Textbook charts Flashcards
(186 cards)
1
Q
Stage 0 COPD
A
Patient has cough and sputum production but normal spirometry results
Tx: Vaccines and risk factor assessment
2
Q
Stage 1 COPD
A
Pt. has a FEW1/FVC <0.7
FEV1 = > 80% of predicted
Can be with or without symptoms
Tx: SABAs
3
Q
Stage 2 COPD
A
FEV1/FVC < 0.7
FEV1 = 50-80% predicted
Can be with or without symptoms
Tx: LABAs
4
Q
Stage 3 COPD (severe)
A
FEV1/FVC < 0.7
FEV1= 30-50% predicted
With or without symptoms
Tx: Inhaled steroids
5
Q
Stage 4 COPD
A
FEV/FVC < 0.7
FEV 1 <30% of predicted OR FEV1 < 50% predicted with chronic hypoxemia
Tx: Long term O2 therapy and surgical intervention
6
Q
First time lipid screening recommendations in children and adolescents
A
FH of dyslipidemia
FH of premature CVD or dyslipidemia (<55 years or <65 years in woman)
Unknown FH
Other CV risk factors
BMI >85th percentile
HTN (>95th percentile)
Cigarette smoking
Diabetes mellitus
7
Q
Empty can test
A
Pt has arm abducted and elbow extended while elevating their arm against resistance
Tests supraspinatus for a rotator cuff injury
8
Q
External rotation test
A
Tests infraspinatus and teres minor for injury
9
Q
LIFT OFF TEST
A
Pt places hand on lumbar back and attempts to lift hand off back
Tests subscapularis for injury (also could just do internal rotation)
10
Q
Hawkins impingement
A
Pain with internal rotation when the arm is flexed to 90 degrees with the elbow bent to 90 degrees
Tests for subacromial impingement of the supraspinatus tendon
11
Q
Drop arm test
A
Patient cannot lower arm slowly from raised position
Test for large and extensive rotator cuff tears
12
Q
Anterior drawer test at ANKLE
A
Tests fnxn of the anterior talofibular ligament
13
Q
Inversion stress test of ankle
A
Tests calcaneofibular ligament, positive test is a “clunk”
14
Q
Squeeze test of ankle
A
Examiner compresses tibia and fibula at midcalf
+= Pain at the anterior ankle joint below where the examiner is squeezing
-Indicates syndesmosis (high ankle injury)
15
Q
Introduction of solid food for infants
A
4-6 months
16
Q
Plantar fasciitis tx
A
Shoe inserts, NSAIDs, icing, rest
17
Q
Polymyalgia rheumatica
A
Inflammatory disorder that presents as pain and stiffness in the shoulder and pelvic girdle
Typically has an elevated ESR
*Tx: Corticosteroids
18
Q
Refeeding Syndrome
A
Fatal shifts in electrolytes that occur in patients who were previously malnourished
***Patients will have hypophosphatemia
19
Q
Initial tx of hypercalcemia of malignancy
A
IV fluids; will enhance excretion
20
Q
Brown to black leopard spotting of the colonic mucosa
A
Melanosis coli
Benign condition resulting from abuse of laxatives; resolves after discontinued use
21
Q
Colonoscopy in a person who has a first degree member with colon cancer
A
Screen at 40 and repeat every 5 years
Also do if they have 2 second degree members with colonocarcinoma
22
Q
Drugs that can cause lupus pleuritis or drug induced pleuritis
A
Hydralazine
Procainamide
Quinidine
23
Q
DOC in WPW
A
Procainamide; other drugs slow AV conduction and can paradoxically in WPW cause tachycardia
24
Q
Metformin has to be stopped prior to what imaging study
A
CT angiography (or anything w/ contrast) due to increased stress on the kidneys
25
Pt w/ nursing home pneumonia tx
Ceftazidime + Levofloxacin + Vancomycin
First two covered gram pos, gram neg, BOTH cover pseud, and last for MRSA
26
SSRI you cant use in pregnancy
Paroxetine; assoc. w/ cardiac defects
27
Treatment resistant osteoporosis can be treated with...
Teriparatide; its intermittent use activates osteoblasts more than osteoclasts
28
When to treat for the flu
As soon as it is suspected; many rapid tests can be negative so look at community trends to test for
29
Aspirin age recommendations
In Men 45-79 and women 55-79
30
Mitral valve prolapse tx
BBs
Severe? =>> Surgery
31
Pt w/ sulfa allergy who wants to climb a mountain
Dexamethasone
32
Natural remedy for varicose veins
Horse chestnut seed
-Contains some escin, which reduces edema and lowers fluid exudation by decreasing vascular permeability
33
Most common cause of erythema multiforme
HSV
34
Pyogenic tenosynovitis
Typically presents in a trigger finger like presentation
Treat w/ antibiotics and splinting or potentially surgical drainage w/ antibiotics
35
Postural orthostatic tachycardia syndrome
Rise in hr by >30/min when standing up
Sx: Position dependent headaches, abdominal pain, lightheadedness, palpitations, sweating, and nausea
-Most patients will not pass out; usually a female
36
CAGE screening
Cut down
Angry
Guilty
Eye opener
37
PCP tx.
Haldol
Acidify urine to excrete
***These pts. have vertical AND horizontal nystagmus as well as their aggressive psychosis
38
Trazadones use in practice today
Actually used to help people go to sleep
39
Mirtazapine
SNRI assoc. w/ weight gain
40
TCA side effects
Convulsions, Cardiac probs (QT prolongation), and coma
-Also have anticholinergic ADRs
Amitryptyline, nortriptyline, imipramine, desipramine
41
Pt. on an MAOI and suddenly has severe HTN
HTN crisis probably precipitated by eating wine or cheese (Hypertensive crisis)
42
Lithium ADRs
Teratogen
Nephrotoxic
Nephrogenic DI
Narrow TI
43
Ativan
Lorazepam (short acting)
44
Valium
Diazepam (medium acting)
45
Clonidine
Clonazepam (long acting)
46
Pt on fluphenazine w/ fever, rigidity, and AMS
NMS
=>>Treat w/ dantrolene
Other ADRs of typical antipsychotics include gynecomastia, galactorrhea, amenorrhea (anti-dopaminergic), and extrapyramidal symptoms
47
Last antipsychotic to try if all else has failed
Clozapine
48
Extrapyramidal sx
Akasthesia (restlessness)
```
Acute dystonia (involuntary spastic contractions, torticollis, hammering)
-treat w/ anticholinergics
```
Dyskinesia
Tardive dyskinesia (irreversible sensitization leading to facial tics)
49
Atypical antipsychotics
Olanzapine, quetiapine, risperidone, ariprazole
Treats both positive and negative psychotic sx
50
Indications for thyroid nodule biopsy
Greater than 1cm
Symptomatic
History or thyroid cancer
51
Acute cervical Radiculopathy Tx
Conservative (NSAIDS, ice)
52
Treatment for an acute hemorrhoid presenting at <24 hours
Hemorrhoidectomy in office
53
Patellofemoral pain
Usually in females and presents with pain moving on hilly terrain as well as with hip abduction
54
Pioglitazone
Thiazolodine drug that increases the sensitivity of the peripheral tissues to insulin via PPAR activation
55
Repaglinide
Nonsulfonylurea drug that also stimulates insulin secretion
56
Acarbose
A-glucosidase inhibitor that ️Decreases the absorption of carbs
57
Labs to monitor on E. coli O 157 patients
Renal labs, be on the lookout for HUS
58
Anterior talofibular ligament
Most common sprained ligament on the lateral malleolus; could also be the calcaneofibular ligament or the posterior talofibular ligament
59
Pt has a positive stick of 3-5 RBCs...what do you do next?
Repeat UA in 6 weeks
60
Risk factors for bladder cancer
Smoking
Benzene dyes
Aromatic amines
History of urologic disease
Analgesic abuse
Pelvic irradiation
61
Doc for hyperthyroidism
Radioactive iodine
⭐️Can't use in pregnant ladies though
62
Tx of thyroid storm
PTU/methimazole + BBs
May also give hydrocortisone to prevent an adrenal crisis
63
Child with asthma exacerbation and already received Albuterol and steroids
Can try magnesium sulfate before Iv steroids
64
Ethylene glycol toxicity
Patient presents with a metabolic acidosis with an increased anion gap and subsequent renal failure
Urine will have calcium oxalate crystals, patient will appear acutely intoxicated and have Hypocalcemia
Tx: Fomepizole
65
Baby born to hep b mom
Give hep B and Hep B IG
66
Rotavirus contraindication
Kid with history of intusussusception
67
Young toilet trained female who develops a beefy red rash on her perineum
Strep pyogenes infection; usually from improper hygiene
Will be from the perineum and down to the anus
68
Latex allergies can cross react with what foods?
Avocados, bananas, chestnuts
69
Anticoagulation for A-fib
Low risk (no other comorbidities) = Aspirin
Anything else= Warfarin
70
DOC for pneumocystis pneumonia
Bactrim
Could also add corticosteroids
71
Patient who presents with urethral discharge but has not improved with azithromycin and ceftriaxone
Prescribe metronidazole; could be trichonomas vaginalis
72
Treatment for otitis media
Amoxicillin; 10 days
73
Breastfeeding with bilateral nipple pain, erythema, and swelling
Probably a candida infxn
74
what drug can ppt Angioedema
ACEIs
75
Cat scratch disease treatment
Azithromycin
76
Drugs that can induce ovulation in PCOS patients
Clomiphene
Metformin
Rosiglitazone
77
Treatment for HIT
Discontinue heparin and start a different anticoagulant
78
What must be monitored while on Vancomycin?
Trough serum levels; too low and resistance will develop
79
SSRIs and cough syrup
Possible cause of serotonin syndrome
80
Test to rule out adrenalcortical insufficiency
Morning cortisol
81
Patient with frequent PVCs but is otherwise healthy
Needs evaluation and possible treatment for CAD
82
Tx for sudden sensorineural hearing loss in an elderly patient
Corticosteroids
Possibly O2
83
Subacute thyroiditis
Painful gland, hyperthyroidism, elevated ESR
Tx: Corticosteroid
84
Perinephric abscess
Collection of the puss in the tissue surrounded by the kidney; diagnosis made when patient with pyelonephritis has a persistent fever and flank pain that is unresponsive to IV antibiotics
RFs: Urinary tract abnormalities, DM,
Tests: CT
85
Imaging for septic arthritis in a child
US
86
Female athlete triad
Amenorrhea
Osteoporosis
Disordered eating
87
Treatment of hyponatremia w/ <125meq/Na
Use 3% saline
88
EKG findings w/ hypokalemia
ST segment depression
Flattened T waves
Prominent U waves
89
EKG findings w/ hyperkalemia
Peaked T waves
Flattend P waves
Widened QRS
90
Tx of hyperkalemia
1. IV calcium (stabilizes the myocardium)
2. Glucose and insulin (shifts K+ into cells)
3. Kayexalate (do this last)
91
Centor Criteria
Absence of cough
Enlarged/tender anterior cervical adenopathy
Fever of 100.4 or higher
Tonsillar swelling/exudates
Age 3-14
Score 2-3 =>> Rapid strep test
Score 4 =>> Empiric treatment
92
Features of malignant pulmonary nodules
Size >10mm
Irregular shape
"Ground-glass" appearance
No calcification/eccentric calcifications
Double the size of a previous image
93
Pt with well controlled hypothyroidism and is pregnant
Still need to increase their thyroid medication as thyroid dysfunction is assoc. w/ pregnancy
94
Complete rotator cuff tear in a young patient management
Surgery
95
Best imaging study for osteomyelitis
MRI
96
Treatments for coronary artery stenosis
Aspirin
BBs (after MI)
ACEIs (at high risk after MI)
ARBs (CAD)
Amiodarone (coexisting arrhythmias)
97
Painkiller prescribed for ESRD pts
Fentanyl; because it is metabolized in the liver
98
Drugs to give patient with a confirmed MI
Aspirin and Heparin
Clopidogrel if there is an aspirin allergy
99
Drugs that are CI'd in new onset chest pain
CCBs
100
Gottron's papules
Sign of dermatomyositis; appears a purple-wart like features on the hands but usually appear quickly
101
Prophylactic for traveler's diarrhea
Rifaximin
102
Gestational diabetes glucose goal
<100
103
Dupuytren's contracture
Progressive thickening and nodule formation on the palmar fascia leading to a contracture of the associated finger
Commonly seeing pitting of the skin right before the contracture
104
Tx for status epliepticus
Lorazepam
Follow w/ phenytoin
105
Tx for acute dystonia
Diphenyhydramine
Benztropine
Typically occurs after taking a medication
106
Tx for ingrown nails
Nail avulsion followed by phenolization or direct surgical excision of the nail matrix
107
B-quant eval for ectopic pregnancy
<1500 =>> Get a repeat in 48 hrs =>> Still hasn't risen =>> Probably an ectopic
108
Epididymitis tx
Ceftriaxone and doxycycline
MCC are Neisseria and Chlamydia
109
Fibroid surgery
Wants kids? =>> Myomectomy
Doesnt? =>> TAH
Wants kids but it's too big to cut out? =>> Leuprolide to shrink it
110
Telogen effuvium
Shredding hair loss that occurs after a stressful event (illness, surgery, pregnancy) and occurs about 3 months after the event
Will go away 6 months after the event
111
Screening of asymptomatic patients for COPD pts
Not recommended
112
Erythema infectiosum
"Fifth disease"
Caused by parvovirus B19; presents with a slapped cheek appearance and an exanthem that spreads to the trunk and the extremities as a diffuse macular rash; will eventually become lacy and reticulated
113
Fracture that occurs with hyperextension of the wrist
Triquetral fracture; tenderness will be noted on the dorsal wrist of the ulnar side
Radiograph will show a bony avulsion
114
DOC for supraventricular arrhythmia
Adenosine
115
Post thrombotic syndrome
Chronic pain, swelling, and skin changes in the affected limb of a DVT
-Compression stockings help to prevent
116
Albumin as an acute phase reactant
Decreases
117
Treatment of PMS
Luteal-phase spironolactone
118
Contrast media to use in patients with kidney disease
Iso-osmolar or hyposomolar
Rather than the normal, high osmolar
119
Urge incontinence
Patients who suddenly realize they reallllyyy have to go to the bathroom and are usually unable to reach it in time
120
Atypical antipsychotic NOT ASSOCIATED with weight gain
Aripiprazole
121
Augmentin plus side
Covers anaerobes
122
SCFE s/s
Pain with physical activity, usually in the upper thigh
*****Limited internal rotation of the hip
123
Preop eval in RA patient
Cervical spine imaging to detect atlantoaxial subluxation
-Would make intubation difficult
124
Blood pressure in stroke patients
Do not treat HTN unless it is <220/<120
-HTN is thought to be a protective mechanism to preserve cerebral blood flow
125
Behcet's syndrome
Recurring genital and oral ulcerations alongside relapsing uveitis
More common in Asian peopl
Can lead to arthritis, vasculitis, intestinal manifestations, or neurologic probs
Usually have the development of sterile pustules that are slightly painful
126
Stress incontinence
Stretching of the cardinal ligament after multiple births =>> cystocele formation
Dx: (+) Q-tip test (>30 degrees rotation)
Tx: Kegel exercises, pessaries, surgery
127
Overactive/hypertonic bladder
Random spasms or detrusor instability
Dx: Patients have increased urge and leak, usually need to run to the bathroom
Tx: Antispasmodics (oxybutinin) `
128
Overflow incontinence
Absent detrusor detractions
Often assoc. w/ MS, trauma, or antispasmodic meds
Incontinence occurs once pressure in the bladder exceeds that of the sphincter
Dx: Distended bladder, focal neurologic deficits
129
Anticoagulant monitoring methods
Anti-factor Xa levels =>> LMWH
aPTT =>> Unfractionated heparin
INR =>> Warfarin
130
Follow up on a positive PPD
CXR
131
First work up in a patient with possible septic arthritis
CBC and ESR, then do an aspiration
132
Alopecia areata
Localized AI reaction to hair follicles; can spread to cover the entire scalp or body
Tx: Intralesional corticosteroid injections, usually will recover in 6 months
133
Test to perform before removing an adrenal mass
Renal vein sampling
Turns out, the abnormal values are found opposite the mass sometimes
134
Using other drugs in addition to Chantix
Is not beneficial and can in fact increase incidence of nausea and headache
135
Tx for Raynaud's
CCBs
136
First study in a patient with a syncopal episode
EKG
137
High risk angina associations
ST segment changes
Hypotension
Mitral regurgitation murmur that has worsened
New S3
Prolonged pain at rest
Pulmonary edema
138
Contrast media to use in patients with kidney disease
Iso-osmolar or hyposomolar
Rather than the normal, high osmolar
139
Urge incontinence
Patients who suddenly realize they reallllyyy have to go to the bathroom and are usually unable to reach it in time
140
Atypical antipsychotic NOT ASSOCIATED with weight gain
Aripiprazole
141
Augmentin plus side
Covers anaerobes
142
SCFE s/s
Pain with physical activity, usually in the upper thigh
*****Limited internal rotation of the hip
143
Preop eval in RA patient
Cervical spine imaging to detect atlantoaxial subluxation
-Would make intubation difficult
144
Blood pressure in stroke patients
Do not treat HTN unless it is <220/<120
-HTN is thought to be a protective mechanism to preserve cerebral blood flow
145
Behcet's syndrome
Recurring genital and oral ulcerations alongside relapsing uveitis
More common in Asian peopl
Can lead to arthritis, vasculitis, intestinal manifestations, or neurologic probs
Usually have the development of sterile pustules that are slightly painful
146
Stress incontinence
Stretching of the cardinal ligament after multiple births =>> cystocele formation
Dx: (+) Q-tip test (>30 degrees rotation)
Tx: Kegel exercises, pessaries, surgery
147
Overactive/hypertonic bladder
Random spasms or detrusor instability
Dx: Patients have increased urge and leak, usually need to run to the bathroom
Tx: Antispasmodics (oxybutinin) `
148
Overflow incontinence
Absent detrusor detractions
Often assoc. w/ MS, trauma, or antispasmodic meds
Incontinence occurs once pressure in the bladder exceeds that of the sphincter
Dx: Distended bladder, focal neurologic deficits
149
Anticoagulant monitoring methods
Anti-factor Xa levels =>> LMWH
aPTT =>> Unfractionated heparin
INR =>> Warfarin
150
Follow up on a positive PPD
CXR
151
First work up in a patient with possible septic arthritis
CBC and ESR, then do an aspiration
152
Alopecia areata
Localized AI reaction to hair follicles; can spread to cover the entire scalp or body
Tx: Intralesional corticosteroid injections, usually will recover in 6 months
153
Test to perform before removing an adrenal mass
Renal vein sampling
Turns out, the abnormal values are found opposite the mass sometimes
154
Using other drugs in addition to Chantix
Is not beneficial and can in fact increase incidence of nausea and headache
155
Tx for Raynaud's
CCBs
156
First study in a patient with a syncopal episode
EKG
157
High risk angina associations
ST segment changes
Hypotension
Mitral regurgitation murmur that has worsened
New S3
Prolonged pain at rest
Pulmonary edema
158
Back up to use if you cannot use Vancomycin for MRSA
Linezolid
159
CAP tx
Ceftriaxone, Azithromycin (combo in hospital)
Azithromycin (outpatient)
Possibly Moxifloxacin if needed (PROBS WRONG ON TEST)
160
HCAP
Vancomycin and Piperacillin/Tazobactam
Cover MRSA and Pseudomonas
161
Meningitis tx
Ceftriaxone, Vancomycin, Steroids
162
UTI tx
Amoxicillin (pregnant ladies)
Nitrofurantoin
Bactrim (can't use if in renal failure)
Cerftiaxone (IV, for pyelonephritis)
Ciprofloxacin (outpatient pyelonephritis)
163
NSAID you can use with a history of MI
Naproxen
164
Acute paronyhcia
Local trauma to the nail fold or cuticle followed by an infxn
Tx: Topical antibiotics
165
Bacterial vaginosis diagnostic criteria
1. Thin, homogenous vaginal discharge
2. Vaginal pH >4.5
3. Positive KOH test
4. Presence of clue cells on a wet mount
166
Acute diverticulitis tx
Bowel rest, quinolone, and metronidazole
-If diverticulitis is asymptomatic, just treat with a high-fiber diet
167
Tympanoplasty indication
>3 ear infxns in 6 months or >4 in one year
168
Baby who turns blue with feeds and snores
Choanal atresia
Dx: Try to pass a catheter thru the nose
Tx: Surgery
169
Pregnant woman with a HepB exposure and who is unvaccinated
Give HBIG and vaccine right away; there are no contraindications
170
Other findings in Legionella pneumonia
Hyponatremia
Diarrhea
Elevated liver enzymes
171
Pneumonia tx in patients with chronic disease
Levofloxain, moxifloxacin
172
Organism assoc. w/ COPD assoc. pneuonia
H. influenza
173
Tx of normal pneumonia
3rd generation cephalosporin (Ceftriaxone) + Macrolide (Azithromycin)
or
Moxifloxacin
174
CURB 65
Confusion of new onset
Urea > 19mg/dL (BUN)
RR >30
Bp <90/<60
65 or older
-Any one of these positive =>> Admit
175
Organism assoc. w/ COPD assoc. pneuonia
H. influenza
176
Tx of normal pneumonia
3rd generation cephalosporin (Ceftriaxone) + Macrolide (Azithromycin)
or
Moxifloxacin
177
CURB 65
Confusion of new onset
Urea > 19mg/dL (BUN)
RR >30
Bp <90/<60
65 or older
-Any one of these positive =>> Admit
178
Noncontraceptive benefits of OCPs
️Decreased incidence of benign Breast disease
Relief from menstrual disorders
Reduced risk of uterine leiomyomata
Protection from ovarian cysts
Reduction of acne
Improvement of BMD
️Decreased risk of colorectal cancer
Protection against ovarian cancer, endometrial cancer, iron deficiency anemia, PID, and Fibrocystic Breast diseAse
179
Concerning murmurs during pre athletic screens
Diastolic murmurs
Grade 3/6 or louder
HCM or MARFAN possibility
180
Secondary action of Lasix
Bronchodilator
181
MCC of CHF
Cad
182
Cardio thoracic ratio greater than 50%
Systolic dysfunction likely due to CHF
183
PSVT Tx
Adenosine
184
Tarsal tunnel syndrome
Entrapment of the posterior tibial nerve as it courses behind the medial malleous
Pain with probation of the foot and parasthesia in the medial ankle and heel and sometimes the plantar surface
185
What would the parathyroid hormone look like with Hypercalcemia in Hyperparathyroidism?
Normal
| It should be suppressed
186
Workup of Horner's
Need a CXR to rule out a Pancoast tumor
