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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
Q

What bugs do AIDS pts need prophylaxis against when CD4 falls below

(a) 200
(b) 100
(c) 50

A

(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
Q

Normal values for

(a) Total cholesterol
(b) HDL
(c) LDL
(d) TGs

A

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
Q

Describe the mini-cog

A

Mini-cog = 3 word recall + draw clock test to assess cognitive fxn in the elderly

28
Q

Differentiate primary vs. secondary prevention of CVD

A

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
Q

What does it mean to have an ASCVD risk of 3.2%

A

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
Q

What percent of hypertension is secondary?

(a) Most common cause of secondary HTN
(b) Other causes of secondary HTN

A

5% of hypertension is secondary (95% primary/idiopathic)

(a) Renal artery stenosis
(b) CKD, sleep apnea, hyperaldosteronism, Cushing’s, coarctation, thyroid disease

31
Q

1st line tx for outpatient pyelonephritis

A

Ciprofloxacin

-oral fluoroquinolones achieve high drug concentration in the renal medulla

32
Q

Where do diabetic ulcers develop?

(a) Tx

A

Diabetic ulcers result from neuropathy, they occur at pressure points of the feet

(a) Tx = off load pressure w/ casts and special shoes

33
Q

Followup appointment for pt w/

(a) prehypertension
(b) stage 1 HTN
(c) stage 2 HTN

A

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
Q

What does a UCx that grows Proteus mirabilis indicate?

A

If Urine culture grows proetus mirabilis- image pt /c it’s associated w/ urologic stones

35
Q

Differentiate what you’re looking for on a slide of vaginal discharge

(a) + KOH
(b) + NS

A

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
Q

What is anti-phospholipid syndrome?

(a) Hallmark clinical feature
(b) Related findings
(c) Skin manifestation
(d) Associated condition

A

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
Q

How can the following increase risk for liver disease

(a) Diabetes
(b) IVDU
(c) Alcohol use
(b) Fruit, shellfish, veggies

A

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
Q

Meds that are approved for angina treatment and their mechanism

A

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
Q

Kaposi’s sarcoma

(a) Appearance
(b) Tx

A

Kaposi’s sarcoma

a) Start off as red/purple patches (raised more than 1 cm
(b) Tx- lesions will often resolve w/ HAART

40
Q

What may LE hair loss indicate in a diabetic?

A

Peripheral neuropathy

41
Q

Differentiate the 4 parts of Medicare

A

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
Q

1st line tx for chlamydia

(a) 2nd line tx

A

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
Q

Differentiate hemochromatosis and Wilson’s disease

A

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
Q

Describe some of the criteria of a frail elder

A 
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
Q

Most common manifestation of diabetic neuropathy

A

Distal polyneuropathy

-numbness/tingling in a typical ‘stocking-glove’ distribution

46
Q

Criteria for metabolic syndrome

A

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
Q

Risk of chronic infection after initial infection of Hep B vs. Hep C

A

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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