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54 Cards in this Set
- Front
- Back
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Three main preventive care services
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1) immunization and chemoprophylaxis
2) screening for early disease detection 3) health education and counseling |
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Who needs an influenza shot
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1) adults 50 and older
2) pts with chronic medical conditions 3) nursing home residents 4) women in 2nd or 3rd trimester 5) household contacts or caregivers of high-risk individuals |
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Adult vaccines
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PPV: once to adults > 65, younger pts with chronic dz or asplenia
HepB: anyone under 18 not previously immunized, high risk pts Zoster: single dose for adults > 60 |
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Buckman's protocol for breaking bad news (SPIKES)
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SET up the interview.
assess the pt's PERCEPTION obtain the pt's INVITATION Give KNOWLEDGE to the pt address EMOTIONS with empathy STRATEGIZE and SUMMARIZE |
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Opioid analgesiscs
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Dose interval: q 3-4 h EXCEPT Methadone q 6-8 h, Meperidine q 2-3 h.
Oral or Parenteral: morphine, meperidine (seizure risk), methadone, fentanyl N/A parenteral: oxycodone, codeine, hydrocodone. |
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Vomiting in Palliative Care
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4 NTs mediate vomiting in the medulla: serotonin, dopamine, histamine, ACh.
Dx: evaluate GI, CNS, pharmacologic, metabolic and psychological causes. Firstline Rx: Prokinetic agent (METOCLOPRAMIDE) Other Rx: Antihistamines (meclizine, hydroxyzine), dopamine antagonists (prochlorperazine, promethazine, haloperidol, ondansetron) |
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Stimulant laxatives
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prune juice
docusate bisacodyl |
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Osmotic laxatives
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milk of magnesia
lactulose magnesium citrate |
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detergent laxatives
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(stool softeners)
docusate sodium docusate calcium |
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prokinetic laxative
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metoclopramide (Reglan)
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DDx: Chest Pain
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Panic DO
GERD, other GI (#2) Acute Coronary Syndromes (ACS) Stable Angina Musculoskeletal pain (#1) MVP Pleural and Pulmonary Pain Psychosocial pain (thoracic aorta dissection, vertebral or rib metastases, enlarged mediastinal nodes from lymphoma, sarcoidosis, collagen vascular disease) |
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2 step evaluation of chest pain
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1) rapid evaluation for ACS: onset/character of pain, prior hx, ECG: ST elevation or depression in 2 consecutive leads, Q waves in at least 2 leads, T wave hyperacuity.
2) Complete evaluation once ACS has been ruled out (or in and Rx started) |
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Chest pain from pericarditis
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worse when recumbent, relieved by sitting forward, diffuse ECG changes
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ACS prediction
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angina pectoris is best predictor of CAD
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anti-platelet therapy
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Suspect ACS: 325 mg aspirin immediately, then daily indefinitely.
The most effective medical intervention for prevention of death/MI in ACS patients |
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Causes of hypothyroidism
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1) congenital
2) autoimmune (Hashimotos thyroiditis) 3) surgical removal 4) drugs: amiodarone, lithium 5) transient pospartum |
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Causes of hyperthyroidism (thyrotoxicosis)
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1) Graves' dz
2) toxic nodular goiter/ hyperfunctioning nodules 3) thyroiditis (transient leakage of hormone following viral illness or postpartum) 4) excess iodine ingestion (diet, amiodarone, etc) |
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Thyroid nodules
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Most common: colloid nodule
Cysts and thyroiditis are also common The remaining 20% are: benign follicular adenomas, cancer (papillary carcinoma, follicular, medullary, anaplastic, lymphoma) |
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Red flags that a thyroid nodule might be cancer
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family hx
rapid growth firm or hard nodule nodule fixed to adjacent structures vocal cord paralysis regional LAD |
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Clinical prediction of GAS pharyngitis
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1 point each:
-fever -absence of cough -tender anterior cervical LAD -tonsillar swelling or exudates -age less than 15 years 4-5 points: 51% chance of strep 3 points: 35% chance of strep 2 points: 17% chance of strep |
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Clinical signs of EBV pharyngitis (vs. strep pharyngitis)
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-fatigue
-posterior cervical LAD -inguinal LAD -palatal petechiae -splenomegaly |
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Gallbladder dz
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-recurrent, episodic RUQ or epigastric pain, may radiate to scapular area
-transabdominal ultrasound -Murphy sign: hold breath 2* to RUQ palpation -cholescintigram for detecting acute cholecystitis (inflammation 2* to cystic duct obstruction) -acute cholangitis: obstruction of common bile duct by stones |
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Charcot's triad for acute cholangitis
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pain
fever jaundice |
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Acute Pancreatitis
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-often caused by alcohol (50%) or gallstones (30%)
-upper abdominal pain, often radiates to the back -anorexia, nausea, vomiting, fever, decreased bowel sounds -serum lipase, abdominal CT for dx |
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Manning criteria for IBS
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-pain relief with bowl action
-more frequent stools with onset of pain -looser stools with onset of pain -passage of mucus -sensation of incomplete evacuation -abdominal distention presence of fewer than 2 rules out IBS |
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Red flags for patients with elevated LFTs
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-abdominal pain
-elevated other markers of liver fx -hematemesis -rectal bleeding -Signs of advanced liver failure: spider angiomas, lower ext edema, CHF, hepatojugular reflex |
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HBV laboratory markers
(HBsAg, anti-HBs, anti-HBc IgM or IgG, HBeAg, anti-HBe) |
-HBsAg: acute or chronic infection
-anti-HBs: marker of immunity -anti-HBc IgM: infection in previous 6 mo -anti-HBc IgG: more distant HBV infection (cleared or persistent) -HBeAg: high level of viral replication (marker of infectivity) -anti-HBe: low rate of viral replication |
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Hepatic encephalopathy
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thought to be a result of nitrogenous waste buildup.
Rx: oral lactulose, antibiotics against nitrogen-producing bacteria |
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Behcet's Dz
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Vasculitis
Painful apthous ulcers, plus: -genital sores -skin problems (rashes, acne-like sores, nodules) -joint problems, often at knee -uveitis |
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Lichen Planus
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Flat-topped, violaceous, pruritic, shiny papules on skin of wrists, eyelids, shins, can occur in mouth.
Tx: corticosteroids Cause: unknown |
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Rosacea
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D/o of sebacious glands
-bulbous appearance of nose -butterfly rash -papules, pustules, telangiectasia, flushing -blepharitis -worsened by alcohol Rx: Metrogel, PO dox/mino or accutane for severe cases |
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Perioral dermatitis
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D/o of sebacious glands
-spares vermillion border Rx: Metrogel, PO dox/mino |
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molluscum contagiosum
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-poxvirus
-discrete pearly papules -central umbilication -spread with scratching -common in HIV pts |
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Herpes zoster
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-reactivation of varicella
-vesicles on an erythematous base -if affects ciliary branch of trigeminal nerve, may involve eye and cause blindness. -complication: post-herpetic neuralgia |
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Measles (rubeola)
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-paramyxovirus
-prodrome: cough, coryza, conjunctivitis plus fever -koplik spots (white on erythematous base) on buccal mucosa -rash: head, spreads down |
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rubella (german measles)
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-togavirus
-suboccipital LAD -rash begins on face, spreads -dangerous to fetus |
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hand, foot and mouth dz
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-coxsackie A
-vesicular rash on hands and feet -ulcerations in mouth |
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roseola infantum
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-herpes virus (HHV-6)
-abrupt very high fever 1-5 days without malaise or other signs -rash appears after fever is gone -rash mainly on neck and trunk |
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erythema infectiosum
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-fifth disease
-parvovirus b-19 -slapped cheeks -maculopapular rash: extremities, spreads to trunk (reticular) |
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cutaneous larva migrans
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-hookworm
-erythematous, pruritic, serpiginous thread-like lesion marks burrow of migrating nematode larvae -back, hands, feet, buttocks |
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basal cell carcinoma
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-pearly edged
-telangiectasia -ulcerated center -almost never metastasizes |
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squamous cell carcinoma
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-actinic keratosis precursor
-erythematous nodules on sun-exposed areas -nodules ulcerate and crust -may metastasize |
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pityriasis alba
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-common hypopigmentation in children and young adults
-arms and face Tx: steroids or antifungal often regresses with time |
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lentigo
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-liver spot
-pigmented macule -doesn't darken with sun exposure |
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Impetigo
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-honey crusted lesions
-vesicular or bullous -s. aureus, strep pyogenes Rx: 1st gen cephalosporin, nafcillin |
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Scheuermann's dz
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Common cause of kyphosis in children.
Tx: brace, PT. May need sx if >60 degrees deformity |
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Common etiologies of back pain (children, adult, elderly)
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Children:
-discitis -spondylolysis -sprain/strain -herniated disc -scheuermann's dz Adult -strain/spasm -herniated disc -spondylolysis -discitis Elderly -osteoarthritis |
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Rotator cuff muscles
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supraspinatous
infraspinatous teres minor subscapularis |
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Systems that contribute to stability (prevent dizziness)
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vision
peripheral vestibular and auditory proprioception (extremities and spine) cerebral cortex vestibular nuclei brainstem cerebellum |
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Categories of dizziness
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-Vertigo (central or peripheral vestibular systems, migraine, panic d/o)
-Presyncope (low bp, low co, anemia) -Disequilibrium (often multi-factorial; neuromuscular probs, proprioceptive d/o, visual impairment, cns dz) -Nonspecific |
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vestibular neuronitis (acute labyrinthitis)
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-acute vertigo that is prolonged and severe.
-may have imbalance, nystagmus, nausea -possible viral etiology -lasts days to weeks Tx: methylprednisone. -Other meds sometimes used: metoclopramide, diazepam, mg sulfate, gabapentin. -also used: vestibular electrical stimulation (VES) or transcutaneous electrical nerve stimulation (TENS) |
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Meniere's dz
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-repeated vertigo attacks lasting hrs to days
-occur over many yrs -low frequency unilateral tinnitus, hearing loss -endolymphatic htn (hydrops) -low salt diet + hydrochlorothiazide/triamterene (Dyazide) |
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Diabetic autonomic neuropathy
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-includes cardiac autonomic neuropathy
-irregular hr -resting tachycardia -exercise intolerance -orthostatic hypotension -silent myocardial ischemia |
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Causes of disequilibrium
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-proprioceptive and somatosensory loss
-post-stroke residual deficits -medication adverse effects (classically: aminoglycosides) -cerebellar degeneration (chronic alcoholism, Friedrich's ataxia) -Parkinson's dz |
