Primary Care Flashcards
Thiazides
Monitor for hyponatremia and hypokalemia
Monitor for uric acid and calcium levels
Caution: acute gout and no uric acid-lowering therapy
ACE inhibitors
Do not use with ARB or direct renin inhibitor
Monitor for hyperkalemia
risk of acute renal failure if severe b/l renal artery stenosis
Cough d/t bradykinin production
AVOID in pregnancy
ARB
Do not use with ACE inhibitors or direct renin inhibitors
Monitor for hyperkalemia
Risk of ARF if severe bilateral renal artery stenosis
AVOID in pregnancy
Calcium channel blockers
Associated with dose-related pedal edema (F>M)
Ethambutol
Optic neuritis
Isoniazid
Peripheral neuropathy due to B6 depletion
Increased LFTs
Pyrazinimide
Hyperuricemia, hepatotoxicity, and joint pain.
Monitor with uric acid and liver function tests.
Rifampin
Orange bodily secretions, hepatitis, flu-like symptoms and poor clotting.
Monitor liver function tests and complete blood counts.
Myeloma
Cancerous plasma cells lead to excess monoclonal antibodies that build-up in kidneys and bone marrow
Lymphoma
Cancer of mature lymphocytes in lymphoid tissue (B-cells and T-cells that move through lymphatic system)
Hodgkins and Non-Hodgkins
Acute Leukemia
Cancer of immature progenitor cells (blasts) in the bone marrow. Non-functional. Can be myeloid or lymphoid lines.
Rapid onset with high numbers of WBCs, rapid proliferation and turn over can lead to viscous, sticky blood and clotting.
Chronic Leukemia
Cancer of mature, functional WBCs in the bone marrow from either lymphoid or myeloid lineage.
Slow, indolent onset
Myeloproliferative disease
Cancer involving bone marrow cells that produce RBCs, platelets or fibroblasts.
Myelodysplasia
Pre-cancerous disease of bone marrow where the dysplastic cells may cause abnormal or inadequate blood cell production.
Can progress to acute leukemia.
Most common in elderly.
Bone marrow tries to compensate by increasing hematopoeisis.
Hodgkin’s Lymphoma
Usually starts in cervical lymph nodes - painless cervical lymphadenopathy
Contagious spread b/t lymph nodes in one local area
Rarely extranodal - local
Reed Sternberg (owl eye cells)
Pruritus
Young adults 15-34 age (but has bimodal distribution with >50)
Better prognosis
Associated with EBV/mono
Radiation + chemo
Non-Hodgkin’s Lymphoma
Adenopathy and extranodal - distant spread No contagious spread Hepatosplenomegaly, Leukemic phase Mid-50s Worse prognosis Chemo
Lupus
ANA, anti-dsDNA, anti-smith, anti-histones
Txt: NSAIDs, steroids, immunosuppressants, hydroxychloroquine
Drug-induced lupus
Hydralazine Isoniazid Procainamide Phenytoin Sulfonamides False-positive test for syphilis
Erythema multiforme
Target lesions on face, trunk, palms and soles
Usually d/t infxn: herpes simplex most common viral cause, mycoplasma, lupus, hepatitis, lymphoma
Can also be caused by sulfas, PCN, barbiturates, phenytoin
Stevens-Johnson S/o
Prodrome of fever, flu sx.
Mucocutaneous lesions
cutaneous lesions on face and thorax coalesce into painful erythema
Bullae, vesicles, Nikolsky sign
Palms and soles usually spared
Caused by: sulfas, phenobarbital,carbamazepine, lamotrigine, allopurinol, NSAIDs, mycoplasma pneumoniae
Rheumatoid Arthritis
Patient will be a woman 40 - 50-years-old
Complaining of morning stiffness lasting > 30 minutes
PE will show symmetrical soft, red, tender, swelling in joints -MCP, PIP. Bilateral ulnar deviation at MCP, boutonniere deformity, and swan-neck deformity
Labs will show positive RF, anti-cyclic citrullinated peptide antibodies
Most commonly caused by autoimmune destruction of synovial joints
Treatment is DMARDs. Monitor CBC for bone marrow suppression
Multiple sclerosis
Patient will be a Caucasian female
Complaining of pain with eye movement, monocular vision loss, sensory abnormalities
PE will show spinal electric shock sensation with neck flexion (Lhermitte phenomenon)
CSF will show ↑ IgG protein, WBC pleocytosis
Diagnosis is made by T2-weighted MRI
Most commonly caused by a demyelinating disorder
Treatment is symptomatic, methylprednisolone, interferon beta-1a
Comments: Bilateral internuclear ophthalmoplegia is pathognomonic
Vitamin D deficiency may be a risk factor for MS
Absence seizures
Patient will be a child 5 - 10-years-old
Complaining of sudden mental status alteration without motor activity, blank stare
EEG would show symmetric 3-Hz spike and wave activity
Treatment is ethosuximide
Comments: no aura or postictal state
Hypercalcemia
Patient will be complaining of bone pain (Bones), kidney stones (Stones), abdominal pain (Groans), lethargy, psychosis (Psychiatric overtones)
ECG will show shortened QT interval
Most commonly caused by:
Malignancy (most common inpatient cause)
Primary hyperparathyroidism (most common outpatient cause)
Treatment is IV fluids
