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Fam med > Panda fam med: 3 > Flashcards

Panda fam med: 3 Flashcards

1
Q

Rx that Decrease CV-related Events in:

  1. Type 2 DM
  2. Impaired Glucose Tolerance
A
  1. Type 2 DM: Metformin

2. Impaired Glucose Tolerance: Acarbose

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2
Q

Nonspecific LBP Management

  • Rx
  • Lifestyle
  • Alternative Medicine
A
  • Rx: Analgesics = NSAID / Tramadol
  • Lifestyle: normal activity / rehab
  • Alternative medicine: accupuncture
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3
Q

Patient p/w signs and symptoms of hyperthyroidism. He has a painful thyroid gland. TFTs are consistent with hyperthyroid state. You suspect subacute thyroiditis:

  • How to confirm vs. grave’s or functioning nodule?
  • How to treat?
A
  • Order radiouptake scan –> low in Subacute Thyroiditis

- Treat: STEROIDS

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4
Q

Criteria for Home O2 with COPD (3)

A
  1. PaO2 55 / Cor Pulmonale
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5
Q

(T/F) Hypothyroid women will need less of their levothyroixine dose in pregnancy.

A

False, they will need more. Two reasons:

  1. Extra living creature
  2. Increase E = increase TBG
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6
Q

3 Statistical Analyses to evaluate Tests

A
  1. PPV
  2. NPV
  3. LR
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7
Q

Solitary Pulmonary Nodule:

- 4 Features s/o Malignancy

A
  1. Features s/o Malignancy
    - Absent calcifications
    - Irregular Borders
    - Size >1.0 cm
    - Ground Glass Appearance
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8
Q

2 Components to Generalized Anxiety Disorder Treatment

A
  1. CBT
  2. Rx ~ “Battling Stress Since Birth”
    - Buspirone (5HTA)
    - SSRI
    - SNRI
    - BNZ
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9
Q

Estimate Blood Glucose from A1C

A

6.0 = 120

every +1 A1C = +30 BG (7 = 150, 8 = 180)

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10
Q

High Risk CRC Patients

  • Define High Risk (3)
  • Outline Screening Guidelines (when to start / frequency)
A

High Risk:

  1. 1x 1st Degree Relative with CRC
  2. 2x 2nd Degree Relatives with CRC
  3. Relative with Malignant Polyp <60

These patients should get:

  1. Colonoscopy at 40 OR
  2. 10 years before age of family history
  3. SCHEDULE = q5 years
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11
Q

When should the following patients get repeat colonoscopy given initial results at 50 y/o:

  • Hyperplastic polyp
  • Single low risk adenoma
  • ≥3 small (
A

When should the following patients get repeat colonoscopy given initial results at 50 y/o:

  • Hyperplastic polyp: q10 (non-malignant)
  • Single low risk adenoma: q5-10 yr
  • ≥3 small (
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12
Q

Describe Eye Findings in Sudden Loss of Vision

1. Vitreous Hemorrhage

A

new onset floaters / difficult to visualize fundus / 2nd MCC - diabetic retinopathy

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13
Q

Describe Eye Findings in Sudden Loss of Vision

2. Retinal Detachment

A

new onset flashes of light / MCC 2/2 vitreous detachment

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14
Q

Describe Eye Findings in Sudden Loss of Vision

3. CRAO

A

pale optic disk, cherry red fovea, boxcar veins

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15
Q

Describe Eye Findings in Sudden Loss of Vision

4. CRVO

A

dilated tortutous veins, cotton wool spots, retinal hemorrhage

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16
Q

Describe Eye Findings in Sudden Loss of Vision

5. AMD

A

b/l progressive loss of CENTRAL vision / first sign is distortion of vertical lines

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17
Q

Describe Eye Findings in Sudden Loss of Vision

6. Choroidal Rupture

A

2/2 trauma, hemorrhage with crescenting around optic nerve

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18
Q

Describe Eye Findings in Sudden Loss of Vision

7. Amaurosis Fugax

A

pale retina

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19
Q

(T/F) Radiation exposure is greater with CT Head > CT Chest / Abdomen.

A

FALSE. Less area being scanned in head, low radiation risk.

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20
Q

Incidentaloma of Adrenal Gland W/U (Draw Algorithm)

A

> 5cm = Operate
check Functional Status
- <5cm + Non-Functional = q6mo CT Scan

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21
Q

When to do immediate bx on cervical node

A
  • > 3cm
  • Supraclavicular location
  • Constitutional / B Symptoms
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22
Q

When to use abx for cervical node

A
  • Inflammatory ~ tender / fever / chills
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23
Q

When to obs cervical node for 4-6 wk

A

if otherwise asymptomatic

- If change = Biopsy or Image

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24
Q

What patients when admitted should get VTE PPx?

A 
ABCDEF
Age >40
BMI >30
CHD or Risk Equivalents
aDmitted >3 days
Estrogen Therapy
Fun Stuff (s/p Cath / procedures)
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25
Q

Treatment for Status Epilepticus

A

Ativan —> Phenytoin / FosP –> Phenobarb / Versed / Propofol

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26
Q

Treatment for Pre-Menopausal Women with Isolated Hirsutism

A
  1. OCP

2. Spironolactone

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27
Q

CDiff Management Protocol

A
  1. Stop Offending Antibiotic
  2. PO Flagyl
  3. Repeat PO Flagyl if Responded
  4. PO Vanc
  5. Rifaxamin
  6. Fecal Transplant
28
Q

Epididimytis

  • Presentation
  • Etiology
  • Treatment protocol
A

Presentation:

  • Dysuria / urinary frequency
  • U/L Testicular pain that gets better with elevation (Prehn’s Sign)

Etiology / Treatment

  • 15-35: MC Bugs = GC/CT so Treat with Ceftriaxone/Doxy
  • 35: MC Bugs = GNR so Treat with Broad Quinolones
29
Q

Permissive HTN

A

Allow HTN s/p stroke unless BP >220/120.

***Note, if going to give tPA, lower to 185/110

***Don’t confuse with cutoff for HTN urgency / emergency = 180/120

30
Q

Retropharyngeal vs. Peritonsillar Abscess

  • Age Group for Each
  • Key Presentations / Features for Each
  • Diagnosis for Each
  • Treatment for both
A

Retropharyngeal

  • Age Group: kids (2-4)
  • Presentation: drooling
  • Diagnosis: LATERAL NECK FILMS with bulging posterior pharynx
  • Treatment: ABx + ID

Peritonsillar

  • Age: teens (commonly 2/2 GAS throat)
  • Key Features: TRISMUS
  • Diagnosis: CT NECK
  • Treatment: ABx + ID
31
Q

Coronary Leads for:

  1. Anterior
  2. Inferior
  3. Lateral
A
  1. Anterior = LAD Territory = V1-V6
  2. Inferior = RCA Territory = II, III and aVF
  3. Lateral = Circumflex Territory = I, aVL
32
Q

Description and Management for PP Woman breastfeeding with:

  • PP Blues
  • PP Depression
  • PP Psychosis
A
  • PP Blues: crying, feeling down but PREDOMINANT feeling is JOY. Resolves ≤2 weeks. Management = Reassurance.
  • PP Depression: SIGECAPS after ≥2 weeks postpartum. Management = SERTRALINE (breast feeding mom). Close f/u.
  • PP Psychosis: hospitalization
33
Q

Impetigo: give etiology, presentation and treatment for:

  • Bullous
  • Non-Bullous
A

Bullous

  • Yellow filled blisters caused by S. Aureus
  • Treatment (Covering MRSA) = Bactrim / Clinda

Non-Bullous

  • Crusting caused by MSSA vs. GAS
  • Treatment = Topical Mupirocen
34
Q

Normal Hair Cycle

A

Normal Hair Cycle:

Anagen (Growing) –> Catagen (Follicles shut down) –> Telogen (Shedding)

35
Q

Telogen Effluvium

A
  • 2/2 stressful event = surgery, pregnancy, stress

- Shifts anagen hairs –> telogen phase = more than normal shedding

36
Q

Anagen Eflluvium

A
  • 2/2 directly toxic substance = chemotherapy

- Loss of anagen (actively growing) hair

37
Q

Alopecia Arreata

A

2/2 AI conditions with loss of round patches of hair

  • Treat first with intralesional corticosteroids (Triamcinolone)
  • Treat then with topical steroids
38
Q

Laryngotracheitis

  • Bug
  • Presentation
  • CXR Findings
  • Treatment
A

Laryngotrachieitis = Croup

  • Bug = Virus (Parinfluenza)
  • Presentation = Barking Cough / Respiratory Distress
  • CXR: frontal xray showing subglottic tracheal stenosis = “Steeply Sign”
  • Treatment = 1x dose STEROIDS +/- Racemic Epi if retractions/stridor
39
Q

Bronchiolitis

  • Bug
  • Presentation
  • CXR Findings
  • Treatment
A

Bronchiolitis = RSV

  • Bug = Virus (RSV)
  • Presentation = Fever / Respiratory Distress
  • CXR: hyperinflation
  • Treatment = SUPPORTIVE (SaO2 >90) –> Bronchodilators / O2 (SaO2 <90)
  • Rx: +/- Ribivarin for active disease / Plivizumab for PPx in premies
40
Q

Epiglottitis

  • Bug
  • Presentation
  • CXR Findings
  • Treatment
A

Epiglottis

  • Bug = H. Influenza B
  • Presentation = Toxic, Drooling, Tripod with Respiratory Distress
  • CXR = edematous epiglottis = thumbprint sign
  • Treatment: establish airway + ABx (3rd Gen Ceph)
41
Q

5 Things to Decrease Contrast-Induced Nephropathy

A
  1. Use Low Osmolar / iso-osmolar contrast
  2. Use Lowest volume needed
  3. Pre-hydrate with isotonic saline
  4. Pre-hydrate with NaHCO3
  5. Pre-hydrate with NAC
42
Q

Which antipsychotic is least likely to cause metabolic syndrome /weight gain?

Which has highest chance of doing so?

A

Aripiprizole b/c it is a PARTIAL D2 agonist (rather than D2 antagonist)

Olanzapine

43
Q

Osteoporosis Definitions (2)

A
  1. BMD of Hip/Spine <2.5 deviations from mean (Bone Density)

2. Fracture of any bone from low impact @any age (Bone Quality)

44
Q

U/L Nasal Obstruction

  • Overall MCC amongst all ages
  • MCC in adults
  • MCC in peds
A

Overall: Common Cold = Mucosal Hypertrophy
Adults: anatomic pathology (deviated septum)
Peds: foreign body

45
Q

Aseptic Pustule =

A

Bechet’s disease

46
Q

Pericarditis

  • EKG Findings (4)
  • All patients should get…
  • Treatment (2)
A

EKG Findings

  1. PR Depression with Diffuse ST Elevation
  2. PR Depression with normal ST
  3. Inverted T wave
  4. nl

All patients should get ECHO to evaluate for the effusion that is there almost always

Treatment: NSAID +/- Colchicine

47
Q

When do advanced directives go into effect?

A

When persons are UNABLE TO COMMUNICATE CARE (≠as soon as signed; directives can always be changed later by person)

48
Q

DVT in Pregnancy Management

A

Initiate LMWH (Warfarin in teratogenic) and continue throughout pregnancy. Initiate LMWH + Coumadin and continue 6 weeks PP.

49
Q

For onchomycosis, what would you treat with?

A

SYSTEMIC (have to get in the nail ≠ topical) Terbinafine

50
Q

MCC Proteinuria in Children?

  • Definition
  • How to diagnose?
A

Orthostatic Proteinuria
- Defined: >2+ proteinuria with nl creatine clearance

  • Diagnose = Repeat in 2 weeks –> Split Urine Protein Test
    1. Collect UProtein_ AM (high b/c supine all night)
    2. Collect UProtein_PM (low b/c standing all day)
51
Q

Lead time v.s Length Time Bias

A

Lead Time Bias: earlier detection of disease increases disease prevalence and gives impression that prolongs life, although atual mortality is unchanged.

Length Time Bias: slow-growing / smoldering diseases are more likely to be picked up compared to fast-growing / diseases of rapid onset. For example: slow growing CRC is more likely to get picked up by a SCREENING colonoscopy compared to a fast growing CRC tumor that brings a patient in b/c of diarrhea / bleeding per rectum.

52
Q

2 Tests to Distinguish between primary HyperPTH and Familial Hypocalciuric Hypercalcemia

A
  1. 24 hour Urinary Calcium
    - High in HyperPTH b/c spilling Ca
    - Low in FHH
  2. U_Ca/U_Cr Ratio
    - Same as above
53
Q

Patient presents with signs/symptoms of AGE / colitis. You test the feces, which is negative for fecal leukocytes. DDx?

A
  1. Viral
  2. Celiac

Both have NO FECAL LEUK

54
Q

Until what GA can USG be used for estimating GA?

- 13 weeks ~ best estimate?

A

22 weeks

13: Combo of BPD, AC, FL

55
Q

Best test for hematuria of unknown etiology?

A

Repeat UA

Image Upper Urinary Tract: CT Urography (≥≥≥ IVP)

Evaluate Lower Urinary Tract: Cystoscopy / Cytology

***Need to get the CT to rule out RCC, get the urography component to visualize the urinary tract

56
Q

Management of MI 2/2 Cocaine?

A

BNZ

57
Q

MCC Hypoglycemia in a previously well-controlled diabetic?

A

Diabetic renal disease

58
Q

Triple / Quad Therapy for H. Pylori?

A

ABCP

  • Triple: Amoxicillin (or Flagyl), Clarithryomycin and PPI
  • Quad: Amoxicillin (or Flagyl), Bismuth, Clarithryomycin and PPI
59
Q

Post Partum Urinary Retention

  • Definition
  • Management
A
  • Definition: ≥150 cc residual up to 6 hours after delivery

- Management: discharge with foley and close f/u

60
Q

During initial prenatal screen, woman is found HIV+. What other screening test will she need this pregnancy?

A

Toxoplasmosis Serology

***Only time screening for toxoplasmosis is indicated is in HIV+ pregnant women.

61
Q

Acrochordons

A

Skin Tags

Common in diabetics / obesity

62
Q

Patient has inflammatory skin lesions on tips of fingers after coming back from a prolonged ski trip?

A

Pernia / Chilblains

63
Q

Hydrocele Management

A

Don’t operate until ≥12 months as most will resolve. Only exception is +hernia.

64
Q

Undescended Testes

  • Synonym
  • Management
A

Cryptorchidism

- Same management (surgery at 1 year); this is to prevent infertility / malignant degeneration

65
Q

Best management for meth dependence?

A

CBT

Fam med (5 decks)

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