family medicine ( urgent care) rotation Flashcards
treat sore throat pain
viscous lidocaine swish and spit
Treat allergic rhinitis may help with post nasal drip
flonase ( fluticasone proprionate) 50mcg spray 2 sprays in each nostril once daily
Inflammatory marker of 2 and 4
HLA 2 and 4
What is HLA B 27
while 90% of people with ankylosing spondylitis (AS) are HLA-B27 positive, only a fraction of people with HLA-B27 ever develop AS. such as reactive arthritis (Reiter’s Syndrome), certain eye disorders such as acute anterior uveitis and iritis, psoriatic arthritis and ulcerative colitis associated spondyloarthritis. The shared association with HLA-B27 leads to increased clustering of these diseases
What is RSD ( reflex sympathetic dystrophy syndrome)
The symptoms of reflex sympathetic dystrophy syndrome typically begin with burning pain, especially in an arm, finger(s), palm of the hand(s), and/or shoulder(s). In some individuals, RSDS may occur in one or both legs or it may be localized to one knee or hip. Frequently, RSDS may be misdiagnosed as a painful nerve injury. The skin over the affected area(s) may become swollen (edema) and inflamed. Affected skin may be extremely sensitive to touch and to hot or cold temperatures (cutaneous hypersensitivity). The affected limb(s) may perspire excessively and be warm to the touch (vasomotor instability). The exact cause of RSDS is not fully understood, although it may be associated with injury to the nerves, trauma, surgery, atherosclerotic cardiovascular disease, infection, or radiation therapy.
Which tick dz may present with straie
Bartonella
I’m not so depleated that I need 50,000 IU vitamin D, but it;s pretty rough. What should I give
5000 IU daily
had a stroke in the past, what do I need to listen for?
carotid bruit
describe the dix hallpike
turn head to 45 degrees while sitting. quickly lay back with head extended over the edge of the table and observe eyes for nystagmus. sit up let rest and do the other side
avandia =Rosiglitazone
is a thiazoladinedione.
Why are we weary of treating diabetes with TZD’s
bladder cancer
Name the DPP4 inhibitors ( for diabetes…)
Generic Name Brand Name linagliptin Tradjenta saxagliptin Onglyza sitagliptin Januvia
How do DPP4 inhibitors work
Incretin is a natural hormone that your body makes. It tells your body to release insulin after you eat. Insulin lowers blood sugar. When your body makes incretin, an enzyme called dipeptidyl peptidase-4 (DPP-4) removes it from your body. This is a normal, healthy process for people without diabetes. Some people with type 2 diabetes do not make enough incretin. This is where DPP-4 inhibitor medicines are helpful. Stopping (inhibiting) DPP-4 helps the incretin that is in the body to stay there longer. This triggers insulin to be released, which lowers blood sugar.
colcrys= colchacine. Used for
Treats and prevents gout attacks.
liver spots
age spots due to age or UV radiation. no physiologic association with the liver
Plaquenil = hydroxychloroquine
Treats or prevents malaria. Also used to treat lupus and arthritis Side effects: N, D, change in vision must see eye dr.
minocycline is a
tetracycline. bacteriostatic
panteprazole
n
lomotil
m
When should patients not take imodium to stop diarrhea
antibiotic induced- dont want to miss the development of C dif
sinus infection what to do
augmentin if pen allergic zpack + nasonex
low back pain with no sx into the legs
aleve BID for 10 days and a medrol dose pack
I have this weird mass on my arm it is fluid filled but not something i can drain. what to do
send for US
what is DHEA
an intermediate in the production of estrogen and androgen
What is ALS
lou gehrigs - progressive degeneration of the motor neurons in ALS eventually leads to their death. When the motor neurons die, the ability of the brain to initiate and control muscle movement is lost. no treatment. riluzole is the only known drug at this time that slows progression
Sympathetic and parasympathetic function, GO!
Sympathetic: pupil dilation, accelerated heart rate, dilated bronchioles, stop digestion, increase epi and norepi release from adrenal, inhibit paristalsis and excertion, relax bladder
Parasympathetic: pupil constriction, decreased heart rate, constricted bronchioles, stimulates digestion and bile release, stimulates peristalsis and excretion, constricts bladder
venous stasis ( dermatitis)
Due to venous insufficiency/ hypertension.
Dx: Dopplar studies to r/o dvt or view incompetant valves.
TX: compression stockings. Be sure to evaluate arterial flow before perscribing or this may cause problems. Apply before getting out of bed in the morning. DIscomfort will lessen as edema resolves
without treatment, ulcers may result
hormones of sympathetic vs parasympathetic NS
Sympathetic Epi and Norepi
Parasympathetic: acetylcholine
IgA
Found on mucus membranes ( nose, breathing passages, digestive tract, ears, eyes, and vagina), saliva, tears, blood. 10-15% of our antibodies
IgG
Smallest and most abundant (75-80%). Found in all body fluids. Fight bacterial and viral infections. The only antibody that can cross the placenta to protect the fetus. synthesized by plasma B cells. Lots in colostrum
IgM
Found in blood and lymph. Are the first to respond to an infection. The largest of the antibodies. Tell other immune cells to destroy forgein substances. 5-10% of all antibodies.
IgE
Lungs, skin, mucus membranes. React to allergens and poisens. High in people with allergies.
IgD
Found in tissue that lines the belly chest. Function not clear
CMV, and congenital
A herpes infection (5). Asymptomatic in healthy people but can be life threatening to immunosuppressed. May cause blindness, encephalitis, hepatitis, seizures, pneumonia. Transmit by all body fluids and via placenta. up to 75% of transplant recipients get it.
SX: fever, lymphadenopathy, sore throat, myalgias, anorexia, fatigue ( monolike sx)
Dx: culture or antibody detection
TX: no Tx
Congenital: TORCH. hydrops fetalis, sensorineural hearing loss. jaundice, low birthweight, rash, seizure, hepatosplenomegaly
Parvo B 19 ( 5th disease)= erythema infectiousum
Little symptoms in a child but presents similar to Lyme in an adult.
Transmit by respiratory droplets( or blood). Contageous before symptomatic, probably not after then. 50% likely to pass to household contacts. 25% likely to pass to classroom contacts.
IgG= should be immune ot future infection. Not always
SX: begin ~6 days post exposure. fever HA, N, D. fever breaks, cheeks get red, lacey ( reticular rash) on trunk and extremities.
Congenital: hydrops fetalis due to severe anemia. worst if weeks 14-20 of preg.
Hand foot and mouth disease = coxsackie
SX: fever, malaise, sore throat, painful blisters of tongue gums and cheeks, red rash of palms, soles, buttock, irritability, loss of appetite
Spread by: Nasal secretions or throat discharge,
Saliva,
Fluid from blisters,
Stool,
Respiratory droplets
MC in summer and fall
Antibodies usually develop so older dont usually get it, usually affects under 10 years old
comlications: dehydration BC, hepatitis, meningitis
TX: symptomatic only: tylenol or motrin, a topic anesthetic for mouth
Zithromax, tell me about it.
Bacteriostatic. macrolide.
Rides on WBC’s to the infection
Side effects: diarrhea, nausea, abd pain
shifty evidence days it causes irregular heartbeat
MTHFR gene
pulmonary embolisms, addictions, fibromyalgia, miscarriages, schizophrenia, severe depression, cancer and autism
ALS
