general questions Flashcards
what drug should every diabetic patient be on
either an ACE or an ARB
what is the goal A1C for a diabetic patietn
<7%
what is the goal LDL for a patient with hypercolesterol
<100
what are the diabetic five?
1) smoking cessation, 2) blood pressure control, 3) lipid control, 4) aspirin/metformin, 5) glucose control.
what is the BP goal for a patient with diabetes
<130
what is the best imaging technique for an acute head bleed?
CT without contrast.
when do migraines typically occur?
usually present in adolescence. To have the first incidence of migraine occur when an adult is uncommon.
what are the symptoms of a migraine?
photophobia, auras, extremely painful headache that can localize in 60-70% patients. nausea and vomiting are not uncommon.
what are some treatments for migraines
NSAIDs, sumatriptans, ergot alkaloids.
why do we order a CT with contrast?
this would be to identify a space-occupying lesion, such as a tumor. Bleeds are foiund withiout contrast.
what is first line treatment for a tension headache
NSAIDs
what is first line treatment for a mild-to-moderate migraine
NSAIDs with combination analgesics like acetominiophen, caffeine.
what is first line treatment for a moderate to severe migraine
triptans. also use this for mild to moderate that are refractory
how do the kidneys reabsorb acid
by losing potassium
what are the labs for excessive vomiting
metabolic alkalosis (increased HCO3), hypochloremia, hypokalemia.
why do we not schedule mammagraphy for women under 35. what test is better to confirm breast lumps in women under 35
density of breast tissue.
ultrasound.
what is the indication for BRCA testing
significant family history. multiple first degree relatives (mother, daughter, sisters) who have had breast cancer at young ages (<40-50)
what is pinworm and its presentation
enterobiasis. most commonly presents as perianal itching, abdominal pain/fullness, nausea and vomiting. diagnosed with the scotch tape test that results in white eggs.
first line therapy for pin worm
menbendazole or albendazole. these are teratogenic,. watch out for others in the house! these are teratogeni
what is secdond line therapy for pinworm
pyrantel pamoate
how do we evaluate acute coronary syndrome
ECG and serial troponins
what are the symptoms of acute coronary syndrome
diaphoresis, chest pain –can radiate to the jaw, squeezing sensation in the chest.
what is the gold standard for diagnosing aortic aneurysm
aortogram.
what if a suspected acute coronary patient does not have elevated troponins
then its most likely stable angina
what do troponins measure
infarcted cardiac tissue
what do we use stress echos for
to stratify risky patients with medically stable, low-risk patients with coronary syndrome
what is the test pulmonary embolism
pulmonary angiogram
what should you think of when you see euvolemic hyponatremia?
SIADH!
what are the diagnostic criteria for SIADH
euvolemic hyponatremia, hypotonicity (osmolality <280), inappropriately concentrated urine with normal renal function
what is the treatment for vaginal candidiasis
oral fluconazole, or vaginal creams such as miconazole or clotrimazole
what is the most common cause of primary glomerulonehritis and the presentation
IgA nephropathy. episodes of gross hematuria that occur 5 days after a respiratory infection.
what is postinfectious glomerulonephritis and its presentation
after infection with streptococcal. <7 years of age, dark brown urine, periorbital and peripheral edema, there is latent period of 10 post pharyngitis, (antistreptolysin O titer would be expected to be elevated), need RBC casts for glomerular disease.
what is the most indicative finding of glomerular disease
dysmorphic RBCs. Normal morphology tends to indicate lower urinary tract syndromes
how do we treat emergent hyperkalemia and why
with IV calcium gluconate or calcium. this does nothing to the potassium levels, but does reduce cardiac membrane depolarization and thus protects the cardiac muscle.
what is emergent hyperkalemia
hyperkalemia that is causing EKG changes.
what drugs can cause retention of potassium
ACEi and spironolactone (potassium sparing diuretic).
what are treatments for hyperkalemia?
sodium bicarb, insulin + glucose, hemodialysis –last line effort.
what causes renal artery stenosis
fibromuscular dysplasia of the vessel wall. usually occurs in females under 50.
what to look for to diagnose wolfe-parkinson-white on EKG
widened QRS complex with a delta wave.
what is the treatment for WPW
ablation of the accessory pathway.
how do we treat a positive gonnorrhea test
with ceftriaxone and azithromycin. you must treat for both G and Chlamydia as they are commonly coinfected.
what are alternative treatments for gonorrhea
fluoroquinolones orally are acceptable
what is the best treatment for gonorrhea
one time injection in office with ceftriaxone.
what is the best treatment for chlamydia
oral one week doxycycline or one time dose azirthromycin
what is the presentation of myastenia gravis
ptosis, fatigue, muscle weakness, dysarthria, difficulty chewing, double vision. abdnomality of the thymus is highly likely many will have thymoma or hyperplasia of the thymus.
what is the treatment for myastenia
edrophonium. IV. this is an achetylcholine esterase inhibitor and will immediately improve the patient’s symptoms.
what causes myastenia gravis
autoantibodies to the ach receptors.
what does split s2 usually indicate?
atrial septal defect.
what do we give patients with exacerbations of COPD?
patients are typically given steroids and empirically treatd with antibiotics.
what antibiotics are used to empirically treat acute exacerbations of COPD?
amoxicillin, trimethoprim, doxycycline.
these will cover the strep and atypicals.
microcytic anemia in a male is what until proven otherwise
colorectal cancer. patients with mircocytic anemia need upper and lower endoscopy.
what is G6PD deficiency
X-LINKED RECESSIVE DISEASE that mainly effectbs meditaranean and african descent. this makes red blood cells sensitive to oxidative stress.
what is the presentation of G6PD deficiency
when there is an inciting agent that causes increased oxidative radicals there will be red blood cell lysis, anemia, jaundice without hepatomegaly.
what are some things that increase acute G6PD deficiency symptoms
viruses, bacterial infections, sulfonamides, dapsone, quinine, nitrofurantoin, fava beans.
what are diabetic patients assumed to have immediately
coronary artery disease. this governs their lipid goals
what measure of LDL should diabetic patients have?
low as possible. patients with known coronary artery disease, diabetes, previous MI, angina, need an LDL lower than 100.
what is the typical goal for LDL in low risk patients
<130
what is a common finding for turner’s syndrome
coartation of the aorta.
what is coarctation of the aorta and how does it present
this is a congenital heart defect that causes secondary hypertension. colateral vessels typically form and this causes notching of the ribs in the chest. there is usually a murmur.
polymyalgia rheumatica presentation and labs
diffuse arthralgia, fatigue, stiffness which usually resides within hours, occasional fevers. usually present with elevated ESR. usually occurs in the elderly, with the stiffness being localized to the shoulders and the hips.
what is the treatment of polymyalgia rheumatica
prednisone usually makes them feel much bette.
what is the best choice of birth control for young women with dysmenorrhea and a risk for ovarian cancer
oral contraceptives. these will reduce the risk of ovarian cancer and are effective at stopping pregnancy. IUD are only recommended for parous woman in committed relationships –apparently IUD increase the risk for infections as they are foreign body.
who should be hospitalized for pneumonia?
elderly, mental status changes, decreased vitals, medical comorbidities.
what is used to treat community acquired pneumonia and what bugs are the likely causes?
azithromycin is first line therapy. erythromycin and tetracyclines both work, azithromycin has better coverage for h flu.
what is the most common hereditary bleeding disorder
von willebrand
what is the presentation of von willebrands
family history, personal history of bruising or excessive bleeding with surgeries or menses. labs for PT and PTT will be normal, but bleeding time will be lengthened.
what is the treatment for von willebrands
desmopressin
what is hydroxurea used to treat?
sickle cell
what is splenectomy treatment for
refractory ITP
how does desmopressin help von willebrands
it increases the production and release of von willebrand factor.
solitary pulmonary nodule workup
if the patient is low-risk for cancer then observation is okay and repeat imaging in several months.
what size pulmonary nodules are low risk
<2cm
what age group is low risk for pulmonary nodules
<35
what size makes lesions more likely to be malignant
> 3cm
what do malignant nodules look like
bigger than 3 cm, with irregular borders. they will also grow more rapidly.
what is the work up for a patient that is thought to be short stature
look at growth velocity, if less than 5% then this is low. the next best thing to do is measure the bone age. bone age should match chronological age.
what is the bone age for constitutional delay?
bone age will be behind chronological age.
what does growth hormone deficiency look like?
short stature with overweight.