HY Medicine Outpatient Flashcards
(123 cards)
1
Q
First line tx for stage 1 HTN?
A
HCTZ
2
Q
second line tx for stage 2 HTN?
A
HCTZ +ACEI/ARB/BB/CB
3
Q
What is stage 1 HTN?
A
>140/90
4
Q
What is stage 2 HTN?
A
>160/100
5
Q
What is the most common cause of 2o HTN?
A
renovascular disease
6
Q
What is the most common cause of 2o HTN in YOUNG WOMEN?
A
OCPs
7
Q
What Tx fo HTN in a diabetic or stroke pt?
A
ACEi
8
Q
What Tx fo HTN if CAD or CHF
A
beta blocker
9
Q
What Tx fo HTN if pregnant
A
Ca-channel blocker
10
Q
What Tx fo HTN if refractory
A
check for compliance
11
Q
what is goal BP? if CKD or DM?
A
140/90 130/80
12
Q
What are goal lipids for -low risk -med risk -high risk patients?
A
low: >190 med: >160 high: >130 OR TG>500
13
Q
What first line tx for elevated LDL?
A
statin
14
Q
what is first line tx for patient with TG > 500?
A
niacin
15
Q
what labs for initial eval of hyperlipidemia?
A
TSH LFTs renal fasting glucose
16
Q
side effects of statins
A
hepatotoxicity and rhabdo (LFTs, CK)
17
Q
side effects of Niacin
A
flushing, hyperglycemia, hyperuricemia (check CK, LFTs)
18
Q
side effects of bile acid resins
A
GI distress, poorly tolerated
19
Q
side effects of Fibrates (gemfibrazol)
A
hepatotox rhabdo cholesterol gallstones (check CK, LFTs)
20
Q
Mgmt of severe HA with HTN
A
- non con head CT to r/o ICH 2. then LP
21
Q
Tx tension HA
A
NSAIDS or Tylenol Sumatriptan if severe
22
Q
Tx Cluster HA
A
sumatriptan and O2 for acute attacks verapamil for ppx
23
Q
cluster HA symptoms
A
unilateral tearing/stabbing pain behind eye ipsilateral tearing, flush or nasal discharge
24
Q
Tx for migraines
A
Sumatriptan for acute attacks -TCA or propranolol for ppx
25
Rebound analgesic HA
tx wean from analgesics \*do not give more pain meds
26
Proposed etiology of migraines?
stress--\> decreased 5HT--\> vasospasm--\> HA
27
What dx consider for a cold that gets better for a few days and then gets worse?
secondary bacterial infxn
28
DDx cough \> 3wks
smoking, postnasal drip, GERD or asthma
29
Viral vs bacterial sinusitis
viral \< 7-10d --\> pseudoephedrine bacterial \> 7-10d --\> decongestant + amoxicillin
30
What is dyspepsia
spectrum of epigastric pain: -pain/discomfort -heartburn -bloating -indigestion 90% due to GI causes (PUD, GERD, gastritis, nonulcer dyspepsia)
31
management of dyspepsia
severe GI dz--\> endoscopy and urease breath test suspect MI: EKG and cardiac enzymes H pylori: clarithromycin + amoxicillin + PPI
32
GERD sx?
heartburn, regurgitation, waterbrash (sour taste), cough, dyspepsia
33
treatment for GERD?
PPI, if persists \>6weeks --\> dx EGD with biopsy
34
Tx for mild and severe esophagitis
mild: PPIs severe: Nissen fundoplication
35
Tx Barrett esophagus
no dysplasia--\> PPIs low-grade dysplasia--\> lap Nissen and annual surveillance high grade--\> esophagectomy
36
recurrent pneumonia with lipid laden macrophages seen in what illness?
GERD
37
Sx of complicated diarrhea?
nausea, vomiting, fever
38
mgmt complicated diarrhea?
fecal leukocytes \*if + for WBCs--\> stool cx for C diff toxin
39
Tx for bacterial diarrhea or C diff diarrhea
bacterial: cipro x 5 d c diff: flagyl or PO vanc
40
MCC acute diarrhea
virus
41
MCC chronic diarrhea
IBS
42
diarrhea x daycare ddx
roatvirus, shigella, giardia
43
diarrhea x mycotic aneurysm
salmonella
44
diarrhea x PNA x hyponatremia
legionella
45
workup of constipation: 2o cause
TSH, renal panel
46
workup of constipation: suspect colorectal cancer
fecal occult blood test
47
workup of constipation: suspect obstruction
KUB
48
IBS sx
altered bowel habits (diarrhea, constipation or both) that improve with defecation and chronic abdominal pain
49
Nausea vomiting mgmt suspect 2o cause
CBC, renal panel, LFTs
50
Nausea vomiting mgmt women
bHCG
51
Nausea vomiting mgmt severe dehydration
admit + IVF (1/2 NS +K)
52
MCC of nausea and vomiting
viral gastroenteritis or food poisoning
53
common electrolyte abnormality seen with nausea and vomiting
hypochloremic, hypokalemic metabolic alkalosis
54
presentation of hemorrhoids
dilated perianal veins BRBPR or painful thrombosis
55
which hemorrhoids tend to be more painful, external or internal?
external, below the dentate line
56
What is lumbar strain?
dull LBP after physical activity
57
herniated disc sx?
sciatic type LBP radiating to butt/thigh, worse with sitting or leaning forward
58
degenerative disc dz sx
chronic LBP, worse with activity
59
cauda equina sx?
bilateral sciatic + bowel/bladder sx, neuro sx
60
vertebral osteomyelitis
LBP, fever, tender to palp
61
malignancy lower back pain
LBP night sweats, h/o cancer, failure to improve
62
spinal stenosis sx
LBP worse wtih activity, better with sitting or leaning forward
63
compression fx
well-localized LBP, worse with activity
64
sondylolisthesis
LBP worse with hyperextension
65
dx radiculopathy?
straight leg raise
66
workup compression fx, tumor mets or osteo?
x-ray
67
suspect cauda equina?
dx emergent MRI and consult neurosurg
68
When do x ray for ankle pain?
Ottowa rules: can't walk 4 steps, bony tenderness over malleoli, navicular bone or base of 5th metatarsal
69
Tx for ankle sprain without Ottowa criteria?
RICE and PT
70
Sx of supraspinatus tendinitis?
aka impingement syndrome dull pain over lateral deltoid with arm aBduction
71
tx for supraspinatus tendinitis?
steroid injections, surgical acromioplasty (dull pain)
72
Sx of lateral epicondylitis Tx
pain at lateral elbow with supination or pronation tx: forearm splint, PT
73
Sx of medial epicondylitis Tx
Sx: pain at medial elbow wtih wrist flexion Tx: forearm splint, PT
74
De quervain dz sx
pain at radial wrist with thumb gripping dx finkelstein test tx: thumb spica and NSAIDs
75
Tx olecranon bursitis
reassurance
76
Tx trochanteric bursitis?
NSAIDs, steroid injections
77
How can you confirm Carpal tunnel?
EMG tx: wrist splint, then steroid shot, then surgical carpal tunnel release
78
Tx for OA?
glucosamine chondroitin supplements -weight loss and PT -acetominophen and NSAIDs steroid injections joint replacement
79
Where are Heberden and Bouchard nodes located?
See these in osteoarthritis HeberDen at DIP Bouchard at PIP
80
Osteoporosis screening?
\>65 with DEXA q2 years \<2.5 SD
81
osteoporosis RFs
postmenopause, old age, steroid or heparin use
82
tx osteoporosis
calcium, vit D, weight bearing exercise, bisphosphonates or HRT
83
Sx with age-related macular degeneration?
loss of central vision, scotoma
84
drusen (yellow-white deposits under pigmented epithelium) = ?
macular degenderation
85
tx for macular degeneration
ranibizumab decreased the rate of vision loss from WET ARMD
86
ddx wet vs dry ARMD?
wet: sudden onset dry: gradual onset
87
sx with glaucoma?
loss of peripheral vision
88
dx glaucoma?
increased intra-ocular pressure
89
DDx open vs closed angle glaucoma
open is gradual onset closed is sudden onset with severe eye pain, tearing, n/v
90
tx open angle glaucoma?
topical BBlockers, alpha agonists, acetazolamide or prostaglandins
91
tx closed angle glaucoma
pilocarpine drops and emergent iridctomy
92
causes of cataracts?
old age, smoking, diabetes
93
Subconjunctival Hematoma
tx = reassurance
94
what is keratoconjunctivitis sicca? tx?
dry eyes
tx = eye drops
95
What is Blepharitis? tx?
eyelid inflammation due to s. aureus
Tx = warm compress
96
What is scleritis? tx?
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
Uveitis sx? tx?
inflammation of iris--\> circumcorneal injection, eye pain, blurry vision
tx = consult ophtho
98
What is HSV keratitis? sx? tx?
* similar to conjunctivitis but fluorescein stain shows a dendritic ulcer
* tx = topical ACV
99
Viral conjunctivitis sx and tx
swollen red eye with **watery** discharge
tx = cold compress
100
bacterial conjunctivitis sx and tx
sx: s. pneumo infx--\> rapid onset red eye with **mucopurulent discharge**
tx: topical Cipro
101
Hyperacute conjunctivitis: sx and tx
sx: N. gonorrhoeae infx: rapid onset red eye with *copious* mucopurulent discharge
tx: topical and PO ceftriaxone
102
allergic conjunctivitis: sx and tx
bilateral red eye with itching, tearing and other upper respiratory sx
tx: topical antihistamines
103
Amaurosis fugax tx
resolves spontaneously
104
sudden, transient monocular vision loss
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
how dx sleep apnea?
polysomnography
106
tx for REM sleep disorder?
modafinil, or methylphenidate (ritalin)
107
DDx conductive vs. sensorineural hearing loss
Conductive: decreased perception of low volume sounds
Sensorineural: decreased perception of low and high colume sounds with tinnitus
108
tx for sensorineural hearing loss
tx underlying cause, consider cochlear implants
109
MCC of conductive hearing loss?
cerumen impaction
110
MCC sensorineural hearing loss
presbycusis
111
Stress incontinence: sx and tx
Sx: urine leakage with exertion or straining
tx: surgery to stabilize hypermobile urethra
kegel exercises
pessaries
112
Urge incontinence sx and tx
urine leakage due to involuntary bladder contractions (detrusor hyperactivity)
tx: anitcholinegics (oxybutinin) and TCAs (imipramine)
113
Overflow incontinence sx and tx
urine leakage due to urinary retention and overdistention
tx: intermittent self cath
assoc with MS
114
Bypass incontinence sx tx
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
functional incontinence sx tx
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
Chronic fatigue syndrome
\>6 months chronic fatigue, not due to medical or psych disorder
Dx: CBC, TSH, fasting glucose, renal panel, UA, LFTs
Tx: CBT +SSRIs
117
Erectile dysfunction tx
sildafenil (viagra)
118
MCC erectile dysfunction
penile vasculature atherosclerosis
other causes: anti-HTN meds, alcohol
119
mneumonic for Wernicke-Korsakoff?
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
Smoking tx
Varenecline/Chantix
Buproprion
both are partial nicotine agonists
121
Screening for hyperlipidemia
q5 yrs in adults
122
Colorectal cancer screening
annual: FOBT and colonoscopy q10 or flexible sigmoidoscopy q5
123
Screening for diabetics
refer to ophtho for annual fundoscopic exam
