Medicards

Question 1

Otitis media

Answer 1

Bugs: s. pneumo, h flu
Drugs: amox 80mg/kg/day, three doses

Question 2

Sinusitis

Answer 2

Bugs: s pneumo, h flu
Drugs: amox, double dose, or levo

Question 3

pharyngitis

Answer 3

Bugs: group A strep
Drugs: PCN 500mg bid for 10 days
- erythromycin 10 days with allergy
- amox in kids

Question 4

pneumonia

Answer 4

Bugs: s pneumo, atypicals, h flu
Drugs: macrolide, doxy, levo if refractory

Question 5

travellers diarrhea

Answer 5

Bugs: e coli, salmonella, shigella, campylobacter, parasite
Drugs: Cipro 500 BID if sxn more than 1 day, blood or fever, azithro for kids
- metro for giardia and entamoeba

Question 6

pseudomembranous colitis

Answer 6

Bugs: c diff
Drugs: flagyl or PO vanco

Question 7

UTI

Answer 7

Bugs: e coli, gram negs, s sphrophyticus
Drugs: macrobid 100 BID 5 days
- bactrim DS BID 3 days
- cipro 250 BID 3days

Question 8

Chlamydia

Answer 8

a gram of axithro

Question 9

gonorrhea

Answer 9

ceftriaxone 250 IM

Question 10

vagainitis

Answer 10

candida - OTC antifungal or 150 fluconazole
BV: flagyl
Trichomonas: flagyl

Question 11

cellulitis/impetigo/abscess

Answer 11

• diclox/keflex or clinda
• bacroban for impetigo
• bacrim/doxy for MRSA

Question 12

penicillins

Answer 12

side effects: GI, allergy, yeast infection, lower seizure threshold, c diff

bugs: group A strep, oral anaerobes, syphilis
- also s pneumoiae

Question 13

amoxicillin

Answer 13

• good for group A strep, listeria, oral anaerobes
• OK for s pneumo, enterococcus
• no staph or gonorrhea

Question 14

dicloxacillin

Answer 14

• good for s aureus, strep, oral anaerobes

Question 15

augmentin

Answer 15

• good for group A strep, oral anaerobes, h flu, e coli, pasteurella, s aureus

Question 16

Audit-C

Answer 16

1. how often do you drink
2. how many drinks on a typical day
3. how often more than 6 drinks in one occasion
4. able to stop
5. failed to do normal tasks
6. first morning drink
7. guilt or remorse
8. black outs
9. injured as a result
10. anyone else concerned

Question 17

labs for alcoholics

Answer 17

CLUG
CBC - look at MCV
LFTs
Uric acid
GGT

Question 18

naltrexone

Answer 18

Pop target: abstain from EtOH and opioids (not currently using) or abstain completely
Side effects: GI upset, depression, LFT elevation
Mechanism: blocks opioid receptor, ID card for safety, unclear why it works for alcohol

Question 19

acamprosate

Answer 19

Pop target: want to cut down, or on opioids suboxone or methadone
Side Effects: none
Mechanism: GABA receptor in brain

Question 20

disulfiram

Answer 20

Pop target: motivated patient, avoid in frail or with known varices
Side Effects: high BP, severe withdrawal, vomiting with drinking
Mechanism: blocks ETOH pathway, high toxic metabolite

Question 21

Diabetes rule of 3s (microvascular)

Answer 21

• eyes = retinopathy
• kidneys = microalbumin, ACEi, renal function
• feet = exam

Question 22

Diabetes rule of 3s (blood sugar)

Answer 22

• A1c = 3-6 months, less than 8
• lifestyle
• medications = metformin, oral agents, insulin

Question 23

Diabetes rule of 3s (macrovascular)

Answer 23

• BP 140/90
• lipids = statin if necessary
• CVD prevention = smoking, lifestyle, aspirin

Question 24

get up and go test

Answer 24

rise from seat, hands across chest, walk 10 feet and return to chair, more than 30 seconds is increased fall risk

Question 25

meds with increased in fall

Answer 25

digoxin, antihistamines, antihypertensives, antipsychotics, benzos, diuretics, muscle relaxants, narcotics, laxatives, MAOis, TCAs, vasodilators

Question 26

causes of reversible dementia

Answer 26

depression, hypothyroid, normal pressure hydrocephalus, HSV, lyme, HIV, neurosyphilis, uremia, adrenal, hepatic encephalopathy, B12/thiamine, alcohol, tumor

Question 27

causes of delirium (DELIRIUM)

Answer 27

Drugs
Eyes, Ears (sensory)
Low O2
Infection
Retention or urine/stool
Ictal states, intracranial processes
Under hydration/nutrition
Metabolic (natremia, alcohol benzos)

Question 28

confusion assessment method for delirium

Answer 28

1. acute onset and fluctuating course
2. inattention
3. disorganized thinking
4. altered consciousness
   1 and 2 plus 3 or 4

Question 29

ADLs

Answer 29

bathing, dressing, toileting, feeding, transferring, continence, ambulation

Question 30

IADLs

Answer 30

telephone, travel, shopping, meal prep, housework, medication, money management

Question 31

reversible causes of urinary incontinence (DIAPERS)

Answer 31

Delirium
Infection
Atrophic vaginitis
Pharmaceuticals
Endocrine
Restricted mobility
Stool impaction

Question 32

causes of secondary hypertension

Answer 32

pheochromocytoma, renal artery stenosis, renal parenchymal disease, polycystic kidneys, OSA, hyperthyroid, hyperparathyroid, primary aldo, cushing, aortic coarctation

Question 33

CAD Risk factors (CDEFGH)

Answer 33

Cigarettes
Diabetes
Epidemiology 
Family history
Glycerides 
Hypertension

Question 34

Hypertension complications

Answer 34

CVA, CAD, CHF, PVD, kidney disease, retinopathy

Question 35

drug classes of hypertensives

Answer 35

ACEi
Beta blockers
CCBs
Diuretic
Everything else
- If A/B add C/D and reverse

Question 36

ACEi

Answer 36

Pro: DM, CHF, post MI, CAD, CKD
Con: AKI, bilateral RAS, dry cough, angioedema, hyperkalemia, pregnancy

Question 37

beta blocker

Answer 37

Pro: CAD/MI/angina, CHF, tachy-arrhythmias, performance anxiety, headache, glaucoma, tremor
Con: depression, fatigue, stamina, sexual dysfunction, withdrawal, heart block, asthma/COPD, worse in AAs

Question 38

CCBs

Answer 38

Pro: CHF (diastolic only), tachy-arrhythmias, angina, headache, raynaud’s
Con: systolic CHF, leg edema, constipation, headache, GERD, heart block

Question 39

diuretics

Answer 39

Pro: osteoporosis, kidney stones, peripheral edema, synergistic, cheap
Con: hypokalemia, gout, glucose intolerance, lipid intolerance

Question 40

Four principles of motivational interviewing (RLEA)

Answer 40

• righting reflex
• listening in order to understand
• effortless empathy
• ambivalence - find differences between behavior and values