fm Flashcards
Zoster vaccine at age
60
HPV vaccine at age between
9 to 26 years old
COPD tx above 80%
albuterol (short acting beta 2 agonist)
COPD tx 50-80% fev1
Albuterol + Salmeterol (long acting beta agonist)
COPD tx fev1 30-50%
Albuterol+ salmeterol+ inhaled steroid
COPD very severe FEV1 <30%
albuterol + salmeterol+ inhaled steroid + add oxygen therapy
what are other metrics for when patients need to start using oxygen therapy at home?
O2 less that 88, or PaO2 less than 55
Sx of Gout
acute abrupt onset of severe pain of the metatarsal phalangeal joint of foot, at base of big toe, will become swollen, really red, and extremely painful (might wake patient up at middle of night)
Gout joint filled with what
Uric acid crystals which are negatively birefringence
first thing to do with hot swollen joint (like in gout)
aspiration (where you’ll find uric acid crystals)
pseudogout is positive or negatively birefringence?
Positively birefringence
Pseudogout made up of what
calcium pyrophosphate crystals that are rhomboid in shapet
Tx for acute gout first line
NSAIDS: indomethacin (#1) or colchicine
Tx for acute gout first line if have any sort of kidney disease or CKD or where GFR is low or creatine is high
intraarticular steroid injection
Tx for chronic gout with low and high uric acid in urine
low uric acid- Probenecid
High uric acid- Allopurinol
Sx of septic arthritis
any hot swollen joint in knee or hip and secondary to systemic infections; extremely tender swollen joint that’s red adn cant bear weight on hip or bend knee. Severe pain, fever, leukocytosis
Dx of septic arthritis
arthrocentesis with over 50K WBCs
Tx of septic arthritis
IV antibiotics
what to check for in initial visit prenatal care
CBC, urininalysis, STD, HIV, Hepatitis B, a pap smear, Blood typing, rubella
what to check for in 28 week prenatal care
CBC (anemia), diabetes screening, Rhogam shot if Rh negative
prenatal care for 35-37 weeks
Group B strep test
what to do if group B strep test at 35-37 weeks is positive
penicillin prophylaxis 4 hours before delivery
what to give at 27-36 weeks prenatal care visit?
Tdap vaccine
what age and when to do Pap smears
21-65 every 3 years
what to do with atypical squamous cells in pap
HPV test, if positive then coplposcopy , if low grade or high grade, colposcopy, if CIN1,2, or 3, cancerous and do hysterectomy
2 month old baby milestone
can lift head off ground in prone positition
4 month old baby milestone
can roll over
6 month old baby milestone
can sit up on own
9 month old baby milestone
can crawl or cruise (use furniture for support while moving)
12 month old milestone
can use 1-3 words, other than mama or dada
2 year old milestone
hundreds of words, 2-word phrases
3 years old
thousands of words, and can use 3-word phrases
5 years old
can dress themselves and write their own name
6 year old milestone
can tie shoes and identify left and right
audiometry and vision testing starts when
4 years old
first flu shot when
at 6 months
first live vaccine when (MMR)
1 years old
when to do blood transfusion
hemoglobin <7
most common cause of folate deficiency
alcohol abuse
what to do when pt has chronic diarrhea
do stool ova and parasite test
next step for acute gasteroenteritis with hematochezia
stool analysis for white blood cells -> if positive when inflammatory diarrhea
hydration for gasterinteritis patient that’s hypotensive
IV fluids
hydration ofr gasteroenteritis patient w/ normotensive bp
oral rehydration therapy (glucose and salt)
common culprits of inflammatory diarrhea
Campylobacter, salmonella (EHEC), shigella, Yersinia
what treatment for inflammatory diarrhea (campylobacter, salmonella (EHEC), shigella, yersinia)
supportive care, but if young, immunosuppressed or elderly, give antibiotics
why do we not give antibiotics like fluoroquinoline with EHEC
leads to HUS which we need to treat w/ dialysis
why do we avoid loperamide with inflammatory diarrhea
its an anti-diarrheal that will trap bacteria
C.Difficile happens after taking broad spectrum like what
clindamycin
how to dx c.diff
toxin a and b analysis of stool
sx of c.diff
diarrhea post antibiotics, abdominal pain, fever, leukocytosis
treatment for c. diff
oral vancomycin
most common cause of viral, watery diarrhea
norovirus and rotavirus
norovirus and rotavirus associated with what
viral watery diarrhea thats associated w/ cruise ships or classrooms. Rotavirus common in winter
DEXA scan at what age
65 years old
DEXA scan with T-score <2.5
osteoporosis
DEXA scan between -1 and -2.5
osteopenia
first line tx for osteoporosis
bisphosphonates (alendronate)
X-ray indicated when for ankle injury
posterior malleolus tenderness OR inability to bear weight immediately after injury
next step if 1st time hematuria or proteinuria detected
repeat urinalysis w/ microscopic analysis bc it can show RBC casts or dysmorphic RBCs (indicating glomerular bleeding)
what is dx w/ lots of blood on dipstick but no RBC
rhabdomyolysis- its myoglobin
Hyperthyroid tx
methimazole and propylthiouracil (PTU) (treats grave;s)
main side effect w/ methimazole and propylthiouracyl
agranulocytosis
what to do w/ pregnancy and hypothyroidism
increase levothyroxine
thyroid nodule next step
TSH level and ultrasound
next step if thyroid nodule and patient is hyperthyroid (low TSH)
radioactive iodine uptake
next step if patient has cold nodule in radioactive iodine uptake (not hyperthyroid) and > 1cm
biopsy
next step if patient has cold nodule in radioactive iodine uptake (not hyperthyroid) and < 1cm
follow up in 6 months
diagnosis for hot nodules for thyroid
they are hyperthyroid and not malignant
dx for cold nodules
euthyroid and more likely to be malignant
dx for diffuse radioactive iodine uptake of thyroid
grave’s
dx for radioactive iodine uptake taken up in 1 area
toxic adenoma
dx for radioactive iodine uptake in multiple patchy areas
multinodule goiter (multiple toxic adenomas)
toxic adenoma or multinodular goiter tx
radioactive iodine therapy (ablates nodules)
what to do w/ cancerous thyroid nodule
tx is surgical removal
normal fetal heart rate
110-160 bpm
pneumonic VEAL CHOP
variable deceleration- cord compression
Early deceleration - Head compression
Acceleration - OK!
Later deceleration - Placental insufficiency
fetal tachycardia (>160) indicates what
maternal infection
Sinusoidal pattern in FHR tracings indicates what
fetal anemia
Complete heart block in FHR tracings indicates what
maternal lupus
what are good accelerations for fetal heart rate tracings
sign of healthy baby if 15bpm increase for 15 seconds, twice in 20 mins (rules out hypoxia)
what to do if reduced movement in fetus
non-stress test to check for accelerations
when to do biophysical profile for fetus
if non-stress test us non-reassuring, so we can assess breathing, tone, movement, and amniotic fluid volume. if score <4 then deluver
what is hypercalcemia
normal level 8-10 so aboveh
hypercalcemia an lead to what
arrhythmias or coma
first line tx for hypercalcemia
IV fluids
what to do first for hyponatremic patient
check osmolarity (normal is 275-295)
cause of Hypertonic Hyponatremia
elevated glucose
cause of Isotonic hyponatremia
elevated proteins or fat
hypotonic hyponatremia divided into what
hypervolemic, euvolemic, and hypovolemic
hypervolemic hypotonic hyponatremia cause and tx
CHF and CKD, tx fluid restriction
Euvolemic hypotonic hyponatremia cause and tx
SIADH, Primary polydipsia, Tx fluid restriction
Hypovolemic hypotonic hyponatremia cause and tx
diuretics and vomiting. If no sx, tx w/ normal saline. If severe hyponaremia w. sx and Na+ < 120, tx w. hypertonic saline 3%
Hypokalemia and hyperkalemia sx and tx
both w/ weakness.
hypokalemia: tx w/ oral potassium replacement
Hyperkalemia: check EKG, if peaked T waves and wide QRS, risk for arrhythmia. First line tx is calcium gluconate (stabilizes cardiac membrane) followed by insulin
Acute bronchitis dx and tx
Dx: by exclusion, mostly viral. usually starts w/ runny nose and fever>
TX: Supportive care
Otitis media and externa Dx and rx
Acute otitis media: infection of middle ear, Tx w/ amoxicillin
Dx: on otoscopy, will see very puffed out , red , erythematous ear drum.
MCC: Strep pneumo, H. Flu, moraxella>
MCC of meningitis: S. Pneumo, H. Flu, N. Meningitidis
Otitis media w/ effusion: middle air there are fluid bubbles behind the wall (treat supportively)
Otitis externa: Associated w/ swimmers or diabetics, usually caused by Pseudomonas
what drugs decrease mortality in MI
ACE inhibitors, Beta-blockers, Aspirin:
Use ace inhibitors indefinitely bc prevents future ischemic events and left ventricular hypertrophy from remodeling after an MI
next step for patient w/ stable angina
Exercise stress test or pharmacologic stress test if exercise is contraindicated
next step for pt w/ Acute coronary syndrome (acute chest pain or chest pain that’s getting worse).
EKG and tropinin; STEMI -> Straight to cath lab. New LBBB w/ Sx of MI -> cath lab
how to treat acute coronary syndrome or other coronary events
MONA C-BASH. Morphine, oxygen, nitrates, aspirin, clopidogrel, beta blockers, ace inhibitors, statin, heparin
What to tx women w/ DM associated w/ candidiasis and vaginal yeast infection
- Azoles
what does person have who took antibiotics and then vaginal discharge
candida
what to treat Gardnerella (asymptomatic vaginosis) w/
Metronidazole
First step for hematochezia
if stable, colonoscopy
Unstable- give IV fluids and perform EGD
Diverticulitis presentation, dx and tx
Presentation: LL quadrant pain, fever, leukocytosis, constipation
Dx: CT abdomen
Tx: Fluoroquinolones and metronidazole
What are the associations w/ Ulcerative colitis
Colon cancer, toxic megacolon, primary sclerosing cholangitis
next step for older person w/ micocytic anemia
colonoscopy to rule out cancer
Rust colored sputum dx
S. Pneumo
Legionella symptoms and common in what
pneumonia + diarrhea+ hyponatremia and common in elderly smokers who hang in areas w/ dirty AC or w/ contaminated water
In patient and outpatient tx for pneumonia
inpatient: Fluoroquinolone (cover for pseudomonas)
outpatient: amoxicillin (typical pneumonia) , macrolide (atypical pneumonia)
causes for typical pneumonia (lobar consolidation)
S. pneumo, H. Flu, moraxella
Causes for atypical pneumonia
mycoplasma, chlamydia, legionella
admit criteria for pneumonia
CURB-65 (confusion, uremia (BUN>20), RR (tachypnic) BP low, age >65 . 2 or more of these symptoms
Depression dx
SIG E CAPS (sleep, interest, guilt, energy, concentration, appetite, psychomotos, suicidality) 5 of the 9
tx for depression
SSRI, take 4-6 weeks to start working, continue for at least 9 months
Contraindications to breastfeeding
HIV and chemotherapy
Mastitis tx
Dicloxacillin
next step if breast abscess shows flutulance on palpation
tx w/ antibiotics, FNA or incision and drainage
how to Dx CHF
ECHO
symptoms of CHF w/ acute exacerbation and tx
sudden SOB w. pulmonary edema. Tx: Furosemide (loop diuretic)- helps alleviate BP and drains out fluid
Sx of CHF
presents w/ paroxysmal nocturnal dyspnea or orthopnea ( hard to breathe when lying down)
Class 1-4 treatments for CHF
Class 1 (no symptoms) - ACE-Inhibitor
Class 2 (sx w/ activity)- ACEI and BB
Class 3 (sx only stop at rest) - ACEI, BB, and diuretics (spironolactone)
Class 4 (Sx at rest) add drugs that increase contractility (ionotropes like digoxin)
What are the heart failure drugs that improve mortality (3)
ACE inhibitors, beta-blockers, spironolactone (potassium sparing diuretic)
oral contraceptive contraindications and why
migraines w/ aura, smokers >35 age, increased risk of DVT, MI, PE and stroke (prothrombotic)
benefits of oral contraceptives
protect against ovarian and endometrial cancer, but slight increased risk for breast cancer
Copper IUD contraindicated in what and best use
contraindicated in menorrhagia and most effective emergency contraception
definition of HTN and first step
anything >140/90 on 3 consecutive visits, start anti-HTN, uf not under that in 1 min, then increase dose or add drug
first line txs for hypertension
Calcium channel blockers, ACE inhibitors, thiazides
HTN tx for african americans
thiazides or calcium channel blockers preferred (avoid ace inhibitors because predisposed to angioedema and ACE inhibitors precent breakdown of bradykinin)
proetinuria first line tx
ACE inhibitors
Intussusception definition, sx, dx, and tx
telescoping of ileum into cecum -> irritation to the mucosa and possibly ischemia, which can cause mucosa to slough off (currant jelly stool)
sx: Currant jelly stooks, colicky pain, RLQ pain/ intermittent abdominal pain
Dx: abdominal x-ray to rule out perforation
Tx: Air enema
what is intussusception associated in and which vaccine is contraindicated
associated w/ Henoch-schonlein purpura;
Contraindicated for rotavirus vaccine in affected children
midgut volvulus embryonic pathology, sx, dx
intestines twist around SMA, Sx bilous vomitint, constant abdominal pain, Dx abdominal x-ray to rule put performation (upper GI series (x-ray w/ barium swallow), will see double bubble sign or corckscrew sign)
Jejunal atresia cause and dx
caused by vascular accident in utero usually caused by cocaine use by mother. Dx is triple bubble sign
Duodenal atresia association and sign
associated w/ down syndrome and will see double bubble sign
Boerhaave syndrome sx, dx, tx
perforation of esophagus (often caused by endoscopic procedures) , sx pneumomediastinum on chest x-ray, fever, and crepitus on palpation of the skin.
Dx, gastrografin swallow or CXR (pneumomediastinum) (endoscopy not recommended because will make it worse
Tx: surgucal
tx for weight loss
first line- lifestyle modification, if fails then Orlistat (pancreatic lipase inhibitor), IN patients w/ PCOS, metformin can aid in weight loss, Bariatric surgery inicated for pts w/ bmi over 40 or 35 w/ comorbidities
what are complication and tx for bariatric surgery
stromal stenosis and dumping syndrome (food going through too fast and not being absorbed, leading to diarrhea)
Tx for dumping syndrome: eating small, high-protein meals
Migraine headache POUND criteria
pulsatile, one-day duration, unilateral, nausea/vominting, debilitating
first linetx for migraine headache
conservative measures, then sumatriptan for severe cases. Prophylaxis: beta blockers or TCA
