Memorize Flashcards
(105 cards)
1
Q
T2DM Diagnostic Labs
A
A1c 6.5<
FPG 126<
2h GTT 200<
Random 200
2
Q
Pre-DM Diagnostic Labs
A
A1c 5.7-6.4
FPG 100-125
2h GTT 140-199
3
Q
Normal BP and Tx
A
<120/80, maintain
4
Q
Elevated BP and Tx
A
120-129/80, lifestyle and med check
5
Q
Stage 1 BP and Tx
A
130-139/80-89 , 10%< Meds, 10%> lifestyle
6
Q
Stage 2 BP and Tx
A
140/90< meds + lifestyle
7
Q
AA , no comorbidities
A
thiazide or CCB
8
Q
Nonblack, no comorbidities
A
Thiazide, ccb, ACE, ARB
9
Q
HTN tx w/ comorbidities
A
ACE or ARB +/- CCB, thiazide
10
Q
HTN tx w/ cardiac comorb
A
ACE or ARB + BB and diuretic if volume overload
11
Q
HTN tx with pregnant or possibly pregnant pt
A
methylodopa, nifedipine, labetalol
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
13
Q
CHADS-VASC score Tx
A
0= low risk, no tx 1= ASA or anticoagulant 2<= anticoagulant
14
Q
4 Statin Groups
A
- ASCVD
- LDL 190<
- DM LDL 70<
- 40-75yr ,LDL 70-189with 7.5%
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
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
17
Q
15mm< TB+
A
no known risk factors for TB
18
Q
CAP bacteria
A
Mycoplasma pneumoniae
Chlamydophilia pneumoniae
Legionella – less common
S. pneumoniae
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
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
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)
22
Q
CAP Tx Comorbidities
A
Respiratory FQ (levofloxacin 750 mg qd x 5 days)
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
24
Q
Group A COPD Tx
A
A bronchodilator
25
Group B COPD Tx
A long acting bronchodilator (LABA or LAMA )
26
Group C COPD Tx
LAMA
27
Group D COPD Tx
LAMA or LAMA + LABA or ICS + LABA
28
AECB Tx
Mild: Amox, doxy or TMP/SMX
SeverE: Augmentin, z-pak, clarith
29
Classifications of asthma
Intermittent, Mild Persistent, Moderate Persistent, Severe Persistent
30
Step 1 Asthma Tx
SABA
31
Step 2 Asthma Tx
Low dose ICS
32
Step 3 Asthma Tx
Low dose ICS + LABA or Med-dose ICS
33
Step 4 Asthma Tx
Med-dose ICS + LABA
34
Step 5 Asthma Tx
High-dose ICS + LABA
35
Step 6 Asthma Tx
Step 5 + Oral corticosteroid
36
Rule of Two's
Well controlled, not well controlled , very poorly controlled
37
ANA Staining patterns
- homogenous
- peripheral
- speckled
- nucleolar
- homogenous: SLE, RA
- peripheral: most specific for SLE
- speckled: least specific, can be scleroderma, raynauds, sjogrens, RA
- nucleolar: SLE, scleroderma, CREST
38
Serum complement in SLE
Decreased in active SLE
39
Drug induced SLE
HIP- hydralazine, INH, procainamide
40
CREST
```
Calcinosis
Raynaud’s phenomenon
esophageal dysmotility
sclerodactyly,
telangiectasia
```
41
SSNOOP
```
headache red flag
Systemic symptoms
Secondary conditions
Neurological s/s
Onset sudden
Onset after age 40
Pattern change
```
42
Migraine prophylaxis
2
43
Bacterial/septic meningitis organisms
```
Haemophilus influenzae
Neisseria meningitidis (“meningococcal meningitis”)
Streptococcus pneumoniae (“pneumococcal meningitis”): incidence has decreased in children with use of Prevnar
```
44
brudzinski and kernigs
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
fever warnings
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
trigemminal neuralgia
```
CN V (5)
Carbamazepine (Tegretol) is gold standard for treatment
```
47
bells palsy
CN 7
48
DEMENTIA
```
drugs
emotional illness
metabolic/endocrine
eye/ear
nutritional
tumors.trauma
infection
alcoholism
```
49
DELIRIUMS
```
drugs
eyes/ears
low o2
infections
retention of stool/urine
ictal state
underhydration/undernutrition
metabolic causes
subdural hematoma
```
50
Syphilis s/s & Tx
-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
Chancroid s/s & Tx
-painful ulcer , ragged edge, with regional lymphadenopathy
| Tx: Rocephin, azith ,cipro
52
Lymphogranuloma venereum
- r//o syphilis and chancroid
- suppurative lymphaenopathy
- Chlamydia trachomatis (not that chlamydia)
- Tx Doxy 100mg BID x21 d
53
HPV Strands
```
6&11= genital warts
16&18= cancer
```
54
Genital wart Tx
- Patient-applied: podofilox; imiquimod (Aldara), sinecatechins 15% ointment
- Provider-administered: cryotherapy, podophyllin, trichloroacetic acid (TCA) or bichloroacetic acid (BCA) 80-90%, surgery
55
GC Tx
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
Chlamydia Tx
```
azithromycin 1 g orally in single dose
OR doxycycline (Vibramycin) 100 mg PO BID for 7 days.
```
57
Tric s/s & Tx
- increase phd, strawberry cervix yellow/white/frothy,motile
| - metronidazole (Flagyl) 2 Gm PO in a single dose
58
BV s/s & Tx
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
candidiasis
Fluconazole (Diflucan ) 150 mg PO for single dose therapy
60
PID tx
-Rocephin (ceftriaxone) 250 mg IM x1
PLUS doxycycline 100 mg BID x 14 days
+ Flagyl 500 mg BID x 14 days
61
Prostatitis
- d/t STD (<35) -->Rochephin IM + chlamydia tx (azith/doxy)
- d/t UTI --> Cipro x 14days
- chronic--> 6wk tx
62
Gleason grade & score
```
Grade = 1-5 (5 is the worst)
Score= most present cells + second most present
```
63
Gastric ulcer pain
GET that food away from me
64
Duodenal ulcer pain
relieved by food
65
Appendicitis s/s
- pain precedes vomit
| - McBurney,Rovsing,Psoas,Obturator, rebound pain
66
Murphy's sign
Gaullbalaldler
67
Pancreatitis S/s
severe LUQ or epigastric pain, often refractory to analgesics, with radiation to back, N&V
-Lipase, Amylase (lipase more specific)
68
Increased AST with normal ALT
-Cardiac, skeletal cause-- get a CK
69
Increased AST and ALT
d/t liver
70
AST>ALT (by 2:1)
Non infectious= Think AST- Alcohol, statin, tylenol
71
ALT>AST
Think hepatitis!
72
HBsAg
Anti-HBs
Anti-HBc
HBsAg- Infected
Anti-HBs- Immunity (vaccine, or natural)
Anti-HBc- Infection d/t natural (always +)
73
PPI Use length
GERD-8 wks
Duodenal ulcer-4 wks
Gastric ulcer-8 wks
74
PUD H pylori NEG tx
treat with 4 (DU) – 8 (GU) weeks PPI therapy
75
PUD H pylori POS tx
```
PPI
Clarithromycin
Amox
Metronidazole
x14 d
or
PPI
TCN
Bismuth
Metronidazole
```
76
H pylori treatment failure
```
PAL=
PPI
Amox
Levo
x14d
```
77
Diverticulitis tx
AM/CL BID
| or TMP/SMX or Cipro/levo PLUS flagyl 7-10days
78
Iron supplement dose
300 mgm TID
79
B-Thalassemia trait/major
```
LOW mcv
NORMAL RDW
target cells on smear
refer
Mediterranean or northern Asian heritage
```
80
IDA
LOW mcv
INCREASED rdw
LOW ferritin/iron
INCREASED transferrin/TIBC
81
Plumbism
anemic
| stippled RBC on smear
82
B12 Deficiency anemia
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
Folic Acid deficiency anemia
INCREASED mcv
Anisocytosis on smear
NO neuro symptoms
-folic acid 1-5 mg QD
84
Neutrophils
```
"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
Lymphocytes
20-40%
T cell and B cell
increased in ACTUE viral and CHRONIC bacterial (and mono!)
86
Monosyctes
1-6%
clean up crew
increase CHRONIC infection and inflammatory d/s
87
Eosinophils
Worms, Wheezes , weird diseases
88
Basophils
0-1%
| Increase in myeloproliferative dz and leukemia
89
ALL
- 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
CLL
50<
- sustained lymphocytosis
- Asymptomatic generalized lymphadenopathy
- ---bone marrow aspiration
91
AML
- middle age/ older adults
- secondary leukemia (increased . downs)
- anemia, thrombocytopenia
- auer rods
92
Asprin use to prevent CV dz & Colorectal cancer
Adults aged 50 to 59 years with a ≥10% 10-year CVD risk
93
Breast Cancer
- 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
Cervical cancer
- 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
Colorectal cancer
age 50 years and continuing until age 75 years.
96
prostate
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
lung cancer
55-80 w/ smoke hx --> LDCT
98
Osteoporosis
- 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
Pneumonia vaccine
- 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
Treatment: Uncomplicated UTI in WCBA
- 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
UTI in Men
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
UTI in Peds
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
Pyelo
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
DIAPERS
```
-Functional incontinence
Delirium
Infection
Atrophic urethritis, vaginitis
Pharmaceuticals
Psychological
Excess urinary output (e.g., CHF, hyperglycemia)
Restricted mobility
Stool impaction
```
105
CREAM
```
Kawasaki Disease Mnemonic
conjuctivitis
rash
edema
adenopathy
mucosal involvement
```
