Key Points Flashcards
screen for metabolic syndrome and EPS
Antipsychotics
great for anxiety and depression. BBW SI in kids. Dont stop abruptly
SSRIs
Most likey SSRI to cause sexual dysfucntion
(Partoxetine (paxil)
sense of risk or harm; disturbing thoughts and images with compulsion that is done to reduce the anxiety about the obsessions
OCD
Tx for OCD
Tx: SSRI and CBT
When does USPSTF say to start screening for substance abuse?
CAGE vs. AUDIT?
18 for substance use/ abuse . CAGE,
AUDIT (14 years old and up )
Meds for active alcohol withdrawal
Librium, ativan, valium
(can’t use if taken opioids in last week). Can drink on this med . helps with alcohol cravings
Naltrexone
Meds to help with alcohol cravings
Naltrexone
Acamprosate
Disulfiram (antabuse)
Vitamin supplementation for alcoholics
B12
Thiamine
Folic acid
Magnesium
What might labs show in alcoholic pt
low platelet count
increased MCV
elevated AST and ALT
hypertriglyceridemia
Delayed attainment of milestones; concern for social interactions; reaction to loud noises; language impairment (not a specific sign); repetitive behaviors (lining up toys, not ok with messing up line)
ASD
Screening tools for ASD. Ages to use?
CHAT =
MCHAT =
CAST=
CHAT 18-24 mos
MCHAT Toddlers
CAST over age 3
WHat is necessary for dx of ASD?
What else to look for?
Sx have to be present since age 1
Check lead levels
When can you dx ADHD
not before age 4
lanugo, peripheral edema (low albumin), amenorrhea, BMI <18.5
At risk for osteoporosis/osteopenia
anorexia
proteinuria, low albumin, high lipids, peripheral edema, periorbital edema
DM #1 cause in adults
ED
Chronic condition, not curable. Tx recurrence with corticosteroid
nephrotic syndrome
often occurs after strep infection. Hematuria
Tx often supportive, abx if needed, diuretics. Hospital if severe.
Glomerulonephritis
> 150mg/day → caused by exercise, can indicate renal disease and/or HTN
Proteinuria
30-150mg protein in urine /day → early sign renal disease, esp in diabetics
Microalbuminuria
How to tx Proteinuria?
Tx: ACEi or ARB. control HTN and DM; may need Na and protein restricted diet
What do bence jones proteins in urine indicate
multiple myeloma
Painless hematuria…
think bladder CA. Smoking increases risk
3 or more RBCs per high-power field
hematuria
Persistent if occurs on 2 or more occasions
Can be exercise induced
DDx: meses, UTI, renal disease, stone (urolithiasis) Bladder CA
False positives: semen, vit c supplements
hematuria
If hematuria present with protein …
refer to nephrologist
prostate nontender, rubbery, smooth, can’t feel median sulcus
BPH
How to treat BPH
Tx: alpha blocker at bedtime to combat drop in BP (terazosin, doxazosin)
TURP, prostatectomy
Alpha blockers= relax the muscle of the prostate and bladder neck, which allows urine to flow more easily
super tender, boggy prostate
Presents as infection (chills, fever, pain, blood in urine or semen, urinary sx)
Prostatitis
How to tx Prostatitis?
Tx: bactrim 1 tab BID for 6 weeks OR cipro 500mg BID x 6 wks
asymmetric, nodular, hard prostate
Prostate CA
PSA if >4 and no signs of prostatitis if PSA increased >0.75 in one year OR nodule on DRE
refer to urology!
How to tx incontinence
anticholinergics (Detrol, oxybutynin (Ditropan), pseudoephedrine
Kidneys can’t get rid of phosphate which then binds to calcium and lowers serum ca levels and parathyroid releases more parathyroid hormone, and causes renal hyperparathyroidism
Elevated calcium and phos (as well as BUN/creat, low GFR)
Avoid NSAIDs
Monitor for anemia
Vit d supplements
CKD
look for CV disease, psychological issues
Tx: PDE5i - don’t take w/ nitrates
Common SE of ssris, snris, tcas
Erectile Dysfunction
chronic w/ exacerbations and remissions, often chronic LBP that wakes pts up in middle of the night. Pain otherwise worse in the morning
Ankylosing Spondylitis
(+) HLAB27 Needs regular visits to ortho and cardio NO glucocorticoids NSAIDs and refer to rheum for biologics PT
Ankylosing Spondylitis
pain worse at night, limping, palpable mass
Bone tumor
most common bone tumor
osteoscarcoma
2nd most common bone tumor… often in leg with palpable mass
Ewing sarcoma
Benign bone tumor
Osteochondroma
Tx plan for possible bone tumor
Diag: x-ray first, then biopsy
Bone tumors in adults are usually bone marrow =
multiple myeloma
joint extremely tender, warm, red, swollen, decreased ROM
HCTZ (and other diuretics) compete with uric acid transporter, resulting in increased uric acid levels
gout
Acute gout tx
Acute: NSAIDs and colchicine; corticosteroids for subsequent attacks
Chronic/ maintenance tx of gout
allopurinol (can cause increase in flares so start anti-inflammatory at same time- indomethacin, colchicine, naproxen)
Hydrox
Low purine diet (avoid, meat , seafood, alcohol)
can lead to osteomyelitis if not treated. IMMEDIATE ER (IV ABX)
ACUTE onset pain, red, swollen, warmth to one joint
never give corticosteroid!
Infectious/Septic Arthritis
progressive, more than 6 wks
Limp, multiple joints, may have rash
ANA (+)
Immediate referral to rheumatologist (biologics, DMARDs, NSAIDs)
JRA
T-score ≤ -2.5
OR T score <-1 and > -2.5 and ≥2% & 10-yr major fracture risk 20% or 3% hip fracture risk
Osteoporosis
osteonecrosis of jaw; risk of esophagitis. Can cause pathologic fracture. Need drug holiday every 5 yrs for 3-5 years
Bisphosphonates
Lifestyle changes for osteoporosis
Weight bearing exercise, stop smoking, decrease alcohol and caffeine, calcium, vit d, limit steroid use
asymmetric arthritis
Trendelenburg gait
Osteoarthritis
difference between
Heberden nodes and
Bouchard nodes
Heberden nodes - distal
Bouchard nodes - proximal
Bouchard before Heberden
only found in OA not RA
Tx of Osteoarthritis
acetaminophen, NSAIDs, Tramadol (Ultram), consider topical NSAIDs for pts over 75 (lidocaine patches); exercise
new onset severe temporal HA, jaw claudication, vision changes
A/w polymyalgia rheumatica
Temporal artery usu tender and thick
GCA
tx of GCA
: prednisone 1mg/kg daily (max 60mg daily) for at least one month, then taper and remain on prednisone for 2-3 years. Low dose aspirin
Swollen, tender joints, BILATERAL, w/ systemic sx
Rheumatoid arthritis
