Screening and Preventive Medicine Flashcards
Breast Cancer screening
Mammography starting at age 50 q2years
Lung cancer screening
Age >55 with a >30 pack year history and quitting <15 years ago
Test: Low dose CT scan q1y
Quit at 80 years old or when they have quit smoking >15 years ago
AAA screening
Men >65 and who have EVER smoked
Test: Abdominal US
Calcium oxalate crystals in gout
Seen in end stage renal disease Pts
Acute PolyArticular arthritis
Suspect underlying endocarditis or disseminated Gonococcal infxn
Prenatal labs
CBC
HBsAg
Hiv testing
Rpr
Urinalysis
Urine cx
Rubella antibody
Type and screen
Pap smear
Cervical Swab for chlamydia and gonorrhea e
Asymptomatic bacteruria risks in pregnant ladies
Preterm labor
Acute pyelonephritis
Low birth weight
6 month shots
DtAP
Hep b
Hib
Pneumococcal
Rotavirus
Influenza
Six month milestones
Six strangers switch sitting at 6 months
Drug used to treat public speaking phobias
BBs
Panic attack treatment
Control= SSRIs
Abortive=Benzos
MDD symptoms
Sleep Interest Guilt Energy Concentration Appetite Pyschomotor Suicidal thoughts
Need 5/8
Post partum psychosis tx
Antipsychotics
Diagnostic criteria for diabetes
Fasting blood glucose of >126
HbA1C >6.5
Plasma glucose of 200mg/dl or greater 2 hours after a 75g glucose challenge
Random plasma glucose of 200 or greater with hyperglycemic symptoms
Antihypertensive to use in black people
Thiazides OR amlodipine
Guidelines for starting statins
- Anyone under the age of 75 with atherosclerotic CV disease
- LDL >190
- Anyone older than 40 w/ a 10-year CVD risk of >7.5%
- Diabetics with an LDL of greater than 70
Thyroid nodule workup
TSH
Ultrasound
Biopsy; especially if it is >1cm or has normal/reduced functioning
Vaccine that cannot be administered after 15 weeks
Rotavirus
PCOS diagnostic criteria
Hyperandrogenism, evidenced by hirsutism or elevated serum androgen levels
Oligomenorrhea with cycle length greater than or equal to 35 days
Multifollicular ovaries on pelvic US (12 or greater)
Patient with suspected SAH
Refer to ER immediately; do not even get CT if you are in outpatient
Diabetic medications that help to lose weight
Metformin and Incretins (Exenatide)
Treatment for IBS with diarrhea
Peppermint oil
Frozen shoulder
Idiopathic condition that causes loss of active and passive shoulder rotation and severe pain, especially at night
Commonly happens in DM Type II patients
Erythema toxicum neonatorum
“Flea bitten” rash on the upper body of a newborn; infant is otherwise in no significant distress
Rash looks like small pustules surrounded by an erythematous base
Croup tx
Mild- Mist
Moderate- Racemic epi, steroids, O2
Severe-
-Patient is 3months-3 years old and has barking cough with stridor
Croup that does not improve w/ racemic epinephrine
Probably dealing with bacterial tracheitis; give antibiotics and get tracheal culture
Will probably see purulence in the back of the throat as well
<2 year old presenting w/ asthma like symptoms in the winter
Think bronchiolitis
Acne rosacea
Patient presents with central facial erythema and telangectasia that can progress to rhinophyma, flushing triggered by food or emotions, ocular problems, and pustules
Tx: Sunscreen use, oral metronidaozle or tetracycline
Posterior tibialis tendinopathy
Patient will have pain and swelling behind their medial malleolus but will not recall spraining their ankle
Tx: Immobilization in a boot or cast for 2-3 weeks
Restless leg syndrome treatment
Pramiprexole, ropirinole
Also try iron supplementation if there ferritin is low
TST result interpretation
High risk? =» >5mm is positive
Low risk? =» >15mm is positive
Testing to get for pyloric stenosis
Abdominal x ray to rule out a perforation
Indications for battery removal
Hasn’t progressed in 3 days
Flat button battery
Lewy body dementia
Presents with vivid hallucinations, fluctuation in cognition, and parkinsonian Extrapyramidal signs with postural instability
Tremor may not be present
Metabolic syndrome
Constellation of symptoms including 3 of the following
Waist circumference >102 cm
Triglycerides > 150
HDL < 40 if male, <50 if female
Blood pressure >130/85
Fasting plasma glucose >100
Or if a patient is being treated for any of these
Increased risk of CVD and DM
Antiepileptics to use in pregnancy if you have to
Lamotrigine, leviteracetam (L-drugs)
Uterine rupture
Usually occurs at the site of a c-section scar; occurs with contractions, is painful, and regression of fetal station
Tx: Crash c-sec
Prepubertal labial adhesions
Idiopathic condition in which pediatric patients have adhesions near the introitus of the vagina that may interrupt urination, create a pulling sensation, or cause recurrent UTIs
Tx: Topical estrogen
Pallidotomy
Surgery for disabling unilateral tremor and dyskinesia from Parkinson’s disease
Monteggia fracture
Distal fracture of the ulnar with dislocation of the radius
Due to someone blocking something with their backarm
Galezzia Fracture
Radius break with ulnar dislocation
Fracture of the femoral head
Needs a prosthesis for repair
Often presents in an old lady with a shortened and externally rotated leg
Antibiotics that are CYP inhibitors
Macrolides (erythromycin, Clarithromycin)
Statins and other drugs metabolized in the liver are CI’d while using these abs
Tx for HELLP
Delivery
Make sure to be observant of lab values
Child with Glomerulonephritis following a uri
Probably an IgA nephropathy
Other sites for herpes
Butt and sacrum
Pregnant lady with cervical trauma
Keep her in the supine position with the uterus deflected laterally
Surgery for an AAA
Tender mass
Back pain
> 5.5 cm
Non opioid that can provide pain relief from compression fractures
Calcitonin
Surgery for an AAA
Tender mass
Back pain
> 5.5 cm
Non opioid that can provide pain relief from compression fractures
Calcitonin
MCC of tracheitis
S. Aureus
LCP Tx
Conservative, brace the hip while maintaining some motion
SCFE Tx
Surgical pinning of the femoral head
If not, can lead to Avascular necrosis
Aspirin OD
Early: Tinnitus, N/V, vertigo, Respiratory alkalosis
Late: Anion gap acidosis, obtunded, coma, hyperpyrexia, Metabolic acidosis
Dx: Salicylate level
Tx: Alkalinize the urine
Cyanide OD
Causes: Smoke inhalation, nitroprusside OD
Pt: Sick w/ cherry red skin and blood
Tx: Thiosulfate
Organophosphate poisoning tx
Atropine and Pralidoxime (if you have to choose, pick pralidoxime)
Signs: Salivation
Lacrimation
Urination
Diarrhea
GI upset
Emesis
Best tx for nocturnal enuresis
Bed wetting alarm
Common deficiency after gastric bypass surgery
Iron and B12
DRESS syndrome
Drug Reaction with Eosinophilia and Systemic Symptoms
Erythroderma accompanied by fever, lymphadenopathy, elevated liver enzymes, and eosinophilia
-Typically caused by a medication such as antiepileptics or allopurinol
Tx: Corticosteroids and stop offending drug
Preventing post op atelectasis
Deep inspiration, coughing, incentive spirometry, and pain control
Postimplantation syndrome
Self-limited fever, elevated CRP, and leukocytosis w/ negative blood cx
Usually follows an aortic aneurysm repair
Recurrent wheezing differential in children
Bronchomalacia
Vascular rings
GERD
Indications for palivizumab
Child with…
Chronic lung disease
Prematurity
Congenital heart disease
Antispasmodics for IBS
Dicyclomine, hyoscyamine
Used as need when pain is mild and infrequent
IBS tx for frequent and severe pain
TCAs
Diarrhea-predominant IBS tx
Loperamide
Rifaximin
Constipation-predominant IBS tx
Fiber (like psyllium)
Polyethylene glycol
Lubiprostone (activates intestinal chloride channels)
Linaclotide (increases gut motility) and secretions)
Jersey Finger
Tearing of the flexor tendons
Occurs after a ripping motion when someone is trying to hold on it
Tx: NSAIDs, splinting, surgery last resort
Mallet finger
Tearing of the extensor tendon
Occurs when a ball hits someones finger tip
Tx: NSAIDs, splinting, steroids, surgery last resort
Trigger Finger
Stenosing tenosynovitis (not a sports injury), patient when forcing finger into extension will see a pop
Tx: Splinting, NSAIDs, Steroids, Surgery last resort
Dequervain’s Tenosynovitis
Mom holding a baby and guy lifting weights
Patient complains of thumb pain
Patient can’t make a fist and then deviate towards the ulna
Tx: NSAIDs, splinting, steroids, NO SURGERY
Felon
Abscess on the pulp of the finger; patient will have a lot of pain, fever, and leukocytosis
Is a product of penetrating injury
Tx: High lateral I and D; sometimes antibiotics if severe
Colon cancer screening in patients with a positive family history
Start 10 years before the onset in their family member
Main action of metformin
Inhibition of glucose production in the liver
Child who is mildly dehydrated during illness at home
Start kid on an oral rehydration solution (not just water)
Treatment of infantile gonococcal ocular infxn
Single dose of ceftriaxone intramuscularly
Only drug that can intranasally reduce cold sx
Ipratropium
Bisphosphonates risks
Osteonecrosis of the jaw
Anemia
Burning while swallowin
CIs: Decreased renal fnxn, hypocalcemia
Hypersensitivity pneumonitis
Patient is exposed to irritant and develops chills, cough, SOB
CXR will be normal, PFTs show restrictive changes
Onion skinning in the midshaft of the femur
Ewing’s sarcoma
Sunburst pattern on the distal femur
Osteosarcoma
Childhood Obstructive Sleep Apnea tx
Adenotonsillectomy
Calcaneal apophysitis
“Sever Disease”
Heel pain that occurs when the bones grow faster than the muscles and tendons; the Achilles tendon pulls with repetitive running or jumping causing microtrauma
Tx: NSAIDs, ice, stretching, orthotics
Child with apneic episode
Admit for observation but don’t treat right away
Treatment for a GBS pos pregnant lady who is allergic ato penicillin
Cefazolin
Pain relief in hepatic cirrhosis patient
Anything but NSAIDS, even acetaminophen
Red rash with Coal red luminescence under a woods lamp
Indicates a corynebacterium infxn, treat with erythromycin instead of an antifungals
Abnormal ABI
> 1.4
Indicates arterial calcification and mandates a CT follow up
Ottawa Rules for radiography
Pain in the malleolus or mid foot zone with tenderness over the distal tibia or fibula, lateral or medial malleolus, the base of the fifth metatarsal, or at the navicular bone
OR
Inability to bear weight immediately after the injury AND when evaluated by the physician
CI’d drug in hypertensive cardiomyopathy
CCB
These drugs have a negative inotropic effect
️Chronic Antihypertensive to use in pregnancy
Labetalol
Tx for hypoactive sexual desire disorder
️Topical testosterone, for males and females
Indications for hospital admission due to upper GI bleed
Age >60
Systolic pressure <100
Heart rate >100
Shock
Major comorbidities
Rotavirus vaccine deadline
15 WEEKS
Persistent occiput posterior delivery position
Assoc with higher risk of c-sec, assisted vaginal delivery, and lower likelihood of spontaneous delivery
Parkland fluid for burn
50% of fluid in 1st 8 hrs, 50% in next 16
Rubella in an infant
Prodrome: Tender Lymphadenopathy
Later: Fever and rash (a lot like measles)
There are no koplik spots like in measles
Workup of secondary amenorrhea
- Progesterone withdrawal challenge
- Estrogen
- FSH, LH
- MRI of anterior pituitary
- Hypothalamus = diagnosis of exclusion
Tx for prolactinoma
Dopamine agonists
Pre or post exposure prophylaxis for HIV
Emtiricitabine and Tenofovir
HIV prophylaxis
CD4 <200 : PCP (Bactrim or Dapsone)
CD4 <100 : Toxoplasmosis (Bactrim or Pyrimethamine)
CD4 <50 : MAC (Azithromycin weekly)
Treatment for SVT
Radiofrequency ablation
Ventilator tx for ARDS
Decreased tidal volumes with increased PEEP
First line tx for diabetic peripheral neuropathy
TCAs
Surgery for asymptomatic gallstones
Only if they have a hemoglobinopathy since they have an increased risk for pigmented gallstones
Thessaly test
Positive test indicates a meniscal tear
Patient bends knee to 20 degrees and then internally and externally rotates it
Acute rectal fissure pain relief
Botox
Indication for adenosine administration in cardiac cases
Symptomatic bradycardia
Stages of syphilis
1: Painless ulcer with nontender lymphadenopathy
2: Fever, rash on palms and soles of the feet, usually targetoid as well
3: Neurosyphilis (can be any neuro symptom but usually tabes dorsalis with a loss of proprioception), Argyll-Robertson pupil, aortic regurgitation
Lymphogranuloma Venereum
Painless ulcer like syphilis BUT there is TENDER lymphadenopathy and usually draining pus
Pt is probably IC as well
Tx: Doxycycline
Gestational hypertension
> 140/>80 that begins after 20 weeks; there is no proteinurea or edema though
Has a potential to progress to preeclampsia
Preeclampsia management
Weekly followups with frequent screenings until Week 34
Be on the lookout for alarm symptoms, in that case, you deliver no matter what week it is
Alarm features: Increased creatinine, low platelets, RUQ pain, pulmonary edema, elevated LFTs, headaches, visual changes
Pain with passive stretching of the muscles and excessive pain out of proportion to a recent injury
Most reliable indicators of compartment syndrome
DVT assessment
Low risk= D dimer
High risk= Go straight to ultrasound
Croup tx
Single dose of corticosteroids
Epinephrine as well if it is severe
Lyme disease prophylaxis
Single 200 mg dose of doxycycline
Prolonged phases of labor
Latent phase:
> 20 hrs (nulli)
> 14 hrs (multi)
Active phase:
> 1.2 cm/hr (nulli)
> 1.5 (multi)
Stage II:
> 3hrs (nulli)
> 2 hrs (multi)
Stage III:
> 30 mins
Baby in breech presentation
Try external inversion
If it doesn’t work, c section
Indications for surgery in diverticulitis
Generalized peritonitis
Unconfined perforation
Uncontrolled sepsis
Undrainable abscess
Failure of conservative management
Exercise for elderly people in nursing homes
Resistance training
Lichen planus is associated with what disease?
HCV
HbA1c goals in patients with significant comorbidities and are old
<8.5
Likelihood ratio of 1
Means the test is fuckin useless
Cardiac pre op eval
EF <35% =» needs to be better
MI =» Wait 6 months
Workup: EKG, Echo, Stress if indicated for a CAD patient
Tx: MI= Stent/CABG
CHF= Diuresis
Pulmonary pre op eval
Workup: PFTs, maybe ABG on the day of
Tx: O2
Inhalers to control underlying disease
*******SMOKING CESSATION 8 WEEKS IN ADVANCE
Liver pre op eval
Work-up: Albumin, PT, PTT, total bilirubin, check for ascites and encephalopathy
Any of these positive, don’t go to surgery
Tx: Liver transplant
Nutrition pre op eval
Loss of 20% of body weight in less than 3 months, albumin <3, and anergic skin test
Work up: Prealbumin, CRP,
Tx: 10 days of nutrition
Patients who have gotten the BCG vaccine get screened for TB how?
INF-y assay
Brugada syndrome
Ion channel disorder common in Asian people that presents as a RBBB with an elevation of the J point and flat or negative t wave
Can cause deadly arrhythmias
Secondary prevention
Screening and intervention
Stop screening for colon cancer at what age?
75 or 85 if there has been a positive one recently
AAA Screening
MEN >65 who have EVER smoked
-Only have to screen once
Hep C screening
Baby boomers get screened once
(1945-1965)
Test for Hep C ab
People who HTN should be screen for what disease?
Diabetes; perform an A1C
HLD screening
> 35 or >20 with risk factors in men
> 45 or >30 with risk factors in women
Max doses of epinephrine for anaphylaxis
- 3-0.5 mL in adults
0. 01 mg/kg with a max dose of .3 mg/kg in kids
Cat bite treatment
10-14 days of Augmentin
High risk for Pasteurella multocida
Next step in therapy after confirming a stroke
Determine if thrombolytic therapy can be used
If it has been >3 hrs since onset, they are not a candidate
**CTs rule out hemorrhage, tumors, or abscess but do not always show ischemia right away
Anosognosia
Unawareness of a disability; common feature of strokes
Drugs to give after a stroke
Aspirin within 48 hours! Could also use clopidogrel
Also start DVT prophylaxis with heparin
Long term anticoagulation is not indicated after this acute period unless they have arterial disease that can cause clots
Stroke in a child
Suspect SCD
Severe high blood pressure after a stroke
Could be hypertensive encephalopathy or intracranial hemorrhage
BP goal in a 60 year old w. HTN
150/90
CKD and ARBS
THEY HAVE TO GET ACEIS OR ARBS
Emergency hypertension crisis tx q
IV BBs, CCBs or nitrates
BB to use in CKD
Labetalol
Drug to use if spironolactone causes gynecomastia
Eplerenone
HSV positive pregnant woman
Place them on therapy to reduce risk of viral shedding at time of delivery and breastfeeding
TdaP in pregnant women
Give between 27 and 36 weeks due to increasing incidence of pertussis
Uveitis
Assoc. w/ a sluggishly reactive pupil, photophobia, and conjunctival injection
Assoc. w/ Ankylosing spondylitis and other HLA-b27 conditions
Tx: Ocular corticosteroids
Dysplasia seen in esophagus with chronic GERD management
Local ablative therapies; doesn’t really matter what
Follow up with surveillance EGDs
Alarm symptoms with GERD and management
N/V
Anemia
Weight Loss
Progressive dysphagia
Recurrent vomiting
Jaundice
Management: EGD with biopsy
Patient who is on BBs, is hypotensive, and not responding to epinephrine
Give glucagon; their adrenergic receptors are blocked
Labs to monitor on Lithium patients
Lithium drug levels
Renal fnxn
TSH
H pylori serologic tests
Do not differentiate between active and past infxn
Increased bilirubin in the urine
Sign of Conjugated bilirubinemia
H pylori workup
Serological test to screen
Stool test to work up
Urea breath test if inconclusive, save this one because it is the most expensive
Erythema marginatum
Erythematous, serpinginous macules with pale centers
Caused by group a strep
Medicine to give patients with diabetic nephropathy
ACEIs or arbs
These drugs reduce the progression of disease to ESRD as well as decreasing their cardiovascular risk
Treatment of acute COPD exacerbation
Steroids, beta agonists, and antibiotics!
Scleroderma S&s
Thickening of the skin
Raynauds
Esophageal dis motility
Interstitial lung disease
⭐️ anti- centromere antibodies!
Gout work up
24 hour urine for Uric acid
If ️Decreased ➡️ prescribe probenecid which blocks resporption of Uric acid in the renal tubules
If increased/normal ➡️ allopurinol which ️Decreases the breakdown of purines
Hypertensive urgency Tx
Labetalol
Nitroprusside if it’s an EMERGENCY
Congenital syphilis
Baby presents with rash involving the palms and soles of the feet, bloody nasal drainage, Hepatosplenomegaly, and lymhadenopathy
⭐️Blood nasal drainage = SNUFFLES
What follow should occur after confirmed Zollinger-Ellison
Men 1
Treatment of superficial thrombophlebitis
Symptomatic: RICE
- Presents with a hardened, red, and inflamed vessel; typically not like a regular DVT
- Typically DVTs cannot be palpated; if you do have a DVT, treat with heparin and long term coumadin
What should you check before starting a TCA?
QT interval =» Get an EKG
MAOis
Selegline, Phenylzine, Tranylcyramine
Management of inevitable or missed abortion
Oxtocin to expel remaining tissue; D and C if there is still some left
Pramlinitide
️Inhibits inappropriately high glucagon secretion during episodes of hyperglycemia
Insulin secretagogue classes
Sulfonylureas, Meglitinides (Nateglinide), and glp-1 agonists (Exenatide)
Glp-1 agonists also cause early satiety
Spinal stenosis causes
Degenerative arthritis
Spondylolisthesis
Anti-mitochondrial antibodies
Primary biliary cirrhosis
Labyrinthitis
Vestibular neuritis
Post-viral inflammation of CN VIII that is benign and will resolve on its own; patients have peripheral nystagmus, balance issues, and hearing loss
Classic patient for pseudotumor cerebri
Young, obese female on OCPs
Testing for Addison’s
ACTH or Cosyntropin stimulation test
Ischemic tubular necrosis
Increased BUN:Cr (meaning there it is 15:1 ish instead of 10:1 ish) and ENa
-In pre-renal failure, these are typically increased
Pasteurella multocida infxn
Simply shows up as cellulitis; if you see lymphadenopathy, think Bartonella henslae
Management of possible septic endocarditis
Echocardiogram to eval for vegetations
pCO2 that has risen after an asthma attack
Indicator of impending respiratory failure, Even if they appear stable!
-It indicates that the airways are so constricted that the patient can no longer get rid of CO 2
“Silent chest” of a severe attack
Tx: Admit and intubate
Onchomcosis
Presents as a yellow, somewhat tender nail
F/U: KOH examination of nail scrapings
Tx: Oral terbinafine, itraconazole
Vesicoureteral reflux
Antibiotic prophylaxis until it resolves; if it is severe and does not resolve, possible intervention
Causes of non-anion gap metabolic acidosis
Type I Renal Tubular Acidosis (decreased secretion of h+; can be caused by stones
GI bicarbonate loss
Dexamethasone suppression test
Suppresses cortisol levels if there is a pituitary adenoma
If there is an adrenal tumor or ectopic ACTH producing mass, it will not be suppressed
Patient with COPD who presents with acute bronchitis like symptoms
Go ahead and give antibiotics even tho you wouldnt do that for a normal person
Albuminocytologic dissociation
Increased WBC and normal WBC in a spinal tap
Found in Guillan-Barre; don’t need to do this usually to diagnose but just in case
Outpatient treatment of MRSA
Bactrim
Think MRSA if a gram pos infxn, such as a skin infxn, did not go away with a normal B-lactam drug
Patient with ASCUS cells and a high risk HPV strain on testing
Colposcopy
Otitis media with effusion remaining for a long time after an acute infxn
Possible tube placement if it is affecting their hearing
Woman presenting with signs of appendicitis
Still get a pregnancy test
Alprostadil
Prostaglandin analogue that can be used for erectile dysnfnxn when there is a CI for tadalafil (such as nitrate use)
Elements of minimal change disease
Proteinuria
Edema
Hypoalbuminemia
Hyperlipidemia
Thyroid Nodule workup
- TSH (if hyper, don’t worry about it)
Euthyroid?
=»2. FNA
4-2-1 rule for kids
First 10kg =» 40ml/kg/hr
Next 10 =» 20/ml/kg/hr
After 20 =» 1/ml/kg/hr
First step in management of GERD
Lifestyle modifications
- H2 blockers; antacids
- PPIs; H2 blockers
- Nissen fundoplication
Cardiac pre op clearance
IF they have had coronary angiography or vessel grafting in the past couple years, they good
If they have stable CHF, diabetes, uncontrolled HTN, or other mild risk factors, get a stress test before echo
Pregnant diabetic drug changes
Switch any oral drugs to insulin
Universal recommendation for menopausal women
1200mg/day of calcium
Vitamin d of 800IU/day
Consider using what drugs in conjunction with opioids?
Bisacodyl or any other stool softener
Lymphedema management options
Support, pneumatic compression, drainage, and surgery
Squaring appearance of the foot with lower extremity swelling
Kaposi-Stemmer sign
Seen with lymphedema
Tx for organophosphate poisoning
Atropine
Pralidoxime
