UTI, HTN, lymphadenopathy

Question 1

Elderly woman becomes incontinent and confused. No fever. What do you do?

Answer 1

Give ciprofloxacin to treat for cystitis.

UTI is a very common cause of incontinence in the elderly! Especially if patient is also confused or also immobile.

Question 2

When would you put an indwelling catheter in for urinary incontinence?

Answer 2

Last resort. Only if you cant intermittent cath them and their incontinence is chronic

Question 3

How do you treat urge urinary incontinence?

Answer 3

oxybutynin or tolterodine

Question 4

How do you dose diuretics for elderly patients?

Answer 4

Low dose (they are more salt sensitive) and follow-up in 1 week to check electrolytes

Question 5

What is the goal BP for people >60?

Answer 5

150/90 UNLESS they have CKD or diabetes (in which case its 140/90)

Question 6

What is goal BP for patients with diabetes OR CKD OR both?

Answer 6

140/90 for all cases

Question 7

What is first line treatment for diabetics with HTN?

Answer 7

Black: thiazide or CCB
Others: thiazide or CCB or ACE or ARB

Question 8

Which group of patients should get an ACE or ARB first line for HTN no matter what their race or other comorbidities?

Answer 8

Patients with CKD

Question 9

What are signs of coarcatation of the aorta?

Answer 9

Delayed lower extremity pulses
Fainter lower extremity pulses
Hypertension (bc they check at the arm)
"3" sign on X-ray
rib notching on X-ray
systolic and diastolic murmurs heard on the back from collateral vessels

50% will also have bicuspid aortic valve: systolic murmur, ejection click

Question 10

What is stage 2 hypertension? Why is this important?

Answer 10

higher than 160/100 (only one needs to be met)

This is important because then you start them with two drugs instead of just one, even if they’ve never been treated before

Question 11

What are alarm signs for lymphadenopathy?

Answer 11

• Older than 40 yrs old
• Greater than 2 cm lymphadenopathy
• Non-mobile, ragged (non-rubbery) lymph node
• Systemic symptoms
• Persistently enlared nodes for longer than 2 weeks

Question 12

How soon does the early antigen antibody test for EBV become positive?

Answer 12

1 month after infection

Question 13

What is the best test for diagnosing EBV early (esp if less than 1 month after dz)

Answer 13

anti-VCA (capsid) IgM antibody

heterophile agglutination test (monospot)

Question 14

Which site is the least preferred for biopsy of lymph nodes?

Answer 14

Inguinal region

Question 15

How do you screen for hearing loss?

Answer 15

Whispered voice test OR handheld audioscopy

Question 16

What is meclizine?

Answer 16

An antihistamine that is used to treat patients with prolonged sustained vertigo (ex: acute viral labyrinthitis)

Question 17

What are criteria for alcohol abuse?

Answer 17

more than 14 drinks per week (7 for women)
more than 4 drinks per occasion (3 for women)
2+ Cage questions

Question 18

What is first line treatment for BPH?

Answer 18

alpha-adrenergic antagonists (include tamsulosin, alfuzosin, terazosin and doxazosin)

decrease urinary symptoms in most men with mild to moderate BPH