Varney's Ch. 5: Common Conditions in Primary Care Flashcards
What is the level of Hgb that is diagnostic for anemia?
<12.0 g/dL (women)
What types of anemias are considered NORMOLITIC anemia?
- acute blood loss
- autoimmune disease
- sickle cell
What types of anemias are considered MICROLYTIC anemia?
- iron deficiency
- thalassemia
- anemia of chronic disease
What types of anemias are considered MACROLYTIC anemia?
- folate deficiency
- vitamin B deficiency
What type of anemia will have a high TIBC (total iron binding capacity)?
1. folate deficiency
2. iron deficiency
3. vitamin B12 deficiency
4. sickle cell anemia
- Iron deficiency anemia
What ferritin level is diagnostic of iron-deficiency anemia?
<100-150 ng/mL
What are iron-rich foods?
- green leafy vegetables
- egg yolks
- raisins or prunes
- liver or oysters
What is the recommended dose for correcting iron-deficiency anemia?
325 mg ferrous sulfate daily.
How can the daily iron supplementation be adjusted to decrease side effects?
every-other-day dosing
What medication should be avoided when taking iron?
antacids - decrease absorption
After iron levels have been normalized, how much longer is supplementation recommended to adequately replenish iron stores?
3 months.
Is the MCV high or low in macrocytic anemia?
high
What ethnicities are associated with beta-thalassemia?
Chinese, Asian, Africain
What ethnicities are associated with sickle cell disease?
African
What ethnicities are affected by G6PD (glucose-6-phosphate dehydrogenase)?
Mediterranean or African descent
What happens in G6PD (glucose-6-phosphate dehydrogenase)?
Lack of G6PD enzymes=RBC breakdown, especially during an infection or with oxidative drugs.
What type of genetic inheritance is G6PD?
X-linked, affecting mostly males.
What meds are contraindicated in G6PD individuals?
Sulfa, nitrofurantoin (macrobid), NSAIDS, touidine blue and methylene blue, fava beans, and some legumes.
Which type of genetic inheritance is Von Willebrand’s disease?
A. X-linked
B. autosomal recessive
C. autosomal dominant
D. Y-linked
C. Autosomal Dominant.
Which type of genetic inheritance is sickle cell disease?
A. X-linked
B. autosomal recessive
C. autosomal dominant
D. Y-linked
B. Autosomal Recessive
Which type of genetic inheritance is thalassemia disease?
A. X-linked
B. autosomal recessive
C. autosomal dominant
D. Y-linked
B. Autosomal Recessive
Which type of genetic inheritance is G6PD disease?
A. X-linked
B. autosomal recessive
C. autosomal dominant
D. Y-linked
A. X-linked
What is the mechanism of Von Willebrand’s Disease and what condition is it associated with?
Defects in the protein needed for platelet adhesion, effecting clotting factor VIII. Causes heavy menses (20% of cases)
What labs would you order to diagnose Von Willebrand’s Disease?
- Platelets (normal)
- Ferritin (low)
- Coagulation (prolonged)
What is the lifespan of a WBC?
10 days
What are the sx of thrombocytopenia?
- heavy menstrual bleeding
- fatigue
- easily bruised
- enlarged spleen
What are the causes of thrombocytopenia?
- Meds - NSAIDS, statins, PCN, sulfonamides, chemo
- Environmental
- Excessive alcohol
- Autoimmune Dz
- Cancers
- Splenic retention - infection, tumors
What stage of hypertension is a BP of 134/81?
Stage 1 HTN
What stage of hypertension is a BP of 156/107
Stage 2 HTN
What labs need to be done for hypertension?
- fasting blood sugar
- thyroid
- serum creatinine
- lipid profile
- serum Na, K, Ca
Lifestyle changes recommended for primary hypertension
- weight loss
- low sodium diet <2400 mg/day
- exercise
- smoking cessation
- moderate alcohol consumption
First-line med management for primary hypertension?
Low-dose thiazide diuretic.
What level of LDL-C would you prescribe a maximally tolerated statin (ex: high dose atorvastatin or rosuvastatin)?
LDL-C = >190 mg/dL
What level of LDL-C would you prescribe a moderate-intensity statin (ex: lower dose atorvastatin, rosuvastatin, simvastatin)?
LDL-C = 70-189 mg/dL and 40-75 years with diabetes
What level of LDL-C would you prescribe a low-intensity statin (ex: lovastatin or pravastatin)?
- LDL-C = 70-189 mg/dL and 40-75 years WITHOUT diabetes OR
- 10-year risk score >7.5%
What is a safe pharmacologic treatment for rhinorrhea, sneezing, and congestion?
Ipratropium bromide (Atrovent) nasal spray. 2 sprays in each nostril 3-4xday
What Abx can you prescribe for rhinosinusitis (sinus infection)?
- amoxicillin or ampicillin/clavulanate
- doxycycline (PCN alternative)
- Clindamycin/cefixime or cefpodoxime
What Abx can you prescribe for pharyngitis caused by GAS (group A beta-hemolytic Streptococcus)?
- amoxicillin OR penicillin - 10 days
- Clindamycin OR clarithromycin OR azithromycin (PCN alternative)
What can be prescribed for bronchitis?
- albuterol inhaler for relief or cough and wheezing (2 puffs q 4-6 hrs)
What is the recommended therapy for pertussis?
Macrolide Abx-Erythromycin, azithromycin, or clarithromycin. Can prescribe prophylaxis for those in close contact.
What do you prescribe for asthma if there are mild symptoms (occurring <2 days/week and <2 nighttime wakening/month)
Albuterol sulfate (Proventil) as needed.
When would you prescribe omeprazole for an 8-week cours?
GERD treatment or diagnosis
When would you prescribe triple therapy of a PPI, clarithromycin and amoxicillin for 14 days?
Peptic ulcers caused by H. pylori.
What is the name of an infection ascending to the kidneys that has fever, flank pain with bacteriuria?
pyelonephritis
When is a UTI labeled as “recurrent UTI”
2 episodes of acute bacterial cystitis (pos. cultures) within 6 months. OR 3 episodes in 12 months.
What is the recommended first-line treatment for an uncomplicated lower UTI?
- nitrofurantoin (Macrodantin) OR nitrofurantoin monohydrate with macrocrystals (Macrobid)
- phenazopyridine HCl (Pyridium) 200 mg 3xday for 48 hours
What is the second and third-line treatments for a UTI/pyelonephritis?
- TMP-SMX (trimethoprim-sulfamethoxazole=Bactrim)
- (serious infection) Augmentin, fluroquinolones, or beta-lactams
What are the criteria for metabolic syndrome?
- waist circumference >88cm women
- triglycerides >150 mg/dL
- HDL-C <50 mg/dL
- BP >130/85
- fasting glucose >110 mg/dL
What is diagnostic for diabetes?
- HA1c >6.5%
- Fasting >126 mg/dL
- 2 hr/75g >200 mg/dL
What should the starting dose be for thyroid hormones for a newly diagnosed hypothyroidism?
50 mcg/day, recheck in 4-6 weeks, increase until euthyroid state is achieved.
What is the initial treatment for carpal tunnel?
Splinting at night.
