Primary Care I (Disease & Diagnosis)

Question 1

Addison’s Disease

Answer 1

Symptoms:

• Can cause diffuse hyperpigmentation
• Generalized fatigue and weakness
• Poor appetite
• Amennorhea
• Loss of axillary hair in women
• N/V, diarrhea

Question 2

Group A beta-hemolytic streptococcal infection (GABHS) pharyngitis

(Accounts for 15-30% of sore throats in children and 5-15% in adults annually in U.S.)

Answer 2

• More common in late winter and early spring.
• Strongest independent predictors of GABHS
  1. patient age 5-15 years
  2. Absence of cough
  3. Tender anterior cervical adenopathy
  4. Tonsillitis exudates
  5. Fever

Other indicators:

6. Acute onset
7. Intensely inflamed tonsils

DIAGNOSIS:

-A rapid antigen detection test should be ordered in patients with a modified Centor or FeverPAIN SCORE OF 2 or 3.

FIRST LINE TREATMENT:

• 10 day course of penicillin or amoxicillin.
• If patient is allergic to penicillin, treat with first-generation cephalosporin, clindamycin, or macrolide antibiotics.
• NSAIDS are more effective than acetaminophen and placebo for treatment of fever and pain associated with GABHS pharyngitis.
• Medicare’s throat lozenges q. 2h are also effective.
• Corticosteroids provide only a small reduction in duration of symptoms and should not be used routinely.
• Incubation period is 24-72 hours.

*

Differential Dx:
-Infectious mononucleosis

• Hand, Foot, Mouth Disease (more common in summer) (more common in children <5 years)
• Herpangina (more common in summer) (more common in children <5 years)

Question 3

Three Names used to describe the new onset of cardiac ischemia chest pain at rest but without evidence of acute myocardial infarction.

Answer 3

1. Unstable angina
2. Preinfarct angina
3. Crescendo angina

Question 4

CWS

Answer 4

Chest Wall Syndrome

-The main cause of chest pain in primary-care practice.

Question 5

Pseudohypertension

Answer 5

A phenomenon where severe vessel rigidity of the brachial artery prevents the BP cuff from completely compressing the artery, resulting in a falsely elevated BP reading (may increase it by 30 mm Hg or more. By itself does not present a disease state.

Question 6

Dyslipidemia

Answer 6

(AKA Hyperlipidemia)

General term for elevated concentrations of any or all of the different types of lipids in the plasma.

A major risk factor for CVD.

Total cholesterol:
Desirable <200

Triglycerides:
Normal <150

HDL:
Low<40
High (optimal:cardioprotective) >60

Question 7

Gastroenteritis

Answer 7

Inflammation of the stomach and intestine. May manifest with any of the following:

1. Anorexia
2. Nausea/vomiting
3. Diarrhea