[1] Common Ambulatory Care Cases

Question 1

A diagnosis of Dyspepsia requires at least this duration of time

Answer 1

2 weeks

Question 2

Alarm Features of Dyspepsia (14)

Answer 2

1. Age at Onset > 55
2. Weight Loss
3. Anemia
4. Hematemesis
5. Melena
6. Hematochezia
7. Dysphagia
8. Odynophagia
9. Persistent Vomiting
10. Abdominal Mass
11. Jaundice
12. Chronic NSAID Intake
13. Chronic Alcohol Intake
14. Previous History of Ulcer

Question 3

[Treatment]

Dyspepsia

Answer 3

2-4 weeks PPI, 1 tab OD before breakfast

Question 4

[Watch Out For]

Dyspepsia

Answer 4

1. Increased abdominal pain
2. Alarm symptoms
3. Absence of improvement after >7 days of treatment

Question 5

[Alternative Medical Treatments]

Dyspepsia

Answer 5

1. H2-RA Antagonists (e.g. Ranitidine)

2. Antacids (e.g. Aluminum + Magnesium Hydroxide or Alginates)

Question 6

[Non-Pharmacologic Treatment]

Dyspepsia

Answer 6

1. Small frequent feedings
2. Avoid skipping meals
3. Avoid alcohol, milk, tea, carbonated drinks, coffee, acidic food/beverages
4. Avoid smoking
5. Head elevation at bedtime
6. Last meal 2 hours before bedtime

Question 7

How much zinc supplementation should you give to a patient suffering from diarrhea who is 2-6 months old?

Answer 7

1/2 tablet daily for 14 days

Zinc = 20mg/tab

Question 8

How much zinc supplementation should you give to a patient suffering from diarrhea who is 6 months or older?

Answer 8

1 tablet daily for 14 days

Zinc = 20mg/tab

Question 9

Based off JNC7/8 Guidelines, how do you differentiate Hypertensive Urgency from Hypertensive Emergency?

Answer 9

Urgency: BP > 180/120 without end organ damage

Emergency: BP > 180/120 with evidence of impending or progressive target organ damage

Question 10

How quickly should you lower a patients BP if he is experiencing Hypertensive Urgency?

Answer 10

Lower BP within 2-3 days

Question 11

How quickly should you lower a patients BP if he is experiencing Hypertensive Emergency?

Answer 11

Lower BP no more than 25% of MAP in minutes to 1 hour

Question 12

Acute Uncomplicated Cystitis is probable with a CFU/mL count of?

Answer 12

> 100 CFU/mL

Question 13

Acute Uncomplicated Cystitis is probable with a wbc/hpf count of?

Answer 13

> = 5 wbc/hpf

Question 14

[Treatment]

Acute Uncomplicated Cystitis

Answer 14

Nitrofurantoin 100mg tab BID for 5 days

Fosfomycin 3g sachet in 1/2 glass water SD

Question 15

[Dosage]

Cotrimoxazole for AUC

Answer 15

160/800mg BID for 3 days

Question 16

[Symptoms]

Acute Pyelonephritis

Answer 16

Fever (>38C)
Chills
Flank Pain
CVA Tenderness
Nausea
Vomiting 
\+/- Lower UTI Symptoms

Question 17

Acute Pyelonephritis is probable with a CFU/mL count of?

Answer 17

> 10,000 CFU/mL

Question 18

Acute Pyelonephritis is probable with a wbc/hpf count of?

Answer 18

> 5 wbc/hpf

Question 19

[Indications for Admission]

Acute Pyelonephritis

Answer 19

1. Inability to maintain oral hydration or take medications
2. Concern about compliance
3. Uncertainty about diagnosis
4. Severe illness with high fever, severe pain, marked debility
5. Signs of Sepsis

Question 20

[Pharmacologic Treatment]

Acute Pyelonephritis

Answer 20

Ceftriaxone 1g IM/IV SD

Question 21

How do you diagnose Asymptomatic Bacteriuria in Adults?

Answer 21

> 100,000 CFU/mL of one or more uropathogens in two consecutive midstream urine specimen or in one catheterized urine specimen in the absence of symptoms attributable to UTI

Question 22

[UTI in Pregnancy]

When must pregnant women be screened?

Answer 22

First prenatal visit between 9 - 17 weeks AOG

Question 23

[UTI in Pregnancy]

Test of choice to diagnose UTI in Pregnancy

Answer 23

Clean catch midstream urine

Question 24

[Pharmacologic Treatment]

UTI in Pregnancy

Answer 24

Co-amoxiclav
Cephalexin
Nitrofurantoin (not for those near term)
Cotrimoxazole (not in 1st and 3rd trimester)

Question 25

What is the definition of Recurrent UTI?

Answer 25

Episodes of acute uncomplicated UTI documented by urine culture occurring >2x/year in a non-pregnant woman with no known urinary tract abnormality

Question 26

Complicated UTI

Answer 26

1. Presence of Indwelling Catheter/Intermittent Catheterization 2. Incomplete emptying of bladder with >100mL retained urine post-voiding 3. Obstructive Uropathy due to bladder outlet obstruction, calculus and other causes 4. Renal Transplant 5. Diabetes Mellitus 6. UTI in Males, except in young males presenting exclusively with lower UTI symptoms

Question 27

Significant Bacteruria in Complicated UTI is defined as?

Answer 27

>100,000 CFU/mL

Question 28

[Pharmacologic Treatment] Complicated UTI

Answer 28

Oral Fluoroquinolones for 7-14 days

Question 29

UTI in males is generally considered to be complicated, when is it NOT considered complicated UTI?

Answer 29

1st episode of symptomatic LUTS occurring in young (15-40 y/o) healthy sexually active men with no clinical/historical evidence of structural/functional urologic abnormality

Question 30

[Pharmacologic Treatment] UTI in Males

Answer 30

TMP-SMZ/Fluoroquinolones 7 day regimen

Question 31

What are the different criteria for Moderate-Risk CAP

Answer 31

1. RR >= 30 2. PR >= 125 3. Temp >= 40 or

Question 32

What are the different criteria for High Risk CAP

Answer 32

Any of the criteria under moderate risk CAP + Severe Sepsis/Septic Shock

Question 33

[Pharmacologic Therapy] Low Risk CAP w/o Comorbidities

Answer 33

Amoxicillin or Extended Macrolides (Suspected atypical pathogen)

Question 34

[Pharmacologic Therapy] Low Risk CAP w/ Comorbidities

Answer 34

B-lactam/B-lactamase Inhibitor (BLIC) or Second-Generation Oral Cephalosphorins +/- Extended Macrolides

Question 35

[Pharmacologic Therapy] Moderate Risk CAP

Answer 35

IV Non-Antipseudomonal BLIC + Extended Macrolide or IV Non-Antipseudomonal BLIC + Respiratory Fluoroquinolones

Question 36

[Pharmacologic Therapy] High Risk CAP w/o Risk for P. aeruginosa

Answer 36

IV Non-Antipseudomonal BLIC + IV Extended Macrolide/IV Respiratory Fluoroquinolone

Question 37

[Pharmacologic Therapy] High Risk CAP w/ Risk for P. aeruginosa

Answer 37

IV Antipneumococcal Antipseudomonal BLIC + IV Extended Macrolide + Aminoglycoside or IV Antipneumococcal Antipseudomonal BLIC + IV Ciprofloxacin/Levofloxacin (High Dose)