Family Medicine Clerkship - Brainscape Flash Cards - Cases 6-10
Case 6: pharmacotherapy that offers most consistent relief for allergic rhinitis?
nasal corticosteroids
Case 6: MoA of pseudoephedrine and other decongestants, incl topical?
alpha-adrenoreceptor agonist
Case 6: ADRs of steroid nasal sprays?
URIs, epistaxis, pharyngitis
Case 6: intranasal corticos take ____ to have full effect?
2-4 weeks
Case 6: emergency dose of epi for anaphylaxis?
0.2 - 0.5 mg (0.2 - 0.5 mL of 1:1000 epi sol’n) SQ or IM, q15-30 mins
Case 7: What are the 5 A’s of smoking cessation counselling?
ASK, ADVISE in personalized manner, ASSESS readiness, ASSIST to quit, ARRANGE f/u
Case 7: bupropion dosing and schedule for smoking cessation?
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)
Case 7: efficacy of bupropion
increased 17% -> 30% vs placebo
Case 7: varenicline MoA
nicotine partial agonist
Case 7: ADRs of varenicline
nausea, trouble sleeping and anbl/vivid dreams
Case 7: varenicline efficacy
similar to bupropion
Case 7: best strategy for nicotine replacement
use a patch QD + PRNs of gum/lozenge/nasal spray/inhalers
Case 7: your patient smokes 25+ cigs/day, what dose of gum to Rx?
4mg, acidic beverages can decr absorption so d/c 15 mins prior
Case 7: NRTs are Pregnancy Class ___ drugs?
D
Case 7: bupropion and varenicline are Pregnancy Class ___ drugs?
C
Case PIMP: bleeding in diverticulosis vs. diverticulitis
much more common in diverticuLOSIS & usu painless, very rare in diverticuLITIS
Case PIMP: Wells’ Criteria for DVT?
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
Case PIMP: Sens/Spec of Homan’s Sign
10-54% sensitive, 39-89% specific
Case PIMP: telltale sign of Baker’s cyst?
crescent-shaped ecchymosis near either malleolus
Case PIMP: complications of diverticulitis
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
Case PIMP: triad of sx for diverticulitis
LLQ pain, leukocytosis, fever
Case PIMP: imaging to dx or r/o diverticulitis
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)
Case 9: WHO classification of anemia
Hb < 12 (women) or < 13 (men)
Case 9: b12 vs folate deficient macrocytic anemia?
b12 has elevated both MMA & homocysteine; folate is just homocysteine
Case 9: initial work-up of anemia
CBC w/ reticulocyte count (see Step Up p 326)
Case 9: B12 dosing schedule
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
Case 9: alcohol abuse commonly causes macrocytic anemia d/t ____ deficiency
FOLATE normal MMA & low homocysteine
Case 10: acute vs. subacute vs. chronic diarrhea
< 2 weeks | 2 - 4 weeks | > 4 weeks
Case 10: DDx for chronic diarrhea
Crohn’s, U.C., parasites, IBS, gluten intolerance, lactose intolerance
Case 10: Labs for acute diarrhea
stool leukocytes, guaic, electrolytes and renal fxn
Case 10: blood in the stool in setting of actue diarrhea = most likely organisms?
EHEC, EIEC, Yersinia spp, Shigella and Entamoeba histolytica
Case 10: tx options for suspected bacterial traveler’s diarrhea
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
Case 10: tx for c. diff
metronidazole or p.o. vanco
Case 10: what are warning signs of complicated diarrhea?
not improving after 48 hrs, dehydration, blood and high fever
