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How do you diagnose Asthma?
Episodic symptoms of airflow obstruction that is at least partially reversible, either spontaneously or following bronchodilator therapy
At what times in the day are asthma symptoms typically worse?
At night or early in the morning
What will you hear on lung auscultation in an asthma patient?
Prolonged expiration and diffuse wheezes on physical examination
In an asthma patient, what will pulmonary function testing show?
Limitation of airflow or positive bronchoprovocation challenge
What are the treatments of asthma, by stage?
- 1. SABA PRN Persistent Asthma:
- 2. Low-dose ICS
- 3. Above + LABA
- or Med-dose ICS
- 4. Medium-dose ICS + LABA
- 5. High-dose ICS + LABA
- 6. High-dose ICS + LABA + oral corticosteroid
How do you distinguish between an acute, chronic and persistent cough?
Acute < 3 weeks, chronic > 8weeks, persistent > 3 weeks
When should you get a chest x-ray for a patient with an acute cough? For a persistent or chronic cough?
Any adult with acute cough who shows abnormal vital signs or in whom the chest examination is suggestive of pneumonia. Persistent or chronic- when ACEi and post-infectious cough are excluded.
What are the most likely causes of cough when the CxR is normal?
Post-nasal drip, asthma, GERD
How do you diagnose diabetes?
A1C > 6.5% or FPG > 126 mg/dL or 2h plasma glucose > 200 mg/dL or in a patient with classic sx of hyperglycemia or hyperglycemic crisis, a random plasma glucose > 200 mg/dL
What are the goals of diabetes treatment?
Preprandial capillary plasma glucose: 70-130 mg/dL
- Peak post-prandial (1-2 h after start of meal) < 180
What is normal HTN?
What is pre-HTN?
What is Stage 1 HTN?
What is Stage 2 HTN?
What labs will you order for a patient who has just been diagnosed with HTN?
UA, blood glucose, Hct and lipid panel, serum K, Cr, Ca. EKG
What is the goal BP for a patient with Stage 1 or 2 HTN without CKD or DM?
What is the goal BP for a HTN patient with CKD or DM?
What is the DASH diet?
A diet rich in fruits, vegetables, and low-fat dairy foods and low in saturated and total fats, has been shown to lower blood pressure.
How would you explain what 2 grams of sodium looks like to a patient?
1 teaspoon full
How much EtOH would you suggest for HTN men? How about HTN women or lighter-weight people?
No more than 2 per day for men, no more than 1 for women and lighter people
When should loop diuretics be used in the treatment of HTN?
When there is kidney dysfunction (Cr > 2.5)
How will you develop an anti-hypertensive regimen?
With the AB/CD rule. For persons younger than 55 and not black- ACEi or ARB, then add C or D. For persons 55 and older or black, CCB or diuretic, then add ACEi or ARB.
What are some adverse effects of ACEi?
Cough, hypotension, dizziness, kidney dysfunction, hyperkalemia, angioedema; taste alteration and rash, rarely proteinuria, blood dyscrasia. Contraindicated in pregnancy.
What are some adverse effects of ARBs?
Hyperkalemia, kidney dysfunction, rare angioedema. Contraindicated in pregnancy.
What will you use for resistant hypertension?
When developing an anti-hypertensive regimen, what are some compelling indications that would influence the drugs you choose?
HF, hx of MI, high cardiovascular disease risk, diabetes, CKD, hx of stroke
How do you treat an acute tension headache?
How do you treat a chronic tension headache?
How do you treat a cluster headache?
Oxygen 100% at 10-12 L/min for 15-20 min
How do you shorten a cluster headache?
How do you prophylax for a cluster headache? Or migraine?
How can you treat a chronic daily headache?
Amitriptyline 1 mg/kg, or anticonvulsants like topiramate or gabapentin.
What is your differential for back pain?
SPRM. Muscular strain, primary spine disease (disk herniation, degenerative arthritis), systemic diseases (mets), and regional diseases (aortic aneurysm)
For the posterior chest physical exam, at how many points will you test for tactile fremitus?
For the posterior chest physical exam, at how many points will you percuss?
What elements will you perform in the auscultation part of the posterior chest physical exam?
Auscultation: Listen at points 1-7, pt breaths through an open mouth. "99", "eeee", whispered "1-2-3"
For the anterior chest- what makes up the palpation part of the exam?
Chest expansion and tactile fremitus (1-3)
Anterior chest PE- how many points to percuss?
How many points to auscultate on anterior chest PE?
What would you like to do?
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