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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
Q

Light’s criteria

A

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
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26
Q

Important professional relationships to build in family med

A
  1. cardiologist
  2. dermatologist
  3. orthopedist

ENT(kids)

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27
Q

Siliocsis

A

Mining, quarry work, pottery, sandblasting

Modular opacities in ULF and egg shell calcification of hilar and mediastinal modes

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28
Q

Black lung dz/ coal worker pneumonconiosis

A

Small upper lobe nodules and hyperinflation

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29
Q

Caplan syndrome

A

Black lung with RA

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30
Q

Berylliosis

A

Electronics, aerospace, ceramics, dye and manufacturing

Increased lung marking and possible hikes LAD

Tx with steroids, O2, and methotrexate

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31
Q

Byssinosis/brown lung dz/Monday fever

A

Pneumoconiosis from cotton exposure

32
Q

Asbestosis

A

Old building construction, ship yards, pipe fitters

Pleural plaques and lower lobe lung changes

33
Q

Acute lipoid pneumonia

A

Caused by vaping or other oil inhalation

Tx with IV methylprednisone(120-500mg daily) followed by oral prednisone taper

34
Q

JUPITER trial

A

Suppression of low grade inflammation by statins improves clinical outcomes in pts even when they don’t have CHD

35
Q

Tx of otitis externa

A

Ciprofloxacin/dexamethasone drops

Protect war against moisture (drying agent include isopropyl alcohol and acetic acid)

36
Q

Mastoiditis

A

Complication of prolonged or inadequately treated otitis media

CT scan needed

IV abx and myringotomy for drainages followed by possible tympanostomy tube placement

37
Q

Peak ages of AOM

A

6-18months

38
Q

4MC pathogens causing AOM

A

S pneumo
H flu
M cat
Strep pyogenes

39
Q

If bulla on TM you should suspect this organism

A

Mycoplasma pneumo

40
Q

Tx of AOM

A

10-14 d amoxicillin is DOC

Cefixime in children

Consider erythromycin-sulfisoxazole if allergic to pcn

41
Q

Causes of chronic otitis media

A

AOM, trauma, or cholesteatoma

42
Q

Tx of Eustachian tube dysfunction

A
  1. Decongestants
  2. Swallowing/yawning
  3. Intranasal corticosteroids
43
Q

Presentation of cholesteatoma

A

Chronic otitis media and painless otorrhea

44
Q

CSF for bacterial meningitis

A

Elevated PMN (100-10,000)
Low glucose (<45)
Elevated total protein
Increased ICP

45
Q

If you suspect bacterial meningitis when do you give abx?

A

Immediately treat empirically for suspected bacterial

DO NOT wait for LP or CT results

46
Q

If you suspect bacterial meningitis when do you get a CT before an LP?

A

> 60yo, immunodeficiency, hx of CNS dz, AMS, focal neurological findings, and papilledema

47
Q

MC bacterial meningitis pathogens and tx based on age

A

<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
Q

Cervical cancer screening schedule

A

21-29: pap every 3 years

30-65: pap and HPV every 5 years

49
Q

Broca’s aphasia

A

Damage to the left frontemporal region

Results in difficulty with language production

50
Q

Wernickie’s aphasia

A

Damage to left temporal-parietal lobe

Results in difficulty understanding speech so pt can produce fluent speech but it’s meaningless

51
Q

1st line tx for unstable bradycardia

A

Atropine

*exception 3rd degree block . In this case pacing is 1st line

52
Q

2 “shockable” using defibrillator

A

Ventricular fibrillation

Pulseless ventricular tachycardia

53
Q

Tx for unstable tachyarrhythmia

A

Synchronized cardioversion

54
Q

Signs of unstable cardiac status

A

Hypotension
AMS
Refractory chest pain
Acute heart failure

55
Q

Wide QRS stable tachycardia tx

A

Amiodarone

*exception WPW: procanimide if stable and cardioversion if unstable

56
Q

Normal QRS stable tachycardia tx

A

A flutter or Afib: BB or CCB

Other: cavalier maneuvers, adenosine and then BB or CCB

57
Q

How to determine cardiac axis

A

Look at leads I and aVF

Both positive: normal axis
Positive I and negative aVF: LAD
Negative I and positive aVF: RAD

58
Q

How do you evaluate atrial enlargement?

A

Look at lead II for morphology of P waves and look at V1 to evaluate if p wave is more positive or negative

59
Q

How do you evaluate ekg for ventricular Hypertrophy?

A

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
Q

Wide QRS+slurred R in V5or6+deep S in V1=

A

LBBB

61
Q

Wide QRS+RsR in V1or2+wide S in V6=

A

RBBB

62
Q

MC type of PSVT

A

Orthodromic(narrow QRS) AV nodal reentry

63
Q

Which accessory pathways cause AV reciprocating tachycardia?

A

Bundle of kent(WPW) and bundle of James(LGL)

64
Q

Tx for narrow QRS SVT

A

1st: Adenosine
2nd: AV nodal blockers (BB and CCB)

65
Q

Doxylamine

A

Antihistamine/sedative-hypnotic for insomnia

66
Q

Labs to dx diabetes

A

Fasting plasma >126
2hr GTT >200
A1c >6.5%
Random glucose with sx >200

67
Q

Impaired fasting glucose

A

Fasting glucose 100-125

68
Q

Impaired glucose tolerance

A

2hr GTT 140-199

69
Q

How does A1c correlate to avg blood sugar

A 
6%= 120
7%=150
8%=200 
9%=250
10%=300
11%=350
70
Q

DM2 drugs that cause weight loss

A

glp1 and SGLT2

71
Q

DM2 drugs that cause weight gain

A

Sulfonylureas and insulin

*same DM2 drugs associated with hypoglycemia

72
Q

Long acting insulins

A

Glargine, Detroit, degludec

73
Q

Intermediate/basal insulins

A

Hamlin N and Novolin N

74
Q

Regular/short acting insulins

A

Humbling R and novolin R

75
Q

Rapid acting/bolus (mealtime or correction) insulin

A

Glulisine, aspartame’s, lispro, apedria

PANCE prep JQ (15 decks)

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