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Primary Care 2 > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Examples of neurodevelopmental disorders

A

ADHD, autism, ID, cerebral palsy

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2
Q

Environmental causes of neurodevelopmental disorders

A

Prenatal alcohol, hypoxic brain injury, lead toxicity

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3
Q

Genetic causes of neurodevelopmental disorders

A

Metabolic PKU, trisomy 21, fragile X

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4
Q

Impaired social communication, repetitive and stereotyped behavior, interests and activities

A

Autism

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5
Q

Geriatrics

A

<60

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6
Q

Goal in geriatric care

A

optimize function

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7
Q

What to assess in geriatric

A

Function, gait, cognition, fall risk, polypharmacy, social support, finances, advanced care planning

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8
Q

5 I’s of geriatric assessment

A

intellectual impairment, iatrogenic disorders, incontinence, immobility, instability

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9
Q

Mini cog exam

A

3 item recall + clock

If you get all 3 items correct, you do not need to do the clock drawing

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10
Q

2 question screen

A

for depression

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11
Q

BEERS criteria

A

Anticholinergics, antihistamines, benzodiazepines, muscle relaxants, antihistamines, nitrofurantoin, alpha 1 blockers, TCAs, 1st gen antipsychotics

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12
Q

Most common incontinence

A

Urge

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13
Q

BPH type of incontinence

A

Overflow

Treat with alpha blockers

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14
Q

Neuro incontinence

A

Urge

Treat with anticholinergics

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15
Q

Decreased musculature incontinence

A

Stress

treat with kegals

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16
Q

Normal sleep cycle for geriatrics

A

3-5 hours

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17
Q

Osteoporosis

A

> 2.5 SD below mean on DEXA scan

Due to decreased estrogen, calcium and vitamin D, exercise, and increased alcohol

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18
Q

Sarcopenia

A

Decreased muscle mass

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19
Q

Presbyopia

A

Decreased near vision due to stiffness of lens

Need reading glasses

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20
Q

Presbycusis

A

Decreased hearing, especially high pitched sounds

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21
Q

Frailness

A

Decreased weight, weakness, slow walking speed, exhaustion, decreased activity

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22
Q

Xerostemia

A

Dry mouth

Treat with pilocarpine or cevimeline

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23
Q

Dysphagia

A

Difficulty swallowing

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24
Q

Pharmacokinetics

A

Absorption, distribution, metabolism, elimination

Zinc, calcium, iron, multivitamins alter absorption

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25
Q

Pharmacodynamics

A

How the body responds to drugs

Decreased baroreceptor response in elderly and increased sensitivity to anticholinergics

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26
Q

Aim of palliative care

A

Improve quality of life

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27
Q

nociceptive pain

A

Localized, sharp or throbbing or aching

Use NSAIDs, acetaminophen, opioids

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28
Q

Neuropathic pain

A

Burning

Use amitriptyline, neurontin, lidocain patch, capsaicin

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29
Q

Avoid what opioids in renal failure

A

Morphine

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30
Q

What opioids are safest for renal failure

A

Fentanyl and methadone

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31
Q

Treatment of dyspnea in palliative care

A

Morphine

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32
Q

Metabolic syndrome

A

High fasting blood sugar, high BP, High triglycerides, truncal obesity, low HDL, xanthomas

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33
Q

Diagnostic for insulin resistance

A

gold standard is euglycemic insulin clamp technique or fasting plasma insulin concentration (increased plasma insulin and normal glucose=insulin resistance)

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34
Q

Where is cholesterol synthesized

A

in the liver

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35
Q

Medications that may cause elevated cholesterol and lipids

A

Amiodarone, steroids, cyclosporine, beta blockers

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36
Q

When should you repeat lipid panel

A

4-12 weeks after initiating lipid lowering therapy

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37
Q

Goals/high values for cholesterol

A

Total: goal <200, 200-239 borderline, >240 high
LDL: Goal <100, 100-129 above normal, 130-160 borderline high, >160 high
HDL: Goal >60 for cardioprotective, <40 major risk
Triglycerides: Goal <150, >500 high, >1000 risk of pancreatitis

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38
Q

SE statins

A

myopathy (check CK levels), hepatic inflammation (check LFT)

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39
Q

When to take statins

A

bedtime

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40
Q

Target groups for statins

A

> 190 LDL
DM and LDL 70-189 and age 40-75
CVD disease
ASCVD risk >7.5%

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41
Q

Xanthelasma

A

Yellow fatty deposits on eyelids

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42
Q

Xanthomas

A

Fatty deposits on elbows, knees, joints

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43
Q

Secondary hypertension due to

A

Renal stenosis, pheochromocytoma, coarctation of aorta, cushing disease, thyroid disease, alcohol, OCP, steroids

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44
Q

Consider secondary htn if age

A

<30 or >65

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45
Q

Goals of BP

A

<60 age <140/90
>60 age <150/90
DM regardless of age <140/90

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46
Q

If BP goal not reached within 1 month

A

Increase dose or add another med

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47
Q

Masked HTN

A

Normal in office but high out of office

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48
Q

Symptoms of end organ damage in htn

A

blindness, loss of visual acuity, headaches, confusion, seizures, impotence, claudication, chest pain, dyspnea, palpitations, syncope, hematuria, dysuria, oliguria

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49
Q

monitor what after starting ACEI/ARB or diuretic

A

K+ and renal function

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50
Q

Risk factors for PAD

A

HTN, DM, increased lipids, tobacco use

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51
Q

Symptoms of PAD

A

poor wound healing, claudication, dependent rubor, loss of hair on extremities

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52
Q

Dx for PAD

A

ABI <0.9, US, Angiogram

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53
Q

PE for PAD

A

Pain, pulseless, paresthesia, pallor

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54
Q

Tx PAD

A

aspirin, statin, BP control, DM control, compression stockings, decrease smoking

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55
Q

HF with reduced EF

A

Systolic HF–LV

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56
Q

HF with normal EF

A

Diastolic HF–RV

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57
Q

Sx/PE of HF

A

Dyspnea, fatigue, edema, JVD

S3 heart sound, crackles, hepatomegaly, displaced PMI, cardiac enlargement

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58
Q

Gold standard for diagnosing HF

A

Echo

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59
Q

Strongest marker for HF prediction

A

BNP

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60
Q

Chest X ray can show what in HF

A

Cardiac enlargement

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61
Q

Daily weights in HF

A

Call if >2ib in 1 day or 5ib in 1 week

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62
Q

Tx of HF

A

Beta blocker, ACEI/ARB, loop diuretic, spirinolactone

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63
Q

What meds should you avoid in HF

A

NSAIDs, and CCB

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64
Q

Beta blockers recommended for HF

A

Carvedilol, metoprolol, bisoprolol

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65
Q

S1 and S2

A

S1: closure of AV valves
S2: closure of SL valves

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66
Q

Systolic murmurs

A 
Aortic stenosis
Pulmonary stenosis
Tricuspid regurg
Mitral regurg
MVP
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67
Q

Diastolic murmurs

A

Aortic regurg
Pulmonary regurg
Tricuspid stenosis
Mitral stenosis

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68
Q

Harsh crescendo-de-crescendo murmur

A

AS

69
Q

Midsystolic click

A

MVP

70
Q

MVP tx

A

beta blockers, ACEI

71
Q

Most important goal in A fib control

A

Ventricular rate control

72
Q

1st degree AV block

A

Prolonged PR interval but always has a QRS

73
Q

2nd degree AV block type 1

A

Prolonged PR interval increasing until QRS dropped

74
Q

2nd degree AV block type 2

A

Prolonged or normal PR interval and random QRS drop

75
Q

3rd degree AV block

A

No relationship between PR and QRS

76
Q

Adduction

A

movement towards midline of body

77
Q

Abduction

A

Movement away from midline of body

78
Q

Most common malignant tumor of bone

A

multiple myeloma

79
Q

Labs in multiple myeloma

A

Increased alkaline phosphatase, bence jones proteins, M spike, Increased CRP and ESR

80
Q

Pain management in bone tumors

A

Vertebroplast, radiation, biphosphonates

81
Q

Shoulder injuries hurt more often when

A

Arm is elevated

82
Q

Radiculopathy feel better when

A

Arm elevated

83
Q

Tests for shoulder

A

Apprehension, empty can, drop arm, impingement, Hawkin, NEER

84
Q

Adhesive capsulitis

A

Shoulder immobilization or gradual onset of shoulder pain

85
Q

Medial epicondylitis

A

Golfers elbow

86
Q

Lateral epicondylitis

A

Tennis elbow

87
Q

ROM testing for elbow

A

Flexion, extension, suppination, pronation

88
Q

Treatment of fibromyalgia

A

Amitriptyline, SSRI, cyclobenzaprine

89
Q

Dx for fibromyalgia

A

> 7 tender points for >3 months

90
Q

Symmetric wrist/hand pain

A

Think RA, SLE or malignancy

91
Q

Tests for capal tunnel

A

Phalen

Tinnel–push on median nerve

92
Q

Most common cause of secondary osteoporosis

A

Steroids

93
Q

DEXA scan recommended

A

Women >65 and men >70

94
Q

Recommendations for Ca and Vit D

A

Ca 1000-1200mg daily

Vit D 800-1000 daily

95
Q

Medications for osteoporosis

A

Biphosphonates, denosumab, calcitonin, taloxifene

96
Q

Education for biphosphanates

A

Do not lie down for 30 minutes-60 minutes after

CI in esophageal dysmotility

97
Q

Master controller

A

Hypothalamus

98
Q

Anterior pituitary hormones

A

FLAT PEG

FSH, LH, ACTH, TSH, Prolactin, Endoprhins, growth hormones

99
Q

Posterior pituitary hormones

A

Oxytocin, ADH

100
Q

Begin DM screening

A

Age 45

101
Q

Dx for diabertes

A

Random BG >200
Fasting BG >126
A1C >6.5

102
Q

Dx for pre-diabetes

A

Random BG 140-199
Fasting BG 100-125
A1C 5.7-6.4

103
Q

Somogyi effect

A

Rebound hyperglycemic in the morning due to hypoglycemic in the middle of the night–give less night time insulin

104
Q

Dawn phenomenon

A

High hyperglycemia in the morning due to growth hormones released at night–increase night time insulin dose

105
Q

Rapid acting insulin

A

Lispro, aspart, glusiline

106
Q

long acting insulin

A

Detemir, glargine

107
Q

Microvascular complications of DM

A

Retinopathy, neuropathy, nephropathy

108
Q

Macrovascular complications of DM

A

CAD, PVD, stroke

109
Q

Secondary causes of DM

A

Pheochromocystoma, cushing, acromegaly, hypokalemia, hyperaldosterone, diuretic use, pancreatitis, drug induced

110
Q

DKA S/S

A

Abdominal pain, N/V, Kussmaul respirations, dehydrated, fruity breath, tachycardia, hypotension, decreased LOC

111
Q

C-peptide

A

<0.5 Type 1 DM

>0.5 Type 2 DM

112
Q

ADA A1C goal

A

<7
<8 in elderly
<6 in type 1 and pregnancy

113
Q

Biguanides

A

Metformin
Site of action: liver–decrease gluconeogenesis
SE: N/V
NO hypoglycemia
CI in Cr >1.4
Can cause fatal lactic acidosis
D/C 24-48 hours before surgical procedure

114
Q

Sulfonylureas

A

Glipizide
Site of action: pancreas–increase insulin secretion
SE: weight gain, hypoglycemia

115
Q

Thiazolidinediones

A

Rosiglitazone
Site of action: muscle–increase insulin sensitivity
SE: weight gain and edema
CI in HF + liver disease

116
Q

Hypoglycemia

A

BG <70

S/S: shaking, sweating, tachycardia, weak, pallor, decreased LOC

117
Q

Secondary causes of obesity

A

cushing, PCOS, hypothyroid, insulinoma

118
Q

Medications that can cause obesity

A

Steroids, TCA, phenothiazines

119
Q

Tx obesity

A

Phentermine, amphetamines, orlistat

120
Q

Most common cause of hyperthyroidism

A

Graves disease

121
Q

Tx of hyperthyroidism

A

PTU, Methimazole, beta blockers

122
Q

hyperthyroidism tx in pregnancy

A

PTU first trimester, methimazole second and third trimester

123
Q

SE of PTU/methimazole

A

rash, jaundice, arthralgia

124
Q

Tx of choice of hyperthyroid if >20 years

A

Radioiodine therapy

125
Q

Norma TSH

A

0.5-5.5

126
Q

Normal T4 total

A

4.6-12

127
Q

Normal T4 free

A

0.7-1.9

128
Q

Normal T3

A

80-180

129
Q

Medications that can increase T4

A

Amiodarone, amphetamines, synthroid

130
Q

Most common cause of hypothyroidism

A

Chronic autoimmune thyroiditis

131
Q

Myxedema

A

Skin thickening and CV/Renal issues due to hypothyroidism

132
Q

Tx hypothyroidism

A

Levothyroxine start 50mcg/day

Do labs in 4-6 weeks and then assess dosage

133
Q

Education for levothyroxine

A

Take 1 hour before breakfast and 2 hours before/4 hours after antacids, ferrous sulfate, carafate

134
Q

Drugs that can decrease thyroid

A

lithium, interferon alfa, tyrosine kinase inhibitors

135
Q

Tx of vertigo

A

Meclizine, diamox, antiemetics

136
Q

Vertigo vs dizzy

A

Vertigo: room is spinning
Dizzy: you are spinning

137
Q

Hallpike-dix

A

Dx fo BPPV

138
Q

Paresthesia

A

Numbness and tingling

139
Q

Paresis

A

weakness

140
Q

First line tx of seizures

A

Levetiracetam (Keppra)

Check serum levels 2-3x in first 6 months and then every 6 months or if dose changes

141
Q

S/S PD

A

Resting tremor, bradykinesia, shuffling gait, rigidity

142
Q

PD due to

A

Decreased dopamine

143
Q

Tx of PD

A

Levodopa-carbidoba first line

Others: selegiline, bromocriptine, ropinirole, pramipexole, entacapone, trihexyphenidyl, benzotropine, amantadine

144
Q

Aborptive headache meds

A

Acetaminophen, aspirine, excedrine FIRST LINE

ergo derivatives, triptans

145
Q

Caution with ____ when using triptans

A

CV disease

146
Q

Preventive tx of headaches

A

Beta blockers, anticonvulsants, CCB, TCA

147
Q

First line preventive tx of cluster headache

A

verapamil or lithium

148
Q

Most common bacteria for meningitis for adults

A

Strep pneumoniae

149
Q

Brudzinski sign

A

Patient actively flexes hips when neck is passively flexed

150
Q

Kernig sign

A

Resists passive knee extension when hip flexed to abdomen

151
Q

Bacterial meningitis LP

A

Decreased glucose

152
Q

Viral meningitis LP

A

Increased or normal glucose

153
Q

Tx fo bacterial meningitis

A

Vancomycin + ceftriaxone

154
Q

Meningitis vaccine

A

11-18 years old
If vaccinated between 2-6 years old, should be re-vaccinated again after 3 years
If vaccinated <7 years old, should be re-vaccinated after 5 years

155
Q

Pneumococcal vaccine

A

> 65 one time dose

156
Q

HIB vaccine

A

2,4,6, 12-15 months

157
Q

Sleeping sickness

A

Encephalitis

Usually due to virus

158
Q

Tx of encephalitis

A

Antiviral + seizure control

159
Q

Rash of herpes zoster

A

Papular lesions with vesicles

160
Q

Dx for herpes zoster

A

tzank smear

161
Q

Tx of herpes zoster

A

Acyclovir within 72 hours, capsaicin cream, amitriptyline or neurontin

162
Q

Vaccines for shingles

A

Zostavax: live
Shingrix: non live
only vaccinate 2-3 weeks after attack

163
Q

Trigeminal neuralgia

A

CN5
Tic douloureux
Recurrent pain on one side of face–burning, sharp, penetrating, stabbing

164
Q

Tx of trigeminal neuralgia

A

Anticonvulsants–carbamazepine + oxcarbazepine first line
All are sedating
Must monitor lab values

165
Q

Bell’s palsy

A

CN 7
Acute and progressive onset
PE: flattening of nasolabrial fold; unable to raise eyebrow or wrinkle forehead, asymmetric smile

166
Q

Tx for bell’s palsy

A

Steroids (prednisone high dose then taper) + acyclovir + artificial tears
Eye protection important

167
Q

Basal skull fracture signs

A

Raccoon sign + battle sign

168
Q

Heat stroke s/s

A

Red, hot, dry skin

169
Q

Heat exhaustion s/s

A

Skin pale and flushed

Primary Care 2 (5 decks)

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