Primary Care Flashcards
When is the greatest loss on bone mineral density?
The first 2 years after menopause
Osteoporosis is defined as…?
A T score below -2.5
Etiology of osteoporosis?
Tx with glucocorticosteroids, Vit D deficiency, thyroid replacement therapy, active peptic ulcer disease, abnormal kidney and liver function, malabsorption syndromes and estrogen loss.
What is Cholecystitis?
Inflammation of the gall bladder.
What is Cholelithiasis?
Obstruction of the gall bladder.
Signs and Symptoms of Cholelithiasis and Cholecystitis?
RUQ and epigastric pain radiating to upper back and intolerance of fatty foods. Pain can be intermittent or constant. Jaundice = Cholelithiasis. Abdominal pain and fever = Cholecystitis.
What is the diagnosis of Chole (both)?
Positive Murphy’s Sign: curl fingers under rib cage over liver and ask pt to exhale. Postivie if inspiration is interrupted or whencing is noticed.
Tx for Chole (both)
Drugs may dissolve stones, cholecystectomy may be preferred. For acute disease refer to surgeon.
Non-pharm management of osteoperosis
Midwife will consult. Diet with protein, vit D and Calcium. Weight bearing exercise, i.e. walking 30 min 3xs per wk
Pharm management of Osteoporosis
Fossamax (bisphosphonate) PO q weekly or Boniva q monthly. Reloxifene (SERM). HRT and Vit D - 800IU + 1200mg Calcium. (Thiazide diuretics for HTN may decrease bone loss by reducing urinary excretion or calcium.
MOA of Fossamax (bisphosphate)
Decrease Bone turnover, inhibit resorption, increase formation of bone
MOA of Reloxifine (SERM)
acts like Estrogen on bone and heart, but not on breast and uterus, improves bone, lipid profile by decreasing LDL, but has no effect on HDL
Dx for Type 2 DM
Fasting > or = 126, random or 2hr 75mg glucola challenge 200 or over; HcbA1C >6.5%
S/S Pyleonephritis (UTI)
low grade fever, chills, dysuria, flank pain (CVAT) usually on right side 50%, 25% bilateral.
Tx for acute Pyleonephritis
Bactim 160/800mg PO BID 14 days or Cephlosporin (Keflex) 250-500mg PO QID
Consult with pyleo
Genotype is defined as
Combination of genetic factors in an individual
Prolonged untreated GERD can cause
Barrett’s esophagus
A 40 year old woman comes in for her annual exam. Her BP is 138/85. You recognize this as:
Prehypertension and suggest lifestyle modifications
Patient comes into the office after stepping on a rusty nail. she inquires about the tetanus vaccine. had a full series and received last booster about 9 years ago. You advise her to
Be revaccinated with a booster as this is an unclean wound and her adult booster was more than 5 years ago.
The varicella immunization is only contraindicated in what 2 groups
Pregnancy and HIV infections
Osteopenia is defined as a T-score between
-1.0 and -2.5
Recommended daily calcium intake for women 19-50 years old
1000 mg
A component of the physical exam that suggests metabolic syndrome
waist circumference >40inches in men or >35 inches in women
Most common type of skin cancer in America is
Basal cell carcinoma
Daycare worker comes in with honey crusted lesions on her arm. She said that she gotten some mosquito bites. You recognize these lesions as
Impetigo
19 y/o female, has annular lesions with a raised border on her trunk, mildly pruritic. Skin scraping viewed with KOH under the microscope shows hyphae. What is it
Tinea corporis
An afebrile 25 y/o female returns from a beach holidday with complaints of left ear pain of 24hrs. The pinna is exquisitely tender with traction. The pt has what
Otitis externa
A normal weight is defined as a BMI of
18.5-24
A major goal in the treatment of asthma is to reduce the incidence of
Inflammation
a non-pregnant female with uncomplicated cystitis, preferred length of antibiotic treatment
3 days
Recurrent UTI is defined as how many episodes
at least 3 per year
A 50 yr old overweight female has a blood pressure of 120/90 on routine screening. would you diagnose as HTN
To diagnose HTN she should have 2 BP checks on 2 separate occasions.
52 y/o obese smoker with BP consistantly ranging from 150-160/90-96. What meds would you recommend
Thiazide diuretics
Asthma symptoms that occur more than twice/week with exacerbations that may affect activity classified as
Mild persistant
Headaches that present as severe unilateral, orbital, supraorbital, or temporal pain in nature
Cluster headaches
HGBa1C >= to 6.5% is diagnostic for
Type II DM
The single best test to evaluate for hypothyroidism proceeded by thyroid glad failure
TSH
Fasting glucose of 100-125 or glucose levels of 140-199 at 2 hrs pp indicate what
pre diabetes
RBCs that are hypochromic and microcytic show increased total iron binding capacity and decreased serum iron suggest what
Iron deficiency anemia
LDL > 160 and an associated risk factor for CHD is counseled to begin an appropriate trial fo dietary therapy. When to reevaluate
3 months
An active 25 y/o presents with an 8cm oval shaped area of erythema that blanches with pressure, does not deesdquamate, vesiculate, or have any scale at periphery. They appeared 2 weeks following a camping trip. You suspect
Lyme Disease
Initial and most important step in the managment of GERD is
Lifestyle modification
Form of hepatitis is the only acute from, never results in a chronic disease and lifelong immunity is expected from all patients who recover from it
Hep C
Single most important action you can take with a patient you suspect is the victim of intimate partner violence is what
Help develop a safe exit plan
When a pt presents with persistent diarrhea following 2 courses of abx you should suspect
C. Diff
