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Fam med > Panda fam med: 4 > Flashcards

Panda fam med: 4 Flashcards

1
Q

How to differentiate between Waldenstrom’s and MGUS?

A

Both may have monoclonal expansion of IgM, but only MGUS has Bence Jones Proteinuria

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2
Q

Management of Fight Bite (2)

A
  1. Radiograph (r/o Boxer’s Fracture)

2. ABx with ANY TEAR IN SKIn

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3
Q

MCC Syncope

  • Pathophys
  • Presentation
  • Diagnosis
A

Neurocardiogenic / Vasovagal

  • Pathophys: increase SNS tone —> sudden withdrawal (fear / emotion).
  • Alternative: excess PaNS stimulation (blood rush to head / carotid)
  • Diagnosis: Tilt Table test to recreate hyptension / bradycarda
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4
Q

Only alternative medicine to work for migraines?

A

Biofeedback

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5
Q

Best treatment for nerve gas toxicity (2)

A

nerve gas = sarin = increase AcH Like organophosphates

  1. Atropine
  2. Pralidoxine
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6
Q

Rx for EtOH Dependence (3)

A

Naltrexone, Acamprosate, Disulfram

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7
Q

Autonomic Hyperreflexia

A
  • Common in spinal trauma above T6
  • Lack of SNS inhibition = increase SNS tone
  • P/w HA, HTN, Flushing, Dilated Pupils and Goosebumps
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8
Q

Child of jehovas witness who needs blood?

A
  • Give the blood (emergency situation, parent’s religious belief ≠ child)
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9
Q

Child with treatable ALL with parents refusing chemo?

A

Court order to overturn the parents; this is treatable condition and it parent’s do not understand the disease process

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10
Q

Child with ALL with poor prognosis refusing chemo?

A

Respect parent’s wishes

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11
Q

Which anti-psych Rx causes agranulocytosis?

A

Clozapine

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12
Q

Live Flu Vaccine

  • Who can get it?
  • Who requires 2 doses?
A

Live Flu = Intranasal Flu Vaccine

  • All healthy / non-pregnant persons can get it (before 50, then switch to typical protocol)
  • 2 doses for t ever been vaccinated
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13
Q

MCC of Blindness

  • ≥65
  • <65
  • AA
  • Worldwide
A
  • ≥65: ARMD
  • <65: Diabetes
  • AA: Glaucoma (non-reversible)
  • Worldwide: CT A-C
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14
Q

MCC Galactorrhea in Women of Reproductive Age?

A

OCP (E –> increase Prolactin)

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15
Q

Management of Fibroids:

  • Pregnancy Desired (1)
  • Pregnancy Not Desired (3 Sx / 3 Rx)
A
  • Preg: Myomectomy

- No Preg: TAH, UAE, Endometrial Ablation, OCP, Danazol (Androgen PA) and GnRH Analogue

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16
Q

3 CI to E-containing OCP

A
  1. Smokers >35
  2. H/o DVT / VTE
  3. CHD / CHF
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17
Q

Diaphragm in Sex

  • How long to keep in?
  • When to take out?
A

Keep in 6-24 hours after intercourse, take out after 24 to decrease risk of Toxic Shock

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18
Q

Best test for ectopic pregnancy?

A

hCG Level (1500-2000) @classic 6 week with TVUSG showing nothing inside uterus

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19
Q

4 Protective Things Agst Endometrial Cancer

A
  1. Late Menarche (decrease E)
  2. Early Menopause (same)
  3. OCP - regulate E exposure
  4. Mulliparity - decrease estrogen during the pregnancy
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20
Q

Normal Progressive of Female Puberty

A

Thelarche —> Adrenarche —> Growth Spurt —> Menache

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21
Q

Trich Cervicitis Treatment

  • First time
  • Relapse
A
  • First time: 2g Flagyl in Single PO Dose

- Relapse: 500 mg BID x 7 days

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22
Q

Postterm pregnancy is ≥_____

A

42 weeks

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23
Q

During PNC a patient is found to be CT positive.Next best step?

A

Normally would treat with doxy, but this is CI in pregnancy. Give arithryomycin / amoxicillin. Remember, no doxy in pregnancy or children <8 y/o.

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24
Q

2 CI to Electrosurgical Destruction of a skin lesion

A

Pacemaker

Melanoma

25
Q

Max Tyelnol Dose / Day

A

4000 mg

26
Q

Define:

- Pre-eclampsia (Mild vs. Severe)

A

Pre-E: >20 weeks HTN and Proteinuria (recall edema removed b/c 2+ LE edema is common in pregnancy)

  • HTN: 140/90 is mild, 160/110 is severe
  • Proteinuria: >0.3g/24 hr (mild) –> 5g/24 hr (severe)
27
Q
  • Gestational HTN
A

Gestational HTN: >20 weeks HTN

28
Q

Chronic HTN in Pregnancy

A

Chronic HTN: <20 weeks HTN

29
Q

<20 weeks HTN + Proteinuria

A

GTN

30
Q

Early Decelerations

A

mirror uterine contractions = head compression

31
Q

Variable Decelerations

A

cord compression

32
Q

Late Decelerations

A

2/2 fetal hypoxemia / acidosis (placental problems)

33
Q

SVT Management (3)

A
  1. Vagal Maneuvers
  2. Adenosine
  3. Beta Blockers / CCB
34
Q

HTN Based on Ethnicity

  • Caucasian (2)
  • AA
A

Caucasian = ACE I / Beta Blockers

AA = HCTZ / CCB (as less RAAS dependent)

35
Q

Upper Extremity DVT

  • MCC Inpatient
  • MCC Outpatient
A

Most commonly affects axillo-subclavian system

  • MCC Inpatient = Central Venous Lines
  • MCC Outpatient = structural abnormalities of the thoracic outlet associated with strenuous exercise
36
Q

ECT Therapy

  • Indications
  • Contraindications
  • Patients at high risk for getting complications
A
  • Indications: Severe refractory depression, pregnancy, catatonia, NMS
  • NO CONTRAINDICATIONS (including pregnancy / pacemakers)
  • Patients high risk for complications from ECT = increased ICP / recent hemorrhagic or ischemic CVA
37
Q

Age to Begin Solid Foods

Why (2)

A

4-6 months

Why?

  1. Extrusion Reflex (pushing material out of mouth) exists until 4 months
  2. No benefit from solid food until this age
38
Q

Best SCREENING test for hypogonadism?

Next best test if abnormal screening test?

A

TOTAL Testosterone (≠Free, too expensive)

FSH / LH, to determine if primary / secondary testicular

39
Q

When to operate on AAA?

A

> 5.5 cm

40
Q

Aortic Stenosis
- When to operative in asymptomatic patients?

  • How to tell if older pt with CHD’s symptoms are from CHD or AS?
A
  • NO OPERATIVES FOR ASX PATIENTS = Watchful Waiting; operate only when symptomatic
  • ECHO, findings s/o Surgery for AS
    1. Pressure Gradient >50
    2. Aortic Valve Area <1.0 cm2
41
Q

Definition of COPD

Diagnosis of COPD

A

COPD = Chronic Bronchitis (>3 months of productive cough for 2 years) and Emphysema (dilation of post-terminal bronchiole 2/2 loss of elastase)

Diagnosis of COPD = SPIROMETRY with decrease FEV1&raquo_space;> decrease FVC = low ratio

42
Q

Diagnosis of Peripheral Arterial Disease

  • Clinical Diagnosis vs. Neurogenic Claudication
  • Diagnostic Tests (3)
A
  • Clinical: leg pain worse with walking, relieved by rest. Neurogenic claudication occurs at rest and is often better with walking.
  • Diagnostics
    1. ABI <20 mmHg upon walking / exercise
43
Q

Woman with signs / symptoms of UTI:

  • DDx if Acute Onset
  • DDx if Progressive Onset
  • UA with pyuria but no growth on UCx =
A 
Acute = classic UTI with GNR > S. Saprophyticus
Gradual = STI Urethritis (CT / GC, HSV)

*UA with Pyuria and No growth on UCx = Chlamydia

44
Q

Gait Abnormalities

  • Best Screening Test
  • Interpretation of Findings
A
  • Best Screening Test = Get Up and Go: patient gets up without using arms and walks 3 m and then back
  • Interpretation of Findings
    14 seconds = high fall risk
    >20 seconds = severe gait imbalance
45
Q

“Walking on Ice Gait”

A

Visual Impairment (Cataracts)

46
Q

Short-stepped Shuffling Gait

A

PD

47
Q

Steppage Gait

A

Neuropathy

48
Q

Pregnant woman (or Newborn) is found to be anemic based off of Hb/HCT on CBC. What is the next best step?

A

Trial of Fe. DO NOT order more serum studies / Hb Electrophoresis as 9/10 these are caused by Fe Deficiency Anemia.

49
Q

MCC of Acute Interstitial Nephritis

A

Abx

50
Q

Primary vs. Secondary Hypothyroidism

  • TSH / T4 Levels in Both
  • How to follow Synthroid Dosing in Both
A

Primary

  • HIGH TSH with LOW T4
  • Follow Synthroid dosing with TSH levels

Secondary

  • LOW TSH with LOW T4
  • Can’t use TSH to follow Synthroid b/c of pituitary failure, use T4 levels
51
Q

Patient presents with stones, bones, moans and groans.

  • MCC (specifically!)
  • Next best serum test?
  • Finding on EKG
A

MCC = Parathyroid Adenoma
Next Best Serum Test = PTH
Short QT interval

52
Q

When to order a SPOT U_Protein/Creatinine Ratio

A

Order when +Proteinuria on dipstick without clear etiology. Best would be a 24 hour urine protein, but in KIDS and NON-COMPLIANT adult patients, this is a good estimate.

53
Q

Cervical Radiculopathy

  • Physical Exam Test
  • Work Up
  • Management
A

PE Test = Spurling Maneuver (Rotate + extend head) = worsens radiculopathy pain

Work Up = need C-Spine Imaging

Mgmt: if no pathology on C-Spine Imaging = conservative + NSAID

54
Q

Indications for Trial of CSx without SVD Attempt

A

Fetal Macrosomia (Defined as 4500-5000)
>4500 in Diabetic Mothers
>5000 in Non-Diabetic Mothers

55
Q

Comment on Vacuum Delivery vs. Forceps / SVD

  • Risk of fetal trauma
  • Maternal soft tissue trauma
  • Risk of Shoulder Dystocia
A
  • Increased risk of fetal cephalophematoma / retinal hemorrhage
  • Decrease risk of maternal soft tissue vs. forces
  • Decrease risk of Dystocia vs. SVD
56
Q

Pertussis

  • Microbiology
  • Transmission
  • Pathophysiology
  • Presentation (3 Stages)
  • Common PE findings
  • Common Lab Findings
  • Gold Standard Diagnosis
  • Treatment
A
  • Microbiology: gram- coccobaccilus B. Pertussis
  • Transmission: respiratory droplets
  • Pathophysiology: infects respiratory epithelium
  • Presentation (3 Stages): Catarrhal (URI Sx) —> Paroxysmal (Cough) —> Convalescent
  • Common PE findings: Conjunctival Hemorrhage, UE Petechia and Post-tussive emesis
  • Common Lab Findings: lymphocytosis
  • Gold Standard Diagnosis: Nasopharyngeal swab
  • Treatment: Azithromycin > Erythromycin for patient and family
57
Q

Patellofemoral Pain

  • Epidemiology
  • Presentation (3)
  • Management
A
  • Epidemiology: young female athletes; associated with low core strength
  • Presentation: anterior knee pain worse with CLIMBING / DESCENDING stairs, popping sensation and positive J sign (lateral patellar deviation during extension)
  • Build up surrounding leg muscles
58
Q

Patient presents with locking of the knee. DDx?

A

Loose Body / Meniscal Tear

59
Q

Serum Tumor Markers

  • PSA / PAP
  • CEA
  • AFP
  • HCG
  • CA-125
  • CA-19-9
A

PSA: prostatic hypertrophy / cancer
PAP: definite for prostatic cancer
CEA: sensitive for COLON, ESOPHAGEAL and LIVER
HCG: Hydaditiform Mole, Choriocarcinoma, GTND
CA-125: Ovarian
CA-19-9: Pancreas

Fam med (5 decks)

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