Miscellaneous Flashcards
Treatment for FOOSH? injury caused by falling on wrist that was fully extended and person complains of pain between extensor pollicis longus and brevis tendons
You are suspicious for a fracture of the scaphoid bone (even if not visible on x-ray) so the treatment is to immobilize both the thumb and the wrist in a Thumb Spica Splint
Common Side Effect of Chantix (Verenicline)
nausea. Not good to use with the patch because it increases nausea, dizziness, etc
Circumflex Artery Occlusion you would see changes in leads
I, AVL,V5
Occlusion of the LAD causes changes in leads
VI, V6
Occlusion of the R. coronary causes changes in leads
II, III, AVF
Post Partum depression
check a thyroid function
- it should resolve in ten days
- give Sertralline for breast feeding women
bullous impetigo in diaper area
caused by Staph aureus and
highest cancer risk in which autoimmune dz?
Dermtomyositis
Proctalgia fugax
pain in the rectal area
Telogen effluvium
hair shedding due to stress (severe illness, pregnancy) after three months into the stress
Best drug for terminating supraventricular arrhythmias?
Adenosine
Which drug for bradycardia?
atropine
Which drug for ventricular arrhythmias?
bretylium, procainamide, lidocaine
Genital warts
no need to biopsy and do DNA testing
-treat it to treat cervical & genital cancer
Dysfunctional Uterine Bleeding
treatment is progestin on a 21-day cycle
Most effective treatment of allergies?
intranasal glucocorticoids
Dexamethasone for Croup
one dose is enough for treatment
Pre-Menstrual Syndrome
psychological and physical symptoms before period starts.
Treatment: Spironolactone during the luteal phase
A 23-year-old gravida 1 para 0 at 36 weeks gestation presents to the office complaining of ankle swelling and headache for the past 2 days. She denies any abdominal pain or visual disturbances. On examination you note a fundal height of 35 cm, a fetal heart rate of 140 beats/min, 2+ lower extremity edema, and a blood pressure of 144/92 mm Hg. A urine dipstick shows 1+ proteinuria. A cervical examination reveals 2 cm dilation, 90% effacement, –1 station, and vertex presentation.
This patient most likely has preeclampsia, which is defined as an elevated blood pressure and proteinuria after 20 weeks gestation. The patient needs further evaluation, including a 24-hour urine for quantitative measurement of protein, blood pressure monitoring, and laboratory evaluation that includes hemoglobin, hematocrit, a platelet count, and serum levels of transaminase, creatinine, albumin, LDH, and uric acid. A peripheral smear and coagulation profiles also may be obtained. Antepartum fetal testing, such as a nonstress test to assess fetal well-being, would also be appropriate.
Patient has acute asthma attck with wheezing.
You give a beta 2 agonist (-buterol) but
After two hours he continues to experience wheezing and shortness of breath
What do you give him now?
an oral steroid
—the LABAs have a very long onset of action
Which anti-asthmatic is used from prophylaxis?
Cromyln sodium
Urge Incontinence
when you don’t make it to the bathroom in time
Overflow incontinence
when the bladder cannot empty normally and becomes overdistended
- -seen in elderly in Nursing homes due to medications
- -DM does not affect bladder muscle sensation
After you it has been ruled out that you do not have a PE, what is the next diagnostic test?
D-dimer
Risk of Long QT Syndrome (esp w. sudden death in family and syncopal episodes)
Get a resting EKG
Pneumthorax
small one (
Osteoporosis v Osteopenia
Osteoporosis is FRAGILITY or a low impact fracture or as a spine or hip BMD 2.5 standard deviations below the mean of a young healthy woman.
A T-score
After suffering a stroke your BP is very high (200/110). What do you do?
nothing because it is the body’s way of perfusing the brain
Patient with HTN and DM. What do you give them?
ACE but if they develop cough, switch to ARB. No difference in effectiveness
In iron deficiency anemia, will Ferritin be high or low?
low. the only marker that will be high is the TIBC
Hypercalcemic crisis treatment
volume replacement and hydration
What are the Criteria for Diagnosing Strep Throat?
Centor Criteria- Tonsillar exudates tender anterior cervical lymphadenopathy absence of cough history of fever
Muscle Relaxants - never give Soma
Methyl…
Muscle strength
0 - no muscle contraction
1- musc contraction but no movement
2- musc contraction + movement with gravity neutralized
3-movement against gravity
4-movement against gravity plus resistance
5-normal strength
Mulivitamins Elderly- are they recommded or not
Not recommended by AAFP
Side effect of CCBs (Amlodipine etc)?
because they cause vasodilation they cause edema,
also hypotension, cough, nausea, dizziness
How do you treat sever hyponatremia causing serious complications (seizures and confusion)?
Hypertonic saline (3%)- can use Furosemide concomitantly
72 y.o. male presenting in a-fib. He has a history of HTN. What is the first thing to do?
ventricular rate control with a CCB or beta-blocker and Warfarin for anticoagulation. All three.
Which insulin is peakless?
Glargine
Which hypoglycemic for pregnant women?
insulin
Which insulins can be given IV?
Regular and Lisprip
How do Sulfonylureas work?
block K+ channels to cause insulin release
Examples of Oral sulfonylureas?
Glipizide, Glyburide
Which function do you have to watch with OSUs?
Liver and Kidney –> side effect: hypoglycemia (shaky, sweaty), weight gain, allergies (sulfa drugs)
Metformin (Glucophage)
is euglycemic (does not cause hypoglycemia)
- increases tissue sensitivity to insulin (by binding to PPARs) and decreases liver glugoneogenesis
- side effect: Lactic acidosis and GI distress
- does not cause weight gain
Glitazones (Pioglitazone, Rosiglitazone)
increases peripheral tissue sensitivity
-side effects: weight gain and edema
GLP-1 is an incretin that acts on beta cells to increase insulin production. What are some examples?
1) Exanatide
- -side effect: hypoglycemia (esp if used with OSU)
2) Sitagliptin (Genuvia)
- -inhibits DPP-4 which inhibits the destroyer of incretins (GLP1)
Systolic heart failure needs
ACE and BB
- do not use Verapamil because of neg inotropic effects
- -> if they are still short of breath after walking one mile then you can add direct-acting vasodilator (Hydralazine, Isobarbide)
Treatment for non-bullous impetigo?
Topical Mupirocin (Bactroban)
Best antidepressant for kids/adolescents?
Prozac - Fluoxetine
autoimmune hair loss (alopecia), what do you give?
Intralesional Triamcinolone
community acquired pneumonia in a young adult?
treat with Azithromycin because it will cover Mycoplasma pneumoniae
Which fluoroquinolone covers atypicals (Mycoplasma)
Levofloxacin
Treatment of Toenail infection?
Terbinafine (Lamisil) for 12 weeks - taken orally every day
Antipsychotics that cause weight gain?
- pines (Olanzapine and Clozapine)
- –Ariprazole (Abilify) will not
Ottawa Ankle Rules stipulate that you do an XRay when
- Person cannot take four steps immediately after injury or when being evaluated
- has localized tenderness over the navicular bone or
local tenderness over the base of the 5th metatarsal - local tenderness along the edge of either maleolus
What do you give for nursing home acquired pneumonia?
Levofloxacin
Ginko Biloba and Aspirin, are they a good combo?
no- there is an increased risk of intracerebral hemorrhage
Treatment of Traveler’s diarrhea?
Bismuth subsalicylate, Loperamide
antidepressant that preserves sexual function?
Buproprion
Patellofemoral Stress Syndrome
- presents w. knee pain upon climbing stairs w. -tenderness over the medial retinaculum
- also known as Runner’s knee
- Treatment is Physical TherapyI
Inducers of CYP enzymes in liver
PHENYTOIN
Syncope with Exercise is manifested by
organic heart disease- aortic stenosis
Obesity in children should be measured by BMI
for age and gender
55 y.o with Angina should be given Aspirin plus?
Clopidogrel (Plaix)
-DO NOT GIVE ACE within first 24 hours
Pre-natal care: when should you get an ultrasound?
It is not routinely recommended- it is only for special concerns: gestational age, size/date discreprecencies, vaginal bleeding, multiple gestations and other high risk situations.
What labs are done at first prenatal visit?
CBC- Hb-no anemia
HBsAg
HIV
Syphillis screening with RPR
Urinalysis
Urine culture
Rubella antibody- live attenuated virus in the postpartum period
Blood typing and Rh status
Pap smear and cervical swab for GC and Chlamydia
-Folic acid given
-GBS culture (35-37 wk) - if positive give Penicillin
Trisomy screening, what tests are done during weeks 10 and 13?
First trimester screening for nuchal translucency (NT) via ultrasound or combined test of NT and serum markers hCG and PAPP-A testing between 10 and 13 weeks
Trisomy screening, what tests are done during weeks 16 and 18?
Second trimester triple (AFP, hCG, ESTRIOL) or quadruple (triple screen plus inhibin A) but these can be performed between 15 and 20 weeks if necessary
When do you do the Gestational Diabetes screening?
wk 26-28 (second trimester)
If you have allergies and mild persistent asthma, what kind of inhaler do you get?
oral Monteleukast (leukotrient modiefier)
Which is the best antihistamine for allergic rhinitis if you operate heavy machinery?
fEXOFENADINE - second generation, less ssedating
Smoking Cessation - Non nicotine meds
Buproprion and Varenicline (Chantix)
Nictotine ones are gum, patch, inhaler, nasal spray and lozenge
Buproprion
blocks NE and DA
- contraindicated in people with eating disorders or those on MAOIs in the last 2 weeks or people with seizures
- side effects: insomnia and dry mouth
- can be used in combos with other
- It is safe in pregnancy
Verenacline nicotine receptor partial agonist that may reduce cravings. What should it not be used in?
It causes neuropsychiatric symptoms- behavioral changes, agitation, depression, suicidal behaviors. Not for anyone with a psych history
Side effects of Verenacline?
trouble sleeping, vivid or strange dreams
nausea
GAPS Recommendation (Guidelines for Adolescent Preventive Services) for young adults ages 11-21
occurs annually; should include at least three complete physicals (for early, middle and late adolescence)
- counseling about sexual activity, injury protection, diet, exercise
- adolescents should be screened annually for HTN (THOSE ABOVE 90TH %ile for age will be treated
- should be screened for smoking tobacco and other substances)
- lipid screening for those above average risk or family history; same for TB (working in health care, lived in homeless shelter etc)
- Not recommended colonoscopy and toxicology
- screen for GC/Chlamydia if symptomatic and promiscous sexual behavior by nucleic acid amplification
- cervical cancer screening at she 21 (or younger in those having sex or immunocompromised.
- annual screening for depression
- vaccines- Tdap, Hep B, MMR, Varicella-if never had chicken pox (if never immunized), Hep A to travelers, Meningococcal vaccine, Gardasil- starting at age 11/12
- preparticipation physical can include all of these things but also check for HOCM, eating disorders, Marfans screening
When is HOCM heard the loudest?
best heard at the left sternal border and is louder with activities that decrease cardiac preload ad EDV in the left ventricle.
- standing, straining with Valsalva maneuver
- squatting will decrease the murmur
- use ECHO to diagnose HOCM
When do you refer an adolescent to cardiology before clearing for athletic participation?
- stigmata of Marfan’s
- murmur suggestive of HOCM
- grade 3/6 systolic murmur
- any diastolic murmur
Wheny ou have a pt w Stage 1 HTN and obesity, what else should you check?
Blood glucose
Serum potassium, Creatinine, Calcium, HCT
-get an EKG for CAD and LVH
-get them on DASH diet, increase physical activity and reduce weight
If pt has DM and HTN, what is the antihypertensive med to give? What if they have CAD?
ACE inhibitor. ARB, Diuretic, CCB, Beta Blocker
