1 Flashcards
(121 cards)
1
Q
Loss of elastic recoil is characteristic of what kind of COPD
A
emphysema
increased airway resistance is characteristic of bronchitis
2
Q
what is the most common sx of emphysema
A
dyspnea seen with hyperinflation barrel chest increase in AP diameter V/Q matched defects
3
Q
sxs of chronic bronchitis
A
productive cough wheezing rales rhonci peripheral edema cyanosis
4
Q
increased CO2 is characteristic of chronic bronchitis or emphysema
A
chornic bronchitis
5
Q
anything over this temp celicius is technically a fever
A
38
6
Q
what is the presentation of PUD
A
dyspepsia that is worse at night
GIB
(MCC of upper GIB)
7
Q
duodenal ulcers are better or worse with meals
A
better
8
Q
MC type of Peptic ulcers
A
dueodenal (4x)
more common in younger pts
9
Q
diagnostic test for PUD
A
endoscopy
10
Q
what is gastritis
A
superficial inflammation / irritation of stomach mucosa with mucosal injury
11
Q
CC of gastritis
A
. H. pylori MCC
NSAID / ASA / Alcohol 2nd MCC
less common Autoimmune / Pernicious anemia
12
Q
MC presentation of gastritis
A
epigastric pain
13
Q
MC virsu associated with gastroenteritis in adults
what is the most common virus in children
A
adults –>NORO
children–>ROTA
14
Q
questions would want to ask if you suspect gastroenteritis
A
recent travel (e.coli)
recent anbx (C. Diff)
15
Q
sxs of invasive gastroenteritis
A
increased fever
blood and fecal leukocytes
large bowel involvement
mimics acute appendicitis
initially watery
16
Q
sxs of shigella
A
lower abd pain explosive watery diarrhea mucoid blood febrile seizures
17
Q
nonivasive gastroenteritis szs
A
vomiting
increase i voluminous stool
small bowel involvement
copious watery diarrhea “rice water”
grey, no fecal door/blood/pus
severe dehydration
18
Q
Canned home foods is a RF for this gastroenteririts pathogen
A
C perfringens
19
Q
pork and poultry are RF for these gastroenteririts pathogen
A
Salmonella
20
Q
shellfish and gastroenteritis think this pathgen
A
V. Cholerae
21
Q
picnic and egg salad think this gastroenteritis RF
A
S. auereus
22
Q
DO NOT GIVE ANTIDIARRHEAL WITH this type of gastroenteririts
A
invasive (fever, blood, leukocytes large bowel involvement)
23
Q
antiemetics that can be used for gastroenteririts include
A
5HT3 inihibitors
dopamine blockers like reglan (if not heart conditions)
24
Q
anbx TX for shigella
A
Trimethoprim-sulfamethoxazole (Bactrim) 1st line if severe
25
anbx tx for vibrio
tetracyclines, FQ
26
C. diff tx
metro or vanco
27
Salmonella tx
FQ
28
constipation questions to ask
new onset after 50
opiate use
DM
hypothyroid
MS
29
Labs for constipation
CBC, CMP, TSH
30
Tx for constipation
bulk forming laxitices (metamucil)
increase fiber 20g
stool softner like sENNA
31
ROME criteria for constipation
less than 3 BM/ week
with straining
hard or lumpy
sensation of incomplete evacuation
32
acute pancreatitis causes
gallstones (40%)
ETOH (35%)
33
sxs of acute pancreatitis
epigastric boring pain that radiates to the back
34
PE of acute pancreatitis
tachy
necrotizing hemorrhagic
Cullen's (periubilical ecchy)
Grey turner( flank ecchymosis)
35
Labs if you suspect acute pancreatitis
```
increase tg
Increase lipase (more specific than amylase)
```
greater than 3x ULN of amylase
increase ALT: 3x suggest gallstone
36
dx test of choice for acute pancreatitis
abd CT
can rule out gallstones with abd U/S
37
Tx for acute pancreatitis
supportive
NPO]
IV
38
Ranson's at admission
at admission
```
glucose >200
age>55
ldh>350
ast>250
wbc>16k
```
39
ranson's w/in 48 hrs
```
calcium <8
hct>10% fall
pO2<60 mmHG
BUN>1.8
HCO3<20
fluid sequestration> 6L
```
40
chronic pancreatits
ETOH 70%
| idipathic 15%
41
triad of chronic pancreatitis
calcifications on plain ab =d xray
steatorrhea
DM
42
UC differs from crohn's b/c
limited to colon
begin in rectum always and contiguous spread
mucosa and submucosa
43
UC sxs
LLQ colicky MC
bloody diarrhea hallmark
hematochezia
44
crohn's dz differs from UC b/c
can be any segment of GI
MC terminal
transmural
45
crohn's sxs
RLQ pain
| apthous ulcers
46
Chron's complications
B12 deficiency
fistual
perianal dz
47
skipped lesions and cobbles-atoning on colonscopy is associated with
chron's
48
string sign
barium enema of chron's
49
TX for IBD
5-ASA (oral mesalamine)
sulfasalazine (UC)
prednisone
immune modifying
anti tnf
50
MC sx of diverticulitis
GIB and LLQ pain
51
labs and diagnostics with diverticulitis
CT scan fat stranding and increased WBC
guiac +
52
diverticulosis tx
high fiber
53
diverticulitis tx
clear liquid diet abx (cipro or bactrim +falgyl)
54
MCC of small bowel obstructions
post surgical adhesions
55
HX of small bowel obstructions
Cramping abd pain
▪ Abd distention
▪ Vomiting
▪ Obstipation (no stool/passing gas)
56
early small bowel obstruction expect
▪ hyperactive bowel
▪ high pitched tinkles
▪ visible peristalsis
57
ABD XRAY in small bowel obstruction expect
Abd XR: air fluid levels in step ladder pattern, dilated bowel loops
58
initial tx of SBO
- aggressive fluid resuscitation (very dehydrated)
- electrolyte repletion
- NG tube (evacuate air & fluid)
59
Four Cardinal signs of strangulated bowel:
1) fever
2) tachycardia
3) leukocytosis
4) localized abd tenderness
60
Hep A symptoms
hepatomegaly
jaundice
RUQ pain
61
HepA contagious until
1 week after jaundice
62
HepA test
IgM anti HaV positive
63
Gallstones in gallbladder, no inflammation
Cholelithiasis
64
Cholelithiasis sxs
Biliary "colic" episodes
▪ abrupt RUQ/epigastric pain, nausea
▪ 30min to 1hr
▪ precipitated by fatty/large meals
65
Cholelithiasis tx
Asymptomatic = observation
Symptomatic = elective cholecystectomy
66
GB cystic duct obstruction by gallstone → inflammation / infection
Acute cholecystitis
67
cholecystitis MC pathogens
E. coli MC
Klebsiella
Enterococci
68
SXS and physical of cholecystitis
RUQ/epigastric pain
▪ precipitated by fatty/large meals
Physical exam:
▪ fever
▪ enlarged, palpable gallbladder
(+) Murphy's: inspiratory arrest
(+) referred pain R-shoulder/scapular d/t phrenic nerve irritation
69
eferred pain R-shoulder/scapular d/t phrenic nerve irritation
seen in cholecytitis is known as
Boas sign:
70
dx tests of cholecystitis
Initial test → US
Gold standard → HIDA scan
↑ WBCs with left shift
71
cholecystitis TX
```
NPO, IVF, Abx (Ceftriaxone + Flagyl) → laparoscopic cholecystectomy
for acute (within 72h) and chronic
```
72
stone obstruct cystic duct)
stone obstruct cystic duct)
73
stone obstruct cystic duct)
choledocholithiasis
74
stone causing biliary tract infection)
stone causing biliary tract infection)
75
Transient relaxation / incompetency of Lower esophageal sphincter
associated with what sxs
GERD
Heartburn (pyrosis) hallmark
Worse with supine (flat) position
regurgitation
dysphagia
76
RF for GERD
Weight gain
Fatty food
Caffeinated or carbonated drinks
Alcohol, tobacco, drug use
77
Lifestyle modifications
elevate head of bed 15cm (6 inch)
- avoid eating 2-3hr before bed
- avoid strong stimulants (coffee, alcohol, smoking)
- avoid fatty food, chocolate
- weight loss
78
tx for GERD outside of lifestyle modifications
▪ H2RA (-tidine) then upper endoscopy
stage 3 use prazole PPI
79
drugs that lower LES pressure and can casue GERD (6)
```
Anticholinergic
▪ Antihistamine
▪ TCA
▪ CCB
▪ Progesterone
▪ Nitrates
```
80
TX for IBS
smoking cessation, low
fat/unprocessed food
▪ Exercise, antibiotics, antispasmodics, peppermint oil, and probiotics appear to improve symptoms
81
ESOPHAGITIS causes
1. MCC GERD (Reflux)
▪ mechanical or functional abnl of LES
2. Eosinophilic / atopic dz → esophagitis
3. Pill induced esophagitis
▪ bisphosphonates
▪ NSAIDs
4. Infectious cause in immunocompromised
▪ Candida
▪ CMV
▪ HSV
82
esophagitis common sx
odynophagia -hallmark of infx
dysphagia
retrosternal CP
83
dx test for esophagitis
upper endoscopy
84
Achalasia
Loss of Auerbach's plexus →
increased LES pressure
leads to lack of persitalsis
85
dx test for achlasia
Double contrast barium swallow →
"Bird's beak" appearance of LES
esphageal manometry
86
tx for achlasia
botox injection
nitrates
CCB
LES
87
test for suspected rotator cuff injury
▪ Hawkins: elbow/shoulder flexed with internal rotation
▪ Neer: pronated arm, pain with forward flex
▪ Jobes: pain with "empty can"
88
questions for differentiating arthritis
when is it worse?
morning--> rheumatoid
later in the day--> osteo
89
what is classically spared in rheumatoid arthtritis
DIP
90
prodrome of constitutional sxs are classically seen in this form of arthritis
what are they
rheumatoid arthritis has prodrome
fever
fatigue
wt loss
anorexia
91
what dx test do you need to confirm RA
ccp antibodies
can also look at rheumatoid factor
XRAY
92
osteoarthritis dx tests
xray
93
tx of osteoarhtritis
NSAIDS
elderly with bleeding risk --> actetome
94
what is reactive arthritis
autoimmune response 1-4 s/p chlamydia
seen with conjunctivits or urethritis
95
sinusitis -what is it
symptomatic inflammation of ≥1 paranasal sinuses of <4 weeks’ duration resulting from impaired drainage and retained secretions accompanied by obstruction, facial pain/pressure/fullness, or both. Because rhinitis and sinusitis usually coexist, “rhinosinusitis” is the preferred term.
96
three important features of sinusitis
Inflammation and edema of the sinus mucosa
Obstruction of the sinus ostia
Impaired mucociliary clearance
97
most cases of sinusitis are due to
vast majority of cases
| (rhinovirus; influenza A and B; parainfluenza virus; respiratory syncytial; adeno-, corona-, and enteroviruses)
98
bacterial sinusitis can be differentiated from viral how?
More likely if symptoms worsen within 5 to 6 days after initial improvement
No improvement within 10 days of symptom onset
>3 to 4 days of fever >102°F and facial pain and purulent nasal discharge
99
hx of sinusitis
Worsening of symptoms >5 to 6 days after initial improvement
Persistent symptoms for ≥10 days
Persistent purulent nasal discharge
Unilateral upper tooth or facial pain
Unilateral maxillary sinus tenderness
Fever
100
associated sxs of sinusitis
Headache
Nasal congestion
Retro-orbital pain
Otalgia
Hyposomia
Halitosis
Chronic cough
101
sxs with sinusitis requiring immediate attention
Visual disturbances, especially diplopia
Periorbital swelling or erythema
Altered mental status
102
PE of sinusitis
Fever
Edema and erythema of nasal mucosa
Purulent discharge
Tenderness to palpation over sinus(es)
Pain localized to sinuses when bending forward
Transillumination of the sinuses may confirm fluid in sinuses (helpful if asymmetric; not helpful if symmetric exam).
103
tx for sinusitis
Pseudoephedrine HCl
Phenylephrine nasal spray (limited use)
Oxymetazoline nasal spray (e.g., Afrin) (not to be used >3 days)
104
when would you suspect strep throat
pharyngitis sxs with high fever
105
viruses associated with pharyngitis
Rhinovirus
Adenovirus (associated with conjunctivitis)
Parainfluenza virus
Coxsackievirus (hand-foot-mouth disease)
Coronavirus
106
sxs associated with pharyngitis
Sore throat
Difficulty swallowing (dysphagia) or pain on swallowing (odynophagia)
Cough (uncommon in GAS pharyngitis)
Hoarseness; “hot potato” voice
Fever
Anorexia
Chills
Malaise; fatigue
Headache
Dysuria and arthralgias (suggest gonococcal etiology)
Sick contacts with similar symptoms or confirmed diagnosis
107
PE of pharyngitis
Enlarged tonsils with or without exudate
Pharyngeal erythema
Unilateral tonsillar swelling (“frog’s belly”) or uvular deviation (concern for peritonsillar abscess)
Trismus; stridor; drooling (concern for peritonsillar or retropharyngeal abscess)
Cervical adenopathy (anterior suggestive of GAS, posterior most commonly associated with infectious mononucleosis)
Fever (higher in bacterial infections)
Pharyngeal ulcers (CMV, HIV, Crohn, other autoimmune vasculitides)
Scarlet fever rash: Punctate erythematous macules with reddened flexor creases and circumoral pallor suggests streptococcal pharyngitis.
Tonsillar/soft palate petechiae and hepatosplenomegaly suggest infectious mononucleosis (EBV/CMV).
Gray oral pseudomembrane suggests diphtheria and occasionally infectious mononucleosis (EBV/CMV).
Characteristic erythematous-based clear vesicles suggest HSV or coxsackie A virus infection (herpangina).
Conjunctivitis suggests adenovirus.
108
ddx of pharyngitis
Viral syndrome
Streptococcal infection
Allergic rhinitis/postnasal drip
GERD
Malignancy (lymphoma or squamous cell carcinoma)
Irritants/chemicals (detergent/caustic ingestion)
Atypical bacterial (e.g., gonococcal, chlamydial, syphilis, pertussis, diphtheria)
Oral candidiasis (patients typically complain mostly of dysphagia)
Epiglottitis (associated with stridor, drooling, and progressive respiratory distress)
109
how to decide whether or not to test for stre
+1 point: tonsillar exudates
+1 point: tender anterior chain cervical adenopathy
+1 point: absence of cough
+1 point: fever by history
+1 point: age <15 years
0 point: age 15 to 45 years
−1 point: age >45 years+1 point: tonsillar exudates
+1 point: tender anterior chain cervical adenopathy
+1 point: absence of cough
+1 point: fever by history
+1 point: age <15 years
0 point: age 15 to 45 years
−1 point: age >45 years
110
once you have your
If 4 points, positive predictive value of ~80%; treat empirically.
If 2 to 3 points, positive predictive value of ~50%, rapid strep antigen; treat if GAS-positive.
If 0 or 1 point, positive predictive value <20%; do not test; treat empirically with follow-up as needed.
111
viral pharyngitis sxs that would not warrant testing for GAS
cough, rhinorrhea, hoarseness, oral ulcers, diarrhea, conjunctivitis, rash) (1)[A]
112
tx for viral pharyngitis
Salt water gargles
Viscous lidocaine (2%) 5 to 10 mL PO q4h swish/spit
Acetaminophen 10 to 15 mg/kg/dose q4h PRN pain or fever (pediatric). In adults, do not exceed >3 g/day.
NSAIDs for pain or fever (more effective than acetaminophen for GAS pharyngitis)
Anesthetic lozenges
Cool-mist humidifier
Hydration (PO or IV)
113
anbx for GAS
Antibiotics (particularly penicillin) are chosen primarily to prevent complications.
60–70% primary care visits by children with pharyngitis result in antibiotic prescriptions (4). Empiric therapy results in antibiotic overuse.
Treatment duration generally 10 days (1)[A]
Antibiotics do not reduce risk of poststreptococcal glomerulonephritis.
Antibiotics shorten duration of symptoms by approximately 16 hours (5).
Antibiotics may prevent pharyngitis/fever by day 3 (NNT 4 if GAS-positive, 6.5 if GAS-negative, 14.4 if untested) (5)[A].
114
GAS COURSE
Streptococcal pharyngitis runs a 5- to 7-day course with peak fever at 2 to 3 days.
Symptoms will resolve spontaneously without treatment, but rheumatic complications are still possible.
115
how long does influenza last
7 days, followed by additional days of cough and fatigue
116
how long does URI last
3-14 days
117
when would you not want to use HCTZ, Chlorthalidone
DM or gout
118
presentation of arrhythmias
```
▪ Palpitations MC
▪ dizzy
▪ lightheaded
▪ syncope
▪ SOB
```
119
LDL target
LDL cholesterol levels should be less than 100 mg/dL. Levels of 100 to 129 mg/dL are acceptable for people with no health issues but may be of more concern for those with heart disease or heart disease risk factors. A reading of 130 to 159 mg/dL is borderline high and 160 to 189 mg/dL is high
120
Triad of lupus
▪ joint pain (90%)
▪ fever
▪ malar "butterfly rash"
121
cardiac ROS
```
Chest pain?
• Palpitations?
• Dyspnea on exertion DOE? o SOB on exertion?
• Orthopnea?
o SOB when lying down?
• Paroxysmal nocturnal dyspnea PND?
o Do you awake in the middle of the
night and feel like you have to run
to the window to get air?
• Leg edema?
o Swelling in legs?
• Hx of cardiac problems? (HTN, MI, CHF,
rheumatic fever, heart murmur)?
o **Move to PMH if positive
• Ever had/last EKG?
o **Move to HM: Screening
• Ever had/last heart tests (echo, stress
tests)?
o **Move to HM: Screening
• Cardiac procedures (cath, stent)
o **Move to PMH: Surgeries if yes
```
