-
For how long to antacids provide relief?
~ 30 min
-
For how long to H2 blockers provide relief? (Pepcid, Tagamet, Zantac)
How long do they take to start working?
-
How long should a PPI be prescribed? What if symptoms return?
-
Which studies might be most important to order for a pt taking sertraline?
B12, folate, TSH
-
The most common side effect of amlodipine.
lower extremity edema
-
What might elevations in AST/ALT indicate?
death of hepatocytes (died and spilled contents)
-
What might an elevation in alk phos indicate?
- prob with liver OR bone
- (also expected in pregnancy and teens)
-
ALT > AST 2-10x normal (ALT:AST>1).
Viral hepatitis
-
AST > ALT
- EtOH, drugs, liver disease
- (Acetaminophen, Statins, Tequila)
-
-
What does PT/albumin level tell you?
How well liver is making things (liver only organ that makes albumin)
-
AST:ALT ratio <1;
ALT & AST 2-5 x ULN;
ALP 2-3 x ULN
NAFLD
-
#1 cause of liver trasplants.
NAFLD
-
What does HBsAg tell you?
acutely infected with Hep B or not
-
What does anti-HBs tell you?
Immune or not to Hep B
-
What does anti-HBc tell you?
past infection or not of Hep B
-
What does anti-HAV IgG tell you?
- (+) = immune
- (-) = not immune
-
What does anti-HAV IgM tell you?
- (+) = acutely infected with Hep A
- (-) = not acutely infected
-
What should you order to screen for Hep C?
What if exposure in last 6 months?
-
How soon does anti-HCV become positive after exposure to Hep C?
as early as 8 weeks
-
Positive McBurney's point & confirmatory test.
- suspect appendicitis
- CT (US in child)
-
URQ pain? Initial test? What if inconclusive?
- suspect cholecystitis
- US
- HIDA scan
-
Elevated TG and acute abdominal pain. What tests?
- pancreatitis
- amylase, lipase
-
Test for bowel obstruction.
flat & erect X-ray
-
Most reliable indicator of infection (UTI).
pyuria
-
Secondary causes of HTN.
- renal, vascular
- endocrine, neurologic
- pharmacologic
- pregnancy > 20 weeks
-
What are the major risks of prescribing levothyroxine?
- Accelerated bone loss,
- atrial fibrillation
-
Consider Metformin for IFG if?
- A1C 5.7-6.4
- age <60
- BMI 35 or greater
- women w/ h/o gest DM
-
Meds assoc with increased risk of dev of T2DM.
- statins
- atypical antipsych
- HCTZ
-
Examples of sulfonylureas.
- glimepiride
- glipizide
- glyburide
-
What kind of po med for DM if irregular eating schedule?
-
After initiating insulin, usually discontinue what?
sulfonylureas, glitazones
-
New onset ED can be a significant finding for what?
prostate CA
-
PSA > _____ needs biopsy.
10
-
PSA between ______-_____ almost always biopsied.
4-10
-
-
Tx for epididymitis.
- Ceftriaxone 250mg IM +
- doxy 100mg bid x 10 days
- (culture)
-
Which disease can present with palmar rashes?
- 1. Rocky Mountain Spotted
- 2. Syphilis
- 3. Erythema multiforme
-
Elderly pt w/ acute onset severe eye pain w/ ha, n, v, halos around lights, decreased vision. Mid-dilated pupil oval-shaped. Cloudy cornea. Cupping of optic nerve.
- Acute Angle-Closure Glaucoma
- EMERGENCY!
-
What is scotomoa?
retinal detachment
-
Cauliflowerlike growth, hearing loss on affected ear. Landmarks not visible. h/o choronic OM infections.
- Cholesteatoma
- tx: abx, surgical debridement, refer to HEENT
-
Acute onset of eye pain, photophobia, blurred vision of affected eye.
- Look for herpetic rash on tip of nose to r/o shingles of CN5; fernlike lines w/ fluorescein(avoid steroid drops)
- could also be corneal abrasion: use topical abx 3-5 days Do NOT patch eye. f/u in 24 hrs
- consider pain rx for 48 hrs
-
Older black pt with DM, gradual onset of peripheral vision changes, then central.
- check IOP (cupping = increased)
- Refer pt for primary open-angle glaucoma
- can lead to blindness
- TX: timolol eye drops to lower IOP (not w/ resp probs or HF)
-
Older pt acute onset of severe frontal ha or eye pain w/ blurred vision and tearing, halos around lights. Sometimes n/v.
Refer to ED! (Primary angle-closure glaucoma)
-
Red sore eyes. Increased tearing. No purulent discharge (like in conjunctivitis).
- Anterior uveitis (Iritis)
- higher risk with autoimmune DO
- REFER
-
Elderly smoker with gradual or sudden and painLESS central vision loss. Straight lines appear distorted.
- Age-related Macular Degeneration (AMD)
- Amsler grid, REFER
- (high-dose antioxidants and zinc)
-
Chronic autoimmune DO w/ dry eyes (and gritty) and mouth > 3 months. Swollen and inflamed salivary glands.
- Sjogren's Syndrome
- OTC substitute tid
- REFER to ophthalmologist & rheum
-
Strep throat complications.
- Scarlet fever (sandpaper rash)
- Rheumatic fever (can affect heart valves, joints, brain)
- peritonsillar abscess - ED STAT
-
Complications from AOM.
- cholesteatoma
- Mastoiditis
- periorbital/orbital cellulitis - REFER to ED
- Meningitis
-
If Amor was used in past 3 months, how should you treat AOM?
Augmentin or Ceftin
-
What to use to tx AOM if PCN allergic?
macrolides, sulfas
-
Rinne test results of BC ____ AC with conductive hearing loss.
>
-
______ test results in lateralization to the affected ear.
Weber
-
Most common tx for impacted cerumen.
carbamide peroxide
-
Signs of CF.
- chronic cough
- persistent vomiting, especially with cough
- salty sweat/skin
- recurrent URI
- abdominal distention
-
The recommendations are _____ days of abx for children 2 years or older who have mild to moderate acute otitis media (AOM).
Children < 2 yrs should be treated for ___ days.
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