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From Flashcardlet > FM Pretest - Chronic Confitions > Flashcards

FM Pretest - Chronic Confitions Flashcards

0
Q

What is the most sensitive test for alcohol abuse? Most specific?

A
  • sensitive: GGT

- specific: MCV

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1
Q

Tx of choice for premature ejaculation?

A

-SSRIs bc they increase threshold for orgasm

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2
Q

MOA of naltrexone with alcohol abuse?

A
  • reduce the reinforcing effects of alcohol

- doesnt allow the pt to become “drunk”

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3
Q

Drug if choice to prevent relapse of alcoholism?

A

-Acamprosate

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4
Q

Mild persistent asthma sx?

A
  • sx more than 2x per week, but less than once a day

- night time sx more than 2x per month

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5
Q

Moderate persistent asthma sx?

A
  • daily sx

- night time sx at least once a week

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6
Q

Mild intermittent asthma sx?

A
  • sx less than 2 times a week

- night time sx less than 2 times a month

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7
Q

Peak flow measurements of what mean the asthma tx should be reevaluated?

A

-50-80%

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8
Q

Peak flow measurements of what require immediate medical attention?

A
  • < 50%
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9
Q

Spondylolisthesis

A
  • anterior displacement of vertebrae in relation to the one below
  • most common cause of low back pain in patients younger than age 26
  • especially seen in athletes
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10
Q

Whatis the only tx found to improve the natural history of COPD progression?

A

-supplemental oxygen

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11
Q

First line tx for COPD?

A

-An inhaled anticholinergic = (ipratropium

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12
Q

What is the first lab abnormality seen in chronic renal failure?

A
  • anemia, the kidneys epo production drops when the GFR is below 60
  • other results, such as hyponatremia, hyperkalemia, etc wouldnt be seen until function drops below 30
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13
Q

Hypoesthesia

A

-numbness

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14
Q

Hyperesthesia

A

-increased sensitivity

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15
Q

Paresthesia

A

-pins and needles

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16
Q

Allodynia

A

-severe pain, usually from innocuous stimuli

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17
Q

What is the most common cause if death in patients with cirrhosis?

A

-bleeding from varicies secondary to chronic high pressures in portal veins

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18
Q

5 absolute contraindications to liver transplant?

A
  1. Portal vein thrombosis
  2. Severe medical illness
  3. Malignancy
  4. Hepatobiloary sepsis
  5. Lack of patient understanding
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19
Q

What drug has been proven to be the best for advanced Alzheimer’s dementia?

A

-memantine

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20
Q

Drug of choice for hyperlipidemia in diabetics?

A

-statins

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21
Q

What DM drug is safer to use with a creatinine > 1.5 ?

A

-thiazolidinediones

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22
Q

sitagliptin: MOA?

A
  • AKA: januvia
  • dipeptidyl peptidase-4 (DPP-4) inhibitor = prolongs activity of endogenously released GLP-1 = dtimulates insulin and suppresses glucagon secretion, delays gastric emptying, reduces appetite
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23
Q

What percentage of total units should be long acting?

A

-40-50% (ex lantus)

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24
Q

How do you determine what a low dose of NPH will be?

A

-0.1 U/kg of body weight

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25
Q

Target LDL for pts w/ known CAD or DM?

A

-less than or equal to 70

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26
Q

What is the target LDL with a 10 yr coronary disease risk > 20%? 10-20%?

A
  • > 20% = < 100
  • 10-20% = < 130
  • <10% = < 160
27
Q

Of all the lipid values, which is the best predictor of an adverse outcome? What is the most effective way to improve that number?

A
  • low HDL = worse

- can improve the most w/ exercise

28
Q

How will smoking cessation effect a pts lipid levels?

A
  • increase HDL by 5-10 mg/dL

- does NOT affect LDL, VLDL, or TGs

29
Q

What is the lipid lowering mechanism of fish-oil?

A

-decreases the secretion of TGs by the liver

30
Q

Gemfibrozole: MOA?

A
  • changes hepatic metabolism of lipoproteins

- can increase HDL and decrease TGs

31
Q

Ezetemibe: MOA?

A
  • AKA: Zetia
  • lowers the cholesterol by interfering w/ absorption of cholesterol in the gut
  • good to use in combo with statins to get max decrease in LDL without all the side effects of high doses of statins
32
Q

Which 2 cholesterol med increases HDL the most? Rank?

A
  1. Niacin (25-35%)

2. Fenifibrates (15-25%)

33
Q

Which 2 cholesterol meds decrease the TGs the most? Rank?

A
  1. Fenofibrate

2. Statins

34
Q

What should be done after an HIV positive needle stick?

A
  1. Determine vicitm’s HIV viral load level

2. Start using at least 2 medications for prophylaxis

35
Q

When should pap smears be done in HIV positive pts?

A

-every 6 mnths

36
Q

Loosing weight and HTN?

A

-10 lbs lost usually means 20mmHg decrease in systolic bp

37
Q

What is stage 2 HTN? Tx?

A
  • systolic > 160
  • OR diastolic > 90
  • tx:two-drug combination tx (usually thiazide + ACEi, ARB, Bb, or CCB)
38
Q

What is HTN in arms, but low bp in the legs a sign of?

A
  • coarctation of the aorta

- more than 50% of the pts w/ coarctation of the aorta also have bicuspid aortic valaves

39
Q

What is the recommended first line monotx to prevent occurrence of CV morbidity and mortality?

A

-low-dose diuretic

40
Q

What tx is recommended to prevent recurrent strokes?

A

-ACEi plus diuretic

41
Q

What are the ABCDs of treating HTN?

A
  • A = ACEi –> should be used as first line tx in all pts younger than 55 or are black
  • B = beta blocker –> can be used, but not are not ideal first-line
  • C = CCB –> first line tx for pts older than 55 &/or black
  • D = diuretics –> also can be used as first line tx in pts who are older than 55 &/or black
  • if mono tx is not working add another from a diff category (ex. A or B + C or D)
  • if still need more control add another from a diff category (ex. A (or B) + C + D)
42
Q

Anginal equivalent

A

-a pt has no chest pain, but has other sx of cardiac ischemia (ex dyspnea) that is brought on by exertion and relieved by rest

43
Q

What are 3 contraindications for a stress EKG? Why? What test should be done in its place?

A
  1. Left ventricular hypertrophy with strain
  2. Left bundle branch block
  3. ST-segment baseline abnormaliities in the pre-cordial leads
    - these EKG abnormalities make the stress test EKG hard to read
    - use: thallium exercise test instead
44
Q

What dosage of beta blocker should be used for angina?

A
  • dosage should be adjusted so that the heart rate is between 50-60 bpm
  • not all pts will respond to Bbs
  • all Bbs are essentially the same
45
Q

What BMI is overweight?

A

> 25

46
Q

What BMI is obese?

A
  • > 30
47
Q

What BMI is class II obesity?

A
  • > 35
48
Q

What BMI is extreme obesity (class III obesity)?

A
  • > 40
49
Q

Complication rate with bariatric surgeries?

A

-40%

50
Q

Obesity and osteoporosis?

A
  • obesity is considered to be protective –> bc increased estrogen
  • unless the person is sedentary
51
Q

What drug can be used for osteoporosis tx and for bone pain?

A

-calcitonin

52
Q

Bisphosphonates: MOA?

A

-bind to bone surface and inhibit osteoclast activity

53
Q

Selective estrogen receptor modulators: MOA? Name 2?

A
  • MOA: block the activity of cytokines
    1. Raloxifene
    2. Evista
54
Q

Fluoride: MOA

A

-stimulates osteoblasts –> but doesnt result in normal bone to be formed

55
Q

Tx of PTSD? 2 best drugs?

A
  • antidepressants should be used
    1. Sertraline
    2. Paroxetine
56
Q

What antidepressant should not be used in pts with liver dz?

A

-nefazodone

57
Q

What antidepressant should not be used in pts w/ HTN?

A

-venlafaxine

58
Q

Which 2 antidepressants should be avoided in pts with hypersomnia and motor retardation?

A
  1. Nefazodone

2. Mirtazapine

59
Q

Which 2 antidepressants should not be used in pts with agitation and insomnia?

A
  1. Bupropion

2. Venlafaxine

60
Q

Which 2 antidepressants should not be used in obese patients?

A
  1. Mirtazapine

2. Tricyclic antidepressants

61
Q

Which antidepressants should not be used in patients with a seizure disorder?

A

-buproprion

62
Q

Tx for a pt started on an antidepressant that becomes manic?

A
  1. neuroleptic for the acute phase

2. Then a mood stabilizer

63
Q

What 3 tests should be done in a child who is suspected to have ADHD?

A
  1. Blood chemistries
  2. TSH
  3. Lead level
64
Q

What are the 2 most commonly reported sx of hyperTH?

A
  1. Tachycardia

2. Fatigue

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