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Flashcards in Ambulatory Section Deck (94):
1

DD for headache

VOMIT

Vascular: hemorrahge, hematoma, temporal arteritis

Other: malignant HTN, pseudotumor cerebri, postlumbar puncture, pheo

Meds: nitrates, alcohol withdrawal, chronic analgesics

Infection: meningitis, encephalitis, abscess, sinusitis, herpes zoster, fever

Tumor

2

2ndary causes of hyperlipidemia

PM REC
(M: GET Bent)

Pregnancy
Meds: Glucocorticoids, Estrogens, Thiazides, B-blockers

Renal dz: nephrotic syndrome and uremia
Endocrine: DM, cushing, hypothyroid
Chronic liver disease

3

recommendations for statin therapy

1) anyone with LDL 190 or above
2) 40-75 and DM and LDL over 70
3) ASCVD present
4) 40-75 no DM but 10 yr risk ASCVD 10% or higher

4

treatment for tension headache

find casual factor like depression or anxiety

then nsaids and acetaminophen and asa

migraine meds if severe

5

first line treatment for cluster headache

oxygen and triptan

6

prophylaxis for cluster headache

most responsive of all HA types

1) verapamil
2) ergotamine, methysergide, lithium, prednisone alternatives

7

treatment for migraines

NSAIDs, tylenol if mild,
DHE or triptan if don't work

Sumatriptin

8

DHE MOA, use, and contraindications

5HT-1 agonist

terminate pain migraine

contraindications in: CAD, pregnancy, TIAs, PAD, sepsis

9

sumatriptin MOA and contraindications

5HT1 receptor agonist

contraindications: CAD, pregnancy, uncontrolled HTN, basilar artery migraine, hemiplegic migraine, MAOI, SSRI or lithium use

10

prophylaxis for migraine

consider in pts with weekly episodes that interfere with activities

TCAs and B-Blockers (propranolol most effective)

alt: verapimil, valproic acid, methysergide

11

menstrual migraine and treatment

occurs btwn 2 days before menstruation and the last day of menses

treatment: normal migraine and estrogen

prophylaxis is NSAID

12

acute cough length vs chronic

less than 3 = acute

13

patient who had migraine headache and no meds work. probably what

porbably not a migraine HA

14

treatment for acute bronchitis

bronchodilators and cough suppressants

15

which sinusitis may mimic pain of dental caries

maxillary sinusitis

16

chronic sinusitis last how long

2-3 months

17

pts with history of multiple sinus infections and courses of abx are at risk for infection with what

S aureus and gram negative rods

18

if pt has cold for longer than how many days then think bacterial sinusitis

8-10 days

19

antibiotics for sinusitis

augmentun, bactrim, levo/moxiflox, cefuroxime

20

treatment for chronic sinusitis

penicillinase resistant abx

21

laryngitis most commonly caused by what

virus

possible m cat or h influe

22

centor criteria, how many points for abx automatically

4 or more

23

centor criteria, how many points for culture

2,3

24

treatment for strep

alternative for allergy

PCN 10 days
erythromycin if pt allergic to PCN

25

initial treatment of GERD

behavior mod, antacids and H2 blocker

then PPI if above fails

surgery last resort

26

important parts of history in pts with diarrhea

is there blood
fever, abdominal pain, vomit?
sick contacts?
travel outside US?
linked to certain foods?
medical problems?
recent changes in meds?

27

acute diarrhea and h and P shows complications then what is next

microscopic exam of stool for WBCs

positive then check for C diff
-if neg and diarrhea persist longer than expected can do flex sigmoid with bx

28

indications for diagnostic studeis in diarrhea

chornic
severe illness or high fever
blood in stool
severe abdominal pain
ICP
volume depletion

29

what tests to order if ordering for diarrhea

CBC
stool sample (check for leukocytes)
ova and parasites
c diff culture and toxic
giardia antigen

30

abx in what diarrhea

infectious diarrhea, decrease illness by 24 hours

cipro

31

abx in diarrhea when

high fever, bloody stools, severe
stool culture grows pathogenic organism
traveler's diarrhea
C diff infection

32

causes of constipation

diet (lack fiber)
meds (lanticholinerg, CCBs, iron, narcotics)
IBS
obstruction
ileus
hemorrhoids, fissures
endocrine: hypothyroid, hypercalcemia, hypokalemia, uremia, dehydration
neuromuscular disorders
hirschsprung

33

the most common electrolyte/acid base abnormality seen with severe diarrhea is what

metabolic acidosis and hypokalemia

34

endocrine causes of constipation

hypothyroid, hypokalemia, hypercalcemia

35

diagnosing constipation

think labs for TSH, calcium, CBC (CRC suspected) electrolytes (obstruction suspected)

always r/o obstruction, may need abdominal films and flex sig

rectal exam

36

how long should sx be present for IBS to be diagnosed

3 months

37

Rome III diagnostic criteria for IBS

recurrent abdominal pain/discomfort 3 days or more per month in last 3 months and 2 or more of the following:

1) pain/discomfort improves with pooping
2) sx onset associated with change in freq of stool
3) sx onset associated with change in form of stool

38

treatment of IBS

diet and lifestyle change if mild

diarrhea: diphenoxylate, loperamide
constipation: psyllium, cisapride, colace
abdominal pain: antispasmodics
-pinaverium, trimebutine, cimetropium/dicyclomine, antidepressants, firaximin

39

treatment for hyperemesis gravidarum

promethazine

40

treatment for hemorrhoids

sitz baths
ice pack
stool softener
high fiber
topical steroids

band ligation for internal hemorrhoids
surgical if conservative methods do not work

41

nonexudative ARMD or dry mac dengen cause and sx

tx

atrophy and degen of central retina

yellow white deposits called drusen form

vitamins

42

tx for wet ARMD

(ranibizumab) anti-VEGF inhibitors maybe photocoag

43

chronic open angle glaucoma treatment

a agonist
b blocker

carbonic anhydrase inhib
prostaglandin analogue

44

acute angle closure glaucoma treatment

emergency

timolol, brimonidine, pilocarpine, prednisolone drops
IV acetazolamide
oral mannitol

laser or surgery is definitive treatment

45

keratoconjunctivitis sicca is another name for what

dry eye

46

blepharitis associated with what infection

staphylococcus

47

scleritis is associated with what disease


sx
pain with what
tx

RA

eye pain, severe and deep

pain on palpation of eyeball

systemic corticosteroids

48

acute anterior uveitis associated with what disesaes

sarcoid, ankylosing spondylitis, reiter syndrome and IBD

49

dendritic ulcer on the cornea that is usually unilateral and can result in irreversible vision loss if untreated

what is treatment

Herpes simplex keratitis

topical gancyclovir gel
oral acyclovir or valcylovir if cannot tolerate topical therapy

50

bacterial conjunctivitis most commonly caused by what

S aureus in adults

51

chlamydial conjunctivitis

trachoma (serotypes A,B,C)

inclusion conjunctivitis (D and K)

trachoma: most common cause of blindness

D and K: genital hand eye contact with STI

52

allergic conjunctivitis bilateral or unilateral?

bilateral usually

53

bacterial conjunctivitis treatment

erythromycin, cipro, sulfacetamide

SEC

54

hyperacute gonoccoccal conjunctivitis treatment

ceftriaxone 1g IM and topical therapy

55

chlamydial conjunctivitis treatment

oral tetra, doxy, erythromycin for 2 weeks

56

sudden transient loss of vision in one or both eyes

what should oyou order

amaurosis fugax

carotid ultraounorgraphy and cardiac workup

57

causes of transient monocular vision loss

carotid artery disease, cardioembolic phenom, giant cell arteritis, and more

58

treatment for obstructive sleep apnea

behavior mod

positive airway pressure therapy

if severe then continuous positive airway pressure
uvolopalatopharyngoplasty
tracheosteomy is last result

59

treatment for narcolepsy

modafinil
methylphenidate
or amphetamines

60

conductive hearing loss

lesions in external or middle ear

61

conducitve hearing loss from external canal causes

cerumen impaction
otitis externa
exostoses (bony outgrowths from exposure to cold water)

62

middle ear conductive hearing loss

middle ear effusion, otitis media, allergic rhinitis

otosclerosis (AD condition)
neoplasm, malformations of ear

63

sensorineural hearing loss causes

presbycusis (aging), high freq hearing loss and discrimination difficulty

noise induced hearing loss: hair cells of corti damaged

Infection
drug induced
torch infection
meniere disease
CNS causes

64

meniere disease

treatment for vertigo

unilateral hearing loss
tinnitus, vertigo, pressure

salt restriction and meclizine for vertigo

65

CNS causes of sensorineural hearing loss

acoustic neruomas, meningitis, syphilis, meningioma

66

obstruction to urine flow like BPH, prostate cancer, strictirues, severe constipation cause what kind of incontinence

overflow

67

nocturnal wetting in what incontinence

urge and overflow

68

diagnoses of incontinence

UA to r/o infection and hematuria

postvoid cath
-normal is less than 50 mL, if greater than may be obstruction or hypotonic bladder

urine culture

renal fnct studies with glucose

69

differential diagnosis of fatigue

psychiatric
endocrine
hematologic/oncologic
metabolic
infectious
cardiopulmonary
meds (clonidine, methyldopa)
chronic fatigue syndrome

70

lab workup with fatigue

CBC
TSH
glucose
BMP (electrolyte abnormalities)
UA, BUN/CR
LFT

71

chronic fatigue syndrome

fatigue over 6 months not due to medical or psychiatric disorder

A) new or definite fatigue not alleviated by rest
and
B) 4 or more of following sx for at least 6 months
1) decreased short term mem or conentration
2) muscle pain
3) sore throat
4) tender LAD
5) unrefreshing sleep
6) joint pain
7) HAs
8) post exertional malaise for over 24 hours

72

treatment for chronic fatigue syndrome

behavioral therapy
antidepressants (if depression too)
NSAIDs for pain

73

most important risk factor for ED

atherosclerosis risk factors

74

diagnosing ED

DRE, neuro exam, assess for PAD

labs: CBC, chem, glucose, lipids, T levels, prolactin, thyroid

consider vascular testing

psychogenic posible

75

CAGE questions

Cut down
annoyed
guilty
eye opener

76

which is reversible with alcohol problems wernicke or korsafoff

wernicke

77

screening for hyperipidemia yrs

measure nonfasting total cholesterol and HDL every 5 years

78

average risk pts 50-75 yrs old CRC screen

colonoscopy q10 yrs
flex sig q5 yrs and fecal occult blood test q3yrs
fecal occult every year

79

screening for someone with family history of CRC or adenomatous polyps in first degree relative

colonscopy at age 40 or 10 years younger than the youngest case in family
-if normal repeat in 3-5 years

80

families with FAP, what testing

genetic testing at age 10

colectomy if positive needs to be considered
if not positive then colonosopy every 1-2 yrs at puberty

81

families with hereditary nonpolyposis CRC testing

genetic testing at age 21
if positive then colonoscopy q2 yrs until 40 then every year after

82

patients with UC screening

8 years after diagnosis get colonoscopy then every year after

83

age for high risk adults to get low dose CT of chest when screening for lung cancer

55-80

84

when can you D/C pap screens

at age 65 with 3 consec neg paps or 2 neg pap with neg HPV testing within last 10 yrs and most recent test within last 5 years

85

ovarian cancer screening rec

none

86

all sexually active women under age what should be screened for chlam and gon

24

87

hep C screen rec

pts at risk and one time screen in pts born btwn 1945-1965

88

what pts screen for hep B

at risk
injection drug useres, MSM, hemodialyiss

89

DM screen

BMI at or over 25 and one risk factor for diabetes

test every three years

adults without risk factors start at age 45

90

pneumococcal polysaccharide PPSV23 and PCV13 vaccine schedule

adults over 65 get PPSV23

age 19-64 with ICP, asplenia, kidney disease, CSF leak, or cochlear implants get PCV13 then PPSV23 8 weeks later

adults with chronic problems like COPD and DM get PPSV23 before 65

91

Tdap primary series

1, 1-2 months, 6-12 months

92

booster of tdap

booster every 10 years Td

people over 19 should have 1 booster of Tdap instead of Td

93

varicella zoster vaccine

adults over 60

94

hepatitis B primary schedule

0, 1, 6 months