Key Points

Question 1

screen for metabolic syndrome and EPS

Answer 1

Antipsychotics

Question 2

great for anxiety and depression. BBW SI in kids. Dont stop abruptly

Answer 2

SSRIs

Question 3

Most likey SSRI to cause sexual dysfucntion

Answer 3

(Partoxetine (paxil)

Question 4

sense of risk or harm; disturbing thoughts and images with compulsion that is done to reduce the anxiety about the obsessions

Answer 4

OCD

Question 5

Tx for OCD

Answer 5

Tx: SSRI and CBT

Question 6

When does USPSTF say to start screening for substance abuse?

CAGE vs. AUDIT?

Answer 6

18 for substance use/ abuse . CAGE,

AUDIT (14 years old and up )

Question 7

Meds for active alcohol withdrawal

Answer 7

Librium, ativan, valium

Question 8

(can’t use if taken opioids in last week). Can drink on this med . helps with alcohol cravings

Answer 8

Naltrexone

Question 9

Meds to help with alcohol cravings

Answer 9

Naltrexone
Acamprosate
Disulfiram (antabuse)

Question 10

Vitamin supplementation for alcoholics

Answer 10

B12
Thiamine
Folic acid
Magnesium

Question 11

What might labs show in alcoholic pt

Answer 11

low platelet count
increased MCV
elevated AST and ALT
hypertriglyceridemia

Question 12

Delayed attainment of milestones; concern for social interactions; reaction to loud noises; language impairment (not a specific sign); repetitive behaviors (lining up toys, not ok with messing up line)

Answer 12

ASD

Question 13

Screening tools for ASD. Ages to use?

CHAT =
MCHAT =
CAST=

Answer 13

CHAT 18-24 mos
MCHAT Toddlers
CAST over age 3

Question 14

WHat is necessary for dx of ASD?

What else to look for?

Answer 14

Sx have to be present since age 1

Check lead levels

Question 15

When can you dx ADHD

Answer 15

not before age 4

Question 16

lanugo, peripheral edema (low albumin), amenorrhea, BMI <18.5
At risk for osteoporosis/osteopenia

Answer 16

anorexia

Question 17

proteinuria, low albumin, high lipids, peripheral edema, periorbital edema

DM #1 cause in adults
ED
Chronic condition, not curable. Tx recurrence with corticosteroid

Answer 17

nephrotic syndrome

Question 18

often occurs after strep infection. Hematuria

Tx often supportive, abx if needed, diuretics. Hospital if severe.

Answer 18

Glomerulonephritis

Question 19

> 150mg/day → caused by exercise, can indicate renal disease and/or HTN

Answer 19

Proteinuria

Question 20

30-150mg protein in urine /day → early sign renal disease, esp in diabetics

Answer 20

Microalbuminuria

Question 21

How to tx Proteinuria?

Answer 21

Tx: ACEi or ARB. control HTN and DM; may need Na and protein restricted diet

Question 22

What do bence jones proteins in urine indicate

Answer 22

multiple myeloma

Question 23

Painless hematuria…

Answer 23

think bladder CA. Smoking increases risk

Question 24

3 or more RBCs per high-power field

Answer 24

hematuria

Question 25

Persistent if occurs on 2 or more occasions Can be exercise induced DDx: meses, UTI, renal disease, stone (urolithiasis) Bladder CA False positives: semen, vit c supplements

Answer 25

hematuria

Question 26

If hematuria present with protein ...

Answer 26

refer to nephrologist

Question 27

prostate nontender, rubbery, smooth, can’t feel median sulcus

Answer 27

BPH

Question 28

How to treat BPH

Answer 28

Tx: alpha blocker at bedtime to combat drop in BP (terazosin, doxazosin) TURP, prostatectomy Alpha blockers= relax the muscle of the prostate and bladder neck, which allows urine to flow more easily

Question 29

super tender, boggy prostate | Presents as infection (chills, fever, pain, blood in urine or semen, urinary sx)

Answer 29

Prostatitis

Question 30

How to tx Prostatitis?

Answer 30

Tx: bactrim 1 tab BID for 6 weeks OR cipro 500mg BID x 6 wks

Question 31

asymmetric, nodular, hard prostate

Answer 31

Prostate CA

Question 32

PSA if >4 and no signs of prostatitis if PSA increased >0.75 in one year OR nodule on DRE

Answer 32

refer to urology!

Question 33

How to tx incontinence

Answer 33

anticholinergics (Detrol, oxybutynin (Ditropan), pseudoephedrine

Question 34

Kidneys can't get rid of phosphate which then binds to calcium and lowers serum ca levels and parathyroid releases more parathyroid hormone, and causes renal hyperparathyroidism Elevated calcium and phos (as well as BUN/creat, low GFR) Avoid NSAIDs Monitor for anemia Vit d supplements

Answer 34

CKD

Question 35

look for CV disease, psychological issues Tx: PDE5i - don’t take w/ nitrates Common SE of ssris, snris, tcas

Answer 35

Erectile Dysfunction

Question 36

chronic w/ exacerbations and remissions, often chronic LBP that wakes pts up in middle of the night. Pain otherwise worse in the morning

Answer 36

Ankylosing Spondylitis

Question 37

``` (+) HLAB27 Needs regular visits to ortho and cardio NO glucocorticoids NSAIDs and refer to rheum for biologics PT ```

Answer 37

Ankylosing Spondylitis

Question 38

pain worse at night, limping, palpable mass

Answer 38

Bone tumor

Question 39

most common bone tumor

Answer 39

osteoscarcoma

Question 40

2nd most common bone tumor... often in leg with palpable mass

Answer 40

Ewing sarcoma

Question 41

Benign bone tumor

Answer 41

Osteochondroma

Question 42

Tx plan for possible bone tumor

Answer 42

Diag: x-ray first, then biopsy

Question 43

Bone tumors in adults are usually bone marrow =

Answer 43

multiple myeloma

Question 44

joint extremely tender, warm, red, swollen, decreased ROM HCTZ (and other diuretics) compete with uric acid transporter, resulting in increased uric acid levels

Answer 44

gout

Question 45

Acute gout tx

Answer 45

Acute: NSAIDs and colchicine; corticosteroids for subsequent attacks

Question 46

Chronic/ maintenance tx of gout

Answer 46

allopurinol (can cause increase in flares so start anti-inflammatory at same time- indomethacin, colchicine, naproxen) Hydrox Low purine diet (avoid, meat , seafood, alcohol)

Question 47

can lead to osteomyelitis if not treated. IMMEDIATE ER (IV ABX) ACUTE onset pain, red, swollen, warmth to one joint never give corticosteroid!

Answer 47

Infectious/Septic Arthritis

Question 48

progressive, more than 6 wks Limp, multiple joints, may have rash ANA (+) Immediate referral to rheumatologist (biologics, DMARDs, NSAIDs)

Answer 48

JRA

Question 49

T-score ≤ -2.5 OR T score <-1 and > -2.5 and ≥2% & 10-yr major fracture risk 20% or 3% hip fracture risk

Answer 49

Osteoporosis

Question 50

osteonecrosis of jaw; risk of esophagitis. Can cause pathologic fracture. Need drug holiday every 5 yrs for 3-5 years

Answer 50

Bisphosphonates

Question 51

Lifestyle changes for osteoporosis

Answer 51

Weight bearing exercise, stop smoking, decrease alcohol and caffeine, calcium, vit d, limit steroid use

Question 52

asymmetric arthritis | Trendelenburg gait

Answer 52

Osteoarthritis

Question 53

difference between Heberden nodes and Bouchard nodes

Answer 53

Heberden nodes - distal Bouchard nodes - proximal *Bouchard before Heberden* only found in OA not RA

Question 54

Tx of Osteoarthritis

Answer 54

acetaminophen, NSAIDs, Tramadol (Ultram), consider topical NSAIDs for pts over 75 (lidocaine patches); exercise

Question 55

new onset severe temporal HA, jaw claudication, vision changes A/w polymyalgia rheumatica Temporal artery usu tender and thick

Answer 55

GCA

Question 56

tx of GCA

Answer 56

: prednisone 1mg/kg daily (max 60mg daily) for at least one month, then taper and remain on prednisone for 2-3 years. Low dose aspirin

Question 57

Swollen, tender joints, BILATERAL, w/ systemic sx

Answer 57

Rheumatoid arthritis