Acute Problems Flashcards
(135 cards)
1
Q
What is temporal arteritis?
A
Temporal arteritis is a condition in which the temporal arteries, which supply blood to the head and brain, become inflamed or damaged.
2
Q
What other symptoms are accompanying an URI?>
A
- kind of cough
- sick contacts
- confounding illness
- Treatment
3
Q
Symptoms of viral infection on exam
A
- Nares-erythema, blue or boggy
- Oropharynx-watch for exudate/erythema
- Lymphadenopathy
- Pulmonary exam-URI vs pna
4
Q
Flu vs common cold
A
Flu-myalgia
cold- sore throat
flu-fever, headache, fatigue, cough
Cold-sore throat, sneezing nasal congestion
5
Q
How is common cold treated?
A
- antipyretic/analgesics
- children no medicine effective
- nasal suction
- guaifenesin, mucolytic
5.
6
Q
When is it appropriate to treat a URI with antibiotic therapy?
A
avoid broad spectrum ABT treat for 10 days
7
Q
How is Group A strep URI treated
A
PCN 10 day course
8
Q
Treating EBV with amoxicillin is associate dwith what?
A
Rash
9
Q
Which of the following is most likely the main indication for antibiotic treatment in children with group A Streptococcus pharyngitis?
A
Prevention of rheumatic fever
10
Q
Symptoms of whiplash
A
- History of acute injury
- neck pain, reduced mobility, occipital headache
- imaging demonstrates no changes
11
Q
What is cervical radiculopathy
A
The clinical description of when a nerve root in the cervical spine becomes inflamed or damaged, resulting in a change in neurological function.
12
Q
Symptoms of cervical radiculopathy.
A
Neurological deficits, such as numbness, altered reflexes, or weakness, may radiate anywhere from the neck into the shoulder, arm, hand, or fingers
13
Q
Causes of cervical radiculopathy?
A
Radiculopathy may be caused by trauma either acute disc damage or exacerbation of degenerative disease
14
Q
What is Spurling’s test
A
Reproduction of radiculopathy when the examiner rotates the patient’s neck to the ipsilateral side and extends it applying gentle downward pressure
15
Q
What is the definition of ipsilateral?
A
belonging to or occurring on the same side of the body.
16
Q
How is acute neck injury managed?
A
- APAP
- NSAID’s
- Muscle relaxants
- Tramadol
- Opiates
- PT
17
Q
How long can whiplash last
A
about half of whip lash patients will continue to have neck pain at one year
18
Q
What are key diagnoses to rule out when assessing a patient for back pain?
A
- Cauda equina syndrome
- metastatic cancer
- epidural abscess
- vertebral osteomyelitis
19
Q
How is acute back pain managed in family medicine
A
- Analgesics
2. PT
20
Q
What percentage of acute back pain becomes chronic?
A
20 percent
21
Q
a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine
A
Spinal stenosis
22
Q
If treatment is not working and the patient has decreased functioning when treating LBP, is imaging a next step
A
- yes if treatment has been effective
23
Q
If analgesics and PT have failed what is the next best step in treating LBP
A
- Epidural glucocorticoid injection
24
Q
How long does epidural injection for back pain last
A
3 months or less
25
What is the annual limit for steroid injections for LBP
6 annual limit for injections for LBP
26
Are glucocorticoid injections helpful for spinal stenosis?
not effective
27
What are the major causes of shoulder pain to consider?
1. Rotator cuff tendonitis
2. Adhesive capsulitis
3. acromioclavicular joint disease
4. Biceps tendonitis
5. Glenohumeral arthritis instability
28
What shoulder disorder is more common among patients with diabetes and hypothyroidism?
Adhesive capsulitis
29
If the pain in the shoulder is located anterior/superior what is the likely cause or diagnosis?
AC joint disease
30
If the patient has pain with overhead activity what is the likely diagnosis?
Rotator cuff disorders
31
If the patient has pain with the Hawkin's test what is the likely cause of the pain?
Rotator cuff
32
What is the likely diagnosis if a patient has positive pain with the empty can test?
supraspinatus tear
33
If a patient has positive pain during the cross body abduction test what is the likely cause of the pain?
AC joint disease is a possibility
34
If a patient has pain during the external rotation test what is the likely cause of the pain
Infraspinatus tendon pathology
35
During the speed test if a patient has pain what is a possible diagnosis?
Biceps tendonitis
36
If the patient has pain with the cross body abduction test what is the likely cause of pain?
AC joint disease
37
How is shoulder pain managed?
```
Modification of activity
Analgesics
Cortico steroids
Physical Therapy
Surgical referral
```
38
How did the injury occur
1. Direct blow
2. foot planted
3. Previous injury
39
How is the knee assessed for injury?
1. Inspection
2. ROM
3. Palpate pain, warmth, effusion
4. Patellofemoral syndrome, crepitus on quad contraction
5. Assess cruciate/collateral ligaments
6. Meniscal testing with poor sensitivity
40
When the patient has a suspected meniscal tear what should the provider do to correctly confirm diagnosis?
MRI
41
The Thessaly test is useful for diagnosis an injury to the?
Menisci
42
Which of the following conditions is characterized by pain around or behind the patella resulting from chronic overuse and is largely a diagnosis of exclusion?
Patellofemoral pain
43
Anterior knee pain what type of injury would the provider consider?
1. Patellar tendonitis jumpers knee
| 2. Patellofemoral syndrome
44
What type of injury should be suspected if the patients knee pain located medially on the knee?
1. MCI sprain
2. Medial meniscal tear
3. Pes amserine bursitis
45
Lateral knee pain or injury could be related to?
1. Lateral meniscal tear
| 2. iliotibial band syndrome
46
Patellar subluxation is more common in male or female
female
47
Tibial apophysitis (Osgood-Schlatter disease)
1. Pain over the tibial tuberosity in adolescent s/p recent growth spurt, worse with squatting, stairs, quad strain
48
This in just is actually a hip injury which can be avascular necrosis, which can present as knee pain.
Slipped capital femoral epiphysis can result in referred knee pain
49
IT band syndrome
1. Pain is worse with stairs
| 2. TIP lateral epicondyle 3 cm above joint line
50
Meniscal tear twisting motion with foot planted can be acute or chronic may present with:
1. Effusion
| 2. MRI for diagnosis
51
What is patellofemoral syndrome?
1. Stiff when standing
2. Most common diagnosis in anterior knee pain among athletes
3. Pain with climbing stairs
4. J sign lateral patellar tracking as knee extended from 90 degrees flexion to full extension.
5. Recommend PT
52
How is osteoarthritis treated
1. Exercise therapy
2. weight loss
3. APAP
4. Glucosamine/chondroitin
53
How are ankle sprains treated?
1. Early mobilization
54
Achilles tendonitis
1. Avoid hill workouts
| 2. PT
55
How is Peroneal tendonitis treated?
1. Lateral heel wedges, ankle taping may not help healing
2. Commitment to PT, ROM strengthening
3. Surgical repair
56
How is Plantar Facititis treated
1. Stretching's
2. Deep myofascial massage
3. analgesic
4. Ice massage
OTC orthotics: Injection triamcinolone long acting synthetic corticosteroid, superior to dry needling, lidocaine alone.
Severe: extra corporeal shock wave therapy or fasciotomy
57
Which of the following is the most appropriate management of chronic midportion Achilles tendinopathy
1. Eccentric calf strengthening
58
Causes of hand and wrist pain?
1. Osteoarthritis
2. RA
3. Tendonitis
4. Fracture/sprain
4. Overuse injuries
59
What is De Quervains tenosynovitis
1. Radial pain limited to 1st extensor compartment
2. History of over use not necessary
3. Inflammation of the extensor pollicis brevis and abductor pollicis logus
4. Finkelsteins test with good sensitivity/specificity
60
What is the treatment for De Quervains tenosynovitis?
1. Splinting
2. Rest
3. can go straight to injection
61
Carpal Tunnel Syndrome
Palmar's surface
| can involve entire hand motor and sensory does not involve dorsum of the hand
62
Tapping over the median nerve elicits tingling or pain is called the what sign for diagnosis of Carpal tunnel syndrome?
Tinel sign
63
Tingling in the median nerve distribution with flexion for diagnosing carpal tunnel syndrome?
Phalen sign
64
Full compression of the carpal tunnel to elicit symptoms is what kind of test for carpal tunnel?
Compression test
65
What is the treatment for carpal tunnel syndrome?
1. Avoid overuse
2. Splinting (2-8) monitor for reduced ROM
3. Corticosteroids for short term use
4. Injection with triamcinolone acetonide 20 mg
5. Resistant cases surgery
66
Fracture that occurs after a fall with an outstretched hand
Scaphoid Fracture of the wrist
67
What are complications of a scaphoid fratucture
1. Non union
2. Avascular necrosis
3. Arthritis
4. Mal union
68
de Quervain tenosynovitis is inflammation of which of the following structures?
Extensor pollicis brevis and abductor pollicis longus tendons
69
A 32-year-old man is brought into the emergency department because of pain in his right wrist after he fell onto his outstretched arm with his wrist in dorsiflexion. On physical examination, he has tenderness in the anatomical snuffbox. Neurovascular examination is unremarkable. An X-ray shows no abnormal findings. Which of the following is the most appropriate next step in management
Immobilization and X-ray in 10 days
70
Which provocative test is used to diagnose de Quervain's tenosynovitis?
Finkelsteins test
71
Which of the following is the most appropriate step in management of a patient with a clinical diagnosis of carpal tunnel syndrome that has caused no sensory deficits and has not disrupted sleep or daily function?
Splinting
72
What the are three separate categories of abdominal pain
1. Upper GI
2. Lower GI
3. Non Gi
73
What are common upper GI causes of pain?
1. GERD
2. Gastritis
3. Gastric Duodenal ulcer
4. Biliary colic
5. Pancreatitis
6. Malignancy
74
What are common causes of main Lower GI
1. Functional bowel d/o
2. Inflammatory bowel disease
3. Diverticulosis
4. Mechanical obstruction
5. Malignancy
6. appendicitis
75
What are non GI disorders?
1. Kidney stores
2. Reproductive d/o
3. Malignancy
76
What are demographic factors related to upper GI pain
1. Age
2. Sex
3. ETOH
4. Smoking
5. Caffeine
77
Past medical history of abdominal pain
1. what caused pain in the past
2. surgical history
3. medications
78
What labs should be ordered for abdominal pain?
1. Liver and kidney
2. CBC may not be helpful
3. try to focus labs evaluation cholestasis, pancreatitis
uranalysis
79
For diagnosing and assessing abdominal pain what imaging films would be most helpful?
1. Plain films limited to bowel obstruction/perforation
2. U/S less complications, superior for biliary tract and reproductive imaging
3. general screening exam: colonoscopy, cervical cancer screening
80
Which of the following is not a known risk factor for gastropathy/gastritis?
Chronic opiate use
81
What does Hematochezia mean?
passage of fresh blood from the anus usually in stool or mixed with stool
82
What is the difference between Hematochezia and Melena?
Hematochezia is fresh frank blood where as Melena is dark and tarry stools
83
What is a maculopapular rash?
1. Can be raised or flat skin lesions the name is a blend of the words macule which are flat discolored skin lesions and papule which are small bumps.
84
More of a generalized rash
Atopic dermatitis
85
How is dermatitis treated?
1. Avoidance of triggers
2. Treat dyshidrosis
3. topical corticosteroids
4. Emollients
86
What the difference between a fungal rash and a contact dermatitis?
1. Fungal rashes have maculopapular erythema with central clearing and scale.
2. Feet hands, intertriginous areas large people
87
How are fungal rashes treated?
1. OTC products to reduce moisture-prevention
| 2. Topical antifungals
88
Which of the following best describes the clinical presentation of allergic contact dermatitis?
Well-demarcated, pruritic, eczematous eruption localized to the area of skin that comes in contact with the allergen
89
Why must cellulitis be monitored closely?
1. Cellulitis can develop into necrotizing faciitis
90
What should clinicians look for when assessing for atopic dermatitis?
1. Scaling and lichenification with pruritus
2. often in children linked with family history of atopy
3. 30% of children with AD eventually develop asthma
4. Distribution: flexor surfaces, neck, forehead, behind ears.
91
How is atomic dermatitis treated in children?
1. Low heat showers gentle or no soaps
2. Emollients
3. Topical corticosteroids
4. Topical calcineum inhibitors
92
What causes 5th disease
Parvovirus B19
93
Children with the slapped cheek appearance have what disease?
5ths disease a viral exanthem
| Fishnet pattern, lace appearance over the body
94
What is the classic pattern of Roseola
1. Fever for a few days
| 2. Followed by a maculopapular rash central to peripheral spread
95
When assessing for Nummular Eczema what should the clinician be aware of?
1. 2 to 10 cm erythematous plaques with scale and sharp border.
2. Distribution: dorsal hands and feet: extensor surfaces of limbs
96
What is the treatment for Nummular Eczema?
1. Moisturizers
2. Topical corticosteroids
3. Dermatology referral
97
What will the clinician assess when diagnosing Pityriasis Rosea?
1. Round or oval salmon colored patches 5 to 10 mm
2. Christmas tree pattern on back may find prominent herald patch
3. Limited duration without severe pruritis usually no intervention beyond reassurance.
98
How is psoriasis treated and managed?
1. Topical corticosteroids for less than 5% skin involvement
2. Larger area refer to derm
3. Topical calcineurin
99
What are classic symptoms of PID?
1. Cervical motion tenderness
2. Mucopurulent cervical discharge
3. lack of leukocytosis on wet mount
100
Treatment of PID should be?
1. Parenteral treatment
2. Cefotetan or cefoxitin plus doxycycline
3. Clindamycin and gentamycin
4. IM ceftriaxone with oral doxycycline or flagyl
101
What should be done with patients who have persistent ovarian cyst?
1. Gyn referral
| 2. CA-125
102
What is the most common type of kidney stone found?
1. Calcium oxalate
103
What is the work up for kidney stone
1. U/A
| 2. U/S or CT
104
What medications promote stone formation?
1. Bactrim, Amoxicillin, Quinolones
2. Sulfonylureas
3. Potassium sparing diuretics
4. Laxatives
105
How are kidney stones managed?
1. Hydration 2 ltiers per 24 hours
| 2. pain management antispasmodics, calcium channel blockers may hasten stone passage by 5-7 days
106
What are symptoms of prostatitis?
1. Pain peaks at 20-40 years and over 70 years
2. E coli most common organism
3. pain may be suprapubic, rectal, perineal
4. dull or sharp pain
5. Digital rectal exam for symptomatic patients
6. urine culture may be negative
7. STD testing high risk <35 years of age
107
How is prostatitis treated?
1. Ceftriaxone IM x 1 then doxycycline for 10 days
| 2. Quinoline ( or TMP-SMX x 10-14 days)
108
Which of the following is the most common cause of struvite kidney stones?
1. UTI
109
What are first line ABT for treatment of UTI?
1. Bactrim x 3 days
2. Macrodantin x 5 days
3. Fosfomycin x 1 dose
4. Fluoroquinolones
110
UTI in children 2 to 24 months what should the clinician be aware of?
1. defined by abnormal UA plus at least 50 CFU/ml
2. Renal and bladder U/s should be performed
3. VCUG not necessary after first UTI
111
How are UTI's managed in young children?
Oral ABT 7-14 days
112
A voiding cystourethrogram (VCUG) in children primarily evaluates which of the following?
Vesicoureteral reflux
113
Most common causes of chest pain in primary care are?
1. Chest wall pain/costochondritis
| 2. GERD
114
What type of pain accompanies acute MI
1. Radaites to both arms/neck/jaw
2. New 3rd heart sound
3. hypotension
115
What types of chest pain are more common and cause chest wall pain?
1. Stinging sharp pain
2. reproducible pain on palpation
3. Muscle tension
116
What symptoms accompany Gerd
1. burning retrosternal pain
| 2. better with PPI or antacid
117
What is Wells Criteria used for?
1. Evaluate risk of DVT and PE symptoms
118
What symptoms of a Thoracic Aortic Aneurysm?
1. Tearing pain that goes through to back
| 2. brachial BP difference
119
What are symptoms of a tension headache?
1. Bilateral mild to moderate pressure in the head
2. less aggravated with physical activity
3. Absence of N/V photo and phonophobia
4. look for connection to stress/anxiety
120
What is the acronym for assessing migraine headaches?
1. POUND pusatile
2. On for 4 to 72 hours
3. unilateral location
4. Nausea/Vomiting
5. Disability
121
What is the acronym for assessing migraine headaches?
1. POUND pulsatile
2. On for 4 to 72 hours
3. unilateral location
4. Nausea/Vomiting
5. Disability
122
Prevention of tension type headaches can be treated with?
1. Amitriptyline 1-=75 mg nightly
2. Relaxation/biofeedback
3. psychotherapy
4. acupuncture
123
Most common medication used for migraines?
triptans
124
Triptans should be avoided in patients with the following:
1. CVD
| 2. multiple risk factors pts taking SSRI's
125
What medications can be used to treat migraines proph?
1. Beta blockers
2. TCA's
3. Topiramate
4. Divalproex
5. Gabapentin
6. Ca-channel blockers
126
How is dizziness assessed in patients?
1. Orthostatic b/p
2. Hallpike diagnostic BPPV
3. Cranial Romberg gait
4. Cardiac exam
127
What blood work for diagnosing dizziness?
1. Anemia
2. Thyroid
3. BMP
128
How is Meniere's disease treated?
1. Salt restriction
2. Diuretics such as triamterene/hctz
chlorothiazide
129
How is vestibular neuritis treated?
Methy-lprednisone taper over 3 weeks
130
How is vestibular neuritis treated?
Methyl-prednisone taper over 3 weeks
131
Which of the following is the classic triad of Meniere's disease?
Episodic vertigo, tinnitus, hearing loss
132
Which of the following drug classes is best avoided in patients with asthma?
Non selective beta blockers
133
Which of the following signs is LEAST consistent with heart failure?
Finger clubbing
134
Which of the following symptoms is most specific to heart failure
Orthopnea
135
Diagnostic work up for shortness of breath
1. CXR
2. EKG
3. Spirometry with bronchodilator
Labs:
1. CBC, CMP, BNP, ntBNP
2. Possible D-Dimer
3. Echo
4. Chest CT
5. Cardiac stress test
