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1
Q

T2DM Diagnostic Labs

A

A1c 6.5<
FPG 126<
2h GTT 200<
Random 200

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2
Q

Pre-DM Diagnostic Labs

A

A1c 5.7-6.4
FPG 100-125
2h GTT 140-199

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3
Q

Normal BP and Tx

A

<120/80, maintain

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4
Q

Elevated BP and Tx

A

120-129/80, lifestyle and med check

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5
Q

Stage 1 BP and Tx

A

130-139/80-89 , 10%< Meds, 10%> lifestyle

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6
Q

Stage 2 BP and Tx

A

140/90< meds + lifestyle

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7
Q

AA , no comorbidities

A

thiazide or CCB

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8
Q

Nonblack, no comorbidities

A

Thiazide, ccb, ACE, ARB

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9
Q

HTN tx w/ comorbidities

A

ACE or ARB +/- CCB, thiazide

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10
Q

HTN tx w/ cardiac comorb

A

ACE or ARB + BB and diuretic if volume overload

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11
Q

HTN tx with pregnant or possibly pregnant pt

A

methylodopa, nifedipine, labetalol

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12
Q

CHADS-VASC

A 
Congestive HF		1 point
Hypertension			1 point
Age 65 – 74 years		1 point
Age > 75 years		2 points
Diabetes				1 point
Stroke/TIA			2 points
Vascular disease		1 point
Sex (female)			1 point
Maximum possible score:	9 points
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13
Q

CHADS-VASC score Tx

A 
0= low risk, no tx
1= ASA or anticoagulant 
2<= anticoagulant
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14
Q

4 Statin Groups

A
  1. ASCVD
  2. LDL 190<
  3. DM LDL 70<
  4. 40-75yr ,LDL 70-189with 7.5%
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15
Q

5mm< TB +

A

-People living with HIV
-Recent close contacts of people with infectious TB
-People with chest x-ray findings suggestive of previous TB disease
-People with organ transplants
Other immunosuppressed patients

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16
Q

10mm< TB +

A
  • People who have recently (<5 years) come to U.S. from high-prevalence countries
  • People who inject drugs
  • People who live or work in high-risk congregate settings (including hospitals)
  • Mycobacteriology laboratory workers
  • People with certain medical conditions that increase risk for TB
  • Children younger than 4 years old
  • Infants, children, or adolescents exposed to adults in high-risk categories
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17
Q

15mm< TB+

A

no known risk factors for TB

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18
Q

CAP bacteria

A

Mycoplasma pneumoniae
Chlamydophilia pneumoniae
Legionella – less common
S. pneumoniae

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19
Q

CURB65

A 
C (confusion) = 1 point
U (BUN >19 mg/dl) = 1 point
R (RR >30) = 1 point
B (B/P < 90/60) = 1 point
65 (Age > 65) = 1 point
Score = 1 (outpatient therapy)
>1 = hospitalization (the higher the score, the greater the mortality rate
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20
Q

CAP Tx Healthy Adult

A

Advanced macrolide (azithromycin [Zithromax] x 5 days or clarithromycin [Biaxin ]500mg bid (or ER 1 gm qd) x 7 days) or doxycycline 100 mg po bid x 5-7 days

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21
Q

CAP Tx Health Adult w/ recent Antbx use

A

Respiratory FQ* or

azith OR clarith) plus (high dose amox (1 gm po tid )OR high dose AM/CL (ER 1000/62.5 2 tabs po bid)

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22
Q

CAP Tx Comorbidities

A

Respiratory FQ (levofloxacin 750 mg qd x 5 days)

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23
Q

CAP Tx 3month-18yr

A

Antibiotics not routinely required for <4 years (generally viral)

  • 1st line: amox 90 mg/kg/d in 2 divided doses x 5d
  • Alt: Azith 10 mg/kg on Day 1, then 5 mg/kg/d on Days 2-5or AM-CL
  • Alt: AM-CL 90 mg/kg/d in 2 div. doses x 5d
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24
Q

Group A COPD Tx

A

A bronchodilator

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25
Q

Group B COPD Tx

A

A long acting bronchodilator (LABA or LAMA )

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26
Q

Group C COPD Tx

A

LAMA

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27
Q

Group D COPD Tx

A

LAMA or LAMA + LABA or ICS + LABA

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28
Q

AECB Tx

A

Mild: Amox, doxy or TMP/SMX
SeverE: Augmentin, z-pak, clarith

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29
Q

Classifications of asthma

A

Intermittent, Mild Persistent, Moderate Persistent, Severe Persistent

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30
Q

Step 1 Asthma Tx

A

SABA

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31
Q

Step 2 Asthma Tx

A

Low dose ICS

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32
Q

Step 3 Asthma Tx

A

Low dose ICS + LABA or Med-dose ICS

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33
Q

Step 4 Asthma Tx

A

Med-dose ICS + LABA

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34
Q

Step 5 Asthma Tx

A

High-dose ICS + LABA

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35
Q

Step 6 Asthma Tx

A

Step 5 + Oral corticosteroid

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36
Q

Rule of Two’s

A

Well controlled, not well controlled , very poorly controlled

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37
Q

ANA Staining patterns

  • homogenous
  • peripheral
  • speckled
  • nucleolar
A
  • homogenous: SLE, RA
  • peripheral: most specific for SLE
  • speckled: least specific, can be scleroderma, raynauds, sjogrens, RA
  • nucleolar: SLE, scleroderma, CREST
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38
Q

Serum complement in SLE

A

Decreased in active SLE

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39
Q

Drug induced SLE

A

HIP- hydralazine, INH, procainamide

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40
Q

CREST

A 
Calcinosis
 Raynaud’s phenomenon
esophageal dysmotility
sclerodactyly,
telangiectasia
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41
Q

SSNOOP

A 
headache red flag 
Systemic symptoms
Secondary conditions
Neurological s/s
Onset sudden
Onset after age 40
Pattern change
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42
Q

Migraine prophylaxis

A

2

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43
Q

Bacterial/septic meningitis organisms

A 
Haemophilus influenzae
Neisseria meningitidis (“meningococcal meningitis”)
Streptococcus pneumoniae (“pneumococcal meningitis”): incidence has decreased in children with use of Prevnar
44
Q

brudzinski and kernigs

A

b: tilt head -A positive Brudzinski sign occurs when this causes flexion of the hips.
k: Flex your knee and hip in a 90˚ angle while someone else slowly extends your knee. + pain

45
Q

fever warnings

A

Fever in infants <6 months is always concerning.
Intermediate risk of serious infection: >102* F in infant 3-6 m
Severe risk of serious infection: >100*F in infant <3 m

46
Q

trigemminal neuralgia

A 
CN V (5)
Carbamazepine (Tegretol) is gold standard for treatment
47
Q

bells palsy

A

CN 7

48
Q

DEMENTIA

A 
drugs
emotional illness
metabolic/endocrine
eye/ear
nutritional
tumors.trauma
infection 
alcoholism
49
Q

DELIRIUMS

A 
drugs
eyes/ears
low o2
infections
retention of stool/urine
ictal state
underhydration/undernutrition
metabolic causes
subdural hematoma
50
Q

Syphilis s/s & Tx

A

-Painless w/ indurated base
Tx: DOC: Benzathine PCN G (Bicillin L-A, not Bicillin C-R)
Primary, Secondary or Early Latent Syphillis: 2.4 million units IM in a single dose for adults
Late Latent, Latent of Unknown Duration, or Tertiary:7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals
Children: 50,000 units/kg IM (up to 2.4 million units) in a single dose

51
Q

Chancroid s/s & Tx

A

-painful ulcer , ragged edge, with regional lymphadenopathy

Tx: Rocephin, azith ,cipro

52
Q

Lymphogranuloma venereum

A
  • r//o syphilis and chancroid
  • suppurative lymphaenopathy
  • Chlamydia trachomatis (not that chlamydia)
  • Tx Doxy 100mg BID x21 d
53
Q

HPV Strands

A 
6&amp;11= genital warts
16&amp;18= cancer
54
Q

Genital wart Tx

A
  • Patient-applied: podofilox; imiquimod (Aldara), sinecatechins 15% ointment
  • Provider-administered: cryotherapy, podophyllin, trichloroacetic acid (TCA) or bichloroacetic acid (BCA) 80-90%, surgery
55
Q

GC Tx

A

ceftriaxone (Rocephin) 250 mg IM in single dose
Alternative: cefixime (Suprax) 400 mg PO single dose
—-If you use this, must test for cure in 1 week
—-qCannot use this for GC in pharyn

56
Q

Chlamydia Tx

A 
azithromycin 1 g orally in single dose 
OR doxycycline (Vibramycin)  100 mg PO BID for 7 days.
57
Q

Tric s/s & Tx

A
  • increase phd, strawberry cervix yellow/white/frothy,motile

- metronidazole (Flagyl) 2 Gm PO in a single dose

58
Q

BV s/s & Tx

A

Amsel criteria: Need 3 of 4
1.Homogeneous, thin, grayish-white discharge that smoothly coats the vaginal walls
2.pH >4.5
3.Positive “Whiff test”: notice dead fish odor when performing speculum exam and when drop of KOH is applied to secretions
4.>20% “Clue cells” seen on saline wet prep of secretions
“Pepper shaken on a fried egg”
- metronidazole (Flagyl) 500 mg BID x7 d

59
Q

candidiasis

A

Fluconazole (Diflucan ) 150 mg PO for single dose therapy

60
Q

PID tx

A

-Rocephin (ceftriaxone) 250 mg IM x1
PLUS doxycycline 100 mg BID x 14 days
+ Flagyl 500 mg BID x 14 days

61
Q

Prostatitis

A
  • d/t STD (<35) –>Rochephin IM + chlamydia tx (azith/doxy)
  • d/t UTI –> Cipro x 14days
  • chronic–> 6wk tx
62
Q

Gleason grade & score

A 
Grade = 1-5 (5 is the worst)
Score= most present cells + second most present
63
Q

Gastric ulcer pain

A

GET that food away from me

64
Q

Duodenal ulcer pain

A

relieved by food

65
Q

Appendicitis s/s

A
  • pain precedes vomit

- McBurney,Rovsing,Psoas,Obturator, rebound pain

66
Q

Murphy’s sign

A

Gaullbalaldler

67
Q

Pancreatitis S/s

A

severe LUQ or epigastric pain, often refractory to analgesics, with radiation to back, N&V
-Lipase, Amylase (lipase more specific)

68
Q

Increased AST with normal ALT

A

-Cardiac, skeletal cause– get a CK

69
Q

Increased AST and ALT

A

d/t liver

70
Q

AST>ALT (by 2:1)

A

Non infectious= Think AST- Alcohol, statin, tylenol

71
Q

ALT>AST

A

Think hepatitis!

72
Q

HBsAg
Anti-HBs
Anti-HBc

A

HBsAg- Infected
Anti-HBs- Immunity (vaccine, or natural)
Anti-HBc- Infection d/t natural (always +)

73
Q

PPI Use length

A

GERD-8 wks
Duodenal ulcer-4 wks
Gastric ulcer-8 wks

74
Q

PUD H pylori NEG tx

A

treat with 4 (DU) – 8 (GU) weeks PPI therapy

75
Q

PUD H pylori POS tx

A 
PPI
Clarithromycin
Amox
Metronidazole 
x14 d
or 
PPI
TCN
Bismuth
Metronidazole
76
Q

H pylori treatment failure

A 
PAL= 
PPI 
Amox
Levo 
x14d
77
Q

Diverticulitis tx

A

AM/CL BID

or TMP/SMX or Cipro/levo PLUS flagyl 7-10days

78
Q

Iron supplement dose

A

300 mgm TID

79
Q

B-Thalassemia trait/major

A 
LOW mcv
NORMAL RDW
target cells on smear
refer
Mediterranean or northern Asian heritage
80
Q

IDA

A

LOW mcv
INCREASED rdw
LOW ferritin/iron
INCREASED transferrin/TIBC

81
Q

Plumbism

A

anemic

stippled RBC on smear

82
Q

B12 Deficiency anemia

A

INCREASED mcv

  • PA/long term metformin use
  • stocking-glove peripheral neuropathy, loss of vibratory and position sense in LE
  • 1000mcg IM x 4wk then monthly
83
Q

Folic Acid deficiency anemia

A

INCREASED mcv
Anisocytosis on smear
NO neuro symptoms
-folic acid 1-5 mg QD

84
Q

Neutrophils

A 
"polys" 50-70%
first responder to infection
BAND cells (immature) 
Shift to left:
Increase WBC, Increase neutrophils, bands 10-12%
-hypersegmented = b12 folate def
85
Q

Lymphocytes

A

20-40%
T cell and B cell
increased in ACTUE viral and CHRONIC bacterial (and mono!)

86
Q

Monosyctes

A

1-6%
clean up crew
increase CHRONIC infection and inflammatory d/s

87
Q

Eosinophils

A

Worms, Wheezes , weird diseases

88
Q

Basophils

A

0-1%

Increase in myeloproliferative dz and leukemia

89
Q

ALL

A
  • 2-5yr most common child cancer (down increased risk)
  • loss of normal blood cell function (mostly b cells)
  • anemia, thrombocytopenia, neutropenia
  • —bone marrow aspiration
90
Q

CLL

A

50<

  • sustained lymphocytosis
  • Asymptomatic generalized lymphadenopathy
  • —bone marrow aspiration
91
Q

AML

A
  • middle age/ older adults
  • secondary leukemia (increased . downs)
  • anemia, thrombocytopenia
  • auer rods
92
Q

Asprin use to prevent CV dz & Colorectal cancer

A

Adults aged 50 to 59 years with a ≥10% 10-year CVD risk

93
Q

Breast Cancer

A
  • biennial screening mammography for women aged 50 to 74 years.
  • UTSPSTF:Women aged 40 to 49 years isindividual choice
  • ACA says start at 40
94
Q

Cervical cancer

A
  • 21 to 65 q3years
  • 30< cytology + HPV can do q5yr
  • if hysterectomy d/tNOT cancer, can stop
  • 65< w/ adequate screening hx, can stop
95
Q

Colorectal cancer

A

age 50 years and continuing until age 75 years.

96
Q

prostate

A

For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)–based screening for prostate cancer should be an individual one.

97
Q

lung cancer

A

55-80 w/ smoke hx –> LDCT

98
Q

Osteoporosis

A
  • bone measurement testing to prevent osteoporotic fractures in women 65 years and older.
  • women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool.
99
Q

Pneumonia vaccine

A
  • All adults 65< or high risk adults (2-64) should get PPSV23 (Pneumovax)
  • 65< (never had pneumovax) give prevnar fist and then 12months late give pneumo.
  • Anyone who received any doses of PPSV23 before age 65 should receive 1 final dose of the vaccine at age 65 or older. Administer this last dose at least 5 years after the prior PPSV23 dose.
100
Q

Treatment: Uncomplicated UTI in WCBA

A
  • local E. coli resistance to TMP/SMX <20% and no sulfa allergy: TMP/SMX-DS BID x 3 days
  • If sulfa allergic or E. coli resistance >20%: NTF 100mg bid x 5 days or fosfomycin (Monurol) 3 gms x 1 dose
  • 7 day therapy recommended in pregnancy
101
Q

UTI in Men

A

TMP/SMX bid (except areas with resistance >20%) or NTF 100mg bid (simple w/o concern for prostatis) or fluoroquinolone (Cipro or Levaquin)
x7days
-Do not use NTF or beta lactams if concern for prostatitis

102
Q

UTI in Peds

A

Amoxicillin-clavulanate 30- 45 mg/kg/day po ÷ q12h OR
TMP/SMX 6-12 mg/kg/day trimethoprim component divided q12h
Cephalexin or cefixime

103
Q

Pyelo

A

Ciprofloxacin 500mg bid or ER 1000mg qd OR levofloxcin 750 mg qd or ofloxacin 400mg bid x 5-7 days (uncomplicated)
If fluorquinolone resistance >10%: Ceftriaxome 1 gm IV X 10 days or gentamycin, tobramycin IM

104
Q

DIAPERS

A 
-Functional incontinence 
Delirium
Infection
Atrophic urethritis, vaginitis
Pharmaceuticals
Psychological
Excess urinary output (e.g., CHF, hyperglycemia)
Restricted mobility
Stool impaction
105
Q

CREAM

A 
Kawasaki Disease Mnemonic
conjuctivitis
rash
edema
adenopathy
mucosal involvement

COMP (2 decks)

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