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184 Cards in this Set
- Front
- Back
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When do you treat BP with one drug?
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>140 SBP or >90 DBP
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When do you treat BP with two drugs?
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> 160 SBP or > 100 DBP
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BP goal for T2DM
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<130/80
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Lifestyle modifications for HTN management
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Body weight <20% greater than ideal
<2400 mg Na daily EtOH < 2 oz daily |
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Define: "HTN emergency"
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BP >180/120 with signs of end-organ damage (e.g. stroke, papilledema, etc)
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First-line antihypertensives for most patients
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Diuretic
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First-line antihypertensives for CAD patients
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Vasodilating β-blockers (e.g. carvedilol, nebivolol)
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First-line antihypertensives for CHF patients
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ACE/ARB
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First-line antihypertensives in diabetics
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ACE/ARB
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First-line antihypertensives in CKD patients
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ACE/ARB
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First-line antihypertensives for patients with isolated systolic HTN
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Ca2+ channel blockers
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Diuretic toxicities
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Hypokalemia
Hyperuricemia Hyperglycemia Hyperlipidemia Hyponatremia |
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Ca2+ channel blocker toxicities
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Headache
Flushing Edema Constipation |
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Lipid screening protocol
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Every 5 years for "average risk" patients, beginning by 35 for men and 40 for women
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LDL goal: low risk (0-1 risk factors)
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<160
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LDL goal: mild-to-moderate risk (2 or more risk factors)
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<130
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LDL goal: high risk (CAD, DM, stroke)
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<100 (<70 optional)
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Normal TG levels
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<150
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Bordeline TG levels
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150-199
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High TG levels
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200-499
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Very high TG levels
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>500
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Metabolic Syndrome: The 5 Features
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Hyperglycemia (>110 fasting)
Abdominal obesity (M>40, W>35) HTN (>130/85) Low HDL (M<40, W<50) Hypertriglyceridemia (>150) |
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Frequency of fasting lipid testing in patients treated for dyslipidemia
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Annually
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Mammogram guidlines
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Annually starting at 40
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Pap guidelines
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At least every 3 years until 65
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DEXA guidelines
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Women at 65
High risk women at 60 |
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What is length bias?
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Screening tends to identify only those tumors that are slow-growing and have, on average, a better prognosis (thus it appears that screening improves outcomes)
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Three cancers for which screening is justified
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Breast, colon, and cervical
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Diabetes screening guidelines
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All adults >45 every 3 years
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HIV screening guidelines
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All persons 13-64
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Who should NOT receive the live influenza vaccine?
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Pregnant women and those with chronic diseases (e.g. diabetes)
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Pneumovax guidelines
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All adults 65+ and adults with other risk factors (diabetes, asthma, cirrhosis, asplenia)
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If you get a pneumovax before 65 years...
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...you should get a single booster 5 years later
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Tdap guidelines
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Booster every 10 years
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HPV vaccine guidlines
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All people (females AND males) 9 to 26
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Zoster vaccine guidlines
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All adults 60+
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Peritoneal signs
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Tenderness, guarding, rebound
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MCC of acute abdominal pain in patients > 50 years
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Biliary disease
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Dx: acute abdominal pain in a woman with multiple sexual partners
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PID
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Most common diagnoses in patients with acute abdominal pain
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Appendicitis, biliary disease, or nonspecific abdominal pain
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Imaging in acute abdominal pain
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Chest and abdominal plain films to rule out obstruction/perforation or extraabdominal processes that present with abdominal pain (e.g. pneumothorax, aortic dissection)
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Classic relieving position for someone with pancreatitis
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Leaning forward
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Dx: jaundice + intense epigastric pain radiating to the back
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Gallstone pancreatitis
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Ideal imaging modality for cholelithiasis
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US
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MCC of acute abdominal pain in patients < 50 years
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Appendicitis
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Ideal imaging modality for acute appendicitis
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Contract-enhanced abdominopelvic CT
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RLQ pain with very early nausea and vomiting: appendicitis?
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Early-onset nausea/vomiting should put the diagnosis of appendicitis into question
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Dx: diffuse abdominal pain with hyperactive bowel sounds and distention
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Obstruction
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Dx: diffuse abdominal pain with hyperactive bowel sounds and distention
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Small bowel obstruction
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Dx: dilation of cecum and R hemicolon without mechanical obstruction
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Ogilvie syndrome
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MCCs of Ogilvie syndrome
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Trauma, infection, and cardiac disease (e.g. MI, CHF)
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MCCs: mechanical colonic obstruction
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Tumors and sigmoid volvulus
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Dx: acute LLQ pain with rigidity and a palpable mass
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Diverticulitis with abscess formation
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Things to never miss in a woman with lower abdominal pain
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Ectopic pregnancy
PID Endometriosis Ruptured ovarian cyst |
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MCC of small bowel ischemia
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Arterial embolism
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Three MCCs of diffuse abdominal pain
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Ischemic bowel
Acute peritonitis Small bowel obstruction |
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MCC: colonic ischemia
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Hypoperfusion 2/2 hypotension, peripheral vascular disease, etc.
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MC location: pancreatic adenocarcinoma
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Pancreatic head
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Six ACE side effects
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Cough
Angioedema Hyperkalemia Rash Dysgeusia Leukopenia |
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Define PFT "bronchodilator response"
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>12% increase AND 200+ mL increase in FEV1
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Diagnostic cut-off for asthma with a methacholine challenge
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20%+ decrease in at least two flow parameters
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FEV1/FVC ratio: obstructive lung disease
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<70%
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FEV1/FVC ratio: restrictive lung disease
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>75%
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How do you differentiate between parenchymal and extraparenchymal obstructive lung disease?
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DLCO (low in parenchymal)
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How do you differentiate between intrathoracic and extrathoracic restrictive lung disease?
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DLCO (low in intrathoracic)
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MCC: acute cough
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Viral URI
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Classic URI viruses
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Coronavirus
Adenovirus Rhinovirus |
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Classic symptoms: viral rhinosinusitis
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Rhinorrhea, sneezing, nasal congestion, post-nasal drainage
+/- fever, HA, sore throat |
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Clinical diagnostic criteria: influenza
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T > 37.7 plus one of the following: cough, rhinorrhea, or pharyngitis
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Classic presentation: influenza
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Sudden onset fever and malaise
Followed by cough, HA, myalgias, and nasal/pulmoary symptoms |
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Two MCCs of hemoptysis in ambulatory patients
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1. infection
2. malignancy |
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Define: "upper airway cough syndrome"
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Post-nasal drip
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Tx: upper airway cough syndrome
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First-gen. antihistamines
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Which three conditions constitute 90% of chronic cough cases in non-smokers not currently taking an ACE?
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GERD
UACS Asthma |
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When should asymptomatic bateriuria be treated?
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Prengancy, after catheter removal, neutropenia, and prior to invasive urologic surgery
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One diagnostic test you MUST do in suspected pyelonephrtitis
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Blood cultures for hematogenous sources
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Tx: uncomplicated cystitis in a non-pregnant young woman
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TMP-SMX for 3 days
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Tx: complicated cystitis
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Urine culture + 7-14 days fluoroquinolone
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First-line tx: pyelonephritis
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Fluoroquinolones
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Management: patient with persistent fever and flank pain despite appropriate abx tx
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CT to evaluate for perinephric abscess
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Tx: acute prostatitis
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4-6 weeks of a fluoroquinolone or extended-spectrum cephalosporin +/- aminoglycoside
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Tx: women with recurrent uncomplicated UTIs
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Consider daily nitrofurantoin or TMP-SMX
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Management of acute uncomplicated bacterial bronchitis
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Conservative, no antibiotics unless B. pertussis
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Evidence for vit. C, echinaceae in URIs
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None.
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% of pharyngitis cases due to GABHS
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5-15%
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MCC: acute pharyngitis
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Viral
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Four components of the Centor score
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1. Fever
2. Absent cough 3. Tonsilar exudates 4. Tender anterior cervical lymphadenopathy |
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At what Centor score is a rapid strep test indicated?
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2
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Treatment of choice: GABHS pharyngitis
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Penicillin v
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MC bacteria: otitis media
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S. pneumonia
H. influenza M. catarrhalis |
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Tx: otitis media
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Amoxicilin OR macrolide if allergic for 10-14 days
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If Centor score of 4, then...
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Empiric penicillin V
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MC bacterial causes of sinusitis
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S. pneumonia
H. influenza M. catarrhalis |
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Classic symptoms: viral URI
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Cough ,mild fever, rhinorrhea, and sore throat that develops over 1-3 days
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Differentiating nonspecific viraul URI from influenza
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Flu: very rapid-onset with very high fever 39+ C and diffuse myalgias
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Abx for acute URI?
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Never, even with purulent sputum or nasal discharge
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Which symptom is definitively NOT a feature of the sinusitis syndrome?
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Cough
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Dx: fatigue, malaise, myalgias followed by sore throat, adenopathy, fever, HSM
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EBV
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MCC of death 2/2 infectious disease
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Community-acquired pneumonia
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MC route in innoculation: community-acquired pneumonia
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Pathogens descend from the oropharynx to the lower respiratory tract
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CURB-65 criteria
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1. Confusion
2. Urea > 19.6 3. Respirations > 30 4. BP < 90 systolic/<60 diastolic 5. >65 years of age |
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CURB-65 critera: when to admit
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2 or more
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CURB-65 critera: when to admit to ICU
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3+
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Interpretation of mediastinal or hilar lypmhadenopathy on CXR
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Fungal or mycobacterial pneumonia
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Treatment: uncomplicated outpatient community-acquired pneumonia
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Macrolide (azithromycin) or doxycycline
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Treatement: CAP in a patient with comorbid chronic disease (e.,g. diabetes, COPD)
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Fluoroquinolone
OR Beta lactam + macrolide |
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Diagnostic criteria: diabetes
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Fasting glucose >125
Random glucose >200 with symptoms HbA1C > 6.4% |
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Side-effects: thiazolidinediones
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Edema
Weight gain |
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Contraindication: metformin
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CKD
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Side-effects: sulfonylureas
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Hypoglycemia
Weight gain |
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Side-effects: metformin
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GI upset
Low B12 |
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Blood pressure cut-off: diabetes screening
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No screening for patients with BP <135/80
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Initial screening tests to be done after a diagnosis of diabetes is made
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Fasting lipids
Electrolytes Renal function EKG Microalbuminuria |
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First-line diabetes management during pregnancy
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Insulin
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Which therapy is initiated once microalbuminuria can be demonstrated?
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ACE/ARB
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Heart disease prophylaxis in diabetics
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ASA 81 mg
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A1C testing in diabetics: how often?
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Every 3-6 months
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How often: microalbuminuria screening in a diabetic
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Annually
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How often: fasting lipid panel in diabetics
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Annually
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What percentage of caloric intake should come from fats?
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25-35%
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Upper limit of recommended daily cholesterol intake
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200 mg
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Dx: elevated creatinine with ACE/ARB
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Renal artery stenosis
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3 MC tumors for mets to bone
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Prostate
Lung Breast |
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MCC: low back pain
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Non-specific musculoskeletal pain
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Dx: low back pain worsened by Valsalva, defecation, or cough
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Lumbosarcal disk herniation
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MC sites of disc herniation
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>95% at L4/L5 and L5/S1
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Classic description: spinal stenosis
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Significant bilateral leg pain worsened by standing and relieved by lying down
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What not to miss: rapidly-progressing, bilateral neurologic deficits
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Spinal compression
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Things not to miss: low back pain that wakes the patient from sleep
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Metastasis
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Which factor is most important in predicting the course of low back pain?
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Psychosocial stress
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Findings suggestive of psychosocial factors exacerbating lower back pain
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1. Nondermatomal distribution
2. Pain with passive rotation 3. Pain with axial loading |
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OA: symmetric or asymmetric?
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Symmetric
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RA: symmetric or asymmetric?
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Symmetric
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All patients with acute monoarticular arthritis require...
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Joint aspiration with Gram stain, culture, and crystal analysis
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The 3 major extraarticular manifestations of RA
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1. Pulmonary (pleuritis, interstitial lung disease)
2. Cardiac (pericarditis) 3. Ocular (scleritis) |
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Arthritis 1-4 weeks after non-specific GI/GU infection
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Reactive arthritis
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MC site of joint infection
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Knee
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MCC of knee pain in patients < 45 years
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Patellofemoral pain syndrome
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Classic presentation: patellofemoral pain syndrome
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Peripatellar pain exacerbated by overuse e.g. running, going down stairs, or sitting
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Classic presentation: iliotibial band syndrome
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Knife-like lateral knee pain with vigorous knee use e.g. running
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Classic findings: meniscal tears
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Pain with locking and clicking
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MC mechanism of shoulder pain
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Impingement between coracoacromial tendon and humeral head
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Two MCC of shoulder pain
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Subacromial bursitis
Rotator cuff tendonitis |
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What percentage of joint infections are monoarticular?
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80%
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Risk factors: septic arthritis
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Preexisting arthritis
Joint prostheses IV drug use Alcoholism Diabetes Immune compromise |
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Antibiotic prophylaxis in patients with prostheses undergoing procedure?
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Never.
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Cell count and differential: bacterial septic arthritis
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>50k
90% PMN |
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Cell count and differential: mycobacterial or funcal septic arthritis
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10-30k
50% PMN |
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MCC: septic arthritis
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Staph and Strep
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Dx: migratory arthralgias + tenosynovitis + dermatitis
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Gonococcal arthritis
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Tx: pseudomonal arthritis
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Ceftazidime + gentamicin
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Length of tx for most cases of bacterial septic arthritis
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4 weeks
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Reactive arthritis triad
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Urethritis/cervicitis
Conjunctivitis Arthritis |
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Hyperuricemia: under-excretion or over-production?
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90% under-excretion
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Dx: morning stiffness with crepitus and bony enlargement
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OA
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Dx: tenderness to palpation below and anteromedial to the knee joint
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Anserine bursitis
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Classic distribution: RA
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Symmetric hands, wrists, feet
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Classic spinal segment involved in RA
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Cervical spine
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Classic CBC findings in RA
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Normocytic anemia
Thrombocytosis |
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Composition: rheumatoid nodules
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Cholesterol crystals
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MCC of death in RA
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CAD
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Hallmark feature of the spondyloarthropathies
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Enthesitis
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Two diagnoses: "sausage digits"
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Psoriatic arthritis
Reactive arthritis |
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Pattern of arthritis in the spondyloarthropathies
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Asymmetric, oligoarticular of large joints in lower extremities
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MC extraarticular manifestation of the spondyloarthropathies
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Inflammatory eye disease (conjunctivitis, uveitis, keratitis)
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Classic pulmonary involvement in the spondyloarthropathies
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Apical interstitial fibrosis
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Classic distinguishing factor: RA vs. psoriatic arthritis
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DIP involvement in psoriatic arthritis
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1st-line tx: ankylosing spondylitis
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TNF-a inhibitors
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"SOAP BRAIN MD" mnemonic
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Serositis
Oral ulcers Arthritis Photosensitive rash Blood dyscrasias Renal disease ANA Immunologic disease Neurologic disease Malar rash Discoid rash |
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Diagnosis: SLE
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4/11 "BRAIN SOAP MD" findings
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Common blood dyscrasias in SLE
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Leukopenia
Lymphopenia Thrombocytopenia Anemia |
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Immunologic findings in SLE
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Anti-dsDNA Abs
Anti-Smith Abs Antiphospholipid Abs |
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Reasonable initial therapy for SLE
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Hydroxychloroquine
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Labs: dermato- and polymyositis
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2x elevation of CK, aldolase, AST
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Two key depression screening questions
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Within the past 2 weeks, have you...
...felt down, depressed, or hopeless? ...felt little pleasure or interest in doing things? |
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"SIG E CAPS" mnemonic
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Sleep changes
Interest level changes Guilt Energy changes Cognitive changes Appetite changes Psychomotor symptoms Suicidal ideation |
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Ten years after smoking cessation, lung cancer risk declines by...
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...30-50%
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Abuse vs. dependence
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Abuse: use that results in personal or legal problems
Dependence: physiologic addiction and maladaptive behavior |
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CAGE questionnaire for problem drinking
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- Have you ever felt that you should CUT back?
- Have others ANNOYED you by criticizing your drinking? -Have you ever felt bad or GUILTY about drinking? -Have you EVER taken a drink first thing in the morning? |
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"Positive" score on the CAGE questionnaire
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2+
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Classic laboratory findings in alcoholism
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Elevated AST/ALT
Macrocytic anemia |
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Components of the Mini Cog
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Remember three words after drawing a clock
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Features of chest pain that make ACS unlikely
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Positional, reproducible, and stabbing/sharp pain
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EKG: pericarditis
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Diffuse ST-segment elevation with PR depression
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