Primary Care

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HuskerDevil
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87917
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Primary Care
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2011-05-26 17:18:35
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DPAP2012 Primary Care
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Primary Care cards made by previous students
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  1. Dash Diet =
    • low in Na, fat
    • high in K+, fiber, calcium
    • lowers SBP 8-14
  2. Loop Diuretics: Site of Action
    loop of henle
  3. Thiazide Diuretics: Site of Action
    Proximal distal renal tubule
  4. K-Sparing Diuretics / Aldosterone Antagonists: Site of Action
    Distal renal tubule & collecting duct
  5. Carbonic Anhydrase Inhibitors: Site of Action
    Proximal renal tubule
  6. Lung Ausc: Long Expiratory Phase
    COPD
  7. Bronchitis Vs Pneumonia
    • bronch: prior URI;
    • cough, low fever, clear lungs or ronchi, nl CXR;
    • Pneumo: acute cough/fever/tachypnea, CP, WBCs, pulmo infilt on CXR
  8. Vaginal D/C & Ph DDx
    • candida, BV, trich: itching & d/c
    • BV / trich: pH > 4.5, candida lower pH
  9. Hypertrophic Cardiomyopathy: Genetics, Prevalence, Dx Test, Exam
    • auto dom
    • most common sudden death <35 yo;
    • dx via echo: asymmetric septal hypertrophy & LV outflow obstruction
    • squatting increases venous return & decreases murmur
    • standing increases venous pooling & murmur
    • SEM at LSB
  10. Benign Flow Murmurs ___ with Valsalva
    diminish or do not change (HOCM increases)
  11. Risk Factors for AOM
    • <2 yo
    • bottle fed
    • prematurity
    • smoker in house
    • daycare
    • Native American
  12. Recurrent OM =
    3 episodes AOM in 6 mos or 4 in 1 yr
  13. Sinusitis Abx Tx
    • 1st - amoxil or cefuroxime (ceftin)
    • PCN allergy: biaxin, azithro, Bactrim
    • 2nd: Aug or levo
  14. Int/Ext Hordeolum
    • internal: meibomian glands
    • ext: zeis
  15. Hordeolum Tx
    • topical Abx (bacitracin or erythro) if w/ blepharoconjunctivitis
    • systemic if preseptal cellulitis (keflex/aug)
  16. Ages Of Sinus Devt
    • maxillary/ethmoid present at birth
    • sphenoid: 2-5 yo
    • frontal: 7-8 yo
  17. HTN BP Goals (For Nl, CAD, DM)
    • Nl: < 140/90
    • DM or CKD: < 130/80
  18. CAD Risk Factors
    • FH
    • Male
    • Hyperlipid
    • DM
    • HTN
    • Inactivity
    • Obese
    • Smoking
  19. Frequency of Tests for HM
    • Pap: F sexually active <65 yo
    • mammo: ACS qyr >40, USPSTF 1-2yr >50yo
    • DRE/PSA: no screen >75 yo
    • FOBT: qyr >50
    • colonoscopy q10 yr
  20. Anticholinergic Effects: S/S, Causative Meds
    • dry mouth
    • dry eyes
    • mydriasis
    • urinary retention
    • constipation
    • ipratropium, tiotroprium
  21. HTN Lifestyle Mods
    • wt reduction (BMI 18.5 - 25) (biggest fx on bp)
    • dash diet
    • Na reduction
    • aerobic 30 min
    • limit EtOH
  22. HTN Med Choices: w/o CE
    • stage 1: thiazide, ACE/ARB, BB, CCB
    • stage 2: 2 drug combo (usu HCTZ + ACE etc)
  23. HTN Med Choices: w/ CE
    • thiazide: HF, CVD risk, DM
    • ARB: HF/DM
    • BB: any but CKD/stroke prevention
    • CCB: CVD risk/DM
  24. Thrombophlebitis Mgmt
    • Local heat & elevation
    • bed rest
    • NSAID
    • ASA
    • avoid long standing
    • assoc w/ DVT in 20%
  25. A-Fib Mgmt
    • hemo unstable: cardiovert
    • stable: consider rate ctrl (BB/CCB), anticoag, poss cardiovert
  26. Venous Thrombosis: 80% Occur In:
    deep v. of calf
  27. Syncope: Types
    • Vasopressor
    • orthostatic hypotension
    • cardiogenic
  28. Intermittent Asthma
    • sx < 2/week, noc <2/mo
    • FEV1 > 80%
    • SABA
  29. Cough DDx
    URI, allergies, asthma, COPD, CA, GERD
  30. Hyperthyroidism
    BW
  31. Hypoglycemia
    • glucose <60
    • usu 2/2 med use
    • poss insulinoma
  32. Thyroid Nodule: High Index of Suspicion
    • h/o xrt
    • young men, firm nodule
    • hoarse/v. cord paralysis
    • high calcitonin
    • cold nodule on uptake scan
    • solid lesion on u/s
    • punctate calcification
    • inc in size w/thyroxine tx
  33. Chalazion
    inflammatory condition 2/2 for body rxn to sebum from meibomian glands
  34. Corneal Abrasion
    • severe pain/photophobia
    • fluorescein: abrasion stains deeper green
    • tx: polymyxin-bacitracin ointment, analgesics
  35. Vertigo DDx
    • Vestibular: BPPV, meniere, vestibular neuritis, labyrinthitis
    • Neuro: migraine, MS, stroke
    • CV: syncope, ortho hypotension
  36. Glaucoma Dx
    abnormal in 2 of 3: optic disk (cup-disk ratio >0.5), visual field, intraocular pressure
  37. Laryngitis
    • persistence may lead to polyps
    • M cat or H flu
    • erythromycin
  38. Pharyngitis: GABHS
    • fever >38C
    • cervical LA
    • no cough
    • tonsillar exudate
  39. A Fib Dx Work Up
    • 12 ECG
    • Echo
    • CXR
    • Thyroid
    • poss Holter or stress test
  40. Atypical CP, Palps, Anx D/O, Sympathetic Hyperreactivity; Mild Systolic Click +/- MR; Young F>M
    MV prolapse
  41. MV Prolapse Mgmt
    • Echo to dx
    • Reassurance
    • BB for palps
    • ASA for TIA / CVA risk
    • surgery for severe MR
  42. Varicose Veins Most Common In:
    saphenous veins
  43. Inflammation, Induration, Erythema & Tenderness Along Superficial V (Usu Long Saphenous V)
    phlebitis
  44. DVT Mgmt:
    • Heparin/Warfarin
    • Thrombolytic tx
    • Embolectomy
    • IVC filter if anticoags are CI
  45. DVT Rfs:
    • Virchow’s triad
    • PG
    • CA
    • Limb trauma
    • Surgery
  46. Mild Persistent Asthma
    • sx >2/wk
    • noc >2/mo
    • FEV1 >80%
    • Tx: low dose ICS (rhinocort, flovent, nasonex, nasocort)
  47. Syncope: Dx Tests
    • ECG
    • autonomic: tilt table, carotid massage
    • electrophysio
    • stress test
  48. Moderate Persistent Asthma
    • sx daily
    • noc >1/week
    • FEV1 60-80%
    • Tx: low-med ICS, LABA (serevent)
  49. Severe Persistent Asthma
    • continual sx
    • freq noc
    • FEV1 <60%
    • Tx: HD ICS, LABA, and oral CS
  50. Hordeolum
    • infxs process in eyelid
    • usu staph aureus
  51. Vestibular Vertigo DDx: Sx Duration
    • BPPV <30 sec
    • Ménière min to hrs
    • vestib neuronitis days
  52. Vestibular Vertigo DDx: Sx Provoked By:
    • BPPV specific posn changes
    • vestib neuronitis: any changes
    • Ménière dz tinnitus/n/v, not provoked by posn change
  53. Vertigo Testing
    • dix-hallpike: +BPPV rotatory nystagmus
    • audiogram: nl BPPV/vestib neuritis, low freq SNHL in Ménière
  54. Vertigo Tx
    • BPPV: epley; vestib neuritis meclizine/valium
    • Ménière: low salt/ acetazolamide
  55. Glaucoma Tx
    • pressure to <16
    • prostaglandins (latanoprost)
    • topical BB or CAI
    • laser trabeculoplasty
  56. Whipple Triad (Hypoglycemia)
    • hypoglycemic sx (tremor, confusion, sweating, nausea, hunger)
    • low BS
    • sx resolve when glucose is normal
  57. Most Aggressive Lung Ca; Not Surgically Treated; Highest Rate Of Mets; Usu Systemic Dz
    small cell lung cancer
  58. Most Common Type Of Lung Cancer
    non-small cell 80%
  59. 2 Most Common Types Of Non-Small Cell Lung Cancer
    squamous, adenocarcinoma
  60. Squamous Cell Lung Cancer Is Usually Where In The Lung
    central
  61. Adenocarcinoma Lung Cancer Is Usually Where In The Lung
    peripheral
  62. What Are The Most Frequent Symptoms Associated With Advanced Lung Cancer
    • Cough
    • wt loss
    • dyspnea
    • chest pain
    • hemoptysis
    • bone pain
    • lymphadenopathy
    • hepatomegaly
    • clubbing
    • hoarseness
    • SVC syndrome
  63. Initial Imaging Modality For Suspicion Of Lung Cancer
    chest x-ray
  64. A __ Lesion On Chest X-Ray Is Considered Malignant Until Proven Otherwise
    non-calcified
  65. Imaging Used To Evaluate For Lung Mets
    pet, brain ct, mr
  66. Imaging Modality Considered The Standard Of Care In Proper Staging Of Lung Tumors
    bronchoscopy
  67. Gold Standard For Lymph Node Evaluation With Lung Cancer
    cervical mediastinoscopy
  68. Heartburn: DDx
    • GERD: regurg, dysphagia
    • PUD/ gastritis: epigastric pain, n/v, bloating
    • Gallstones: colicky RUQ
    • Pancreas: severe constant mid-abd
  69. PUD: H Pylori Dx Testing
    • rapid urease (s/s 90/98)
    • if neg, do histo stain
    • sero test (stays pos)
    • fecal Ag (can use to test of cure)
    • urea breath test
  70. Fever, High WBC, LLQ Pain; Poss Painless Rectal Bleed
    acute diverticular dz
  71. Abd Pain Assoc W/Bowel Dysfn, Often Relieved By BM
    IBS
  72. Biliary Dz: Dx Test
    • u/s is definitive for GS
    • u/s or HIDA for cholecystitis
    • xray/CT for porcelain
    • u/s or ERCP for choledocho
  73. Common Causes Of Gastritis
    NSAIDs, EtOH, stress, portal HTN
  74. Diarrhea
    • >3/day or 200 mL
    • osmotic vs secretory
    • dx: fecal WBC, occult blood, flex sig/bx, upper GI
  75. BPH Sxs
    • Obstructive: hesitancy, dec force of stream, incomplete voiding, straining, dribbling
    • irritative: urgency, freq, nocturia
  76. Ed
    • 50% of 40-70 yo
    • usually organic (vs psych)
    • poss CV/DM/ meds
  77. Cystitis: DDx
    • Women: vulvovaginitis, PID
    • Men: urethritis, prostatitis
    • bladder CA, voiding dysfn
  78. Epididymitis: Men <40 Yo
    STI: urethritis, CT or NG
  79. Urethritis
    • dysuria, pruritus, d/c
    • NG or NGU (CT, myco genitalium, ureaplasma)
    • ceft/doxy or zithro
  80. Vaginitis DDx
    • candida (azoles), trich/BV (pH >4.5; flagyl)
    • genital warts (podophyllum/ trichloroacetic acid)
  81. Breast Mass
    fibrocystic (pain, size fluctuation, multiple/bilateral masses);
  82. Amenorrhea: Physio
    • low/nl FSH: HPA tumor, cushing syn, hypothyroid, high testost, uterine malform
    • high FSH: ovar, Turner, autoimmune
    • high LH: pseudoherm
  83. Incontinence: DRIP
    • drugs/delirium
    • restricted mobility, retention
    • infxn/inflam/impaction
    • polyuria
  84. Urolithiasis Rfs
    • prior stones, FH, low Ca/fluid intake, high oxalate/pro/Na intake, RYGB
    • gout, DM, obesity
  85. Dysmenorrhea: Tx
    • heat, thiamine
    • NSAIDs, celebrex
    • OCPs
  86. Prostatitis
    • acute bac: E coli/pseudomonas/ enterococci
    • pain, fever, irritative voiding sx
    • chronic tx: cipro/septra x1-3 mo
  87. CIN1 =
    • Cervical intraepithelial neoplasia 1
    • low grade lesion, mild dysplasia in lower 3rd of epithelium
    • LSIL
  88. Cervicitis: Edtiology
    • often CT/NG
    • or idiopathic
  89. Contraceptive Methods: Most Vs Least Effective
    • Most: IUD, implants, sterilization
    • Least: diaphragms, condoms, withdrawal/rhythm
  90. Shoulder Pain DDx
    • rotator cuff
    • subacromial bursitis (pain/TTP)
    • humerus fx
    • biceps tendonitis (groove TTP)
    • GH OA
    • SLAP tear (no weakness)
  91. LBP: Most Common Site Of Disk Herniation
    L5-S1 (also L4-L5)
  92. Knee Pain DDx
    • OA
    • Effusion
    • pop cyst
    • bursitis
    • ACL/coll lig
    • meniscus tear
    • PFPS
    • ITB
    • stress fx
  93. Plantar Fasciitis
    • pain worst 1st few steps in AM
    • tx: restrict prolonged standing; arch supports
  94. Carpal Tunnel Syndrome Dx
    • clinical dx
    • pain / paresthesia in median n. dist: digits 1-3 & radial half of 4th
    • sxs worse at night
  95. Hip Pain DDx
    • hip dysplasia
    • nerve entrapment
    • ankyl spondylosis
    • RA
    • lumbar disk pathology
  96. Tests for Suspected (Knee & Hip) OA
    • ES
    • RF
    • synovial fluid analysis
    • imaging
  97. Fibromyalgia
    • F > M 20-50 yo
    • neg inflam sxs/labs
    • fatigue, HA, numbness
    • TCAs, Flexeril, SNRI
  98. Peripheral Neuropathy: Axonal Vs Demyelinating
    axonal: normal conduction velocity, denervation on EMG; demyelinating: slow velocity, no EMG denervation
  99. Tension Type HA
    • mild-mod intensity, bilateral, nonthrobbing HA w/o other assoc features
    • infreq < 1/mo
    • Freq 1-14 days/mo
    • chronic > 15 days/mo
    • NSAIDs & TCAs
  100. MS Testing
    MRI, VER, BAER, SSEP, CSF oligoclonal banding, spinal fluid IgG
  101. Sudden Onset Of LMN D/O, Asym Facial Paresis, Often Hyperacusis & Impaired Taste
    Bell palsy (prev: 30/100K)
  102. Contralateral Hemiplegia, Hemisensory Loss, & Homonymous Hemianopia (& Global Aphasia If Dominant Hemisphere Is Affected) =
    MCA stroke
  103. Essential Tremor
    Tx often not needed; propranolol
  104. Ottawa Rules: Knee: Xray Only If:
    • >55 yo
    • isolated tenderness of patella (with no other bony tenderness)
    • tenderness at head of fibula
    • inability to flex knee to 90 degrees
    • inability to bear wt immediately & in ER
  105. Knee Pain DDx
    • injury to ACL/PCL
    • meniscus
    • PF syndrome
    • Bursitis
    • OSD
    • ITB
    • baker cyst
    • OA
    • RA
  106. GERD: Pathophys, S/S
    • low LES/high intra abd pressure
    • burning epigastric pain, recurs despite food
    • cough, hoarse, dysphagia
  107. Barrett Esophagus Physio
    low stomach pH changes esoph squamous cells to adenomatous cells
  108. GERD: Dx Tests, Tx
    • EGD, barium (inc upper GI; sens < EGD), manometry
    • tx avoid trigger foods
    • H2 or PPI
  109. PUD: Tx
    triple tx: PPI or H2 + clarithro + amox or flagyl x 7-14 days
  110. Diverticular Dz DDx
    colon ca, appy, IBD, IBS, ischemic colitis, UTI, PID
  111. Ibs DDx
    • dietary (lactose)
    • celiac dz (wt loss)
    • IBD, colon ca (wt loss, anemia)
  112. Biliary Dz Rfs
    4Fs, Hispanic, rapid wt loss, insulin resistance/ CHO intake, high TG, IBD
  113. Biliary Dz Labs
    • WBCs in GS/choledocho
    • ALT/AST, alk phos, bili
    • poss amylase
  114. Causes Of Upper GI Bleed
    PUD, MW tear, AVM, esophageal varices
  115. Diarrhea: Inflam Vs Non-Inflammatory Agents
    • inflam: cMV, E histo, EHEC, C diff, SSC
    • non-inflam: noro, rota, Giardia, crypto, SA, B cereus, vibrio cholera
  116. Diarrhea: Abx For:
    • Shigella, cholera, ETEC, C diff
    • No Abx for salmo, campy, EHEC, Yersinia
  117. BPH Tx
    • mild: watchful waiting
    • mod-severe: TURP
    • med tx (terazosin, doxazosin; finasteride)
  118. Cystitis: Tx
    • usu E coli / enterococci
    • F: FQ (Cipro/oflox), Keflex, macrobid x3days
    • complicated gets C&S
  119. Oral Rehydration Solution:
    3.5 g NaCl, 2.5 g Na HCO3, 1.5 g KCl, 20 g glucose, in 1L water
  120. Epididymitis: Men >40 Yo
    d/t UTI or prostatitis, usu GNR
  121. Epididymitis: S/S
    • scrotal pain radiating via spermatic cord to flank
    • fever, swelling
    • poss prostate TTP
    • high WBC
  122. Epididymitis: Tx
    • STI: ceftriaxone/doxy x10-21 days
    • nonSTI: UTI tx (cipro/keflex/septra x21-28 days)
  123. Prostatitis: Bac Vs Nonbacterial
    • nonbac: no h/o UTI or pos cx
    • consider bladder ca in older men: do cytology & cystoscopy
  124. Urethritis: DDx
    • UTI
    • Candida
    • noninfxs urethritis (FBO),
    • stones
    • ReA
    • chronic prostatitis
  125. Amenorrhea: Dx Tests
    LH, FSH, PRL, testost, TSH, FT4, hCG
  126. Incontinence: PE
    • distended bladder, lg prostate, uterine prolapse, cystocele, rectocele, mass/impaction
    • neuro: CVA, spcord dz, cog impairment
  127. Urge Incontinence: Causes
    usu invol detrusor activity, poss rel to CVA, dementia, PD, spcord injury
  128. Incontinence Dx Testing
    • ua, PVR (postvoid residual)(usu via cath) >200 mL
    • renal labs
  129. Most (80%) Kidney Stones Are
    • calcium (Ca Ox, Ca PO4)
    • others: uric acid, struvite (Mg NH4 PO4)
  130. Struvite Stones Form in Pts With
    • UTI (proteus / klebs: urease forming)
    • staghorn: often struvite
  131. Urolithiasis Dx / Tx
    • flank pain +/- hematuria
    • ID stone
    • noncontrast CT/IVP
    • 24hr urine, U Ca:Cr ratio
    • tx diet to lower Ca/ oxalate
  132. CIN 2 =
    • high grade lesion
    • mod dysplasia, atypical changes in basal 2/3 of epithelium
    • HSIL
  133. CIN 3
    • high grade lesion, severe dysplasia/ ca in situ
    • >lower 2/3 of epi plus full thickness lesions
    • HSIL
  134. CIN & HPV
    • HPV 6&11: LSIL, warts
    • Benign
    • HPV 16 & 18: HSIL, ca
  135. Causes of Secondary Dysmenorrhea
    endometriosis, adenomyosis, uterine leiomyomata, chronic PID
  136. Primary Dysmenorrhea Etiology
    frequent/ prolonged uterine contrxns - decrease blood flow to myometrium → ischemia (uterine "angina")
  137. OCP Cis
    • h/o thrombo / stroke, estro-dependent tumor
    • liver dz, PG, CVA or CAD, AUB, smoker if >35 yo
  138. Ocps MOA
    inhibition of midcycle LH/FSH surge: prevents ovulation
  139. Rotator Cuff PE
    • RC: pain, less ROM w/overhead supraspinatus (empty can) weak to abd
    • Neers: pain w/forward flexion
    • Hawkins: pain on int rotation; + drop off test
  140. LBP DDx
    • cauda equina (urinary probs, fecal incontinence, prog weakness, saddle anesthesia), spondyl (pain improves w/rest)
    • tumor, infxn/ inflam (pain doesnt improve)
  141. LBP Tests
    • xrays if pain >4 wks
    • MRI/CT sens > xray for infxn, ca, hern disk, stenosis
    • CBC, UA, Ca, PO4, ESR, alk phos
  142. LBP: Anemia, ESR
    anemia w/MM, high ESR in malig, infxn, CTD
  143. Hemarthrosis
    usu d/t injury (most common ACL), rapid effusion (2-4 hrs)
  144. Most Common Cause Of Knee Pain In Pts <45 Yo =
    • PFPS
    • esp women
  145. Young Pt W/Ant Knee Pain Worse W/Repetitious Flexion & Without Clear Alternative Cause:
    PFPS
  146. Local TTP, Pain On Motion And At Rest; Occasional Loss Of Active Movement; Swelling, Erythema, Warmth:
    bursitis
  147. Most Common Knee Injuries
    • medial: anserine bursitis
    • MCL (most common lig)
    • medial meniscus (most vulnerable)
  148. 2nd Most Common Knee Pain Site
    • anterior: PFPS
    • prepatellar bursitis
    • OSD
    • inflam arthritis
  149. Least Common Knee Pain Site
    • lateral: lat meniscus
    • ITB
  150. Diffuse Anterior Knee Pain W/ Swelling & Inflammatory Change
    inflammatory arthritis (RA, gout, pseudogout) or septic arthritis
  151. OA S/S
    • >50 yo
    • AM stiffness <30 min
    • Crepitus
    • Bony tenderness & enlargement
    • No palpable warmth
  152. Meniscus Tear Dx Made By:
    MRI or diagnostic arthroscopy
  153. Osteoporosis RF
    • Advanced age
    • Previous fx
    • Also LT glucocorticoid tx
    • Low body wt (< 58 kg [127 lb])
    • FH hip fx
    • Smoking
    • Excess alcohol intake
  154. Osteoporosis Epi
    • F>M (4:1)
    • W&Asian > Hisp > AA
    • 4 in 10 WF will fx
  155. DEXA Values
    • T score: BMD > -1SD below YN = nml
    • severe osteo = BMD <-2.5
  156. Best Predictor Of Fx Risk
    bone density (75-85% of variance in bone strength)
  157. DEXA Used For:
    PA spine, lateral spine, hip, forearm, total body
  158. T-Score: Osteopenia
    -1 to -2.5 SD below YN
  159. Lachman Test Assesses:
    anterior-to-posterior laxity
  160. McMurray Test:
    • rotate foot outward to test medial meniscus
    • inward to test lateral; + is painful click
  161. Most Common Causes Of Shoulder Pain In Absence Of Trauma =
    RC tendonitis, bursitis, bicipital tendonitis
  162. CTS Tests
    • +Phalen, +Tinel
    • NCS/EMG to r/o neuropathy and as pre-op
  163. CTS Tx
    • wrist splinting
    • glucocorticoid injxn (or oral)
    • OT/PT (carpal bone mobiln)
    • n. gliding
    • NSAIDs
    • surgery
  164. Most Common Hip Problems
    Trochanteric & gluteus medius bursitis, OA, femur fx
  165. Lateral Hip Pain That Is Aggravated By Direct Pressure
    trochanteric bursitis
  166. Meralgia Paresthetica Affects The _____ Nerve
    lateral femoral cutaneous nerve
  167. Positive Faber Test Suggests:
    hip disease, iliopsoas spasm, or sacroiliac disease
  168. Hip Pain Exam:
    inspect, gait, palpate, Faber, SLR, pulses
  169. Hip Dx Tests:
    • wt bearing xray
    • bone scan if suspect fx/necrosis
    • MRI TOC for fx not seen in xray, and necrosis/ infxn/tumor
    • u/s for kids effusion
  170. Acute Monoarticular Sxs, Consider:
    tauma, infxn, crystalline dz (gout/ pseudogout)
  171. OA Vs RA
    • OA: worse w/motion (PM stiffness), better w/rest
    • hands DIP Heberdens
    • thumb CMC.
    • RA: hand MCP/PIP
    • warm tender joint swelling
    • AM stiffness
  172. OA Tx
    • short acting NSAID (motrin/naproxen) x2-4 wks
    • inc dose prn
    • COX-2 in some pts
    • Csteroid injxn
  173. Fibromyalgia DDx
    RA, SLE, hypothyroid, polymyositis (weakness, not pain), polymyalgia rheum, low PO4
  174. Most Common Type Of Diabetic Polyradiculopathy =
    high lumbar radiculopathy of L2, L3, L4 roots, causing diabetic amyotrophy
  175. Osteonecrosis
    • Groin pain (less often thigh / buttock pain) = femoral head dz. Wt-bearing & pain w/motion, possibly rest/night pain
    • RF: steroids
    • dx: MRI sens > xray/scan
  176. Severe Anterolateral Hip Tenderness, Severe Pain W/Wt Bearing, Intolerance To Passive Hip Rotation; Xray Normal (Dx W/MRI) =
    occult hip fx (nondisplaced fx of femoral neck)
  177. Cluster HA
    unilateral, orbital/temporal w/tearing; Tx O2, sumatriptan, prevent w/verapamil
  178. HA Prevalence
    cluster M>F, parox hemicrania F>M
  179. HA: Serious Sxs
    • meningits (fever, HA, stiff neck: LP/bld cx)
    • SAH (sudden onset: CT); subdural
  180. Ms S/S
    • 15-50 yo
    • optic neuritis
    • fatigue
    • Lhermitte sx
    • Uhthoff's phenomenon
  181. MS Tx
    • methylprednisolone/ IVIg for acute
    • glatiramer & interferon for relapsing- remitting sx
  182. Bell Palsy DDx
    Lyme dz, tumor, AIDS, sarcoidosis, herpes zoster in geniculate ganglion
  183. MCA Stroke: Anterior Main Div Occlusion Vs Posterior
    • anterior occlusion: expressive dysphasia
    • posterior: receptive/ Wernicke
  184. Posterior Cerebral Artery Occlusion Leads To:
    thalamic syndrome: contralateral hemisensory deficit, spont pain & hyperpathia
  185. Anterior Comm Artery Occlusion Causes:
    weakness & cortical sensory loss in contralateral leg, poss arm weakness
  186. Ischemic Stroke Tx
    ASA, some get thrombolytics (dipyridamole, heparin for cardioembolic)
  187. Hemorrhagic Stroke Tx
    supportive; poss surg (stroke/AVM); aneurysm clipping/coil embolization
  188. Anemia: RBC Production Problem (Vs Destruction Prob) Distinguished By:
    • Retic count
    • hypoproliferative = retic low (<2); hyper = retic high (>3)
  189. Formula: Corrected Retic
    % retic x HCT/45% = absolute % retics
  190. Causes Of Fe Def Anemia
    • Dec’d intake/ Poor diet
    • dec’d absorption
    • Inc’d loss (GI bleed, menorrhagia,neoplasm)
    • Inc’d reqs (PG, lactation)
  191. Anemia Of Chronic Dz
    • Mostly normal labs (poss microcytic)
    • low erythropoietin
    • tx underlying dz & coexisting defs; epo?
  192. S/S = Glossitis, Periph Neuropathy (Stocking-Glove Paresthesias); MCV 110-140; Low Retic, Hyperseg Pmns, High Methylmalonic A.
    B12 def
  193. Folic Acid Def Findings
    • Malnourished
    • glossitis, cheilitis
    • NO neuro S/S
    • RBC folate <150 ng/mL
  194. Triad: Anemia, Splenomegaly And Jaundice
    Hereditary spherocytosis
  195. Microcytic Anemia: DDX
    TICS: thal, iron def, chronic inflammation, sideroblastic
  196. Macrocytic Anemia
    folate or B12 deficiency
  197. Normoocytic Anemia
    anemia of chronic dz?
  198. Tx For Beta Thal Major
    Txn, splenectomy, Fe chelation; allogeneic BM trans to cure
  199. Beefy Red Patches/Plaques With Satellite Lesions =
    Candidiasis
  200. Lower Respiratory Tract Starts Below What Anatomic Structure
    vocal chords
  201. Diagnosed By New Infiltrate On Exam Or X-Ray
    pneumonia
  202. No. 1 Cause Of Death From Infectious Disease In The US Is From
    pneumonia
  203. Hospital Aquired Pneumonia Is Defined As Symptom Onset >___ Hours After Hospital Admission
    48
  204. Most Common Bacterium Associated With Pneumonia World Wide
    Streptococcus pneumoniae
  205. Pneumococcus Colonizes ____% of Healthy Adults
    5 to 10
  206. May Have Associated Non-Respiratory Syndromes (CNS, Immune Hemolytic Anemia)
    Mycoplasma pneumoniae
  207. ‘Discovered’ In 1976; Found In Aquatic Environments
    Legionella pneumophilia
  208. 50% Of 20 Yo Have Serologic Evidence Of Past Infxn; Assoc W/ Chronic Inflammatory Dz (Atherosclerosis)
    Chlamydia pneumonia
  209. May Cause Necrotizing Infiltrates Or Pneumatoceles
    • GN org or Staph pneumonia
    • aspiration pneumonia
  210. Inhalation Of Oropharyngeal Or Gastric Contents (Volume-Dependent)
    aspiration pneumonia
  211. RF For Infxn With Drug Resistant Pneumococci
    recent beta lactam tx (within the past 3 months); >65 yo
  212. RF For GN Pneumonia Infxn
    residence in a nursing home
  213. RF For Enteric GN Pneumonia Infection
    underlying cardiopulmonary dz
  214. RF For Pseudomonas Aeruginosa Infxn
    • Corticosteroid tx (> 10 mg/d of prednisone)
    • Structural lung dz (bronchiectasis)
    • Broad-spectrum abx (> 7 d in past month)
  215. Respiratory Quinolone
    Moxifloxacin, gatifloxacin, levofloxacin, or gemifloxacin
  216. Outpatient Therapy For Pneumonia In Otherwise Healthy Patients
    • Advanced generation macrolide (azithro or biaxin)
    • doxycycline if allergic
  217. Outpatient Tx For Pneumonia In Pts W/ Cardiopulmonary Dz And/Or Other Modifying Factors
    Anti-pneumococcal FQ: macrolide PLUS b-Lactam (oral cefpodoxime, cefuroxime, high-dose amoxicillin, amox/clavulanate; or parenteral ceftriaxone followed by oral cefpodoxime)
  218. Rate Of Influenza Has _____ Cf To Previous Decade, Poss D/T Aging Popn And/Or Change In Predominating Viral Strains (H3N2)
    doubled
  219. Influenza Has An Incubation Period Of ___ Days
    1 to 4
  220. Fever, Myalgia, Headache, Malaise, Nonproductive Cough, Sore Throat, Rhinitis Are All Symptoms Of
    influenza
  221. Influenza: Resolution in ___ Days, Though Cough And Malaise Can Persist For Over 2 Weeks
    5 to 7
  222. Children With Influenza May Present With
    otitis media, nausea, vomiting
  223. Viral Cultures Are Optimal From ______ Specimens And Require Specific Viral Culture Media
    nasopharyngeal
  224. Only _______ Effective Against Both Influenza A And B
    ostelmavir and zanamivir
  225. Who Needs Annual Influenza Vaccinations
    • 6 mo-18 yo & >50 yo
    • LT aspirin tx; PG
    • chronic med conditions (pulmo, cardiac, metabolic, renal, neuro, immunodef, hemoglobinopathy)
    • nursing home res
  226. Radiographic Findings Include Infiltrates In Mid Or Lower Lung Fields, Hilar Adenopathy, Cavitation
    tuberculosis
  227. Cough, Weight Loss, Fever, Night Sweats, Hemoptysis, Fatigue, Decreased Appetite, Chest Pain Can Be The Clinical Presentation Of _____
    reactivated tuberculosis
  228. CXR With Upper Lobe Infiltrates, Particularly The Apical And Posterior Segments, Cavitation Common
    reactivated tuberculosis
  229. Lower Respiratory Tract Is Normally Sterile If
    directly sampled
  230. Acceptable Sputum Spec: <__ Squamous Epithelial Cells/Low Power Field
    10
  231. Macrophages: Activated Phagocytic Cells Common In ____
    fungal, acid-fast & some atypical bacterial infections
  232. Most Common Cause Of Bacterial Pneumonia (70%)
    Streptococcus pneumoniae
  233. Lancet Shaped Gram Positive Cocci In Pairs
    Streptococcus pneumoniae
  234. Culture Is Never Indicated In
    chronic bronchitis
  235. If You Suspect Atypical Bacteria You Should
    notify the lab in advance
  236. TB Infection Spread Person To Person Via ____
    respiratory droplets in air (cough)
  237. Positive PPD Zone Size >= __ Mm If No Risk Factors
    15
  238. Positive PPD Zone Size >= __ Mm If Co-Morbid RF (DM, CKD, Ca, IVDA, Congregate Setting, Immigrant <5yrs from Endemic Area (Asia, Africa, Latin America), Mycobacteriology Lab Tech, Gastrectomy
    10
  239. Positive PPD Zone Size >= __ Mm If HIV+, Contact Of TB+ Person, Organ TP/Immunosuppression, Fibrotic CXR, On 15 Mg Prednisone/Day, Or TNF Alpha Inhibitor
    5
  240. Substance Used For Control In PPD Test
    candida albicans antigen
  241. The Inability to React To Skin Tests Because Of A Weakened Immune System
    anergy
  242. More Specific Test For LTBI & Can Help Exclude BCG Or Mycobacterium Not TB Reactions.
    Interferon Gamma Release Assay
  243. Vaccine Against Tuberculosis
    Bacille Calmette-Guérin (BCG)
  244. Onset Of Action 5-30 Minutes, With Relief For 4-6 Hours
    SABA
  245. Beta 2 Agonists Have No Anti-Inflammatory Effects and Therefore
    should not be use as the sole therapeutic agent for management of persistent asthma
  246. Patients Achieving ____ Consecutive Months of Improved Asthma Control May Be Considered For a Reduction in Inhaled Corticosteroid Dosing
    3 to 6
  247. Patients With Severe Exacerbation Of Asthma May Require
    IV injection of methylprednisolone or oral prednisone
  248. Allows For Modest Reductions In Doses Of Beta2 Agonists And Corticosteroids
    leukotriene antagonists
  249. Pretreatment With ____ Blocks Allergen And Exercise Induced Bronchoconstriction
    cromolyn
  250. Blocks Vagally Mediated Contraction Of Airway Smooth Muscle And Mucus Secretion
    ipratropium
  251. Not Traditionally Effective In The Treatment Of Asthma Unless COPD Is Also Present
    ipratropium
  252. May Be Particularly Useful In Patients with Moderate To Severe Asthma That Are Poorly Controlled With Conventional Therapy
    omalizumab
  253. The Foundation Of Therapy For COPD
    inhaled bronchodilators such as anticholinergic agents
  254. Liver Function Monitoring Is Essential For
    leukotriene modifiers
  255. Inhaled Bronchodilators That Have A Duration Of Bronchodilation Of At Least 12 Hours After A Single Dose
    LABA
  256. The Preferred ICS For Pregnancy
    budesonide
  257. Preferred Step 1 Treatment For Patients 12 And Up
    SABA PRN
  258. Preferred Step 2 Treatment For Patients 12 And Up
    low dose ICS
  259. Preferred Step 3 Treatment For Patients 12 And Up
    low dose ICS plus LABA or medium dose ICS
  260. Preferred Step 4 Treatment For Patients 12 And Up
    medium dose ICS plus LABA
  261. Preferred Step 5 Treatment For Patients 12 And Up
    high dose ICS plus LABA and consider omalizumab for patients with allergies
  262. Preferred Step 6 Treatment For Patients 12 And Up
    high dose ICS plus LABA plus oral corticosteroids, and consider omalizumab for patients with allergies
  263. Regular Tx With _____ Does Not Modify Long Term Decline In FEV1, But Reduces Frequency Of Exacerbations In COPD Pts W/ FEV1 Of <50%, And Repeated Exacerbations
    inhaled glucocorticosteroids
  264. Long Term Treatment With ______ Is Not Recommended In Patients With COPD
    oral glucocorticosteroids
  265. Reduces Serious Illness And Death In COPD Patients By 50%
    influenza vaccine
  266. Initiate Oxygen Therapy For Very Severe COPD If Paox Is At Or Below ___ Kpa Or Sao2 Is At Or Below __%
    7.3, 88
  267. Antibiotics Should Be Given To COPD Patients With:
    increased dyspnea, increased sputum volume, increased sputum purulence, or who require mechanical ventilation
  268. Carry A Black Box Warning For Asthma (Especially When Used As Monotherapy)
    LABA
  269. Leukotriene Modifier
    Singulair
  270. Approved For Allergic Rhinitis
    Singulair
  271. Effective For Seasonal Asthma And For Prevention Of Exercise Induced Bronchospasm
    mast cell stabilizers
  272. Effective For Seasonal Asthma And For Prevention Of Exercise Induced Bronchospasm
    Cromolyn sodium and nedocromil
  273. Anticholinergic For COPD
    tiotropium (spiriva)
  274. Anticholinergic For Asthma
    Ipratropium (Atrovent)
  275. Should Be Done In The AM And Between Noon And 2PM For 2-3 Weeks To Establish Personal Best, Then QD
    peak flows
  276. Ultimate Goal Of COPD Therapy
    prevention
  277. Oxygen, Consider Surgery
    very severe COPD (stage 4)
  278. Inhaled Corticosteroids In COPD
    severe (stage 3), and very severe (stage 4)
  279. Not Recommended In COPD
    expectorants, mucolytics, antitussives, respiratory stimulants
  280. Only Therapy To Show Mortality Benefit In COPD
    oxygen
  281. Goal Of Oxygen Therapy
    increase PaO2 to > 60 mmHg
  282. Short-Term Cough, Producing Mucoid Sputum, Persistent Cough After 5 Days Of URI, Usually Viral In Etiology
    acute bronchitis

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