TEST 10-13 Flashcards
(105 cards)
What is the difference between ACUTE, SUBACUTE, and CHRONIC LOWER BACK PAIN?
ACUTE12 weeks
What is the management of ACUTE LOWER BACK PAIN?
1) Maintain moderate activity
2) NSAIDs/acetaminiophen
What is the management of CHRONIC LOWER BACK PAIN?
1) Intermittent NSAID/acetaminophen usage
2) Exercise therapy (stretching/strengthening)
Consider: TCA, duloxetine
PHARMACOTHERAPY/non-pharm TX for URGE INCONTINENCE?
PHARMACOTHERAPY/non-pharm TX for OVERFLOW INCONTINENCE?
URGE INCONTINENCE (Increased detrusor) - anti-muscarinic OXYBUTYNIN + bladder training/kegel pelvic floor exercises (=1st line)
OVERFLOW INCONTINENCE (Neurogenic, decreased detrusor) - cholinergic BETHANECHOL +/- INTERMITTENT CATHETERIZATION
What are some of the differences between CHRONIC BRONCHITIS vs CHRONIC BRONCHIECTASIS?
CHRONIC BRONCHIECTASIS
1) MUCOPURULENT SPUTUM: (>100mL sputum = larger volume)
2) Fever/hemoptysis
3) Association w/ infections (PSEUDOMONAS/ ASPERGILLOSIS)
What diagnostic testing is needed for initial diagnosis of CHRONIC BRONCHIECTASIS?
HIGH-RES CT SCAN OF CHEST
AFTER CHRONIC BRONCHIECTASIS is first confirmed by HRCT, what is the next step in management?
After this, what test needs to be done for FOCAL DISEASE? DIFFUSE DISEASE?
SPUTUM CULTURE- Analyze for bacteria and mycobacteria
AFTER sputum culture
1) FOCAL DISEASE: Get BRONCHOSCOPY - Localized airway obstruction
2) DIFFUSE - Congenital disorders/immune dysfn
FEBRILE d/o with PULMONARY (dyspnea/cough) + MUCOCUTANEOUS (papules/nodules) + RETICULONODULAR INFILTRATES on CXR + RETICULOENDOTHELIAL (LAD/HSM) + PANCYTOPENIA/ ELEVATED ALT/LDH in pt in OHIO/MISSOURI
DISSEMINATED HISTOPLASMOSIS
What is the Tx of DISSEMINATED HISTOPLASMOSIS?
1-2wk: SYSTEMIC IV amphotericin B
Post-2wks: ORAL ITRACONAZOLE for >=1yr for maintenance therapy
Which type of dementia characterizes LANGUAGE PROBLEMS (word recall) + VISUOSPATIAL problems (getting lost while driving) BEFORE executive function dysfunction?
ALZHEIMER’S DEMENTIA
Which type of dementia characterizes OCCASIONAL forgetfulness but does NOT interfere with ADL?
NORMAL AGING
Which type of dementia characterizes EXECUTIVE FUNCTION DECLINE after stroke inhibiting ADL + abnormal neuro findings (eg. HEMIPARESIS/PRONATOR DRIFT/ROMBERG SIGN) + early mild memory loss?
VASCULAR DEMENTIA
How is CREUTZFELDT-JAKOB DISEASE diagnosis confirmed?
1) BRAIN BIOPSY - spongiform changes on postpartem brain biopsy
2) Prion protein genetic mutations
What is PSEUDODEMENTIA? (Hint: Correlated with a psychiatric condition)
PSEUDODEMENTIA = Reversible cognitive decline changes associated with MAJOR DEPRESSION DISORDER
What is the Tx of ACUTE CHOLANGITIS?
- SUPPORTIVE CARE
- ANTIBIOTICS (Broad-spectrum): Beta-lactam/beta lactamase inhibitor + 3rd gen CEPHALOSPORIN + METRONIDAZOLE
- BILIARY DRAINAGE - by ERCP with sphincterotomy OR percutaneous trans-hepatic cholangiography
Common side effects of MTX (disease modifying agent for RA) = ?
What can be given as SUPPLEMENTATION to reduce incidence of AE?
HEENT: ORAL ULCERS +
ALOPECIA
LUNGS: PULM toxicity
CBC/BMP: ELEVATED ALT/AST +
BONE MARROW SUPPRESSION (Macro-ovalocytic anemia, leukopenia, thrombocytopenia)
FOLATE SUPPLEMENTATION
Difference between DKA and HHS: (Glc levels, ketones, AG, Sosm)
DKA: Glc 250-500, Ketones +, Elevated AG, Sosm600 (generally 1000), Ketones - , Nl AG, Sosm>320
Lab findings associated with SCHISTIOCYTOSIS:
1) HEMOLYSIS VALUES: Decreased haptoglobin + Increased LDH/bilirubin
2) THROMBOCYTOPENIA
3) HEMOLYTIC ANEMIA
When can one see NEW ONSET RBBB? When can one see NEW ONSET LBBB?
pathology wise
RBBB: pulmonary embolism
LBBB: Acute MI
ELECTRICAL ALTERNANS is fairly specific for “X”
What condition predisposes to developing X?
“X” + JVD/hypotension/muffled heart sounds = Y
X= PERICARDIAL EFFUSION
Often secondary to VIRAL PERICARDITIS
Y= developing CARDIAC TAMPONADE
What do EHRLICHIOSIS and BABESIOSIS have in common? How do you distinguish between them?
(Hint: Pt population + Sx)
Both = THROMBOCYTOPENIA + Mild LEUKOPENIA + do NOT have rash
BABESIOSIS: More common in pts who do NOT have a spleen or immunocompromised +
+ JAUNDICE [elevated ALT/AST]/ HEMOLYTIC SX
EHRLICHIOSIS: NO JAUNDICE/ HEMOLYSIS
Tx of BABESIOSIS = ?
Tx of EHRLICHIOSIS = ?
BABESIOSIS: Atovaquone - Azithromycin OR Quinidine-Clindamycin
ERLICHIOSIS: Doxycycline - EMPIRICALLY treat before confirmatory testing
What is the GOLD STANDARD test when OSA is suspected (daytime somnolence, snoring, morning headaches, poor concentration, restless sleep)?
NOCTURNAL POLYSOMNOGRAPHY
MEGAESOPHAGUS + MEGACOLON +/- CARDIAC DYSFUNCTION = what infectious disease?
CHAGAS DISEASE - protozoa Trypanosoma cruzi