family med quiz Flashcards
(186 cards)
1
Q
involuntary leg movements while sleeping
A
REM sleep behavior disorder
2
Q
name causes of sleep problem in elderly people
A
rem sleep behavior disorder, restless leg hyperthyroidism (might be only symptom) cardiopulmonary problem substances & drugs advanced sleep phase syndrome pain pruritis GERD depression, anxiety sleep apnea environment not conducive to sleep disturbances to sleep wake cycle (jet lag, shift work)
3
Q
Risk factors for completed suicide (name 4)
A
increased age
male
military service
previous attempts
4
Q
which elderly people are more likely to commit suicide
A
widow/widower, live alone, poor health, often have recently seen primary care
lack confidante, stress
5
Q
what does SIGECAPS stand for
A
Sleep changes Interest Guilt/worthlessness Energy Concentration/cognition Appetite Psychomotor Suicide
6
Q
MDD criteria
A
5+/9 sigecaps with at least one being depressed mood or anhedonia lasting at least 2 weeks
7
Q
how do you discern between depression and bereavement
A
bereavement: mood comes in waves/comes and goes can still feel moments of joy; more focused on the loved one; thoughts of death more focused on the loved one and possibly joining them. self esteem more preserved although might feel guilt about not doing enough
8
Q
risk factors for late life depression
A
female low socioeconomic pain insomnia functional impairment cognitive impairment widowed living alone poor health social isolation
9
Q
SAFE-T suicide screen
A
look for Risk factors: previous attempts, psych history, family history, symptoms like anhedonia impulsivity command hallucinations insomnia, stressors, changes in treatment and access to firearms
- protective factors: internal and external
- Suicide inquiry: Ideation/Plan/Behaviors/Intent/Ambivalence
- Risk level
- Document
10
Q
PHQ-2
A
Over the past two weeks, have you often been bothered by either of the following problems?”
- Little interest or pleasure in doing things.
- Feeling down, depressed, hopeless
11
Q
Side effects of SSRIs, SNRIs
A
- headache
- GI
- sexual dysfunction
- sleep disturbance
- falls in elderly
less commonly hyponatremia from SIADH serotonin syndrome (lethargy, death, rhabdomyelosis, kidney failure, restlessness) GI bleeds maybe bone density?
12
Q
Risky side effect of citalopram
A
QT prolongation (can lead to torsades de points)
13
Q
risky side effect of escitalopram
A
QT prolongation (can lead to torsades de points)
14
Q
risky side effect of TCAs
A
arrhythmia
15
Q
________ are less likely than whites to have their depression identified
A
Latinx
16
Q
heavy dependence of the ______ on the ______ increases risk of elder abuse
A
heavy dependence of the caregiver on the elder
17
Q
2 main prongs of CBT-I
A
sleep restriction, sleep compression
18
Q
name two benzodiazopene receptor agonists
A
zolpidem
eszopiclone
19
Q
what TCA can be used as sleep aid
A
doxepin
20
Q
orexen receptor antagonist used as sleep aid
A
suvorexant
21
Q
fluvoxamine
A
luvox, SSRI
22
Q
MOA of TCAs
A
block NE and serotonin reuptake can cause arrhythmias nortriptyline amitriptyline doxepin clomipramine
23
Q
Name 2 SNRIs
A
venlafaxine (effexor)
duloxetine (cymbalta)
24
Q
MOA of bupropion
A
NE and dopamine reuptake inhibitor
25
MOA of mirtazipine
NE and serotonin reuptake inhibitor, antihistamine effects
low drug drug interaction potential
lotta appetite and weight increase
26
vilazodone
viibryd
| serotonin partial agonist and reuptake inhibitor
27
SSRI approved for panic, OCD, PTSD
sertraline
28
pregnancy category D SSRI, short half life so likely to cause discontinuation symptoms
paroxetine (paxil)
29
SSRI used in OCD, often causes vomiting
fluvoxamine (luvox)
30
SSRI approved for GAD, causes prolonged QT
escitalopram
31
what labs should you get when evaluating someone for depression
TSH
CBC
CMP
32
name 3 medical conditions associated with depression
hypothyroidism
dementia
parkinsons
33
Who does the USPSTF say should be screened for chlamydia?
- all sexually active women under 24
| - sexually active women over 25 at increased risk
34
What 5 categories of things should you talk about at preconception convo?
1. Genetic
including folic acid supplementation. 400mcg for most ppl; 1mg for diabetics & epileptics; 4mg if previous neural tube defect
2. Genetic screening (family hx - CF, tay sachs, sickle cell, connexin 26, thalessemia,
3. Mom's infectious disease status
-GC, chlamydia
-HIV
-Hep B
-preconception immunization: varicella, rubella
-toxoplasmosis
-CMV, parvovirus B19 (frequent handwashing)
4. Environmental exposure
-household/ substances & alcohol & tobacco
5. Medical assessment : remember no ACE-I, no thiazides, no warfarin, no benzodiazepines, ARBS
35
Naegele's rule for estimating due date
add 1 year
subtract 3 months
add one week
36
What does HEEEADSSS stand for
```
Home
Eating
Exercise
Employment & Education
Activities
Drugs
Sexuality
Suicide/depression
Safety/violence
```
37
what labs at initial pregnancy appt
```
HIV
CBC (anemia, nutritional deficiency)
HepBsurface ag
rubella immunity
blood typing
RPR
GC/chlamydia (don't think this is official answer)
```
38
labs for 1st trimester bleeding
hCG (should double every 48 hrs)
progesterone (<5 means ectopic, miscarriage)
trichomonas wet mount
CBC (check anemia - not that helpful in looking for infection as most preggers have mild leukocytosis)
remember Rh- moms always get Rhogam during bleeding episodes
39
management of inevitable abortion
- expectant management
- D&C
- vaginal misoprostol
40
early pregnant woman with distended acute abdomen
think ruptured ectopic pregnancy
41
intrauterine contents cannot be seen on US until hCG is > ____ mIU/ml
1500
42
Drinking 1 drink per day for women or 2 drinks per day for men is called _______ alcohol use
moderate
43
define binge drinking
5+ drinks on one or more occaisions in last 30 days
44
heavy drinking is __ drinks on ___ days out last 30
5+, 5+
45
signs of alcohol use disorder
2 or more:
wanting to quit but not being able to
feeling guilt
feeling irritable about being questioned
keep drinking tho causing trouble with family or friends
keep drinking tho cause anxiety, depress
physical symptoms when alcohol wears off
tolerance
cravings
lot of time drinking, being sick from drinking
given up or cut back on other parts of life that are important
more than once gotten into dangerous situations
46
Name 2 PE tests for appendicitis
psoas sign
| obtorator sign
47
Name 2 PE tests for appendicitis
psoas sign: Passive extension of patient's thigh as s/he lies on his/her side with knees extended, or asking the patient to actively
flex his/her thigh and hip causes abdominal pain, often indicative of appendicitis.
obtorator sign: Examiner has patient supine with right hip flexed to 90 degrees; takes patient's right ankle in his right hand as
he uses his left hand to externally/internally rotate patient's hip by moving the knee back and forth. Elicitation of pain in the
abdomen implies acute appendicitis.
48
RUQ pain with N/V after heavy meal, no fever, lasts less than 8 hrs usually
biliary colic - due to stone in cystic duct that gets out of way. needs US, cholecystectomy if stones
49
If there is jaundice and/or gallstone pancreatitis suggestive of a common duct stone (choledocholelithiasis), what kind of imagining might you get?
ERCP
50
medication for alcohol use disorder
naltrexone, acamprosate
| also CBT, MET, AA
51
what labs would you get for RUQ pain
```
electrolytes bc of vomiting
LFTs
CBC - look for leukocytosis that might suggest infection, eg cholocystitis, and anemia due to internal bleed
amylase/lipase
UA - in case its renal colic
```
52
RUQ pain that is sharp, N/V, fever, doesn't go away
acute cholecystitis - due to stone that doesnt dislodge from cystic duct
often after fatty meal
+/- Murphy's sign
emergency cholectomy
53
nausea/vomiting, constant epigastric pain radiating to back, abdominal tenderness on exam
acute pancreatitis
often after alcohol
may be hard to differentiate biliary colic from gallstone pancreatitis
classic but rare signs are bruising over bellybutton, flank
*dehydration! coma! shock!
plural effusion risk
there may be jaundice if common bile duct obstruction!
54
abdominal distention, high pitched bowel sounds, lack of flatulence, diffuse colicky pain , n/v that helps pain
obstructed small bowel
| maybe associated constipation
55
```
mid epigastric pain or R or L UQ pain
maybe N/V
gets better with food and antacids
maybe bloating, early satiety
bloody emesis, tarry stools
```
```
duodenal ulcer
PPI for 4-6 weeks
stop nsaids, aspirin
if H pylori positive: H pylori eradication therapy = PPI + bismuth+ tetracycline + metronidazole for 2 weeks
complication: perforation
```
56
H pylori eradication therapy
PPI + bismuth subsalicylate + metronidazole + tetracycline for 2 weeks
57
malaise, RUQ pain, pruritis, N/V, anorexia, icterus, jaundice, insidious onset
hepatitis
58
menopause is ____months without a cycle
12
59
USPSTF mammography guidelines
every other year 50-74yo
60
symptoms and PE findings of atropic vaginitis
frequent UTI, uregency frequency, dyspareunia, vaginal itching, smoother vaginal mucosa and cervix
treat with estrogen cream or ring
61
Name risk factors for endometrial cancer
```
unopposed estrogen therapy
tamoxifen (used for breast cancer)
nulliparity
early menarche
late menopause
obesity
anovulatory cycles
age
irregular cycles
(smoking weirdly decreases endometrial cancer risk)
```
62
when to use drugs to treat osteoposis
-2.5 t score
| t score between -2.5 and -1 and hip fracture risk 3%
63
Hormone therapy for menopause
increases stroke and MI risk
after 3 years, increases breast cancer risk
obvi don't use unopposed systemic estrogen
decreases osteoporeosis risk
64
Name 3 osteoporeosis bisphosphonate drugs
alendronate
ibandronate
zolendronic acid (yearly injection)
65
zoledronic acid
yearly injectable bisphosphonate
66
Name 3 non-bisphosphonate drugs that can be used to treat osteoporosis
calcitonin
parathyroid hormone (Forteo)
raloxifene
67
what medications besides HT can be used for menopause symptoms
SSRIs, SNRIs, gabapentin, clonidine
68
Name 5 tests for evaluation of post menopausal bleeding
- TSH - make sure its not thyroid prob
- CBC- anemia? thrombocytopenia?
- endometrial biopsy (gold standard) but only after...
- transvaginal ultrasound - look at thickness of endometrium to screen for endometrial cancer, also gives you some idea about fibroids, polyps or other uterine masses, ovary pathology
- LH, FSH (elevation confirms menopause)
69
Differential for post menopausal uterine bleeding
- cervical polyps: but you should know this is rare in post menopausal women; much more common in post partum, perimenopausal women
- proliferative endometrium: especially in women with a lot of circulating estrogen -- is she on HT?
- endometrium hyperplasia: this is a premalignant condition and 25% go on to cancer!
- endometrial cancer: 4th most common cause of cancer in women and 90% of women with have vaginal bleeding
- hormone producing ovarian tumors: not common for ovarian tumors to cause vaginal bleeding but obvi need to consider it
70
symptoms of IBS
flatulence, bloating, mucus in stool, changes in consistancy and frequency, abdominal pain related to defecation, often feel better after pooping. worse with stress, diary, caffeine. can be brought on by bout of gastroenteritis.
71
mid epigastric pain in pt that smokes, drinks, uses nsaids. worse with spicy food and stress. Nausea. decreased appetite.
gastritis
72
associations of Gallbladder disease
```
recently pregnant
uses OCPs
pain in RUQ, radiates to back, shoulder
fat, forty, fertile, female
eating fatty foods
```
73
a moderately severe to severe epigastric pain that often radiates to the back, and is
accompanied by nausea, vomiting and anorexia. There is usually a history of excessive alcohol use/abuse or a
family history of pancreatitis, although this can also be caused by gallstones, hypertriglyceridemia and other less
common causes.
pancreatitis
If suspicion is high, laboratory tests (lipase, amylase) and imaging (abdominal ultrasound or CT
scan) are needed to investigate further.
74
Cervical motion tenderness
Discharge
abdominal or pelvic pain, which is worse with sexual
intercourse or with activities such as running or jumping,
mild menstrual irregularities
PID
KOH/wet mount, naat
ceftriaxone + azithromycin
75
Patients present with divergent
symptoms ranging from no pain and normal menses, to intense pain and irregular or absent menses. A good
history, the physical exam and lab testing (always get a pregnanacy test if the patient has a uterus) are crucial for
this diagnosis. Imaging is also usually needed. You need the date of the patient's last menstrual period (LMP), her
menstrual history, most recent intercourse dates, the types of contraception used currently and used in the past
/ever used, history of any vaginal or pelvic infections, and history of previous ectopic or normal pregnancies.
Ectopic pregnancy is a medical emergency. Early medical treatment reduces the need for surgery, but if the
fallopian tube is in danger of rupture, surgical intervention may be necessary. P
76
modalities for diagnosing IBD
flexible sigmoidoscopy, endoscopy, barium enema, colonoscopy
77
Centor criteria
fever
NO cough
cervical lymphadenopathy
tonsillar erythema or exudate
+1 point if under 15
0 points if 15-45
-1 point if over 45
if they are a kid and get 2 points, they get a strep test (and cx whether it's positive or negative)
If they are an adult and get 3 points, they get a strep test
78
what are 2 most common complications of flu
bacterial pneumonia
| otitis media
79
tx for streptococcal pneumonia
amoxicillin
80
when is a kid considered overweight or obese?
overweight if 85-95 percentile of BMI
| obese if >95 percentile BMI
81
5-2-1-0 obesity prevention
```
5 servings frutis and veg
2 hrs screen time
1 hr exercise
0 sugary drinks
family meals
healthy breakfast
kids self reg meals
```
82
pulmonary findings that indicate consolidation
```
crackles
tactile fremitis (increased)
egophony
whispered pectoriliquy
dullness to percussion
```
83
amantidine
give within first 48 hrs of flu
84
rimantidine
give within first 48 hrs of flu
85
zanamivir or oseltamivir
give w/in first 48 hrs of flu
86
Can cause a low-grade fever, rhinorrhea, sneezing, nasal congestion and cough.
Last about one week.
Nasal discharge can begin as clear and gradually progress to colored, but that isn't a predictor of bacterial
involvement.
URI
87
Often starts as a viral illness and progresses to wheezing, cough, dyspnea, and cyanosis.
Infants require supportive treatment, including oxygen if hypoxic, while they are recovering.
Bronchiolitis
| often caused by RSV
88
crackles, fever >100.4, pleuritic chest pain, chills, cough, dyspnea, often no prodrome in children, often pleural effusion
strep pneumo pneumonia in children; treat with amoxicillin
89
chills, fever, dry, nonproductive cough) and the
| predominance of extrapulmonary symptoms, such as GI symptoms and arthralgias.
atypical pneumonia
viral, rsv, flu, varicella, measles, adenovirus, rhinovirus, parainfluenza, etc.
especially 4mo-5yo kids
90
cough +/- purulent sputum for 5+ days maybe rhonchi (snoring sound from mucus) maybe wheezes maybe normal lung exam
acute bronchitis
usually viral
supportive treatment
91
```
upper and lower respiratory tract symptoms
*abruptt* onset
high fever 102-104
myalgia, malaise, fatigue, headache
rhonchi
```
flu
92
fever, sore throat, and tender cervical lymphadenopathy .
Group a beta hemalytic steptococcal pharyngitis
with sandpaper rough macular rash--> scarlet fever
give penicillin V to prevent compliciations
93
who should be screened for hyperlipidemia?
anyone over 20 if at increased risk -- obesity, DM, fam hx, etc
94
Clinicians should discuss aspirin chemoprevention with ____for primary prevention of myocardial infarction
men >50
95
4 mechanisms of TIA or possible stroke
embolic - usually from heart (e.g. afib) or carotids (atherosclerosis)
thrombotic (MOST COMMON)
cardiogenic (decreased perfusion)
hemorrhagic
(hypercoagulobility, anemia, vasospasm)
96
expressive and receptive aphasia plus facial weakness associated with stroke from...
MCA
97
name 3 causes of facial asymmetry
bells palsy
stroke (think mca )
horner's syndrome
(all CN VII)
98
anticoagulation for high risk nonvalvular AF pts
warfarin or DOACs
dual clopidogrel and aspirin if they above won't work. more bleeding risk
99
primary stroke prevention for *low risk* AF pts
aspirin
100
primary stroke prevention for AF with valve problems
warfarin!
101
anticoagulation for stroke pt with AF
warfarin or doac. if they can't take these, aspirin
102
all patients with history of stroke or tia should be on _____ statin
high intensity
atorvastatin
rosuvastatin
103
doacs
apixaban
dapigatran
edoxaban
rivaroxaban
104
SPRINT trial BP goals for stroke pts
130/80
105
Stroke work up
```
MRI/CT
electrolytes & renal function
cardiac markers -- troponin trend, BNP (elevated in left ventricular dysfunction)
CBC, PT, PTT
oxygen saturation
ECG
```
106
DDx for lightheadedness with neuro focal findings
```
stroke, tia
mi/cad
seizure
med side effect
afib
structural heart disease
hypertensive emergency
```
107
elementary school admission vacc
```
Three hepatitis B
Five DTaP
Four polio
Two MMR
Two varicella
```
108
lead screening questions
Does your child live in or regularly visit a house or child care facility built before 1950?
Does your child live in or regularly visit a house or child care facility built before 1978 that is being or has recently been
renovated or remodeled (within the last six months)?
Does your child have a sibling or playmate who has or did have lead poisoning?
109
fever, pharyngitis, and lymphadenopathy esp posterior cervical
palatal petechia
hs
monospot
EBV
rash with amoxicillin
110
nspiratory stridor, "hot potato" (muffled) voice, dysphagia, and drooling.
Classically patients will be seated in a "tripod" position, leaning forwards and projecting the chin.
usually 1-6 yo
epiglottitis
very dangerous!
Hib
hospital!
111
starts like common cold, but cough worsens, around for at least 14 days,
Pertussis
| can be fatal in infants
112
most common among teens
drooling and muffled ("hot potato") voice.
Trismus occurs in two-thirds of patients and may help distinguish from tonsillitis.
complication of strep throat
Peritonsillar
abscess
Urgent surgical evaluation with drainage and antibiotic therapy are the mainstays of treatment
113
fever, difficulty swallowing, neck or ear pain, muffled "hot potato"
voice, and unwillingness to move the neck. Patients typically appear ill.
Most common among young children ages 2 to 4, but can occur at other ages.
Retropharyngeal
abscess
can be life threatening need hospital. lateral neck film or ct
114
barking cough, inspiratory stridor, and hoarse voice
viral croup
+/- steeple sign on x ray
make diagnosis clinically
115
```
a viral (or, less commonly, bacterial) infection of the inner ear causes inflammation of the
vestibular branch of the eighth cranial nerve.
```
vestibular neuritis
116
infection affects both branches of the eighth cranial nerve resulting in tinnitus and/or
hearing loss as well as vertigo.
acute labarynthitis
117
Dix-Hallpike manuever
confirm benign paroxysmal positional vertigo
nystagmus has fast component in direction of pathology
epley manuever = tx
118
how to tx otitis media in kids <6 mo
antibiotics
119
how to tx otitis media in kids 6mo - 2 yrs
cautious observation
120
how to tx otitis media in kids > 2 yo
don't need antibiotics if uncomplicated
121
do you treat maxillary sinusitis with abx?
nope!
122
symptomatic tx of URI
decongestant (such as pseudoephedrine) or saline nasal spray for congestion
acetaminophen for fever and pain
Physicians frequently recommend pushing fluids, though a recent Cochrane review found no studies investigating this
recommendation.
Echinacea has not been consistently demonstrated to improve symptoms of the common cold.
Vitamin C has shown mixed evidence in its ability to shorten the duration of the common cold. It may be worth a try for
some patients, but it can cause kidney stones.
Nasal ipratropium spray has been shown to slightly reduce rhinorrhea (runny nose) in the common cold, but not nasal
congestion (stuffy nose).
123
tx for benign paroxysmal positional vertigo
epley manuever
vestibular rehabilitation
meds like meclizine, dimenhydrinate
antiemetics like metoclopramide, promethazine
124
indications of central lesion causing vertigo
nyastagmus persists with fixed gaze, normal head thrust test
| get imaging
125
recent uri, vertigo, no hearing loss, nystagmus does not change direction with gaze
vestibular neuritis
126
recent uri, vertigo, + hearing loss, nystagmus does not change direction with gaze
acute labarynthititis
127
s acute onset vertigo that can be associated with nausea and vomiting and intact hearing
episodic
BPPV
128
Episodes of unilateral hearing loss, tinnitus, and vertigo f
Mennieres disease
129
Episodes of unilateral hearing loss, tinnitus, and vertigo
Mennieres disease
130
HTN plus any kidney issues -- what antihypertensive?
ACEi/ARB
131
antihypertensive if history of stroke
acei
132
older pt acute onset headache, nausea and/or vomiting
always suspect stroke
get non contrast CT, cbc to look for coagulopathy, blood glucose to look for hypoglycemia, UA, CXR ECG to look for heart probs
also need to consider subarachnoid hemorrhage
133
sudden severe headache, middle to older age person, photophobia, nausea vomiting
wouldnt be migraine starting this late in life
think subarachnoid hemorrhage
get noncontrast CT but may be equivoqal --> lumbar puncture
134
adrenal insufficiency with insufficient aldosterone would cause_____natremia dnd ______kalemia
hyponatremia and hyperkalemia
135
Mammogram is the preferred imaging study for women over 35, while women younger than 35 should get ultrasound to evaluate a breast mass.
if a cystic mass found, probably not malignant. no further eval. If solid -- biopsy.
136
Enterobiasis
```
aka pinworm
girls can get vulvovaginitis, uti
mebendazole
albendazole
treat whole household
wash bedding and clothing, clip fingernails
```
137
when you see euvolemic hyponatremia always think ...
SIADH
-hypotonicity (look at low plasma osmolality)
-inappropriately concentrated urine relative to hypotonic plasma
-normal renal function! kidneys are just fine
too much ADH (vasopressin) is causing body to hold on to free water in CD
causes:
1. cancer - especially small cell lung, pancreatic
2. CNS probs
3. drugs - antipsychotics, chlorpropamide, chemo
(remember that ppl with schizophrenia on antipsychotics might actually drink too much water --psychogenic polydipsia
138
diabetes insipidus usually causes _____natremia
mechanism of central DI:
mecanism of nephrogenic DI
hypernatremia. Pt will pee a lot
central DI: not enough ADH production, often due to surgical trauma to hypothalamus or pituitary
nephrogenic DI: kidneys dont respond to ADH, usually inherited in kids, usually caused by drugs in adults like lithium
139
tx for trichomonas or bacterial vaginitis
metronidazole
| positive WHiff test for both
140
tx for yeast infection
clotramazole
141
post strep glomerulonephritis
the patient's age (<7 years old)
dark brown colored urine (representing hematuria), and periorbital and peripheral edema.
There is also a latent period of around 10 days following pharyngitis before symptoms of glomerulonephritis occur, although for glomerulonephritis following streptococcal impetigo, the latent period can be as long as 3-4 weeks.
anti-streptolysin O titer,
RBC casts --When
you see casts in the urine sediment - whether WBC, RBC, or granular - you have glomerular disease. This is a useful pearl to remember – it’s only when cells get squeezed through the
glomerulus that they will form casts. Dysmorphic RBCs (especially acanthocytes) are also highly suggestive of glomerular disease. Patients with bleeding from sources other than the glomerulus
- such as a patient with renal stones, bladder cancer, or a urinary tract infection - should have RBCs with normal morphology, since those cells are not being squeezed from the glomerulus into
the collecting tubule. IgA nephropathy (answer A) is the most common cause of primary glomerulonephritis. The most common presentation is recurrent episodes of gross hematuria that occur
around *5 days* after an upper respiratory infection.
142
kid with hematuria, proteinuria, abdominal pain, palpabale purpura, arthralgia
henoch scholein
igA deposits in small vessels
provoked by meds, group a beta hemolytic strep, parvovirus B19, other infections, allergy
supportive care
143
Hyperkalemia with EKG changes needs immediate treatment with
i.v. calcium to protect the heart
144
classic ecg finding of hyperkalemia
peaked t wave
145
markedly elevated blood pressure in an otherwise healthy young person and the presence of an
abdominal bruit
fibromuscular dysplasia
146
hypertension, obesitymoon facies, a “buffalo hump,” purple striae, a
Cushings, most commonly from exogenous corticosteroids
147
most common cause of syncope in young people is vasovagal but serious cardiac issues are...
wolf parkinson white (look for delta wave -- radio ablation)
long or short QT
hypertrophic cardiomyopathy
valve disease
148
Edrophonium test is to confirm...
mysthenia gravis 1) The key feature of MG is fatigable muscle weakness.
Patients will typically report that their symptoms worsen throughout the day. Oculobulbar myasthenia gravis is the most common type, resulting in the signs and symptoms presented in the
question stem: double vision, ptosis, dysarthria, and difficulty chewing. 2) Myasthenia gravis has a bimodal age distribution, so there are two classic groups of patients who get MG: young women
in their 20s or 30s with autoimmune disorders (RA, SLE, hyperthyroidism, etc.), and men in their 70s or 80s. 3) MG is caused by autoantibodies that bind to postsynaptic ACh receptors. A
commonly tested point is distinguishing myasthenia gravis from Lambert-Eaton syndrome, which is a paraneoplastic disorder (usually associated with small cell lung cancer) in which antibodies
are produced against the pre-synaptic Ca2+ channels. 4) The treatment of myasthenia gravis begins with anticholinesterase drugs like neostigmine or pyridostigmine, which increase the amount
of ACh in the synapse, overcoming the antibody blockade. Prednisone or other immunosuppressive drugs are also used, and i.v. Ig or plasmaphresis are used for refractory cases to more
directly target the responsible autoantibodies. 5) Myasthenia gravis almost always have some abnormality of the thymus: 75% will have thymic hyperplasia, and 15% will have an overt thymoma.
Since the disease is mediated by T cells, removal of the thymus can be curative in patients who fail medical therapy. Regardless, once the diagnosis of MG has been established, it is reasonable
to rule out thymoma via CT scan. If you answered B, a chest CT, you either recognized that this was a case of myasthenia gravis and were pursuing a thymoma, or you thought that this was a
case of Lambert-Eaton myasthenic syndrome and were looking for a small cell lung cancer. A chest CT will provide useful – and potentially even necessary – diagnostic and prognostic
information, but first you should confirm the initial diagnosis of myasthenia gravis with the edrophonium test or EMG
149
fixed splitting of S2 in a child
think atrial septal defect
(normal s2 splitting is only on inspiration)
ASD leads to pulmonary tensions and eventually Eisenmenger syndrome where left to right shunt revereses
150
midsystolic click followed by a late systolic murmur heard best at the apex of the heart
mitral valve prolapse
151
PROVE tetralogy of fallot
```
Pulmonary stenosis
Right ventricular hypertrophy
overarching aorta
ventricular septal defect
early cyanosis
```
152
what do you give for acute COPD exacerbation
abx and systemic corticosteroids
153
A useful mnemonic to remember the differential of microcytic anemias is “TAILS”
```
Thalasemmia
Anemia of chronic disease
iron deficiency
lead poisoning
sideroblastic anemia
```
**Microcytic anemia/ iron deficient anemia in male is colorectal cancer until proven otherwise. First test is always endoscopy.
154
increased LDH and decreased haptoglobin in setting of anemia suggests
hemolysis of RBCs
| commonly tested cause: G6PD deficiency
155
Extra” heart beat that originates in the left or right ventricle
Typically no P wave
Wide QRS complex, usually > 0.16 sec
Often followed by a compensatory pause
PVC
| premature ventricular contraction
156
pvc trigger
```
htn
Ischemia/MI
Cardiomyopathy/HF
Anxiety, catecholamines
Stimulants (legal or illegal)
Electrolyte abnormalities (low K, Mag, high Ca)
Hyperthyroidism
```
157
clinical significance PVC
high number” = more significant
Polymorphic = more significant
Even simple PVCs in otherwise healthy patients have shown association with increased all-cause mortality
Presence of PVCs, especially frequent or complex, associated with worse prognosis post-MI
158
workup pvc
Labs: BMP, Mag, Ca, TSH
Holter monitor or event monitor
Echo
Stress test
159
pvc tx
Treat the underlying cause
Beta blocker or calcium channel blocker
Antiarrhythmics
Catheter ablation
160
afib
Rapid and irregular rhythm that originates in the atria
RR interval has no repetitive pattern (“irregularly irregular”)
No distinct P waves; will see fibrillatory waves, instead
Typical ventricular rate is from 90 – 170
Usually narrow QRS
161
causes of afib
```
Age
HTN and coronary disease
Structural heart disease
Alcohol (holiday heart syndrome)
Hyperthyroidism
Lung problems (COPD, PE)
Stimulants
MI
Hypoxia
```
162
what are clinically significant effects of afib
```
chf
mi
stroke
reduced ef
palpitations
```
163
when should someone with afib be hospitalized
```
Hemodynamically unstable
Treatment of underlying cause
Concern for ACS
Elderly
Unable to control rate
```
164
afib workup
```
Look for an underlying cause
EKG
Echo: LVH, atrial size, valves
Electrolytes, TSH, CBC
Consider ischemia
```
165
afib treatment
either rate or rhythm control
| cha2ds2vas 2+ def anticoag
166
cha2ds2vas
```
chf
htn
age >75 2 pt
diabetes
stroke/tia hx 2 pt
vascular disease
age 64-75
sex (female)
1: maybe get anticoag
2: definitely anticoag
```
167
supraventricular tachycardia
Fast rhythm originating in the atria
Narrow QRS
Rate from 120 - 220
168
probs cause by SVT
hemodynamic instability
ischemia
HF
syncope
169
immediate tx for SVT (name 4)
Vagal maneuvers
Adenosine 6 mg IVP, repeat 6 mg IVP 2 min later, 12 mg IVP 2 min later
IV Ca channel blocker (nondihydropyridine)
IV beta blocker
170
long term management of SVT
```
Self-termination with valsalva
“Pill in the pocket”
B-blocker or nondihydropyridine
Other anti-arrythmics
Catheter ablation
```
171
DSM def of insomnia
Difficulty initiating or maintaining sleep, or non-refreshing sleep
Impairment or distress
3x/week for one month
172
sleep restriction goal 90% efficiency; relaxation and cognitive therapy; CBT-I superior to drugs in long term. benzos superior in short term
benzodiazapenes have reversible dementia risk
| antihistamines have dementia risk
173
moa of z drugs
```
bind to GABA receptor
benzodiazapene receptor agonists
zolpidem
zaleplon
eszopiclone
*decrease sleep latency
```
174
how does suvorexent work
orexen receptor antagonist, works in hypothalamus; blocks wakefulness but also reward pathway. can lead to depression
175
non drug sleep approaches
keep sleep log
melatonin .3-.5 mg (** especially for delayed sleep phase disorder can move up sleep phase by 40 min)
light therapy
mindfulness based therapy for insomnia
176
recommended melatonin dose
.3-.5mg
177
USPSTF screening recs for sleep apnea
dont do it for everybody
-when indicated, Epsworth sleepiness sclare
STOP-BANG
178
common co morbidities of osa
afib, obesity, depression, chf, htn, cad, dm, stroke
179
diagnostic criteria for OSA
polysomnography, apnea-hypoanea index AHI
| >15 AHI events in a night
180
OSA treatment
*CPAP (oral devices are second line)
weight loss
positioning (poor compliance)
(conflicting evidence on whether osa tx actually lowers cardiovascular risk)
181
creepy crawly sensation when resting, relieved with activity
RLS
182
things that provoke RLS
```
low iron, make sure ferritin >50
dopamin antagonists like neuroleptics, metoclopramide
SSRIs,
TCAs
caffeine
lithium
antihistamines
```
183
Name 4 drugs to treat RLS
carpadopa/levodopa
gabapentin
ropinirole
pramipexole
(all dopamine agonists)
184
pramipexole
dopamine agonist used to treat RLS
185
ropinirole
dopamine agonist used to treat RLS
186
when to use low to mod dose statin for primary cvd prevention
1) they are aged 40 to 75 years;
2) they have 1 or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking);
and 3) they have a calculated 10-year risk of a cardiovascular event of 10% or greater.
