miscellaneous family practice notes

Question 1

Stage hypertension

Answer 1

Pre-hypertension = 1 20–139/80–89

Stage I = 140–159/90–99
Stage II = 160+/100+

Question 2

Herbal supplements causing hypertension

Answer 2

Arnica
Bitter orange
ephedra = Ma–huang
ginkgo
Ginseng
guarana
licorice
senna
St. John's wort

Question 3

Treatment of cocaine-induced hypertension

Answer 3

–Nitroglycerin
–Benzodiazepines
–Calcium channel blockers
–Labetalol (only allowable beta blocker)

do not use beta blockers as this will increase the vasoconstriction of the coronary arteries

Question 4

initiation of pharmacologic therapy for hypertension

Answer 4

Persons <60 years of age with a systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg
Persons ≥60 years of age with a systolic blood pressure ≥150 mm Hg or a diastolic blood pressure ≥90 mm Hg
Persons ≥18 years of age with chronic kidney disease who have a systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg
Persons ≥18 years of age with diabetes mellitus who have a systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg

Question 5

treatment for acute exacerbation of multiple sclerosis

Answer 5

steroids

Question 6

diagnosis of serotonin syndrome

Answer 6

increase serotoninergic activity in Central nervous system
–Neuromuscular abnormalities
–Mental changes
–Agitation
–Confusion
–Tachycardia
–elevated blood pressure
–Dry mouth
–Usually within 24 hours of starting SSRI

–May have slow horizontal nystagmus
–May have spontaneous clonus

Question 7

treatment of serotonin syndrome

Answer 7

–diazepam to count patient
–Propanolol for hypertension
–Antidote, if needed is cyproheptadine
–Avoid HALOPERIDOL

Question 8

positive predictive value

Answer 8

the percentage of patients with a positive test for a disease who actually
have the disease.

Question 9

negative predictive value

Answer 9

the percentage of patients with a negative test for disease who actually do not have the disease

Question 10

defined sensitivity of the test

Answer 10

the percentage of people who have a disease who Will get a positive result

Question 11

define specificity

Answer 11

the percentage of people who do not have the disease and get a negative test result

Question 12

define Gilbert’s syndrome

Answer 12

=hereditary condition with unconjugated hyperbilirubinemia
–usually normal liver enzymesan asymptomatic
–Bilirubin increases with stress, fasting, and infection

Question 13

most likely drug involved in breast tenderness and gynecomastia

Answer 13

spironolactone

Question 14

most common cause of death in rheumatoid arthritis

Answer 14

–coronary artery disease

Also have an increase in
––Thromboembolic events
––Infections
––Lymphoma
––Lung cancer

Question 15

drug of choice for polynephritis

Answer 15

Cipro

Question 16

findings in idiopathic thrombocytopenic purpura

Answer 16

thrombocytopenia which is isolated and has no other cause

Question 17

drug of choice for pertussis

Answer 17

azithromycin

Question 18

contraindications for ParaGard and or Mirena

Answer 18

–Mirena is preferred for most conditions

–ParaGard is preferred in the presence of severe liver disease, thromboembolic events, or liver cancer

Question 19

prevalence of migraines

Answer 19

–men = 10%
–Women = 20% have them

Question 20

classification of migraine headaches with aura

Answer 20

International Headache Society Diagnostic Criteria for Migraine Headache With and Without Aura
Migraine without aura

Headache lasts 4 to 72 hours (untreated or unsuccessfully treated)

Headache has at least 2 of the following:

Aggravation by or causing avoidance of routine physical activity (e.g., walking, climbing stairs)

Moderate or severe pain

Pulsating quality

Unilateral location

During headache, at least 1 of the following:

Nausea and/or vomiting

Photophobia and phonophobia

Not attributed to another disorder

History of at least 5 attacks fulfilling above criteria

Question 21

classification of migraine headaches without aura

Answer 21

Migraine with aura*

Aura consisting of at least 1 of the following, but no motor weakness:

Fully reversible dysphasic speech disturbance

Sensory symptoms that are fully reversible, including positive features (e.g., pins and needles) and/or negative features (e.g., numbness)

Visual symptoms that are fully reversible, including positive features (e.g., flickering lights, spots, lines) and/or negative features (e.g., loss of vision)

At least 2 of the following:

Homonymous visual symptoms and/or unilateral sensory symptoms

At least 1 aura symptom develops gradually over 5 minutes, or different aura symptoms occur in succession over 5 minutes

Each symptom lasts at least 5 minutes, but no longer than 60 minutes

Headache fulfilling criteria for migraine without aura begins during the aura or follows aura within 60 minutes

Not attributed to another disorder

History of at least 2 attacks fulfilling above criteria

Question 22

episodic vertigo triggered by head motion

Answer 22

episodic proximal positional vertigo

Question 23

Ménière’s disease

Answer 23

vertigo 
tinitis
unilateral hearing loss
last 20 minutes–12 hours
Ear fullness

Question 24

contraindications to MMR vaccine

Answer 24

–allergy to neomycin
–Immunosuppression
–Pregnancy

Question 25

Lewy body dementia characterized by

Answer 25

``` –memory deficits –Reduced alertness –parkinsonian features –rigidity –Resting tremor –Bradykinesia –Gait disorder ```

Question 26

triad of normal pressure hydrocephalus

Answer 26

"wacky, wet, wobbly," –personality change –Urinary incontinence –Gait disorder

Question 27

Hashimoto's disease

Answer 27

–most common cause of hypothyroidism –May actually start with hyperthyroidism –anti-thyroglobulin autoantibodies –anti-thyroid peroxidase

Question 28

Graves' disease in pregnancy

Answer 28

= hyperthyroidism –Treatment with PTU (propylthiouracil) –use beta blockers initially if thyroid storm

Question 29

differences between chalazion and hordeolum

Answer 29

chalazion = blocked oil duct Hordeolum =infected oil duct

Question 30

Salter-Harris fracture classifications

Answer 30

``` Salter I =S = slipped epiphysis Salter II =A= above epiphysis Salter III =L =lower than physis Salter IV =T = through physis Salter V =ER =wrecked physis ( compression) ```

Question 31

historical features in DKA

Answer 31

``` 5 I's of diabetic neuropathy(history of) –infection –ischemia (cardiac or mesentery) –infarction –Ignorance (poor control) –intoxication ```

Question 32

types of diabetic neuropathy

Answer 32

autonomic –––gastroparesis, orthostasis, constipation acute mononeuropathy –––Cranial nerve palsy, foot drop Distal, symmetrical, –––Sensory > motor neuropathy

Question 33

Calcium pyrophosphate deposition disease

Answer 33

=pseudogout

Question 34

components of the tetralogy of Fallot

Answer 34

–overriding aorta –Pulmonary stenosis –Ventricular septal defect –Right ventricular hypertrophy

Question 35

aortic stenosis

Answer 35

``` –older patient –history of hypertension or diabetes –Dyspnea, syncope, chest pain –crescendo–decrescendo murmur –Murmur radiates to carotids –Murmur decreases with Valsalva ```

Question 36

positive direct Coombs test indicates?

Answer 36

autoimmune red blood cell lysis

Question 37

what are Howell-Jolly bodies and what did they indicate

Answer 37

nucleic remnants in erythrocytes that were not filtered out by spleen –Indicates deficient splenic activity or lack of spleen

Question 38

diagnoses of hereditary spherocytosis

Answer 38

osmotic fragility test. Spherocytes are already distended and lyse more quickly than normal cells in hypotonic solution

Question 39

characteristics of preeclampsia

Answer 39

–hypertension –proteinuria –20+ weeks of pregnancy

Question 40

characteristics of eclampsia

Answer 40

history of preeclampsia plus seizures –Can occur up to 2–4 weeks postpartum –Treated with magnesium

Question 41

earliest symptoms of magnesium toxicity

Answer 41

loss of deep tendon reflexes

Question 42

most common heart valve abnormality

Answer 42

bicuspid valve of the aortic valve

Question 43

prophylaxis for deer tick bite

Answer 43

doxycycline 200 mg, 1 dose within 72 hours a bite

Question 44

symptoms of hypoparathyroidism

Answer 44

``` hypoparathyroidism causes –low vitamin D –Intensity –Seizures –refractory heart failure –Altered mental status –'s stridor ```

Question 45

contraindications to statins

Answer 45

–pregnancy –Breast-feeding –Unexplained liver disease –myopathies

Question 46

symptoms of Pancoast tumor

Answer 46

``` = tumors on the apex of the lung –arm swelling –Horner's syndrome –Shoulder swelling –Atrophy of arm and hand muscles ```

Question 47

Horner syndrome

Answer 47

–myelosis –ptosis –Ahydrosis

Question 48

carcinoid syndrome symptoms

Answer 48

–tachycardia –facial flushing –Diarrhea Caused by endogenous secretion of serotonin and kallikrein

Question 49

symptoms of marasmus

Answer 49

= protein-energy malnutrition ``` –Loss of subcutaneous fat –Muscle wasting –Normal hair! –Emaciated –Strong appetite ```

Question 50

symptoms of kwashiorkor

Answer 50

=protein deficiency ``` –poor appetite –Edema –Distended abdomen –Peeling skin –Diarrhea ```

Question 51

chalazion symptoms

Answer 51

–blocked meibomian oil gland –Usually upper lid –Nontender –treat with warm compresses

Question 52

hordeolum symptoms

Answer 52

= stye –Usually lower lid –usually bacterial –Treat with warm compresses –Usually self drain within a week

Question 53

Henoch-Schönlein purpura

Answer 53

= acute systemic vasculitis –primarily affects venules and arterials –associated with palpable pruritic rash that begins in the lower extremities and extends to the abdomen –associated with joint pain, abdominal pain and hematuria

Question 54

monitoring amiodarone therapy

Answer 54

–chest x-ray to look for interstitial pneumonitis –Hepatic profile –Renal profile

Question 55

Kawasaki's disease

Answer 55

``` –fever lasting for 4–5 days –Bilateral conjunctivitis –oral mucosal changes(strawberry tongue) –bilateral conjunctival injection –cervical adenopathy –extremity changes with erythema or palm or sole desquamation –child less than 4 years old ```

Question 56

developmental dysplasia of hip

Answer 56

–limited hip abduction –more common in females –mild laxity self-corrects –Barlow's maneuver attempts to dislocated hip –Ortolani's maneuver attempts to reduce it After 6 months –llimited hip adduction most important sign –Galeazzi sign = knees flexed, feet on floor, check for knee height discrepancy –Imaged with ultrasound –Look for asymmetric skin creases and legs

Question 57

most common types of bone cancer in children

Answer 57

–osteosarcoma | –Ewing sarcoma

Question 58

rhabdomyolysis diagnosis

Answer 58

cause = alcohol, drugs, heat, trauma, exercise ``` –CPK = >5 times upper limit of normal –hemoglobinuria with few RBCs –hyperkalemia –Hyperphosphatemia –hypocalcemia ``` TX = IV fluids, bicarbonate, EKG Complications =DIC, ARF, compartment syndrome

Question 59

chromosomes and Turner's syndrome

Answer 59

45 XO

Question 60

EKG changes in various infarctions

Answer 60

Anterior wall ST elevation in leads I, AVL, and V2 to V6. Inferior wall ST elevation in leads II, III, and AVF. Lateral wall ST depressions in leads I, AVL, and V5 to V6. Posterior wall ST depressions and then elevations in V1 to V3