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Emma Family Med > FM - Random > Flashcards

FM - Random Flashcards

1
Q

painful arc test

A

AC or glenohumeral injury

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2
Q

hawkins test

A

rotator cuff tendonitis or subacromial impingement

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3
Q

neer impingement

A

rotator cuff tendonitis

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4
Q

empty can

A

supraspinatus

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5
Q

fixed ext rotation

A

infraspinatus and teres minor

hold until m. falls

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6
Q

lift-off

A

subscapularis

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7
Q

SSRI w/ rebound anxiety/irritability/paresthesias, N/V/D

A

Paxil (paroxetine)

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8
Q

chloroquine-resistant malaria

A

mefloquine

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9
Q

mefloquine-resistant malaria

A

doxycycline

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10
Q

UTI tx in pregnancy

A

nitrofurantoin

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11
Q

triple therapy

A

clarithromycin
amoxicillin
PPI

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12
Q

quadruple therapy

A

metronidazole
tetracycline
PPI
bismuth salicylate

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13
Q

Red Man Syndrome

A

vanco

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14
Q

orange/red urine

A

rifampin

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15
Q

oto/nephrotox

A

aminoglycosides (gentamicin)

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16
Q

C/G screen

A

<25 y/o F

sexually active

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17
Q

HEADSS

A 
home
education
activities
drugs
sex 
safety/suicide
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18
Q

high-intensity statin

A

<75yo w/ CVD

40-75yo w/ DM and CHD risk >7.5%

> 21yo w/ LDL >190 or TG >500

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19
Q

Either High or Moderate

A

> 75yo w/ CVD

40-75yo w/o DM but w/ CHD risk >7.5%

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20
Q

Moderate-intensity Statins

A

40-75yo w/ DM and CHD risk <7.5%

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21
Q

Statins

A

Lowers LDL

AE: Monitor LFTs (monthly for 3 months, then 2-4x/year) Benign CPK elevation

C/I: Acute/Chronic Liver disease

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22
Q

Niacin

A

Lowers TGs, Raises HDL

AE: Cutaneous Flushing
Monitor LFTs (same as above)

C/I: Gout, Chronic Liver Disease, Diabetes w/ poor control

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23
Q

Resins / Bile Acid Sequestrant (Cholestyramine)

A

Lowers LDL, Increases TGs

AE: Diarrhea, poorly tolerated

CI: high triglycerides

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24
Q

Fibrates (gemfibrozil: Lopid)

A

Lowers TGs
(main)
Raises HDL
Lowers VLDL

AE: Gallstones, Myopathy, Monitor LFTs

C/I: Severe Renal/Hepatic Disease

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25
Q

> 60yo

A

Treat if >150/>90 (either) to goal of <150/<90 (both)

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26
Q

<60yo

A

Treat if >140(SBP) or >90 (DBP) to <140(SBP) and <90 (DBP)

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27
Q

> 60yo w/ CKD/T2DM

A

Treat if >140(SBP) or >90 (DBP) to <140(SBP) and <90 (DBP)

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28
Q

30-60yo

A

Treat if DBP >90 to goal of <90

Use HCTZ, CCB, or ACEi

*ACEi good in diabetics, bad in black patients

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29
Q

18-30yo.

A

Treat if DBP >90 to goal of <90

grade E

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30
Q

<60yo

A

Treat SBP >140 to goal of <140

grade E

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31
Q

> 18 w/ CKD or diabetes

A

Treat >140/>90 to goal of <140/<90

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32
Q

> 18yo w/ CKD (but not DM)

A

Treat with ACEi or ARB to improve renal function

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33
Q

Non-black population

A

HCTZ, CCB, or ACEi/ARB

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34
Q

Black population

A

HCTZ or CCB

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35
Q

If BP goal not obtained after 1 mo.

A

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

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36
Q

ACEi pros

A

Good vs. DM, CHF, CAD, CKD; good post MI

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37
Q

ACEi cons

A

Increased BUN/Cr (AKI), bilateral RAS, dry cough in 10%, angioedema, hyperkalemia, ineffective in AA, teratogenic

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38
Q

b-blockers pros

A

Good post-MI, good vs. CAD, angina, CHF, tachyarrhythmias, performance anxiety, headache prophylaxis, glaucoma, essential tremor

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39
Q

b-blockers cons

A

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

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40
Q

CCBs pros

A

Good vs. diastolic CHF, tachyarrhythmias, angina, headache prophylaxis, Raynaud’s disease

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41
Q

CCBs cons

A

Bad vs. systolic CHF; can worsen or cause leg edema, constipation, headache, GERD, heart block/bradycardia

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42
Q

Diuretics

A

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

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43
Q

Thiazolidinediones

A

-azone

can inc MI risk inc bladder cancer

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44
Q

Metformin

A

dec hepatic gluconeogenesis

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45
Q

sulfonylureas

A

K(ATP) chan activator

increased insulin secretion from beta cells

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46
Q

glinides

A

K(ATP) chan activator

increased insulin secretion from beta cells

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47
Q

Alpha-glucosidase inhibitors

A

acarbose, miglitol, voglibose

AE: diarrhea, bloating

ci: cirrhosis or CKD (serum creatinine >2.0mg per dL)

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48
Q

Incretion enhancers

A

GLP-1 agonists and DPP-4 inhibitors

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49
Q

HS rxn to Abacavir

A

HLA-B5701

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50
Q

CD4 100-200

A

TMP/SMX or Dapsone if G6PD deficiency for PCP

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51
Q

CD4 50-100

A

TMP/SMX for toxoplasmosis

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52
Q

CD4 <50

A

azithromycin 1200mg PO/wk for MAC

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53
Q

melanoma suspicion

A

excisional biopsy (saucerization or elliptical excision) w/ <3mm margins

punch biopsy OK if lesions <4mm

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54
Q

erythema nodosum or panniculitis

A

excisional biopsy (saucerization or elliptical excision)

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55
Q

Rashes/blister involving just dermis (cutaneous lymphoma, pemphigoid, etc)

A

shave or punch biopsy

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56
Q

basal cell CA

A

excisional biopsy

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57
Q

impetigo

A

Topical Mupirocin

58
Q

Actinic Keratosis

A

topical 5-FU, cryotherapy

59
Q

fifth disease

A

parvo

no longer contagious if rash seen, but send letter to previous contacts esp preg women

60
Q

tine versicolor

A

selsium blue

61
Q

tine corporis

A

azole creams

62
Q

tine capitis

A

oral azoles or griseofulvin

63
Q

colorectal cancer screening

btwn 50-75

A

FOBT x3
flexible (yearly)

sigmoidoscopy + ROBT (q5yr)

colonoscopy (q10yr)

64
Q

colorectal cancer screening

hx of polyps

A

repeat colonoscopy at 3yr, if nml then repeat in 5yr

65
Q

colorectal cancer screening

FHx of CRC/adenomatous polyps

A

first colonoscopy at 40 y/o or 10 yr before age of dx

repeat 3-5 yr if nml

66
Q

colorectal cancer screening

FHx of FAP

A

genetic testing at 10 y/o

if + –> colonoscopy every 1-2 yr or prophylactic colectomy

67
Q

colorectal cancer screening

FHx of HNPCC

A

genetic testing at 18 y/o, if + …

21-40 y/o –> colonoscopy ev 2 yr

40+ –> colonoscopy ev yr

68
Q

osteoporosis

A

screen women >65 y/o

no screen for men

69
Q

AUDIT-C

A
  1. How often was alcohol consumed in past year?
  2. How many drinks were had on a typical day of drinking in the past year?
  3. How often did you have 6 or more drinks on one occasion in the past year?
70
Q

PREP (Truvada) eligibility

A

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)

71
Q

How to rule out acute or chronic HIV

A

Combined HIV Ag/Ab test (4th generation test) w/i 7d of initiating PrEP

72
Q

contraindications to PREP

A

HIV-infection
high risk HIV exposure within last 72hr (use PEP instead, then consider PrEP)
eGFR <60

73
Q

PREP (when taken daily) offers full protection after _d for rectal and _d for vaginal sex

A

7d for rectal 20d for vaginal

74
Q

Gender identity

A

A person’s internal sense of being a man/male, woman/female, both, neither, or another gender

75
Q

Genderqueer (adj)

A

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

76
Q

Non-binary (adj)

A

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

77
Q

Transfeminine/Trans feminine (adj.)

A

Describes a person who was assigned male at birth, and who identifies with femininity to a greater extent than with masculinity

78
Q

Transmasculine/Trans masculine (adj.)

A

Describes a person who was assigned female at birth, and who identifies with masculinity to a greater extent than with femininity

79
Q

Transsexual (adj.)

A

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.

80
Q

Two-Spirit (adj.)

A

A modern term connecting LGBT Native American and American Indian people with their cultures and tradition

81
Q

Beer’s criteria

A

potentially inappropriate meds for elderly

82
Q

Chantix and NRT can or cannot be combined?

A

Can be combined, has better outcomes

83
Q

Top causes of cough

A

asthma
GERD
postnasal drip

84
Q

HITS

A

IPV screening

Hurt, Insult, Threaten, Scream
score >10 is +

85
Q

STAT

A

IPV screening

Slapped, Threatened, and Throw
+ answer to any is a + screen

86
Q

IPV screening tools

A

HITS
STAT
WAST

87
Q

biguanides

A

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
88
Q

sulfonylureas

A

MOA: stimulates sustained insulin release

  • glyburide
  • glipizide
  • glimepiride

AE: hypOglycemia and weight gain!!!!!!!!

89
Q

SGLT2 inhibitors

A

MOA: dec glucose reabsorption in kidneys

-flozin

AE: hypotension, UTIs, inc urination, genital infections, ketoacidosis

*NO weight gain/hypOglycemia

90
Q

DDP-4 inhibitors

A

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

91
Q

dx criteria for chronic fatigue syndrome

A

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

92
Q

SNRI or SSRI are more effective

A

SNRI slightly, but higher rate AE (N/V)

93
Q

for tx-naive pt, all ___ antidepressants are equally effective

A

second gen

94
Q

Which anti-depressants should be avoided in older adults

A

paroxetine (Paxil) and fluoxetine (prozac)

95
Q

Tx for a first episode of major depression should last at least

A

4 mo.

96
Q

MDD

A

presence of greater than 5 of the following (must include 1 or 2)

  1. depressed mood
  2. anhedonia (dec interest/pleasure)
  3. weight/appetite change
  4. insomnia or hypersomnia
  5. psychomotor agitation or retardation ~daily
  6. fatigue or loss of energy
  7. feelings of worthlessness or xs or inappropriate guilt
  8. indecisiveness/dec concentration
  9. recurrent death/suicide thoughts
97
Q

acupuncture

A

benefits chronic low back pain

98
Q

coenzyme Q10

A

safe ADJUNCTIVE therapy in pt w/ HF and may improve clinical outcomes

99
Q

exercise

A

small-moderate effect in reducing anxiety sx

100
Q

fish oil

A

effective tx for hyperTG

101
Q

ginkgo biloba extract EGb 761

A

improves cognition in pt w/ dementia

102
Q

CBT

A

effective for tx of insomnia

103
Q

movement-oriented mind-body approaches (yoga, tai chi, qi gong)

A

may be beneficial for sleep (esp older adults, cancer survivors)

104
Q

probiotic supplementation

A

significant reduces incidence of abx-assoc diarrhea

105
Q

St. John’s wort (hypericum perforatum)

A

benefits pt w/ mild-moderate depression

106
Q

adjunctive CAM therapy

A

coenzyme q10 (rest are first-line)

107
Q

easily-absorbed types of Omega-3

A

EPA
DHA

fish and algal oil supplements

108
Q

omega-3 vegetarian food sources

A

flax
walnuts
chia
diet supplements made from blue green algae

109
Q

daily fiber recommendation

A

30g

110
Q

daily protein recommendation

A

50g

111
Q

daily calcium recommendation

A

1000mg

1200mg (if postmenopausal woman)

112
Q

single question alcohol screening

A

“How many times in the past year have you had five (men)/four (women) or more drinks in a day?”

113
Q

DASH diet sodium limit

A

2400mg

114
Q

social determinants of health

A

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)

115
Q

effective cold tx for children

A 
acetylcysteine
analgesics
honey
intranasal ipratropium (atrovent)
nasal saline irrigation
ointment (camphor, menthol, eucalyptus oils)
vitamin C
116
Q

effective cold tx for adults

A 
acetaminophen
antihistamine + decongestant
intranasal ipratropium (atrovent)
intranasal oxymetazoline
lactobacillus casei 
NSAIDs
zinc acetate or gluconate
117
Q

STEPS approach for diabetes tx

A

safety, tolerability, effectiveness, price, and simplicity.

118
Q

DPP-4 inhibitors

A

-pancreatitis, hypOglycemia, slight high rate CHF

119
Q

amalyin analogues

A

serious hypOglycemia

should not be used in pt w/ gastroparesis

120
Q

DM 2 screening (USPTF)

A

40-70 y/o overweight or obese adults

repeat testing every 3 years if results are normal

121
Q

DM 2 screening (ADA)

A

45 y/o and older OR younger than 45 with major risk fx (exp. A1c >5.7)

122
Q

DM2 dx

A
  1. fasting glucose >126mg/dL
  2. random glucose >200
  3. 75g two-hour oral glucose tolerance test >200mg/dL
123
Q

acamprosate ci

A

renal failure

124
Q

naltrexone ci

A

liver failure

125
Q

antiepileptic useful in alcohol dependency

A

topiramate

126
Q

risk fx of patellofemoral pain syndrome

A

female sex
running, squatting, stairs
dec quads strength
dynamic valgus

127
Q

most effective tx in improving long and short term pain of patellofemoral pain syndrome

A

exercise therapy

128
Q

NSAIDs effect on patellofemoral pain syndrome

A

improvement may be limited to one week

129
Q

consistent benefits in tx depression

A

yoga

130
Q

inconsistent in tx depression

A

tai chi

qi gong

131
Q

adjunctive depression tx

A

exercise

mindfulness-based intervention

132
Q

most effective tool in ID delirium

A

confusion assessment method

req 1 and 2, and either 3 or 4

  1. acute, fluctuating
  2. inatttention
  3. disorganized thinking
  4. alt level of consciousness
133
Q

delirium

A 
disturbance in attention 
level over short pd of time
disturbance in cognition 
not explained otherwise
evidence that disturb is direct physio consequence
134
Q

The ________ has the best combination of positive and negative likelihood ratios in the dx of ADHD

A

Conners Abbreviated Symptom Questionnaire

135
Q

window period

A

15-17d

from HIV detection to date it can be detected on labs

136
Q

ankylosing spondylitis

A

Onset <40 years old, gradual onset
Pain duration >3 months
Morning stiffness
Improved by exercise

137
Q

spinal stenosis

A

leg pain on walking

relieved by sitting or standing

138
Q

acute low BP pharm tx

A

NSAIDs, acetaminophen, m. relaxants

139
Q

chronic low BP pharm tx

A 
gabapentin
topiramate
cymbalta
NSAIDs
opioids
spinal manipulation (only up to 6 mo.)
140
Q

non effective chronic LBP tx

A 
skel. m. relaxants (cyclobenzaprine)
acetaminophen
antidepressants (EXCEPT cymbalta)
lidocaine patches
transcutaneous elec n. stim
epidural steroid injections
141
Q

women dx with gDM should receive a 75g glucose tolerance test when postpartum?

A

between 4-12 wk postpartum

142
Q

Pt w/ hypertensive disorders of preg should have a BP check when postpartum?

A

within 7d

Emma Family Med (5 decks)

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