Term
What are the most common causes of Secondary Hypertension?
Which 4 organs of most commonly affected by hypertension? |
|
Definition
1) Renal Artery Stenosis (most common), OSA, Endocrine, Meds/OCPs, Coarcation of Aorta
2) Brain, Eyes, Kidneys and CVS |
|
|
Term
| What are the primary non-pharmacological interventions for HTN? |
|
Definition
In order or utility
1) Weight Loss
2) DASH diet
3) Exercise
4) Salt Reduction
5) Alcohol Avoidance |
|
|
Term
What the major pharmacological interventions used to treat essential HTN?
Which can be used in pregnancy?
Which is preferred in diabetics
Which should be avoided in lung disease?
Which should be avoided in heart block |
|
Definition
1) Beta blockers, Thiazides, CCBs, ACE-i/ARB, Hydralazine
First line should be CCB or ACE-I, because they are better in combination if "step up" care is necessary (ACCOMPLISH TRIAL)
2) Pregnancy: Beta Blocker or Hydralazine
3) Diabetics: ACE-i/ARB (renal protection)
4) Beta blockers
5) Beta blockers |
|
|
Term
What are the important side effects of each of the following HTN medications?
1) Thiazides
2) Beta blockers
3) Ace-I/ARB |
|
Definition
1) Hypokalemia, Hyperuricemia, Hyperlipidemia
2) Bronchospasm, Heart block, Hyperlipidemia
3) Renal failure, Hyperkalemia, Dry Cough, Angioedema |
|
|
Term
| How is CAD risk due to Hyperlipidemia generally determined? |
|
Definition
Risk is due to Atherogenic potential of LDL
Total Cholesterol-to-HDL ratio (5 is normal, goal is <4.5) |
|
|
Term
| What are the 5 different Dyslipidemia Syndromes? |
|
Definition
Everyone screened q5y starting at age 20
I: Exogenous/Chylomicrons
IIa: Familial/LDL
IIb: Combined/LDL + VLDL
III: Familial dysbetalipoproteinemia/IDL
IV: Endogenous/VLDL
V: Familial Hypertriglyceridemia: VLDL/Chylomicrons |
|
|
Term
Which 4 categories of people should be started on a Statin?
What needs to be checked before starting a statin? |
|
Definition
1) Clinical ASCVD qualified
2) LDL >190
3) Diabetics 40-75 with LDL 70-189
4) Non-Diabetics 40-75 with LDL 70-189 if ASCVD >7.5%
Check LFTs. Also watch out for myopathy (usually CPK bump is transient) |
|
|
Term
| What are the 4 pharmacological agent classes used to treat hyperlipidemia and how to do act? |
|
Definition
1) Statins: Lower LDL. Check LFTs and CPK
2) Niacin: Raises HDL, Lowewrs TG/LDL. Don't give to Diabetics and watch our for Flushing, LFTs and CPK
3) Bile-Acid binding resins (Cholestyramine, Colestipol): Lowers LDL and increases TG. Given with Niacin, but poorly tolerated.
4) Fibrates (Gemfibrozil): Loewrs VLDL and TG, Increases HDL
- Given to lower TG |
|
|
Term
| What are the 5 primary etiologies of Headache? |
|
Definition
VOMIT
Vascular, Other, Migraine, Infection, Tumor |
|
|
Term
| Why might a lumbar puncture be necessary in the diagnosis of a new-onsest headache when a CT scan is negative? |
|
Definition
|
|
Term
32 yo patient presents with steady, aching HA encircling their head like a hand. They also complain of some shoulder and neck aching.
How is this condition typically managed? |
|
Definition
Tension Headache
1) Behavioral: Identify depression/anxiety/stress
2) MEDS: NSAIDs/ASA/Tylenol |
|
|
Term
32 yo F presents with an excruciating right-sided headache. She endorses eye pain, with a "searing," "stabbing" sensation.
The pain is worse at night, and has lasted for the past 3 months.
What are the acute and prophylactic management strategies for this condition? |
|
Definition
Cluster Headache: 90% are Episodic, whereas 10% are chronic
- Unilateral HA with eye symptoms, worse at night lasting 2-3 months before dissipating.
Acute: Sumatriptan (imitrex) and Inhaled O2
PPX: Verapamil |
|
|
Term
27 yo F presents with throbbing right-sided HA for last 12h. She has vomited once and endorses sensitivity to light. She just began her period 2 days ago.
What are the common provoking factors for this condition? |
|
Definition
Migraine
1) Menstruation
2) Stress
3) Sleep Disturbance
4) Drugs |
|
|
Term
27 yo F presents with throbbing right-sided HA for last 12h. She has vomited once and endorses sensitivity to light. She just began her period 2 days ago.
What is the acute and prophylactic management of this condition? |
|
Definition
Migraine
1) Acute:
- NSAID or Tylenol for mild
- DHE or Triptan for moderate/severe (5-HT1R agonist)
2) PPX
- TCA (Amitriptyline) or Beta Blocker (Propranolol) |
|
|
Term
| What are the 4 major causes of cough with a normal CXR? |
|
Definition
1) Postnasal drip
2) GERD
3) Asthma
4) Ace-Inhibitors |
|
|
Term
| How is Acute Bronchitis diagnosed and treated typically? |
|
Definition
Cough (+/- sputum) with or without chest discomfort and fever.
No Workup unless PNA suspected
Tx with Cough Suppressants |
|
|
Term
| How is Acute Rhino-sinusitis managed? |
|
Definition
Usually Viral (Rhinovirus, Parainfluenza, Corona, Adeno, RSV)
Hydration, Rest, Analgesics, Cough Suppressants, Nasal Spray |
|
|
Term
How is bacterial sinusitis distinguished from viral?
How is it treated and what are the common bugs? |
|
Definition
1) Duration (>10d), Purulent Discharge, Fever
2) Treatment
- Saline Spray
- Decongestants (Oxymetazoline, Pseudoephedrine)
- Antihistamines (Loratidine, Fexofenadine, Chlorpheniramine)
- Antibiotics: Amox/Augmentin/FQ
3) Bugs
- S. pneumo, H. Influenza, Anaerobes |
|
|
Term
| What are the Centor Criteria for determining the need for a workup for Strep Throat? |
|
Definition
1) Fever (+1)
2) Tonsillar Exudates (+1)
3) Age <15 (+1)
4) Age >44 (-1)
5) Tender LNA (+1)
6) Absence of cough (+1)
2 or greater, test
4 or greater just treat (PCN 10d or Erythromycin) |
|
|
Term
| What are the 7 major causes of Dyspepsia (heartburn, bloating, epigastric pain)? |
|
Definition
1) PUD
2) GERD
3) Functional Dyspepsia
4) Gastritis
5) Hepatobiliary
6) Pancreatic
7) Esophageal |
|
|
Term
| What behavioral modifications are most effective for patients with Dyspepsia? |
|
Definition
1) Avoid caffeine, alcohol, coffee, chocolate
2) Avoid eating before sleep, and raise head while sleeping
3) Avoid smoking |
|
|
Term
What is the pathophysiology of dyspepsia that is associated with eating, lying down and cough/hoarseness?
How is it generally managed? |
|
Definition
GERD
1) Decreased LES tone
2) Try Antacid and Behavior Modification
- If fails, try H-blocker or PPI
- If PPI fails after 8 weeks, get Endoscopy
- Finally try Nissen Fundoplication |
|
|
Term
| What does a PNA associated with lipid-laiden macrophages tell you? |
|
Definition
|
|
Term
What etiologies are associated with diarrhea in the following forms?
1) Nausea and Vomiting
2) Blood
3) Immunosuppressed
4) Myalgias, malaise, no fecal WBC |
|
Definition
1) Food (S. aureus or C. perfringens) or Viral Gastro
2) Shigella, Salmonella, EHEC, Y. pestis, C. jejuni
3) MAC, Crypto, CMV
4) Viral gastro |
|
|
Term
What etiologies are associated with diarrhea in the following forms?
1) No fecal leukocytes, food-borne (poultry, ham, potato salad, mayonnaise)
2) No fecal leukocytes, crampy abdominal pain, food-borne
3) Fecal Leukocytes, Blood, Headache, Meat/Animal exposure
4) Watery diarrhea, no fecal WBC, contaminated food/water
5) Meat raw milk, TTP/HUS |
|
Definition
1) S. aureus
2) C. perfringens
3) C. jejuni: Treat with FQ
4) ETEC
5) EHEC, DONT give antibiotics |
|
|
Term
| What are the "red flags" of diarrheal illness? What is the workup? |
|
Definition
1) Blood, Systemic symptoms, high fever, dehydration
2) Get stool WBC. If positive, send culture and consider C. dif toxin |
|
|
Term
| What are the important lab tests to order in workup of constipation? |
|
Definition
TSH (hypothyroid), Calcium, CBC (CRC), Electrolytes
Tx: Increase PE, fiber and fluids. Bulk before osmotic laxative |
|
|
Term
| What are the Rome III Criteria for IBS? |
|
Definition
Abdominal symptoms >3d per month for >3 months
+
Pain improved with defecation + change in frequency or nature of stool. |
|
|
Term
| what are the 2 most common causes of nausea and vomiting? |
|
Definition
| Viral Gastro and Food Poisoning. Both managed supportively |
|
|
Term
| How are hemorrhoids managed? |
|
Definition
Sitz bath, Ice packs, Stool softeners, Fiber
Internal rubber band ligation can be used if refractory. |
|
|
Term
Define each of the following types of Lower Back Pain.
1) Pain after bending/twisting without pain distal to knee
2) Neurogenic claudication from slippage of L4-L5 vertebrae
3) Leg pain with back extension/standing, relieved by sitting and bending
4) Leg pain with sitting and bending, coughing and sneezing, positive straight leg raise test, relieved by standing, lying down.
5) Acute back pain in elderly after minor stress, localized to level of fracture with local radiation |
|
Definition
1) Musculoligamentous strain
2) Spondylolithiasis leading to Spinal Stenosis
3) Spinal Stenosis
4) Lumbar disc herniation
5) Vertebral compression fracture |
|
|
Term
What is the most common etiology of Cauda Equina Syndrome?
what are the classic clinical signs? |
|
Definition
1) Acute disc herniation leading to severe lumbar spine stenosis
2) Acute pain, Saddle anesthesia, bladder dysfunction
3) Get MRI immediately |
|
|
Term
How are each of the following managed?
1) Spinal Stenosis
2) Lumbar Disc Herniation
3) Vertebral Compression Fracture |
|
Definition
1) Epidural steroids and if fails, surgery
2) Epidural steroids and PT. 10% need surgery
3) Bracing, Analgesics |
|
|
Term
| Who needs an MRI for back pain? |
|
Definition
1) Unresponsive to conservative management for >3m
2) Progressive Neurological findings, IVDU history, prolonged steroid use, h/x malignancy, h/x recent trauma |
|
|
Term
What is Cervical Radiculopathy and what is it caused by?
How is it diagnosed? |
|
Definition
Unilateral neck pain with radiation to arm and numbness/tingling 2/2 Spondylosis or Disc herniation
Get an MRI |
|
|
Term
| What you should be on the look out for in an elderly patient with early gait disturbance and loss of hand dexterity |
|
Definition
Cervical Myelopathy 2/2/ cord compression
Get MRI and Tx is surgery. Late complications include bowel and bladder dysfunction. |
|
|
Term
What is the most common cause of anterior knee pain that is worse while ascending and descending stairs?
What do you do? |
|
Definition
Patellofemoral Pain
Send to PT for hamstring and Quadriceps strengthening |
|
|
Term
what are the lateral and medial ankle ligaments?
How is an ankle sprain diagnosed and treated? |
|
Definition
1) lateral: ATFL, PTFL, CFL
2) medial: Deltoid
3) No radiograph if patient can walk 4 steps and there is no bony tenderness
4) RICE acutely, then pain free ROM exercise with gradual weight bearing. |
|
|
Term
What is the most common cause of shoulder pain that is worse with abduction and overhead activity?
How is it managed? |
|
Definition
Supraspinatus Tendinitis-Impingement Syndrome
PT and Steroid Injections. Long-term management involves surgery. |
|
|
Term
| What is De Quervain Disease, how is it diagnosed and managed? |
|
Definition
1) Pain in radial wrist, rose with pinch grabbing, due to inflammation of abductor pollicuus longs tendon
2) Finkelstein test (clench thumb under other fingers)
3) Thumb Spica Splint and NSAIDs |
|
|
Term
True or False:
Lateral hip pain is most likely due to Trochanteric Bursitis |
|
Definition
| True! Not OA of hip, which is usually groin pain |
|
|
Term
| What is on the differential for hand numbness? |
|
Definition
1) Carpal Tunnel: compression in tunnel
2) Cervical Radiculopathy
3) Peripheral Neuropathy (DM) |
|
|
Term
| How is Carpel Tunnel Syndrome Diagnosed and Managed? |
|
Definition
1) Tinel sign (tap median nerve over wrist case), Phalen test (palmar flexion at wrist for 1 min), EMG and Nerve conduction (definitive)
2) Wrist splints at night, NSAIDs, local steroid injections and possible surgical release |
|
|
Term
What disease is associated with mono-articular joint pain that is relieved by rest and worse with activity. Morning stiffness is present for 10 min.
What test do you order? |
|
Definition
Osteoarthritis
1) Plain radiographs: joint space narrowing, osteophytes, Subchondral cysts, Sclerosis
2) Weight loss, PT, Acetaminophen (1st line), NSAIDs (2nd line) |
|
|
Term
| Who should get a DEXA scan to r/o Osteoporosis? |
|
Definition
1) All women > 65
2) Women <65 that are post-menopausal with RF
3) Men with RF for fracture
**If normal without risk factors, repeats in 3-5 years**
Tx: weight-bearing exercise, calcium/vitamin D supplementation, smoking cessation |
|
|
Term
What type of eye disease involves central vision loss with preservation of peripheral vision?
What is the most important RF?
How is it treated? |
|
Definition
Macular Degeneration
1) Age
2) Exudative is treated with anti-VEGF injections (Ranibizumab). Both get vitamins |
|
|
Term
What eye condition is associated with increased cup-to-disc ratio?
What are the important RF?
How is it diagnosed? |
|
Definition
Glaucoma: increased IOP leading to optic nerve damage and cupping of optic disc.
1) Age, AA race, FH, Trauma, Steroids
2) Tonometry and Visual Field testing (central sparing with peripheral loss) |
|
|
Term
| What should be done about an acutely painful eye that is red and associated with nausea and vomiting? |
|
Definition
Sounds like closed-angle Glaucoma (hint: halos)
Occlusion of angle between cornea and iris where trabecular meshwork is located.
Diagnose with Tonometry and VF testing (central preserved)
Treat with timolol, brimonidine, dorzolamine, plocarpine and prednisone and Urgently consult Optho. Ultimately, laser/surgery is necessary. |
|
|
Term
| What is first-line treatment for open-angle glaucoma? |
|
Definition
| Topical betal blocker (Timolol) |
|
|
Term
What are the management approaches for each of the following causes of Conjunctivitis?
1) Allergic
2) Viral
3) Acute Bacterial
4) Hypera-cute Bacterial
5) Chlamydial |
|
Definition
1) Topical antihistamines (sometimes systemic)
2) Cold compress, hand washing
3) S. aureus. Topical antibiotics
4) Gonoccocal. 1x IM Ceftriaxone 1g
5) Trachoma or Inclusion. Tetracycline and treat partner |
|
|
Term
| What time of eye condition is associated with a herpetic ulcer? |
|
Definition
HSV-1 Keratitis
Give topical antiviral drops and semi-urgent Optho consult |
|
|
Term
| What test will diagnose the condition associated with daytime sleepiness, desaturations and snoring? |
|
Definition
OSA: Polysmonography
Treat with weight loss, exercise, CPAP for severe, sometimes tonsillectomy, |
|
|
Term
| What are the important complications of OSA? |
|
Definition
1) Pulmonary Hypertension leading to Cor Pulmonale
2) Systemic Hypertension |
|
|
Term
| How is the inherited disorder of REM regulation associated with sleep attacks and cataplexy treated? |
|
Definition
narcolepsy: stimulants
Modafinil, Methylphenidate or Amphetamine |
|
|
Term
What is the first-line pharmacological agent for obesity?
When is gastric bypass indicated? |
|
Definition
1) Orlistate: taken for 4 years
2) BMI >40 and all other measures failed. 29% risk in mortality due to reduction in comorbidities (OSA, HTN, DM, Hyperlipidemia) |
|
|
Term
| What are the major causes of CHL and SNHL? |
|
Definition
1) CHL
- Cerumen
- Exostoses (bony growth from cold)
- Otitis externa
- Otosclerosis
- OME
- TM perforation
2) SNHL
- Age
- Noise
- Drugs
- Menierres
- Infection
- Mass |
|
|
Term
| What are the 5 types of urinary incontinence and their underlying pathophysiology? |
|
Definition
1) Urge
- Detrussor instability
- Get urodynamic study and Tx with Bladder training (if fails, try anti-cholinergics like Oxybutynin and TCA like Imipramine)
2) Stress
- Multiparous woman with pelvic floor weakening leading to bladder neck hyper-mobility
- Tx with Kegels, followed by ERT/Pessary/Urethral Sling
3) Overflow
- Detrussor weakness from neurological or diabetes
- Treat with cholinergics (Bethanechol) to increase contraction, Alpha blockers (Terazosin, Doxazosin) to release sphincter
4) Functional
5) Mixed |
|
|
Term
What type of urinary incontinence is described by each of the following?
1) Diabetic with nocturnal wetting, frequent small volume output with high PVR
2) Multiparous woman with urination with laughing and coughing and low PVR
3) Sudden need to go to bathroom without warning |
|
Definition
1) Overflow: Detrussor weakness
- give cholinergic (Bethanocol) and alpha blockers (Terasozin, Doxazosin)
2) Stress incontinence
- Try keggles, and if fails, use ERT and Pessary
3) Urge Incontinence: Detrussor instability
- Try bladder training first
- If fails, use anti-cholinergic (Oxybutynin) and TCA (Imipramine) |
|
|
Term
| Which tests are part of the normal workup for unexplained fatigue? |
|
Definition
1) CBC (anemia)
2) TSH (thyroid)
3) Renal function
4) Electrolytes
5) LFTs
6) Fasting Glucose |
|
|
Term
How does Viagra work to treat ED?
What drug should you not combine it with? |
|
Definition
PGE inhibitor. Increases cGMP, leading to NO release and smooth muscle relaxation.
Nitrate: serious hypotension |
|
|
Term
| What are the 2 major neurological complications of alcoholism? How can they be prevented? |
|
Definition
Thiamine Deficiency Related
1) Wernicke Encephalopathy (Reversible)
- Give Thiamine with Glucose
- Nystagmus, Ataxia, Opthalmoplegia, Confusion
2) Korsakoff Psychosis (Irreversible)
- Amnesia and Confabulation |
|
|
Term
| What management options are available for treatment Alcoholism? |
|
Definition
1) AA
2) Naltrexone for craving (not in liver failure)
3) Acamprosate if liver disease |
|
|
Term
| What are the 2 first line management options for Smoking Cessation? |
|
Definition
1) Nicotine Replacement Therapy
- Can be supplemented with Bruprion, look out for dry mouth, insomnia and headache
2) Varencycline (a4b2 nACHR partial agonist) |
|
|
Term
What are the screening recommendations for the following conditions?
1) HTN
2) Hyperlipidemia
3) CRC
4) Lung Cancer |
|
Definition
1) >18, every 2 years (if pre-hypertensive every 1 year)
2) Men >35 and women at risk >45
- Non-fasting total cholesterol (200) and HDL (35) every 5 years
3) Every 10 years colonoscopy after 50, or fecal occult blood every year. If UC, 8 years after diagnosis and then annually
4) In 30 pack year smokers who quit <15 years ago, yearly low-dose CT starting at 55 |
|
|
Term
| What are the screening recommendations for Mammograms, Cervical Pap Smears and Ovarian Cancer Screening? |
|
Definition
1) Every 2 years from 50-74
2) 21-29, every 3 years. 30-65 every 3 years or Pap + HPV every 5 years
- Stop at 65 if 3 negative paps
3) None |
|
|
Term
How should be screened for each of the following STIs?
1) HIV
2) Chlamydia
3) Gonorrhea
4) Syphillis |
|
Definition
1) Everyone 15-65 once
2-3) Sexually active women <24
4) Asymptomatic men and woman at high risk |
|
|
Term
| Who needs the Influenza Vaccine? Who should not get it? |
|
Definition
All patients >6m old, annually
Not for immunosupressed, >50, or pregnant |
|
|
Term
| Who needs the Varicella? Who should not get it? |
|
Definition
- Children unless chicken pox
- All adults after 60, one-time regardless of exposure
- Not for pregnancy or immunocompromised |
|
|
Term
| Who needs the Pneumococcal Vaccine? Who should not get it? |
|
Definition
1) PPSV23 given to adults >65 or <65 with COPD or DM
2) PCV13 followed by PPSV23 8 weeks after in immunocompromised patients
3) Repeat dose 5y after initial for high risk patients |
|
|
Term
| Who needs the Hepatitis B Vaccine? What about Hepatitis A? |
|
Definition
1) HBV: 3 doses, 0 1 and 6 months of age (all children)
2) HAV: Travelers, HIV, Chronic renal disease: 2 doses 6 months apart |
|
|
Term
| Who needs the Meningococcal Vaccine? Who should not get it? |
|
Definition
1) Asplenic individuals: 2 doses
2) Military: 1 dose
3) College students: 1 dose
4) Travelers to Mecca: 1 dose |
|
|
Term
| Who needs the Tetaanus Vaccine? |
|
Definition
Td and TdAP
1) Primary series at 1, 1-2 and 6-12m
2) Booster q10 years with first booster as TdAP |
|
|
Term
| Who needs the MMR Vaccine? Who should not get it? |
|
Definition
1) Primary series, 1 or 2 doses separated by 4 months
2) Adult Health Care Workers, Childbearing age Women of unknown Rubella Status
3) Not for pregnancy or immunocompromised |
|
|
Term
| Who needs the HPV Vaccine? |
|
Definition
| Men and Women aged 9-26 in 3 doses |
|
|
Term
| What is the workup for a suspected breast cyst? |
|
Definition
1) Try and drain it. If it contains clear/yellow fluid and disappears, follow up in 1-2m to monitor for recurrence
2) If does not disappear or is bloody, continue with mammography and biopsy (may be FNA or core depending |
|
|
Term
What is the diagnostic workup for suspected breast cancer?
How does age come into play? |
|
Definition
1) If <35, or likelihood of benign disease is very high, perform Ultrasound and FNA
2) If > 35, Triple assessment: CBE, Mammogram, Core Biopsy or Surgical Excision |
|
|
Term
| What are the risk factors for breast cancer? |
|
Definition
- Early Menarche (<12)
- Late Menopause (>55)
- Family History
- Nulliparity |
|
|
Term
| What is the difference between cyclic mastalgia and noncyclic mastalgia? How is persistent, unrelenting mastalgia treated? |
|
Definition
1) Cyclic: diffuse, bilateral, radiates to axilla, related to cycle.
2) Non-Cyclic: unilateral, postmenopausal
3) Can use Danazol (anti-gonadotropin).
- if refractory, try Tamoxifen, Toremifene or Bromocriptine |
|
|
Term
| What is the workup for suspected Galactorhea? |
|
Definition
Commonly medication related, thyroid or endocrine
1) First get pregnancy test
2) If negative, get TSH and Prolactin.
3) If prolactin is elevated, get MRI of pituitary |
|
|
Term
| What is your differential for nipple discharge? |
|
Definition
If unilateral and bloody, you need Mammogram and Surgical Excision of Terminal Duct
1) Galactorhea
2) Intraductal Papilloma
3) Mastitis
4) Cancer
5) Duct ectasia |
|
|
Term
| What are the Rotterdam Criteria for diagnosis PCOS? |
|
Definition
Pathophysiology is Insulin Resistance and Androgen Excess
Need 2 of 3
1) Androgen excess (hirsutism or hormone level)
2) Oligomenhorea
3) Multifollicular disease (>12) on pelvic sonogram |
|
|
Term
| What are the effective treatment methods for PCOS? |
|
Definition
Pathophysiology is Insulin Resistance and Androgen Excess
1) Weight loss: helps with fertility
2) Clomiphene Citrate: Infertility (also Aromatase inhibitors)
3) TZD/Metformin: Insulin Resistance
4) Contraceptives: Regulate Cycle |
|
|
Term
| How does the regularity of intervals between Menorrhagia help to determine the underlying cause? |
|
Definition
1) Regular: Anatomic
- Fibroids, Polyps, Meds, Liver Disease
2) Irregular (Menometrorrhagia): Endocrine (HPO axis)
- Order serum prolactin, LH and TSH |
|
|
Term
| How is Menometrorrhagia managed clinically? |
|
Definition
Depends on Age!
- Usually get a pregnancy test, TSH, LH, Prolactin
1) <35, give birth control and watch
2) >35 or Risk Factors, get pelvic US and endometrial biopsy. If abnormal biopsy, get hysteroscopy with D & C |
|
|
Term
| What are the risk factors for endometrial cancer? |
|
Definition
1) Anovulatory cycles
2) Nulliparity
3) Early Menarche
4) Late Menopause
5) > 35 years old
6) Tamoxifen use
7) Obesity |
|
|
Term
What are the important side effects of the following anti-HTN medications?
1) Thiazides
2) Ace-I
3) Beta Blocker |
|
Definition
1) Hypokalemia, Hyperuricemia, Hyperlipidemia
- Good in "salt sensitive" cases
- good in AAs
- good in Osteoporosis and Calcium Stones (reduce calcium)
2) ACE-I: Cough, peripheral edema, hyperlipidemia, hyperkalemia, angioedema
- Good in renal protection in Diabetics, but also risk of renal failure
3) Beta Blocker: Bronchospasm, Heart Block, Bradycardia
- Not in heart block, depression or lung disease |
|
|
Term
What hypertension meds are good in pregnancy?
Which are good in african americans? |
|
Definition
1) Hydralazine and beta blocker
2) CCB and Thiazides |
|
|
Term
| Who should be screened for hyperlipidemia? |
|
Definition
1) Men >35 every 5 years
2) Women > 45 if risk of CAD |
|
|
Term
| Who should be started on a statin? |
|
Definition
** Always check LFTs before starting**
Depends on LDL, ASCVD risk and DM status
1) LDL >190: high intensity
2) Non-diabetics 40-75 with LDL 70-189 and ASCVD >7.5%: moderate
3) Diabetics 40-75 with LDL 70-189
- If ASCVD <7.5 give moderate
- If ASCVD >7.5 give high intensity |
|
|
Term
| What are the diagnostic criteria for DM? |
|
Definition
1) Fasting > 126
2) >200 after 7g Load
3) Random >200
4) A1C > 6.5% |
|
|
Term
| What are the management goals for diabetics in terms of LDL, A1C and BP? |
|
Definition
| LDL <100, A1C <7%, BP <140/90 |
|
|
Term
| What diabetes medications cause hypoglycemia? What medication avoids this? |
|
Definition
Metformin is 1st line because of decreased risk: Decreases gluconeogenesis in liver.
SFU in particular are high risk. These drugs stimulate insulin release in pancreas. |
|
|
Term
What are the important side effects of the following diabetes drugs? Who should avoid their use?
1) Metformin
2) SFU
3) TZDs/Glitazones |
|
Definition
1) GI (nausea and vomiting) and Life-threatening Lactic Acidosis.
- Avoid in renal failure, liver failure and heart failure.
2) Weight gain, Hypoglycemia, Poor response rate
- They are cheap and 2nd line indication with Insulin
3) Weight gain, edema
- Not in heart failure or liver disease |
|
|
Term
How do the following diabetes medications work?
1) Metformin
2) SFU
3) TZD
4) Acarbose
5) Pramlintide
6) GLP-1 Agonist (Exenatide) |
|
Definition
1) Decrease glucose production in liver
2) Stimulate insulin secretion from pancreas
3) Increase insulin sensitivity in adipose and muscle
4) Delay carb absorption in gut (good post-prandial)
5) Amylase-like, inhibiting glucagon secretion
6) Stimulates insulin release (early satiety) |
|
|
Term
What are the maternal and fetal risks of gestational diabetes?
When should women be screened? |
|
Definition
1) Maternal: DKA, UTI, Pre-ecclampsia
2) Fetal: RDS, Macrosomia, Hypoglycemia, Hydramnios
3) at 24-28 weeks, get 50g 1h test. If >135, get 3h 100mg test
- Management goal is glucose < 105 |
|
|
Term
A patient comes in with chest pain you suspect is cardiac.
Describe your initial steps |
|
Definition
Get IV axis and Telemetry
1) MONA (morphine, oxygen, nitroglycerine, aspirin)
2) Order EKG/CXR/CBC/CMP/PT/INR
3) Start beta blocker, GPIIb/IIIa inhibitor, Ace-I, heparin |
|
|
Term
| How do you manage an acute CHF exacerbation? |
|
Definition
1) O2 with non rebreather and Telemetry bed
2) Pulse ox and IV access
3) Give Furosemide
4) Give Nitro (if normotensive) |
|
|
Term
| Describe the principles of outpatient management of CHF |
|
Definition
1) Sodium and Fluid Restriction
2) Avoid NSAIDs
3) High-dose ACE-I/ARB is first line
- Not in pregnancy, renal failure, hyperkalemia, hypotension
4) Beta Blockers (only AFTER exacerbation)
5) Diuretics (loops)
6) Stage III/IV, Spironolactone/Eplenerone
**Hydralazine + Nitrates in AA** |
|
|
Term
| Who should get an ICD in CHF? |
|
Definition
If EF <35% and >1 year life expectancy, placement of ICD is indicated.
If medical management failed, first try cardiac resynchronization before ICD. |
|
|
Term
What is the appropriate prophylaxis treatment for the following headaches?
1) Tension
2) Migraine
3) Cluster |
|
Definition
1) Amitriptyline (TCA)
2) Verapamil
3) Amitriptyline (TCA) or Beta blocker (Propranolol) |
|
|
Term
What is the general management of Acute Bronchitis?
When is a CXR reasonable? |
|
Definition
1) Cough suppressant, Bronchodilator, Analgesic
2) If fever, lasting >3w or smoker |
|
|
Term
| Why is Allergic Rhinitis treatment sometimes dangerous in elderly? |
|
Definition
| Antihistamine Decongestants can cause addiction in young, elderly and pregnant |
|
|
Term
| What are the Centor Criteria for strep test? |
|
Definition
2-3 get test. >4 treat
1) Absence of cough
2) Tender LNA
3) Exudate
4) Age <15
5) Fever
6) Age >44 lose a point |
|
|
Term
| How is strep throat treated? |
|
Definition
| PCN V for 10d. If Pen-allergic, use Erythromycin |
|
|
Term
What is the treatment of COPD by stage?
1) Stage 1
2) Stage 2
3) Stage 3
4) Stage 4
5) Exacerbation |
|
Definition
1) Inhaled SA bronchodilator
2) (FEV1 50-80%). LA bronchodilator
3) FEV1 30-50%. Inhaled CS
4) FEV1 <30%. O2 (PaO2 <55 or SaO2 <88%)
5) Antibiotics, Systemic CS (40 for 10-14d), Albuterol/Ipratroprium |
|
|
Term
| What is the general therapeutic workup for Dyspepsia? |
|
Definition
1) Danger signs (bleeding, weight loss, suspected perf): UGI
2) Otherwise, PPI for 8w, then UGI if fails |
|
|
Term
What are the causes of PUD?
How is it diagnosed?
How is it managed? |
|
Definition
1) NSAIDS and H. pylori
2) Stop NSAIDS and perform antibody testing for H. pylori (also Nitrogen breath test). Gold standard is biopsy
3) If H. pylori positive, Triple therapy (Clarithromycin, Omeprazole, Amox/MTZ. Confirm eradication with stool antigen
If UGIB, get CBC q6h, LFTs, amylase/lipase, EKG, CXR |
|
|
Term
| Describe the workup of a patient with diarrhea. |
|
Definition
1) Red flags (blood, systemic symptoms, fever, dehydration, N/V), then get fecal WBC
- If positive, send culture and consider C. dif
- If negative, treat symptomatically
2) For ABX, use FQ for C. jejuni and Shigella (NOT EHEC). Use Cipro for ETEC. In children or pregnant women, use Macrolide |
|
|
Term
What is the workup for constipation?
How is it usually treated? |
|
Definition
1) TSH, calcium, CBC (if CRC suspected), electrolytes
2) Increase PE, fiber, fluids
- Try bulk laxatives over osmotic |
|
|
Term
| What is the treatment of diarrhea in IBS. What about constipation? |
|
Definition
1) Diarrhea: Diphenoxylate, Loperamide
2) Constipation: Colace, Psylium
Remember, 3d per month for 3 month and improvement with defecation |
|
|
Term
| How do you manage an immediate and delayed reaction to an insect sting? |
|
Definition
1) Immediate ICE and anti-histamine
2) Delayed (24-48h later) give oral steroid and tetanus PPX
**For spider spite, think MRSA and give Bactrim or Clindamycin** |
|
|
Term
| What do you do about a cat bite |
|
Definition
P. multicoda! Give Augmentin for 10-14d
Eikenella is common in human |
|
|
Term
| What are the major stages of alcohol withdrawal in the first 72h? |
|
Definition
a. <12h: insomnia, tremulousness, anxiety, GI upset
b. 12-24h: Visual, auditory, tactile hallucinations
c. 24-48h: Seizures
d. 48-72h: DT |
|
|
Term
What are the common causes of CKD?
What is the normal workup?
How do you treat? |
|
Definition
1) DM, HTN, Glomerulonephritis, Drugs (NSAIDs, Aminoglycosides, Radiocontrast)
2) Order CMP, microscopic evaluation or urine and renal US
3) Protein restriction, Statins, ACE-i/ARB.
- Then add thiazide or CCB (not beta bicker)
- If GFR <25-30, add phos binder
- Can treat anemia with EPO |
|
|
Term
| What are the 5 major things to worry abut in a child who presents with nausea and vomiting? How can you differentiate? |
|
Definition
1) Intussusception: Get AXR to rule out perf, then do enema
- BIlious vomiting
- Currant jelly stool
- Colicky abdominal pain and sausage-like mass
2) Volvulus/Malrotation
- Before 1 month of age
- Bilious vomiting and constant abdominal pain
- If HDS, get UGI series, otherwise go to OR
3) Hypertrophic Pyloric Stenosis
- Non Bilious, projectile vomiting in 1 month old.
- Get Ultrasound and UGI
4) Foreign Body
- Will pass except batter or flat disk
5) Ingestion |
|
|
Term
| When should live vaccines be avoided in HIV? |
|
Definition
| CD4<200, no live vaccines in patient or close contacts |
|
|
Term
How can you assess stroke risk?
What type of stroke is defined by each of the following?
1) LE>UE, cognitive and personality changes
2) Contralateral hemiparesis, spatial neglect, impaired conjugate gaze
3) Nystagmus, dysarthria, dysphagia, loss in all 4 extremities
4) Ipsilateral gait and limb ataxia |
|
Definition
ABCD2 (Age, Blood Pressure, clinical features, duration, diabetes)
1) ACA
2) MCA
3) VB system
4) Cerebellum |
|
|
Term
| How should contacts of an HAV positive patient be managed? |
|
Definition
IgG or Vaccine.
IgG if immunocompromised, adults >40 or chronic liver disease |
|
|
Term
What is the management for each of the following types of Vaginitis?
1) Thin discharge with fishy odor on KOH prep
2) Green, frothy malodorous discharge
3) Cottage-cheese, without odor and with pruritus |
|
Definition
1) TV. MTZ 2g 1 dose patient and partner
2) BV. MTZ oral or topical. No treat partner
3) Candida. Vaginal cream or oral Fluconazole and treat partner. |
|
|
Term
What is your differential for pediatric limp?
What is the management for each condition? |
|
Definition
1) Congenital Aplasia
- Xray and Splint
2) Slipped Capital FE: overweight adolescent
- Xray (risk of avascular necrosis)
- Surgical pinning of femoral head
3) Legg-Calve-Perthes: Avascular necrosis of femoral head
- Gradual onset hip, thigh pain an limping
- Conservative treatment
4) Infection
- Tap joint. >50k WBC and ESR>20 think infection. <10k WBC think Transient Synovitis
5) Growing pain: only at night.
- Watch and wait |
|
|
Term
| What is the differential for Wheezing/Stridor in a child? How is each treated |
|
Definition
1) Foreign Body
- Heimlich if >1
- In Hospital, bronchoscopy
2) Croup (Parainfluenza virus)
- Steeple sign on X-ray.
- Severity by resting stridor and retractions
- Steroids and Nebulized Epinephrine
3) Epiglottis
- Hot potato voice, drooling, dysphagia, sniffing position
- Thumb sign on X-ray
- Antibiotics and airway management
4) PTA
- Get CT neck
- I and D and Antibiotics (Unasyn or Clinda for 14d)
5) RSV Bronchiolitis
- If Sat <90%, need humidified air
- Conservative |
|
|
Term
| How is CA PNA treated outpatient? Inpatient? |
|
Definition
1) Outpatient: Macrolide or Doxycycline.
- If DM, heart or lung disease, use FQ or combination of beta lactam and macrolide
2) Inpatient: IV Beta lactam (Unasyn or Ceftriaxone) + Macrolide. Alternative is IV FQ |
|
|
Term
| How is hospital acquired PNA treated? |
|
Definition
Remember, Legionella has hyponatremia, diarrhea and elevated LFTs.
Need Anti-Pseudomonas (Zosyn, Imipenem, Cefepime) and FQ and/or amino glycoside. For MRSA, add Vanco |
|
|
Term
|
Definition
Confusion, BUN>19, RR>30, BP (90/60), Age 65
Do you need hospitalization for PNA? |
|
|
Term
| What are the indication for Pneumococcal vaccine? |
|
Definition
1) >65, get PCV-13 followed by PPSV-23 (6-12m later)
- Repeat after 5 y if Asplenic or Immunocompromised
2) If got PPSV-23 before 65, repeat sequence of 13-23 after
3) If got 23 after 65, just add 13 12 months later
4) If underlying condition <65, give PPSV-23 |
|
|
Term
| What are language red flags for ASD workup at 12, 16 and 24 months of age? |
|
Definition
Screen at 18 and 24m
1) No babbling or pointing by 12m
2) No single words by 16m
3) No 2-word phrases by 2y |
|
|
Term
| How is Tourette's Treated? |
|
Definition
1) Neuroleptics: Pimozide and Haloperidol
2) Clonidine
3) Botox for phonic tics |
|
|
Term
| What is Tetrabenazine used for? |
|
Definition
| Dopamine-depleting agent used for chorea in Huntington's |
|
|
Term
| How is an Asthma exacerbation handled inpatient? |
|
Definition
| Albuterol and Oral CS. No ABx needed. Oxygen as well |
|
|
Term
Name each of the following types of Lower Back Pain and describe your management.
1) Leg pain with back extension. Worse with standing and walking.
2) Saddle anesthesia, urinary incontinence
3) No pain distal to knee. Developed after bending
4) Leg pain with straight leg raise. Better lying down. Worse with cough
5) Acute pain in elderly patient with Osteoporosis without leg radiation |
|
Definition
1) Spinal Stenosis
- Epidural Steroid injections. If fails surgery
2) Cauda Equina
- Emergent MRI and Steroids. Then to OR
3) Lumbosacral Strain. Early Use
4) Disc Herniation
- No imaging
- Steroids, anti-inflattory meds, PT (10% will need surgery)
5) Vertebral compression fracture
- Order plain film TL radiographs
- Bracing, analgesics, Sometimes Kyphoplasty. |
|
|
Term
Patient presents with unilateral neck pain with radiation down right arm.
What is the next step? |
|
Definition
Sounds like Cervical Radiculopathy (usually 2/2 Spondylosis or Disc herniation)
Cervical Myelopathy also possible, if spinal cord compression took place. There is usually early gait disturbance, with loss of hand dexterity and bowel/bladder dysfunction later in the disease
Get an MRI |
|
|
Term
What drugs predispose patients to develop Gout?
What is the basic workup? |
|
Definition
Thiazides, Chemotherapy agents and Loop Diuretics can all lead to Hyperuricemia.
Aspirate joint: MSU crystals. Needle shaped with negative birefringence on polarizing microscopy. 20-60k WBC, but <100k.
Tx: NSAID/Colcicine acute. Probenicid, Allopurinol chronic |
|
|
Term
What are the important risk factors for Infectious Arthritis?
How do you diagnose and treat? |
|
Definition
1) DM, Alcoholism, Malignancy, HIV, steroids, IVDU
2) Joint Aspiration with >100K WBC, ESR >20 >90% PMNs
3) Tx: IV antibiotics and surgical drainage |
|
|
Term
What is the most common cause of shoulder pain that is worse with abduction?
What is the workup? |
|
Definition
Supraspinatous tendinitis-Impingement Syndrome.
If weakness with abduction, r/o SITS tear with MRI.
Tx: Steroid injections and PT. Surgery also ultimately effective. |
|
|
Term
| How do you manage lateral and medial epicondylitis? |
|
Definition
1) Lateral
- Splint forearm and PT
2) Medial
- Splint forearm |
|
|
Term
| Describe the workup and treatment for a patient with radial wrist pain that is worse with pinch grabbing |
|
Definition
Sounds like De Quervain Disease, which effects abductor pollicis longus tendon
Dx: Finkelstein test
Tx: Thumb spica spilint and NSAIDs |
|
|
Term
| What is the differential for hand numbness? |
|
Definition
1) Carpel tunnel
2) Cervical radiculopathy
3) Peripheral neuropathy (DM) |
|
|
Term
| How is carpel tunnel treated? |
|
Definition
- Wrist splints at night
- NSAIDS
- Local steroid injections
- Surgical release |
|
|
Term
| What are the first-line treatments for Osteoarthritis? |
|
Definition
1) Weight loss
2) PT
3) Acetaminophen
2nd line is NSAIDs, and Steroid Injections |
|
|
Term
| What are the RF for Osteoporosis? How is it managed? |
|
Definition
1) Age, Estrogen depletion, Light weight, Gender, Calcium/D deficiency, Endocrine, Smoking, Meds
2) Weight bearing exercise, Vitamin D, Calcium, Smoking cessation
- Bisphosphonates (1st, look out for esophagitis)
- SERMS, HRT, PTH or Calcitonin also options. |
|
|
Term
What is the pathophysiology of Glaucoma?
How is it treated for open and closed angles? |
|
Definition
1) Optic nerve damage from increased IOP
2) Open-angle: topical beta blocker first. Then add alpha agonist, CA inhibitor and/or PGE analogue.
3) Closed: Refer, lower IOP with timolol, brimonidine, dorzolamine, pilocarpine, and prednisone. Laser/surgery is definitive. |
|
|
Term
| How would you handle a dendritoform ocular ulcer? |
|
Definition
Think HSV Keratitis
Refer semi-urgently to Optho and give topical anti-viral drops. |
|
|
Term
| What are the primary causes of bacterial conjunctivitis? |
|
Definition
1) Staph Aureus usually (topical antibiotics)
2) N. Gonorrhea if hyperacute (give 1g IM ceftriaxone)
3) Chlamydial trachoma
- Give tetracycline and treat partner |
|
|
Term
| What medications should be avoided in venous insufficiency? |
|
Definition
|
|
Term
| What are 5 causes of LE edema? |
|
Definition
1) Venous insufficiency
2) DVT
3) OSA
4) Meds
5) Lymphedema
6) CHF |
|
|
Term
What are the diagnostic criterion for OSA?
How is it treated? |
|
Definition
Nocturnal Polysomnography
- AHI or RDI >15
- >5 with other symptoms
2) Weight loss, exercise, alcohol avoidance, CPAP |
|
|
Term
What are the risk factors for Erectile Dysfunction.
Who should you be especially careful treating? |
|
Definition
1) HTN, Smoking, Hyperlipidemia, DM
2) Viagra should not be given to someone on Nitrates
- Increases cGMP, which leads to release of NO and relaxation of smooth muscle |
|
|
Term
| What are the major neuropsychiatric complications of Alcoholism? How can they be prevented? |
|
Definition
1) Wernicke Encephalopathy (Reversible)
- Thiamine deficiency leads to nystagmus, ataxia, opthalmoplegia, confusion
2) Korsakoff Psychosis: Amnestic, Confabulation
3) Give Thiamine. Treat Alcoholism with AA, Naltrexone (decrease craving) and Acamprosate (if liver disease and can't take Naltrexone) |
|
|
Term
| What agent can help alcoholics who have liver disease? |
|
Definition
| Can't use Naltrexone. Try Acamprosate |
|
|
Term
| How should be screened for HTN? |
|
Definition
| Everyone > 18 at 2 y intervals (1 year if pre-hypertensive) |
|
|
Term
| What are the important things to address at the first pre-natal visit? |
|
Definition
1) LMP
- EDD= subtract 3 months from LMP and add 7 days
2) Labs: CBC, HBsAg, HIV, RPR, Urinalysis, Urine Culture. Rubella, Blood type, Rh status antibody screen, Pap smear, cervical swab for STI.
3) FU every 4 weeks until 28, then 2 weeks until 36w, then 1w |
|
|
Term
| When and how is Trisomy screening performed? |
|
Definition
1st trimester: NT and serum makers hCG and PAPP-A (10-13 weeks)
2nd trimester: Triple screen (b-hCG, estriol, AFP) or quad screen (b-hCG, estriol, AFP and inhibit A) (16-18w)
IF concerning screen, get CVS (10-13w) or Amniocentesis (16-18w) |
|
|
Term
| What pre-natal testing should be carried out at 28w gestation? |
|
Definition
1) Gestational Diabetes Screening
2) H/H and RPR if at risk
3) RHOGAM for known Rh-negative woman. |
|
|
Term
| How should be given Progestin at 36-37 weeks gestation? |
|
Definition
| History of premature birth |
|
|
Term
| Which vaccines should pregnant women receive? Which should be avoided? |
|
Definition
Tdap at 27-36 weeks regardless of prior status
Do not give MMR, Varicella, Influenza (live). Give Rubella after birth if needed. |
|
|
Term
| What is the definitive treatment for Graves disease? How does the management change in Pregnancy? |
|
Definition
1) Iodine ablation
2) Methimazole nor Iodine can be used (also to in breastfeeding mothers or children)
- Use PTU instead (watch our for hepatotoxicity) |
|
|
Term
| How can Thyroiditis, Toxic Adenoma and Graves be distinguished on an iodine uptake scan? |
|
Definition
Thyroiditis is patchy
Adenoma is focal
Graves is diffuse |
|
|
Term
| What is the workup for a thyroid nodule? |
|
Definition
1) Start with US and TSH
2) If >1cm with normal or elevated TSH, get FNA |
|
|
Term
| What are the tell tale signs of labor? How are they confirmed? |
|
Definition
1) Rupture of membranes
- pH >6.5 with Nitrazine paper
- Positive for Ferning
2) Baseline fHR 140
3) Contractions every 3m |
|
|
Term
| What are the major stages of labor and how are they characterized? |
|
Definition
Stage 1: Latent and then Active after 4cm
- Onset of labor to completely dilated cervix
- Should be dilating 1.2-1.5cm per hour with strong, regular contractions
2) Second: Complete dilation (10cm) to birth of child (1-2h)
3) Third: Birth of child to afterbirth (30m) |
|
|
Term
| What are the normal baseline fHR and variability values? |
|
Definition
1) fHR between 110-160
2) Short (6/25 bpm) and long term (3-5 cycles per min)
3) Accelerations of at least 15 bpm for >15s |
|
|
Term
| What are the 3 types of fetal heart rate decelerations and what do they indicate? |
|
Definition
1) Early: fetal head compression by increased vaginal tone (not worriesome)
2) Late: UP insufficiency (hypotension, impaired placental circulation, abruption)
3) Variable: Umbilical chord compression during contractions (common in PROM) |
|
|
Term
| What is a category 1 FHT. What about category 2 and 3? |
|
Definition
Category 1:
- Normal baseline (110-160)
- Moderate variability
- No late or variable decelerations
- +/- early decelerations
Category 2: Intermediate
Category 3:
- Absent baseline FHR variability with late decelerations
- Absent baseline FHR variability with variable decelerations
- Absent baseline FHR variability with bradycardia
- Sinusoidal pattern |
|
|
Term
| What are the 4 cardinal movements of birth? |
|
Definition
1) Flexion
2) Internal Rotation
3) Extension
4) Rotation |
|
|
Term
| What are the major maternal and fetal benefits of breatfeeding |
|
Definition
1) Maternal: Uterine tone, weight loss, reduced incidence of ovarian and breast cancer, contraceptive (progestin-only)
2) Fetal: Nutrition, immunity, reduced GI illness |
|
|
Term
| What are the contraindications to breast feeding? |
|
Definition
1) HIV
2) TB
3) Acute HBV
4) Herpetic breast lesion
5) Chemo
6) Substance abuse |
|
|
Term
| How should contraception be managed in the early postpartum period? |
|
Definition
Progestin-only in breastfeeding or Dep shot (starting after 6w)
Lactation-induced amenorrhea is 99% effective up to 6 months.
Menstruation usually begins 3 months after birth or later if breast feeding. |
|
|
Term
| What are the 4 risk factors for post-partum hemorrhage and how is it managed? |
|
Definition
Tone (atony), Trauma, Tissue (retained), Thrombin.
Atony is most common and is treated with Bimanual compression and Ptosin administration |
|
|
Term
| What is the most common concern in post-partum fever? |
|
Definition
Endometritis: give broad-spectrum Abx (ampicillin + gentamycin)
UTI, mastitis, and wound infection is also a concern. |
|
|
Term
| What are the functional ADLs? |
|
Definition
| Bathing, Continence, Dressing, Eating, Transferring, Toiletting, Grooming |
|
|
Term
| Which vaccinations should be maintained as part of adolescent health maintenance? |
|
Definition
1) Td booster at 11-12, then every 10 years after (first should be Tdap).
2) MMR booster if not received at 4-6.
3) MCV at 11-12 or before high school. Booster at age 16. |
|
|
Term
| When should an IUD not be used? |
|
Definition
Current STD or recent PID
- Bleeding (especially copper) and risk of cancer |
|
|
Term
| What are the important side effects of the Depo Provera shot? When is it highly appropriate? |
|
Definition
SE: Irregular menses, weight gain, Depression, Osteoporosis, Uterine bleeding, Breast cancer, Liver tumors.
2) Breast feeding, Dysmenorrhea, Ovarian Cysts, Endometriosis |
|
|
Term
| What are the major indications for use of a combined oral contraceptive? |
|
Definition
1) Dysmenorrhea
2) Iron deficiency anemia
3) Ovarian cysts
4) Endometriosis
5) Fibrocystic breast disease, 6) ovarian/endometrial cancer. |
|
|
Term
| Who should not be placed on combined oral contraceptives? |
|
Definition
- Not in smokers >35 (MI and stroke)
- HTN, CAD
- Impaired liver function
- Breast cancer
- Migraines with aura, |
|
|
Term
| What are the primary options for post-coital contraception? |
|
Definition
1) Levonorgestrel (Plan B) or Mifepristone (RU 486)
- Give within 72h (ideally 12)
- Can also place copper IUD within 5d |
|
|
Term
What are the important signs of each of the following causes of geriatric anemia?
1) Iron
2) B12
3) Folate
4) ACD |
|
Definition
1) Koilonychia, Glossitis, Dysphagia
2) Elevated MMA, Neurological
3) Elevated Homocystine
4) Normal ferritin, but low iron and TIBC |
|
|
Term
| What is the first thing to check in the workup of Hypercalcemia? |
|
Definition
Correct for albumin
[0.8 x (Normal albumin) – (Patient albumin)] + (Serum calcium) |
|
|
Term
What is the differential for Hypercalcemia?
What is your first step? |
|
Definition
Hyperparathyroidism, Cancer, Immobility, Meds
1) Get PTH
2) If normal/low, think primary hyperparathyroidism (Adenoma)
- Rule out FHH with 24h urine calcium
3) If high think about renal failure |
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Term
| What is the workup for Hyponatremia? |
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Definition
1)Hypovolemic:
- look at Urine Na. If low, think GI. If high, think renal failure
- Fluid replacement with NS, unless severe (<125) then use 3% hypertonic.
- Correct slowly to avoid CPM
2)Euvolemic: SIADH or psychiatric
- Fluid restriction
3)Hypervolemic: nephrotic, CHF, liver failure
- Diuretics, salt/water restriction |
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Term
| What is the workup for Hypernatremia? |
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Definition
Check urine osmolality
- High (>400 mOsm), then body is conserving water and water loss is due to hypotonic fluid loss (GI, sweating, etc)
- Low (<300 mOsM), DI (central or nephrogenic) |
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Term
| What are the EKG changes associated with Hypokalemia? |
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Definition
| ST depression, flattened T waves, prominent U waves. |
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Term
| What are the major causes of Hyperkalemia? |
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Definition
| ACE-I, Thiazides, ARBs, Acidosis, Insulin deficiency, Renal failure, RTA |
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Term
| How should you start the treatment of a patient with newly established MDD? |
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Definition
| SSRI Trial of 4-6w. Once in remission, 4-9 months needs to be continued. |
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Term
What are the major side effects of the following drugs?
1) Citalopram
2) Mirtazapine
3) Clomipramine
4) Buproprion
5) Trazadone
6) Duloxetine |
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Definition
1) An SSRI (like Fluoxetine, Paroxetine)
- Sexual, Weight Gain, GI, insomnia
2) An SNRI
- Similar to SSRI, but particularly good in Insomnia and Anorexia
3) TCA like Amatriptyline, Doxepin etc.
- Anti-muscarinic, Histamine blockage, Adrenergic
4) Atypical: good for smoking and mood
- Risk is seizure, dry mouth
5) Atypical
- Risk is priapism
6) SNRI
- Like SSRI |
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Term
| What is the major concern of drugs like Phenelzine, Tranylcypromise and Selegeline? |
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Definition
MAOIs require tyramine restriction because of chance of crisis
They also interact with SRI and Meperidine |
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Term
| What are the first tests you order in a patient with suspected Dimentia? |
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Definition
| TSH, CBC, B12/Folate, CMP, Brain Imaging |
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Term
| What drugs are used to treat Alzehimer's dimentia and what are their side effects? |
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Definition
1) Donepezil (mild to moderate)
- N/V/D/HA
2) Galantamine (mild to moderate)
- Arrhythmia, Bradycardia, Urinary obstruction
3) Rivastigmine
4) Memantine (NDMA antagonist) |
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Term
What type of dimentia is described by each of the following?
1) Sudden onset, step-wise progression
2) Cognitive without motor deficits
3) Vivid hallucinations, cognitive fluctuations, extrapyramidal signs, postural instability
4) Personality changes (anti-social or disinhibited) and stereotyped behaviors? |
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Definition
Always rule out NP hydrocephalus, Metabolic and chronic subdural hematoma
1) Vascular
2) Alzheimer
3) Lewy Body
4) FTD |
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Term
| What are the five major anxiety disorders? |
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Definition
Panic, OCD, GAD, PTSD, Phobia
PPPOG |
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Term
| Describe the management of a patient with a newly diagnosed manic episode of >1w |
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Definition
Bipolar
- Lithium, Valproate, Carbamazepine.
- Anti-deperessents NOT used because they can precipitate mania. |
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Term
Fever and Rash Match.
1) 3d followed by maculopapular rash starting on trunk and spreading to extremeties
2) Rash in clusters followed by malaise, fever and anorrexia with papules/vesicles at various stages.
3) Slapped cheek rash
4) 2d fever followed by sore throat and rash (sandpaper) starting on upper trunk and then spreading to rest of trunk and extremeties |
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Definition
1) Roseola (HHV-6): Supportive
2) Varicella: Confirm with Tzank or PCR
- Acyclovir will shorten if given within 24h and child > 2y old
3) Erythema Infectiousum (Parvovirus B19)
- Fifths disease
- Look out for aplastic crisis
- Pregnancy can lead to fetal hydrops and loss
4) GAS Rheumatic Fever
- PCN or Cephalosporin/macrolide if allergic
- Return to school after 24h afebrile |
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Term
Abdominal pain followed by macular, papular or petechial eruption beginning on wrists and ankles and spreading centrally and to palms and soles.
Next step? |
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Definition
RMSF
- Low WBC, Low platelets, Hyponatremia and elevated LFTs
- Confirm by serology (not necessary)
- Treat EMPIRICALLY with doxycycline until 3d without fever |
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Term
High fevers, AMS and non-blanching rash
What is it and how to you treat patient and contacts? |
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Definition
N. Meningitides
- Start antibiotics before LP
- <30d give ampicillin + gentamycin
- Adults n eed vancomycin + ceftriaxone
- CONTACTS: PPX with Cipro or Rifampin |
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Term
| What is the importance of grapefruit juice and st. john's wort in drug reactions? |
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Definition
CYPs inhibited by Grapefruit Juice, which interacts with statins/anti-arrhythmics/immunousppressents/CCBs
CYPs induced by St. John’s Wort (lower effectiveness of OCPs) |
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