Brainscape's Knowledge GenomeTM

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


See full index

From Flashcardlet > Family Medicine Case Files wk 5 & 6 > Flashcards

Family Medicine Case Files wk 5 & 6 Flashcards

0
Q

When are grass pollens typically present?

A
  • late spring through early fall

- but can be present year-round in warner weather too

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

Allergic shiners

A

-dark circles around the eyes related to vasodilation or nasal congestion

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

When is ragweed present?

A

-late summer and early fall

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

Antihistamines: MOA

A

-competitively antagonize the receptors for histamine, which is released from the mast cells

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

Decongestants: MOA? Use? Most common one used?

A
  • can be taken orally or intranasally
  • constrict the blood vessels of the nasal mucosa and reduce the overall volume of the mucosa
  • pseudophedrine is the most commonly used
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What can happen with chronic use of nasal decongestants?

A

-rebound hyperemia and worsening of sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

3 Sx of oral decongestants

A
  1. Tachy
  2. Trenors
  3. Insomnia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Leukotriene inhibitors: use?

A
  • indicated for both allergic rhinitis and maintenance tx for persistent asthma
  • especially useful in pts with both asthma and allergies or in pts whose asthma is triggered by allergies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Desensitization tx

A
  • used in pts who remain symptomatic despite mac medical tx
  • steps:
    1. Test to figure out specific antigens
    2. Inject pt with highly diluted antigen
    3. Inject weekly or bi-weekly while gradually increasing the concentration of the antigen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tx of anaphylaxis

A
  1. injection of aqueous epi 1:1,000 in a dose of 0.2 to 0.5 mL (0.2-0.5 mg) –> given subcutaneously or IM ASAP, can be repeated in 10-15min if needed
  2. Fluid replacement –> lots of fluid moves into interstitial space
  3. Antihistamines –> if severe
  4. Steroids –> if severe
  5. Bronchodilators –> if severe
    * *should be observed in hospital for 12-24 hrs bc sx can reoccur!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Status asthmaticus

A

-an airway obstruction that lasts for days or weeks and is refractory to tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

4 Most common causes of conjunctivitis?

A
  1. bacterial
  2. viral
  3. allergy
  4. chemical irritants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the most common bacterial causes of conjunctivitis?

A
  1. Staph
  2. Strep
  3. H. Influenzae
  4. Morexella
  5. Pseudo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bacterial Conjunctivitis: tx

A
  • can be self-limiting in 10-14 days

- give a sulfonamide instilled locally 3x daily to clear the infection in 2-3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common cause of epidemic keratoconjunctivitis? Tx?

A
  • adenovirus
  • highly contagious
  • tx:
    1. sulfonamide tx to prevent secondary infections
    2. Hot compress to reduce discomfort
    3. Weak topical steroids to tx corneal infiltrates
  • usually lasts 2 wks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Noninfectious causes of conjunctivitis: tx

A

-oral antihistamines or topical antihistamines or anti-inflammatory eye drops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What can be the cause of diarrhea if the stool was found to have leukocytes present in it?

A
  1. Salmonella
  2. Shigella
  3. Yersinia
  4. E. colic
  5. C. Diff
  6. Campylobacter
  7. Entamoeba histolytica
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Nephritic

A

-hematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Nephrotic

A

-proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Acute diarrhea

A

-present for less than 2 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Chronic diarrhea

A

-present for more than 4 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Subacute diarrhea

A

-present for 2-4 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Diarrhea in travler’s to Mexico

A

-caused by enterotoxigenic E. coli

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

Common cause of diarrhea in campers

A

-giardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Diarrhea from undercooked chicken

A

-salmonella or shigella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Diarrhea from undercooked hamburger

A

-enterohemorrhagic E. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Diarrhea from mayo

A
  1. Staph aureus

2. Salmonella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Diarrhea from raw seafood

A
  1. Vibrio
  2. Salmonella
  3. Hep A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Causes of illness after eating a mayo containing salad w/in 6 hrs, 8-12 hrs, or w/in 12-14 hrs

A
  • < 6 hrs = s. aureus
  • 8-12 hrs = c. Perfringens
  • 12-14 hrs = e. coli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

3 causes of diarrhea in daycare settings?

A
  1. Shigella
  2. Giardia
  3. Rotavirus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Dx of diarrhea?

A
  • most patients dont need work up bc disease is self limiting
  • exceptions:
    1. Fever > 100.4 *F
    2. Bloody diarrhea
    3. Severe abdominal pain
    4. Profuse diarrhea
    5. Dehydration
    6. > 48 hrs
    7. Kids, elderly, Immunoincomp pts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Ssx of traveler’s diarrhea

A
  1. > 3 loose stools in 24 hrs
  2. Abdominal cramping
  3. Nausea
  4. Vomiting
  5. Fever
  6. Tenesmus
    * *usually occurs within first 2 wks of travel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which antibiotics can cause c. diff?

A
  • classically associated w/ clindamycin, but ANY antibiotic can cause pseudomembranous colitis
  • most common:
    1. Clinda
    2. Cephalosporins
    3. Penicillins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the most common cause of diarrhea? Tx?

A
  • viral

- tx: rehydration, antibiotics WONT help!

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

OTC tx of acute diarrhea

A
  • will help slow down the frequency of the stool
  • can make certain infections worse bc they prevent your body from getting rid of the organism that is causing the diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Antibiotic prophylaxis for traveler’s diarrhea

A
  • not indicated unless the pt is at incased risk for complications from diarrhea or dehydration (ex inflammatory bowel dz, renal dz, or immunocomp)
  • fluoroquinolones are used
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Antibiotics for tx of acute diarrhea

A
  • can help with bacterial diarrhea
  • quinolones are usually used (ciprofloxacin) for 1 or 2 days
  • -cannot be used in children or pregnant women
  • azithromycin as a single dose in adults and for 3 days in children
  • -can be used in prego moms
  • rifaximin can be used in diarrhea caused by noninvasive strains of e. coli (wont work for fever or blood in stool)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Tx for diarrhea caused by c. diff?

A
  1. Metronidazole

2. Vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

When should you begin screening women for lipid disorders?

A

-age 45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Risk factors for breast cancer

A
  1. Having first child after age 30
  2. Family hx of breast cancer
  3. Personal hx of breast cancer or atypical hyperplasia found on previous breast bx
  4. Known carrier of BRCA-1 or BRCA-2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Recommendations for mammographies for general population?

A

-start at age 40 (or some sources say 50) and screen every 1-2 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Risk factors for cervical cancer (4)?

A
  1. Early onset of sexual intercourse
  2. Multiple sex partners
  3. HPV infections
  4. Tobacco use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

In what 2 groups of women apis cervical cancer seen in?

A
  1. Women not screened in over 5 yrs

2. Women who had an abnormal pap and did not follow-up on it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How many postmenopausal women will have an osteoporosis related fracture in their lifetime?

A

-HALF!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How is screening for osteoporosis done?

A
  • with a DXA scan = dual-energy x-ray absorptiometry
  • this is the best predictor of a hip fracture
  • measurement is compared to that of young adults –> result reported as a T score
  • osteoporosis = at or below 2.5 SD less than than that of the young adults
  • osteopenia = at or below 1.0-2.5 SD less
45
Q

Osteoporosis screening recommendations

A

-women > 65 & > 60 in higher risk women

46
Q

What are the calcium and vit D recommendations for women > 50 yrs

A
  • 1200mg calcium

- 400-800 IU of vit D per day

47
Q

What are 3 medications that can be used to tx hyperthyroidism? MOA? Sfx?

A
  1. Propylthiouracil –> preferred in pregnancy
  2. Methimazole
  3. Carbimazole
    - MOA: inhibit the organification of iodine
    - sfx: most serious = agranulocytosis
48
Q

What is the definitive tx of hyperthyroidism? What in a sfx? Who is it contraindicated in?

A
  • radioactive iodine –> destroys thyroid gland
  • 40% of pts will become hypothyroid & will need thyroid hormone replacement
  • contraindicated in pregnant women, bc fetus thyroid can take it up and it will destroy their thyroid too –> creatinism
49
Q

Thyroid storm

A
  • acute hypermetabolic state associated w/ sudden release of lg amnts of thyroid hormone into circulation
  • causes autonomic instability and CNS dysfunction
  • can cause altered mental status, coma, or seizures + fever, restlessness, or psychoticlike behavior
  • high mortality risk! MEDICAL EMERGENCY!
50
Q

What are the 3 most common causes of hyperthyroidism?

A
  1. Graves disease
  2. Autonomous nodule that secretes thyroxine
  3. Thyroiditis (usually early stage)
51
Q

What is the tx of choice for graves dz?

A
  • radioactive iodine

- as long as the pt is not pregnant, breastfeeding, or a child

52
Q

Tx of graves dz in adolescents?

A

-use antithyroid drugs bc Grave’s may go into spontaneous remission for them after 6-18 mnths

53
Q

Tx for thyroid storm

A
  1. High doses of propothyluracil (PTU)
  2. Beta blockers –> to control tachycardia and other peripheral sx
  3. Hydrocortisone –> prevent possible adrenal crisis
54
Q

3 most common causes of hypothyroidism?

A
  1. Hashimoto thyroiditis
  2. Post-Graves dz thyroid ablation and surgical removal of thyroid gland
  3. Secondary hypoTH related to hypothalamic or pituitary dysfunction
55
Q

Imaging and serologic testing for primary hypothyroidism

A

-once dx for primary hypoTH is made and the thyroid is normal on physical exam, no other tests are required

56
Q

What should be done when a thyroid nodule is found?

A

-further work-up bc 5-6% of identified nodules are malignant

57
Q

In what ots are thyroid nodules more likely to be malignant in?

A
  1. children
  2. adults younger than 30
  3. adults older than 60
  4. pts with hx of head or neck irradiation
58
Q

Lubiprstone: MOA? Use? Sfx?

A
  • MOA: activates intestinal chloride channels and increases fluid secretion
  • use: for IBS in women with constipation
  • sfx: nausea
59
Q

Describe the abdominal pain commonly seen with fibromyalgia

A
  • usually in the lower abdomen, esp in the left lower quadrant
  • cramping pain of intermittent frequency and variable intensity
  • pain often improves or is relieved with defication
  • pain will NOT wake a person up from sleep
60
Q

IBS dx

A
  • in absence of structural or biochemical explanation (or “alarm features”) of sx and the Rome Criteria a pt can be dx
  • avoid expensive and unnecessary tests when possible
  • a CBC and stool Hemoccult test should be done!
  • a colonoscopy should be done in any pt > 50 yrs old!
61
Q

“Alarm features” of GI sx

A
  1. Fever
  2. Anemia
  3. Involuntary weight loss of > 10 lbs
  4. Hematochezia
  5. Melena
  6. Refractory or bloody diarrhea
  7. Family hx of colon cancer of inflammatory bowel dz
    * *these usually point to an underlying organic etiology & may warrant further workup
62
Q

Tx of abdominal pain with IBS?

A
  1. Antispasmodics –> dicyclomine and hyoscyamine as needed

2. Low-dose tricyclic antidepressants –> when pain is frequent and severe

63
Q

Tx for pts with IBS and depression or anxiety?

A

-SSRIs

64
Q

Tx for constipation-predominant IBS

A

-increase giber intake, via diet or supplement

65
Q

Tx for diarrhea-predominant IBS

A
  • Loperamide

- reduces frequency of loose stools and urgency

66
Q

How to remove a stinger

A
  • remove ASAP
  • better to scrape or brush the stinger off the skin, rather than grasp it bc grasping it at the base can compress the venom-containing sac and causes increased venom release
  • BUT its better to rapidly remove the stinger than to spend time looking around for something to scrape the stinger out with (ex credit card)
67
Q

Hymenoptera

A
  • order of insects that cause the most insect stings
  • includes:
    1. Wasps
    2. Yellow-jackets
    3. Hornets
    4. Honeybees
    5. Bumblebees
    6. Fire ants
68
Q

Local rxns of insect stings: ssx? When do they occur? Tx?

A
  • ssx: redness, swelling, pain, & itching
  • occur almost immediately, last for a few hrs
  • caused by histamine release in response to the venom
  • tx: ice and anti-histamine ps for itching
  • also give TETANUS prophylaxis
69
Q

Delayed rxns to insect stings?

A
  • large local rxns mediated by immunoglobulins (IgE) that are reactive to the venom
  • lg (> 10 cm in diameter) area of redness and warmth–> often confused with cellulitis
  • develops 24-48 hrs later
  • tx: oral steroids
  • tetanus prophylaxis should be done!
    • a person with a lg delayed rxn to a sting is more likely to have another one in the future, but this does not change their risk or anaphylaxis
70
Q

4 most common animal bites causing rabies in US?

A
  1. Bats
  2. Skunks
  3. Dogs
  4. Foxes
71
Q

Tx of animal bites

A
  1. Clean wound with soap and water
  2. Irrigate the wound with saline
  3. Debridement
  4. Tetanus vaccine if needed
  5. Contact animal control about rabies
  6. 5-7 days of antibiotic prophylaxis (amoxicillin-clavulanate = augmentin), or longer if cellulitis is present
  7. Hospitalization or surgery might be necessary if severe!
72
Q

Risk factors for animal bites becoming infected?

A
  1. Larger
  2. Deeper
  3. Hand wounds
  4. Presence of chronic illness or immune suppression
  5. Cat & humans > dogs to become infectious
73
Q

4 Common bacteria involved in cat and dog bites?

A
  1. Staphylococci
  2. Streptococci
  3. Anaerobic species
  4. Pasturella species
74
Q

5 species common in human bites?

A
  1. Staphylococci
  2. Streptococci
  3. Haemophilus species
  4. Eikenella species
  5. Anaerobes
75
Q

What is the most common bacteria involved in human bites that cause a closed fist injury?

A

-eikenella species

76
Q

Anosognosia

A

-no awareness of disability

77
Q

Work up for pt that presents with stroke sx?

A
  1. CT scan WITHOUT contrast –> look for hemorrhage, tumor, abcess
  2. Glucose level
  3. Drug screen
  4. Coagulation studies
  5. Serum electrolytes
  6. Renal function tests
  7. Lipid profile
  8. CBC
  9. Ekg
78
Q

Transient ischemic attack

A

-a focal neurologic deficit lasting less than 24 hrs

79
Q

Residual ischemic neurological deficit (RIND)

A

-a neurologic deficit of greater than 24 hrs and less than 3 wks

80
Q

Risk factors for a stroke?

A
  1. HTN –> most important!
  2. DM
  3. Age
  4. Male sex
  5. Family hx
  6. Dyslipidemia
  7. Smoking
  8. Certain CV conditions –> a fib, MI, endocarditis, carotid stenosis, rheumatic heart dz, presence of mechanical valve, advanced dilated cardiomyopathy, patent foramen ovale or AsD
81
Q

What disease puts children at risk for a stroke?

A

-sickle cell anemia

82
Q

Ssx of vertebrobasilar strokes?

A
  1. Motor or sensory loss of ALL 4 limbs
  2. Crossed signs
  3. Disconjugate gaze
  4. Nystagmus
  5. Dysarthria
  6. Dysphagia
83
Q

Tx of HTN with strokes

A
  • unless a hypertensive encephalopathy, aortic dissection, acute renal failure, or PE is present, tx of HTN should be cautious!
  • give anti-HTN meds when systolic BP is > 220 or diastolic is > 120
  • if anti-thrombolitics will be given, then decrease pts systolic P to < 185 and diastolic to < 110
  • most commonly used:
    1. Labetalol
    2. Nicardipine
    3. Sodium nitroprusside
84
Q

Aspirin and strokes

A
  • most pts w/ non-hemorrhagic stroke should receive aspirin w/in first 48hrs
  • EXCEPT when anti-thrombolytics are given
85
Q

Contraindications to TPA

A
  1. Stroke occurred > 3 hrs ago
  2. Recent surgery
  3. Trauma
  4. GI bleeding
  5. MI
  6. Use of certain anticoag meds
  7. Uncontrolled HTN
86
Q

Poststroke cerebral edema tx

A
  • mannitol

- decompression surgery

87
Q

What is the LDL goal for a pt that had a stroke?

A

-less than 100

88
Q

P. jiroveci pnuemonia: ssx?

A
  1. Nonproductive cough
  2. Fever
  3. Dyspnea that worsens over few days to few weeks
  4. Tachypenia
  5. Hypoxic
  6. Bilateral infiltrates seen on CXR w/ “ground glass” appearance
89
Q

Prophylaxis for P. jiroveci?

A

-TMP/SMX in HIV pts with CD4 count < 200 cells/microL

90
Q

AIDS

A
  • advanced stage of HIV infection

- opportunistic infections are required for the dx

91
Q

What are the 3 laboratory categories of HIV pts?

A
  1. CD4 cell count of 500 or more
  2. CD4 cell count of 200-499
  3. CD4 cell count of < 200 cells
92
Q

HIV clinical category A

A
  • asymptomatic
  • primary infection and generalized lymphadenopathy
  • persistent generalized lymphadenopathy = enlarged lymph nodes that involve at least 2 noncontiguous sites other than inguinal nodes
93
Q

HIV category B

A

-have symptomatic conditions that are either indicative of a defect in cell-mediated immunity or that are complicated by HIV infections (NOT AIDS defining infections!)

94
Q

HIV category C

A

-symptomatic AIDS defining conditions

95
Q

HIV dx

A
  • standard screening test = ELISA

- positive ELISAs must be confirmed with Western Blot to rule out false positives

96
Q

Once HIV is dx, what should be done before tx?

A
  • report to local health authorities –> partner notification laws vary by state
  • HIV genotype testing –> to ID strains that may be resistant to tx
  • determine HIV RNA levels to help assess the disease activity
  • measure CD4 lymphocyte counts
  • CBC, metabolic panel, & urinalysis
  • screening for other STDs
  • PPD
97
Q

Mycobacterium avium prophylaxis

A
  • should be initiated in HIV pts if their CD4 count falls to less than 75 cells/microL
  • azithromycin
98
Q

What is usually the cause of prehepatic jaundice?

A
  • hemolysis of RBCs
  • they overwhelm the liver’s ability to conjugate and clear the bilirubin through its normal pthwys
  • causes hyperbilirubinemia of unconjugated bilirubin
99
Q

Causes of hepatic hyperbilirubinemia

A
  • causes either conjugated or unconjugated hyperbilirubinemia
  • viruses and alcohol decrease the liver’s ability to transport bilirubin AFTER it has been conjugated, so get conjugated hyperbilirubinemia
100
Q

Causes of posthepatic jaundice

A
  • usually caused by obstruction to the flow of bile through the bile ducts
  • can be caused by stones, strictures, or tumors
  • get a conjugated hyperbilirubinemia
101
Q

What is measured in the direct bilirubin?

A

-the conjugated bilirubin

102
Q

Which bilirubin is excreted in the urine? What does a high level mean?

A
  • conjugated

- high urine level = conjugated hyperbilirubinemia

103
Q

Which bilirubin can be high in Gilbert’s syndrome?

A

-unconjugated

104
Q

Hepatitis A: ssx? Incubation period? Transmission period? How long does the illness last? Tx?

A
  • ssx: jaundice, fever, malaise, abdominal discomfort
  • incubation period: 2-8 wks
  • transmission: possible for 2-3 weeks after symptoms begin
  • lasts: 4-6 wks (buts can last up to 6 mnths)
  • tx: supportive
105
Q

Hep B and hepatocellular carcinoma

A

-hep B causes 80% of the hepatocellular carcinoma cases worldwide

106
Q

What does anti-HBcAg IgM mean?

A

-acute hep B infection

107
Q

Tx of acute Hep B v. Chronic Hep B? Acute –> chronic?

A
  • acute = supportive
  • chronic = antiviral tx
  • the younger the pt = the more likely an acute infection is to become chronic
108
Q

Hep B vaccine recommendations

A
  • universally for all children

- adults at high risk

109
Q

Most common cause of chronic liver dz in the US?

A

-hepatitis C

From Flashcardlet (79 decks)

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