Panda fam med: 3 Flashcards
Rx that Decrease CV-related Events in:
- Type 2 DM
- Impaired Glucose Tolerance
- Type 2 DM: Metformin
2. Impaired Glucose Tolerance: Acarbose
Nonspecific LBP Management
- Rx
- Lifestyle
- Alternative Medicine
- Rx: Analgesics = NSAID / Tramadol
- Lifestyle: normal activity / rehab
- Alternative medicine: accupuncture
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?
- Order radiouptake scan –> low in Subacute Thyroiditis
- Treat: STEROIDS
Criteria for Home O2 with COPD (3)
- PaO2 55 / Cor Pulmonale
(T/F) Hypothyroid women will need less of their levothyroixine dose in pregnancy.
False, they will need more. Two reasons:
- Extra living creature
- Increase E = increase TBG
3 Statistical Analyses to evaluate Tests
- PPV
- NPV
- LR
Solitary Pulmonary Nodule:
- 4 Features s/o Malignancy
- Features s/o Malignancy
- Absent calcifications
- Irregular Borders
- Size >1.0 cm
- Ground Glass Appearance
2 Components to Generalized Anxiety Disorder Treatment
- CBT
- Rx ~ “Battling Stress Since Birth”
- Buspirone (5HTA)
- SSRI
- SNRI
- BNZ
Estimate Blood Glucose from A1C
6.0 = 120
every +1 A1C = +30 BG (7 = 150, 8 = 180)
High Risk CRC Patients
- Define High Risk (3)
- Outline Screening Guidelines (when to start / frequency)
High Risk:
- 1x 1st Degree Relative with CRC
- 2x 2nd Degree Relatives with CRC
- Relative with Malignant Polyp <60
These patients should get:
- Colonoscopy at 40 OR
- 10 years before age of family history
- SCHEDULE = q5 years
When should the following patients get repeat colonoscopy given initial results at 50 y/o:
- Hyperplastic polyp
- Single low risk adenoma
- ≥3 small (
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 (
Describe Eye Findings in Sudden Loss of Vision
1. Vitreous Hemorrhage
new onset floaters / difficult to visualize fundus / 2nd MCC - diabetic retinopathy
Describe Eye Findings in Sudden Loss of Vision
2. Retinal Detachment
new onset flashes of light / MCC 2/2 vitreous detachment
Describe Eye Findings in Sudden Loss of Vision
3. CRAO
pale optic disk, cherry red fovea, boxcar veins
Describe Eye Findings in Sudden Loss of Vision
4. CRVO
dilated tortutous veins, cotton wool spots, retinal hemorrhage
Describe Eye Findings in Sudden Loss of Vision
5. AMD
b/l progressive loss of CENTRAL vision / first sign is distortion of vertical lines
Describe Eye Findings in Sudden Loss of Vision
6. Choroidal Rupture
2/2 trauma, hemorrhage with crescenting around optic nerve
Describe Eye Findings in Sudden Loss of Vision
7. Amaurosis Fugax
pale retina
(T/F) Radiation exposure is greater with CT Head > CT Chest / Abdomen.
FALSE. Less area being scanned in head, low radiation risk.
Incidentaloma of Adrenal Gland W/U (Draw Algorithm)
> 5cm = Operate
check Functional Status
- <5cm + Non-Functional = q6mo CT Scan
When to do immediate bx on cervical node
- > 3cm
- Supraclavicular location
- Constitutional / B Symptoms
When to use abx for cervical node
- Inflammatory ~ tender / fever / chills
When to obs cervical node for 4-6 wk
if otherwise asymptomatic
- If change = Biopsy or Image
What patients when admitted should get VTE PPx?
ABCDEF Age >40 BMI >30 CHD or Risk Equivalents aDmitted >3 days Estrogen Therapy Fun Stuff (s/p Cath / procedures)
Treatment for Status Epilepticus
Ativan —> Phenytoin / FosP –> Phenobarb / Versed / Propofol
Treatment for Pre-Menopausal Women with Isolated Hirsutism
- OCP
2. Spironolactone
CDiff Management Protocol
- Stop Offending Antibiotic
- PO Flagyl
- Repeat PO Flagyl if Responded
- PO Vanc
- Rifaxamin
- Fecal Transplant
Epididimytis
- Presentation
- Etiology
- Treatment protocol
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
Permissive HTN
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
Retropharyngeal vs. Peritonsillar Abscess
- Age Group for Each
- Key Presentations / Features for Each
- Diagnosis for Each
- Treatment for both
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
Coronary Leads for:
- Anterior
- Inferior
- Lateral
- Anterior = LAD Territory = V1-V6
- Inferior = RCA Territory = II, III and aVF
- Lateral = Circumflex Territory = I, aVL
Description and Management for PP Woman breastfeeding with:
- PP Blues
- PP Depression
- PP Psychosis
- 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
Impetigo: give etiology, presentation and treatment for:
- Bullous
- Non-Bullous
Bullous
- Yellow filled blisters caused by S. Aureus
- Treatment (Covering MRSA) = Bactrim / Clinda
Non-Bullous
- Crusting caused by MSSA vs. GAS
- Treatment = Topical Mupirocen
Normal Hair Cycle
Normal Hair Cycle:
Anagen (Growing) –> Catagen (Follicles shut down) –> Telogen (Shedding)
Telogen Effluvium
- 2/2 stressful event = surgery, pregnancy, stress
- Shifts anagen hairs –> telogen phase = more than normal shedding
Anagen Eflluvium
- 2/2 directly toxic substance = chemotherapy
- Loss of anagen (actively growing) hair
Alopecia Arreata
2/2 AI conditions with loss of round patches of hair
- Treat first with intralesional corticosteroids (Triamcinolone)
- Treat then with topical steroids
Laryngotracheitis
- Bug
- Presentation
- CXR Findings
- Treatment
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
Bronchiolitis
- Bug
- Presentation
- CXR Findings
- Treatment
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
Epiglottitis
- Bug
- Presentation
- CXR Findings
- Treatment
Epiglottis
- Bug = H. Influenza B
- Presentation = Toxic, Drooling, Tripod with Respiratory Distress
- CXR = edematous epiglottis = thumbprint sign
- Treatment: establish airway + ABx (3rd Gen Ceph)
5 Things to Decrease Contrast-Induced Nephropathy
- Use Low Osmolar / iso-osmolar contrast
- Use Lowest volume needed
- Pre-hydrate with isotonic saline
- Pre-hydrate with NaHCO3
- Pre-hydrate with NAC
Which antipsychotic is least likely to cause metabolic syndrome /weight gain?
Which has highest chance of doing so?
Aripiprizole b/c it is a PARTIAL D2 agonist (rather than D2 antagonist)
Olanzapine
Osteoporosis Definitions (2)
- BMD of Hip/Spine <2.5 deviations from mean (Bone Density)
2. Fracture of any bone from low impact @any age (Bone Quality)
U/L Nasal Obstruction
- Overall MCC amongst all ages
- MCC in adults
- MCC in peds
Overall: Common Cold = Mucosal Hypertrophy
Adults: anatomic pathology (deviated septum)
Peds: foreign body
Aseptic Pustule =
Bechet’s disease
Pericarditis
- EKG Findings (4)
- All patients should get…
- Treatment (2)
EKG Findings
- PR Depression with Diffuse ST Elevation
- PR Depression with normal ST
- Inverted T wave
- nl
All patients should get ECHO to evaluate for the effusion that is there almost always
Treatment: NSAID +/- Colchicine
When do advanced directives go into effect?
When persons are UNABLE TO COMMUNICATE CARE (≠as soon as signed; directives can always be changed later by person)
DVT in Pregnancy Management
Initiate LMWH (Warfarin in teratogenic) and continue throughout pregnancy. Initiate LMWH + Coumadin and continue 6 weeks PP.
For onchomycosis, what would you treat with?
SYSTEMIC (have to get in the nail ≠ topical) Terbinafine
MCC Proteinuria in Children?
- Definition
- How to diagnose?
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)
Lead time v.s Length Time Bias
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.
2 Tests to Distinguish between primary HyperPTH and Familial Hypocalciuric Hypercalcemia
- 24 hour Urinary Calcium
- High in HyperPTH b/c spilling Ca
- Low in FHH - U_Ca/U_Cr Ratio
- Same as above
Patient presents with signs/symptoms of AGE / colitis. You test the feces, which is negative for fecal leukocytes. DDx?
- Viral
- Celiac
Both have NO FECAL LEUK
Until what GA can USG be used for estimating GA?
- 13 weeks ~ best estimate?
22 weeks
13: Combo of BPD, AC, FL
Best test for hematuria of unknown etiology?
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
Management of MI 2/2 Cocaine?
BNZ
MCC Hypoglycemia in a previously well-controlled diabetic?
Diabetic renal disease
Triple / Quad Therapy for H. Pylori?
ABCP
- Triple: Amoxicillin (or Flagyl), Clarithryomycin and PPI
- Quad: Amoxicillin (or Flagyl), Bismuth, Clarithryomycin and PPI
Post Partum Urinary Retention
- Definition
- Management
- Definition: ≥150 cc residual up to 6 hours after delivery
- Management: discharge with foley and close f/u
During initial prenatal screen, woman is found HIV+. What other screening test will she need this pregnancy?
Toxoplasmosis Serology
***Only time screening for toxoplasmosis is indicated is in HIV+ pregnant women.
Acrochordons
Skin Tags
Common in diabetics / obesity
Patient has inflammatory skin lesions on tips of fingers after coming back from a prolonged ski trip?
Pernia / Chilblains
Hydrocele Management
Don’t operate until ≥12 months as most will resolve. Only exception is +hernia.
Undescended Testes
- Synonym
- Management
Cryptorchidism
- Same management (surgery at 1 year); this is to prevent infertility / malignant degeneration
Best management for meth dependence?
CBT
