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PANCE prep JQ > HTFM Notes > Flashcards

HTFM Notes Flashcards

1
Q

1st line pharm therapy for insomnia

A

Melatonin agonist: melatonin and ramelteon

TCAs: doxepin and mirtazapine

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2
Q

2nd line therapy for insomnia

A

Z-drugs: zolpidem, zaleplon, eszopiclone

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3
Q

Sedating antihistamines

A

Benadryl and hydroxyzine

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4
Q

Zyprexa

A

Antipsychotic drug that can be used for agitation and won’t knock pt out like haldol would

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5
Q

Aceon

A

Perinodolil- underused ACE inhibitor

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6
Q

Benzo potential side effects

A 
Memory impairment 
Loss of coordination 
Daytime somnolence
Dependence 
resp suppression
Withdrawal
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7
Q

Theophylline can be used in severe or refractory asthma or COPD but you should lookout for these signs of toxicity

A

GI upset
Hypotension
Seizures
Dysthymia

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8
Q

Signs of MDD

A

Sleep
Interest
Guilt

Energy

Concentration
Appetite
Physcomotor changes
Suicidal thoughts

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9
Q

PHQ 2

A

Do you have little enjoyment or interest in doing things?

Do you feel down, depressed, or hopeless?

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10
Q

SSRIs

A 
Citalopram (Celexa)
Escitalopram (lexapro)
Parotixine (Paxil)
Fluoxetine (Prozac)
Sertraline (Zoloft)
Fluvoxamine (Zyvox)

*1st line for depression

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11
Q

SNRIs

A

Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)

*depression tx that is particularly effective in pts with pain syndrome or significant fatigue

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12
Q

Bupropion

A

Inhibits uptake of dopamine and norepinephrine.

Wellbutrin for depression. Less GI distress and sexual dysfunction compared to SSRIs

Zyban for smoking cessation

C/I in seizure and eating disorders

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13
Q

Trazodone

A

Serotonin antagonist and reuptake inhibitor

Used for depression, anxiety, and insomnia

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14
Q

GAD pharmacology management

A

First line - Antidepressants
Second line - buspirone

Benzos for short term use only

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15
Q

Posterior column spinal cord tract

A

Vibration and proprioception

Crosses at level of brainstem/medulla

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16
Q

Lateral spinothalamic tract

A

Pain and temperature

Crosses at level of spinal cord

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17
Q

Anterior spinothalamic tract

A

Touch

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18
Q

Lateral corticospinal tract

A

Voluntary movement

Crosses at level of medulla

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19
Q

Brown sequard syndrome

A

Unilateral damage of spinal cord results in

loss of motor funct on, vibration sense and proprioception of same side and

loss of pain and temp on contralateral side

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20
Q

Central cord damage

A

Results in loss of pain and temp

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21
Q

Anterior spinal cord damage

A

Paralysis and loss of pain/temp

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22
Q

Compare and contrast cauda equina syndrome with conus medullaris syndrome

A

BOTH present with saddle anesthesia

Cauda Equina is asymmetric and presents with more severe pain and weakness. B&B are late and less severe.

Conus medullaris is symmetrical, B&B problems are early and severe.

BOTH are emergencies that need imaging and decompression

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23
Q

What causes transudative pulmonary effusion?

A

CHF (MC), nephrotic syndrome, cirrhosis, PE

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24
Q

What causes exudative pulmonary effusion?

A

Infection, inflammation, PE

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25
Light’s criteria
The presence of ANY of these indicates exudative fluid 1. pleural protein:serum protein ratio >0.5 2. pleural LDH:serum LDH ratio >0.6 3. pleural LDH >2/3 ULN
26
Important professional relationships to build in family med
1. cardiologist 2. dermatologist 3. orthopedist ENT(kids)
27
Siliocsis
Mining, quarry work, pottery, sandblasting Modular opacities in ULF and egg shell calcification of hilar and mediastinal modes
28
Black lung dz/ coal worker pneumonconiosis
Small upper lobe nodules and hyperinflation
29
Caplan syndrome
Black lung with RA
30
Berylliosis
Electronics, aerospace, ceramics, dye and manufacturing Increased lung marking and possible hikes LAD Tx with steroids, O2, and methotrexate
31
Byssinosis/brown lung dz/Monday fever
Pneumoconiosis from cotton exposure
32
Asbestosis
Old building construction, ship yards, pipe fitters Pleural plaques and lower lobe lung changes
33
Acute lipoid pneumonia
Caused by vaping or other oil inhalation Tx with IV methylprednisone(120-500mg daily) followed by oral prednisone taper
34
JUPITER trial
Suppression of low grade inflammation by statins improves clinical outcomes in pts even when they don’t have CHD
35
Tx of otitis externa
Ciprofloxacin/dexamethasone drops Protect war against moisture (drying agent include isopropyl alcohol and acetic acid)
36
Mastoiditis
Complication of prolonged or inadequately treated otitis media CT scan needed IV abx and myringotomy for drainages followed by possible tympanostomy tube placement
37
Peak ages of AOM
6-18months
38
4MC pathogens causing AOM
S pneumo H flu M cat Strep pyogenes
39
If bulla on TM you should suspect this organism
Mycoplasma pneumo
40
Tx of AOM
10-14 d amoxicillin is DOC Cefixime in children Consider erythromycin-sulfisoxazole if allergic to pcn
41
Causes of chronic otitis media
AOM, trauma, or cholesteatoma
42
Tx of Eustachian tube dysfunction
1. Decongestants 2. Swallowing/yawning 3. Intranasal corticosteroids
43
Presentation of cholesteatoma
Chronic otitis media and painless otorrhea
44
CSF for bacterial meningitis
Elevated PMN (100-10,000) Low glucose (<45) Elevated total protein Increased ICP
45
If you suspect bacterial meningitis when do you give abx?
Immediately treat empirically for suspected bacterial DO NOT wait for LP or CT results
46
If you suspect bacterial meningitis when do you get a CT before an LP?
>60yo, immunodeficiency, hx of CNS dz, AMS, focal neurological findings, and papilledema
47
MC bacterial meningitis pathogens and tx based on age
<1 month: GBS and listeria. Ampicillin 1mo-50yo: neisseria meningitidis or strep pneumo. Ceftriaxione and vanco. >50: strep pneumo or listeria. Ampicillin and ceftriaxone *add dexamethasone if strep suspected
48
Cervical cancer screening schedule
21-29: pap every 3 years | 30-65: pap and HPV every 5 years
49
Broca’s aphasia
Damage to the left frontemporal region Results in difficulty with language production
50
Wernickie’s aphasia
Damage to left temporal-parietal lobe Results in difficulty understanding speech so pt can produce fluent speech but it’s meaningless
51
1st line tx for unstable bradycardia
Atropine *exception 3rd degree block . In this case pacing is 1st line
52
2 “shockable” using defibrillator
Ventricular fibrillation Pulseless ventricular tachycardia
53
Tx for unstable tachyarrhythmia
Synchronized cardioversion
54
Signs of unstable cardiac status
Hypotension AMS Refractory chest pain Acute heart failure
55
Wide QRS stable tachycardia tx
Amiodarone *exception WPW: procanimide if stable and cardioversion if unstable
56
Normal QRS stable tachycardia tx
A flutter or Afib: BB or CCB Other: cavalier maneuvers, adenosine and then BB or CCB
57
How to determine cardiac axis
Look at leads I and aVF Both positive: normal axis Positive I and negative aVF: LAD Negative I and positive aVF: RAD
58
How do you evaluate atrial enlargement?
Look at lead II for morphology of P waves and look at V1 to evaluate if p wave is more positive or negative
59
How do you evaluate ekg for ventricular Hypertrophy?
R: V1 R>S or R is >7mm L: add S if V1 to R in V5or6 (>35mm in men or 30in women). R in aVL + S in V3 (>28men or 20women)
60
Wide QRS+slurred R in V5or6+deep S in V1=
LBBB
61
Wide QRS+RsR in V1or2+wide S in V6=
RBBB
62
MC type of PSVT
Orthodromic(narrow QRS) AV nodal reentry
63
Which accessory pathways cause AV reciprocating tachycardia?
Bundle of kent(WPW) and bundle of James(LGL)
64
Tx for narrow QRS SVT
1st: Adenosine 2nd: AV nodal blockers (BB and CCB)
65
Doxylamine
Antihistamine/sedative-hypnotic for insomnia
66
Labs to dx diabetes
Fasting plasma >126 2hr GTT >200 A1c >6.5% Random glucose with sx >200
67
Impaired fasting glucose
Fasting glucose 100-125
68
Impaired glucose tolerance
2hr GTT 140-199
69
How does A1c correlate to avg blood sugar
``` 6%= 120 7%=150 8%=200 9%=250 10%=300 11%=350 ```
70
DM2 drugs that cause weight loss
glp1 and SGLT2
71
DM2 drugs that cause weight gain
Sulfonylureas and insulin *same DM2 drugs associated with hypoglycemia
72
Long acting insulins
Glargine, Detroit, degludec
73
Intermediate/basal insulins
Hamlin N and Novolin N
74
Regular/short acting insulins
Humbling R and novolin R
75
Rapid acting/bolus (mealtime or correction) insulin
Glulisine, aspartame’s, lispro, apedria

PANCE prep JQ (15 decks)

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