question

Screening for AAA

answer

Men 65-75 who have ever smoked (A)

question

Test used to screen for AAA

answer

Abdominal duplex ultrasonography

question

Treatment for AAA

answer

>5.5 cm --> surgery 3.0-5.4 cm --> repeated surveillance Q3-12 months Growth >1.0 cm/yr --> surgery

question

Screening for Alcohol Misuse

answer

Persons older than 18 years

question

Screening Tests for Alcohol Misuse

answer

AUDIT, AUDIT-C, or number of times person drank >5 (4 if woman or older than 65) drinks in the past year

question

Treatment for Alcohol Misuse

answer

Behavioral Counseling interventions

question

Recommendation for Aspirin Usage

answer

Men 45-79 years old (MI protection) Women 55-79 (Stroke protection) *Benefit of MI reduction must outweigh the risk of GI hemorrhage

question

Risk Factors For GI Hemorrhage

answer

Men Other NSAID usage Hx of GI ulcer Uncontrolled HTN Anticoagulation

question

Screening for Asymptomatic Bacteriuria

answer

Women at 12-16 weeks of pregnancy or first prenatal visit if farther along

question

Screening Test for Asymptomatic Bacteriuria

answer

Urine culture Dipstick and microscopy have poor PPV and NPV

question

Treatment for Asymptomatic Bacteriuria

answer

Nitrofurantoin

question

Prophylactic Aspirin for the Prevention of Colon Cancer

answer

The USPSTF DOES NOT recommend this due to risk of GI hemorrhage

question

Bacterial Vaginosis Screening in Pregnant Women

answer

The USPSTF DOES NOT recommend this due to lack of evidence that it reduces mortality or morbidity

question

Amsel Criteria

answer

Need 3/4: 1. Fishy odor with addition of KOH 2. Vaginal pH >4.7 3. Clue cells on wet mount 4. Thin, homogenous discharge

question

Treatment of BV

answer

Oral Metronidazole or oral Clindamycin or Vaginal Metronidazole or Vaginal Clindamycin creams

question

Screening for Bladder Cancer

answer

The USPSTF DOES NOT recommend this due to lack of accurate screening methods

question

Screening for HTN

answer

Adults > 18 years

question

Diagnosis of HTN

answer

>140 systolic or >90 diastolic Must have 2 different BP readings that are elevated over a period of 1-several weeks

question

Categories of BP

answer

Normal = <120/<80 PreHTN = 120-129/80-89 Stage 1 HTN = 140-159/90-99 Stage 2 HTN = 160+/100+

question

Major CV Risk Factors

answer

HTN Obesity Dyslipidemia DM Cigarette smoking Inactivity Age >55 (men) or >65 (women Family History of premature CVD: <55 (men) and <65 (women)

question

Causes of HTN

answer

Sleep Apnea Drug-induced (diuretics, cyclosporine, glucocorticoids, amiodarone) Chronic kidney disease Primary Aldosteronism (Conn's Syndrome) Cushing's Syndrome Pheochromocytoma (MEN II and III) Coarctation of aorta (Turner's) Thyroid/Parathyroid disease

question

Goal BPs for Treatment (JNC8)

answer

;140/90 for adults ;60 years without CKD 60 years without CKD ;140/90 for all ages with DM, but no CKD ;140/90 for all ages with CKD +/- DM

question

Treatment of HTN for Non-Black without CKD

answer

Thiazide Diuretic ACE-I ARB CCB

question

Treatment of HTN for Black without CKD

answer

Thiazide Diuretic CCB

question

Treatment of HTN for All Races with CKD +/- DM

answer

ACE-I ARB

question

BRCA-Related Cancer Screening

answer

All women with family members who had breast, ovarian, tubal, and/or peritoneal cancers

question

Medications for Breast Cancer Risk Reduction

answer

Offer tamoxifen or raloxifene to women at high risk with low risk for adverse side effects

question

Mammography Screening

answer

Women 50-74: biennial (every other year) Women under 50: Take the patient's factors into context and weigh benefits and risks Women >75: not recommended to get screening

question

Breastfeeding recommendations

answer

Interventions to educate and encourage women during pregnancy and postnatal period to breastfeed

question

Carotid Artery Stenosis Screening

answer

USPSTF DOES NOT recommend screening for the general population for asymptomatic carotid stenosis

question

Diagnostic Test for Carotid Artery Stenosis

answer

Ultrasonography of Carotid Artery with Doppler flow

question

High Intensity Statin

answer

Lowers LDL-C by >/=50% Atorvostatin 40-80 mg Rosuvostatin 20-40 mg

question

Medium Intensity Statin

answer

Lowers LDL-C by 30-50% Atorvostatin 10-20 mg Rosuvostatin 5-10 mg Simvastatin 20-40 mg Provastatin 40-80 mg Lovastatin 40 mg Fluvastatin 40 mg BID

question

Low Intensity Statin

answer

Lowers LDL-C by </=30% Pravastatin 10-20 mg Lovastatin 20 mg

question

Cervical Cancer Screening

answer

Women 21-65 Pap smear with cytology Q3 years Women 30-65 Pap smear with HPV testing Q5 years

question

Cervical Cancer Screening Exemptions

answer

Women >65 years with previously normal screenings Women who had a hysterectomy with removal of the cervix and no history of precancerous lesion

question

High Grade Intraepithelial Lesion Treatments

answer

Cryotherapy, laser therapy, loop excision and cold knife excision

question

Early Stage Cervical Cancer Treatment

answer

Surgery or chemoradiation

question

Ottawa Rules for Ankle

answer

XR required if 1/3: Tenderness at posterior edge of lateral malleolus Tenderness at posterior edge of medial malleolus Inability to bear weight both immediately after injury or in the ED

question

Ottawa Rules for Foot

answer

XR required if 1/3: Tenderness at base of 5th metatarsal Tenderness at navicular Inability to bear weight both immediately after injury or in the ED

question

Exceptions to the Ottawa Rules

answer

Inebriation/uncooperative patient Other distracting painful injuries that cloud the perception of pain in the regions listed in rules Diminished sensation in legs Gross swelling which prevents palpating of medial malleolus ***Patient is under 18 years old****

question

Ottawa Rules for Knee

answer

Age >55 Isolated tenderness of patella Tenderness at head of fibula Inability to flex 90 degrees Inability to bear weight both immediately and in the ED

question

Chlamydia and Gonorrhea Screening for Women

answer

Women 24 with risk factors identified

question

Risk Factors for Gonorrhea/Chlamydial Infection in Women

answer

Age 20-24 New sex partner More than 1 sex partner Sex partner with concurrent sex partners Sex partner with an STI Inconsistent condom usage Previous or coexisting STI Exchange of sex for money or drugs Incarceration Military recruits Black and Hispanic

question

Screening Test for Gonorrhea/Chlamydia

answer

Nucleic Acid Amplification Test (NAAT)

question

Screening for Chronic Kidney Disease

answer

USPSTF has insufficient information to recommend screening for CKD in asymptomatic adults

question

Screening for COPD

answer

The USPSTF DOES NOT recommend screening for COPD in asymptomatic adults using spirometry

question

Diagnosis of COPD

answer

FEV1:FVC ratio of <70% with less than 12% reversibility

question

Colorectal Cancer Screening

answer

Start screening at 50 years and continue until the age of 75 years

question

Screening Tests for Colorectal Cancer

answer

Fecal Occult Blood Testing (annually) Sigmoidoscopy (Q5 years) Screening Colonoscopy (Q10 years)

question

Screening for Colon Cancer in Adults >75 years

answer

76-85: recommendation against screening unless patient has risk factors >85: do not screen as there is no net benefit

question

Screening for Congenital Hypothyroidism

answer

All infants should be screened for T4 and TSH

question

Timing of Congenital Hypothyroidism Screening

answer

Between 2-4 days of age

question

Treatment for Congenital Hypothyroidism

answer

Confirmatory testing and thyroid hormone replacement within 2 weeks after birth

question

Dental Carries Prevention in Children Under 5 years

answer

USPSTF recommends that fluoride should be prescribed for children 6 months to 5 years old if water is deficient in fluoride

question

Screening for Depression in Adults

answer

Screen all adults 18+ when staff-assisted depression care supports are in place

question

Screening for Depression in Adolescents

answer

Screen adolescents 12-18 years old for MDD when staff-assisted depression care supports are in place

question

Screening for DM Type 2 in Adults

answer

Screen adults with sustained high blood pressure (treated or untreated) >135/80

question

Screening Tests for DM II

answer

Fasting plasma glucose 2 hour post-load plasma glucose HgbA1C

question

Fall Prevention in Older Adults

answer

Exercise or physical therapy and Vit D supplementation to prevent falls in adults >65 years

question

Risk Factors for Falls

answer

Age Hx of falls Hx of mobility problems Poor performance on Get-Up-and-Go Test

question

Get-Up-and-Go Test

answer

Time it takes for a person to rise from an armchair, walk 10 feet, turn, walk back and sit down (Average healthy adult >60 years can do it in 10 seconds)

question

Folic Acid Supplementation in Pregnant Women

answer

Take supplements with 0.4 to 0.8 mg of folic acid to reduce risk of NTDs 4.0 mg in women with a Hx of NTDs in prior pregnancies ***All women who are capable of pregnancy should take it***

question

Screening for HSV

answer

USPSTF DOES NOT recommend screening asymptomatic pregnant women nor routine screening for asymptomatic adolescents and adults

question

Gestational Diabetes Mellitus Screening

answer

Screen all pregnant women after 24 weeks of gestation

question

GDM Screening Test

answer

50 g oral glucose challenge test (OGCT)

question

Positive OGCT? (>130 mg/dL)

answer

Do the 100 g oral glucose tolerance test (OGTT)

question

Interventions for Overweight/Obese Patients With Additional CVD Risk Factors

answer

Behavioral counseling, with intense focus on healthful diet and physical activity, over an extended period of time ***Refer at a BMI of 30 + CVD risk factors***

question

Screening for Hearing Loss in Newborns

answer

Screen all newborns

question

Screening Test for Newborns' Hearing

answer

Otoaccoustic Emissions Test (OAE) If failed OAE test, then follow up with Auditory Brainstem Response (ABR)

question

When to Screen Newborns for Hearing Loss

answer

Before 1 month of age Confirmatory testing before 3 months of age if failed first test

question

Screening for Hearing Loss in Adults

answer

USPSTF has insufficient evidence to determine the benefits of screening for hearing loss in asymptomatic adults over the age of 50

question

Screening for Hepatitis B in Pregnant Women

answer

Screen all pregnant women

question

Screening Test for Hepatitis B in Pregnant Women

answer

HBsAg detection, regardless of previous negative HBsAg results

question

Timing of Screening for HBV in Pregnant Women

answer

At first prenatal visit At hospital for birth in women with unknown status or continuing risk factors for HBV infection

question

Treatment for HBV infection of pregnant women

answer

Infants should receive HBV vaccine and HBIG within 12 hours of birth

question

Screening for HBV Infection in General Population

answer

Screen all person at high risk for infection

question

Risk Factors for HBV Infection

answer

Country of origin Lack of immunization in persons with parents from a country/region with high prevalence HIV infection Injection Drug Users Household or sexual contacts of HBV-infected persons Male homosexuals Hemodialysis Immunosuppressive therapy

question

Treatment for HBV

answer

Pegylated Interferon-Alpha-2a entecavir Tenofovir

question

Screening for Hepatitis C Infection in General Population

answer

Screen all persons at high risk for infection Screen adults born between 1945 and 1965

question

Screening Test for HCV Infection

answer

Anti-HCV antibody testing, with confirmatory PCR testing

question

Risk Factors for HCV Infection

answer

Past/present injection drug use Sex with an injection drug user Blood transfusion before 1992 Long term hemodialysis Born to HCV-infected mother Incarceration

question

Treatment for HCV Infection

answer

Pegylated Interferon plus Ribavirin for 48 weeks

question

Screening for HIV

answer

Screen in adolescents and adults aged 15-65 years Screen younger adolescents and older adults at increased risk Screen all pregnant women for HIV

question

Risk Factors for HIV Infection

answer

Male Homosexuals Active Injection Drug Users Exchanging Drugs for Sex or Money Sexual contact with a known HIV-positive individual

question

Screening Tests for HIV

answer

Rapid screening test (positive results requires work up) Serum testing: ELISA, followed by confirmatory Western Blot Immunofluorescent assay

question

Hyperbilirubinemia Screening in Infants

answer

USPSTF has insufficient evidence to recommend screening for hyperbilirubinemia

question

Screening for Idiopathic Scoliosis in Asymptomatic Adolescents

answer

USPSTF DOES NOT recommend screening for idiopathic scoliosis in asymptomatic adolescents

question

Screening for Intimate Partner Violence

answer

Screen women of childbearing age for intimate partner violence and provide or refer women who screen positive to intervention services

question

Screening for Abuse of Elderly and Vulnerable Adults

answer

USPSTF has insufficient evidence to recommend screening

question

Screening Test for Intimate Partner Violence

answer

HITS (Hurt, Insult, Threaten, or Scream)

question

Screening for Iron Deficiency Anemia

answer

USPSTF has insufficient evidence to recommend screening asymptomatic infants 6-12 months for Iron Deficiency Anemia Screen all asymptomatic pregnant women

question

Iron Supplementation Recommendations

answer

Routine iron supplementation for children aged 6-12 months at increased risk of developing Iron Deficiency Anemia Routine supplementation for pregnant women with Iron Deficiency Anemia

question

Risk Factors for Developing Iron Deficiency Anemia

answer

Rapid growth Inadequate dietary intake Blood loss Decreased absorption Prematurity

question

Screening For Lead Levels

answer

USPSTF has insufficient evidence to recommend screening symptomatic children 1-5 years at increased risk USPSTF DOES NOT recommend screening children 1-5 years with average risk USPSTF DOES NOT recommend screening asymptomatic pregnant women

question

Screening for Lipid Disorders in Adults

answer

Men ;35: Screen them Men 20-35: Screen if they have increased CVD risk Women 20+: Screen them if they have increased CVD risk

question

Screening Test for Lipid Disorders

answer

Lipid Panel: Total Cholesterol, LDL-C, HDL-C, Triglycerides

question

Screening for Lipid Disorders in Children 1-20

answer

USPSTF has insufficient evidence to recommend screening children aged 1-20

question

Prophylactic Use of Aspirin in Pregnant Women

answer

Low dose aspirin (81 mg) after 12 weeks in women at high risk for preeclampsia

question

Risk Factors for Preeclampsia

answer

Hx of Preeclampsia Multifetal gestation Chronic HTN DM Renal disease Autoimmune disease

question

Goal BPs for Treatment (JNC7)

answer

;130/80 for Diabetics ;140/90 for everyone else

question

Screening for Lung Cancer

answer

Annual screening for lung cancer with low dose CT in adults 55-80 with a 30 pack year smoking history + smoking currently OR 30 pack year smoking history and quit in the past 15 years

question

Most Common Form of Lung Cancer

answer

Non-small cell lung cancer: Adenocarcinoma Squamous Cell Carcinoma Large Cell Carcinoma

question

Adenocarcinoma of Lung

answer

Peripheral More common in Women Most common in nonsmokers and overall Bronchioalveolar subtype = lepidic, with hazy infiltrates similar to pneumonia

question

Squamous Cell Carcinoma

answer

Central More common in Men Associated with cigarette smoking Hypercalcemia due to PTHrP Cavitation with keratin pearls

question

Large Cell Carcinoma

answer

Peripheral Pleomorphic giant and highly anaplastic undifferentiated cells Diagnosis of exclusion

question

Small Cell (Oat Cell) Carcinoma

answer

Central May produce ACTH, ADH, or Abs to presynaptic Ca2+ channels Amplified myc gene

question

Bronchial Carcinoid Tumor

answer

Central Mass effect symptoms Carcinoid syndrome with right-sided heart problems

question

Menopausal Hormone Therapy Recommendation

answer

USPSTF DOES NOT recommend using combined estrogen and progestin in postmenopausal women NOR recommend the use of estrogen in postmenopausal women who have had a hysterectomy

question

Screening for Obesity in Adults

answer

Screen all adults and refer adults with BMI ;30 to intensive, multicomponent behavioral interventions

question

Screening for Obesity in Children and Adolescents

answer

Screen children 6+ years for obesity and refer to comprehensive, intensive behavioral intervention

question

Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum

answer

Prophylactic ocular topical medication for all newborns within 24 hours of birth

question

Prophylactic Ocular Topical Treatments for Gonococcal Ophthalmia Neonatorum

answer

1.0% Tetracylcine or 0.5% Erythromycin ophthalmic ointment

question

Screening for Osteoporosis

answer

Screen Women 65 or older OR Women whose fracture risk is equal to or greater than that of a 65 year old white woman

question

Screening for Osteoporosis in Men

answer

USPSTF has insufficient evidence to recommend

question

Screening Tests for Osteoporosis

answer

DEXA of hip and lumbar spine Quantitative US of the calcaneus

question

Risk Factors for Osteoporosis in Women 50-64 years old

answer

BMI ;21 Smoker Daily alcohol use Parental fracture history White race

question

Treatment for Osteoporosis

answer

Adequate Calcium and Vit D intake Weight-bearing exercise Bisphosphonates (inhibit osteoclast activity) PTH Raloxifene (SERM) Denosumab (Ab to RANKL)

question

Screening for Ovarian Cancer

answer

USPSTF DOES NOT recommend screening for ovarian cancer in women (no screening test that is both sensitive and specific for it)

question

Screening for Pancreatic Cancer

answer

USPSTF DOES NOT recommend screening for pancreatic cancer in asymptomatic adults

question

PKU Screening in Newborns

answer

Screen all newborns for PKU within 24 hours of life (up to 7 days if necessary) with confirmatory testing by 2 weeks of age

question

Screening Test for PKU

answer

Guthrie Bacterial Inhibition Assay Automated Fluorometric Assay Tandem Mass Spectrometry

question

Treatment for PKU

answer

Phenylalanine restrictions instituted shortly after birth

question

Screening for Prostate Cancer

answer

USPSTF DOES NOT recommend using PSA as a screen for prostate cancer

question

RhD Incompatibility Screening

answer

Screen all pregnant women during their first visit for pregnancy related care Repeated RhD Ab testing for all unsensitized RhD negative women at 24-28 weeks gestation, unless father is known to be RhD negative

question

Behavioral Counseling for STDs

answer

Do intensive behavioral counseling for all sexually active adolescents and adults at increased risk for STDs

question

Sickle Cell Disease Screening

answer

Screen all newborns for SCD with confirmatory testing no later than 2 months of age

question

Screening Test for SCD

answer

Thin-layer isoelectric focusing OR High performance liquid chromatography

question

Treatment for SCD in newborns

answer

Prophylactic Penicillin by 2 months of age

question

Skin Cancer Counseling

answer

Counsel all children, adolescents and adults 10-24 years of age with fair skin about minimizing exposure to UV radiation

question

Skin Cancer Screening

answer

USPSTF has insufficient evidence to assess benefits and harms of skin cancer screening

question

Suicide Risk in Adolescents, Adults, and Older Adults

answer

USPSTF has insufficient evidence to assess benefits and harms of screening for suicide risk

question

Screening for Syphilis Infection

answer

Screen all pregnant women Screen persons at increased risk for syphilis infection

question

Screening Test for Syphilis

answer

RPR, with confirmatory test by Fluorescent Treponemal Antibody (FTAb) or Treponema palladium particle agglutination test (TPPA)

question

Risk Factors for Syphilis Infection

answer

Male homosexuals Commercial Sex Workers Exchanging Sex for Drugs Adult Correctional Facilities

question

Testicular Cancer Screening

answer

USPSTF DOES NOT recommend screening for testicular cancer in adolescent or adult men

question

Counseling About Tobacco Use

answer

Counsel all adults and pregnant women about tobacco use and provide interventions Counsel all school age children and adolescents about tobacco use and provide interventions

question

Visual Impairment Screening in Children 1-5

answer

Screen children 3-5 years old to detect amblyopia or its risk factors USPSTF has insufficient evidence to recommend screening in children 1-3

question

Preventative Vit D and Calcium to Prevent Fractures

answer

VitD supplementation is effective in preventing falls in community-dwelling adults 65+ years old who are at increased risk of falls

question

Vit D Deficiency Screening

answer

USPSTF has insufficient evidence to assess benefits and harms of screening in children under 18 years old

question

Vitamin Supplementation to Prevent CVD or Cancer

answer

USPSTF DOES NOT recommend using Beta-Carotene or Vit E supplements to prevent CVD or Cancer

question

Impingement of L3-L4 Level

answer

Impinges L4 Deficits: Patellar jerk reflex, dorsiflexion of foot, and sensory of medial aspect of tibia

question

Impingement of L4-L5 Level

answer

Impinges L5 Deficits: Extensor of great toe, sensory of dorsum of foot/base of first toe

question

Impingement of L5-S1 Level

answer

Impinges S1 Deficits: Ankle jerk reflex, plantar flexion, sensory of buttocks, posterior thigh, calf, lateral ankle and foot

question

Sciatica is Common With Which Impingements

answer

L4-L5 and L5-S1

question

Signs of Cauda Equina Syndrome

answer

Difficulty urinating --> Overflow incontinence Fecal Incontinence Progressive Weakness Saddle Anesthesia

question

Spinal Stenosis

answer

Usually seen in Adults ;50 years Pain/paresthesias of lower extremities or back Pseudoclaudication ***Symptoms worsen with standing or back extension***

question

Spondylisthesis

answer

Forward subluxation of a vertebral body, usually in L4-L5 or L5-S1

question

Inflammatory Diskitis

answer

Young age Caused by S. aureus, with refusal to walk, fever, signs of sepsis, disk space narrowing and sclerosis on radiograph

question

Spondylolysis

answer

Older than 10 years old Caused by hyperextension, with back and buttock pain accompanied by lordosis with activity and tight hamstrings

question

Ankylosing Spondylitis

answer

HLA-B27 Morning spinal stiffness, IBD, sacroiliitis, bamboo spine on XR

question

Straight Leg Raising Test

answer

Ipsi: more sensitive for herniated disk (pain = positive herniated disk) Contra: more specific for herniated disk (no pain = negative herniated disk)

question

Beck's Triad

answer

Jugular Venous distension, muffled heart sounds, decreased BP -----> Cardiac Tamponade

question

Contraindications to Thrombolytics

answer

Active internal bleeding Hx of cerebrovascular disease Recent surgery Intracranial neoplasms AVM Aneurysms Bleeding Diathesis Severe Uncontrolled HTN

question

2 Month Vaccines

answer

HepB-2 RV-1 DTaP-1 Hib-1 PCV-1 IPV-1

question

4 Month Vaccines

answer

RV-2 DTap-2 Hib-2 PCV-2 IPV-2

question

6 Month Vaccines

answer

HepB (3rd dose by 18 months) RV (3rd dose before 8 months) DTaP-3 Hib-3 PCV-3 IPV (3rd dose by 18 months) Annual Influenza

question

12 Month Vaccines

answer

Hib-4 PCV-4 MMR-1 Varicella-1 HepA-1

question

4 Year Old Vaccines

answer

DTaP-4 IPV-4 Influenza MMR Varicella

question

Drugs Used to Treat Acute MI

answer

Beta Blockers Heparin Nitrates ACE-Inhibitors Thrombolytics ASA

question

Food Poisoning: Reheated Rice

answer

B. cereus

question

Food Poisoning: C. Botulinum

answer

Canned foods, honey for infants

question

Food Poisoning: Steam Table (Reheated Meat Dishes)

answer

C. perfringens

question

Food Poisoning: E. coli

answer

Undercooked meat

question

Food Poisoning: Eggs, Poultry, Meat

answer

Salmonella

question

Food Poisoning: S. aureus

answer

Mayonnaise (potato salad), Custard dishes Occurs within 1-2 hours of eating

question

Food Poisoning: Seafood

answer

V. parahaemolyticus or V. vulnificus

question

Campylobacter Diarrhea

answer

Seagull-shaped organisms, grown at 42* C Common with poultry Bloody stools Tx: Erythromycin or Fluoroquinolone

question

Entamoeba histolytica diarrhea

answer

Dysentery, bloody stools Liver abscess Flask-shaped ulcer on histo Tx: Metronidazole and Iodoquinol(for cysts)

question

Giardia diarrhea

answer

Seen in hikers, day cares, travel Foul-smelling, fatty diarrhea Tumbling, owl-eye cysts in water Tx: Metronidazole

question

ETEC diarrhea

answer

Traveler's diarrhea Tx: short course of fluoroquinolone or TMP/SMX ****Tx with Azithromycin in children and pregnant women****

question

EHEC

answer

O157:H7 May present with HUS Bloody diarrhea Tx: Fluoroquinolone or TMP/SMX

question

Salmonella Diarrhea

answer

Poultry and eggs Flagellar motility on microscopy Many animal reservoirs: armadillos, turtle, birds Tx: avoid Abx unless disease is severe --> may prolong carrier status

question

Shigella Diarrhea

answer

Reservoirs only in humans and primates Acute onset bloody diarrhea Tx: Fluoroquinolone; TMP-SMX if sensitive

question

C. difficile Diarrhea

answer

Pseudomembranous colitis Abx usage recently Tx: Metronidazole or oral Vancomycin

question

Vibrio cholerae Diarrhea

answer

Comma-shaped organisms Rice-water diarrhea --> copious amounts Tx: Oral rehydration therapy; Doxycycline for adults and Azithromycin for children/pregnant women

question

Viral Diarrhea

answer

Norovirus (Norwalk) = adults, usually on cruises Rotavirus = children, often in day care

question

Celiac Sprue

answer

Gluten-sensitive enteropathy Diarrhea, malabsorption, weight loss Test for Tissue Transglutimase antibody and Endymysial antibody Gluten restriction

question

Peripheral Vertigo DDx

answer

BPV = otoliths Acute Labyrinthitis = viral infection with inflammation Ménière disease = increased pressure leads to vertigo, tinnitus and hearing loss Damage to CN VIII = acoustic neuroma or ototoxic meds (loop diuretics, aminoglycosides, and high dose salicylates)

question

Central Vertigo DDx

answer

Damage to brainstem = usually other CN findings as well Migraine = vasospasm of Vertebrobasilar artery MS Phenytoin and other meds

question

Tx of Peripheral Vertigo

answer

BPV = Epley maneuver to relocate debris; can symptomatically tx with Meclizine, Dimenhydrinate, Antiemetics, and Benzos Méniére's Disease = Acetazolamide or HCTZ

question

Migraine Headache

answer

15-45 year olds 3:1 female predominance Unilateral, pulsatile, moderate-to-severe pain, aggravation with movement 80% with Family Hx Sx: N/V, photo or phonophobia May experience paresthesias, numbness, strange odors or speech disturbances

question

Tx for Migraines

answer

Avoiding headache triggers, withdrawal from stressful environments and rest Avoid caffeine, chocolate, alcohol, tyramine, nitrates and artificial sweeteners NSAIDs, acetaminophen, antiemetics, caffeine ****Triptans are most common abortive agents****

question

Contraindication to Using Triptans or Ergotamine

answer

Vasoconstrictive properties -->CAD, PVD, and uncontrolled hypertension

question

Tension Headache

answer

Mild-to-moderate pain in B/L occipital-frontal areas Associated with stress, muscle contraction No N/V or sleep awakening

question

Tx for Tension Headache

answer

Avoidance of stress or improved stress management NSAIDs or Acetominophen Amitriptyline

question

Cluster Headaches

answer

Severe, unilateral, periorbital or temporal area Lacrimation, rhinorrhea, ptosis, miosis, eyelid edema Occur in clusters with 1-8xper day for 4-6 weeks 8:1 men predominance

question

Tx for Cluster Headaches

answer

Avoid known precipitants 100% O2 for 15 minutes Sumatriptan NSAIDs, Propanolol, Amitriptyline, Lithium

question

Temporal Arteritis

answer

Unilateral, erythematous tenderness in temporal region in elderly persons Increased ESR usually Dx requires Bx of temporal artery Start CS if suspected --> can lead to blindness if not treated

question

GERD

answer

Burning pain in epigastric, sternal, or throat regions Sour taste in mouth Aggravated by laying down or bending over Relieved with food, but returns 1-2 hours later Worsened by smoking

question

Nonulcer dyspepsia

answer

Dx of Exclusion --> looks like GERD and PUD

question

EGD

answer

Detects: esophagitis, erosions, ulcerations, malignancies, webs, diverticuli, and strictures ***Indicated in anyone >45 years with new onset heartburn***

question

Barium Studies

answer

Reveals anatomic abnormalities, such as esophageal spasm and possibly reflux

question

Esophageal pH monitoring

answer

Used for patients with GERD and normal EGD, patients with atypical symptoms, or patients refractory to treatment Correlates % of time pH<4 with sxs

question

Rapid Urease Test

answer

Tissue sample analyzed for urease to detect H. pylori Requires EGD

question

Histologic Staining for H. pylori

answer

Silver stain (Warthin-Starry) for H. pylori Expensive and more time-consuming

question

Serologic and Fecal Antigen Test for H. pylori

answer

Serologic: Noninvasive, inexpensive Remains indefinitely positive if patient has ever been infected Fecal: Inconvenient, inexpensive Can be used to test for cure

question

Urea Breath Test

answer

Patient ingests Urea with radio labeled Carbon Measures exhaled radio labeled Carbon

question

Long Term Tx for GERD is Required if:

answer

Severe esophagitis Barrett Esophagus Stricture Atypical symptoms

question

Triple Therapy

answer

Amoxicillin (Metronidazole if allergic) Clarithromycin PPI (Omeprazole)

question

Quadruple Therapy

answer

Used as 2nd line therapy or in areas with high Clarithromycin resistance PPI (Omeprazole) Bismuth Tetracycline Metronidazole or Tinidazole

question

NSAIDs That Can Be Substituted if Ulcers are Present

answer

Salsalate COX-2 Inhibitor Misoprostol

question

Renal Cell Carcinoma

answer

90% have hematuria Gene deletion on Chromosome 3 (VHL) Can produce EPO, ACTH, PTHrP Triad of Flank Pain, Hematuria, and Abdominal Mass

question

Painless Hematuria

answer

Suggests bladder cancer (Transitional Cell Carcinoma), especially in people over 50

question

Hematuria with Hx of URI

answer

IgA Nephropathy (Berger Disease) Can lead to HSP

question

Hematuria with Hemoptysis

answer

Goodpasture Syndrome (Anti-GBM)

question

Hematuria with Fever, CVA Tenderness and Skin Rash

answer

Interstitial Nephritis --> often have eosinophiluria

question

Drugs that Cause Interstitial Nephritis

answer

Thiazides Penicillin Derivatives Sulfonamides Rifampin INH NSAIDs

question

Hemorrhagic Cystitis

answer

Cyclophosphamide

question

Red-Colored Urine without Hematuria

answer

Pyridium Rifampin

question

Malar Rash, Fatigue, Joint Pain and Hematuria

answer

SLE Decreased complement levels

question

Palpable Purpura, Arthritis, Abdominal Pain

answer

Henoch-Schönlein Purpura

question

Person >40 with Hematuria or Persistent Hematuria

answer

Further work up needed --> start with CBC, BUN, Cr and IVP If IVP normal, then do cytoscopy for adults >40 years

question

Risk Factor for Bladder Cancer

answer

Aniline Dyes Smoking

question

Focal Necrotizing Vasculitis, Necrotizing Granulomas in Paranasal Sinuses and Lungs, and Necrotizing Glomerulonephritis

answer

Wegener's Vasculitis PR3-ANCA/c-ANCA

question

Hypercalcemia, Renal Insufficiency, Anemia, and Bone Lytic Lesions or Back Pain

answer

Multiple Myeloma Serum and urine electrophoresis

question

Mild Jaundice After Fasting or Infection

answer

Gilbert Syndrome Family Hx of similar

question

Jaundice Due to Drugs

answer

Acetaminophen, INH, Nitrofurantoin, MTX, Sulfa, OCP, Chlorpromazine, and Phenytoin

question

Charcot Triad

answer

High Fever RUQ pain Jaundice ****R/O Cholangitis****

question

Kayser-Fleischer Rings

answer

Wilson disease Decreased ceruloplasmin and increased urine copper

question

Transaminases Elevated out of Proportion to Alkaline Phosphatase

answer

Suggests liver dysfunction

question

Elevated Alk Phos and Gamma Glutyl Transpeptidase out of Proportion to Transaminases

answer

Obstructive dysfunction

question

AMA Abs

answer

Primary Biliary Cirrhosis Middle aged women Tx with Ursodiol

question

Hemochromatosis

answer

Increased Total Iron, Transferrin Saturation, and Ferritin Decreased TIBC (iron is taking up all the available spots) Cirrhosis, Diabetes mellitus, skin pigmentation, CHF and testicular atrophy Tx with Deferoxamine

question

Anti-SM Abs

answer

Autoimmune Hepatitis

question

Weight loss and jaundice

answer

Suspect Carcinoma at the head of the pancreas

question

Twisting Injury of Knee

answer

Meniscal tear

question

Direct Blow to Knee While Foot is Planted

answer

Sprains of medial and lateral collateral ligaments

question

Patellofemoral Syndrome

answer

Overuse with muscular imbalance Repeated impact with knee in flexion leads to inflammation of patellofemoral groove

question

Osgood-Schlatter

answer

Anterior Tibial tubercle pain due to micro avulsions of growth plate on the tibial tubercle where the patellar tendon inserts

question

Locking of knee

answer

Torn meniscus or loose body that becomes trapped

question

Sudden Onset of Severe Knee Pain in Middle Aged Man

answer

Gout

question

Young Individual with Red, Swollen Joint and Elevated Temperature

answer

Gonococcal septic arthritis

question

Lachman Test

answer

Knee flexed 20-30* and move tibia forward Tests anterior-to-posterior laxity

question

Drawer Test

answer

Knee Flexed 90* and move tibia forward Tests anterior-to-posterior laxity

question

McMurray Test

answer

Evaluates meniscus

question

Negative Birefringement Crystals

answer

Uric acid crystals --> Gout

question

Positive Birefringement Crystals

answer

Calcium pyrophosphate crystals --> pseudogout

question

Fat Globules on Arthrocentesis

answer

Bone fracture

question

Treatment for Patellofemoral Syndrome

answer

Rest NSAIDs Ice Nonimpact activities

question

Treatment of Osgood-Schlatter

answer

Relative rest Ice NSAIDs Stretching exercises

question

LAD With Sheep Exposure

answer

Brucellosis

question

LAD With Cave Exposure

answer

Histoplasmosis

question

LAD With Rabbits, Ticks, or Deer Fly

answer

Tularemia

question

LAD With California Exposure, Especially After Earthquake

answer

Coccidioidomycosis

question

LAD With Dog or Cat Bite

answer

Pasteurella multocida

question

LAD With Cat Scratches

answer

B. henselae

question

Enlarged Supraclavicular LN

answer

Suggests malignancy

question

Vomiting Centers in Brain

answer

Medullary Reticular Formation Chemoreceptor Trigger Zone in 4th ventricle

question

Bilious Vomitus

answer

Open Pylorus

question

Feculent Vomitus

answer

Lower GI obstruction or gastrocolic fistula

question

Diabetic Individual with N/V

answer

Suspect DKA

question

Persistent Early Morning Vomiting

answer

Pregnancy Increased intracranial pressure --> possibly brain tumor

question

Diabetic or Elderly Individual with N/V

answer

Suspect MI

question

Prochlorperazine and Promethazine

answer

Low potency typical antipsychotic (D2 antagonists) Most commonly prescribed drugs in Fam Med SE: Sedation and EPS in children

question

Serotonin Antagonists (Ondansetron)

answer

Mostly used for chemotherapy nausea

question

Meclizine

answer

Antihistamine used for vestibular symptoms

question

Tx for Gastroparesis

answer

Metoclopramide (Reglan)

question

Scopolamine

answer

Anticholinergic used for prophylaxis of motion sickness

question

Multiple, Symmetric Join Involvement

answer

RA

question

Nocturnal Joint Pain in Younger Patient

answer

Suspect a bone tumor

question

Pain That Increases With Usage

answer

OA

question

Reiter Syndrome

answer

Chlamydia trachomatis Conjunctivitis, Arthritis, and Urethritis Keratoderma blennorrhagia --> kyperkeratotic lesion on palms and soles Balanitis Circinate --> shallow, painless ulcer on penis

question

Sudden Onset of Pain, Erythema, Limited Range of Motion, and Swelling

answer

Gout

question

Lupus-like Syndrome

answer

Sulfonamides Hydralazine INH Procainamide Phenytoin

question

Joint Pain + Diarrhea, Conjunctivitis and Uveitis

answer

IBD

question

Joint Pain + Dry Mouth/Eyes

answer

Sjögren Syndrome

question

Joint Pain + Heliotropic Rash

answer

Polymyositis or Dermatomyositis

question

Joint Pain + Nail Pitting

answer

Psoriatic Arthritis

question

Joint Pain + Erythema Migrans

answer

Lyme Disease Usually after going camping in New England

question

Joint Pain + Tophi

answer

Gout

question

XR of OA

answer

Nonuniform joint space narrowing, changes in subchondral bone and osteophytes ***XR severity doesn't correlate to the severity of disease***

question

XR of RA

answer

Periarticular soft tissue swelling, periarticular osteopenia, uniform loss of joint space and bony erosion

question

Infliximab

answer

Monoclonal Ab to TNF-alpha Predisposes to infection --> can reactivate latent TB

question

Etanercept

answer

Fusion protein of receptor for TNF-alpha and IgG Fc Decoy receptor

question

Rituximab

answer

Ab to CD20 Used for RA (with MTX) and for B cell non-Hodgkin lymphoma

question

Gout Treatment

answer

Allopurinol Probenecid Colchicine

question

Palpitation + Exophthalmos

answer

Hyperthyroidism

question

Palpitation + Acute Flushing, Elevated BP

answer

Pheochromocytoma

question

Medications That Can Cause Palpitation

answer

Theophylline Digoxin Beta Agonists Anti-arrhythmics Pseudoephedrine Alcohol Cocaine TCAs

question

Exertion Does What to PACs or PVCs?

answer

Makes them disappear

question

Short PR Interval with Delta Wave

answer

WPW Syndrome Associated with Paroxysmal Supraventricular Tachycardia

question

Younger, Low Risk Patients with A-fib

answer

Tx with ASA ***No need for anticoagulation***

question

Tonsillar and Palatal Ulcerations

answer

Herpangina --> caused by Coxsackie virus

question

EBV Infection

answer

Pharyngitis Posterior cervical LAD Malaise Fever Axillary and inguinal LAD

question

Centor Criteria

answer

Exudative pharyngitis Fever Tender anterior cervical LAD Absence of cough Modifier: add 1 point >44 years old --> subtract 1 point Abx at 4-5, culture 2-3 and symptomatic tx -1-1

question

Early Morning Sore Throat without Fever

answer

GERD

question

Sexual Activity + Greenish Exudates and Dysuria

answer

Gonococcal pharyngitis

question

Sandpaper Rash + Strawberry Tongue, Pharyngitis, and Circumoral Pallor

answer

Scarlet Fever

question

Jones Criteria for Rheumatic Heart Disease

answer

One major: Polyarthritis, Carditis, Erythema Marginatum, Subcutaneous Nodules, Syndenham's Chorea Two minor: Fever ;102.1, Arthralgia, Elevated CRP or ESR, Leukocytosis, EKG showing heart block, previous RHD

question

Diphtheria

answer

Adherent, gray membrane Low grade fever Tonsillitis Tender cervical LAD ***Tx with Antitoxin and Penicillin/Erythromycin***

question

Kawasaki Disease

answer

B/L conjunctivitis Unilateral cervical LAD Strawberry tongue Rash of hands and feet ***Tx with ASA***

question

Tx for Streptococcal Pharyngitis

answer

Penicillin Allergic to PCN: Clindamycin, Erythromycin, or Azithromycin

question

Ig Light Chains in Urine

answer

Multiple Myeloma Can cause proteinuria that is negative on dipstick ***Test with Sulfosalicylic Acid***

question

Nephrotic Syndrome

answer

Massive proteinuria (;3.5 g/day) Hypoalbuminemia Hyperlipidemia Lipiduria Edema ****Susceptible to encapsulated bacterial infection****

question

Diabetic + Proteinuria

answer

Check eyes --> Diabetic retinopathy

question

Diagnostic Steps in Evaluating Proteinuria

answer

2 separate, positive dipstick tests 24 hour urine collection UA, CMP, Lipids, ESR, ASO titer, C3-C4 level U/S to rule out PCKD, masses or obstructive nephropathy

question

Chalazion

answer

Sterile inflammation of the Meibomian gland

question

Blepharitis

answer

Infection, inflammation and scaling of eyelid margins

question

Dacryocystitis

answer

Occlusion of the nasolacrimal duct with secondary infxn

question

Allergic Conjunctivitis

answer

Itching Allergic shiners Rhinorrhea

question

Ciliary Flush

answer

Violaceous hyperemia of vessels surrounding the cornea Photophobia, ciliary flush and sluggishly reactive pupil --> Iritis

question

Acute Angle Closure Glaucoma

answer

Pain Dilated pupil Shallow anterior chamber Halos around lights Most common in adults ;50

question

Diagnosing Corneal Abrasions

answer

Fluorescein dye test Slit lamp with cobalt-blue light

question

Tx for Blepharitis

answer

Eyelid hygiene with diluted baby shampoo

question

Tx for Hordeolum

answer

Warm compresses and topical Abx

question

Tx for Chronic Chalazion

answer

Intralesional steroid injections or surgical drainage

question

Hyperacute Bacterial Conjunctivitis

answer

May be sight-threatening Usually has copious purulent drainage and associated with STDs in newborns

question

Tx for Iritis

answer

Cycloplegic and anti-inflammatory meds

question

Acute Tx for Glaucoma

answer

Acetazolamide and Topical pilocarpine ophthalmic solution

question

Sxs of Sinusitis

answer

Purulent nasal discharge Facial pain exacerbated by leaning forward Maxillary toothache

question

Sxs of Pneumonia

answer

High Fever Dyspnea CP Hypoxia or cardiopulmonary failure

question

HIV + Pneumonia

answer

PCP CMV Aspergillosis or other fungus Mycobacterium tuberculae

question

Legionella Pneumonia

answer

Hyponatremia, GI symptoms, fever, and myalgias Usually from environmental water source habitat ***Test for antigen in urine, silver stain ***

question

Tx of Rhinosunusitis

answer

Hydration OTC analgesics and decongestants Guaifenesin Symptoms for 7-10 days: Amoxicillin or Cefuroxime (Clarithromycin, TMP-SMX if allergic)

question

Empiric Therapy for Pneumonia

answer

Previously healthy, no Abx use in past 3 months: Doxycycline or Macrolide (-thromycins) Previously healthy, Abx use recently: Fluoroquinolone

question

Tx for Pseudomonas

answer

Zosyn (Pipercillin/Tazobactam) Cefepime Imipenem Meropenem PLUS Ciprofloxacin or Levofloxacin

question

Empiric Tx for HCAP

answer

Macrolide (Azithromycin) 3rd generation Cephalosporin (Cefepime) Vancomycin

question

Dyspnea + Substernal Chest Pain

answer

Angina

question

Dyspnea + Swollen Leg

answer

PE

question

Dyspnea + Hx of Melena or Menometorrhagia

answer

Anemia

question

Dyspnea + Perioral Numbness and Paresthesias

answer

Anxiety

question

Dyspnea + S3

answer

CHF

question

Dyspnea + Barrel-chest

answer

COPD

question

Dyspnea + HSM, Ascites, and Spider Angiomas

answer

Cirrhosis with likely pleural effusion

question

CXR with Honeycomb Appearance

answer

Interstitial Lung Disease

question

Dyspnea + Normal CV and Pulmonary Evaluation

answer

GERD with secondary bronchospasm

question

Dyspnea in Pediatric Patient

answer

Foreign body aspiration or upper airway obstruction

question

Four Muscles of Rotator Cuff

answer

Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis

question

Trauma + Shoulder Pain

answer

Rotator cuff tear OR Dislocation/Subluxation

question

Bicipital Tendonitis

answer

Often accompanies rotator cuff tendonitis Pain can be sever and radiates down anterior aspect of humerus

question

Frozen Shoulder (Adhesive Capsulitis)

answer

Chronic pain and stiffness with limited motion Middle age, often women Usually after a period of immobilization

question

Pain with AROM and PROM of Shoulder

answer

Joint or ligament involvement

question

Pain with AROM Only of Shoulder

answer

Muscular and/or tendon injury

question

Empty Can Sign

answer

Pain and weakness when arms are abducted and extended with thumbs pointing down

question

Drop Off Test

answer

Passive abduction of shoulder and observing for a sudden drop of the arm Positive = rotator cuff tear

question

Cross-arm Test

answer

Raise arm and adduct across chest, assess for pain Positive = AC joint pathology

question

Tx for Torn Rotator Cuff

answer

NSAIDs, physical therapy and possibly surgery

question

Tx for AC sprains

answer

NSAIDs and sling

question

Facial Edema, Especially Tongue

answer

ACE-Inhibitor --> angioedema

question

JVD + Peripheral Edema + Rales

answer

Pulmonary HTN Right-sided CHF

question

Inguinal Adenopathy In Elderly Male

answer

Prostatic Mass

question

Chronic Venous Insufficiency

answer

Stasis Dermatitis Venous varicosities ***Most common cause of B/L LE edema***

question

Nonpitting Leg Edema

answer

Suspect Hypothyroidism (Myxedema)

question

Unilateral Leg Edema

answer

Suspect DVT --> Get U/S

question

B/L Leg Edema That Doesn't Respond to Diuretics

answer

Chronic Venous Insufficiency or Lymphedema

question

Stigmata Of Systemic Disease

answer

Hair loss Temporal wasting Pallor Poor hygiene Bruising Jaundice Diminished orientation

question

Weight Loss + Oral Thrush

answer

Suspect HIV

question

D-Xylose Test

answer

Tests for reducing sugars in stool to determine if pancreatic enzymes are functionally intact

question

Foul-smelling Stools with Weight Loss, Diarrhea and Bloating

answer

Suspect Celiac Sprue Test for Tissue Transglutimase Abs and Endomysial Abs

question

Medications That Contribute to Acne

answer

CS Androgens Anticonvulsants Lithium

question

Acne Rosacea

answer

Affects adults in 30-50 years range Vascular component with eruptive component Sensitive to extreme heat or cold, excessive sunlight, ingesting highly seasoned or spicy foods

question

Folliculitis

answer

Infection of hair follicles with S. aureus Usually associated with shaving

question

Tx for Mild, Noninflammatory Acne

answer

Topical Retinoid at low strength

question

Tx for Mild, Minimally Inflammatory Acne

answer

Topical Retinoid at night Benzoyl peroxide

question

Tx for Moderately Inflammatory Acne

answer

Topical Retinoid Oral Abx

question

Tx for Severe Inflammatory Acne

answer

Isotretinoin alone OR Topical Retinoid Oral Abx Isotretinoin

question

Restrictions on Isotretinoin

answer

Female patients must commit to two forms of birth control for at least 1 month prior to therapy, during therapy and 1 month after therapy

question

CAGE Test

answer

Felt the need to Cut down on drinking? Annoyed by people criticizing your drinking? Felt Guilty about your drinking? Need an Eye-opener in the morning?

question

End-Stage Liver Disease Signs

answer

Cirrhosis Ascites Edema Palmar erythema Testicular atrophy Rosacea Cardiomegaly Peripheral Neuropathy

question

Dilated Pupils = ______ Drugs

answer

Stimulants

question

Constricted Pupils = _______ Drugs

answer

Opiates

question

Tx for Alcohol Withdrawals

answer

Long-acting Benzos --> Diazepam or Chlordiazepoxide (Librium)

question

Tx for Benzos Withdrawals

answer

Phenobarbital or long-acting Benzos

question

Tx for Opiate Withdrawal

answer

Methadone +/- Clonidine

question

Iron is Absorbed Where

answer

Duodenum

question

B12 is Absorbed Where

answer

Terminal Ileum --> Crohn's disease can lead to deficiency

question

Most Common Causes of Blood Loss

answer

GI bleeding Menstrual bleeding

question

Signs of Iron Deficiency

answer

Cheilosis of mouth Koilonychia (spoon-shaped nails) Brittle nails

question

Signs of B12 Deficiency

answer

Abnormal reflexes Ataxia Babinski sign Poor position and vibration sense

question

Iron Deficiency in Children

answer

Ask about excessive cow's milk intake Assess for thalassemia

question

Folate Deficiency Causes

answer

Alcoholism Phenytoin TMP-SMX Sulfasalazine

question

Iron Deficiency Anemia Iron Studies

answer

TIBC is elevated Decreased serum iron Decreased Ferritin

question

Anemia of Chronic Disease Iron Studies

answer

TIBC is decreased Decreased serum iron Decreased Ferritin

question

Serum Iron Increased in Microcytic Anemia

answer

Sideroblastic Anemia

question

Differentiating Between B12 and Folate Deficiency

answer

Methylmalonic acid and homocysteine levels are elevated in B12 Only homocysteine levels are elevated in Folate

question

Basophilic Stippling

answer

Lead Poisoning or Thalassemia

question

Tx for Anxiety

answer

BZD SSRIs Buspirone Gabapentin Beta blockers

question

Pathologic Anxiety is Associated With

answer

Agoraphobia Depression Phobias Psychosis Drug Usage

question

Intermittent Asthma

answer

Symptoms less than 2 times/week and <2 nighttime symptoms/month Tx with SABA

question

Persistent - Mild Asthma

answer

Symptoms more than 2 times/week and >3-4 nighttime symptoms/month Tx with low dose inhaled CS and SABA

question

Persistent - Moderate Asthma

answer

Symptoms daily and >1 nighttime symptoms/week Tx with low-medium dose inhaled CS + LABA and SABA

question

Persistent - Sever Asthma

answer

Continual symptoms with multiple beta2-agonist usage each day and very frequent nightly symptoms Tx with high dose CS + LABA + Omalizumab and SABA

question

Atopic Dermatitis Symptoms

answer

Pruritus Papules and vesicles (acute) Scaling plaques and lichenification (chronic) Flexural creases

question

Tx for Atopic Dermatitis

answer

Avoid hot water baths or showers Emoliant, like Aquaphor Antihistamines Topical CS Trigger avoidance Tars Tacrolimus and Pemecrolimus

question

AD and Vaccine reaction

answer

Smallpox --> can cause life-threatening severe reactions

question

Chronic Bronchitis

answer

Productive cough that occurs >3 months/year for 2 consecutive years --> dirty-chest appearance on CXR Typically are "blue bloaters" (overweight and cyanotic) ***Clinical Diagnosis***

question

Emphysema

answer

Abnormal dilatation of terminal airspaces with destruction of alveolar septa --> hyperinflation of lungs on CXR Typically are "pink puffers" (thin and barrel-chested) ***Pathologic Diagnosis***

question

Emphysema in Patients <45 years

answer

Alpha1 Antitrypsin Deficiency Often have hepatitis or cirrhosis as well

question

Tx for Mild COPD

answer

SABA (Albuterol) or Anticholinergic (Ipatropium)

question

Tx for Moderate COPD

answer

SABA or Anticholinergic AND LABA or long-acting anticholinergic

question

Tx for Severe COPD

answer

SABA, LABA, Anticholinergic (short and/or long-acting) AND Inhaled CS

question

Tx for Very Severe COPD

answer

SABA, LABA, Anticholinergic (short and/or long-acting) AND Inhaled CS Consider O2 Therapy as well

question

Caution in Using O2 with COPD Patients

answer

Can cause hypercarbia due to decreased respiratory drive Just keep O2 sats >90%

question

Acute Exacerbation of COPD Tx

answer

Oral CS for 2 weeks, tapering off Abx (Doxy, Augmentin, Levofloxacin) O2 supplementation SABA or Anticholinergic

question

Systolic CHF

answer

Decreased contractility of LV --> reduced EF (<45%) Dilated cardiomyopathy

question

Diastolic CHF

answer

Inability of the LV to relax properly --> increased filling pressure, pulmonary congestion and decreased cardiac return Hypertrophic cardiomyopathy

question

Tx for Acute CHF Exacerbation

answer

Nitroglycerin ACE-I (ARB if can't tolerate) Loop Diuretic Beta blocker (on d/c) Spironolactone if EF ;35%

question

Long Term Complications of DM

answer

Retinopathy Nephropathy Neuropathy Atherosclerosis

question

DM + Bronzing of the Skin, Testicular Atrophy, and Cirrhosis

answer

Hemachromatosis

question

Diagnostic Criteria of DM

answer

Fasting BG ;126 mg/dL Two hour OGTT ;200 mg/dL Random FSBG ;200 mg/dL with symptoms HgbA1C ;6.5%

question

Sulfonylureas

answer

Close K+ channel in Beta cells --> stimulate insulin release Glyburide, Glimepiride and Glipizide Can cause weight gain and hypoglycemia

question

Thiazolidinediones (TZDs)

answer

Increase insulin sensitivity in peripheral tissue by binding to PPAR-gamma -glitazones Can cause MI, hepatotoxicity, weight gain, and heart failure

question

Metformin

answer

Decreases gluconeogenesis, increases glycolysis, and increases peripheral glucose uptake First line in DM II Can cause GI upset and Lactic Acidosis

question

Alpha Glucosidase Inhibitors

answer

Inhibit intestinal brush-border enzymes Acarbose and Miglitol Can cause GI disturbances

question

Exenatide

answer

GLP-1 analog --> increases insulin and decreases glucagon release and its effect is inversely related to the blood sugar level Can cause N/V and pancreatitis

question

CT Findings of Diverticulitis

answer

Pericolic fat infiltration Thickened fascia Muscular hypertrophy Arrowhead sign

question

Acute HIV infection

answer

Fever Fatigue Rash Headache LAD Pharyngitis

question

Most Common Cause of Fever in HIV

answer

PCP infection

question

Systemic Signs of HIV Infection

answer

Sinusitis Oral Thrush (Candida) CMV Retinitis Toxoplasmosis Cryptococcal meningitis Kaposi Sarcoma (HHV-8)

question

Screening Test for Woman With HIV

answer

Pap smear --> increased risk of cervical cancer STD evaluation

question

Protease Inhibitors

answer

-navir Inhibits protease, so new viruses can't be produced SE: Hyperglycemia, GI intolerance and lipodsystrophy

question

NRTI (Nucleoside Reverse Transcriptase Inhibitors)

answer

Bind to Reverse Transcriptase and terminate DNA chain Tenofovir (nucleotide), Didanosine, Lamivudine, and Zidovudine SE: Bone marrow suppression, peripheral neuropathy, anemia (AZT), pancreatitis (Didanosine)

question

Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

answer

Bind at a different site of Reverse Transcriptase from NRTIs Efavirenz, Nevirapine, Delaviridine SE: Rash and hepatotoxicity

question

Raltegravir

answer

Inhibits Integrase, preventing HIV genome integration into host cell chromosomes SE: Hypercholesterolemia

question

Enfuvirtide

answer

Binds gp41, inhibiting viral entry

question

Maraviroc

answer

Binds CCR-5 and inhibits interaction with gp120

question

Pregnant Women with HIV

answer

Do C/S Treat mother with AZT and infant with AZT for 6 weeks

question

HTN + Family/personal Hx of Renal Disease

answer

Renal Artery Stenosis

question

HTN + Paroxysmal Tachycardia, Sweating, Flushing

answer

Pheochromocytoma

question

HTN + Daytime Drowsiness, Nighttime Awakenings, Snoring

answer

Sleep Apnea

question

HTN + Hirsutism and Easy Bruising

answer

Cushing's Syndrome

Family Medicine Shelf (USPSTF + Blueprints + AAFP Questions) – Flashcards

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