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Medicine shelf > Ambulatory high yields: respiratory, GI, MSK > Flashcards

Ambulatory high yields: respiratory, GI, MSK Flashcards

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1
Q

Should further investigate a cough once it has lasted how long?

A

> 1 month

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2
Q

4 MCCs of chronic cough in adults?

A

Smoking, GERD, asthma, post-nasal drip

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3
Q

3 indications for CXR for a cough?

A

Chronic cough (>8 wk), hemoptysis, if a pulmonary cause is suspected

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4
Q

Tx of post-nasal drip?

A

1st gen antihistamine/decongestant prep

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5
Q

MC presenting symptom of acute bronchitis?

A

Cough (with or w/o sputum)

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6
Q

MC route of spread of the common cold?

A

Hand to hand

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7
Q

Patient has a cold lasting 8 - 10 days or a cold that improves but then gets worse after a few days. What do you suspect?

A

Acute bacterial sinusitis

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8
Q

3 MCCs of acute bacterial sinusitis?

A

Strep pneumo, H. flu, anaerobes

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9
Q

MC sinuses involved in acute sinusitis?

A

Maxillary

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10
Q

Nasal stuffiness, purulent nasal DC, cough, pain over cheeks that mimics pain of dental caries?

A

Maxillary sinusitis

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11
Q

Nasal stuffiness, purulent nasal DC, cough, pain in lower forehead?

A

Frontal sinusitis

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12
Q

Nasal stuffiness, purulent nasal DC, cough, retro-orbital pain?

A

Ethmoid sinusitis

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13
Q

How long do Sx have to last to diagnose chronic sinusitis?

A

2-3 mo

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14
Q

Imaging test to do if sinusitis is complicated or may require surgery?

A

CT (coronal)

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15
Q

If acute sinusitis hasn’t improved after 2 weeks of proper treatment, what do you do next?

A

Sinus xray + penicillinase-resistant antibiotic

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16
Q

Sinusitis of which sinus is most likely to cause orbital cellulitis?

A

Ethmoid

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17
Q

Treatment of acute bacterial sinusitis?

A

Saline nasal spray (helps drainage) + decongestants (no more than 3-5 days) + Abx. Avoid anti-histamines unless patient also has allergies.

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18
Q

Name 2 decongestants

A

Pseudoephedrine, oxymetazoline

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19
Q

Patient with hoarseness, cough, and URI Sx. Dx?

A

Laryngitis

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20
Q

Why should patients with laryngitis rest their voices?

A

Avoid formation of vocal nodules

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21
Q

MCC of sore throat?

A

Virus

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22
Q

What can a throat culture tell you that a rapid strep test can’t?

A

Bacterial vs viral cause if non-streptococcal bacteria is the cause

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23
Q

How do you treat strep throat?

A

PN q10 days

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24
Q

Tx of strep in a PN-allergic patient?

A

Erythromycin

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25
4 MCCs of dyspepsia/heartburn?
PUD, GERD, gastritis, nonulcer dyspepsia
26
How long do dyspepsia Sx need to be present to diagnose nonulcer dyspepsia?
>4 wk. And you better have done an endoscopy!
27
Test of choice for eval of dyspepsia?
Endoscopy
28
7 major indications for endoscopy in dyspepsia?
1. alarm sx 2. >45 yo w/ new dyspepsia 3. recurrent vomiting or evidence of GIB 4. signs of PUD complications 5. recurrent sx 6. no response to empiric therapy 7. evidence of systemic illness
29
GERD + dysphagia: most likely cause?
Peptic strictures
30
When do you do an endoscopy w/ Bx for suspected GERD?
if heartburn is refractory or is accompanied by dysphagia, odynophagia, or GIB.
31
Gold standard for Dx GERD?
24 hr pH monitoring of LE
32
How do you confirm dx of suspected peptic stricture?
EGD
33
Tx of peptic stricture?
Dilation
34
Who should be screened for Barretts and how?
Patients with symptomatic GERD for at least 5 years. Endoscopy w/ Bx.
35
What cytologic finding on bronch can diagnose aspiration of gastric contents (leading to recurrent PNA)?
Lipid-laden macrophages
36
Initial treatment of GERD?
Antacids + behavior mod
37
Fever + bloody diarrhea: 4 common orgs?
Campylobacter, shigella, salmonella, EHEC
38
Diarrhea w/o fever or blood: 3 major groups of causes?
Viral, food poisoning, ETEC
39
What workup is required in mild-mod diarrhea?
Assess vol status, abd exam, FOB. Nothing else!
40
Major causes of diarrhea w/ fecal leukocytes?
Campylobacter, shigella, salmonella, EIEC, c diff
41
MC acid base abnormality in severe diarrhea?
Metabolic acidosis and hypokalemia
42
Empiric abx for patients with mod-severe diarrhea?
5 days of cipro
43
If H&P suggest obstruction, what should you do next?
Abd xray
44
4 major complications of chronic constipation?
Hemorrhoids, rectal prolapse, anal fissures, fecal impaction
45
Myalgias, malaise, HA, watery diarrhea, ab pain, n/v for 2-3 days
Acute viral gastroenteritis
46
Abd pain, diarrhea w/ fecal wbcs, n/v a day or two after eating chicken
Salmonella
47
Diarrhea w/ fecal wbcs, abd pain, tenesmus, n/v lasting 4-5 days
Shigella
48
Tx of shigella?
TMP-SMX
49
Abd pain, n/v/d <6 hrs after a picnic?
Staph food poisoning
50
HA, fever and fatigue--> diarrhea (w/ wbcs) and abd pain
Camplyobacter
51
Tx of campylobacter?
Erythromycin
52
Diarrhea and crampy abd pain lasting <24 hr
C. perfringens
53
Traveler w/ watery diarrhea, nausea, abd pain lasting a few days
ETEC
54
Very sick patient w/ bloody diarrhea. Hamburger.
EHEC
55
Voluminous diarrhea, vomiting, abd pain in the third world
Vibrio cholerae
56
How long do sx have to last to dx IBS?
3 mo
57
MCC of gastroenteritis?
Enterobacter
58
Bilious vomiting means obstruction is distal to what?
Ampulla of vater
59
3 major causes of feculent vomit?
Distal intestinal obstruction, bacterial overgrowth, gastrocolic fistula
60
First step in management of vomiting leading to dehydration?
IVF: 1/2NS w/ K
61
Painless BRBPR in heroin abuser?
Internal hemorrhoids (opioid-->constipation-->straining)
62
Sudden painful swelling emerging from anus?
External hemorrhois
63
Tx for internal hemorrhoids?
Rubber band ligation
64
Back pain that's worse with sitting, driving, or lifting (forward flexion). Dx?
Disc herniation
65
Leg pain on back extension. Worse w/ standing or walking; better with bending forward or sitting.
Spinal stenosis
66
Acute bladder dysfxn + perineal/butt numbess
Cauda equina synd
67
Suspect cauda equina syndrome... next best step?
STAT MRI
68
MCC of acute neck pain?
Cervical strain
69
Unilateral neck pain radiating to the arm in a dermatomal pattern. Dx?
Cervical radiculopathy
70
You suspect cervical radiculopathy. What's the best test to dx nerve root compression?
C spine MRI
71
Old person who starts becoming unsteady and loses hand dexterity. What should you r/o and how?
Cervical myelopathy 2/2 cervical stenosis. C spine MRI
72
Anterior knee pain that's worse going up/down stairs
Patellofemoral syndrome
73
Tx of patellofemoral synd?
PT for stretching/strengthening quads and hamstrings
74
Recurrent knee effusions, tenderness along medial or lateral joint line, and positive mcmurray
Meniscal pathology
75
Long jumper w/ pain at inferior pole of patella
Patellar tendinitis
76
Pain along medial patella, "snapping" knee with walking, +/- intermittent effusion
Plica syndrome
77
If you suspect ligamentous instability of knee or a meniscal tear, what's the next best test?
MRI
78
MC ligament injured in sprained ankle
ATFL
79
Patient w/ suspected sprained ankle doesn't require xrays if...
Can walk 4 steps at time of injury and at time of eval + no bony tenderness over distal 6 cm of either malleolus
80
MCC of shoulder pain?
Supraspinatus tendinitis
81
Weakness on shoulder aBduction. Next best test?
Shoulder MRI (weakness should make you think rotator cuff tear > tendinitis)
82
Definitive treatment for impingement syndrome
Acromioplasty
83
Best initial treatment for lateral epicondylitis?
Splinting the forearm w/ counterforce brace
84
Pain in radial aspect of wrist. Reproduced if thumb is clenched in fist and wrist is ulnarly deviated. Dx?
De Quervain's dz
85
Spongy bag of fluid over the olecranon
Olecranon bursitis
86
Lateral hip pain + pain on palpation of greater trochanter
Trochanteric bursitis
87
Hip OA presents with pain in what site?
Groin
88
Initial tx of carpal tunnel?
Night-time wrist splinting + NSAIDs
89
1st line tx for pain of OA?
APAP
90
4 general recommendations for patients w/ osteoporosis?
Daily Ca, daily vit D, weight-bearing exercise, stop smoking
91
Gold standard for Dx of osteoporosis?
DEXA
92
Indications for DEXA?
All women >64; postmenopausal women <65 and all men w/ RF for fracture

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