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Family Med > SG2 > Flashcards

SG2 Flashcards

1
Q

Abdominal aorta normal diameter

A

less than 2cm

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2
Q

Signs of Cushing’s syndrome that are not as obvious

A

Easy bruising, muscle weakness

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3
Q

Calculating basal metabolic rate

A

body weight in pounds times 10. multiply by 1.3 if sedentary, 1.7 heavy activity, 1.9 intense activity

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4
Q

Calculating LDL

A

LDL= total cholesterol- HDL- triglycerides/5

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5
Q

USPSTF lipid screening guidelines

A

All men over age 35, all women over age 45 and younger adults (20-35) with other CHD risk factors

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6
Q

Management of LDL dyslipidemia- what kind of diet is recommended?

A

saturated fat less than 7% of calories; less than 200 mg of cholesterol per day; increased soluble fiber (10-25 g/day) and plant sterols to enhance LDL lowering

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7
Q

Side effects of statins

A

Hepatic dysfunction. So check LFTs before initiating after 12 weeks of therapy, periodically, and with any dose adjustment. Another SE is myopathy

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8
Q

Other meds that treat LDL dyslipidemia besides statins

A

Bile acid sequestrants, nicotinic acid (niacin), fibric acid derivatives, ezetimibe

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9
Q

Bile acid sequestrants- what are the benefits and side effects

A

More modest effect on LDL and HDL; can cause increase in triglycerides, may cauase severe GI distress and constipation

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10
Q

Nicotinic acid (niacin)- how does it work to lower LDL and what are the side effects?

A

more modest effect on LDL; this is the most effective agent for HDL increasing; this can decrease triglycerides; the side effects include body flushing (which can be reduced by taking ASA before the niacin dose)

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11
Q

Fibric acid derivatives- what are they good for?

A

These are the first line agents for reducing triglcerides; they canse a modes effect on decreasing LDL; these can raise the HDL as well as a benefit

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12
Q

Ezetimibe- how does it work?

A

Inhibits the absorption of cholesterol at the intestinal brush border; it increases cholesterol clearance; however, it is unclear whether it decreases atherosclerosis or CHD

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13
Q

Monitoring lipids

A

Check lipids every 6 weeks after starting therapy and every 6-12 mos when patients is on a stable dose

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14
Q

When is medication for weight loss indicated?

A

When BMI is over 30 or over 27 with risk factors

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15
Q

What are some meds for weightloss?

A

Orlistat and prentermine

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16
Q

How does Orlistat work?

A

GI lipase inhibitor that decreases fat absorption. This is the only medication currently FDA approved for weight loss

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17
Q

How does prentermine work?

A

First of all, you should know it is indicated only for short term use. Next, the side effects are those of other stimulants, tachy, hypertension, tremor, insomnia

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18
Q

When is bariatric surgery indicated?

A

BMI over 40 or over 35 with comorbidities

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19
Q

How many migraine episodes are needed for diagnosis?

A

5 episodes are needed for migraine diagnosis

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20
Q

What is the character of a migraine headache?

A

unilateral pulsating

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21
Q

How long do migraines typically last?

A

4 to 72 hours

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22
Q

Are migraines aggravated by physical activity?

A

Yes. However, tension and cluster are not

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23
Q

How many episodes of a tension headache are required for diagnosis?

A

10 episodes are required for diagnosis

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24
Q

How do you describe the pain of a tension headache?

A

bilateral or occipital, with a pressing quality

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25
Q

Are tension headaches associated with phono and photophobia like migraines?

A

Yes, they are associated with photo and phonophobia like migraines

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26
Q

How long do tension headaches last?

A

30 mins to 7 days

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27
Q

Are tension headaches aggravated by physical activity?

A

No, only migraines are aggravated by physical activity

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28
Q

How many episodes of cluster headaches are requires to make the diagnosis?

A

5 episodes of cluster headaches are required to make the diagnosis

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29
Q

How long do cluster headaches last?

A

15 mins to 180 mins

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30
Q

Criteria for diagnosis of medication overuse headache

A

Over 15 headaches per month; regular overuse of an analgesic for over 3 mos; development or worsening of headache during medication overuse

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31
Q

Narcotic dependence

A

Causing clinically significant impairment manifested by at least three of the following: tolerance, withdrawal, increased doses, desire or inability to cut down, significant amount of time spent in search of the drug, interference with activities, continued use despite physical or pscyh problems due to the drug

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32
Q

What is addiction?

A

Persistent craving, loss of control over drug use, compulsive use, and a strong tendency to relapse after withdrawal

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33
Q

Guideline for imaging for headache

A

If patient has migraine with atypical headache patterns or focal neuro signs, patient is high risk for a significant abnormality; study results would alter management

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34
Q

Medications that might trigger headaches

A

progesterone (birth control or hormone replacement); tobacco; caffeine; alcohol; aspartame and phenylalanine (in diet colas)

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35
Q

Migraine-specific abortive meds

A

tryptans, ergot alkaloids

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36
Q

Contraindications to use of tryptans for migraine abortion

A

Use of ergotamine, use of MAOI, history of hemiplegia or basilar migraines, pregnancy, CVD or uncontrolled hypertenson, in combination with SSRIs may cause serotonin syndrome

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37
Q

Contraindications to the use of ergot amines for migraine abortive

A

Use with tryptans; heart disease or angina, hypertension, or peripheral artery disease, pregnancy, renal insuff, breast feeding

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38
Q

Non-specific headache abortants

A

Aspirin/butalbatal/caffeine; Acetominophn/butalbatal/caffeine; Acetominopne/dchloralpheanzol

39
Q

What are some prophylactic headache meds?

A

Beta blockers (propranolol, timolol), Neurostabilizers (depakote, topiramate), TCAs (amitryptiline), CCBs (verapamil); others (magnesium, vit B2)

40
Q

Pretibial myxedema

A

AKA Graves Dermopathy; waxy discolored induration of the skin; caused by deposition of hyaluronic acid in the dermis and subcutis

41
Q

How does excessive iodine cause hyperthyroidism?

A

Causes thyoriditis

42
Q

Causes of goiter (can be seen in hyper, hypo, and euthyroid)

A

Lack of iodine is most common cause of goiter worldwide; Hashimotos disease; Graves disease; Nodules; Thyroid cancer; pregnancy; thyroiditis

43
Q

HCG secreting tumor can cause hyperthyrodisim with high radioactive iodine uptake test- how?

A

HCG looks like TSH (or TRH?) in one of its subunits I think

44
Q

Struma ovarii

A

AKA goiter of the ovary; contains thyorid tissue; cause of hyperthyroidism

45
Q

What kind of antibodies do you see in Graves disease?

A

Thyroid peroxidase antibodies

46
Q

Management of hyperthyroidism

A

Propranolol for symptomatic relief; PTU and methimazole; oral radioactive iodine; surgery

47
Q

Side effects of PTU and methimazole

A

Low white blood cell count in less than 1% of patients. For this reason, it requires regular blood monitoring

48
Q

How long does it take for PTU and methimazole to work?

A

Clinical improvement is seen after 1 month but it is 3 months before thyroid level decreases

49
Q

What are some side effects of radioactive iodine?

A

Soreness of neck or brief worsening of symptoms. Patients with opthalmopathy may experience worsening of their symptoms. Eventually, many patients become hypothyorid and need to take thyroid replacement

50
Q

How do you monitor a patient after she is given radioactive iodine?

A

Check TSH every 2-3 months until it has stabilized and every 6 mos or so after that

51
Q

Treatment of hypothyroidism

A

Levothyroxine. Check TSH one month after starting. In primary hypothyoridism, check annually. In secondary hypothyroidism, must monitor more closely

52
Q

Most common mechanism of injury of ankle sprain

A

plantarflexion and inversion (“down and in”)

53
Q

History of snap or tear

A

Diagnostically significant in a knee injury but not an ankle injury

54
Q

The lateral stabilizing ligaments of the ankle

A

Are the most commonly injured in plantar flex and inversion injuries; These include the anterior talofib, posterior talofib, and the calcaneofibular ligament

55
Q

Tests to assess the stability of the lateral stabilizing ligaments of the ankle

A

Anterior drawer test for anterior talofibular ligament; Inversion test for calcaneofibular ligament; Posterior talofibular ligament is rarely injured so there’s no test for it

56
Q

How do we assess for ankle sprain secondary to eversion and rotation (much less common MOI)

A

Cross-legged test detects high ankle tibiofibular syndesmotic sprain

57
Q

Grading ankle sprains I, II, III

A

I is stretching or small tear (no bruising, no loss of stability); II is incomplete tear (brusing common, moderate functional impairment); III is complete tear and loss of integrity of the ligament (mechanical instability)

58
Q

Peroneal tendon tear is usually secondary to what kind of injury? How does the pain present?

A

Usually inversion injury or repetitive trauma. Persistent pain posterior to the lateral malleolus

59
Q

Talar dome fracture

A

Initial xrays may miss. Watch out for avascular necrosis

60
Q

Tendonitis in the ankle

A

Usually involves posterior tibialis tendon. Swelling, warmth and stiffness are common

61
Q

Subtalar injury

A

Dislocation invoves talocalcaneal and talonavicular joints

62
Q

Tarsal tunnel syndrome

A

Entrapment of the tibial nerve. Pain, tingling, and burning sensation along the sole of the foot and/or the inside of the ankle

63
Q

Syndesmatic injury

A

Positive ankle squeeze test. Involves interosseous membrane and anterior inferior tibiofibular ligament

64
Q

Ottawa ankle rules

A

Sensitivity of 97 to 100%. Xrays of the ankle are needed if: there is pain in the malleolar zone and EITHER bony tenderness along the distal 6 cm of the posterior edge of the malleolus OR inability to bear weight both immediately and in the ED

65
Q

Ottawa foot rules

A

Xrays are indicated if there is pain in the midfoot region and EITHER bony tenderness at the navicular base or base of the fifth metatarsal OR inability to bear weight both immediately and in the ED

66
Q

What is the management of an ankle sprain?

A

RICE; Rest x 72 hours; Ice several times throughout the day for 10 mins at a time. Compression. Elevation

67
Q

Most lower back pain resolves in how long?

A

2-4 weeks

68
Q

What is the recurrence rate for back pain?

A

35-75%

69
Q

Pain on the same side as bending laterally

A

Suggestive of bony pathology (OA or neural compression)

70
Q

Pain on the opposite side as bending laterally

A

Suggestive of muscle strain

71
Q

Difficulty with heel walk suggests what pathology?

A

L5 herniation

72
Q

Difficulty with toe walk suggests what pathology?

A

S1 herniation

73
Q

Decreased patellar reflex means nerve impingement where?

A

L3/L4

74
Q

Hip flexion is what roots?

A

L2, L3, L4

75
Q

Hip abduction and hip adduction are what roots?

A

Abduction is L4, L5, S1; Adduction is L2, L3, L4

76
Q

Knee extension and flexion

A

Knee extension is L2, L3, L4. Knee flex is L5, S1, S2

77
Q

Ankle dorsiflex and plantar flex

A

Dorsiflex is L4, L5; plantarflex is S1, S2

78
Q

What is the “crossed leg raise”?

A

Asymptomatic leg is raised and the test is pos if pain is increased in the contralateral leg. Much less sensitive but highly specific for herniated disc

79
Q

What is the FABER test?

A

Looks for pathology of the hip joint or sacrum. Test is positive if pain at the hip or sacral joint or if the leg cannot lower to the point of being paralelle to the opposite leg. Should be done on all patients suspected ofhaving SI pain

80
Q

Achilles tendon reflex is which nerve root?

A

S1

81
Q

Symptoms of spondylolisthesis

A

Aching back and posterior thigh pain that increases with activity or bending

82
Q

When to order studies for lower back pain?

A

In the absence of red flags, imaging is not indicated until after 4 to 6 weeks of conservative treatment

83
Q

Red flags for ordering plain films of the back

A

Age less than 20 or over 70, Hx of trauma, lifting in patient with osteoporosis, hx of cancer, fevers/chills/nightsweats, pain worse when supine or severe at night

84
Q

No studies support the use of steroids in LBP

A

But NSAIDs and opioids help

85
Q

Spinal manipulation is safe treatment for lower back pain and can help in the short term

A

right

86
Q

Diagnosis of hypertension

A

Two measurements at least 5 mins apart, one in each arm, on two separate visits

87
Q

Studies recommended for a new diagnosis of hypertension

A

ECG, U/A, Hct, serum K, Cr and GFR, lipid panel, urinary albumin excretion or albumin/cr ratio (optional in HTN but required in those with DM or CKD), serium calcium

88
Q

Antihypertensive drugs used in the treatment of heart failure patients

A

Thiazides, ACE/Arbs, aldosterone antag, beta blockers

89
Q

Antihypertensives for someone needing recurrent stroke prevention

A

thiazides and ACEis

90
Q

Lifestyle modifications that will lower BP

A

Number 1 is weight reduction then DASH diet then sodium restriction then physical activity then moderation of alcohol consumption

91
Q

Hydrochlorothiazide should be avoided in what patients?

A

Those with a history of gout

92
Q

SE of HCTZ

A

Hyponatremia

93
Q

Doses of HCTZ above what level do not decrease BP further

A

Above 25 mg (which is where most adults start. Elderly patients can start lower)

94
Q

Definition of resistant hypertension

A

Not able to meet BP goal in patients who are adhering to 3 dose BP regimen, including a diuretic.

Family Med (16 decks)

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