Top 55 dx (2)

Question 1

DM Rx

Answer 1

if a1c <7.5, start with lifestyle changes and monotherapy. metformin 500 mg bid, daily

Question 2

DM DD

Answer 2

metabolic syndrome
hypothyroid
prediabetes

Question 3

diarrhea Rx

Answer 3

if afebrile, loperamide 4 mg x 1 PO, then 2 mg PO after each loose stool

Max 16mg/day

Question 4

diarrhea DD

Answer 4

IBS, ulcerative colitis, colon cancer

Question 5

dyspepsia Rx

Answer 5

PPI - pantoprazole 20 mg PO daily for 8 weeks, then reevaluate

Question 6

dyspepsia non pharm

Answer 6

lose weight
eat moderate amounts of food at each meal
avoid food/snacks within three hours of sleep

Question 7

dyspepsia labs

Answer 7

cbc
cmp
lipase
amylase

Question 8

dyspepsia DD

Answer 8

hiatal hernia
esophageal spasms
esophageal cancer

Question 9

dysphagia Rx

Answer 9

none

Question 10

dysphagia non pharm, imaging

Answer 10

swallowing rehab, speech therapy
barium swallow exam, upper endoscopy

Question 11

dysphagia DD

Answer 11

esophageal strictures
MS
esophageal tumor

Question 12

emphysema s/sx

Answer 12

pink puffers
severe dyspnea, normal ABGs
thin
barrel chest
dyspnea on exertion
decreased breath sounds

Question 13

emphysema Rx

Answer 13

SABA albulterol 90 mcg 2 puffs 4-6 h prn
LABA formoterol 12 mcg 1 puff q12h daily

Question 14

fibromyalgia Rx

Answer 14

cyclobenzaprine 5 mg PO one daily at bedtime

Question 15

fibromyalgia non pharm, labs, DD

Answer 15

1. CBT, PT
2. CBC, CMP, CRP, thyroid function test
3. RA, depression, polymyalgia rheumatica

Question 16

fibromyalgia s/sx

Answer 16

soft tissue pain in muscles, ligaments, tendons
post exercise malaise
fatigue
polyarthralgia
headaches
depressed mood
appears tired

Question 17

gallstones s/sx

Answer 17

intense, dull discomfort located in RUQ, epigastric or substernal area that may radiate to back
diaphoresis
NV
triggered by a fatty meal
post prandial pain

Question 18

gallstones rx

Answer 18

ursodiol 8 mg/kg/day PO, divided into three dose (TID)

Question 19

gallstones labs, imagina

Answer 19

cbc cmp amylase lipase
transabdominal US

Question 20

gallstones DD

Answer 20

PUD
acute cholecystitis
pancreatitis

Question 21

acute gout attack s/sx

Answer 21

pain, tenderness, erythema, swelling of affected joint
usually monoarticular, mostly big toe
excruciating pain that awakens them at night

Question 22

acute gout attack rx

Answer 22

NSAID for pain - indomethacin 25 mg q8H PO for 5-10 days, stop med when pain stops

colchicine (kowl chuh seen) 1.5 mg PO x 1, then 0.6 mg PO 1 hour later x 1, for three days

Question 23

acute gout attack non pharm

Answer 23

rest
elevate area
avoid triggers (alcohol)
avoid food high in purine (seafood, shellfish, turkey, bacon)

Question 24

acute gout attack labs, imaging, DD

Answer 24

CBC CMP serum uric acid level
x ray of area
arthritis, fracture, cellulitis

Question 25

ED rx

Answer 25

sildenafil 25 mg once daily, prn, 1 hour before anticipated sexual activity

Question 26

ED non pharm, labs, imaging, DD

Answer 26

1. reduce alcohol, tobacco, drug use; psychosexual therapy 2. cbc, cmp, fasting BG to r/o DM, TSH, testosterone levels, PSA levels 3. color doppler sonography to assess vascular causes 4. urithritis, late stage syphilitic lesions, penile tumor

Question 27

HA s/sx tension, migraine, cluster

Answer 27

tension - NV, bilateral pressure, bandlike pain, sleep issues, social stressors, neck arthritis, neck muscle spasms migraine - unilateral, pulsating, episodic pain, NV, photophobia, phonophobia cluster - periorbital, nighttime unilateral non-pulsating pain, photophobia, tearing, nasal stuffiness

Question 28

HA rx

Answer 28

ibuprofen 400 mg PO q4-6 hours prn prophylactic - topiramate 25 mg qHS x 1week then 50 mg/day q week

Question 29

headache - bilateral pressure, bandlike pressure, neck arthritis, neck muscle spasms

Answer 29

tension

Question 30

headache - unilateral, pulsating, episodic pain

Answer 30

migraine

Question 31

headache - periorbital, nighttime unilateral non-pulsating pain

Answer 31

cluster

Question 32

hematuria can be caused by

Answer 32

infection menstruation vigorous exercise viral illness trauma

Question 33

hematuria Rx

Answer 33

pain - ibuprofen 400 mg PO 2-6 H prn UTI - nitrofurantoin 100 mg PO BID 5 days pyelonephritis - ciprofloxacin 500 mg PO BID 3 days urethritis - doxycycline 100 mg PO BID for 7 days

Question 34

hematuria non pharm, labs, imaging, DD

Answer 34

1. heat pads, increase fluid intake, avoid coffee/soda/alcohol, encourage frequent voiding 2. UA, urine microscopy, CBC CMP 3. abd CT 4. kidney stones, UTI, urethritis