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Amb Care > SIMPLE cases > Flashcards

SIMPLE cases Flashcards

1
Q

Roth’s spots

A

Retinal hemorrhage on pale centers, associated w/ bacterial endocarditis

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2
Q

2 antibodies for RA

Which is better for diagnosis?

A

RA autoantibodies

Rheumatoid factor: present in 85% of RA pts, but its nonspecific

Anti-CCD (citullinated peptide) is highly specific for RA => if anti-CCD is negative, pt doesn’t have RA

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3
Q

What to do on a diabetic food exam

A

Diabetic foot exam:

Visual: Examine skin for ulcers, callous, blisters, nail infection, bone deformity

Pulses: assess for peripheral vascular disease
-sign = hair loss

Sensation: monofilament test
Test achilles reflex

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4
Q

3 lab tests to rule out reversible causes of dementia

A
  1. TSH
  2. BMP
    - hypercalcemia => confusion
    - hyponatremia => change in mental status in the elderly
  3. B12
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5
Q

NASH vs NAFL

A

NADFLD = non-alcoholic fatty liver disease can be divided into NAFL and NASH
-dx of exclusion: pt must nto have h/o heavy alcohol use or other reason for liver inflammation (hepatitis)

NAFL = non-alcoholic fatty liver = generally benign condition where fatty infiltration is simple w/o inflammation

NASH = non-alcoholic steatohepatitis = fatty infiltrate along w/ liver inflammation

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6
Q

Features to distinguish benign vs. malignant mole

A

A- asymmetry (mirror images?)
B- border (is it regular/smooth?)
C- color variation (is it all one color?)
D- diameter (is it under 6 mm?)
E- evolution (has it always been the same size?)

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7
Q

How to test for gonorrhea and chlamydia

A

NAAT: nucleic acid amplification testing

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8
Q

Cystitis

A

synonym for UTI

cystitis = bladder infection

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9
Q

4 key things to assess in a geriatric pt

A
  1. fall risk
  2. dementia/memory changes
  3. frality
    - includes weight loss
  4. urinary incontinence
    - most frequently stress in F, overflow in M
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10
Q

Aminotransferase levels in alcoholic hepatitis

A

Alcoholic hepatitis: typically AST/ALT > 2

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11
Q

Maculopapular rash after starting antibiotics- which abx most likely?

A

Ampicillin, Amoxicillin, Bactrum

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12
Q

Stable vs. unstable angina

A

Stable angina- predictable association w/ exertion and resolution w/ rest/nitroglycerin

Unstable angina- present at rest or increasingly w/ less exertion

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13
Q

After E. Coli, what are the 3 next most common causes of UTI

A

After E. Coli

  • staph saprophyticus
  • klebsiella
  • proteus mirabilis
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14
Q

Differentiate the types of biopsies:

Excisional
Incisional
Punch
Shave

A

Shave biopsy- only take the top-most epithelial layer
-wouldn’t be enough for a melanoma or something, more like a scale/crust

Punch- take a vertical cylinder of tissue
-best used to get a sample of a large lesion in a cosmetically sensitive area

Incisional- taking a piece of tissue, stitch is made

Excisional- type of incisional biopsy where the entire affected area is removed

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15
Q

Describe some manifestations of diabetic autonomic neuropathy

(a) CV
(b) GI
(c) GU

A

Diabetic distal polyneuropathy often comes first, but then autonomic neuropathy can develop

(a) Cardiovascular: orthostatic hypotension, resting sinus tachycardia, postprandial hypotension
(b) GI: gastroparesis, constipation
(c) GU: erectile dysfunction, neurogenic bladder

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16
Q

Advice for pts to avoid hypoglycemia

A

NOT to just eat whenever you may ‘feel’ hypoglycemic- shown that pts have a very poor subjective ability to detect hypoglycemia by symptoms alone.

Instead- check w/ finger sticks frequently

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17
Q

Typical vs. atypical angina

A

Typical:

  • substernal w/ classic quality
  • exertional
  • relief w/ rest or nitroglycerin

Any other characteristics- atypical

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18
Q

When does she need a pelvic exam: 17 yo F who is sexually active

A

Don’t need pelvic exam (pap smear) until 21 REGARDLESS of sexual activity

So doesnt matter if you have sex before 21

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19
Q

Tx for bacterial vaginosis

A

Metronidazole 500 mg BID x 7 days

20
Q

Name 4 things that Medicare does NOT cover that are important, espeically in the very elderly

A

Medicare does not cover:

Vision exam and eyeglasses
Hearing exam and hearing aids
Dental care and dentures
Long-term care

21
Q

Differentiate non-proliferative from proliferative diabetic retinopathy

A

Non-proliferative: see cotton wool spots

Proliferative: see neovascularization and retinal hemorrhage

22
Q

Differentiate the cystitis tx with

(a) Bactrum
(b) Nitrofurantoin

A

Bactrum- 3 day tx

Nitrofurantoin = Macrobid- 5 days

23
Q

Name 3 cancers besides Kaposi’s sarcoma that are linked to HIV

A

4 total AIDS-defining malignancies

  • Kaposi’s sarcoma
  • Non-Hodgkin’s lymphoma
  • Primary CNS Lymphoma
  • Invasive cervical carcinoma
24
Q

In which populations is atypical angina more common?

A

Atypical angina more common in women, elderly, and diabetics

25
What bugs do AIDS pts need prophylaxis against when CD4 falls below (a) 200 (b) 100 (c) 50
(a) When CD4 falls below 200 pts AIDS pts need bactrum for PCP (jiroveci) prophylaxis (b) Below 100- Bactrum for Toxoplasma prophylaxis (c) Below 50- Macrolide for MAC (mycobacterium avium complex) protection
26
Normal values for (a) Total cholesterol (b) HDL (c) LDL (d) TGs
Normal values for (a) Total cholesterol : under 200 mg/dl (b) HDL: over 60 mg/dl - bad is under 40 for males, under 50 for females (c) LDL: under 100 mg/dl (d) TGs: 10-150 mg/dl
27
Describe the mini-cog
Mini-cog = 3 word recall + draw clock test to assess cognitive fxn in the elderly
28
Differentiate primary vs. secondary prevention of CVD
Primary prevention- prevent disease onset in pts w/o any known disease ex: avoid tobacco, DM control, statin etc Secondary prevention- preventing further disease in those w/ known disease ex: avoiding risk factors and more aggressive control of BP, cholesterol, diabetes
29
What does it mean to have an ASCVD risk of 3.2%
Means that 3 ppl out of 100 ppl w/ your same risk percent will have an MI or stroke in the next 10 years
30
What percent of hypertension is secondary? (a) Most common cause of secondary HTN (b) Other causes of secondary HTN
5% of hypertension is secondary (95% primary/idiopathic) (a) Renal artery stenosis (b) CKD, sleep apnea, hyperaldosteronism, Cushing's, coarctation, thyroid disease
31
1st line tx for outpatient pyelonephritis
Ciprofloxacin | -oral fluoroquinolones achieve high drug concentration in the renal medulla
32
Where do diabetic ulcers develop? (a) Tx
Diabetic ulcers result from neuropathy, they occur at pressure points of the feet (a) Tx = off load pressure w/ casts and special shoes
33
Followup appointment for pt w/ (a) prehypertension (b) stage 1 HTN (c) stage 2 HTN
Followup appointment for pt w (a) Prehypertension: (120-139)/(80-89): 1 year (b) Stage 1: (140-159)/(90-99): f/u in 2 mo (c) Stage 2: (over 160)/(over 100): f/u in 1 mo
34
What does a UCx that grows Proteus mirabilis indicate?
If Urine culture grows proetus mirabilis- image pt /c it's associated w/ urologic stones
35
Differentiate what you're looking for on a slide of vaginal discharge (a) + KOH (b) + NS
Vaginal discharge on slide (a) Microscopy + KOH: looking for budding yeast and hyphae for candida vaginal infection - whiff-amne test: add KOH and if tests positive for fishy odor = bacterial vaginosis (b) MIcroscopy of vaginal discharge + NS to look for bacterial vaginosis and trachomonas
36
What is anti-phospholipid syndrome? (a) Hallmark clinical feature (b) Related findings (c) Skin manifestation (d) Associated condition
Anti-phospholipid syndrome = autoimmune multisystem disorder of arterial, venous, or small vessel thromboembolic events +/- pregnancy morbidity in the presence of anti-phospholipid antibodies (a) Hallmark feature = thromboses (b) Related findings = fetal complications (spontaneous abortion etc) (c) Livedo reticularis- reticular purple rash of dilated venules from obstructed capillaries (d) APS can be a primary condition or associated w/ systemic autoimmune diseases specifically (most commonly) SLE
37
How can the following increase risk for liver disease (a) Diabetes (b) IVDU (c) Alcohol use (b) Fruit, shellfish, veggies
RIsk factors for liver disease (a) DM- increases risk for NAFLD (b) IVDU- increases risk for HIV => Hep C (c) EtOH- increases risk for steatohepatitis/cirrhosis (d) Fruit, shellfish, veggies can spread Hep A
38
Meds that are approved for angina treatment and their mechanism
Meds approved for angina tx Beta-blocker: decreases myocardial oxygen consumption by slowing HR and decreasing BP CCB: dilate coronaries to increase flow and decreases myocardial oxygen demand Nitrates: vasodilators
39
Kaposi's sarcoma (a) Appearance (b) Tx
Kaposi's sarcoma | a) Start off as red/purple patches (raised more than 1 cm (b) Tx- lesions will often resolve w/ HAART
40
What may LE hair loss indicate in a diabetic?
Peripheral neuropathy
41
Differentiate the 4 parts of Medicare
Medicare = benefits for ppl after 65 Medicare A: Hospital insurance- covers inpatient care, skilled nursing home, some hospice Medicare B: physician fees and services, covers the outpatient care and some annual preventative services Medicare C: Advantage plan- private plans approved by Medicare that give additional benefits Medicare D: Covers outpatient drug benefits
42
1st line tx for chlamydia (a) 2nd line tx
Chlamydia first line = single dose of Azithromycin 1 mg PO (a) 2nd line = Doxycycline 100 mg PO BID x 7 days - 2nd line bc dang much less compliance
43
Differentiate hemochromatosis and Wilson's disease
Hemochromatosis = disease where too much iron is absorbed => iron deposited in liver Wilson's disease = disease of biliary copper excretion => copper deposits in liver
44
Describe some of the criteria of a frail elder
``` Frality criteria: Patient reported physical exhaustion Weakness as shown by hand grip Slowed walking speed Low physical activity Weight loss greater than 10 lbs in one year ```
45
Most common manifestation of diabetic neuropathy
Distal polyneuropathy | -numbness/tingling in a typical 'stocking-glove' distribution
46
Criteria for metabolic syndrome
Metabolic syndrome: 3+ 1. abdominal obesity (waist circumference) 2. TG over 150 mg/dl 3. BP over 130/80 mmHg 4. HDL under 40 in M, under 50 in F 5. Fasting glucose over 100 mg/dl
47
Risk of chronic infection after initial infection of Hep B vs. Hep C
Much higher risk of chronic infection after acute infection of Hep C 80% of ppl who get Hep C will develop chronic infection vs. only 5% for Hep B

Amb Care (13 decks)

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