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Step Up To Medicine DF > Ambulatory Section > Flashcards

Ambulatory Section Flashcards

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1
Q

DD for headache

A

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

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2
Q

2ndary causes of hyperlipidemia

A

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

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3
Q

recommendations for statin therapy

A

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

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4
Q

treatment for tension headache

A

find casual factor like depression or anxiety

then nsaids and acetaminophen and asa

migraine meds if severe

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5
Q

first line treatment for cluster headache

A

oxygen and triptan

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6
Q

prophylaxis for cluster headache

A

most responsive of all HA types

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

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7
Q

treatment for migraines

A

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

Sumatriptin

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8
Q

DHE MOA, use, and contraindications

A

5HT-1 agonist

terminate pain migraine

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

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9
Q

sumatriptin MOA and contraindications

A

5HT1 receptor agonist

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

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10
Q

prophylaxis for migraine

A

consider in pts with weekly episodes that interfere with activities

TCAs and B-Blockers (propranolol most effective)

alt: verapimil, valproic acid, methysergide

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11
Q

menstrual migraine and treatment

A

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

treatment: normal migraine and estrogen

prophylaxis is NSAID

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12
Q

acute cough length vs chronic

A

less than 3 = acute

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13
Q

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

A

porbably not a migraine HA

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14
Q

treatment for acute bronchitis

A

bronchodilators and cough suppressants

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15
Q

which sinusitis may mimic pain of dental caries

A

maxillary sinusitis

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16
Q

chronic sinusitis last how long

A

2-3 months

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17
Q

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

A

S aureus and gram negative rods

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18
Q

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

A

8-10 days

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19
Q

antibiotics for sinusitis

A

augmentun, bactrim, levo/moxiflox, cefuroxime

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20
Q

treatment for chronic sinusitis

A

penicillinase resistant abx

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21
Q

laryngitis most commonly caused by what

A

virus

possible m cat or h influe

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22
Q

centor criteria, how many points for abx automatically

A

4 or more

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23
Q

centor criteria, how many points for culture

A

2,3

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24
Q

treatment for strep

alternative for allergy

A

PCN 10 days

erythromycin if pt allergic to PCN

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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

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