Random Topics

Question 1

If a patient has erythema, induration, tenderness over a visible vein, what might be occuring?

Answer 1

Superficial Thrombophlebitis

++Check for DVT, occurs in 23% of patients at same time

Question 2

If a patient has unilateral lower leg swelling and pain, with visible redness on the outside with tenderness, what should be first step in management?

Answer 2

Duplex Ultrasound of the Leg – looking for DVT

Question 3

What are the most common differential diagnoses of leg pain and swelling?

Answer 3

Superficial Thrombophlebitis
Chronic Venous Insufficiency
CHF
DVT
Postphlebitic Syndrome
Lymphedema
Other reasons -- Cellulitis/Dermatitis, Traumatic

Question 4

What are the red flag symptoms in a patient who has suspected DVT?

Answer 4

• SOB / Tachypnea
• Chest Pain
• Syncope
• Hypotension
• Fever
• Hypoxia

Question 5

What elements have the greatest positive predictive value of DVT?

Answer 5

• Recent Surgery
• Immobilization for more than 3 days in 4 weeks
• Venous Dilation
• Swelling / Temperature Difference

Question 6

What can a D-dimer test add to evaluation of DVT?

Answer 6

Negative Predictive Value

– if positive, doesn’t mean there is a DVT/PE, but if negative means good indication there is none.

Question 7

What is the best plan of evaluation for a patient suspected of a PE?

Answer 7

Helical Computed Tomography

Question 8

If you have 2x risk factors for DVT according to Well’s criteria, what is your risk?

Answer 8

Moderate – 17% chance

Low = Zero Risk Factors, High = 2+

Question 9

If a patient is considered moderate risk for DVT and has a negative ultrasound performed, abnormal D-dimer, what is next in management?

Answer 9

Repeat US in 1 week, or do contrast venograph study

Question 10

If a patient is started treatment for DVT, what is the management?

Answer 10

Heparin x 5 days

- Start Warfarin at the same time

Question 11

What is the best way to treat Obstructive Sleep Apnea?

Answer 11

• Losing weight
• avoiding alcohol and sedatives
• avoiding supine sleep
• CPAP at Night

Question 12

What are red flag symptoms for sleep disorders?

Answer 12

• Depressed Mood
• Substance Abuse
• Falling asleep during activites
• Lower extremity edema
• Polyuria
• Orthopnea

Question 13

What are good questions to ask a patient screening them for sleep disorder?

Answer 13

• How long it takes to fall asleep?
• Do they nap?
• What is happening when they wake up at night?
• Noise present?
• Medications?

Question 14

What are key parts of an exam that are important in evaluation for sleep disorder?

Answer 14

• Blood Pressure
• Body Mass Index
• CV - Resp Exam
• Iron Deficiency (conjunctivae and nail bed)

Question 15

What is the first step in management of a patient with insomnia not easily explained?

Answer 15

Check for TSH and CBC (for Anemia)

• Most effective is Sleep Diary
• Sleep specialist if suspect OSA

Question 16

For chronic insomnia over 4 weeks, what does the evidence suggest is the best management?

Answer 16

Cognitive behavioral therapy – A

Exercise – B

Question 17

What are recommendations for the best sleep hygiene?

Answer 17

• Avoid Caffeine/Exercise before bed
• Avoid large meals in evening
• Avoid naps
• Regular sleep schedule each day
• Dark Bedroom
• Relaxation time before bed each night.

Question 18

If a patient has significant daytime sleepiness, but is not obese or have any history of snoring, tests negative for OSA, what should be evaluated next?

Answer 18

Sleep Latency Testing – looking for Narcolepsy

If Narcolepsy – Modafinil (stimulant for daytime)

Question 19

What is the single best question to screen for alcohol abuse?

Answer 19

How many times in the past year have you had more than 5 drinks in a day or 4 for women?

• Anything above 0, indicates positive
• Then do CAGE questioning

Question 20

What are the CAGE questions for alcohol screening?

Answer 20

• • Tried to CUT down your use?
• • Annoyed by others criticizing you?
• • Felt GUILTY because of alcohol use?
• • Eye opener in the morning?

Question 21

What is the common depression screening tool to use while interviewing?

Answer 21

SIG E CAPS
S -- Sleeping (too little or too much)
I -- interest
G -- Guilt
E -- Energy
C -- Concentration
A -- Appetite
P -- Psychomotor
S -- Suicidal Thoughts

Question 22

What are the best therapies for depression in elderly?

Answer 22

Exercise
Behavioral Cognitive Therapy
SSRI/SNRI

Question 23

Who needs antibiotics for otitis media?

Answer 23

Children under the age of 6 months
Children between 6months-2 years who have been observed first
Children below 2 with bilateral otitis media

Question 24

What is considered orthostatic hypertension?

Answer 24

A drop in systolic blood pressure 20mmHg with change in position
A drop in diastolic blood pressure 10mmHg with change in position

Question 25

What is consistent with vestibular neuritis?

Answer 25

• • Frequently occurs post-URI
• • Non-positional vertigo, nystagmus to that side
• • No hearing loss
• • Normal Neuro exam

Question 26

When do you need neuroimaging for dizziness?

Answer 26

Suspect of central lesion

• history of migraines with new onset vertigo
• nystagmus that changes direction and doesn’t stop wtih focusing

Question 27

If a patient presents with dizziness, tinnitus, and hearing loss in one ear, do you need imaging? What’s diagnosis?

Answer 27

Menieire’s Disease

– No imaging required. clinical diagnosis.