SM NP review psych, respiratory, endo, musc Flashcards
What are some common screening tools for depression?
PHQ-2
PHQ-9
Why do most patients stop their psych medications at home?
sexual dysfunction and weight gain
How long can it take to see effects of antidepressants
4-6 weeks, then increase dose or switch meds. always double check compliance and underlying causes
How long will your patient be on SSRI>
taper off after 6 months
What is depression commonly treated with?
SSRI, SNRI
What herbal supplement can be used?
St John’s Worts (increases risk of serotonin syndrome)
What do we tell patients about GI complaints related to antidepressants?
They will go away in a few weeks
How do we approach suicidal ideation?
very straightforward, educate, ask for plan
Which SSRI should we avoid in the elderly?
Prozac (long half life)
What are some other medications that be given for depression?
TCAs- Nortitlyine
Which two antidepressants are safest in the elderly?
Zoloft and Lexapro
Which SSRI is most sedating?
Paxil
Which SSRI would likely be avoided in anxious patients?
Prozac
What do we need to consider before we prescribe an atypical antipsychotic?
Zyprexa, seroquel
weight gain and increased lipids increased glucose
What signs and symptoms would we see in bipolar?
phases between mania and depression
What is bipolar treated with
Lithium
Side effect: hypothyroidism
What signs/symptoms would you see with PTSD?
night mares, hypervigilance, exaggerated startle, flashbacks, insomina
What is PTSD commonly treated with
SSRIs
What is seasonal affective disorder
changing of seasons effects the patient’s circadian rhythm treated with sunlight
What is the most predominant symptom of asthma
cough
How do we know if treatment is successful
peakflows
What is the FeV1 with airflow limitation
decreased
What are the stages of asthma
intermittent, mild, moderate, severe
What medication do we never give alone?
LABA
What is the cornerstone of our treatment for asthma
Low dose inhaled corticosteriods (decrease mortality)
What three things impact peak flow?
height
age
gender
What is the go to treatment for acute asthma attacks
ICS + LABA
Common low dose ICS and LABA
budesonide-formoterol (Symbicort)
Steps of asthma treatment
- ICS-LABA PRN
- L-ICS daily
- ICS - LABA daily
- Referral
How do we diagnose COPD?
FEV1/FVC ratio less than 0.70 or 70%
What do we expect to see in COPD
barrel chest, clubbing of fingers, chronic cough, percussion –> hyperresonant
Group A treatment of COPD
Bronchodilator (SABA or LABA)
Group B treatment of COPD
LABA or LAMA long acting bronchodilator
Group C treatment of COPD
LAMA
Group D treatment of COPD
LAMA or combo (ICS-LAMA)
What signs and symptoms do we expect with pneumonia
cough, fever, chills, rhonchi, wheezes, tactile fremitis
How will you decide treatment for pneumonia with no comorbidities or recent antibiotic use
M- macrolide
A- amoxicillin
D- doxycycline
How will you treat pneumonia with comorbidities or antibiotic use in last 90 days
fluoroquinolones or Augmentin + macrolide
What is the CURB 65 criteria
C- Confusion
U- Urea- BUN > 19
R- Respiratory rate > 20
B- Blood pressure < 90/60
Age>65
2 points = consider admission
3 points= must be admitted
Where is TB seen in the lungs?
Upper lungs
When is >5 mm diagnostic for TB
CD4>200, HIV, immunocompromised, immigrant with exposure
When is >10mm diagnostic for TB
immigrant, healthcare worker
When is >15 mm diagnostic for TB
general public
How do you confirm TB diagnosis
Sputum culture
Why must we always treat strep throat with antibiotics
scarlet fever, rheumatic fever
Why can we not treat a patient with strep and mono with Amoxicillin
Morbiliform rash; use macrolide or sporin
What is the key finding of peritonsillar abscess
deviated uvula
Most cases of bronchitis are
nagging cough
95% viral
Do we treat bronchitis with antibiotics?
no unless it is pertussis to reduce how contagious it is
What signs and symptoms do we expect to see with sinusitis
recurrence of symptoms
tooth ache
hurts bending down
What do we treat sinusitis with
Augmentin/ Amoxicillin
What is our screening tool for thyroid disorder
TSH
If TSH is high and T3/T4 are low
Hypothyroidism
First line meds for hypothyroidism
Levothyroxine
First line medication for hyperthyroidism
Beta blockers
tapazole
PTU
What is the parathyroid’s purpose in the body
calcium and phosphorus
high calcium think malignancy
Somogyi Effect
dip in the middle of the night before it rises in the morning
Dawn phenomenon
blood glucose steadily increases all night
When do you screen for diabetes
45; q 3 years unless you have BMI > 30, family hx, PCOS
How we diagnose T2DM?
Hemoglobin A1C > 6.5
fasting glucose
random glucose
Which medications are most notorious for hypoglycemia? Cardioprotective?
SGLT2 inhibitors
GLP1 agonist
When do we discontinue metformin
GFR less than 30
What do you expect to see in Addison’s?
decrease cortisol, hyperpigmentation, increased potassium
What are safety concerns with Addison’s?
Emergency kit of steriods
What do we expect to find in cushings?
increased cortisol, decreased potassium, moon face, trunkal obesity, purple striae
How do we diagnose Lupus?
anti-nuclear steriod test and symptoms
What organ can Lupus really affect
Kidneys
How can you diagnose osteoporosis?
DEXA scan
-2.5 or below
How do you diagnose osteopenia?
-1- -2.5
How do we prevent osteoporosis?
calcium & vitamin D
weightbearing exercise
What are the risk factors associated with osteoporosis?
use of Depo
long term steriods
long term PPI
smoking
What are some treatment options for osteoporosis?
Bisphosphonates (-dronate)
What is a good medication to give to a patient with osteoporosis and hypertension
Thiazides
Heberden’s node
joint closest to the tip of the fingers
Bouchard’s
Closet to the hands
Characteristics of RA
can begin at any age
faster onset
bilaterally
stiffness > 1 hour
systemic symptoms
Bouchard’s nodes
Swan neck deformity
Characteristics of OA
Occurs with age
Slower onset
unilateral
stiffness < 1 hour
no systemic symptoms
Heberdens and Bouchards nose
What would you see on a Xray for arthritis
joint space narrowing
What are treatment options for arthritis
DMARDS
What are some common signs/symptoms of ankylosing spondylitis
lower back up to her neck
autoimmune inflammatory disease
What does ankylosing spondylitis look like on an xray
bamboo spine
When does a scaphoid fracture/ navicular fracture show up on an X-ray? How is it treated?
2 weeks
thumb spica cast
Phalen’s
backwards prayer hands
Tinel’s
tap the inner wrist
How would a patient describe Morton’s Neuroma
“pebble in their shoe between 3rd and 4th toe with numbness and tingling”
Lateral epicondylitis
painful and inflamed tendon on outer elbow
medial epicondylitis
Golfer’s elbow
McMurray Test
Meniscus
Apley test
Meniscus
Continued knee popping
Meniscus
Lachman test
ACL
Anterior drawer test
ACL
Valgus
MCL
Varus
LCL
What is a positive straight leg test
reproduction of pain between 30-70
L4 pain:
squat and rise exam knee jerk diminished
L5 Pain:
heel walking numbness at big toe
S1 painL
walk on toes absent ankle jerk
