Textbook charts Flashcards
Stage 0 COPD
Patient has cough and sputum production but normal spirometry results
Tx: Vaccines and risk factor assessment
Stage 1 COPD
Pt. has a FEW1/FVC <0.7
FEV1 = > 80% of predicted
Can be with or without symptoms
Tx: SABAs
Stage 2 COPD
FEV1/FVC < 0.7
FEV1 = 50-80% predicted
Can be with or without symptoms
Tx: LABAs
Stage 3 COPD (severe)
FEV1/FVC < 0.7
FEV1= 30-50% predicted
With or without symptoms
Tx: Inhaled steroids
Stage 4 COPD
FEV/FVC < 0.7
FEV 1 <30% of predicted OR FEV1 < 50% predicted with chronic hypoxemia
Tx: Long term O2 therapy and surgical intervention
First time lipid screening recommendations in children and adolescents
FH of dyslipidemia
FH of premature CVD or dyslipidemia (<55 years or <65 years in woman)
Unknown FH
Other CV risk factors
BMI >85th percentile
HTN (>95th percentile)
Cigarette smoking
Diabetes mellitus
Empty can test
Pt has arm abducted and elbow extended while elevating their arm against resistance
Tests supraspinatus for a rotator cuff injury
External rotation test
Tests infraspinatus and teres minor for injury
LIFT OFF TEST
Pt places hand on lumbar back and attempts to lift hand off back
Tests subscapularis for injury (also could just do internal rotation)
Hawkins impingement
Pain with internal rotation when the arm is flexed to 90 degrees with the elbow bent to 90 degrees
Tests for subacromial impingement of the supraspinatus tendon
Drop arm test
Patient cannot lower arm slowly from raised position
Test for large and extensive rotator cuff tears
Anterior drawer test at ANKLE
Tests fnxn of the anterior talofibular ligament
Inversion stress test of ankle
Tests calcaneofibular ligament, positive test is a “clunk”
Squeeze test of ankle
Examiner compresses tibia and fibula at midcalf
+= Pain at the anterior ankle joint below where the examiner is squeezing
-Indicates syndesmosis (high ankle injury)
Introduction of solid food for infants
4-6 months
Plantar fasciitis tx
Shoe inserts, NSAIDs, icing, rest
Polymyalgia rheumatica
Inflammatory disorder that presents as pain and stiffness in the shoulder and pelvic girdle
Typically has an elevated ESR
*Tx: Corticosteroids
Refeeding Syndrome
Fatal shifts in electrolytes that occur in patients who were previously malnourished
***Patients will have hypophosphatemia
Initial tx of hypercalcemia of malignancy
IV fluids; will enhance excretion
Brown to black leopard spotting of the colonic mucosa
Melanosis coli
Benign condition resulting from abuse of laxatives; resolves after discontinued use
Colonoscopy in a person who has a first degree member with colon cancer
Screen at 40 and repeat every 5 years
Also do if they have 2 second degree members with colonocarcinoma
Drugs that can cause lupus pleuritis or drug induced pleuritis
Hydralazine
Procainamide
Quinidine
DOC in WPW
Procainamide; other drugs slow AV conduction and can paradoxically in WPW cause tachycardia
Metformin has to be stopped prior to what imaging study
CT angiography (or anything w/ contrast) due to increased stress on the kidneys
Pt w/ nursing home pneumonia tx
Ceftazidime + Levofloxacin + Vancomycin
First two covered gram pos, gram neg, BOTH cover pseud, and last for MRSA
SSRI you cant use in pregnancy
Paroxetine; assoc. w/ cardiac defects
Treatment resistant osteoporosis can be treated with…
Teriparatide; its intermittent use activates osteoblasts more than osteoclasts
When to treat for the flu
As soon as it is suspected; many rapid tests can be negative so look at community trends to test for
Aspirin age recommendations
In Men 45-79 and women 55-79
Mitral valve prolapse tx
BBs
Severe? =» Surgery
Pt w/ sulfa allergy who wants to climb a mountain
Dexamethasone
Natural remedy for varicose veins
Horse chestnut seed
-Contains some escin, which reduces edema and lowers fluid exudation by decreasing vascular permeability
Most common cause of erythema multiforme
HSV
Pyogenic tenosynovitis
Typically presents in a trigger finger like presentation
Treat w/ antibiotics and splinting or potentially surgical drainage w/ antibiotics
Postural orthostatic tachycardia syndrome
Rise in hr by >30/min when standing up
Sx: Position dependent headaches, abdominal pain, lightheadedness, palpitations, sweating, and nausea
-Most patients will not pass out; usually a female
CAGE screening
Cut down
Angry
Guilty
Eye opener
PCP tx.
Haldol
Acidify urine to excrete
***These pts. have vertical AND horizontal nystagmus as well as their aggressive psychosis
Trazadones use in practice today
Actually used to help people go to sleep
Mirtazapine
SNRI assoc. w/ weight gain
TCA side effects
Convulsions, Cardiac probs (QT prolongation), and coma
-Also have anticholinergic ADRs
Amitryptyline, nortriptyline, imipramine, desipramine
Pt. on an MAOI and suddenly has severe HTN
HTN crisis probably precipitated by eating wine or cheese (Hypertensive crisis)
Lithium ADRs
Teratogen
Nephrotoxic
Nephrogenic DI
Narrow TI
Ativan
Lorazepam (short acting)
Valium
Diazepam (medium acting)
Clonidine
Clonazepam (long acting)
Pt on fluphenazine w/ fever, rigidity, and AMS
NMS
=»Treat w/ dantrolene
Other ADRs of typical antipsychotics include gynecomastia, galactorrhea, amenorrhea (anti-dopaminergic), and extrapyramidal symptoms
Last antipsychotic to try if all else has failed
Clozapine
Extrapyramidal sx
Akasthesia (restlessness)
Acute dystonia (involuntary spastic contractions, torticollis, hammering) -treat w/ anticholinergics
Dyskinesia
Tardive dyskinesia (irreversible sensitization leading to facial tics)
Atypical antipsychotics
Olanzapine, quetiapine, risperidone, ariprazole
Treats both positive and negative psychotic sx
Indications for thyroid nodule biopsy
Greater than 1cm
Symptomatic
History or thyroid cancer
Acute cervical Radiculopathy Tx
Conservative (NSAIDS, ice)
Treatment for an acute hemorrhoid presenting at <24 hours
Hemorrhoidectomy in office
Patellofemoral pain
Usually in females and presents with pain moving on hilly terrain as well as with hip abduction
Pioglitazone
Thiazolodine drug that increases the sensitivity of the peripheral tissues to insulin via PPAR activation
Repaglinide
Nonsulfonylurea drug that also stimulates insulin secretion
Acarbose
A-glucosidase inhibitor that ️Decreases the absorption of carbs
Labs to monitor on E. coli O 157 patients
Renal labs, be on the lookout for HUS
Anterior talofibular ligament
Most common sprained ligament on the lateral malleolus; could also be the calcaneofibular ligament or the posterior talofibular ligament
Pt has a positive stick of 3-5 RBCs…what do you do next?
Repeat UA in 6 weeks
Risk factors for bladder cancer
Smoking
Benzene dyes
Aromatic amines
History of urologic disease
Analgesic abuse
Pelvic irradiation
Doc for hyperthyroidism
Radioactive iodine
⭐️Can’t use in pregnant ladies though
Tx of thyroid storm
PTU/methimazole + BBs
May also give hydrocortisone to prevent an adrenal crisis
Child with asthma exacerbation and already received Albuterol and steroids
Can try magnesium sulfate before Iv steroids
Ethylene glycol toxicity
Patient presents with a metabolic acidosis with an increased anion gap and subsequent renal failure
Urine will have calcium oxalate crystals, patient will appear acutely intoxicated and have Hypocalcemia
Tx: Fomepizole
Baby born to hep b mom
Give hep B and Hep B IG
Rotavirus contraindication
Kid with history of intusussusception
Young toilet trained female who develops a beefy red rash on her perineum
Strep pyogenes infection; usually from improper hygiene
Will be from the perineum and down to the anus
Latex allergies can cross react with what foods?
Avocados, bananas, chestnuts
Anticoagulation for A-fib
Low risk (no other comorbidities) = Aspirin
Anything else= Warfarin
DOC for pneumocystis pneumonia
Bactrim
Could also add corticosteroids
Patient who presents with urethral discharge but has not improved with azithromycin and ceftriaxone
Prescribe metronidazole; could be trichonomas vaginalis
Treatment for otitis media
Amoxicillin; 10 days
Breastfeeding with bilateral nipple pain, erythema, and swelling
Probably a candida infxn
what drug can ppt Angioedema
ACEIs
Cat scratch disease treatment
Azithromycin
Drugs that can induce ovulation in PCOS patients
Clomiphene
Metformin
Rosiglitazone
Treatment for HIT
Discontinue heparin and start a different anticoagulant
What must be monitored while on Vancomycin?
Trough serum levels; too low and resistance will develop
SSRIs and cough syrup
Possible cause of serotonin syndrome
Test to rule out adrenalcortical insufficiency
Morning cortisol
Patient with frequent PVCs but is otherwise healthy
Needs evaluation and possible treatment for CAD
Tx for sudden sensorineural hearing loss in an elderly patient
Corticosteroids
Possibly O2
Subacute thyroiditis
Painful gland, hyperthyroidism, elevated ESR
Tx: Corticosteroid
Perinephric abscess
Collection of the puss in the tissue surrounded by the kidney; diagnosis made when patient with pyelonephritis has a persistent fever and flank pain that is unresponsive to IV antibiotics
RFs: Urinary tract abnormalities, DM,
Tests: CT
Imaging for septic arthritis in a child
US
Female athlete triad
Amenorrhea
Osteoporosis
Disordered eating
Treatment of hyponatremia w/ <125meq/Na
Use 3% saline
EKG findings w/ hypokalemia
ST segment depression
Flattened T waves
Prominent U waves
EKG findings w/ hyperkalemia
Peaked T waves
Flattend P waves
Widened QRS
Tx of hyperkalemia
- IV calcium (stabilizes the myocardium)
- Glucose and insulin (shifts K+ into cells)
- Kayexalate (do this last)
Centor Criteria
Absence of cough
Enlarged/tender anterior cervical adenopathy
Fever of 100.4 or higher
Tonsillar swelling/exudates
Age 3-14
Score 2-3 =» Rapid strep test
Score 4 =» Empiric treatment
Features of malignant pulmonary nodules
Size >10mm
Irregular shape
“Ground-glass” appearance
No calcification/eccentric calcifications
Double the size of a previous image
Pt with well controlled hypothyroidism and is pregnant
Still need to increase their thyroid medication as thyroid dysfunction is assoc. w/ pregnancy
Complete rotator cuff tear in a young patient management
Surgery
Best imaging study for osteomyelitis
MRI
Treatments for coronary artery stenosis
Aspirin
BBs (after MI)
ACEIs (at high risk after MI)
ARBs (CAD)
Amiodarone (coexisting arrhythmias)
Painkiller prescribed for ESRD pts
Fentanyl; because it is metabolized in the liver
Drugs to give patient with a confirmed MI
Aspirin and Heparin
Clopidogrel if there is an aspirin allergy
Drugs that are CI’d in new onset chest pain
CCBs
Gottron’s papules
Sign of dermatomyositis; appears a purple-wart like features on the hands but usually appear quickly
Prophylactic for traveler’s diarrhea
Rifaximin
Gestational diabetes glucose goal
<100
Dupuytren’s contracture
Progressive thickening and nodule formation on the palmar fascia leading to a contracture of the associated finger
Commonly seeing pitting of the skin right before the contracture
Tx for status epliepticus
Lorazepam
Follow w/ phenytoin
Tx for acute dystonia
Diphenyhydramine
Benztropine
Typically occurs after taking a medication
Tx for ingrown nails
Nail avulsion followed by phenolization or direct surgical excision of the nail matrix
B-quant eval for ectopic pregnancy
<1500 =» Get a repeat in 48 hrs =» Still hasn’t risen =» Probably an ectopic
Epididymitis tx
Ceftriaxone and doxycycline
MCC are Neisseria and Chlamydia
Fibroid surgery
Wants kids? =» Myomectomy
Doesnt? =» TAH
Wants kids but it’s too big to cut out? =» Leuprolide to shrink it
Telogen effuvium
Shredding hair loss that occurs after a stressful event (illness, surgery, pregnancy) and occurs about 3 months after the event
Will go away 6 months after the event
Screening of asymptomatic patients for COPD pts
Not recommended
Erythema infectiosum
“Fifth disease”
Caused by parvovirus B19; presents with a slapped cheek appearance and an exanthem that spreads to the trunk and the extremities as a diffuse macular rash; will eventually become lacy and reticulated
Fracture that occurs with hyperextension of the wrist
Triquetral fracture; tenderness will be noted on the dorsal wrist of the ulnar side
Radiograph will show a bony avulsion
DOC for supraventricular arrhythmia
Adenosine
Post thrombotic syndrome
Chronic pain, swelling, and skin changes in the affected limb of a DVT
-Compression stockings help to prevent
Albumin as an acute phase reactant
Decreases
Treatment of PMS
Luteal-phase spironolactone
Contrast media to use in patients with kidney disease
Iso-osmolar or hyposomolar
Rather than the normal, high osmolar
Urge incontinence
Patients who suddenly realize they reallllyyy have to go to the bathroom and are usually unable to reach it in time
Atypical antipsychotic NOT ASSOCIATED with weight gain
Aripiprazole
Augmentin plus side
Covers anaerobes
SCFE s/s
Pain with physical activity, usually in the upper thigh
*****Limited internal rotation of the hip
Preop eval in RA patient
Cervical spine imaging to detect atlantoaxial subluxation
-Would make intubation difficult
Blood pressure in stroke patients
Do not treat HTN unless it is <220/<120
-HTN is thought to be a protective mechanism to preserve cerebral blood flow
Behcet’s syndrome
Recurring genital and oral ulcerations alongside relapsing uveitis
More common in Asian peopl
Can lead to arthritis, vasculitis, intestinal manifestations, or neurologic probs
Usually have the development of sterile pustules that are slightly painful
Stress incontinence
Stretching of the cardinal ligament after multiple births =» cystocele formation
Dx: (+) Q-tip test (>30 degrees rotation)
Tx: Kegel exercises, pessaries, surgery
Overactive/hypertonic bladder
Random spasms or detrusor instability
Dx: Patients have increased urge and leak, usually need to run to the bathroom
Tx: Antispasmodics (oxybutinin) `
Overflow incontinence
Absent detrusor detractions
Often assoc. w/ MS, trauma, or antispasmodic meds
Incontinence occurs once pressure in the bladder exceeds that of the sphincter
Dx: Distended bladder, focal neurologic deficits
Anticoagulant monitoring methods
Anti-factor Xa levels =» LMWH
aPTT =» Unfractionated heparin
INR =» Warfarin
Follow up on a positive PPD
CXR
First work up in a patient with possible septic arthritis
CBC and ESR, then do an aspiration
Alopecia areata
Localized AI reaction to hair follicles; can spread to cover the entire scalp or body
Tx: Intralesional corticosteroid injections, usually will recover in 6 months
Test to perform before removing an adrenal mass
Renal vein sampling
Turns out, the abnormal values are found opposite the mass sometimes
Using other drugs in addition to Chantix
Is not beneficial and can in fact increase incidence of nausea and headache
Tx for Raynaud’s
CCBs
First study in a patient with a syncopal episode
EKG
High risk angina associations
ST segment changes
Hypotension
Mitral regurgitation murmur that has worsened
New S3
Prolonged pain at rest
Pulmonary edema
Contrast media to use in patients with kidney disease
Iso-osmolar or hyposomolar
Rather than the normal, high osmolar
Urge incontinence
Patients who suddenly realize they reallllyyy have to go to the bathroom and are usually unable to reach it in time
Atypical antipsychotic NOT ASSOCIATED with weight gain
Aripiprazole
Augmentin plus side
Covers anaerobes
SCFE s/s
Pain with physical activity, usually in the upper thigh
*****Limited internal rotation of the hip
Preop eval in RA patient
Cervical spine imaging to detect atlantoaxial subluxation
-Would make intubation difficult
Blood pressure in stroke patients
Do not treat HTN unless it is <220/<120
-HTN is thought to be a protective mechanism to preserve cerebral blood flow
Behcet’s syndrome
Recurring genital and oral ulcerations alongside relapsing uveitis
More common in Asian peopl
Can lead to arthritis, vasculitis, intestinal manifestations, or neurologic probs
Usually have the development of sterile pustules that are slightly painful
Stress incontinence
Stretching of the cardinal ligament after multiple births =» cystocele formation
Dx: (+) Q-tip test (>30 degrees rotation)
Tx: Kegel exercises, pessaries, surgery
Overactive/hypertonic bladder
Random spasms or detrusor instability
Dx: Patients have increased urge and leak, usually need to run to the bathroom
Tx: Antispasmodics (oxybutinin) `
Overflow incontinence
Absent detrusor detractions
Often assoc. w/ MS, trauma, or antispasmodic meds
Incontinence occurs once pressure in the bladder exceeds that of the sphincter
Dx: Distended bladder, focal neurologic deficits
Anticoagulant monitoring methods
Anti-factor Xa levels =» LMWH
aPTT =» Unfractionated heparin
INR =» Warfarin
Follow up on a positive PPD
CXR
First work up in a patient with possible septic arthritis
CBC and ESR, then do an aspiration
Alopecia areata
Localized AI reaction to hair follicles; can spread to cover the entire scalp or body
Tx: Intralesional corticosteroid injections, usually will recover in 6 months
Test to perform before removing an adrenal mass
Renal vein sampling
Turns out, the abnormal values are found opposite the mass sometimes
Using other drugs in addition to Chantix
Is not beneficial and can in fact increase incidence of nausea and headache
Tx for Raynaud’s
CCBs
First study in a patient with a syncopal episode
EKG
High risk angina associations
ST segment changes
Hypotension
Mitral regurgitation murmur that has worsened
New S3
Prolonged pain at rest
Pulmonary edema
Back up to use if you cannot use Vancomycin for MRSA
Linezolid
CAP tx
Ceftriaxone, Azithromycin (combo in hospital)
Azithromycin (outpatient)
Possibly Moxifloxacin if needed (PROBS WRONG ON TEST)
HCAP
Vancomycin and Piperacillin/Tazobactam
Cover MRSA and Pseudomonas
Meningitis tx
Ceftriaxone, Vancomycin, Steroids
UTI tx
Amoxicillin (pregnant ladies)
Nitrofurantoin
Bactrim (can’t use if in renal failure)
Cerftiaxone (IV, for pyelonephritis)
Ciprofloxacin (outpatient pyelonephritis)
NSAID you can use with a history of MI
Naproxen
Acute paronyhcia
Local trauma to the nail fold or cuticle followed by an infxn
Tx: Topical antibiotics
Bacterial vaginosis diagnostic criteria
- Thin, homogenous vaginal discharge
- Vaginal pH >4.5
- Positive KOH test
- Presence of clue cells on a wet mount
Acute diverticulitis tx
Bowel rest, quinolone, and metronidazole
-If diverticulitis is asymptomatic, just treat with a high-fiber diet
Tympanoplasty indication
> 3 ear infxns in 6 months or >4 in one year
Baby who turns blue with feeds and snores
Choanal atresia
Dx: Try to pass a catheter thru the nose
Tx: Surgery
Pregnant woman with a HepB exposure and who is unvaccinated
Give HBIG and vaccine right away; there are no contraindications
Other findings in Legionella pneumonia
Hyponatremia
Diarrhea
Elevated liver enzymes
Pneumonia tx in patients with chronic disease
Levofloxain, moxifloxacin
Organism assoc. w/ COPD assoc. pneuonia
H. influenza
Tx of normal pneumonia
3rd generation cephalosporin (Ceftriaxone) + Macrolide (Azithromycin)
or
Moxifloxacin
CURB 65
Confusion of new onset
Urea > 19mg/dL (BUN)
RR >30
Bp <90/<60
65 or older
-Any one of these positive =» Admit
Organism assoc. w/ COPD assoc. pneuonia
H. influenza
Tx of normal pneumonia
3rd generation cephalosporin (Ceftriaxone) + Macrolide (Azithromycin)
or
Moxifloxacin
CURB 65
Confusion of new onset
Urea > 19mg/dL (BUN)
RR >30
Bp <90/<60
65 or older
-Any one of these positive =» Admit
Noncontraceptive benefits of OCPs
️Decreased incidence of benign Breast disease
Relief from menstrual disorders
Reduced risk of uterine leiomyomata
Protection from ovarian cysts
Reduction of acne
Improvement of BMD
️Decreased risk of colorectal cancer
Protection against ovarian cancer, endometrial cancer, iron deficiency anemia, PID, and Fibrocystic Breast diseAse
Concerning murmurs during pre athletic screens
Diastolic murmurs
Grade 3/6 or louder
HCM or MARFAN possibility
Secondary action of Lasix
Bronchodilator
MCC of CHF
Cad
Cardio thoracic ratio greater than 50%
Systolic dysfunction likely due to CHF
PSVT Tx
Adenosine
Tarsal tunnel syndrome
Entrapment of the posterior tibial nerve as it courses behind the medial malleous
Pain with probation of the foot and parasthesia in the medial ankle and heel and sometimes the plantar surface
What would the parathyroid hormone look like with Hypercalcemia in Hyperparathyroidism?
Normal
It should be suppressed
Workup of Horner’s
Need a CXR to rule out a Pancoast tumor
