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family medicine > FM > Flashcards

FM Flashcards

1
Q

substances and drugs that can cause or worsen osteoporosis (10)

A
  1. alcohol
  2. nicotine
  3. SSRI
  4. anticonvulsants
  5. Phenytoin
  6. Lithium
  7. PPIs
  8. Thyroxin if overreplaced
  9. Heparin
  10. Corticosteroids
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2
Q

what are the 4 ways/requirements to dx diabetes?

A
  1. symptomatic + random glucose >200
  2. fasting (8hr) glucose >126
  3. 2 hour glucose challenge >200
  4. HgbA1c >6.5%
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3
Q

who are the 4 groups who need high intensity statin?

A
  1. CAD. (stroke, MI, peripheral vascular disease, TIA, carotid stenosis)
  2. LDL = or > 190

3 and 4. LDL >70 , and 45-75 yrs old, and DM (or if no DM, other calculated risk factors >7.5% 10 yr risk)

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4
Q

what are the 5 biggest risk factors for CAD?

A
  1. Diabetes
  2. Smoking
  3. HTN
  4. Dyslipidemia
  5. Age (>55 women, >45 men)
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5
Q

what are your high-moderate intensity statins? (2)

what are your moderate - low intensity statins? (3)

A

high-moderate: atorvastatin, rosuvastatin

mod-low: simvastatin, pravastatin, lovastatin

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6
Q

management of statin induced myositis and/or hepatitis

A

stop statin, once symptoms resolve restart statin at a lower tolerable dose

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7
Q

how often to check lipids when patient is on statins

A

annually

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8
Q

2 main side effects of statins and fibrates

A

myositis

increased LFTs -> hepatitis

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9
Q

which 2 cholesterol meds have diarrhea as a SE

A

ezetimibe (inhibits cholesterol absorption in gut)
bile acid resins (inhibit bile acid reabsorption in gut)

it’s an osmotic effect of the unabsorbed products! can also have steatorrhea. bc fat is in stool. duh. makes sense

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10
Q

between troponins and CKMB which one is better for testing for MI? why?

A

troponins rise first and stay up longer, so this one is better UNLESS YOU’RE TESTING FOR A 2ND MI RIGHT AFTER THEY ALREADY HAD AN MI bc it’s already high from the first one. then use CKMB

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11
Q

tx of MI (MONA BASH C)

A

Morphine
O2
Nitrates
Aspirin

BB
ACEI
Statin
Heparin

Clopidogrel - if stent put in (drug eluding stent= 12 months, bare metal stent = 1 month)

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12
Q

if pt has hx of stroke, what combo of 2 meds is ideal for htn treatment?

A

1 ACEI + thiazide

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13
Q

up to what stage of CKD can patients get ACEI/ARB?

A

until they are stage 4 (then use hydralazine instead)

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14
Q

EKG leads to what part of heart? II, III, aVF

A

inferior

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15
Q

EKG leads to what part of heart? V4, V5

A

anterior

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16
Q

what EKG leads are for lateral heart? (4)

A

I, aVL, V5, V6

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17
Q

EKG leads to what part of heart? V1, V2

A

septal

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18
Q

most causative organism of GU infection (like UTI)

A

E. coli

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19
Q

3 risk factors of UTI

A

intercourse
anal intercourse
OCP use

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20
Q

don’t treat asx UTI except for which 2 exceptions?

A

pregnant women

just had urologic procedure

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21
Q

abx of choice for pregnant UTI (1st and 2nd line)

A

amoxicillin first line

nitrofurantoin if penicillin allergy

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22
Q

things that make UTI classified as complicated (the P’s)

A 
Plastic (catheters)
Procedures (urologic)
Pregnant
Pyelo
Penis
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23
Q

things that make UTI classified as complicated (the P’s)

thus you need to treat with 7 days of abx, whereas uncomplicated is 3 days

A 
Plastic (catheters)
Procedures (urologic)
Pregnant
Pyelo (ambulatory)
Penis (male)
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24
Q

tx for nonambulatory pyelonephritis (combo abx for how long)

A

10 days abx: IV ceftriaxone or IV Amp + Sulbactam. switch when sensitivities come back
admit to hospital

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25
Q

tx for ambulatory pyelonephritis

A

PO cipro 10 days

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26
Q

abx for UTI

A

first line: Bactrim aka TMP-SMX

2nd: nitrofurantoin
3rd: fosfomycin

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27
Q

person dx with pyelonephritis, gets admitted and treated, but not getting better. what do you suspect and next step?

A

suspect abscess.
either CT scan (preferred) or US (if pregnant or renal failure)
must drain abscess, continue IV abx

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28
Q

acute diarrhea is defined as < ___ weeks

A

< 2 weeks. which means any diarrhea < 2 weeks is most likely infectious

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29
Q

idiopathic intracranial hypertension has associations with what 3 things? (remember causes headaches and papilledema but there’s no tumor)

A
  1. overdose vit A (don’t forget isotretinoin/accutane)
  2. glucocorticoid withdrawal
  3. OCP use
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30
Q

you suspect patient has cluster headaches. what test do you do?

A

MRI to rule OUT anything else

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31
Q

how to abort cluster headache? how to prophylax?

A

abort: supplemental O2 or sumatriptan if oxygen fails

prophylax with calcium channel blockers (verapamil)

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32
Q

prophylaxis for chronic migraines (1 med, 2 nonmeds)

A

BB (propanolol)

cognitive feedback and trigger avoidance

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33
Q

Triptan and Ergot are used for migraines but what’s their risk?

A

vasospasm. be careful with patients who have CAD!

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34
Q

if NSAID induced PUD doesnt resolve with stopping NSAIDs, what can you use?

A
  1. antacid: PPI or H2 blockers
  2. Misoprostol
  3. sucralfate
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35
Q

best test to check if h pylori successfully eradicated

A

stool antigen test

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36
Q

how do smoking and alcohol contribute to PUD

A

they are NOT independent risk factors but CAN exacerbate already existing ulcers!

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37
Q

triple therapy for PUD

A
  1. amoxicillin. or metronidazole if penicillin allergy
  2. macrolide: azithro/clarithromycin
  3. PPI
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38
Q

cutoff value in serum gastrin secretion test for ruling in our out gastrinoma

A 
<250 = ruled out
>1000 = ruled in

(in between is equivocal, follow with secretin stimulation test)

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39
Q

when do you need to do EGD with bx for GERD?

A

PPI trial failed
alarm sx present: dysphagia, odynophagia (painful swallowing); gastrointestinal bleeding or anemia; weight loss; and chest pain (different from just burning)

40
Q

which monoclonal antibody med can improve remission of colon cancer?

A

Bevacizumab, it’s a VEGF inhibitor

41
Q

hyper or hypothyroidism gives you:
a-fib, amenorrhea/oligomenorrhea, gynecomastia, decreased libido, decreased deep tendon reflexes, osteoporosis, carpal tunnel, diarrhea and constipation?

A

hypERthyroid: a-fib, increased deep tendon reflexes, amenorrhea/oligomenorrhea, gynecomastia, DECREASED libido, osteoporosis, diarrhea

hypOthyroid: decreased/slower DTR, menorrhagia and/or oligo, also decreased libido, carpal tunnel syndrome, constipation

42
Q

woman comes in with signs of hyperthyroidism but RAIU scan is negative (thyroid cold). what other test do you need to do before concluding it’s factitious?

A

Sestamibi scan of OVARIES to rule out tumor aka STRUMA OVARII

43
Q

3 specific things about grave’s compared to rest of hyperthyroidisms

A
  1. exophthalmos. different from lid lag in hyper or periorbital edema in hypothyroidism!
  2. pretibial myxedema
  3. diagnose by Anti-TSH-R Antibody
44
Q

for thyroid nodule you do TSH. what is next step if tsh is high or low?

A

if low -> high risk so do ultra sound and possibly FNA depending on US findings

if high -> do RAIU to see if nodule is hot or cold. hot is low risk, cold is high risk for cancer do US and possibly FNA depending on US findings

45
Q

which thyroid cancer looks like just normal thyroid tissue?

A

follicular. spreads hematogenously. treat by resection and radioactive iodine ablation

46
Q

which thyroid cancer has C cells producing calcitonin -> hypOcalcemia

A

medullary

it’s also the one part of MEN2 syndromes!

47
Q

which thyroid cancer is found in elderly patients and grows quickly, has bad prognosis

A

anaplastic, GG

48
Q

warning sx of lower back pain indicating emergency (6)

what do u give immediately (besides surgical intervention)

A
  1. history of cancer
  2. urine or bowel incontinence or retention
  3. erectile dysfunction or priapism
  4. bilateral LE weakness
  5. sensory deficits in dermatome pattern (saddle anesthesia)
  6. fever

give dexamethasone!

49
Q

guy was lifting heavy stuff, now has back pain. positive straight leg test, exacerbated by hip flexion, movement, cough, activity.

dx? tx?

A

disc herniation

neurosurg better than conservative management at 6 months. same after 1 yr or more

50
Q

elderly male has sciatica like pain and positive straight leg test, no history of heavy lifting. dx/next step?

A

xray and possibly MRI to rule out compression fracture. if negative, -> osteophyte.
neurosurgery>conservative management

51
Q

woman with back pain. on physical exam, “point tenderness or vertebral step off”

A

compression fracture. she has osteoporosis

52
Q

elderly person with leg and butt pain, pseudoclaudication (positional and sx don’t reach all the way down to feet).
dx?

A

spinal stenosis.

confirm with MRI. needs surgery

53
Q

person with back pain, LOSS of pain/temp, SPARING of proprioception. can have progressive loss of motor and sensation. what is dx?

A

syringomyelia. (pocket of CSF bulges into anterior cord)

54
Q

person with hx of HTN, CAD, smoking, probably male. spastic paralysis and loss of proprioception. what is dx?

A

AAA with affected anterior spinal artery

55
Q

elderly person with back pain, relieved by flatulance or BM. dx?

A

constipation

56
Q

treatment for MSK back pain (inciting event of heavy lifting but no disc herniation or fracture)?

A

NSAIDs and stretching.

NOT BEDREST

57
Q

what micro organism is probably causing the pneumonia of an aspiration risk person (alcoholic, seizure, stroke, dysphagia MS, dementia).

so what abx do you use?

A

Klebsiella + anaerobes

clincamycin for the anaerobes.
idk for the klebsiella lol..

58
Q

person has pneumonia like symptoms but also GI and CNS sxs. what organism do you suspect, what test to confirm, and how to treat?

A

legionella
confirm with urine Ag
treat w/ ampicillin

59
Q

COPD/smokers are at risk for pneumonia caused by what organism

A

Haemophilus influenzae

60
Q

1st and 2nd line tx for ambulatory pneumonia/bronchitis

A

1st line: azithromycin

2nd: doxyclcine, moxifloxacin

61
Q

1st and 2nd line tx for community acquired pneumonia (CAP) inpatient treatment

A

1st: ceftriaxone AND azithromycin
2nd: moxifloxacin

62
Q

1st line inpatient tx for health care pneumonia (HCAP) b/c what organisms are you treating

A

vanc AND pip/tazo

MRSA and pseudomonas

63
Q

immunocompromised person w/ pneumonia. ELEVATED LDH LEVELS. what organism, how to confirm, how to treat?

A

PCP (pneumocystis pneumonia)
confirm with silver stain
treat with bactrim IV (trim/sulf)
add steroids if hypoxemic

64
Q

person been around sheep and and placentas (sheep or humans??) and comes in with pneumonia. what do you suspect, how to confirm

A

chalmydia

confirm with serum Ab

65
Q

walking pneumonia, IgM cold agglutinin dz

A

Mycoplasma pneumonia.

treat with macrolides

66
Q

person comes in with fever and cough, confirm pneumonia with xray. but after 72 hours of empiric therapy, they are still very sick. what study do you do?

A

bronchoalveolar lavage

67
Q

for osteomyelitis:

after debridement and abx, what should you do to follow the progress/response to therapy?

A

ESR and CRP weekly

DO NOT repeat MRI or biopsy

68
Q

abx treatment for nontoxic outpatient cellulitis? what are you covering for?

A

1st gen cephalosporin for Strep

69
Q

abx treatment for nontoxic community acquired MRSA cellulitis?

A

TMP-SMX (Bactrim) and Clinca

70
Q

abx treatment for toxic/inpatient cellulitis? what are you covering for?

A

cover for staph, don’t cover both strep and staph.

IV Vancomycin or Linezolid

71
Q

treatment for gas gangrene is debridement and what 2 abx?

A

Pencillin + clindamycin (to interrupt protein synthesis)

72
Q

2 most likely pathogens causing nec fasc

A

strep and staph, same as cellulitis

73
Q

in real life for nec fasc you would use very broad spectrum abx (vanc + pip/tazo) but on the test what do you choose?

A

3rd gen cephalosporin + clindamycin + ampicillin

74
Q

what are the complications you need to watch out for in CKD? (4)

A
  1. anemia
  2. 2/2 hyper PTH and resulting calcification and mineral bone disorder
  3. volume overload
  4. acidosis
75
Q

difference between cohort study vs case control study. which statistical thing do they use to compare control vs experimental group??

vs longitudinal

A

cohort: currently people known to be exposed to risk factor and those that arent. both followed to see future disease incidence. use RR

case-control: people who have disease (cases) and group who doesn’t (controls), they are investigated to see how much risk factor they were exposed to in the past. use Odds Ratio

longitudinal: theres only one group, no control group. follow the ppl with dz and see how prevalence changes over time

76
Q

what is hawthorn affect?

A

patient/subject bias, where they act differently bc they know they’re being studied

77
Q

how does recall bias affect study

A

sick patients remember more

78
Q

what is goal for BP control?

A

<130 / <80 (aka below the cutoff for stage 1 HTN)

79
Q

what 2 things in a hypertensive patient would cause you to workup for 2ndry causes of HTN?

A
  1. before age 35

2. refractory to 3 meds

80
Q

common drugs that can cause 2/2 HTN (6)

A
  1. hormones: OCPs and estrogen
  2. decongestants (think phenylephrine it’s a pressor)
  3. appetite suppressants (stimulants!)
  4. chronic steroid use
  5. NSAIDs
  6. psych: TCAs and SSRIs
81
Q

causes of 2/2 HTN: abcde

A 
A apnea (OSA)
B bruits (renal a. stenosis), bad kidneys (parenchymal dz/damage)
C coarctation of aorta
D drugs (see drugs flashcard for specifics) and diet
Endocrine (Acromegaly, Conn, Cushing, CAH, Pheo, increased EPO, thyroid or parathyroid dz)
82
Q

diet recommendations for HTN

A

low Na
High K
DASH diet
REDUCE ALCOHOL

83
Q

the 3 beta blockers that work for both CHF and CAD

A

metoprolol
carvedilol
Nebivolol

84
Q

if you’ve had a stroke, the combo drug treatment recommendation is:

A

ACE inhibitor + thiazide diuretic

85
Q

give metformin to all prediabetics and diabetics except those with what 3 comorbidities? why?

A

CHF
CKD
liver dz

bc metformin can induce lactic acidosis

86
Q

cluster headache abort and prophylaxis?

A

acute abort: sumatriptan and Oxygen

prophylaxis: verapamil is 1st line

87
Q

2 first line treatments for migraine prophylaxis

A

TCA (amitriptyline)
BB propanolol

(verapamil is 2nd line. first line for cluster ha ppx)

88
Q

which parasite can cause rectal prolapse in older people, and cognitive problems in younger people? more in tropical places, egg is barrel shaped w/ hyalin plug at end.

can also cause loose stools w/ blood -> anemia

A

whipworm trichuriasis

89
Q

An otherwise healthy 8 year old girl presents with two weeks of perianal pruritis. She has two younger brothers, one of whom has had similar complaints for the past few days. Physical exam reveals perianal erythema with mild excoriations. The “scotch tape test” reveals several bean-shaped white eggs. What is the most likely diagnosis in this patient?

A

Enterobius vermicularis, aka pinworm

90
Q

if you find RBCs in blood, how can you tell if it’s coming from the kidney glomerulus vs elsewhere in GU system (from kidney stones, bladder cancer, urethritis)?

A

dysmorphic RBCs and RBC casts means it’s from glomerulus, they get deformed when they’re squeezed thru the filters

91
Q

in a kid presenting with Alport syndrome, there will be family history of renal failure and ____

A

deafness

92
Q

mid systolic ejection murmur + fixed S2 in asymtpomatic child, what is dx?

A

ASD

93
Q

tx of COPD exacerbation (4)

A
  1. oxygen
  2. bronchodilaters: nebulized ipatropium > albuterol
  3. corticosteroids
  4. abx (amoxicillin, triprim/sulf, azithromycin, doxycycline)
94
Q

iron deficiency anemia in a male is _____ until proven otherwise

A

colorectal cancer

need to get GI workup (colo)

95
Q

most common culprits of triggering hemolytic episodes in G6PD deficient patients

A
  1. viral or bacterial infections
  2. fava beans
  3. nitrofurantoin
  4. quinine
  5. dapsone
  6. sulfonamides (trim/sulf)

family medicine (2 decks)

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