FM - Random Flashcards
painful arc test
AC or glenohumeral injury
hawkins test
rotator cuff tendonitis or subacromial impingement
neer impingement
rotator cuff tendonitis
empty can
supraspinatus
fixed ext rotation
infraspinatus and teres minor
hold until m. falls
lift-off
subscapularis
SSRI w/ rebound anxiety/irritability/paresthesias, N/V/D
Paxil (paroxetine)
chloroquine-resistant malaria
mefloquine
mefloquine-resistant malaria
doxycycline
UTI tx in pregnancy
nitrofurantoin
triple therapy
clarithromycin
amoxicillin
PPI
quadruple therapy
metronidazole
tetracycline
PPI
bismuth salicylate
Red Man Syndrome
vanco
orange/red urine
rifampin
oto/nephrotox
aminoglycosides (gentamicin)
C/G screen
<25 y/o F
sexually active
HEADSS
home education activities drugs sex safety/suicide
high-intensity statin
<75yo w/ CVD
40-75yo w/ DM and CHD risk >7.5%
> 21yo w/ LDL >190 or TG >500
Either High or Moderate
> 75yo w/ CVD
40-75yo w/o DM but w/ CHD risk >7.5%
Moderate-intensity Statins
40-75yo w/ DM and CHD risk <7.5%
Statins
Lowers LDL
AE: Monitor LFTs (monthly for 3 months, then 2-4x/year) Benign CPK elevation
C/I: Acute/Chronic Liver disease
Niacin
Lowers TGs, Raises HDL
AE: Cutaneous Flushing Monitor LFTs (same as above)
C/I: Gout, Chronic Liver Disease, Diabetes w/ poor control
Resins / Bile Acid Sequestrant (Cholestyramine)
Lowers LDL, Increases TGs
AE: Diarrhea, poorly tolerated
CI: high triglycerides
Fibrates (gemfibrozil: Lopid)
Lowers TGs
(main)
Raises HDL
Lowers VLDL
AE: Gallstones, Myopathy, Monitor LFTs
C/I: Severe Renal/Hepatic Disease
> 60yo
Treat if >150/>90 (either) to goal of <150/<90 (both)
<60yo
Treat if >140(SBP) or >90 (DBP) to <140(SBP) and <90 (DBP)
> 60yo w/ CKD/T2DM
Treat if >140(SBP) or >90 (DBP) to <140(SBP) and <90 (DBP)
30-60yo
Treat if DBP >90 to goal of <90
Use HCTZ, CCB, or ACEi
*ACEi good in diabetics, bad in black patients
18-30yo.
Treat if DBP >90 to goal of <90
grade E
<60yo
Treat SBP >140 to goal of <140
grade E
> 18 w/ CKD or diabetes
Treat >140/>90 to goal of <140/<90
> 18yo w/ CKD (but not DM)
Treat with ACEi or ARB to improve renal function
Non-black population
HCTZ, CCB, or ACEi/ARB
Black population
HCTZ or CCB
If BP goal not obtained after 1 mo.
Increase dose of anti-HTN or add second drug
If not obtained after 2nd drug, add 3rd drug .
If BP goal not obtained after 3rd drug, refer to hypertension specialist
ACEi pros
Good vs. DM, CHF, CAD, CKD; good post MI
ACEi cons
Increased BUN/Cr (AKI), bilateral RAS, dry cough in 10%, angioedema, hyperkalemia, ineffective in AA, teratogenic
b-blockers pros
Good post-MI, good vs. CAD, angina, CHF, tachyarrhythmias, performance anxiety, headache prophylaxis, glaucoma, essential tremor
b-blockers cons
Worsens asthma and COPD; can cause or worsen depression, fatigue, decreased stamina, sexual dysfunction, heart block/bradycardia; poor effectiveness in AAs and danger of withdrawal
CCBs pros
Good vs. diastolic CHF, tachyarrhythmias, angina, headache prophylaxis, Raynaud’s disease
CCBs cons
Bad vs. systolic CHF; can worsen or cause leg edema, constipation, headache, GERD, heart block/bradycardia
Diuretics
Good vs. osteoporosis, kidney stones, Can cause hypokalemia; can worsen gout; increases glucose peripheral edema; also, cheap and synergistic intolerance and lipids with other meds
Thiazolidinediones
-azone
can inc MI risk inc bladder cancer
Metformin
dec hepatic gluconeogenesis
sulfonylureas
K(ATP) chan activator
increased insulin secretion from beta cells
glinides
K(ATP) chan activator
increased insulin secretion from beta cells
Alpha-glucosidase inhibitors
acarbose, miglitol, voglibose
AE: diarrhea, bloating
ci: cirrhosis or CKD (serum creatinine >2.0mg per dL)
Incretion enhancers
GLP-1 agonists and DPP-4 inhibitors
HS rxn to Abacavir
HLA-B5701
CD4 100-200
TMP/SMX or Dapsone if G6PD deficiency for PCP
CD4 50-100
TMP/SMX for toxoplasmosis
CD4 <50
azithromycin 1200mg PO/wk for MAC
melanoma suspicion
excisional biopsy (saucerization or elliptical excision) w/ <3mm margins
punch biopsy OK if lesions <4mm
erythema nodosum or panniculitis
excisional biopsy (saucerization or elliptical excision)
Rashes/blister involving just dermis (cutaneous lymphoma, pemphigoid, etc)
shave or punch biopsy
basal cell CA
excisional biopsy
impetigo
Topical Mupirocin
Actinic Keratosis
topical 5-FU, cryotherapy
fifth disease
parvo
no longer contagious if rash seen, but send letter to previous contacts esp preg women
tine versicolor
selsium blue
tine corporis
azole creams
tine capitis
oral azoles or griseofulvin
colorectal cancer screening
btwn 50-75
FOBT x3
flexible (yearly)
sigmoidoscopy + ROBT (q5yr)
colonoscopy (q10yr)
colorectal cancer screening
hx of polyps
repeat colonoscopy at 3yr, if nml then repeat in 5yr
colorectal cancer screening
FHx of CRC/adenomatous polyps
first colonoscopy at 40 y/o or 10 yr before age of dx
repeat 3-5 yr if nml
colorectal cancer screening
FHx of FAP
genetic testing at 10 y/o
if + –> colonoscopy every 1-2 yr or prophylactic colectomy
colorectal cancer screening
FHx of HNPCC
genetic testing at 18 y/o, if + …
21-40 y/o –> colonoscopy ev 2 yr
40+ –> colonoscopy ev yr
osteoporosis
screen women >65 y/o
no screen for men
AUDIT-C
- How often was alcohol consumed in past year?
- How many drinks were had on a typical day of drinking in the past year?
- How often did you have 6 or more drinks on one occasion in the past year?
PREP (Truvada) eligibility
anal/vaginal:
HIV-infected sexual partner
Recent bacterial STI
High number of sex partners
Inconsistent or no condom use
History of engaging in commercial sex work
Being in a high prevalence area or network
IVDU:
HIV-positive injecting partner
History of sharing injection equipment
History of recent drug treatment (but currently injecting)
How to rule out acute or chronic HIV
Combined HIV Ag/Ab test (4th generation test) w/i 7d of initiating PrEP
contraindications to PREP
HIV-infection
high risk HIV exposure within last 72hr (use PEP instead, then consider PrEP)
eGFR <60
PREP (when taken daily) offers full protection after _d for rectal and _d for vaginal sex
7d for rectal 20d for vaginal
Gender identity
A person’s internal sense of being a man/male, woman/female, both, neither, or another gender
Genderqueer (adj)
Describes a person whose gender identity falls outside the traditional gender binary. Other terms for people whose gender identity falls outside the traditional gender binary include gender variant, gender expansive, etc. Some- times written as gender queer
Non-binary (adj)
Describes a person whose gender identity falls outside the traditional gender binary. Sometimes abbreviated to NB or “enby.” Some people identify as “non-binary,” while others identify with another non-binary gender identity, such as genderqueer, gender fluid, or agender
Transfeminine/Trans feminine (adj.)
Describes a person who was assigned male at birth, and who identifies with femininity to a greater extent than with masculinity
Transmasculine/Trans masculine (adj.)
Describes a person who was assigned female at birth, and who identifies with masculinity to a greater extent than with femininity
Transsexual (adj.)
Sometimes used in medical literature or by some transgender people to describe those who have transitioned through medical interventions. Avoid using this term to describe transgender people unless they identify them- selves as such, as it is largely outdated.
Two-Spirit (adj.)
A modern term connecting LGBT Native American and American Indian people with their cultures and tradition
Beer’s criteria
potentially inappropriate meds for elderly
Chantix and NRT can or cannot be combined?
Can be combined, has better outcomes
Top causes of cough
asthma
GERD
postnasal drip
HITS
IPV screening
Hurt, Insult, Threaten, Scream
score >10 is +
STAT
IPV screening
Slapped, Threatened, and Throw
+ answer to any is a + screen
IPV screening tools
HITS
STAT
WAST
biguanides
MOA: dec hepatic glucose output
- metformin
- riomet
AE: N/D, bloating, B12 deficiency
don’t use if GFR <30
“caution” if GFR <45
- NO weight gain/hypOglycemia
- safe in stable CHF
sulfonylureas
MOA: stimulates sustained insulin release
- glyburide
- glipizide
- glimepiride
AE: hypOglycemia and weight gain!!!!!!!!
SGLT2 inhibitors
MOA: dec glucose reabsorption in kidneys
-flozin
AE: hypotension, UTIs, inc urination, genital infections, ketoacidosis
*NO weight gain/hypOglycemia
DDP-4 inhibitors
MOA: incretin enhancers, prolongs action of gut hormones, inc insulin secretion, delays gastric emptying
-gliptin
AE: HA and flu-like sx
*NO weight gain/hypOglycemia
dx criteria for chronic fatigue syndrome
need ALL major PLUS: 8 minor, OR 6 minor and 2 physical
major:
- at least 6 mo
- does not resolve w/ bed rest
- reduces activity to <50%
- other conditions have been excluded
physical:
- Low-grade fever
- nonexudative pharyngitis
- lymphadenopathy
minor: Sore throat; mild fever or chills; lymph node pain; generalized muscle weakness; myalgia; prolonged fatigue after exercise; new-onset headaches; migratory noninflammatory arthralgia; sleep disturbance; neuropsychological symptoms (e.g., photophobia, scotomata, forgetfulness, irritability, confusion, inability to concentrate, depression, difficulty thinking); description of initial onset as acute or subacute
SNRI or SSRI are more effective
SNRI slightly, but higher rate AE (N/V)
for tx-naive pt, all ___ antidepressants are equally effective
second gen
Which anti-depressants should be avoided in older adults
paroxetine (Paxil) and fluoxetine (prozac)
Tx for a first episode of major depression should last at least
4 mo.
MDD
presence of greater than 5 of the following (must include 1 or 2)
- depressed mood
- anhedonia (dec interest/pleasure)
- weight/appetite change
- insomnia or hypersomnia
- psychomotor agitation or retardation ~daily
- fatigue or loss of energy
- feelings of worthlessness or xs or inappropriate guilt
- indecisiveness/dec concentration
- recurrent death/suicide thoughts
acupuncture
benefits chronic low back pain
coenzyme Q10
safe ADJUNCTIVE therapy in pt w/ HF and may improve clinical outcomes
exercise
small-moderate effect in reducing anxiety sx
fish oil
effective tx for hyperTG
ginkgo biloba extract EGb 761
improves cognition in pt w/ dementia
CBT
effective for tx of insomnia
movement-oriented mind-body approaches (yoga, tai chi, qi gong)
may be beneficial for sleep (esp older adults, cancer survivors)
probiotic supplementation
significant reduces incidence of abx-assoc diarrhea
St. John’s wort (hypericum perforatum)
benefits pt w/ mild-moderate depression
adjunctive CAM therapy
coenzyme q10 (rest are first-line)
easily-absorbed types of Omega-3
EPA
DHA
fish and algal oil supplements
omega-3 vegetarian food sources
flax
walnuts
chia
diet supplements made from blue green algae
daily fiber recommendation
30g
daily protein recommendation
50g
daily calcium recommendation
1000mg
1200mg (if postmenopausal woman)
single question alcohol screening
“How many times in the past year have you had five (men)/four (women) or more drinks in a day?”
DASH diet sodium limit
2400mg
social determinants of health
Education, employment opportunities, water, sanitation, housing, food access, level of social inclusion / exclusion, social support networks, stress, early childhood development, race/gender/sexual orientation/etc (as they impact the other SDHs)
effective cold tx for children
acetylcysteine analgesics honey intranasal ipratropium (atrovent) nasal saline irrigation ointment (camphor, menthol, eucalyptus oils) vitamin C
effective cold tx for adults
acetaminophen antihistamine + decongestant intranasal ipratropium (atrovent) intranasal oxymetazoline lactobacillus casei NSAIDs zinc acetate or gluconate
STEPS approach for diabetes tx
safety, tolerability, effectiveness, price, and simplicity.
DPP-4 inhibitors
-pancreatitis, hypOglycemia, slight high rate CHF
amalyin analogues
serious hypOglycemia
should not be used in pt w/ gastroparesis
DM 2 screening (USPTF)
40-70 y/o overweight or obese adults
repeat testing every 3 years if results are normal
DM 2 screening (ADA)
45 y/o and older OR younger than 45 with major risk fx (exp. A1c >5.7)
DM2 dx
- fasting glucose >126mg/dL
- random glucose >200
- 75g two-hour oral glucose tolerance test >200mg/dL
acamprosate ci
renal failure
naltrexone ci
liver failure
antiepileptic useful in alcohol dependency
topiramate
risk fx of patellofemoral pain syndrome
female sex
running, squatting, stairs
dec quads strength
dynamic valgus
most effective tx in improving long and short term pain of patellofemoral pain syndrome
exercise therapy
NSAIDs effect on patellofemoral pain syndrome
improvement may be limited to one week
consistent benefits in tx depression
yoga
inconsistent in tx depression
tai chi
qi gong
adjunctive depression tx
exercise
mindfulness-based intervention
most effective tool in ID delirium
confusion assessment method
req 1 and 2, and either 3 or 4
- acute, fluctuating
- inatttention
- disorganized thinking
- alt level of consciousness
delirium
disturbance in attention level over short pd of time disturbance in cognition not explained otherwise evidence that disturb is direct physio consequence
The ________ has the best combination of positive and negative likelihood ratios in the dx of ADHD
Conners Abbreviated Symptom Questionnaire
window period
15-17d
from HIV detection to date it can be detected on labs
ankylosing spondylitis
Onset <40 years old, gradual onset
Pain duration >3 months
Morning stiffness
Improved by exercise
spinal stenosis
leg pain on walking
relieved by sitting or standing
acute low BP pharm tx
NSAIDs, acetaminophen, m. relaxants
chronic low BP pharm tx
gabapentin topiramate cymbalta NSAIDs opioids spinal manipulation (only up to 6 mo.)
non effective chronic LBP tx
skel. m. relaxants (cyclobenzaprine) acetaminophen antidepressants (EXCEPT cymbalta) lidocaine patches transcutaneous elec n. stim epidural steroid injections
women dx with gDM should receive a 75g glucose tolerance test when postpartum?
between 4-12 wk postpartum
Pt w/ hypertensive disorders of preg should have a BP check when postpartum?
within 7d
