and toes
- scoliosis
- spina bifida
- calf girths for muscle wasting

Palpation
-tender points: paraspinal, sacroiliac joints (ankylosing spondylitis)

Range of motion of back

  • forward flexion- disk pain
  • backward extension- facet joint pain
  • lateral flexion- if decreased (less than 3 cm- modified schooner test)- suggestive of ankylosing spondylitis
  • wright-schober test: less than 5cm increase on full forward flexion of spine

Reflexes

  • knee jerk (L4)
  • ankle jerk (S1)
  • clonus
  • babinski

Power
-quadriceps, hamstrings, psoas (raise knee against resistance), ankle dorsiflexors)

Special tests:
-straight leg test: raise heel and note maximum angle without pain, both sides

60
Q

Headaches Red Flags

A

SSNOOP

  • Systemic symptoms (fever or weight loss)
  • Systemic disease (HIV infection, malignancy)
  • Neurologic symptoms or signs- altered mental state, focal neurological signs (weakness), seizures, papilledema
  • Onset sudden (thunderclap headache), esp after age 40 years
  • Other associated symptoms: trauma, wakened during sleep, worse with valsalva
  • Previous headache history (first, worst, more frequent, or different headache)
61
Q

Headaches

Ddx must rule out

A

MTTT

  • meningitis
  • trauma- hemorrhage
  • tumor
  • temporal arteritis
62
Q

Headaches History

A
  • new onset
  • worse at night?
  • wakes up with pain at night?
  • fever?
  • neck stiffness?
  • seizures?
  • trauma
  • changes in LOC/behavior
  • vomiting
  • severe
  • very young/very old patients
  • previous concussions/ head trauma
  • description: location, one sided vs both sided
  • provoking- coughing, straining, foods
  • quality: pulsatile, throbbing, pounding, pressure, burning, different types
  • radiation, relieving
  • severity
  • timing- how long does it last, morning? night?
  • associated symptoms: aura, nausea, vomiting, photophobia, phonophobia, nuchal rigidity, weakness, numbness, vision changes

-mood, stress, anxiety
-what has pt tried to relieve pain?
Basic info: PMHx, PSHx, meds, allergies, FMhx, smoking, alcohol, drugs

63
Q

Physical exam for headaches

A

HEENT: pupills, fundoscopy
Kernig, Brudzinski,
Neuro: focal neurological findings

64
Q

Vaccination counseling

A

-vaccines protect children from DPTP (diptheria, tetanus, pertussis, polio)
MMR (measles, mumps, rubella)
influenza
hepatitis B
-diseases that were once common and caused serious illness/death
-questions?

  • common side effects: arm pain, mild fever, rash, allergy
  • highly tested
  • risk of disease higher with non-vaccination

-explain vaccination schedule:
2,4,6,12, 18 months. Boosters at 4 years, 14 years

65
Q

Contraindications to immunization

A

MMR is live attenuated

  • egg allergy
  • neomycin allergy (preservative)
  • immunocompromise

-TdP- should not be given in first trimester of pregnancy

66
Q

History for insomnia

A

-Basic info: name, age, occupation, PMHx, PSHx, meds, allergies, smoking, alcohol, FMhx

  • chronology of sleep problems
  • sleep: when? where? night shifts? alcohol? caffeine?
  • time to bed, time waking up
  • what interventions so far?
  • diff falling asleep? waking up in the middle of the night? waking up early morning? daytime somnolence?
  • sleepiness while driving, working, conversation
  • snoring during sleep
  • depression: depressed mood, interests, guilty, concentration, attention, psychomotor, suicidal thoughts

-ROS

67
Q

Advice/Management of insomnia

A
  • regular bed/wake times
  • no daytime naps
  • regular exercise
  • do not use bed for reading, TV, work
  • avoid caffeine, alcohol, smoking
68
Q

Differential for multiple pain

A
  • depression with somatization (headache, stomach, sleep, eating, bowel habit)
  • somatization
  • conversion disorder
  • pain disorder
  • hypochondriasis
  • fibromyalgia
  • chronic fatigue syndrome
  • factitious disorder or malingering
69
Q

Criteria for somatization disorder

A
  • before age of 30
  • at least 8 physical symptoms that have no organic pathology
  • 4 pain symptoms at 4 different sites
  • 2 GI symptoms other than pain
  • 1 reproductive or sexual symptom other than pain
  • 1 pseudo-neurological symptom (e.g. temporary blindness)
70
Q

History for multiple pain syndrome

A

Pain description: location, duration, chronology, aggravating, relieving factors,

  • how has your health been for most of your life?
  • how has pain affected family? relationship with friends?
  • how often do you see a doctor?
  • is there something that you are worried about? a serious illness?

Basic info: PMHx, PSHx, meds, allergies, smoking, alcohol, depression history
ROS

71
Q

History for polymyalgia rheumatica and temporal arteritis

A
  • constitutional: low grade fever, malaise, anorexia, weight loss, muscle weakness, ache, pain, joint inflammation, jaw claudication, stroke
  • MSK: pain, stiffness of muscles in neck, shoulders, arms, hips, back, thighs, usually no weakness or atrophy
  • vision changes*
72
Q

Investigations for temporal arteritis

A 
CBC
ESR (>50)
CRP 
Liver enzymes
Temporal artery biopsy
73
Q

Management of temporal arteritis

A
  • if visual symptoms are absent: start prednisone therapy 2 years, biopsy result should be taken within 2 weeks
  • monitor ESR
  • if visual symptoms are present- admit, and give IV prednisone x 5 days
74
Q

History for 50 year old with elevated liver enzymes

AST>ALT

A

Basic info: PMHx, PSHx, meds, allergies, vaccinations, FMHx, smoking, alcohol

  • travel? blood transfusions? IV drug use? alcohol use?
  • CAGE questionnaire
  • Liver symptoms: jaundice, dark urine, pale stool, pruritis, easy bruising, bleeding
  • Abdo: pain, blood in stools, black stools, nausea, vomiting, vomiting blood
  • Constitutional symptoms: fever, chills, appetitie, weight loss, night sweats
  • sexual history: # partners, gender, STDs
  • ROS
75
Q

Differential for elevated LFTs

A
  1. Alcohol
  2. Infection: HBV, HCV
  3. Drugs/medications
  4. Cancer
  5. Cholestasis
  6. Hepatic ischemia

AST>ALT, AST/ALT> 2, with ASTAST= viral hepatitis

ALP, GGT are markers of cholestatis disease

  • intrinsic: toxic, infectious, inflammatory
  • systemic: sepsis, pregnancy
  • infiltrative: tumor, NASH
  • mass lesions
76
Q

Investigations for elevated liver enzymes

A
  • HBV, HCV, HAV serology
  • AST, ALT, GGT, alk phos
  • Billi
  • INR/PTT, albumin
  • glucose, ceruloplasmin, copper (wilson’s disease), ferritin (hemochromatosis)
  • ANA
  • Anti-smooth muscle antibody
  • Abdo US
  • Liver biopsy
77
Q 
Etiology of hematuria by age group 
0-20 
20-40 
40-60
>60
A 
0-20: glomerulonephritis, UTI, congenital 
20-40: UTI, stones, bladder tumor 
40-60: 
-males: bladder tumor, stones, UTI
-females: UTI, stones bladder tumor 
>60: 
Males: BPH, bladder tumor
Female: bladder tumor, UTI
78
Q

History for fatigue

A
  • onset, chronology
  • past episodes
  • limitations
  • associated with exertion
  • recent viral illness
  • hypothyroid symptoms: weight gain, cold intolerance, dry skin, brittle hair
  • chest pain
  • SOB- congestive heart failure
  • muscle pain?

-sleep history
sleep/wake times, shift work, alcohol, caffeine
trouble falling asleep vs trouble staying asleep
sleepiness while driving, working, conversation

-depression: SIGECAPS

79
Q

Ddx for fatigue

A
  • CHF
  • Thyroid disease
  • Sleep disturbance
  • Anemia
  • Depression
80
Q

Safety to go home with suicidal ideation

A
  • reason for suicidal attempts
  • current plan
  • access to lethal means
  • suicide note
  • given away possessions
  • previous attempts
  • social network
81
Q

Investigations for ankylosing spondylitis

A
  1. lumbar spine xray: fusion of sacroiliac joints, sacroilitis,syndesmophytes
  2. ESR
  3. HLA-B27 positive
82
Q

Ankylosing spondylitis associated conditions

A 
inflammatory arthritis
uveitis
psoriasis
IBD
amyloidosis
radiculopathy 
pericarditis 
angina
83
Q

Treatment for ankylosing spondylitis

A
  • physiotherapy, therapeutic exercises: swimming, back extension
  • pain control: indomethacin, naproxen
  • surgery in severe cases
84
Q

Clinical risk factors for fracture

A 
Advancing age
Previous fracture
Glucocorticoid therapy
Parental history of hip fracture
Low body weight
Current cigarette smoking
Excessive alcohol consumption
Rheumatoid arthritis
Secondary osteoporosis (eg, hypogonadism or premature menopause, malabsorption, chronic liver disease, inflammatory bowel disease)

LMCC (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions