miscellaneous family practice notes Flashcards
Stage hypertension
Pre-hypertension = 1 20–139/80–89
Stage I = 140–159/90–99
Stage II = 160+/100+
Herbal supplements causing hypertension
Arnica Bitter orange ephedra = Ma–huang ginkgo Ginseng guarana licorice senna St. John's wort
Treatment of cocaine-induced hypertension
–Nitroglycerin
–Benzodiazepines
–Calcium channel blockers
–Labetalol (only allowable beta blocker)
do not use beta blockers as this will increase the vasoconstriction of the coronary arteries
initiation of pharmacologic therapy for hypertension
Persons <60 years of age with a systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg
Persons ≥60 years of age with a systolic blood pressure ≥150 mm Hg or a diastolic blood pressure ≥90 mm Hg
Persons ≥18 years of age with chronic kidney disease who have a systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg
Persons ≥18 years of age with diabetes mellitus who have a systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg
treatment for acute exacerbation of multiple sclerosis
steroids
diagnosis of serotonin syndrome
increase serotoninergic activity in Central nervous system –Neuromuscular abnormalities –Mental changes –Agitation –Confusion –Tachycardia –elevated blood pressure –Dry mouth –Usually within 24 hours of starting SSRI
–May have slow horizontal nystagmus
–May have spontaneous clonus
treatment of serotonin syndrome
–diazepam to count patient
–Propanolol for hypertension
–Antidote, if needed is cyproheptadine
–Avoid HALOPERIDOL
positive predictive value
the percentage of patients with a positive test for a disease who actually
have the disease.
negative predictive value
the percentage of patients with a negative test for disease who actually do not have the disease
defined sensitivity of the test
the percentage of people who have a disease who Will get a positive result
define specificity
the percentage of people who do not have the disease and get a negative test result
define Gilbert’s syndrome
=hereditary condition with unconjugated hyperbilirubinemia
–usually normal liver enzymesan asymptomatic
–Bilirubin increases with stress, fasting, and infection
most likely drug involved in breast tenderness and gynecomastia
spironolactone
most common cause of death in rheumatoid arthritis
–coronary artery disease
Also have an increase in ––Thromboembolic events ––Infections ––Lymphoma ––Lung cancer
drug of choice for polynephritis
Cipro
findings in idiopathic thrombocytopenic purpura
thrombocytopenia which is isolated and has no other cause
drug of choice for pertussis
azithromycin
contraindications for ParaGard and or Mirena
–Mirena is preferred for most conditions
–ParaGard is preferred in the presence of severe liver disease, thromboembolic events, or liver cancer
prevalence of migraines
–men = 10% –Women = 20% have them
classification of migraine headaches with aura
International Headache Society Diagnostic Criteria for Migraine Headache With and Without Aura
Migraine without aura
Headache lasts 4 to 72 hours (untreated or unsuccessfully treated)
Headache has at least 2 of the following:
Aggravation by or causing avoidance of routine physical activity (e.g., walking, climbing stairs)
Moderate or severe pain
Pulsating quality
Unilateral location
During headache, at least 1 of the following:
Nausea and/or vomiting
Photophobia and phonophobia
Not attributed to another disorder
History of at least 5 attacks fulfilling above criteria
classification of migraine headaches without aura
Migraine with aura*
Aura consisting of at least 1 of the following, but no motor weakness:
Fully reversible dysphasic speech disturbance
Sensory symptoms that are fully reversible, including positive features (e.g., pins and needles) and/or negative features (e.g., numbness)
Visual symptoms that are fully reversible, including positive features (e.g., flickering lights, spots, lines) and/or negative features (e.g., loss of vision)
At least 2 of the following:
Homonymous visual symptoms and/or unilateral sensory symptoms
At least 1 aura symptom develops gradually over 5 minutes, or different aura symptoms occur in succession over 5 minutes
Each symptom lasts at least 5 minutes, but no longer than 60 minutes
Headache fulfilling criteria for migraine without aura begins during the aura or follows aura within 60 minutes
Not attributed to another disorder
History of at least 2 attacks fulfilling above criteria
episodic vertigo triggered by head motion
episodic proximal positional vertigo
Ménière’s disease
vertigo tinitis unilateral hearing loss last 20 minutes–12 hours Ear fullness
contraindications to MMR vaccine
–allergy to neomycin
–Immunosuppression
–Pregnancy
Lewy body dementia characterized by
–memory deficits
–Reduced alertness
–parkinsonian features
–rigidity
–Resting tremor
–Bradykinesia
–Gait disordertriad of normal pressure hydrocephalus
“wacky, wet, wobbly,”
–personality change
–Urinary incontinence
–Gait disorder
Hashimoto’s disease
–most common cause of hypothyroidism
–May actually start with hyperthyroidism
–anti-thyroglobulin autoantibodies
–anti-thyroid peroxidase
Graves’ disease in pregnancy
= hyperthyroidism
–Treatment with PTU (propylthiouracil)
–use beta blockers initially if thyroid storm
differences between chalazion and hordeolum
chalazion = blocked oil duct
Hordeolum =infected oil duct
Salter-Harris fracture classifications
Salter I =S = slipped epiphysis Salter II =A= above epiphysis Salter III =L =lower than physis Salter IV =T = through physis Salter V =ER =wrecked physis ( compression)
historical features in DKA
5 I's of diabetic neuropathy(history of) –infection –ischemia (cardiac or mesentery) –infarction –Ignorance (poor control) –intoxication
types of diabetic neuropathy
autonomic
–––gastroparesis, orthostasis, constipation
acute mononeuropathy
–––Cranial nerve palsy, foot drop
Distal, symmetrical,
–––Sensory > motor neuropathy
Calcium pyrophosphate deposition disease
=pseudogout
components of the tetralogy of Fallot
–overriding aorta
–Pulmonary stenosis
–Ventricular septal defect
–Right ventricular hypertrophy
aortic stenosis
–older patient –history of hypertension or diabetes –Dyspnea, syncope, chest pain –crescendo–decrescendo murmur –Murmur radiates to carotids –Murmur decreases with Valsalva
positive direct Coombs test indicates?
autoimmune red blood cell lysis
what are Howell-Jolly bodies and what did they indicate
nucleic remnants in erythrocytes that were not filtered out by spleen
–Indicates deficient splenic activity or lack of spleen
diagnoses of hereditary spherocytosis
osmotic fragility test. Spherocytes are already distended and lyse more quickly than normal cells in hypotonic solution
characteristics of preeclampsia
–hypertension
–proteinuria
–20+ weeks of pregnancy
characteristics of eclampsia
history of preeclampsia plus seizures
–Can occur up to 2–4 weeks postpartum
–Treated with magnesium
earliest symptoms of magnesium toxicity
loss of deep tendon reflexes
most common heart valve abnormality
bicuspid valve of the aortic valve
prophylaxis for deer tick bite
doxycycline 200 mg, 1 dose within 72 hours a bite
symptoms of hypoparathyroidism
hypoparathyroidism causes –low vitamin D –Intensity –Seizures –refractory heart failure –Altered mental status –'s stridor
contraindications to statins
–pregnancy
–Breast-feeding
–Unexplained liver disease
–myopathies
symptoms of Pancoast tumor
= tumors on the apex of the lung –arm swelling –Horner's syndrome –Shoulder swelling –Atrophy of arm and hand muscles
Horner syndrome
–myelosis
–ptosis
–Ahydrosis
carcinoid syndrome symptoms
–tachycardia
–facial flushing
–Diarrhea
Caused by endogenous secretion of serotonin and kallikrein
symptoms of marasmus
= protein-energy malnutrition
–Loss of subcutaneous fat –Muscle wasting –Normal hair! –Emaciated –Strong appetite
symptoms of kwashiorkor
=protein deficiency
–poor appetite –Edema –Distended abdomen –Peeling skin –Diarrhea
chalazion symptoms
–blocked meibomian oil gland
–Usually upper lid
–Nontender
–treat with warm compresses
hordeolum symptoms
= stye
–Usually lower lid
–usually bacterial
–Treat with warm compresses
–Usually self drain within a week
Henoch-Schönlein purpura
= acute systemic vasculitis
–primarily affects venules and arterials
–associated with palpable pruritic rash that begins in the lower extremities and extends to the abdomen
–associated with joint pain, abdominal pain and hematuria
monitoring amiodarone therapy
–chest x-ray to look for interstitial pneumonitis
–Hepatic profile
–Renal profile
Kawasaki’s disease
–fever lasting for 4–5 days –Bilateral conjunctivitis –oral mucosal changes(strawberry tongue) –bilateral conjunctival injection –cervical adenopathy –extremity changes with erythema or palm or sole desquamation –child less than 4 years old
developmental dysplasia of hip
–limited hip abduction
–more common in females
–mild laxity self-corrects
–Barlow’s maneuver attempts to dislocated hip
–Ortolani’s maneuver attempts to reduce it
After 6 months
–llimited hip adduction most important sign
–Galeazzi sign = knees flexed, feet on floor, check for knee height discrepancy
–Imaged with ultrasound
–Look for asymmetric skin creases and legs
most common types of bone cancer in children
–osteosarcoma
–Ewing sarcoma
rhabdomyolysis diagnosis
cause = alcohol, drugs, heat, trauma, exercise
–CPK = >5 times upper limit of normal –hemoglobinuria with few RBCs –hyperkalemia –Hyperphosphatemia –hypocalcemia
TX = IV fluids, bicarbonate, EKG
Complications =DIC, ARF, compartment syndrome
chromosomes and Turner’s syndrome
45 XO
EKG changes in various infarctions
Anterior wall ST elevation in leads I, AVL, and V2 to V6.
Inferior wall ST elevation in leads II, III, and AVF.
Lateral wall ST depressions in leads I, AVL, and V5 to V6.
Posterior wall ST depressions and then elevations in V1 to V3
