Family Medicine Clerkship - Brainscape Flash Cards - Cases 6-10

Question 1

Case 6: pharmacotherapy that offers most consistent relief for allergic rhinitis?

Answer 1

nasal corticosteroids

Question 2

Case 6: MoA of pseudoephedrine and other decongestants, incl topical?

Answer 2

alpha-adrenoreceptor agonist

Question 3

Case 6: ADRs of steroid nasal sprays?

Answer 3

URIs, epistaxis, pharyngitis

Question 4

Case 6: intranasal corticos take ____ to have full effect?

Answer 4

2-4 weeks

Question 5

Case 6: emergency dose of epi for anaphylaxis?

Answer 5

0.2 - 0.5 mg (0.2 - 0.5 mL of 1:1000 epi sol’n) SQ or IM, q15-30 mins

Question 6

Case 7: What are the 5 A’s of smoking cessation counselling?

Answer 6

ASK, ADVISE in personalized manner, ASSESS readiness, ASSIST to quit, ARRANGE f/u

Question 7

Case 7: bupropion dosing and schedule for smoking cessation?

Answer 7

start 1-2 weeks prior to quit date, 150 mg QD x 3d then 150mg BID; continue 7-12 mos (can be up to 6 mos)

Question 8

Case 7: efficacy of bupropion

Answer 8

increased 17% -> 30% vs placebo

Question 9

Case 7: varenicline MoA

Answer 9

nicotine partial agonist

Question 10

Case 7: ADRs of varenicline

Answer 10

nausea, trouble sleeping and anbl/vivid dreams

Question 11

Case 7: varenicline efficacy

Answer 11

similar to bupropion

Question 12

Case 7: best strategy for nicotine replacement

Answer 12

use a patch QD + PRNs of gum/lozenge/nasal spray/inhalers

Question 13

Case 7: your patient smokes 25+ cigs/day, what dose of gum to Rx?

Answer 13

4mg, acidic beverages can decr absorption so d/c 15 mins prior

Question 14

Case 7: NRTs are Pregnancy Class ___ drugs?

Answer 14

D

Question 15

Case 7: bupropion and varenicline are Pregnancy Class ___ drugs?

Answer 15

C

Question 16

Case PIMP: bleeding in diverticulosis vs. diverticulitis

Answer 16

much more common in diverticuLOSIS & usu painless, very rare in diverticuLITIS

Question 17

Case PIMP: Wells’ Criteria for DVT?

Answer 17

1 pt each, 3+ pts = incr likelihood; RISK FACTORS: A) active cancer, B) paralysis/paresis +/- plaster imobilization of LE C) bedridden 3+ days OR h/o surg in past 4 weeks; SIGNS:A) asymmetrical calf swelling (>3 cm, 10 cm inf to tibial tuberosity, B) superficial leg (non-varicose) leg veins, C) entire leg swollen, D) assymetrica pitting edema, E) localized tenderness along DV distrib.; MINUS 2 pts for alternative dx equally or more likely

Question 18

Case PIMP: Sens/Spec of Homan’s Sign

Answer 18

10-54% sensitive, 39-89% specific

Question 19

Case PIMP: telltale sign of Baker’s cyst?

Answer 19

crescent-shaped ecchymosis near either malleolus

Question 20

Case PIMP: complications of diverticulitis

Answer 20

1) abscess formation (drain CT-guided or surg), 2) colovesical fistual (50% close spont, accts for 50% of fistulae w/ divertic), 3) obstruction, 4) FREE COLONIC PERF

Question 21

Case PIMP: triad of sx for diverticulitis

Answer 21

LLQ pain, leukocytosis, fever

Question 22

Case PIMP: imaging to dx or r/o diverticulitis

Answer 22

CT w/ oral & IV constrast = ToC; xray to r/o free air, ileus +/- obstruction; do NOT use barium enema or colonoscopy d/t r/o perf (vs. barium enema is ToC for diverticuLOSIS)

Question 23

Case 9: WHO classification of anemia

Answer 23

Hb < 12 (women) or < 13 (men)

Question 24

Case 9: b12 vs folate deficient macrocytic anemia?

Answer 24

b12 has elevated both MMA & homocysteine; folate is just homocysteine

Question 25

Case 9: initial work-up of anemia

Answer 25

CBC w/ reticulocyte count (see Step Up p 326)

Question 26

Case 9: B12 dosing schedule

Answer 26

1000 ug IM qD for 1 week, qW for 1 month, qM pour la reste de leur vie; newer research suggests 1000-2000 ug PO qD might be just as effective

Question 27

Case 9: alcohol abuse commonly causes macrocytic anemia d/t ____ deficiency

Answer 27

FOLATE normal MMA & low homocysteine

Question 28

Case 10: acute vs. subacute vs. chronic diarrhea

Answer 28

< 2 weeks | 2 - 4 weeks | > 4 weeks

Question 29

Case 10: DDx for chronic diarrhea

Answer 29

Crohn’s, U.C., parasites, IBS, gluten intolerance, lactose intolerance

Question 30

Case 10: Labs for acute diarrhea

Answer 30

stool leukocytes, guaic, electrolytes and renal fxn

Question 31

Case 10: blood in the stool in setting of actue diarrhea = most likely organisms?

Answer 31

EHEC, EIEC, Yersinia spp, Shigella and Entamoeba histolytica

Question 32

Case 10: tx options for suspected bacterial traveler’s diarrhea

Answer 32

cipro 500 mg bid x 1-3 d (no preg pts); azithro 1000mg p.o. STAT for adults or 10 mg/kg/d p.o. X 3d for kids

Question 33

Case 10: tx for c. diff

Answer 33

metronidazole or p.o. vanco

Question 34

Case 10: what are warning signs of complicated diarrhea?

Answer 34

not improving after 48 hrs, dehydration, blood and high fever