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Medicine > HY Medicine Outpatient > Flashcards

HY Medicine Outpatient Flashcards

1
Q

First line tx for stage 1 HTN?

A

HCTZ

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2
Q

second line tx for stage 2 HTN?

A

HCTZ +ACEI/ARB/BB/CB

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3
Q

What is stage 1 HTN?

A

>140/90

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4
Q

What is stage 2 HTN?

A

>160/100

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5
Q

What is the most common cause of 2o HTN?

A

renovascular disease

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6
Q

What is the most common cause of 2o HTN in YOUNG WOMEN?

A

OCPs

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7
Q

What Tx fo HTN in a diabetic or stroke pt?

A

ACEi

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8
Q

What Tx fo HTN if CAD or CHF

A

beta blocker

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9
Q

What Tx fo HTN if pregnant

A

Ca-channel blocker

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10
Q

What Tx fo HTN if refractory

A

check for compliance

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11
Q

what is goal BP? if CKD or DM?

A

140/90 130/80

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12
Q

What are goal lipids for -low risk -med risk -high risk patients?

A

low: >190 med: >160 high: >130 OR TG>500

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13
Q

What first line tx for elevated LDL?

A

statin

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14
Q

what is first line tx for patient with TG > 500?

A

niacin

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15
Q

what labs for initial eval of hyperlipidemia?

A

TSH LFTs renal fasting glucose

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16
Q

side effects of statins

A

hepatotoxicity and rhabdo (LFTs, CK)

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17
Q

side effects of Niacin

A

flushing, hyperglycemia, hyperuricemia (check CK, LFTs)

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18
Q

side effects of bile acid resins

A

GI distress, poorly tolerated

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19
Q

side effects of Fibrates (gemfibrazol)

A

hepatotox rhabdo cholesterol gallstones (check CK, LFTs)

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20
Q

Mgmt of severe HA with HTN

A
  1. non con head CT to r/o ICH 2. then LP
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21
Q

Tx tension HA

A

NSAIDS or Tylenol Sumatriptan if severe

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22
Q

Tx Cluster HA

A

sumatriptan and O2 for acute attacks verapamil for ppx

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23
Q

cluster HA symptoms

A

unilateral tearing/stabbing pain behind eye ipsilateral tearing, flush or nasal discharge

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24
Q

Tx for migraines

A

Sumatriptan for acute attacks -TCA or propranolol for ppx

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25
Q

Rebound analgesic HA

A

tx wean from analgesics *do not give more pain meds

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26
Q

Proposed etiology of migraines?

A

stress–> decreased 5HT–> vasospasm–> HA

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27
Q

What dx consider for a cold that gets better for a few days and then gets worse?

A

secondary bacterial infxn

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28
Q

DDx cough > 3wks

A

smoking, postnasal drip, GERD or asthma

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29
Q

Viral vs bacterial sinusitis

A

viral < 7-10d –> pseudoephedrine bacterial > 7-10d –> decongestant + amoxicillin

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30
Q

What is dyspepsia

A

spectrum of epigastric pain: -pain/discomfort -heartburn -bloating -indigestion 90% due to GI causes (PUD, GERD, gastritis, nonulcer dyspepsia)

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31
Q

management of dyspepsia

A

severe GI dz–> endoscopy and urease breath test suspect MI: EKG and cardiac enzymes H pylori: clarithromycin + amoxicillin + PPI

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32
Q

GERD sx?

A

heartburn, regurgitation, waterbrash (sour taste), cough, dyspepsia

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33
Q

treatment for GERD?

A

PPI, if persists >6weeks –> dx EGD with biopsy

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34
Q

Tx for mild and severe esophagitis

A

mild: PPIs severe: Nissen fundoplication

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35
Q

Tx Barrett esophagus

A

no dysplasia–> PPIs low-grade dysplasia–> lap Nissen and annual surveillance high grade–> esophagectomy

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36
Q

recurrent pneumonia with lipid laden macrophages seen in what illness?

A

GERD

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37
Q

Sx of complicated diarrhea?

A

nausea, vomiting, fever

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38
Q

mgmt complicated diarrhea?

A

fecal leukocytes *if + for WBCs–> stool cx for C diff toxin

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39
Q

Tx for bacterial diarrhea or C diff diarrhea

A

bacterial: cipro x 5 d c diff: flagyl or PO vanc

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40
Q

MCC acute diarrhea

A

virus

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41
Q

MCC chronic diarrhea

A

IBS

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42
Q

diarrhea x daycare ddx

A

roatvirus, shigella, giardia

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43
Q

diarrhea x mycotic aneurysm

A

salmonella

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44
Q

diarrhea x PNA x hyponatremia

A

legionella

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45
Q

workup of constipation: 2o cause

A

TSH, renal panel

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46
Q

workup of constipation: suspect colorectal cancer

A

fecal occult blood test

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47
Q

workup of constipation: suspect obstruction

A

KUB

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48
Q

IBS sx

A

altered bowel habits (diarrhea, constipation or both) that improve with defecation and chronic abdominal pain

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49
Q

Nausea vomiting mgmt suspect 2o cause

A

CBC, renal panel, LFTs

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50
Q

Nausea vomiting mgmt women

A

bHCG

51
Q

Nausea vomiting mgmt severe dehydration

A

admit + IVF (1/2 NS +K)

52
Q

MCC of nausea and vomiting

A

viral gastroenteritis or food poisoning

53
Q

common electrolyte abnormality seen with nausea and vomiting

A

hypochloremic, hypokalemic metabolic alkalosis

54
Q

presentation of hemorrhoids

A

dilated perianal veins BRBPR or painful thrombosis

55
Q

which hemorrhoids tend to be more painful, external or internal?

A

external, below the dentate line

56
Q

What is lumbar strain?

A

dull LBP after physical activity

57
Q

herniated disc sx?

A

sciatic type LBP radiating to butt/thigh, worse with sitting or leaning forward

58
Q

degenerative disc dz sx

A

chronic LBP, worse with activity

59
Q

cauda equina sx?

A

bilateral sciatic + bowel/bladder sx, neuro sx

60
Q

vertebral osteomyelitis

A

LBP, fever, tender to palp

61
Q

malignancy lower back pain

A

LBP night sweats, h/o cancer, failure to improve

62
Q

spinal stenosis sx

A

LBP worse wtih activity, better with sitting or leaning forward

63
Q

compression fx

A

well-localized LBP, worse with activity

64
Q

sondylolisthesis

A

LBP worse with hyperextension

65
Q

dx radiculopathy?

A

straight leg raise

66
Q

workup compression fx, tumor mets or osteo?

A

x-ray

67
Q

suspect cauda equina?

A

dx emergent MRI and consult neurosurg

68
Q

When do x ray for ankle pain?

A

Ottowa rules: can’t walk 4 steps, bony tenderness over malleoli, navicular bone or base of 5th metatarsal

69
Q

Tx for ankle sprain without Ottowa criteria?

A

RICE and PT

70
Q

Sx of supraspinatus tendinitis?

A

aka impingement syndrome dull pain over lateral deltoid with arm aBduction

71
Q

tx for supraspinatus tendinitis?

A

steroid injections, surgical acromioplasty (dull pain)

72
Q

Sx of lateral epicondylitis Tx

A

pain at lateral elbow with supination or pronation tx: forearm splint, PT

73
Q

Sx of medial epicondylitis Tx

A

Sx: pain at medial elbow wtih wrist flexion Tx: forearm splint, PT

74
Q

De quervain dz sx

A

pain at radial wrist with thumb gripping dx finkelstein test tx: thumb spica and NSAIDs

75
Q

Tx olecranon bursitis

A

reassurance

76
Q

Tx trochanteric bursitis?

A

NSAIDs, steroid injections

77
Q

How can you confirm Carpal tunnel?

A

EMG tx: wrist splint, then steroid shot, then surgical carpal tunnel release

78
Q

Tx for OA?

A

glucosamine chondroitin supplements -weight loss and PT -acetominophen and NSAIDs steroid injections joint replacement

79
Q

Where are Heberden and Bouchard nodes located?

A

See these in osteoarthritis HeberDen at DIP Bouchard at PIP

80
Q

Osteoporosis screening?

A

>65 with DEXA q2 years <2.5 SD

81
Q

osteoporosis RFs

A

postmenopause, old age, steroid or heparin use

82
Q

tx osteoporosis

A

calcium, vit D, weight bearing exercise, bisphosphonates or HRT

83
Q

Sx with age-related macular degeneration?

A

loss of central vision, scotoma

84
Q

drusen (yellow-white deposits under pigmented epithelium) = ?

A

macular degenderation

85
Q

tx for macular degeneration

A

ranibizumab decreased the rate of vision loss from WET ARMD

86
Q

ddx wet vs dry ARMD?

A

wet: sudden onset dry: gradual onset

87
Q

sx with glaucoma?

A

loss of peripheral vision

88
Q

dx glaucoma?

A

increased intra-ocular pressure

89
Q

DDx open vs closed angle glaucoma

A

open is gradual onset closed is sudden onset with severe eye pain, tearing, n/v

90
Q

tx open angle glaucoma?

A

topical BBlockers, alpha agonists, acetazolamide or prostaglandins

91
Q

tx closed angle glaucoma

A

pilocarpine drops and emergent iridctomy

92
Q

causes of cataracts?

A

old age, smoking, diabetes

93
Q
A

Subconjunctival Hematoma

tx = reassurance

94
Q

what is keratoconjunctivitis sicca? tx?

A

dry eyes

tx = eye drops

95
Q

What is Blepharitis? tx?

A

eyelid inflammation due to s. aureus

Tx = warm compress

96
Q

What is scleritis? tx?

A

inflammation of sclera–> eye pain and blurry vision

(The sclera (from the Greek skleros, meaning hard[1]), also known as the white of the eye, is the opaque, fibrous, protective, outer layer of the eye containing collagen and elastic fiber.)

tx = consult optho, steroids

97
Q

Uveitis sx? tx?

A

inflammation of iris–> circumcorneal injection, eye pain, blurry vision

tx = consult ophtho

98
Q

What is HSV keratitis? sx? tx?

A
  • similar to conjunctivitis but fluorescein stain shows a dendritic ulcer
  • tx = topical ACV
99
Q

Viral conjunctivitis sx and tx

A

swollen red eye with watery discharge

tx = cold compress

100
Q

bacterial conjunctivitis sx and tx

A

sx: s. pneumo infx–> rapid onset red eye with mucopurulent discharge
tx: topical Cipro

101
Q

Hyperacute conjunctivitis: sx and tx

A

sx: N. gonorrhoeae infx: rapid onset red eye with copious mucopurulent discharge
tx: topical and PO ceftriaxone

102
Q

allergic conjunctivitis: sx and tx

A

bilateral red eye with itching, tearing and other upper respiratory sx

tx: topical antihistamines

103
Q

Amaurosis fugax tx

A

resolves spontaneously

104
Q

sudden, transient monocular vision loss

A

amaurosis fugax

internal carotid artery plaque–> embolizes to retinal artery–> sudden, transient monocular loss of vision

dx: hollenhorst plaqeu
workup: carotid US and cardiac workup (EKG and lipid panel)

105
Q

how dx sleep apnea?

A

polysomnography

106
Q

tx for REM sleep disorder?

A

modafinil, or methylphenidate (ritalin)

107
Q

DDx conductive vs. sensorineural hearing loss

A

Conductive: decreased perception of low volume sounds

Sensorineural: decreased perception of low and high colume sounds with tinnitus

108
Q

tx for sensorineural hearing loss

A

tx underlying cause, consider cochlear implants

109
Q

MCC of conductive hearing loss?

A

cerumen impaction

110
Q

MCC sensorineural hearing loss

A

presbycusis

111
Q

Stress incontinence: sx and tx

A

Sx: urine leakage with exertion or straining

tx: surgery to stabilize hypermobile urethra

kegel exercises

pessaries

112
Q

Urge incontinence sx and tx

A

urine leakage due to involuntary bladder contractions (detrusor hyperactivity)

tx: anitcholinegics (oxybutinin) and TCAs (imipramine)

113
Q

Overflow incontinence sx and tx

A

urine leakage due to urinary retention and overdistention

tx: intermittent self cath

assoc with MS

114
Q

Bypass incontinence sx tx

A

urine leakage due to a fistula following pelvic surgeyr or radiation

dx methylene blue or indigo carmine dye

tx surgery to repair the fistula

115
Q

functional incontinence sx tx

A

urine leakage due to physical or psych issues, common in nursing home and gero pts

tx underlying cause

**cause can be delerium/dementia, meds, physical impairment

116
Q

Chronic fatigue syndrome

A

>6 months chronic fatigue, not due to medical or psych disorder

Dx: CBC, TSH, fasting glucose, renal panel, UA, LFTs

Tx: CBT +SSRIs

117
Q

Erectile dysfunction tx

A

sildafenil (viagra)

118
Q

MCC erectile dysfunction

A

penile vasculature atherosclerosis

other causes: anti-HTN meds, alcohol

119
Q

mneumonic for Wernicke-Korsakoff?

A

COAT RAC

Wernicke: Confusion, Ophthalmoplegia (CN VI palsy), ataxia and thiamine deficiency

Korsakoff psychosis due to chronic thiamine deficiency: irreversible retrograde amnesia, anterograde amnesia, confabulations

120
Q

Smoking tx

A

Varenecline/Chantix

Buproprion

both are partial nicotine agonists

121
Q

Screening for hyperlipidemia

A

q5 yrs in adults

122
Q

Colorectal cancer screening

A

annual: FOBT and colonoscopy q10 or flexible sigmoidoscopy q5

123
Q

Screening for diabetics

A

refer to ophtho for annual fundoscopic exam

Medicine (8 decks)

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