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Fam med > Panda fam med: 1 > Flashcards

Panda fam med: 1 Flashcards

1
Q

Two Type 2 diabetic treatments allowed in children?

A
  1. Insulin

2. Metformin

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2
Q

What beta blocker is best in CHF treatment?

A

Carveidolol (Comet Trial)

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3
Q

What are max doses of Lasix / ACE-I?

A
  • Lasix = 80 mg

- ACE-I = 40 mg

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4
Q

If CHF patient is symptomatic on max doses of all meds, next step?

A

Biventricular Pacing

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5
Q

3 Beta Blockers for CHF Patients

A

Metoprolol (b1 specific)
Bisoprolol (b1 specific)
Carveidolol (nonspecific with alpha antagonist properties)

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6
Q

Omega 3 Fatty Acids

  • Mechanism of Protection
  • Long Term Benefits (3)
  • Use in high risk patients, esp allergic to ____
A
  • Mechanism: increase eicosonoid production = decrease platelets/increase vasodilation
  • 3 Longterm Benefits: decrease stroke, non-fatal MI and arrhythmias
  • Good for people allergic to fish
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7
Q

Management for Descending Aortic Dissection:

  • Rx (2)
  • When to Operate?
A

Rx:

  1. Beta Blocker IV
  2. Nitroprusside: always give BB first b/c this will cause reflex SNS activity which will increase LV output and shear stress on aorta

Operate:

  • If ascending component
  • If major branches are involved
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8
Q

Recommendations for AAA Screening

A

All males between 65-75 who have ever smoked. One time screening is recommended unless pathology is found.

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9
Q

LDL Goal for Diabetics

A

<100

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10
Q

Benign Childhood Murmurs (3)

What components of murmur will NEVER include it in benign murmurs of childhood (3).

A
  1. Still’s Murmur: S = S, still’s best heard when supine; musical
  2. Peripheral Pulmonic Stenosis: systolic murmur radiating to b/l axilla
  3. Venous Hum: 2/2 fluttering open/close of jugular veins; best heard when UPRIGHT (vs. Still’s) and on INSPIRATION (b/c venous)

NON-BENIGN FEATURES

  1. Diastolic
  2. Extra sound
  3. > 2/6 on Levine Scale
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11
Q

Management of Stable Angina (2)

A
  1. Beta Blocker

2. ASA

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12
Q

Indications for thrombolytic therapy in AMI? (2)

A

Both are on EKG

  1. Ensure STEMI
    - ≥1mm elevation in 2x limb leads
    - ≥2 mm elevation in 2x precordial leads
  2. Look for New onset LBBB which is c/w complete occlusion
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13
Q

You suspect secondary HTN in a patient. Knowing one of the MCC, what is the best test to order?

A

AM Aldosterone/Renin Ratio looking for primary hyperaldosteronism. If ratio >20 = Dx!

Note: Renovascular HTN (with RAS is MCC 2/2 HTN)

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14
Q

Plantar Fasciitis (Etiology, Presentation, Treatment)

A
  • Etiology: 2/2 overuse (repetitive micro trauma) = obese/always on feet
  • Presentation: heel pain with “First step phenomenon”, gets better throughout day
  • Treatment: OTC Heel Inserts / Achilles Tendon Stretching / NSAID –> Steroid Shot –> Surgery
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15
Q
  1. Tarsal Tunnel (Etiology, Presentation)
A
  • Etiology: compression of post tibial nerve deep to med malleoulus
  • Presentation: medial foot / plantar paresthesias with pain on tapping tarsal tunnel
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16
Q
  1. Fat Pad Atrophy (Etiology, Presentation)
A
  • Etiology: atrophy of fat pad over heel

- Presentation: pain worsens throughout the day

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17
Q

Best anticoagulation for patient undergoing hip repair who has history of previous post-op DVT?

A

SubQ Lovenox before and after surgery

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18
Q

Recommendations for Patients with HCM (2)

(T/F) HCM Patients have decrease lifespan

A

Recs:

  1. No strenuous activity
  2. Screen all first degree with ECHO

False. Risk of SCD 1-5%

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19
Q

3 CIs to using Beta Blockers in CHF?

A
  1. Bradycardia
  2. Heart Block
  3. Severe Asthma
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20
Q

Pre-Op Cardiac Risk

  • Protocol
  • Classify procedures into High / Int / Low Risk
A
  • Protocol: 12 Lead –> Stress Test if + –> Cath if +
  • Classification
    1. HIGH RISK: anything vascular / emergency
    2. INT RISK: head/neck, thoracic/abdominal, prostate
    3. LOW RISK: Breast, Cataract, Endoscopic
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21
Q

Marelgia Paresthetica

A

Compression of LFCN –> sensory loss of ant/lat thigh without motor deficits

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22
Q

Pt with fatigue, adenopathy and pharyngitis is giving ampicillin / PCN. They develop a morbilliform rash. If this patient is then admitted to the ED with respiratory distress, what is the next best step?

A

Add steroids. Patient has MONO; airway obstruction 2/2 inflammation. Give steroids.

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23
Q

5 Malignancies associated with EBV?

A
  1. Nasopharyngeal Carcinoma
  2. Primary CNS Lymphoma
  3. Burkitt’s
  4. Hodgkins
  5. (HIV) Hairy Leukoplakia
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24
Q

HyperCa of Malignancy

  • 3 Etiologies
  • Management Protocol
A
  • 3 Etiologies: PTHrP&raquo_space;> Mets with Release of Local Factors&raquo_space;> Ectopic PTH Secretion
  • Management:
    1. IVF
    2. +/- Lasix to avoid IVF overload
    3. Calcitonin (Acute management) vs. Bisophosphonate (chronic management)
25
Q

Treatment of Torsades?

A

Mg

26
Q

10 y/o has older sibling who died suddenly in a soccer game. His parents have had recurrent syncopal episodes.

  • What do you suspect?
  • Next best diagnostic step?
  • Management?
A
  • Suspect Long QT Syndrome
  • Diagnostic Step: RESTING (≠Stress EKG) for long QT interval
  • Management: beta blockers and NO competitive sports
27
Q

WPW

  • EKG Findings (3)
  • Treatment
A

EKG Findings in WPW

  • Short PR Interval
  • Narrow QRS
  • Delta wave

Treatment: Procainamide

28
Q

You are considering starting a RA / AI patient on TNF-alpha blocker. What 3 diseases do you screen for?

A
  1. Hep B
  2. Hep C
  3. TB
29
Q

Lab Test to W/U Suspected HCV (3 Components)

A
  1. ELISA for HCV Antibody
    +: Proceed to 2nd Immuno Based Assay (#2 below)
    -: Not infected or very early infection
  2. Immunobased Assay for HCV Antibody
    +: Proceed to test for active / resolved infection (#3 below)
    -: Original ELISA was a false+
  3. HCV RNA PCR
    +: Active Disease
    -: Resolved disease
30
Q

OCD:

  • First Line Treatment (2)
  • Alternative to First Line Rx Treatment
A
  • First Line Treatment
    1. SSRI
    2. Exposure-Response Therapy
  • Alternative
    1. Clomipramine
31
Q

NHAP

  • Why to think about different bugs?
  • Inpatient vs. Outpatient Management
A

NHAP: increase colonization of oropharynx with GNR

Management
1. Inpatient: Cover MRSA (Vanc/Linezolid) and 2x Anti-Psuedomonal (Resp Fluoroquinolone and Cephalosporin)

  1. Outpatient: Resp Fluoroquinolone
32
Q

Standard Management of Osteoporosis (3 components)

A
  • Lifestyle Change (no smoking, exercise)
  • Supplements: 800 VitD + 1200 Ca
  • Rx: Bisphosphanate (≠Calcitonin b/c this is more acute management) –> Teriparatide
33
Q

Rx that Decrease Hip Fractures (3)

A

All Bisphosophnate: Alendronate, risedronate, zolendronate

34
Q

Rx for Post-menopausal women with Osteoporosis and FMH of Breast Cancer

A

Raloxifine: agonist in bone / antagonist in breast

35
Q

Rx for Men with Osteoporosis (2)

A
  • Alendronate

- Teriparatide

36
Q

Rx for osteoporosis in Patients on Chronic Steroids

A
  • Supplements (VitD + Ca) and Bisphosphonate
37
Q

Rx that increase risk for osteoporosis (5)

A
  • Steroids
  • Heparin
  • Phenytoin (or any CYP - increase Vit D metabolism)
  • Thyroid replacement
  • Cyclosporin
38
Q

Influenza

  • Microbiology Name
  • Management
A

Orthomyxovirus A/B

Management
48 + Hospitalizations = NA-inhibitors

> 48 and NO Hospitalization = no treatment

39
Q

ASA PPx Men vs. Female

A

Men: 45-79 where risk of MI > GI Bleed
Women: 55-79 where risk of Ischemic CVA > GI Bleed

40
Q

Benign NB Rash (4)

A
  1. Erythema Toxicum: ERYTHEMA surrounding macules/papules/pustules. +Eosinophils on smear
  2. Acne Neonatorum: macules/papules/pustules without surrounding erythema on face.
  3. Staph Pyoderma: vesicular rash with g+cocci in clusters
  4. Milia: pearly keratin plugs without surrounding erythema
41
Q

Patient has symptomatic MVP.

  • What are the symptoms?
  • Treatment?
A 
Symptoms = palpitations
Treatment = Beta Blockers
42
Q

Subclinical Hypothyroidism

  • Clinical Features
  • Labs
  • Risks (vs. Subclinical Hyperthyroidism)
A
  • Clinical Features: ASYMPTOMATIC (thus “Subclinical”)
  • Labs: HIGH TSH (hypothyroid) but NORMAL FT4 (thus Asx)
  • Risk: increase LDL / cholesterol

Don’t confuse with subclinical hyperthyroidism = associated with increase sCHF / arrhythmia / decrease bone density

43
Q

Lithium ADE

What other common Rx causes increase Li levels?

A 
LMNOPP
Lithium...
Movement Disorder (Tremors)
Neph DI
hypOthyroidism
Pregnancy (Ebstein)
High PTH = High Ca

NSAIDs; recall Li is cleared in the kidneys, so anything that simulates AKI or increase resorption (dehydration) will cause increase Li levels.

44
Q

CI to Breast Feeding (7)

4 Common Misconceptions of CI to Breast Feeding

A

CI:

  1. Active HIV
  2. Active HSV over breast
  3. Active TB (≠TB Rx)
  4. Radioactive Iodine
  5. PO Antifunglas/Antimalarials/Antiparasitics
  6. Lithium
  7. Chemotherapeutics

Not CI:

  1. HepB/C
  2. CMV
  3. Warfarin
  4. Active Mastitis
45
Q

3 MC Fish Toxicities

A
  1. Scombroid: eating poorly stored fish where bacterial infection converts histidine –> histamine = anaphylaxis
  2. Ciguatera: eating reef fish; manage symptoms
  3. Shellfish: eating shellfish; manage symptoms
46
Q

POTS vs. Orthostatic Hypotension

  • Criteria
  • Underlying pathophysiology for both
A

POTS
- +30BPM or HR >120 within 10 minutes

Orthostatic Hypotension
- Drop in SBP by 20 or DBP by 10 with increase in HR by 20

Paph

  • Loss of baroreceptor responsiveness
  • Loss of myocardial contractility
47
Q

JNC 7 Guidlines for Post-CVA HTN Rx

A

ACE-I + HCTZ

48
Q

6 Features of Solitary Thyroid Nodule s/o Malignancy

A
  1. H/o Neck Radiation (Papillary)
  2. > 4.0 cm
  3. Fixed / Firm
  4. Signs of Spread (Adenopathy, Dysphagia, Hoarseness)
  5. Male Gender
  6. Non-functioning
49
Q

Approach to Incidentaloma In Thyroid

A

If:

  1. <1.0 cm
  2. Asymptomatic
  3. Normal TFTs

F/u with Serial USG q6-12 months

50
Q

(T/F) In growth issues in hypothyroidism, bone age = chronologic age.

A

False, bone age < chronologic age.

51
Q

4 Indications for PT-ectomy in HyperPTH

A

SCAB

  • Stones
  • Serum Ca >1.0 mg/dL above normal
  • Age <50
  • Decrease Bone density
52
Q

Presbycusis

  • What type of hearing loss?
  • What frequency is affected?
  • Consonants vs. Vowels
A 
Sensorineural
High frequency (=consonants)
53
Q

Known Cirrhotic p/w new onset fevers and diffuse abdominal pain.

  • Next Best Step
  • What will confirm the diagnosis?
  • MC Bugs (3)?
  • Best treatment
A

Diagnostic Paracentesis for SBP

Findings on Paracentesis confirming diagnosis:

  • PMN >250
  • +Fluid Culture
  • MC BUg = EColi > Kelb > Strep Pneumo
  • Best Treatment = Cefotaxime
54
Q

At prenatal visit mother is found to be HBsAg+. What actions should be taken to decrease transmission to baby?

A

At the TIME OF BIRTH, baby should receive:

  1. HBIg
  2. HBV Vaccine (normally occurs anyway)
55
Q

What 4 bugs survive in chlorinated water?

A

Entamoeba Histolytica
Giardia
Cryptosporidium
HAV

56
Q

4 Groups of Patients needing screening for HCV?

A
  1. IVDU (needles)
  2. Accidental needle stick
  3. Transfusions <1987
  4. Persistent Elevations in LFT***
57
Q

IBS

  • Diagnostic Criteria (3)
  • Supplement that helps
  • Most consistent finding
A

Rome Criteria

  • Abdominal Pain / Distention (abd pain = MC finding)
  • Change in consistency / frequency of stool
  • Relief with defecation

Supplement that Helps: Daily Peppermint Oil

58
Q

In ___(3 diseases)__ correct anemia to ______(value)____.

A

CHD, CKD and EPO Replacement Patients = 3 Disease
Anemia Correction: 10-12

*Patients who were corrected all the way did worse from CV-related events

Fam med (5 decks)

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