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fm Flashcards

1
Q

Zoster vaccine at age

A

60

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2
Q

HPV vaccine at age between

A

9 to 26 years old

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3
Q

COPD tx above 80%

A

albuterol (short acting beta 2 agonist)

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4
Q

COPD tx 50-80% fev1

A

Albuterol + Salmeterol (long acting beta agonist)

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5
Q

COPD tx fev1 30-50%

A

Albuterol+ salmeterol+ inhaled steroid

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6
Q

COPD very severe FEV1 <30%

A

albuterol + salmeterol+ inhaled steroid + add oxygen therapy

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7
Q

what are other metrics for when patients need to start using oxygen therapy at home?

A

O2 less that 88, or PaO2 less than 55

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8
Q

Sx of Gout

A

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)

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9
Q

Gout joint filled with what

A

Uric acid crystals which are negatively birefringence

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10
Q

first thing to do with hot swollen joint (like in gout)

A

aspiration (where you’ll find uric acid crystals)

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11
Q

pseudogout is positive or negatively birefringence?

A

Positively birefringence

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12
Q

Pseudogout made up of what

A

calcium pyrophosphate crystals that are rhomboid in shapet

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13
Q

Tx for acute gout first line

A

NSAIDS: indomethacin (#1) or colchicine

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14
Q

Tx for acute gout first line if have any sort of kidney disease or CKD or where GFR is low or creatine is high

A

intraarticular steroid injection

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15
Q

Tx for chronic gout with low and high uric acid in urine

A

low uric acid- Probenecid
High uric acid- Allopurinol

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16
Q

Sx of septic arthritis

A

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

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17
Q

Dx of septic arthritis

A

arthrocentesis with over 50K WBCs

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18
Q

Tx of septic arthritis

A

IV antibiotics

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19
Q

what to check for in initial visit prenatal care

A

CBC, urininalysis, STD, HIV, Hepatitis B, a pap smear, Blood typing, rubella

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20
Q

what to check for in 28 week prenatal care

A

CBC (anemia), diabetes screening, Rhogam shot if Rh negative

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21
Q

prenatal care for 35-37 weeks

A

Group B strep test

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22
Q

what to do if group B strep test at 35-37 weeks is positive

A

penicillin prophylaxis 4 hours before delivery

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23
Q

what to give at 27-36 weeks prenatal care visit?

A

Tdap vaccine

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24
Q

what age and when to do Pap smears

A

21-65 every 3 years

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25
Q

what to do with atypical squamous cells in pap

A

HPV test, if positive then coplposcopy , if low grade or high grade, colposcopy, if CIN1,2, or 3, cancerous and do hysterectomy

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26
Q

2 month old baby milestone

A

can lift head off ground in prone positition

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27
Q

4 month old baby milestone

A

can roll over

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28
Q

6 month old baby milestone

A

can sit up on own

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29
Q

9 month old baby milestone

A

can crawl or cruise (use furniture for support while moving)

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30
Q

12 month old milestone

A

can use 1-3 words, other than mama or dada

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31
Q

2 year old milestone

A

hundreds of words, 2-word phrases

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32
Q

3 years old

A

thousands of words, and can use 3-word phrases

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33
Q

5 years old

A

can dress themselves and write their own name

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34
Q

6 year old milestone

A

can tie shoes and identify left and right

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35
Q

audiometry and vision testing starts when

A

4 years old

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36
Q

first flu shot when

A

at 6 months

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37
Q

first live vaccine when (MMR)

A

1 years old

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38
Q

when to do blood transfusion

A

hemoglobin <7

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39
Q

most common cause of folate deficiency

A

alcohol abuse

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40
Q

what to do when pt has chronic diarrhea

A

do stool ova and parasite test

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41
Q

next step for acute gasteroenteritis with hematochezia

A

stool analysis for white blood cells -> if positive when inflammatory diarrhea

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42
Q

hydration for gasterinteritis patient that’s hypotensive

A

IV fluids

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43
Q

hydration ofr gasteroenteritis patient w/ normotensive bp

A

oral rehydration therapy (glucose and salt)

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44
Q

common culprits of inflammatory diarrhea

A

Campylobacter, salmonella (EHEC), shigella, Yersinia

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45
Q

what treatment for inflammatory diarrhea (campylobacter, salmonella (EHEC), shigella, yersinia)

A

supportive care, but if young, immunosuppressed or elderly, give antibiotics

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46
Q

why do we not give antibiotics like fluoroquinoline with EHEC

A

leads to HUS which we need to treat w/ dialysis

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47
Q

why do we avoid loperamide with inflammatory diarrhea

A

its an anti-diarrheal that will trap bacteria

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48
Q

C.Difficile happens after taking broad spectrum like what

A

clindamycin

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49
Q

how to dx c.diff

A

toxin a and b analysis of stool

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50
Q

sx of c.diff

A

diarrhea post antibiotics, abdominal pain, fever, leukocytosis

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51
Q

treatment for c. diff

A

oral vancomycin

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52
Q

most common cause of viral, watery diarrhea

A

norovirus and rotavirus

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53
Q

norovirus and rotavirus associated with what

A

viral watery diarrhea thats associated w/ cruise ships or classrooms. Rotavirus common in winter

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54
Q

DEXA scan at what age

A

65 years old

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55
Q

DEXA scan with T-score <2.5

A

osteoporosis

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56
Q

DEXA scan between -1 and -2.5

A

osteopenia

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57
Q

first line tx for osteoporosis

A

bisphosphonates (alendronate)

58
Q

X-ray indicated when for ankle injury

A

posterior malleolus tenderness OR inability to bear weight immediately after injury

59
Q

next step if 1st time hematuria or proteinuria detected

A

repeat urinalysis w/ microscopic analysis bc it can show RBC casts or dysmorphic RBCs (indicating glomerular bleeding)

60
Q

what is dx w/ lots of blood on dipstick but no RBC

A

rhabdomyolysis- its myoglobin

61
Q

Hyperthyroid tx

A

methimazole and propylthiouracil (PTU) (treats grave;s)

62
Q

main side effect w/ methimazole and propylthiouracyl

A

agranulocytosis

63
Q

what to do w/ pregnancy and hypothyroidism

A

increase levothyroxine

64
Q
A
64
Q

thyroid nodule next step

A

TSH level and ultrasound

65
Q

next step if thyroid nodule and patient is hyperthyroid (low TSH)

A

radioactive iodine uptake

65
Q

next step if patient has cold nodule in radioactive iodine uptake (not hyperthyroid) and > 1cm

A

biopsy

66
Q

next step if patient has cold nodule in radioactive iodine uptake (not hyperthyroid) and < 1cm

A

follow up in 6 months

67
Q

diagnosis for hot nodules for thyroid

A

they are hyperthyroid and not malignant

67
Q

dx for cold nodules

A

euthyroid and more likely to be malignant

68
Q

dx for diffuse radioactive iodine uptake of thyroid

A

grave’s

69
Q

dx for radioactive iodine uptake taken up in 1 area

A

toxic adenoma

70
Q

dx for radioactive iodine uptake in multiple patchy areas

A

multinodule goiter (multiple toxic adenomas)

71
Q

toxic adenoma or multinodular goiter tx

A

radioactive iodine therapy (ablates nodules)

72
Q

what to do w/ cancerous thyroid nodule

A

tx is surgical removal

73
Q

normal fetal heart rate

A

110-160 bpm

74
Q

pneumonic VEAL CHOP

A

variable deceleration- cord compression
Early deceleration - Head compression
Acceleration - OK!
Later deceleration - Placental insufficiency

75
Q

fetal tachycardia (>160) indicates what

A

maternal infection

76
Q

Sinusoidal pattern in FHR tracings indicates what

A

fetal anemia

77
Q

Complete heart block in FHR tracings indicates what

A

maternal lupus

78
Q

what are good accelerations for fetal heart rate tracings

A

sign of healthy baby if 15bpm increase for 15 seconds, twice in 20 mins (rules out hypoxia)

79
Q

what to do if reduced movement in fetus

A

non-stress test to check for accelerations

80
Q

when to do biophysical profile for fetus

A

if non-stress test us non-reassuring, so we can assess breathing, tone, movement, and amniotic fluid volume. if score <4 then deluver

81
Q

what is hypercalcemia

A

normal level 8-10 so aboveh

82
Q

hypercalcemia an lead to what

A

arrhythmias or coma

83
Q

first line tx for hypercalcemia

A

IV fluids

84
Q

what to do first for hyponatremic patient

A

check osmolarity (normal is 275-295)

85
Q

cause of Hypertonic Hyponatremia

A

elevated glucose

86
Q

cause of Isotonic hyponatremia

A

elevated proteins or fat

87
Q

hypotonic hyponatremia divided into what

A

hypervolemic, euvolemic, and hypovolemic

88
Q

hypervolemic hypotonic hyponatremia cause and tx

A

CHF and CKD, tx fluid restriction

89
Q

Euvolemic hypotonic hyponatremia cause and tx

A

SIADH, Primary polydipsia, Tx fluid restriction

90
Q

Hypovolemic hypotonic hyponatremia cause and tx

A

diuretics and vomiting. If no sx, tx w/ normal saline. If severe hyponaremia w. sx and Na+ < 120, tx w. hypertonic saline 3%

91
Q

Hypokalemia and hyperkalemia sx and tx

A

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

92
Q

Acute bronchitis dx and tx

A

Dx: by exclusion, mostly viral. usually starts w/ runny nose and fever>
TX: Supportive care

93
Q

Otitis media and externa Dx and rx

A

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

94
Q

what drugs decrease mortality in MI

A

ACE inhibitors, Beta-blockers, Aspirin:
Use ace inhibitors indefinitely bc prevents future ischemic events and left ventricular hypertrophy from remodeling after an MI

95
Q

next step for patient w/ stable angina

A

Exercise stress test or pharmacologic stress test if exercise is contraindicated

96
Q

next step for pt w/ Acute coronary syndrome (acute chest pain or chest pain that’s getting worse).

A

EKG and tropinin; STEMI -> Straight to cath lab. New LBBB w/ Sx of MI -> cath lab

97
Q

how to treat acute coronary syndrome or other coronary events

A

MONA C-BASH. Morphine, oxygen, nitrates, aspirin, clopidogrel, beta blockers, ace inhibitors, statin, heparin

98
Q

What to tx women w/ DM associated w/ candidiasis and vaginal yeast infection

A
  • Azoles
99
Q

what does person have who took antibiotics and then vaginal discharge

A

candida

100
Q

what to treat Gardnerella (asymptomatic vaginosis) w/

A

Metronidazole

101
Q

First step for hematochezia

A

if stable, colonoscopy
Unstable- give IV fluids and perform EGD

102
Q

Diverticulitis presentation, dx and tx

A

Presentation: LL quadrant pain, fever, leukocytosis, constipation
Dx: CT abdomen
Tx: Fluoroquinolones and metronidazole

103
Q

What are the associations w/ Ulcerative colitis

A

Colon cancer, toxic megacolon, primary sclerosing cholangitis

104
Q

next step for older person w/ micocytic anemia

A

colonoscopy to rule out cancer

105
Q

Rust colored sputum dx

A

S. Pneumo

106
Q

Legionella symptoms and common in what

A

pneumonia + diarrhea+ hyponatremia and common in elderly smokers who hang in areas w/ dirty AC or w/ contaminated water

107
Q

In patient and outpatient tx for pneumonia

A

inpatient: Fluoroquinolone (cover for pseudomonas)
outpatient: amoxicillin (typical pneumonia) , macrolide (atypical pneumonia)

108
Q

causes for typical pneumonia (lobar consolidation)

A

S. pneumo, H. Flu, moraxella

109
Q

Causes for atypical pneumonia

A

mycoplasma, chlamydia, legionella

110
Q

admit criteria for pneumonia

A

CURB-65 (confusion, uremia (BUN>20), RR (tachypnic) BP low, age >65 . 2 or more of these symptoms

111
Q

Depression dx

A

SIG E CAPS (sleep, interest, guilt, energy, concentration, appetite, psychomotos, suicidality) 5 of the 9

112
Q

tx for depression

A

SSRI, take 4-6 weeks to start working, continue for at least 9 months

113
Q

Contraindications to breastfeeding

A

HIV and chemotherapy

114
Q

Mastitis tx

A

Dicloxacillin

115
Q

next step if breast abscess shows flutulance on palpation

A

tx w/ antibiotics, FNA or incision and drainage

116
Q

how to Dx CHF

A

ECHO

117
Q

symptoms of CHF w/ acute exacerbation and tx

A

sudden SOB w. pulmonary edema. Tx: Furosemide (loop diuretic)- helps alleviate BP and drains out fluid

118
Q

Sx of CHF

A

presents w/ paroxysmal nocturnal dyspnea or orthopnea ( hard to breathe when lying down)

119
Q

Class 1-4 treatments for CHF

A

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)

120
Q

What are the heart failure drugs that improve mortality (3)

A

ACE inhibitors, beta-blockers, spironolactone (potassium sparing diuretic)

121
Q

oral contraceptive contraindications and why

A

migraines w/ aura, smokers >35 age, increased risk of DVT, MI, PE and stroke (prothrombotic)

122
Q

benefits of oral contraceptives

A

protect against ovarian and endometrial cancer, but slight increased risk for breast cancer

123
Q

Copper IUD contraindicated in what and best use

A

contraindicated in menorrhagia and most effective emergency contraception

124
Q

definition of HTN and first step

A

anything >140/90 on 3 consecutive visits, start anti-HTN, uf not under that in 1 min, then increase dose or add drug

125
Q

first line txs for hypertension

A

Calcium channel blockers, ACE inhibitors, thiazides

126
Q

HTN tx for african americans

A

thiazides or calcium channel blockers preferred (avoid ace inhibitors because predisposed to angioedema and ACE inhibitors precent breakdown of bradykinin)

127
Q

proetinuria first line tx

A

ACE inhibitors

128
Q

Intussusception definition, sx, dx, and tx

A

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

129
Q

what is intussusception associated in and which vaccine is contraindicated

A

associated w/ Henoch-schonlein purpura;

Contraindicated for rotavirus vaccine in affected children

130
Q

midgut volvulus embryonic pathology, sx, dx

A

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)

131
Q

Jejunal atresia cause and dx

A

caused by vascular accident in utero usually caused by cocaine use by mother. Dx is triple bubble sign

132
Q

Duodenal atresia association and sign

A

associated w/ down syndrome and will see double bubble sign

133
Q

Boerhaave syndrome sx, dx, tx

A

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

134
Q

tx for weight loss

A

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

135
Q

what are complication and tx for bariatric surgery

A

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

136
Q

Migraine headache POUND criteria

A

pulsatile, one-day duration, unilateral, nausea/vominting, debilitating

137
Q

first linetx for migraine headache

A

conservative measures, then sumatriptan for severe cases. Prophylaxis: beta blockers or TCA

138
Q
A

family medicine shelf (1 decks)

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