family medicine ( urgent care) rotation

Question 1

treat sore throat pain

Answer 1

viscous lidocaine swish and spit

Question 2

Treat allergic rhinitis may help with post nasal drip

Answer 2

flonase ( fluticasone proprionate) 50mcg spray 2 sprays in each nostril once daily

Question 3

Inflammatory marker of 2 and 4

Answer 3

HLA 2 and 4

Question 4

What is HLA B 27

Answer 4

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

Question 5

What is RSD ( reflex sympathetic dystrophy syndrome)

Answer 5

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.

Question 6

Which tick dz may present with straie

Answer 6

Bartonella

Question 7

I’m not so depleated that I need 50,000 IU vitamin D, but it;s pretty rough. What should I give

Answer 7

5000 IU daily

Question 8

had a stroke in the past, what do I need to listen for?

Answer 8

carotid bruit

Question 9

describe the dix hallpike

Answer 9

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

Question 10

avandia =Rosiglitazone

Answer 10

is a thiazoladinedione.

Question 11

Why are we weary of treating diabetes with TZD’s

Answer 11

bladder cancer

Question 12

Name the DPP4 inhibitors ( for diabetes…)

Answer 12

Generic Name Brand Name linagliptin Tradjenta saxagliptin Onglyza sitagliptin Januvia

Question 13

How do DPP4 inhibitors work

Answer 13

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.

Question 14

colcrys= colchacine. Used for

Answer 14

Treats and prevents gout attacks.

Question 15

liver spots

Answer 15

age spots due to age or UV radiation. no physiologic association with the liver

Question 16

Plaquenil = hydroxychloroquine

Answer 16

Treats or prevents malaria. Also used to treat lupus and arthritis Side effects: N, D, change in vision must see eye dr.

Question 17

minocycline is a

Answer 17

tetracycline. bacteriostatic

Question 18

panteprazole

Answer 18

n

Question 19

lomotil

Answer 19

m

Question 20

When should patients not take imodium to stop diarrhea

Answer 20

antibiotic induced- dont want to miss the development of C dif

Question 21

sinus infection what to do

Answer 21

augmentin if pen allergic zpack + nasonex

Question 22

low back pain with no sx into the legs

Answer 22

aleve BID for 10 days and a medrol dose pack

Question 23

I have this weird mass on my arm it is fluid filled but not something i can drain. what to do

Answer 23

send for US

Question 24

what is DHEA

Answer 24

an intermediate in the production of estrogen and androgen

Question 25

What is ALS

Answer 25

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

Question 26

Sympathetic and parasympathetic function, GO!

Answer 26

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

Question 27

venous stasis ( dermatitis)

Answer 27

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

Question 28

hormones of sympathetic vs parasympathetic NS

Answer 28

Sympathetic Epi and Norepi

Parasympathetic: acetylcholine

Question 29

IgA

Answer 29

Found on mucus membranes ( nose, breathing passages, digestive tract, ears, eyes, and vagina), saliva, tears, blood. 10-15% of our antibodies

Question 30

IgG

Answer 30

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

Question 31

IgM

Answer 31

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.

Question 32

IgE

Answer 32

Lungs, skin, mucus membranes. React to allergens and poisens. High in people with allergies.

Question 33

IgD

Answer 33

Found in tissue that lines the belly chest. Function not clear

Question 34

CMV, and congenital

Answer 34

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

Question 35

Parvo B 19 ( 5th disease)= erythema infectiousum

Answer 35

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.

Question 36

Hand foot and mouth disease = coxsackie

Answer 36

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

Question 37

Zithromax, tell me about it.

Answer 37

Bacteriostatic. macrolide.

Rides on WBC’s to the infection

Side effects: diarrhea, nausea, abd pain

shifty evidence days it causes irregular heartbeat

Question 38

MTHFR gene

Answer 38

pulmonary embolisms, addictions, fibromyalgia, miscarriages, schizophrenia, severe depression, cancer and autism

Question 39

ALS