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Family Med > OME > Flashcards

OME Flashcards

1
Q

Dx insomnia w/what criteria?

A

Difficulty falling asleep or waking up too early w/out ability to fall back asleep

3 nights/wk for 3 months

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2
Q

What is the basic treatment for HF?

A

Restrict fluids to < 2 L/day

Restrict salt < 2 g/day

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3
Q

What is the BEST test to Dx heart failure?

What else can you use?

A

Left Heart CATH

BNP, 2D echo (looking at EF)

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4
Q

What defines stage II HTN?

A

> 160 / 100

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5
Q

Acne pt w/severe pustular or nodulocystic disease treat how?

If SEVERE inflammatory or resistant?

A

PO Abx (Doxy, Eryth)

Isoretinoin —> do a UPT

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6
Q

COPD exacerbation w/out signs of infection treat with what?

Can check what level?
How will it look?

A

Doxycycline

Procalcitonin level
Decreased if viral

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7
Q

What diseases automatically are indications for statin therapy?

A

Vascular diseases:

Stroke
CAD
PVD
Carotid stenosis

StarCraft on your PC

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8
Q

Define bronchitis

A

Productive cough for > 3 months in 2 consecutive years

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9
Q

When do you give tPA for ACS?

Door to balloon should be no longer than how long?

A

Facility is more than 60 minutes away

90 minutes

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10
Q

UC flares are treated how?

A

steroids

Abx - Cipro and metronidazole

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11
Q

Quetiapine is useful to treat what?

SEs?

A

2nd line for Bipolar

QTC prolongation, weight gain

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12
Q

Salicylate toxicity causes what sx early in the disease? What acid base status?

Late in the disease?

A

Tinnitus, vertigo, hyperventilation —> respiratory alkalosis

Hyperpyrexia —> AG metabolic acidosis

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13
Q

What signs and symptoms will a chronic bronchitis pt have?

A

JVD, edema, HSM —> Right Heart Failure

INC pulm vascular resistance
Clubbing and edema

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14
Q

If a stress test is positive on a pt, what is the next step?

What kind of pharm stress testing can pts go through?

A

Elective CATH

Adenosine and dobutamine

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15
Q

What are TCAs indicated for?

A

Enuresis

1st line for neuropathic pain

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16
Q

What are the somatic complaints in GAD?

A 
Restlessness
Irritability
Fatigue 
Muscle tension
Trouble [ ]
Sleep changes
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17
Q

What are the stages of sleep and their wave types?

A 
BATS Drink Blood
Beta - awake
Alpha - Drowsy
Theta - N1
Spindles - N2
Delta - N3
Beta - REM
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18
Q

Acute anxiety is treated how?

Chronic?

A

CBT, BENZOs

SSRI

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19
Q

What are the Kubler-Ross states of death and dying?

A 
DABAD
Denial 
Bargaining 
Anger
Acceptance
Depression
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20
Q

Mild persistent asthma:

Daytime sx?

Nocturnal sx?

FEV1?

Tx?

A

< 1 /day

> 2 /month

> 80%

SABA + Low dose ICS

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21
Q

Workup of a pt w/fever and cough w/suspected PNA?

A

CXR and SpO2

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22
Q

Pt experiencing yawning, lacrimation, N/V, and hurts everywhere with sweating is experiencing what?

A

Opiate withdrawal

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23
Q

What is acute dystonia?

Treated how?

A

Involuntary m. Contraction - torticollis, oculogyric crisis, etc

Benzotropine or diphenhydramine

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24
Q

A PCWP < 12 means what in the heart?

How do you find out this info?

A

Noncardiogenic origin

Right Heart CATH

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25
Q

How is grief defined?

Duration is how long?

A

Normal rxn that does NOT impair normal functioning and improves SPONTANEOUSLY

< 12 months

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26
Q

Intermittent asthma:

Daytime sx?

Nocturnal sx?

FEV1?

Tx?

A

= 2 / wk

= 2 /month

> 80%

Rescue inhaler aka SABA

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27
Q

Defensive injury against downward blow called what?

What breaks? What dislocates?

A

Galeazzi Fracture

Radius breaks, ulna dislocates

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28
Q

CKD pts get what BP medication to start?

A

ACEI or ARB

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29
Q

What is emphysema?

A

Destruction of alveolar walls at the terminal bronchiole that cause air trapping

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30
Q

When does baby blues occur?

With which baby?

Treatment?

A

1

Within 2 weeks

None

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31
Q

Presents pt w/COPD that wants to stop smoking, what do they need to know?

What is the best prognostic indicator?

A

Start 8 weeks before surgery bc congestion initially worsens

FEV1/FVC ratio

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32
Q

If pt has methanol or ethylene glycol poisoning, what can be given to inhibit conversion of toxic metabolites?

A

Fomepizole

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33
Q

What toxic substances do not cause an anion gap but do cause an osmolar gap?

Treatment?

A

Ethanol, isopropyl alcohol

Supportive

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34
Q

When does a COPD pt need at home O2?

A

pO2 < 55 on ABG
Or
SpO2 < 88%

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35
Q

What does COPD produce pathologically?

A

Airway inflammation and irreversible bronchoconstriction

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36
Q

When evaluating the heart with an Echo, what are you looking for during stress?

A

Dyskinesia (will be absent on rest)

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37
Q

What is HTN urgency?

Emergency?

A

BP > 180 or > 110 w/out evidence of end organ damage

> 180 or > 110 WITH end organ damage

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38
Q

What is rumination disorder?

Occurs in whom?

A

Regurgitation of food for at least 1 month

Infants or those w/developmental disorder

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39
Q

Pt w/HTN, tachy, dilated pupils is on what drug?

A

Cocaine

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40
Q

Refeeding syndrome causes what electrolyte abnormalities?

A

Low PO4
Low K+
Low Mg2+

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41
Q

Prior to starting Lithium for bipolar, what labs do you need?

A

Cr and TSH

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42
Q

Secretory diarrhea has what kind of Osmotic gap?

Blood or mucous in stool?

Nocturnal sx?

Change w/NPO?

Fecal fat?

A

Normal

No

YES

NO

Normal

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43
Q

What are the 2 methods of treating for specific phobias?

A

Systemic desensitization - takes longer, BEST to

Flooding - time-sensitive need

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44
Q

What contradicts non-cardiac surgery?

A

EF < 35% (75% chance of MI while IN surgery)

MI w/in 6 months (40% mortality at 3 months)

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45
Q

What are the 1st gen antipsychotics in order of strongest to weakest?

A

Haloperidol
Fluphenazine

Thioridazine
Chlorpromazine

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46
Q

What are the most prominent signs of heart failure?

A

S3

Laterally displaced PMI

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47
Q

MC cause of PNA in a COPD/Smoker?

Post viral?

Immunosuppressed?

A

H influ

Staph aureus

Legionella

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48
Q

How do you treat Impetigo?

If bullous or NO response?

Can lead to what if untreated?

A

Topical mupirocin

Clindamycin

PSGN

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49
Q

Defensive injury against upward black called what?

What breaks and what dislocates?

A

Monteggia fracture - MU

Ulna breaks, radius dislocates

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50
Q

COPD pt w/purulent sputum and/or increased production needs what?

Use what?

A

Abx

Amoxicillin, Bactrim, Azithro, Doxy

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51
Q

Osmolar gap < 50 in pt w/diarrhea means what?

> 100?

Formula is what?

A

Secretory

Osmotic

290 - 2(Na + K)

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52
Q

what is acute stress disorder?

A

Traumatic even LESS than 4 weeks from event

Pt will have anhedonia, hyper-vigilance, avoidance, flashbacks

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53
Q

What labs should you get baselines of when starting a statin?

A

Lipids, A1c, CK, LFTs

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54
Q

What causes erysipelas?

Describe it:

Treat how?

Symptoms?

A

Strep pyogenes

Dark red, well-demarcated, indurated lesion in ADULTS!!!

Beta-Lactams (Amoxicillin)

Acute onset fever and chills

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55
Q

How long do cardiac enzymes take to peak?

When can they be considered negative?

A

18 hours

2 sets separated by 6 hours NEG or 18 hours passes

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56
Q

1st Gen antipsychotics antagonize which receptor?

Treat what symptoms?

Cause what symptoms?

A

D2C

+ sx - hallucinations, delusions, disorganized thought

EPS - akathisia, acute dystonia, dyskinesia

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57
Q

GAD diagnosis criteria?

Treatment?

A

Anxiety most days > 6 months AND have > 3 somatic sx

Psychotherapy
- adjunct w/SSRI, buspirone

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58
Q

What is mild substance abuse disorder?

Mod?

Severe?

A

2-3

4-5

6+

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59
Q

What are atypical GERD sx?

A

Hoarseness, cough, NOCTURNAL ASTHMA

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60
Q

What is the 1st step in treating a heart attack w/ST changes in leads II, III, and aVF?

Why?

A

IVF

Bc right-sided infarcts are preload dependent

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61
Q

What is the 4th gen cephalosporin?

Used to cover what?

A

Cefepime

Pseudomonas

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62
Q

When does post-partum depression occur?

Which baby?
Feels how about the baby?

Treatment?

A

With 1 month

> # 1Doesn’t care about it, may hurt it

SSRI

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63
Q

Acetaminophen OD causes what?

Treatment?

A

Liver injury

NAC

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64
Q

Pt w/LDL 70-189 and what else are indications for statins?

A

Age 40-75 and DM

Age 40-75 and Calculated RFs

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65
Q

Hospital Acquired PNA MC bugs?

Treatment?

A

Pseduomonas, MRSA

Vanc + Pip/Tazo

66
Q

Nitrates should be avoided with what kind of chest pain presentation?

A

Right-sided infarcts —> Leads II, III, aVF

67
Q

HTN is defined how?

Dx how?

A

Greater than 140 or 90

2 separate BP taken at 2 separate office visits

68
Q

Treatment for Barrett’s?

Dysplasia?

Adenocarcinoma?

A

High dose PPI

Ablation

Surgical resection

69
Q

What causes central sleep apnea?

Path?

Treatment?

A

Opiates, COPD, idiopathic

Lost intrinsic drive to breath

BiPAP

70
Q

SE’s of TCAs?

A

Widen QRS
Cause seizures
Coma or AMS

71
Q

What are the 4 major categories of substance abuse disorder?

A

Controlling use
Social impairment
Risk taking
Physical/pharm changes

72
Q

Tender prostate in the setting of a UTI is what?

Treat how?

A

Acute prostatitis

Bactrim or FQ

73
Q

Ant dislocation of the shoulder, what is the position of the arm?

What can be damaged?

Dx how?

A

ABducted and ER
“Shaking hands”

Axillary nerve

Xray

74
Q

What defines Pre HTN?

A

Syst < 140

Dia < 90

75
Q

Sx of CO poisoning?

Hg Saturation is what?

Treatment?

A

HA, N/V, delirium

Normal, get a carboxyHg level

100% FiO2 and hyperbaric

76
Q

Major complaint of pt w/OSA is what?

Diagnose how?

Long term consequences lead to what?

A

Daytime somnolence

15 OSA/hour or 5 apneas/hour AND Snoring/breathing pauses w/daytime somnolence

Pulm HTN -> RHF

77
Q

What are the components of the Child-Pugh score for surgery?

Any single marker + means what?

A 
Ascites
Albumin
Bilirubin
Encephalopathy
INR/PT

Mortality of 30-40%

78
Q

Pt with suspected fracture of ankle and is ambulatory?

Nonambulatory?

A

Do Not Image

Xray

79
Q

What is the 1st FQ? Treats what kind of bacteria? What condition?

A

Cipro
Gram (-)’s
UTI

80
Q

Pt in a manic episode gets what med?

Made of what?

A

B52

Benadryl
Ativan
Haloperidol

81
Q

What are the typical (intestinal) sx of GERD?

A

Retrosternal burning chest pain worse w/spicy foods and recumbency, better w/sitting up, antacids and cold water

82
Q

1st step in ACS no matter what?

A

ASA PO

Then troponin levels

83
Q

What are the 3 components of typical chest pain?

A

Substernal
Worse w/exertion
Better with nitroglycerin

84
Q

Bulimia Nervosa severity categorized by what?

What is mild?
Mod?
Severe?
Extreme?

A

The PURGE

1-3 per week
4-7
8-13
> 13

85
Q

Elderly pt FOOSH injury is what?

A

Colles’ fracture

86
Q

What are the severe signs of anorexia nervosa?

Defined how?

Tx?

A

Bradycardia, leukopenia, HoTN

Fear of getting fat despite being underweight AND lack of recognition

CBT

87
Q

What does SIGECAPS stand for?

A 
Sleep - insomnia 
Interest - anhedonia 
Guilt - feeling worthless
Energy - DEC
Concentration - loss of it
Appetite - loss of weight
Psychomotor - slow thoughts, movements 
Suicidal Ideations
88
Q

Pt that is pregnant and has major depression what is the best treatment?

A

ECT

89
Q

Anti-endomysial ABs means what?

What answer never to pick in chronic diarrhea question?

A

Celiac disease

Stool Cx

90
Q

Pt that is having flashbacks and hallucinations is experiencing what?

A

LSD

91
Q

Biopsy of UC colon shows what?

When does colonoscopy screening begin? Continues when?

A

Crypt abscesses and superficial inflammation

8 yrs from diagnosis and continues annually

92
Q

What is amnesic-confabulatory syndrome?

A

Retro and anterograde amnesia, confabulation after lots of drinking

93
Q

How do you treat type A dissections?

Type B?

A

Surgery - replace aortic valve

Medically w/IV Labetalol or BBlocker

94
Q

What defines stage 1 HTN?

A

> 140 / 90

95
Q

What are the 5 stages in order of substance abuse?

A 
Pre-contemplative
Contemplative
Preparation
Action
Maintenance
96
Q

What is the Dx workup for dissection?

A

1 - R/O CAD w/EKG and Troponin

2 - XRay shows widened mediastinum

3 - CT Angio shows false lumen

4 - if renal dz do MRI/TEE

97
Q

When on a statin, when should you assess lipids?

CK and LFTs?

A

Annually

Only when symptomatic

98
Q

Acute asthma exacerbation what is the treatment?

Examine what?

A

O2
Duonebs
Corticosteroids

PEak flow, PE, ABG

99
Q

To be considered HCA PNA must be what exposure?

A

Healthcare facility w/90 days
Acquire PNA w/in 48 hours of admission
Be on a ventilator

100
Q

What are the 2 main theories behind anti-depressant therapy and what do they say?

A

Monoamine hypothesis - not enough nt’s so you sad (No serotonin or NE)

Plasticity concept - happy neurons tend to become easier to stimulate

101
Q

Pt with LDL above what gets a statin?

A

190

102
Q

Cyanide poisoning symptoms?

1st line tx?
2nd? Caution why?

A

Coma, seizure, HoTN, Heart Block, cherry red skin/blood

Thiosulfate
Amyl nitrate —> worsens CO poisoning

103
Q

What are the types of demand ischemia in the heart?

A

Stable and unstable angina

NSTEMI

104
Q

Pts w/CAD should be on what meds?

A 
MONA BASH
Morphine
Oxygen
Nitrates
ASA

BBlocker
ACEI
Statin
Heparin

105
Q

When do you go to surgery for AAA?

When do you screen q6mo? Q1yr?

When do you do surgery regardless of size?

A

> 5.5 cm OR growin .5 cm/6mo

> 4.5cm, > 3.5cm

Pain or tenderness of the aneurysm or BACK PAIN

106
Q

Treatment for mild UC is what?

A

5-ASA or Mesalamine

107
Q

When is AICD placed in HF patient?

What class must they be?

A

EF < 35%

III

108
Q

ABG of COPD pt will show what?

CBC shows what?

A

Hypoxic hypercapnic respiratory acidosis

Erythrocytosis

109
Q

How can the EKG look of a COPD pt?

A

RVH - for pulmonale or Right Axis Deviation

110
Q

If no improvement in Peak Flow of asthma pt after 3 hours of continuous nebs, what happens next?

A

ICU

111
Q

Pt has fever, cough w/Negative CXR, Dx?

Tx?

A

Bronchitis

Azithromycin, then Doxycycline

112
Q

If no alarm sx with GERD, what is next step?

Best Dx test?

Pt that has GERD sx w/alarm symptoms needs what?

A

Treat w/PPI for 6 weeks

24-hour pH monitoring

EGD w/biopsy

113
Q

What is the treatment for a CHF exacerbation?

A 
LMNOP
Lasix
Morphine
Nitrates
Oxygen
Position (elevate HOB)
114
Q

Trazadone is used as what?

Mirtazapine?

A

Sleep aid

Appetite stimulant

115
Q

MDD diagnosed how?

Treatment?

Must treat for how long?

A

5 SIGECAPS for at least 2 weeks

SSRI/SNRI

4-8 weeks at max dosing

116
Q

Valgus stress means what kind of stress?

What is injured?

Dx how?

A

Lateral stress

MCL

MRI

117
Q

HIV pt w/PCP also has what elevated lab value?

Dx how?

If pt has low PaO2 add what?

A

LDH

Silver stain

steroids

118
Q

How do EtOH and BENZOs work?

Symptoms of withdrawal?

Treatment?

A

Stimulate GABA

Over-excitation —> HTN, tachy, tremors, anxiety, dt’s, coma

Long acting BENZO - chlordiazepoxide or diazepam

119
Q

What is Disruptive Mood dysregulation disorder?

A

Kids having at least 3x /wk behavioral outbursts

Evident before age 10

120
Q

What are the pathologies of diastolic HF?

A

MAIN Cause: HTN

Restrictive/Hypertrophic cardiomyopathy
Pericardial tamponade or constrictive pericarditis

121
Q

How long is avg REM latency?

Shorter or longer in narcolepsy?

Depression?

A

40 minutes

Shorter

Shorter

122
Q

What is the 3rd FQ? Treats what kind of bacteria? What condition?

A

Moxifloxacin
G(+) and G(-)’s
PNA

123
Q

Bipolar diagnosed how?

A

3 symptoms + Elevated mood (mania) for at least 1 week

124
Q

What are the symptoms of Right HF?

A

HSM, JVD
Peripheral edema
DOE, Inc JVP

125
Q

How do you screen for AAA?

A

US in men who smoke, over 65 y/o

126
Q

Femoral head fracture requires what?

Intertrochanteric?

Shaft?

Open fracture requires what?

A

Femoral prosthesis

Plates ORIF

Rods

Emergency washout

127
Q

When do nightmares occur?

Memory?

Tone?

A

REM

Yes

No tone

128
Q

How is dysthymia diagnosed?

Treatment?

A

Depressed mood for > 2 years w/out sx for > 2 months at a time

R/o hypothyroid and suicide
Then give SSRI

129
Q

What is the goal BP for someone over age 60?

Everyone else?

A

Below 150/90

Below 140/90

130
Q

How do you treat HTN emergency?

A

IV nitrates or CCBs to get MAP down 25% w/in first 2- 6 hours

131
Q

CURB-65 stands for what?

A

Confusion of new onset
Urea > 7 or BUN > 19
Respirations > 30
BP < 90/60

65 or older

132
Q

Symptoms of opiate withdrawal?

Treatment?

A

Lacrimation, Rhinorrhea, D/N, pain, dysphoria

Clonidine

133
Q

Pt with asthma has FEV1/FVC ratio?

Can be affected how?

If no active disease do what to induce asthma?

A

Decreased

Reversed w/bronchodilators

Methacholine

134
Q

Pt w/toxic ingestion of pills of unknown origin do what?

A

Activated charcoal

NG tube and gastric lavage if it has been less than 1 hour

135
Q

What are the nt’s of sleep?

A 
SAND
Serotonin - Inc Sleep
ACh - Inc Dream
NE - Inc Dream, Dec Wake
Dopamine - Inc Wakes
136
Q

When does post-partum psychosis occur?

Which baby?
Feels how about it?

Treatment?

A

W/in 1 month

> # 1Fears baby, will kill it

Mood stabilizers and antipsychotics

137
Q

What are the signs of Left HF?

A

Orthopnea, crackles, rales
DOE, S3
PND

138
Q

What is the progression for COPD treatment?

A

SABA —> LAMA —> LABAL —> ICS —> PDE4- + steroids

139
Q

Severe Persistent asthma:

Daytime sx?

Nocturnal sx?

FEV1?

Tx?

A

> /= 1 /day

Frequent

< 60%

SABA, High dose ICS + LABA

140
Q

What is the 2nd FQ? Treats what kind of bacteria? What condition?

A

Levofloxacin
Gram (-)’s
Soft tissue infection

141
Q

Post dislocation of the shoulder, what is the position of the arm?

What etiology?

Dx how?

A

ADDucted and IR
“Protected wrist”

Seizure or electricity

Xray

142
Q

When do night terrors occur?

Memory?

Tone?

Treat how?

A

N3

No

Yes

Reassurance or BENZOs (don’t use them)

143
Q

Chronic hypoxia of COPD in alveoli leads to what?

A

INC pulm vascular resistance and Pulm HTN

144
Q

3/3 classic sx for chest pain called what?

2/3?

0-1/3?

A

Typical

Atypical

Non-anginal

145
Q

What meds to use for CAP?

A

Moxi or Ceftraix + Azithro (IV) or Azithro (PO) If ambulatory

146
Q

Urethritis etiology? Big symptom?

Treat with what?

A

STD - discharge

Ceftriaxone + Doxy
OR
Azithro 250 x 1 PO

147
Q

Osmotic diarrhea has what kind of Osmotic gap?

Blood or mucous in stool?

Nocturnal sx?

Change w/NPO?

Fecal fat?

A

Increased

NO

NO

YES

Increased

148
Q

Acne Pt with comedones treat with what?

If inflamed?

If they do NOT respond?

A

Topical retinoids

ADD benzoyl peroxide

ADD topical Abx

149
Q

What consists of a complicated UTI?

Treat for how long?

Treat with what?

A

Penis - male
Plastic - foley
Procedure
Pyelo

7 days treatment

Cipro or IV Ceftriaxone

150
Q

What does bupropion treat?

A

Smoking cessation
Depression
Prevents weight gain

151
Q

Narcolepsy definition?

Diagnose how?

Treat how?

A

Rapidly plunge to REM sleep at least 3 times per week for 3 months

CSF hypocretin-1

Schedule naps, stimulants

152
Q

Best way to treat grief?

A

Psychotherapy

153
Q

Pt with edema, erythema, brown discoloration, and scaling has what?

What MAJOR sign involved?

Treatment?

A

Stasis dermatitis

Venous stasis ulcer at Medial Malleolus

Diuretics if volume overload, Compression stockings and leg elevation

154
Q

What is tinea unguium?

Treat with what?

Diagnose how?

A

Onychomycosis (Nail infxn)

Terbinafine is BEST
Itraconazole is ok

KOH prep

155
Q

Bipolar II is what?

Cyclothymia is what?

A

Hypomania and Major depression

At least 2 years of hypomanic and major depressive episode

156
Q

Valproate treats what?

SEs?

A

1st line Bipolar if cannot use Li

Teratogen
Thrombocytopenia
Agranulocytosis
Pancreatitis

157
Q

What is the best treatment for Acute Panic Disorder attacks?

A

BENZOs > psychotherapy

158
Q

What SE can Beta blockers cause?

A

Bradycardia and syncope

159
Q

Moderate persistent asthma:

Daytime sx?

Nocturnal sx?

FEV1?

Tx?

A

> /= 1/day

> 1 /week

60-80%

SABA, Low dose ICS + LABA

160
Q

What are the pathologies of Systolic HF?

A

Leaky valve
Dead heart - ischemia/infarction
Floppy muscle - EtOH, HTN, Drugs

Family Med (1 decks)

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