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CLINICAL YR: Fam Med Study > FM Topic List: Rosh_SmartyPance > Flashcards

FM Topic List: Rosh_SmartyPance Flashcards

1
Q

(SmartyPance)

define stable angina (two factors)

A

predictable

relieved by rest and/or nitro

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2
Q

(SmartyPance)

define unstable angina (three factors)

A

previously stable and predictable symptoms of angina that are:
1 - more frequent
2 - increasing
3 - present at rest

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3
Q

(SmartyPance)

define Prinzmetal variant angina

A

CORONARY ARTERY VASOSPASMS causing
- transient ST-segment elevations,
not associated with clot

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4
Q

(SmartyPance)
what is the most widely used test for diagnosis of ischemic heart disease (i.e. chest discomfort relieved with rest, worsening dyspnea with exertion)?

A

“In patients with classic symptoms of angina, NUCLEAR STRESS TESTING is the most widely used test for diagnosis of ischemic heart disease.”

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5
Q

(SmartyPance)

which arrhythmia presents as early wide BIZARRE QRS with no p wave?

A

PVC

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6
Q

(SmartyPance)

what arrhythmia presents as abnormally shaped P waves?

A

PAC

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7
Q

(SmartyPance)

what is myxedema? what does it make the pt predisposed to?

A

severe hypothyroidism (possibly untreated hypothyroidsim)

carpal tunnel syndrome

(“Patients with myxedema or hypothyroidism have accumulation of myxedemateous tissue under the transverse carpal ligament, which causes compression of the median nerve in the carpal tunnel resulting in the manifestations of carpal tunnel syndrome.”)

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8
Q

(SmartyPance)

what is the hallmark of diabetic retinopathy?

A

NEOVASCULARIZATION

“Neovascularization is the hallmark of proliferative diabetic retinopathy. New vessels can appear at the optic nerve and the macula as a result of retinal hypoxia. They are susceptible to rupture, resulting in vitreous hemorrhage, retinal detachment, and blindness. Proliferative retinopathy requires urgent referral to an ophthalmologist and is usually treated with pan retinal laser photocoagulation.”

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9
Q

(SmartyPance)

What laboratory test could lead to the earliest confirmation of B. pertussisor parapertussis infection?

A

Polymerase Chain Reaction assay and antigen detection

“The diagnosis of pertussis is still primarily clinical, and laboratory results only play a small role in the diagnostics. Although culture used to be the gold standard, PCR assay and antigen detection are now considered more reliable. PCR assay and antigen detection are increasingly used to assist in diagnosing pertussis.”

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10
Q

(SmartyPance)

what are the mainstays of treatment for ulcerative colitis?

A

sulfasalazine
5-amino-salicylacid

corticosteroids for more severe cases

” In addition to sulfasalazine or 5-amino-salicylacid, more severe ulcerative colitis cases require corticosteroids. Corticosteroids are also helpful in Crohn’s disease involving the small bowel. “

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11
Q

(SmartyPance)

describe the aortic regurgitation murmur

A

SOFT
EARLY DIASTOLIC
HIGH-PITCHED MURMUR
BEST HEARD SITTING/LEANING FORWARD

“aortic regurgitation, as it presents as a soft, early diastolic, high-pitched murmur heard best when sitting and leaning forward. It is often a result of rheumatic heart disease, which may be inferred by the patient’s history. “

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12
Q

(RoshReview)
67-year-old woman presents complaining of dark urine. Over several months she has had increased fatigue and weight loss. There has not been any fever or night sweats. On physical examination, she has scleral icterus and mild jaundice. Her abdomen is soft, non-distended with a palpable mass in the right upper quadrant that is non-tender. What imaging is required?

A

ABDOMINAL CT: R/O PANCREATIC CA

“The patient’s symptoms are concerning for pancreatic cancer. This patient has developed painless jaundice, the classic presentation of someone with a mass at the head of the pancreas compressing the bile duct. Patients will often also complain of weight loss typically due to loss of appetite. The imaging study of choice in this situation is an abdominal CT scan.”

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13
Q

(RoshReview)
“An 83-year-old man from a nursing home is sent for evaluation of abdominal distention and vomiting. Nursing home records report no bowel movement for two days and no fevers. On CT scan, no obstructing lesion is identified. What may be beneficial in relieving this condition?”

A

NEOSTIGMINE

“CT scan does not show any obstructing lesion and therefore this is a pseudo-obstruction, also known as Ogilvie syndrome. The exact mechanism of the development of pseudo-obstruction is unknown but suspected to result from malfunction of the autonomic control of the bowel. Patients often have multiple other co-morbid conditions and risk factors include nursing home residence, anticholinergic medication, severe electrolyte disturbance, narcotic exposure, or a history of spine or retroperitoneal trauma. This is a diagnosis of exclusion. Patients may first be treated with a rectal tube and sigmoidoscopy and managed conservatively in the hospital. Neostigmine may be used as a pharmacologic intervention as it is an acetylcholinesterase inhibitor.”

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14
Q

(RoshReview)

Which laboratory finding is most consistent with refeeding syndrome?

A 
HYPOPHOSPHATEMIA
HYPOKALEMIA
THIAMINE DEFICIENCY
CHF
PERIPHERAL EDEMA
Refeeding syndrome is a complication that occurs during nutritional therapy of malnourished patients.
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15
Q

(RoshReview)

what is alpha-1 antitrypsin (AAT) deficiency?

A

alpha-1 antitrypsin (AAT) deficiency is an inherited disorder that affects the lung, liver, and sometimes the skin.

Patients with severe AAT deficiency are at risk for emphysema due to an imbalance of enzymes leading to increased destruction of elastin in the lungs. Liver disease often results from the accumulation of an AAT protein in the liver. Patients with AAT deficiency often report dyspnea, cough, and a history of chronic upper respiratory infections.

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16
Q

(RoshReview)

what distinguishes alpha-1 antitrypsin deficiency from COPD?

A

Younger onset (< 45 years old), a negative smoking history, and a basilar-predominant pattern of emphysema on CXR can help distinguish AAT deficiency from COPD and acute bronchitis.

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17
Q

(SmartyPance)

what premature beat arrythmia presents as narrow QRS complex, no p wave or inverted p wave

A

PJC

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18
Q

(SmartyPance)

name two attributes of paroxysmal supraventricular tachycardia seen on EKG

A

narrow, complex tachycardia

no discernible P waves

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19
Q

(SmartyPance)

what does AFib look like on EKG?

A

irregularly irregular rhythm with

disorganized and irregular atrial activations and

an absence of P waves

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20
Q

(SmartyPance)

what does AFlutter look like on EKG?

A

regular, sawtooth pattern and

narrow QRS complex

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21
Q

(SmartyPance)

what is sick sinus syndrome?

A

a brady-tachy rhythm

arrhythmia in which bradycardia alternates with tachycardia

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22
Q

(SmartyPance)

what is SINUS ARREST in terms of sick sinus syndrome?

A

sinus arrest: prolonged absence of sinus node activity (absent P waves) > 3 seconds

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23
Q

(SmartyPance)

what is SINUS ARRHYTHMIA?

A

Normal, minimal variations in the SA node’s pacing rate in association with the phases of respiration.

Heart rate frequently increases with inspiration,
decreases with expiration

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24
Q

(SmartyPance)

what do PVCs look like on EKG?

A

early WIDE “BIZARRE” QRS

no p wave seen

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25
Q

(SmartyPance)

what does VFib look like on EKG?

A

erratic rhythm with no discernable waves (P, QRS, or T)

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26
Q

(SmartyPance)

what does Torsades de Pointes look like on EKG?

A

polymorphic ventricular tachycardia that appears to be twisting around a baseline

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27
Q

(SmartyPance)

what does ventricular tachycardia look like on EKG?

A

Three or more consecutive ventricular premature beat (VPB) displaying a broad QRS complex tachyarrhythmia

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28
Q

(SmartyPance)

chest pain that is relieved by sitting and/or leaning forward

A

pericarditis

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29
Q

(SmartyPance)

severe, tearing (ripping, knife-like) chest pain radiating to the back

A

aortic dissection

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30
Q

(SmartyPance)

what is most likely problem marked by dyspnea (MC) and pleuritic chest pain?

A

PE

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31
Q

define ACUTE BACTERIAL ENDOCARDITIS and name MC organism

A

infection of normal valves with a virulent organism

S. aureus

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32
Q

(RR)

Epinephrine is a positive chronotropic and inotrope. Stimulation of which receptor is responsible for these properties?

A

BETA-1

stimulation of beta-1 receptors which are located in the heart favor increased heart rate (chronotropy) and more forceful m. contraction (inotropy)

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33
Q

(RR)

where are alpha 1 receptors primarily located?

A

vascular smooth muscle

When activated, vasoconstriction results. This accounts for epi’s ability to increase systolic bp but is not responsible for chronotropy and inotropy.

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34
Q

(RR)

what is the effect of stimulating alpha 2 receptors?

A

VASODILATION

alpha 2 stimulation results in vasodilation and does not contribute to increased chronotropy and inotropy

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34
Q

(RR)

what is the effect of stimulating alpha 2 receptors?

A

VASODILATION

alpha 2 stimulation results in vasodilation and does not contribute to increased chronotropy and inotropy

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35
Q

(RR)
where are beta 2 receptors located?

what does stimulating beta 2 receptors do?

A

beta 2 receptors are located in SMOOTH MUSCLE

stimulation causes VASODILATION

(this is activated in treatment of asthma; does not influence chronotropy and inotropy)

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36
Q

(RR)

what is an example of an alpha-2 agonist?

A

CLONIDINE

(used in the treatment of HTN)

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37
Q

(RR)
a 23 y/o woman presents with intermittent postcoital vaginal bleeding and persistent purulent vaginal discharge for one week. Her cervix is erythematous and friable. There is no cervical motion tenderness on exam. What is the best next step?

A

INITIATE EMPIRIC ANTIBIOTIC THERAPY
(“b/c infectious cervicitis can lead to upper genital tract infections and potentially to infertility, most women w/ cervicitis would receive empiric antibiotic therapy covering BOTH gonorrhoeae and Chlamydia trachomatis at the time of initial evaluation, w/o waiting for lab results”

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38
Q

(RR)

what methods are best for detecting N. gonorrhoeae and C. trachomatis (due to superior sensitivity and specificity)?

A

NUCLEIC ACID AMPLIFICATION TESTING methods are best

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39
Q

(RR)
what are the two most common causes of infectious cervicitis?

how are they treated?

A

Neisserie gonorrhoeae
Chlamydia trachomatis

ceftriaxone 500 mg IM (gonorrhea)
and
doxycycline 100 mg bid x 7 days (chlamydia)

2nd choice: gentamicin + azithromycin

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40
Q

(RR)

what is miliary TB? how does it appear on xray? what is another term for this?

A

“miliary” refers to the pathologic lesions seen on xray that appear as small millet seeds

aka “acute disseminated tuberculosis”

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41
Q

(RR)

The mycobacteria of miliary TB are spread in what way?

A

HEMATOGENOUS ROUTE

“Spread of the mycobacteria occurs through the hematogenous route, which leads to the multisystem nature of miliary TB”

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42
Q

(RR)

name five clinical manifestations of miliary TB

A 
failure to thrive
fever of unknown origin
multiorgan dysfunction
night sweats
rigors
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43
Q

(RR) BUZZWORDS:

Ghon focus

A

primary TB

this is a finding on CXR

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44
Q

(RR)

how is diagnosis made for latent/primary TB?

A

PPD (this is the gold standard)

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45
Q

(RR)

how is diagnosis made for active/reactivation of TB?

A

sputum smears for acid-fast bacilli (AFB)

sputum/tissue culture for AFB (gold standard)

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46
Q

(RR)

Warfarin blocks synthesis of what clotting factors?

A

II
VII
IX
X

and PROTEIN C and PROTEIN S

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47
Q

(RR)

what is used to reverse Warfarin, if needed?

A

VITAMIN K

reverse with VITAMIN K, consider fresh frozen plasma for any life threatening bleed

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48
Q

(RR)

list three primary s/s of aortic stenosis

A

dyspnea

chest pain

syncope

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49
Q

(RR)

give four physical exam findings that go with aortic stenosis (the murmur, the heart sounds)

A

CRESCENDO-DECRESCENDO systolic murmur
radiates to carotids
paradoxically split S2
S4 gallop

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50
Q

(RR)

what is aortic stenosis most commonly caused by

A

DEGENERATIVE CALCIFICATION

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51
Q

(RR)

aortic stenosis murmur decreases or increases with valsalva?

A

DECREASES

“murmur decreases with valsalva”

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52
Q

(RR)

a diastolic murmur heard at the apex is most likely…..

A

MITRAL STENOSIS

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53
Q

(RR)

descriptors of mitral stenosis

A

LOUD S1
OPENING SNAP IN EARLY DIASTOLE
accompanied by a LOW-PITCHED, RUMBLING DIASTOLIC APICAL MURMUR

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54
Q

(RR)

what does mitral valve stenosis most commonly result from?

A

rheumatic heart disease

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55
Q

(RR)

what is the most commonly associated complication of mitral valve stenosis?

A

atrial fibrillation

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56
Q

(RR)

what is the most common organism in necrotizing pneumonia, particularly after a viral URI?

A

STAPH AUREUS

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57
Q

(RR)

post-viral secondary necrotizing pneumonia is usually preceded by what infection?

A

INFLUENZA

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58
Q

(RR)

what is the most common etiologic agent of PUD?

A

Helicobacter pylori

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59
Q

(RR)

what is the second most common cause of PUD?

A

the use of NSAIDs

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60
Q

(RR)

what is the common presentation of PUD?

A

EPIGASTRIC ABDOMINAL PAIN that occurs

TWO to FIVE HOURS AFTER EATING, or when sleeping

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61
Q

(RR)

what are three complications of PUD

A

UPPER GASTROINTESTINAL HEMORRHAGE

perforation

gastric outlet obstruction

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62
Q

(RR)

once H. pylori is confirmed as the cause of PUD, what is the treatment regimen?

A

TRIPLE THERAPY:

clarithromycin 500 mg bid

amoxicillin 1 gram bid (or metronidazole 500 mg bid if PCN-allergic)

PPI once a day for 10-14 days

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63
Q

(RR)

what is quadruple therapy for PUD?

A

bismuth subsalicylate

metronidazole

tetracycline

PPI

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64
Q

(RR) BUZZWORDS

an irregularly irregular rhythm with narrow QRS complexes and no consistent P waves is most likely….

A

ATRIAL FIBRILLATION

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65
Q

(RR)

what is the treatment of atrial fibrillation with rapid ventricular response?

A

if stable, rate control via CALCIUM CHANNEL BLOCKER (e.g.) diltiazem or BETA BLOCKER (e.g. metoprolol)

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66
Q

(RR)

what are the two conditions that make up inflammatory bowel disease?

A

Crohn disease

ulcerative colitis

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67
Q

(RR)

Crohn disease most commonly affects the _______ (which part of the intestinal tract)?

A

TERMINAL ILEUM

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68
Q

(RR)

signs/symptoms of Crohn disease

A

unintentional wt loss

intermittent low-grade fevers

nonbloody diarrhea

RLQ pain

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69
Q

(RR)

extra intestinal manifestations of Crohn’s include:

A

anterior uveitis

primary sclerosing cholangitis

vitamin B12 deficiency

dermatologic manifestations: pyoderma gangrenosum, erythema nodosum

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70
Q

(RR)

how does erythema nodosum present itself when it is manifested by Crohn disease?

A

erythematous

tender

nonulcerated

immobile

nodules on bilateral shins

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71
Q

(RR)
what pleural fluid:serum protein ratio indicates the presence of an exudative effusion consistent with an infectious cause

A

pleural fluid : serum protein > 0.5

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72
Q

(RR)

what is the significance of a high amylase level in a pleural fluid sample?

A

a high amylase level usually indicates the presence of
pancreatitis,
esophageal rupture,
or malignancy

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73
Q

(RR)

what is the most common cause of an esophageal perforation?

A

IATROGENIC

(“most esophageal perforations are iatrogenic and often result from complications of instrumentation (about 60% of all cases). it’s usually from RIGID ENDOSCOPE.

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74
Q

(RR)

what condition is associated with the presence of anal skin tags?

A

inflammatory bowel disease

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75
Q

(RR)

what is the difference in internal vs external hemorrhoids

A

Internal: proximal to the dentate line
External: distal to the dentate line

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76
Q

(RR)

what is the most common cause of acute pericarditis in the US?

A

viral infection

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77
Q

(RR)

most cases of pericarditis present with what?

A

pleuritic postural chest pain

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78
Q

(RR)

what are the typical murmur findings of mitral valve regurgitation?

A

soft S1 and a loud, blowing holosystolic murmur

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79
Q

(RR)

Mitral regurgitation is defined as _______

A

abnormal reversal of blood flow from the left ventricle back into the left atrium

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80
Q

(RR)

common presenting symptoms for mild to moderate, chronic mitral regurgitation

A

exertional dyspnea
fatigue
paroxysmal to persistent atrial fibrillation

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81
Q

(RR)

physical exam findings for mitral regurgitation

A

diminished S1

pansystolic murmur that radiates to the axilla

hyperdynamic left ventricular impulse

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82
Q

(RR)

what increases and decreases the murmur of mitral regurgitation

A

increases with leg raise

decreases with valsalva maneuver

(little respiratory variation)

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83
Q

(SmartyPance)

how does pulmonary hypertension present?

A 
dyspnea on exertion
fatigue
CHEST PAIN
edema
syncope
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84
Q

(SmartyPance)

hallmark of presentation of asthma for young patients

A

WHEEZING and DYSPNEA often associated with
1 - illness
2 - EXERCISE, and
3 - ALLERGIC TRIGGERS

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Perfectly
85
Q

(SmartyPance)

three characteristics of asthma:

A

1 - airway INFLAMMATION
2 - hyperresponsiveness, and
3 - REVERSIBLE airflow OBSTRUCTION

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86
Q

(SmartyPance)

how do we monitor and diagnose asthma?

A

peak flow

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87
Q

(SmartyPance)

what PFT increase after bronchodilator therapy makes us think ASTHMA

A

12%

greater than 12% increase in FEV1 after bronchodilator therapy

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88
Q

(SmartyPance)

what FEV1 to FVC ratio makes us think ASTHMA

A

<80%

FEV1 to FVC ratio <80%

(“you would expect the amount of air exhaled during the first second (FEV1) to be the greatest amount”)

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89
Q

(SmartyPance)
In asthma, since there is an obstruction (inflammation), you will have a ________ FEV1 and therefore a ______ FEV1 to FVC ratio

A

DECREASED / REDUCED

In asthma, since there is an obstruction (inflammation), you will have a DECREASED FEV1 and therefore a REDUCED FEV1 to FVC ratio

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90
Q

(SmartyPance)

name the four categories of asthma

A

intermittent, mild

persistent, mild
persistent, moderate
persistent, severe

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91
Q

(SmartyPance)

how do we define mild intermittent asthma? how do we treat it, via Step 1?

A

mild intermittent = less than 2 times/week or 3-night symptoms/month

Step 1 = short-acting beta2 agonist (SABA) prn

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92
Q

(SmartyPance)

how do we define mild persistent asthma? how do we treat it, via Step 2?

A

mild persistent = more than 2 times/week or 3-4 night symptoms/month

Step 2 = low-dose ICS daily

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93
Q

(SmartyPance)

how do we define moderate persistent asthma? how do we treat it, via Step 3?

A

moderate persistent asthma = daily symptoms or more than 1 nightly episode per week

Step 3 = low dose ICS + LABA daily

(LABA = long acting beta 2 agonist)

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94
Q

(SmartyPance)

how do we define moderate persistent asthma? how do we treat it, via Step 4?

A

moderate persistent asthma = daily symptoms or more than 1 nightly episode per week

Step 4 = medium dose ICS + LABA daily

(LABA = long acting beta 2 agonist)

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95
Q

(SmartyPance)

how do we define severe persistent asthma? how do we treat it, via Step 5?

A

severe persistent asthma = symptoms several times per day and nightly

Step 5 = high dose ICS + LABA daily

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96
Q

(SmartyPance)

how do we define severe persistent asthma? how do we treat it, via Step 6?

A

severe persistent asthma = symptoms several times per day and nightly

Step 6 = high dose ICS + LABA + oral steroids daily

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97
Q

(SmartyPance)

how do we treat acute exacerbation of asthma (4 tools)?

A

oxygen
nebulized SABA
ipratropium bromide
oral corticosteroids

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98
Q

(SmartyPance)

define bronchitis

A

COUGH >5 DAYS
W/ OR W/O SPUTUM PRODUCTION
LASTS 2-3 WEEKS

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99
Q

(SmartyPance)

what does bronchitis look like?

A

chest discomfort
SOB
+/- fever

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100
Q

(SmartyPance)

what is the most common etiology of bronchitis?

101
Q

(SmartyPance)

Does bronchitis require labs or imaging?

A

no, not UNLESS PNEUMONIA IS SUSPECTED

102
Q

(SmartyPance)

what makes us suspect pneumonia in a pt presenting with bronchitis s/s?

A

HR > 100
RR > 24
T > 38C

rales
hypoxemia
mental confusion
systemic illness

103
Q

(SmartyPance)

what do we DO when we suspect pneumonia in a pt presenting with bronchitis s/s?

104
Q

(SmartyPance)

do we recommend abx for pts with bronchitis?

A

NO, abx not recommended (these are usually viral cases)

105
Q

(SmartyPance)

how do we treat bronchitis?

A

SYMPTOMATICALLY:

  • NSAIDs, ASA, tylenol, and/or ipratroprium
  • Cough Suppressants: codeine-containing cough meds
  • Bronchodilators (albuterol)
106
Q

(SmartyPance COPD)

define “chronic bronchitis”

A 
CHRONIC COUGH that is
PRODUCTIVE OF PHLEGM occurring on 
MOST DAYS for
3 MONTHS of the year for 
2 OR MORE CONSECUTIVE YEARS without an otherwise-defined acute cause
107
Q

(SmartyPance COPD)

for chronic bronchitis, what causes the productive cough?

A

EXCESS MUCUS PRODUCTION narrows airways –> productive cough

108
Q

(SmartyPance COPD)

for chronic bronchitis, what is the sequala originating with SCARRING and INFLAMMATION?

A

SCARRING and INFLAMMATION –> enlargement of glands –> smooth muscle hyperplasia = OBSTRUCTION

109
Q

(SmartyPance COPD) BUZZWORDS

Blue Bloaters

110
Q

(SmartyPance COPD)

80% of COPD patients are, or have been:

111
Q

(SmartyPance COPD)

what will you hear during auscultation for COPD/chronic bronchitis?

A

end-expiratory WHEEZES on forced expiration

DECREASED BREATH SOUNDS

inspiratory CRACKLES

HYPERRESONANCE on percussion

112
Q

(SmartyPance COPD)

how do we diagnose COPD?

A 
CLINICALLY:
 - chronic cough
 - productive sputum > 3mo
 - at least 2 consecutive years
PFTs:
 - FEV1/FVC ratio < 0.7
CXR
 - low sensitivity
 - PERIVASCULAR MARKINGS, peribronchial markings
113
Q

(SmartyPance COPD)

what changes might we see in hemoglobin and hematocrit?

A

increased Hgb and increased Hct

these are common because of the chronic hypoxic state

114
Q

(SmartyPance COPD)

how do we treat mild COPD?

A

short-acting bronchodilators

115
Q

(SmartyPance COPD)

how do we treat moderate to severe COPD?

A

long-acting bronchodilators +/- inhaled corticosteroids

116
Q

(SmartyPance COPD)

what is the inhaler of choice for COPD?

A

ipratroprium bromide

117
Q

(SmartyPance COPD)

what is the single most important medication in the long term for COPD?

118
Q

(SmartyPance COPD)

Two important components of COPD treatment:

A

smoking cessation

supplemental O2

119
Q

(SmartyPance COPD)

when do we use antibiotics for COPD pts?

A

when there are acute exacerbations

120
Q

(SmartyPance COPD)

what two vaccinations are a must for COPD pts?

A

flu

pneumococcal

121
Q

(SmartyPance COPD) BUZZWORDS

pink puffers

A

emphysema pts

122
Q

(SmartyPance COPD)

what is emphysema?

A

a consequence of the destruction of alveolar septae

the body’s natural response to decreased lung function is CHRONIC HYPERVENTILATION

123
Q

(SmartyPance COPD)

What are signs a pt has emphysema?

A 
"pink puffer"
barrel chest
pursed lips
----------
MINIMAL COUGH
QUIET LUNGS
THIN, BARREL CHEST
124
Q

(SmartyPance COPD)

what is going on with elastase in emphysema cases?

A

elastase (protease) is in EXCESS and there is an OVERINFLATION of the lungs

125
Q

(SmartyPance COPD)

what is the pathologic diagnosis of emphysema?

A

permanent enlargement of air spaces distal to the terminal bronchioles due to the DESTRUCTION OF ALVEOLAR WALLS

126
Q

(SmartyPance COPD)

what will a chest x ray show for a pt with emphysema?

A

FLATTENED DIAPHRAGM
HYPERINFLATION
SMALL, THIN APPEARING HEART

parenchymal bullae (subpleural blebs) are pathognomonic

127
Q

(SmartyPance COPD)

how do we treat emphysema?

A

SMOKING CESSATION
HOME O2

these are the only interventions shown to lower mortality

128
Q

(SmartyPance COPD)

how do we define acute emphysema exacerbation?

A

increased sputum production or change in character
or
worsening SOB

129
Q

(SmartyPance COPD)

how do we treat emphysema exacerbations?

A

give STEROIDS OR ABX

azithromycin or levofloxacin

130
Q

(SmartyPance COPD)

what can an untreated emphysema exacerbation lead to?

A

ARDS (acute respiratory distress syndrome…bad news)

131
Q

(SmartyPance)

Lung cancer - what are the two kinds, and how common is each?

A

SMALL CELL (15%)

NON-SMALL CELL (85%)

132
Q

(SmartyPance)

What are three main characteristics of Small Cell lung CA?

A
  • 99% smokers
  • DOES NOT RESPOND TO SURGERY
  • metastases at presentation
133
Q

(SmartyPance)

How does small cell lung cancer present?

A

RECURRENT PNEUMONIA

constitutional symptoms = anorexia, wt loss, weakness, cough

134
Q

(SmartyPance)

how do we diagnose small cell lung cancer?

A

CXR - most important for dx (not used for screening)

134
Q

(SmartyPance)

how do we diagnose small cell lung cancer?

A

CXR - most important for dx (not used for screening)

135
Q

(SmartyPance)

how do we stage small cell lung CA?

A

CT CHEST with IV CONTRAST

136
Q

(SmartyPance)

how do we type, histologically, small cell lung CA?

A

tissue biopsy

137
Q

(SmartyPance)

how do we treat small cell lung CA?

A

COMBINATION CHEMOTHERAPY

prognosis for limited small cell lung CA: 10-13% 5-yr survival rate

138
Q

(SmartyPance)

how do we treat non-small cell lung CA?

A

Stages 1-2 = SURGERY!
Stage 3 –> chemo, then surgery
Stage 4 –> palliative :-(

139
Q

(SmartyPance)

how do we define COMMUNITY ACQUIRED PNEUMONIA?

A

it occurs OUTSIDE of the hospital, or,
within 48 hrs of hospital admission
(for pts not residing in long-term care facility)

140
Q

(SmartyPance)

what is the MC cause of community acquired pneumonia (CAP)?

A

Staph pneumoniae (2/3 of cases)

141
Q

(SmartyPance)

s/s of Community Acquired Pneumonia

A 
cough - gradual onset w/ or w/o sputum production
SOB on exertion
SWEATS
CHILLS
RIGORS
CHEST DISCOMFORT
pleurisy
hemoptysis
FEVER
142
Q

(SmartyPance)

How do we diagnose Community Acquired Pneumonia?

A

CXR: LOBAR CONSOLIDATION

NOT NECESSARY IN OPs b/c empiric therapy is effective

143
Q

(SmartyPance)

how do we prevent pneumonia?

A

Pneumovax 23

Prevnar 13

144
Q

(SmartyPance)

when and why does obstructive sleep apnea happen?

A

occurs at night
due to REDUCED TONE IN THE MUSCLES AROUND THE AIRWAY making them unable to support the weight of the parapharyngeal tissue

145
Q

(SmartyPance)

leading risk factor for OSA

146
Q

(SmartyPance)

what aggravates OSA?

A

ETOH
sedatives before sleeping
nasal obstruction (like having a cold)

147
Q

(SmartyPance)

what causes OSA in kids, usually?

A

ADENOTONSILLAR HYPERTROPHY

148
Q

(SmartyPance)

how do we diagnose OSA?

A

polysomnography (sleep study)

149
Q

(SmartyPance)

how do we treat OSA?

A

wt loss

positive airway pressure devices (CPAP)

150
Q

(SmartyPance)

transitional cell carcinoma of the bladder is caused by

A

cigarette smoking

151
Q

(SmartyPance)
cigarette smoking is metabolized…where?

what is the half life of nicotine?

A

metabolized by the LIVER

half-life of nicotine = 1-2 hrs (so people smoke every 1-2 hrs)

152
Q

(SmartyPance)

what is tuberculosis?

A

disease caused by bacteria Mycobacterium tuberculosis (acid-fast bacilli)

153
Q

(SmartyPance)

how does tuberculosis present?

A 
fatigue
productive cough
night sweats
weight loss
post-tussive rales
154
Q

(SmartyPance)

how do we screen for TB?

A

TST (tuberculin skin test) or

IGRAs (interferon-gamma release assays)

155
Q

(SmartyPance)

how do we diagnose TB?

A

sputum for AFB (acid-fast bacilli) smears and Mycobacterium tuberculosis cultures - have to be 3 AFB negative

156
Q

(SmartyPance) BUZZWORDS

cavitary lesions

A

TB (on CXR)

157
Q

(SmartyPance) BUZZWORDS

ghon complexes in the apex of the lungs

A

TB (on CXR)

158
Q

(SmartyPance)

how does TB look on CXR?

A

cavitary lesions
infiltrates
ghon complexes in the apex of the lungs

159
Q

(SmartyPance)

what do we find with biopsy of TB?

A

biopsy ==> caseating granulomas

160
Q

(SmartyPance)

TB treatment for LATENT TB

A

isoniazid for 9 months (+B6 to prevent neuropathy)

161
Q

(SmartyPance)

TB treatment for active TB:

A 
QUAD THERAPY (RIPE):
rifampin
isoniazid
pyrazinamide
ethambutol

(all are hepatotoxic)

162
Q

(SmartyPance)

detail the quad therapy regimen for TB:

A 
four drugs (RIPE) x 8 weeks, then
two drugs (RI) x 16 weeks
163
Q

(SmartyPance)

when can a TB pt stop therapy?

A

pts with active TB will need TWO NEGATIVE AFB SMEARS AND CULTURES in a row negative for therapy cessation

prophylaxis for household members = isoniazid for 1 yr

164
Q

(RR)

mitral valve regurgitation cardiac auscultation findings

A

soft S1

loud, blowing holosystolic murmur

165
Q

(RR)

who are HIGH RISK PATIENTS in need of antibiotic prophylaxis for endocarditis?

A

prosthetic heart valves
prior hx of inf endocarditis
unrepaired cyanotic congenital heart disease
repaired congenital heart disease
repaired congenital heart defects
valve regurgitation due to structurally abnormal valve in transplanted heart

166
Q

(RR)
AHA has published guidelines regarding prophylaxis for inf endocarditis in high-risk patients undergoing what three procedures?

A

dental procedures
invasive respiratory procedures
infected skin or soft tissue procedures

167
Q

(RR)

how do we treat irritable bowel syndrome?

A

SSRIs (like citalopram)

TCAs (like desipramine)

antispasmodics (like atropine, hyoscyamine, dicyclomine or scopolamine)

168
Q

(RR)

what is IBS?

A

a GI syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause

169
Q

(RR)

common s/s of IBS

A

woman (probably)
hx of constipation alternating with diarrhea
abdominal discomfort relieved with bowel movements

170
Q

(RR)

how do we diagnose IBS?

A

with ROME CRITERIA (I’ll make flashcards for ROME later)

171
Q

(RR)

two notable features of second degree heart block (MOBITZ II)

A

PR interval will be fixed and consistent

dropped QRS beats

172
Q

(RR)

what is a finding on XRay suggestive of colon CA?

A

apple core sign

173
Q

(RR)

in which peripheral vascular condition would revascularization or bypass be a course of treatment?

A

in PERIPHERAL ARTERY DISEASE revascularization or bypass may be a course of treatment if anticoagulation is not sufficiently reducing ischemia

174
Q

(RR)
which of the following lowers cholesterol by binding bile acids and forming insoluble complexes that are excreted in the feces?

colesevelam
fenofibrate
gemfibrozil
lovastatin

A

COLESEVELAM
(a bile acid sequestrant that decreases cholesterol absorption by forming insoluble complexes of bile acids that can then be eliminated through feces)

175
Q

(RR)

how does small bowel obstruction typically present (3 items)?

A

diffuse abdominal pain
abdominal distention
vomiting (occasionally)

176
Q

(RR)

what is the string of pearls sign?

A

small round pockets of air that line up (look like a string of pearls) on the abdominal plain film in the setting of a small-bowel obstruction

177
Q

(RR)

who has higher risk of small bowel obstruction?

A

pts with hx of prior abdominal/pelvic surgery

178
Q

(RR)

what does XRay show for small bowel obstruction pts?

A

dilated bowel
air fluid levels
stack of coins or string of pearls

179
Q

(RR)

how is diagnosis made for small bowel obstruction?

180
Q

(RR)

how do we treat small bowel obstruction?

A

treatment is NGT, surgery

181
Q

(RR)

what is the S1 heart sound?

A

mitral and tricuspid valve closure

182
Q

(RR)

what is the S2 heart sound?

A

aortic and pulmonary valve closure

183
Q

(RR)

what is the S3 heart sound?

A

it is in early diastole
it is during rapid ventricular filling phase

large amt of blood striking a very compliant left ventricle

184
Q

(RR)

for whom is S3 a normal heart sound?

A

children

pregnant women

185
Q

(RR)
what is the most common postsurgical complication experienced by patients undergoing surgical treatment for peptic ulcer disease?

A

weight loss

experienced by up to 30% of patients postsurgically

186
Q

(RR)

which kind of peptic ulcer is marked by early satiety and pain immediately after meals?

A

GASTRIC ULCER

my childhood!

187
Q

(RR)
which type of peptic ulcer is marked by pain that awakens pt at night, pain relieved by food, postprandial pain 1-2 hrs delay, and is the most common type of ulcer?

A

DUODENAL ULCER

188
Q

(RR)

duodenal ulcers - alleviated or exacerbated by food?

A

ALLEVIATED BY INGESTING FOOD

mnemonic: “DUDe give me food”

189
Q

(RR)

gastric ulcers - alleviated or exacerbated by food?

A

pain is EXACERBATED by ingesting food

190
Q

(RR)

what is the most common cause of upper GI bleed?

191
Q

(PPP 71)

two man etiologies of hyperlipidemia

A

hypercholesterolemia
(such as hypothyroidism, pregnancy, kidney failure)
hypertriglyceridemia
(such as DM, ETOH, obesity, steroids, estrogen)

192
Q

(PPP 71)

how do we decide when to screen for hyperlipidemia?

A

BASED ON RISKS
sex
age
cardiac risk factors (smoking, HTN, FH of CHD)

193
Q

(PPP 71)

what are the best meds to lower elevated LDL?

A

STATINS

bile acid sequestrants

194
Q

(PPP 71)

what are the best meds to lower elevated triglycerides?

A

FIBRATES

niacin

195
Q

(PPP 71)

what are the best meds to increase HDL?

A

NIACIN (watch for flushing!)

fibrates

196
Q

(PPP 71)

what do we use to treat hyperlipidemia when the pt has DMII?

A

statins

fibrates

197
Q

(PPP 72)

name five common HMG-CoA Reductase Inhibitors

A

(aka statins)
SPLAR

Simvastatin
Pravastatin
Lovastatin
Atorvastatin
Rosuvastatin
198
Q

(PPP 72)

what indications are there for using HMG-CoA reductase inhibitors (statins) and what is one major adverse effect?

A

BEST DRUG TO DECREASE LDL

AE: muscle damage –> myalgias MYOSITIS, RHABDO

199
Q

(PPP 72)

what is the indication for, and three adverse effects of, Nicotinic Acid?

A

(aka NIACIN)
indication –> best drug to increase HDL levels

AE –>

  • increased prostaglandins (FLUSHING, WARM SENSATION, PRURITIS)
    - this can be countered w/ pretreatment of 30 min w/ NSAIDs or ASA)
  • HYPERGLYCEMIA
  • GI SYMPTOMS (n/v, dyspepsia)
    - can be reduced by taking with meals
200
Q

(PPP 72)
Name two FIBRATES.
What are the indications for, and adverse effects of, fibrates?

A

Name: fenofibrate, gemfibrozil

Indications: BEST DRUGS TO DECREASE TRIGLYCERIDES

AE: INCREASED GALLSTONES, HA, dizziness, GI symptoms

201
Q

(PPP 73)

name three BILE ACID SEQUESTRANTS

A

cholestyramine
colestipol
colesevelam

202
Q

(PPP 73)

what are the indications for bile acid sequestrants?

A

indications –>

  • to reduce LDL, often used in combo w/ statin
  • for mild to mod increases in HDL
  • SAFE IN PREGNANCY
  • treats pruritus associated with biliary obstruction
203
Q

(PPP 73)

what are the AE of bile acid sequestrants?

A

INCREASED TRIGLYCERIDE LEVELS
also -
GI side effects
osteoporosis with long term use

204
Q

(PPP 73)

what should we know about the interactions of bile acid sequestrants?

A

they may impair absorption of other medications (listed below) so those meds must be taken 1 hour before or 4 hours after!

Meds like abx, digoxin, warfarin, fat-soluble vitamins

205
Q

(PPP 73)

what is the indication for using EZETIMIBE?

A

reduce LDL

often used in combo w/ a statin to reduce LDL

206
Q

(PPP 60)

define hypertension, and when must it be measured?

A

SBP 130 mmHg or more

and/or

DBP 80 mmHg or more

*at least 2 different readings on at least 2 different visits

207
Q

(PPP 60)

what is the etiology of primary (essential) HTN?

A

idiopathic etiology (95% of the time)

208
Q

(PPP 60)

what is the most common cause of secondary HTN?

A

RENOVASCULAR reasons are the most common cause of secondary HTN (4% of the time) (such as renal artery stenosis)

209
Q

(PPP 60)

name for body systems for which HTN complications are common

A

cardiovascular
neurologic
nephropathy
optic

HTN IS SECOND MC CAUSE OF END STATGE RENAL DISEASE IN THE US (after DM)

210
Q

(PPP 60)

what is the initial management of choice of a newly diagnosed hypertensive pt?

A

LIFESTYLE MANAGEMENT

211
Q

(PPP 60)

what lifestyle management choices are the focus for newly diagnosed hypertensive pt?

A 
1 - salt restriction
2 - smoking cessation
3 - exercise
4 - diet
5 - weight reduction
6 - limited ETOH consumption
212
Q

(PPP 60)

what do we do for hypertensive pts who fail a trial of diet and exercise? and what is our goal?

A

medical management

< 140/90 mmHg is the blood pressure target

(if you’re over 60, you get an easier goal of <150/90 mmHg)

213
Q

(RR)

what is Charcot’s Triad?

A

fever
abdominal pain
jaundice
seen in pts with cholangitis

214
Q

(RR)

what is true concerning bile salts in patients with cholestatic jaundice?

A

They have decreased total bile salt pool size.

(As bile salts are retained in the parenchma of the liver during cholestasis, down-regulation occurs and less bile salts are produced, resulting in a DECREASE IN THE TOTAL BILE SALT POOL SIZE as well as a decrease in the enterohepatic recirculation of the bile salts.)

215
Q 
(RRO
which of the following lab studies should be ordered in a pt being evaluated for hypertriglyceridemia?
a) antinuclear antibody
b) CBC
c) TSH
d) troponin I
A

c) TSH

the causes of hypertriglycerdiemia includes DM, obesity, nephrotic syndromes, HYPOTHYROIDISM

216
Q

(RR)

in what part of the prostate does BPH most commonly develop?

A

transitional zone

217
Q

(RR)

what is first line therapy in patients with panic disorder?

A

Citalopram (SSRI)

218
Q

(RR)
abdominal contents pass LATERAL to the epigastric artery, through the inguinal canal, into scrotum or labia through internal inguinal ring

MC type of hernia

what kind of hernia is this?

219
Q

(RR)
abdominal contents pass MEDIAL to the epigastric artery, directly behind the superficial inguinal ring and do not extend into the scrotum

protrudes DIRECTLY through Hesselbach triangle

what kind of hernia is this?

220
Q

(RR)
what is the target systolic blood pressure for a pt who is a 67 y/o woman w/ hyperlipidemia, HTN, but no diabetes or chronic kidney disease?

A

<150 mmHg

less than 90 mmHg for DBP

221
Q

(RR)

what is the most common lung cancer?

A

NON-SMALL CELL lung cancers

222
Q

(RR)

what is the most common of the non-small cell lung cancers?

A

adenocarcinoma

223
Q

(RR)

what is the gold standard of testing for gonococcal urethritis?

A

NAAT

labs will show gram-negative diplococci

224
Q

(RR)

exudative macular degeneration, 5 characteristics:

A 
CHOROIDAL NEOVASCULARIZATION
sudden loss of vision
bleeding, leakage of subretinal fluid
not total blindness
less common
225
Q

(RR) BUZZWORDS:

drusen

A

nonexudative macular degeneration

they’re yellow deposits visible upon fundoscopic examination

226
Q

(RR)

what is the most common cause of blindiness in the older population?

A

macular degeneration

227
Q

(RR)

what is the gold standard diagnostic study for peripheral artery disease?

A

contrast arteriography

228
Q

(RR)

treatment for acute bacterial prostatitis

A

TMP-SMX or FQ for 4-6 weeks

“The mainstay of therapy is empiric antibiotics directed against gram-negative organisms, typically with trimethoprim-sulfamethoxazole or a fluoroquinolone (levofloxacin or ciprofloxacin) for four to six weeks.”

229
Q

(RR)

what are the three D’s of pellagra?

A

Dermatitis
Dementia
Diarrhea

(pellagra = niacin (B3) deficiency)

230
Q

(RR)

how do we measure niacin for suspected pellagra (B3 deficiency)?

A

N-methylnicotinamide

“Niacin status can be determined by measuring urinary N-methylnicotinamide or the erythrocyte NAD/NADP(ratio)”

231
Q

(RR)

what is triple drug therapy for H. pylori elimination?

A

omeprazole (a PPI)
clarithromycin
amoxicillin

(x 14 days)

232
Q

(RR)

how do we diagnose H. plylori PUD

A

fecal antigen or urea breath test

233
Q

(RR)

what is first line therapy for high triglycerides?

A

FENOFIBRATE

“For patients with triglyceride levels persistently above 886 mg/dL, drug therapy is recommended to lower the risk of pancreatitis. Fenofibrate is the recommended first-line therapy and can reduce triglyceride levels by a half or more.”

234
Q

(RR)
when do pts with a first-degree relative with advanced adenoma or colorectal cancer diagnosed before the age of 60 years need to have a CRC screening?

A

screening colonoscopy at 40 years of age or 10 years younger than the earliest diagnosis in their family (whichever comes first)

235
Q

(RR)

what is the gold standard for diagnosis of iron deficiency anemia?

A

bone marrow examination (which will show low or absent iron stores)

236
Q

(RR)

what do iron studies show in iron deficiency anemia?

A

decreased serum iron level
increase in total iron binding capacity (TIBC)
decrease serum ferritin levels

237
Q

(RR)

MACROCYTES are typically associated with what deficiencies?

A

B12

folate

238
Q

(RR)

what lab values must be closely monitored when treating a pt with allopurinol over time?

A

creatinine

gotta watch the kidneys

239
Q

(RR)

what is the treat-to-target level of uric acid in a gout patient?

A

less than 6 mg/dL (some say 5)

240
Q

(RR)

what are the two major criteria for infective endocarditis (Duke Criteria)?

A

POSITIVE BLOOD CULTURES FOR IE (from two separate blood cultures)

EVIDENCE OF ENDOCARDIAL INVOLVEMENT (i.e. echo positive for IE or new valvular regurgitation)

241
Q

(RR)

what are a few of the minor criteria for Infective Endocarditis (Duke Criteria)?

A

IV drug use or predisposing heart condition
fever > 38 C (100.4 F)
vascular phenomena (emboli, Janeway lesions)
Immunologic phenomena (Osler nodes, Roth spots)

242
Q

(RR)

what do we give to TB patients to modify the isoniazid-associated peripheral neuropathy?

A

pyridoxine (vitamin B6)

243
Q

(RR)

what is first line therapy for pts with mild to moderate Alzheimer’s Disease?

A 
cholinesterase inhibitors
(donepezil, rivastigmine, galantamine)
244
Q

(RR)

what do we give moderate Alzheimer’s Disease patients?

A

in conjunction with cholinesterase inhibitors, add NMDA RECEPTOR ANTAGONIST (like memantine)

245
Q

(RR) BUZZWORDS

Auer rods

A

Acute Myeloid Leukemia

246
Q

What cancer is most commonly associated with a previous hx of a hematologic disorder (such as myelodysplastic syndrome, aplastic anemia, or polycythemia vera)?

A

Acute Myelogenous Leukemia

247
Q

(RR)

what are five clinical s/s of Hodgkin Lymphoma?

A

cervical lymphadenopathy - nontender, enlarged

mediastinal mass on CXR

hepatosplenomegaly

pruritus

B symptoms (fever, wt loss, night sweats)

248
Q

(RR) BUZZWORDS

Reed-Sternberg cells

A

Hodgkin Lymphoma

249
Q

(RR)

what is the initial therapy for typical anal fissures?

A

topical nifedipine

(add in sitz baths, increasing fiber intake, and topical analgesics as supportive measures in conjunction with the nifedipine)

CLINICAL YR: Fam Med Study (2 decks)

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