Occurs subsequent to a thrombus that has erupted from an atherosclerotic lesion mainly from the carotid bifurcation. Results in a sudden transient loss of monocular vision that can lead to retinal ischemia
Chronic cough: SMOKING, POST NASAL DRIP, GERD, ASNTHMA, ACEi
If constipation: order which labs?
HOW is obstruction ruled OUT?
Constipation: then must order: 1. TSH, Ca2+, CBC, electrolytes 2. IF suggestive by H&P = abdominal films and flexible sigmoidoscopy 3. Fecal examination = FISSURES, hemorrhoids, fecal impaction, masses
IG antibodies or paraproteins produced by meloma cells collect in the gllomerluli causeing renal failure or MYEOLOMA KIDNEY.
Patients with MM are at increase risk for infection 2/2 total decrease in function AB and leukopenia 2/2 bone marrow croading with malignant plasma cells. PARAPTOTEIN gap is a common finding in patients with MM. PARAPAROTEINS made by meyloma plasma cells contribute to the total serum protein count but not to the albumen concentration. So while normally there is a 3-4 gap betweeen total and albumin, the gap is HUGE in pateints with MM.
Acute infectious diarrhea: S AUREUS
ABD pain, n/v, diarrhea
No fever, no WBV occurs within 24 hours and stops exposed persons ill between 1-6 hours
What treatments are useful in PREVENTING OA?
1. Decreased alcohol and smoking 2. ERT for pero-postmenopausal women (look at hip, wrist, vertebral compression fracture. Elevated bone density by 2-3% 3. RALOXIFENE - selective ER modulater that acts as an estrogen AGONIST in some tissue and ANTAGONIST in others (BREAST/endometrial)
OF ALL TYPES OF HEADACHE TYPES, WHICH ARE BEST TREATED PROPHYLACTICALLY AND WITH WHICH AGENTS?
Cluster headaches: 1. Use verapamil (CCB) po #1 2. Ergotamine 3. Methylsergide 4. Lithium 5. Corticosteroids
How is sinusitis diagnosed
Diagnosis: >8 day nasal congestion; purulent discharge/drainage from one of the turbintates; transillumination of maxillary sinuses; palpation of sinuses; imaging studies no indicated if ca-illness
Complications: mucocele, polyp; osteomyelitis of frontal bonest/maxilla, cavernos sinus thrombosos
How does narcolepsy differ from cataplexy?
What is the treatment?
Narcolepsy - variable penetrance of REM sleep, regulation resulting in excessive sleep during day with attacks that are involuntary and lasts several minutes
Cataplexy - loss of muscle tone that occurs with intense emotional stimulus (laruger/anger)
Lifestype changes that can be made in patients with preHTN, stage I and stage II HTN?
1. Dec Na+ intake from 4g sodium/day to 3g sodium/day 2. Wt loss/central obesity *HLD/HTN/HM/INSULIN R (Metabolic syndrome) 3. Dec alcohol consumption because OH = pressor and thus acts like vasopressin to increase BP 4. Exercise 5. Decrease SAT FAT 6. Dec unecessary medications 7. Decrease stress
If pateint with ACUTE diarrhea with NO complications - treatment? If patient with ACUTE diarrhea with complications - labs? -IF POSITIVE - treatment: -IF NEGATIVE - treatment:
If acute diarrhea and no complications - hydration, loperamide (OPIOD that rx diarrhea)
If acute diarrhea and complications - 1. Order CBC - look for anemia look at WBC elevation. 2. Stool sample for WBC increase -Positive: stool culture and consider CDIFF IF + = treat diff with Metronidazole IF - = sigmoidoscopy with BIOPSY -Negative: Symptomatic Rx
Essential hypertension v. secondary HTN
(1) Essential: non-identifiable cause but applies to > 95% of HTN cases (2) Secondary: Identifiable cause 1. RAS 2. Endocrine crisis/causes 3. Medications 4. Coartation of the aorta 5. Cocaine 6. Sleep Apnea
What is the most common cause of "red" eye?
Conjunctivitis = most common cause due to inflammation of the transparent membrane that lines the inside of the eyes and globe (bulbar)
Acute bacterial infections: C PERFERINGENS
Diarrhea, crampy abd pain
negative fever, no WBC in fecal matter, lasts a few days
begins within 24 horus - good for treatment with of or for ingestions (CLINDAMYCIN, METRONIDAZOLE)
What are hemorrhoids? Two primary types?
Varicose veins of the anus and the rectum: 1. Internal-dilated submucosal veins of superior rectal plexus above the dentate line thus insenate area that is PAINLESS. 2. External-dilated veins from inferior plexus; distal to dendate line this in sensate area and PAINFUL
Treatment: SITZ bath, ice packs, bed rest, steroids (topical), rubberband ligation if internal or surgical removal
Who should receive:
1. Influenza vaccination 2. Pneumococcal vaccination: 3. Hep B 4. Tetanus
1. Adults > 50YO; Adults < 50YO with chronic Dz; HCW; pregnant women (2nd/3rd trimesters)
2. >65YO, SCA, adult chronic dz (first dose then 2nd dose in 5 years)
3. Everyone - primary (1 mo, 1-2 months, 6-12 months old); secondary is the boosters of 10 years.
What is the most common cause of visual imparitment in developed countries?
Acute purulent medications - actual treatment medication for SINUSITIS
1. INitially - nasal spray AIDS drainage acoid smoke and environmental pollutants 2. Decongestants = pseduoephedrine/oxymetazol that facilitates drainages (use < 3days) 3. Antibiotics = amoxicillin, amoxiillin-clavulonic acid (augmentin), TMP-SMX (bactrum, levofluox, moxiflox, cefuroxime) 4. Antihistamines - use for patients with allergies "drying effect" -loratidine/fexofenadine; chlophiramine
How is HTN diagnosed
Must be at least 2 readigns over a span of 4 or more weeks
NEUROMUSCULAR DISORDERS ASSOCIATED WITH CONSTIPATION
Parkinson's (BG)- treatment is to increase DA Multiple sclerosis - treatment is to use IFN-B CNS lesions - determine cause scleroderma - AntiSSA/SSB DM - autonomic neuropathy (also resulting in electrical dysfunction)
What is the proper method by which to physically examine the knee?
1. Look for distortions or contusions with abnormal bony prominences 2. Determine if EFFUSION present 3. Assess Mcmurray and apley tests for meniscal innjury 4. Determine ROM 5. Look at LCL/MCL 6. Assess ACL by Lachmans or anterior drawer 7. Joint line tenderness 8. Pateller grind test
When is a CBC ordered in patients with a cough? PFT? Bronchoscopy?
CBC with a cough when INFECTION is suspected PFT with a cough when ASTHMA is suspected BRONCH is a last resort if suspect a tumor, foreign body, or tracheal web
What associated conditions are seen with CARPEL TUNNEL SYNDROME?
Hypothyroidism DM Repetitive use of hands in certain professions Activities Pregnancy/Trauma to wrist Acromegaly**
When is a CXR ordered in patients with cough?
Only when pulmonary cases is suspected! -when hemoptysis expected, when chronic cough, when longterm COPD/lung CA
Tennis elbow versus Golfers elbow
Tennis elbow: lateral epicondylitis at elbow -inflammation of extensor tendons of the forearm orginating from lateral epicondyle resulting from supination and pronation -initial treatment: splinting forearm, physical therapy -last resort: SURGERY
Golfers elbow: distal to medial epicondyle -inflammation of the flexor tendons that is exacerbated by wrist flexion
Treatment of VIRAL conjunctivitis
-cold compress -strict handwashing -topical AB if suspect superinfection by a bacterial organism
Complications of HTN on the 1. Heart 2. Eyes 3. CNS 4. Kidney
1. Heart: htn is a mjor risk factor for CAD with angina and MI; CHF if no treatment of HTN because can lead to LVH; deaths due to MI or CHF; PVD; aortic dissection = HTN without atherosclerosis 2. Eyes: cotton wool spots, papilledema, AV nicking (loss of central vein d/t increased arterial wall thickening) 3. CNS: increased intracerebral hemorrhages; elevated stroke subtypes (TIA, ischemic stroke, lacunar stroke, HTN encephalopathy) 4. Kidney: Arteriolosclerosis of AFF or EFF arterioles and glomerulus called nephrosclerosis; dec GFR; dysfunction of tubules with renal failure
ETEC v. EHEC O157:H7
ETEC: (HL, HS) -watery diarrhea, nausea, abd pain -NO fever -NO WBC -<FEW days -"self limiting" thus hydration
Most common symptoms: 1. BRIGHT RED BLOOD PER RECTUM WITH RECTAL PROLAPSE -IF PAINFUL? -IF PAINLESS?
External hemorrhoids Internal hemorrhoids
RED FLAG SIGNS/SYMPTOMS OF LOWER BACK PAIN
1. Saddle anesthesia 2. Major motor loss 3. Immunosuppression 4. Hx of CA 5. Bowel/Bladder incontinence 6, Night time pain 7. UNINTENTIONAL WEIGHT LOSS, FEVER
Most common cause of sensorineural hearing loss?
Presbycusis - gradual hearing loss secondary to age 1. Degeneration of sensory cells and nerve fibers at the base of the choclea 2. Marked with HIGH frequency hearing loss - then progresses to eventual low frequency hearing loss
Most common cause of secondary HTN in females?
Treatment of constipation:
1. DIET + BEHAVIORAL CHANGE: increase exercise, diet, fluid and fiber 2. Use enema (fleet) for temporary relief in patients with relieve from conservative therapy. 3. Surgery is obstruction
What is a Baker's cyst?
Intra-articular pathological cause that mimics DVT or thrombophlebitis
-seen in OA and RA -treatment is actively mofifying diet and will resolve spontaneously
Treatment for chlamydial conjunctivitis
1. Adults and adolescents - ORAL TETRACYCLINE, DOXY, ERYTHRO for 14 days 2. Treat sexual partners for STD too
Tegaserod maleate (ZELNORM) is a _____ agonist used to treat IBS and _____ in females
Serotonin IBS + constipation
Acute diarrhea secondary to SALMONELLA
Abdominal pain diarrhea, bloody stool n/v
fever, WBC, feval, resolves within one week , symptoms start 2-3 days post ingestion. Only treatment if immunocompromises or if enteric fever
Causes of ACUTE DIARRHEA 1. Infections : ____>_______>_______ 2. Medications: _______>_______ 3. Malabsorption: 4. Ischemic bowel in patients with _______.
1. Viral > Bacterial (severe) > Parasite 2. Antibiotics associated diarrhea due to c. difficle toxin in 25% cases; -AB>LAXATIVES>PROKINETICS (Cisapride), ANTACIDS, DIGITIALIS, COLCHICINE, ALCOHOL, MG containing, chemo treatment 2. Lactose intolerance; chrohns disease; celiac disease; CF patients 4. PVD
What is the most common transitional route of common cold v. s. aureus?
Hand-to-hand with the common cold Nares with S. Aureus
Most common causes of acute diarrhea in < 4 weeks?
Most severe causes of acute diarrhea due to?
VIRAL infections: ROTAVIRUS, NORAWALK VIRUS
BACTERIAL infections: SHIGELLA, E. COLI, SALMONELLA, C. JEJUNI, C. PERFERINGENS, C. DIFFICILE
When are nasal steroids used for ACUTE sinusitis?
1. Fluticonasone 2. Beclomethasone
Use if sinusitis is seconary to allergic rhinitis (corticosteroid nasal spray to decrease inflammation
Degenerative disc diseases: how does lumbar spinal stenosis differ?
Osteoarthritis: chronic low back pain, disk space narrowing, osteophytes causing nerve rootcompression and radiculopathy
LSS: narrowing of the spinal canal that can be aquired OR congenital with increased PAIN on activity and relieved by REST and SPINAL flexion because will increase the size of the canal
Majority of complications of OSA
1. Elevated PVR due to hypoxemia which can lead to pulmonary HTN and eventually COR pulmonale
2. Systemic HTN due to increase in sympathetic tone
Acute sinusitis v. Chronic sinusitis
Acute: nasal stuffiness, discharge, cough, sinus pain/pressure (worsens with percussion and leaning forward), 50% with fever
Chronic: nasal stuffiness, postnasal drip, pain/headache, 2-3 months, history of multiple sinus infection and at risk for infection with s auresu and gram - rods.
1. Breast CA - self examination versus mammogram
2. Cervial CA:
Self examination: Monthly self exam for all females greater than 20YO Physicians exam: every 3 years until 40YO then every year > 40YO
Mammogram: every 1-2 years in females >/= 40YO; every year females >/= 50YO
Cervical CA: PAPsmear: within 1st three years of sex OR 21 YO -if two consecutive years are (-) for cervical CA, then repeat every 3 years byt age 35, and repeat every 5 years by age 65
What is the most commonly injured ligament of ankle sprains:
Classification: Diagnosis: Treatment:
ATFL - anterior talofibular ligament
Class I: partial rupture Class II: complete rupture of ATFL and partial rupture of CFL Class III: complete rupture of BOTH ATFL and CFL Diagnostics: Pt walks 4 steps at the time of injury; NO BONY tenderness over distal 6cm then do NOT order a xray.
Treatment: RICE and PT
Most definitive treatment for cataracts:
What is secondary sight?
SURGICAL REMOVAL IS BEST FOR CATARACTS - MOST DEFINITIVE WITH IMPLANTATION OF AN ARTIFICIAL INTRAOCULAR LENS
BECOME INCREASINGLY NEASIGHTED AND NO LONGER NEED READING GLASSES BECAUSE THE CATACT INCREASES REFRACTICE POWER OF THE LENS.
What are the two most common causes of nausea/vomiting?
1. Food poisoning (s. aureus, cdiff) 2. Viral gastroenteritis
Most common cause of acute bacterial diarrhea esp in children
C. Jejuni (comma shaped and oxidase positive)
Headache, bloody stool, fatigue followed by diarrhea and abd pain, + fever, +WBC fecally, < 1 week
Treatment: ERYTHROMYCIN (macrolide)
How often should a patient with BARRETTS esophagus be screened for ADENOCARCINOMA
Every 3 years - an EGD should be performed with BIOPSY to note DYSPLASTIC changes
How does HTN affect the heart?
1. Decreases SVR (thus increases afterload - rx with antibiotics) 2. Elevated LVH (concentric) 3. Decreased LV function 4. This results in dilation of the L ventricle and has signs/symptoms of heart failure
What normally causes laryngitis?
Symptoms: VIRAL in origin - if bacterial = 1. Morexella catarrhalis or 2. H. Influenza Diagnosis: Hoarseness, cough (other URI), self limiting, rest voice until laryngitis resolves to avoid formation of vocal NODULES
Most common spinal tumor causing lower back pain, night pain?
1. Decongestants = initial therapy (1-2 weeks) 2. XRAY films and penicillinase -R > 2 weeks then AB are appropriate 3. Consider ENT consult - because of anatomic difficulties - acute sinusitis takes a lont time to treat.
-no fever; if present, suggests bacterial complication -rhinorrhea, sore throat, malaise, nonproduction cough, nasal congestion -common to have fever in children
Adequate hydration -looses secretions and prevents airway OBS -elevate FLUID intake and inhaling steam -rest and analgesics (ASA/COX3; COXi) -Cough suppressants and nasal spray/first generation antiH
Treatment of GERD
Phase I Phase II Phase III Phase IV Phase V Phase VI
Phase I (initial) - behavioral modification (decrease caffiene, -OH, chocolate, coffee, fatty foods, OJ; sleep with upper body elevated, dec smoking
Phase II (add) - a H2 blockers (cimetidine/ranitidine) + behavioral modification Phase III (switch) - to a PPI like omeprazole Phase IV (add) - add promotility agent + PPI -metoclopromide (DA blocker); bethanechol (ACh agonist) increases GI motility Phase V: COMBO = H2B +promotility or PPI + promotility Phase Vi: Surgery if cases are severe
Lumbar disc herniation
nucleus palposus extrudes through the annulus fibrosis and impingment of nerve root occurs causing RADICULOPATHY @ L4-L5, L5-S1
Screening for HTN = Screening for HLD =
ALL adults > 18YO and older/middle age
Healthy adults >/= 20 YO - nonfasting Totalc and HDL -look every 5 years -if total C < 200 mg/dL and HDL > 35 mg/dL then repeat in 5 years -if total C > 240 mg/dL and or risk factors with 200-240 mg/dL then get completr lipoprotein profile
"common cold" or acute rhinosinusitis
#1 URI (children>adults) - ADV, RSV 1. Primarily viral (coronavirus and rhinovirus) 2. Susceptibilty depends on pre-existing AB levels
identification of rhino v. corona is no important -rhinovirus most common (~50%) with >100 antigenic serotypes so reinfection with another type is likely.
HTN medications that are safe in pregnant women?
SAFE: a-methyl dopa BB hydralazine
UNSAFE: ACEi and ARBS TZD (diuretics) CCB
What causes infectious conjunctivitis?
(1) VIRAL = MOST common form by adenovirus, recent URI with edema or eye that spreads to other eye. D/C watery. Treatment with STEROIDS.
(2) BACTERIAL = S. pneumonia ubt can be by gram (-) too. Irritation, hyperemia, tearing with spread to other eye in <2 days. EXUDATE AND CRUST positive. Treatment with BROAD SPECTRUM AB
(3) CHLAMYDIAL = (1) trachoma a, b, c - #1 WW due to conjunctival scarring (2) inclusion conjunctiva (D-K)
Supraspinatous (rotator cuff tendinitis)
most common cause of shoulder pain due to impingement of greater tuberosity on the acromion with pain with overhead movement
Treatment: steroid injections and/or surgery to treat the acromioplasty
What causes overflow incontinence?
1. neurogenic bladder (pts with DM with lower MN lesions) 2. medications (anti-cholinergics, alpha-agonists 3. obstruction to flow (BPH, prostate CA)
nocturnal wetting; loss of small amounts of urine but large post void (>100mL)
Least potent: fluvastatin < lovastatin < pravastatin < simvastatin < atorvastatin (lipitor): Most potent, most expensive
What is the treatment for laryngitis if VIRAL
Causa Equina Syndrome
MEDICAL EMERGENCY (Compression of roots S1, S2, S3, S4 after spinal trauma/central lumbosacral disc herniations)
1. Bilateral sciatica and motor loss 2. Saddle anesthesia 3. Urinary frequency or urinary retention 4. Lower back pain 5. Impotence (lax anal canal) - loss of bowel control
Treatment for erectile dysfunction
Treatment underlying causes and address atherosclerotic risk factors
-hormone replacement -SILDENAFIL CITRATE (viagra) - smooth muscle relaxation (30-60 min b4 sex) contraindicated in patients current taking nitrates because can result in severe hyPOtension and lead to syncopal episodes. -intracavernosal injections of vasoactive substances.
Episodic: 90% 2-3 mo duration remits mo-years Chronic: 10% 1-2 years without remission
How is GERD diagnosed:
NO diagnostic tests needed to initiate therapy for typical-uncomplicated cases of GERD
If complicated, atypical-uncomplicated cases of GERD 1. Perform endoscopy + BIOPSY (anemia, wt loss, dysphasia present) 2. Upper GI series (contrast barium) - only helpful in identification of ulcers/strictures. NOT DIAGNOSTIC OF GERD 3. 24 hour pH monitoring
When is imaging for the lower back pain performed?
If symptoms do not respond to NSAIDS and rest within one month or if neurological sign erupts.
Treatment: INTIALLY: NSAIDS, REST, and narcotics or muscle relax
If neuro += MRI, if compression --> spine specialist IF CHRONIC: PT, NSAIDS, EPIDURAL injectios as needed
What causes male v. female incontinence
Male = BPH, neurologic disease Female = hormonal, pelvic floor dysfunction/laxity, uninhibited bladder contraction due to aging
Familial type V hyperlipidemia
Elevated VLDL (APO B100) Elevated Chylo (ABO B48)
Which medications can result in hyperlipidemia?
1. GLucocorticoids (the "hump" of excessive fat with urine) 2. Estrogens (elevated adipose) 3. TZD diurattics (elevated LDL, Total Chol, VLDL) 4. Bblockers with elevated TG (VLDL) and Decreased HDL
If GERD is severe and unresponsive to treatment, which should be performed?
1. Antireflux surgery -intractibility -respiratory problems due to aspirates -esophageal injury (ulcer/hemorrhage/stricture/barretts)
A. Nissen fundoplication - done if normal esophageal motility B. Partial fundoplication - when esophageal motility poor
WHich antihistamines are used best in patienst with ACUTE SINUSITIS?
Drying effect of anti-histamines can sometimes make the secrtions thicker and can worsen congestion. IF this occurs, AVOID IT
Type IV hyperlipidemia
Elevated VLDL *endogenously)
Treatment with 1. Niacin 2. Gemfibrils 3. Statins
What is sciatica? What exacerbates this movement?
pain along sciatic nerve + positive neurological deficits
-exacerbated by forward flexion, sitting, driving, lifting, worsens leg pain
1. average risk patients (>50YO without prior GI issues) a. Fecal occult blood test every 1 YEAR + sigmoidoscopy 5 YEARS b. Fecal occult blood test every 1 YEAR + colonoscopy 10 YEARS 2. moderate risk patients (single polyp) a. If initial colonoscopy then repeat it in 3 YEARS b. if OK then go colonoscopy every 5 YEARS c. If family pos for CAC then do colonoscopy @ 40 YO or 10 years younger than youngest cause in family and repeat colonoscopy 3-5 years
3. high risk patients a. IF HNPCC = do test at 21YO -if positive do colonoscopy 2 years until 40 YO then do annually
Leg pain on back extension that worsens wth standig and walking but relief with standing and sitting?
For alcoholism = WERNICKE's encephalopathy and korsakoffs psychosis
If alcoholic - must first administer thriamine then glucose to ensure DT treatment.
Wernickes is REVERSIBLE - thiamine deficiency that manifests with nystagmus, ataxia, apthalmoplegia, and confusion.
Korsakoffs psychosis is irreversible and caused by thismine deficiency and ST memory loss with confabulations.
How is elevated HTN that causes/d organ damage diagnosed?
1. UA 2. CHemistry panel (serum K+, BUN, Cr) 3. Fasting glucose (if diabetic, check microalbuminemia) 4. Lipid panel (see if HDL and elevated LDL --> atherosclerosis) 5. ECG (can tell you Hx of MI or stable v. unstable angina and can not change in LV and CHF.
What is dyspepsia?
Epigastric symptoms that are inclusive of heartburn "indigestion", bloating, pain or discomfort
HIGHLY common confused with angina
Patients with "migraine headaches" for whom no medications work-likely diagnosis?
Rebound analgesic headaches. These occur more frequently
How is LDL calculated?
LDL = TotalC - HDL - (TG/5)
What is the most sensitive and specific test for GERD? THE GOLD STD:
24 hr pH monitoring in lower esophagus = most sensitive, gold standard, usually not necessary
36 YO patient presents to the clinic complaining of a pruritis eruption on his forearms. Denies fever, chills and maliase. PE shoes erythematous rash with occasional veiscles affecting both forearms. NO LAD is apprecirated. Vesicular fluid grows coagulase-negative staphlycocci. His only relevant history is recent owrk in the woods behind home chopping and transporting firewood. Which of the folowing is the most likely diagnosis?
HSV, S. aureus, S. Epidermidis, Supperative hidrasenitis, Contact dermatitis
Contact dermititis. Inflammatory skin condition caused by allergens like poison sumac, cosmetics and nickel. It presents days to weeks after exposure with an intensely pruritic erythematous rash with vesible at teh site of exposure. Secondary infection as a results of excessive scratching is possible and is suggested by pus filled vesicles that would hence test positive for a S. epidermidis infection. However this is generally an organism native to the skin that is generally non-pathogenic
1. HMG-CoA reductase: now chol form in liver 2. Binds to bile in the GI tract and doesnt allow for enterohepatic recirculation, reabsorption 3. Fibrates decreases in TH, BKing down into FFA by elevated LIPASE in ADIPOSE tissue
How might recurrent PNA results as a complication of GERD?
Due to recurrent pulmonary aspirations. Thus if aspirations on bronchoscopy reveal aspirates of gastric contents being lipid laden mceophages (by phagocytosis of fat) then DDX.
Most probable diagnosis instance where patient recalls a bending/twisting of back leading to "giving" way when lifting a heavy object:
What is OSTEOPOROSIS and how can they be differentiated against that of OA and RA?
1. Dec in BONE MASS causing an INC in bone fracture due to decrease in bone mineral density 2. FAILURE to attain optimal peak bone mass b4 30YO or it is due to increased rate of bone resorption >> that of formation after peak mass.
Primary: (I) post menopausal females 51-75YO = loss of trabecular bone; vertebral compression; colles fracture common. (II) female v. male >70YO = loss of cortical and trabecular bone
Pateint with RECURRENT INFECTIONs, PARAPROTEIN gap (total protein v. albumin level > 3-4 difference), and elevated CALCIUM, RENAL IMPAIRMENT, ANEMIA, and BONE PAIN should be readily thought to have?
What are the clinical features of SEVERE hyperlipidemia
1. Xanthomas - hard yellow masses on tendons, finger extensors achilles tendons, plantar tendons. 2. Xanthelasma - yellow plaques on eyelids 2. Pancreatitis if increase TG
What is the most common loss of vision in people > 65YO
ARMD - loss of central vision ebcause macula is affected ***scotoma, distortion, blurred vision with peripheral vision in tact.
Involuntary loss of urine in spurts only due to activities that increase intrabdominal pressure (cough, laugh, sneeze, exercise): ________
Kegel exercises ERT Use of pessary surgery
Endocrine causes of secondary HTN
1. Pheochromocytoma 2. Hyperaldosteronism 3. Thyroid, PTH disease 4. Cushings (elevated cortisol due to primary site of tumor, dec CRH, dec ACTH, inc cortisol...dec immunity, dec inflammation, inc neutrophil release, inc gluconeogenesis, elevated BP by BR 5. Acromegaly
Types of Migranes Headaches
1. Migrane with AURA (15%) = "Classic" -Bilateral homonymous scotoma -Bright, flashing, crescent images (10-20 minutes) 2. Migrane without AURA (80%) - "Common" 3. Menstrual Migrane -2 days before mensus d/t E2 withdrawal 4. Status migrainous > 72 hours of headache that resolves spontaneously
IF TG > 500 mg/dL, Rx: IF TG < 500 mg /dL, Rx:
1. Niacin (dec TG, dec VLDL, elevated HDL) 2. Fibrates (dec VLDL, dec TG, inc HDL)
-gynecomastia, gallstones, weight gain, myopathies can result
How is the causality of sore throat done? Orders?
1. Throat culture = 24 hours (more accurate than rapid strept test) 2. Rapid strept test = results within 1 hour doesnt indicate between any other bacterium other than strept or a virus (this IF negative only rules out GAS but doesnt indicate whether or not it is bacteria or viral 3. Mononucleosis (spot test) = obtain heterophil monospot test. If still suspect mono, but monospot negative think CMV (HHV5) and not EBV HHV4
How is carpel tunnel syndrome treated?
1. Wrist splints (VOLAR CARPEL) -worn at night during sleep to prevent wrist flex 2. NSAIDS 3. LOCAL corticosteroids injection 4. Surgical release -only if persistant and affects the DAILY life
1. Stool WBC: if absent-no need to order cultures because its unlikely to grow pathogenic organisms. If present, send stool for culture OR cdiff assay or treat empirically with AB 2. Stool sample for OVA and PARASITES (test 3 samples) 3. Stool sample for CDIFF CULTURE 4. Stool sample for CDIFF toxin assay (do if patient recently treatment with AB) 5. Stool for giardia antigen - ELISA assay 6. Stool culture - low sensitivity only examines for shigella, salmonella, campylobactor. If patient has severe diarrhea, req hospital plus WBC.
What is the only FDA_approved drug for smoking cessation that can be used in conjunction with couseling and nicotine replacement therapy?
BUPROPION - which is an anti-depressant. LT use
Exudative versus nonexudative ARMD
Nonexudative - dry ARMD -gradual onset -atrophy of central retina -yellow-white deposits of DRUSEN for deep to pigmented epithelium
Exudative/wet ARMD -sudden onset -severe loss -leaks fluids into retina -increases neovasculature
1. JOINT SPACE NARROWING 2. OSTEOPHYTES 3. SCLEROSIS OF SUBCHONDRAL BONY END PLATES ADJACENT TO DISEASE CARTILAGE 4. SUBCHONDRAL CYSTS THAT OCUR DUE TO INCREASED TRANSM OF INTRA-ARTICULAR PRESSURE TO SUBCHONDRAL BONE.
1. Bouchards nodes at the PIP 2. Herberdens nodes at the DIPs
Fever + blood in diarrhea
Shigella Salmonella (+/-) blood C. Jejuni EHEC
What renal diseases are associated with HTN?
1. RAS = #1 cause of secondary HTN 2. ADPKD 3. Chronic renal failure
What is the treatment in patients with MILD OSA? Severe OSA?
Severe - nasal CPAP that prevents occlusion of the upper airway; uvulopalatopharyngoplasty - removal of excess tissue; trachiostomy - last resort
If a patient presents with EROSIVE ESOPHAGITIS, what HIGH RISK complication can result?
Stricture Ulcer Barretts esophagus
Treatment for osteoporosis
1. Bisphosphonates: risendronate, alendronate = decreases bone resorption by decreasing osteoclastic activity by bidning to hydroxyapatite and decrease risks of fractures 2. Calcium supplementation 3. Vitamin D supplementation 4. Calcitonin (nasal spray) - minimal LT benefit but useful ST 5. Weight bearing exercise
If sore throat caused by viral infection like 1. EBV 2. Other virals (rhinoV, ADV, ParaINF, EBV, HSV
1. Symptomatically A. Mono - REST, ACETOMINPHEN/IBUprofen, dec ACTIVITY, increase risk SPLEEN B. Viral - ACETOMINOPHEN, gargling warm salt water, humidifier, throat losengers
Tympanic membrane perforation:
Hx: Pain, conductive hearing loss, TINNITIS, ringing of the ear PE: Bleeding from ear; clot in the meatus; visible tear in the membrane
90% heal spontaneously within 6 weeks; larger perforations req surgery
What is the treatment of cluster headaches
1. Acute: Sumatriptan (IMITREX) = #1; O2 inhalation 2. DO NOT USE NARCOTICS!
Pseudomembranous bacterium causing gray-like lesionson pharynx and is associated with bacteriophages that yeild organism infections?
How is COUGH treated?
If postnasal drip? If nonspecific antitussive rx?
(1) Postnasal drip (PND) - first generation antihistamine decongestant prep
Which viral organisms are responsible for SORE throat
ADV= viral DNA ParaINF = RNA virus (paramyxo) Rhinovirus = RNA virus (picorna) EBV = DNA virus (HHV4) HSV = HSV 1/2 DNA
Carpel tunnel clinical features:
Numbness, pain/tingling in median nerve distribution that worsens at night with weakness and THENAR atrophy
*****TINELS SIGN = tap over median nerve at weist crease that will cause paresthesias in median nerve distribution
******PHALENS sign = palmer flex 1 min with median nerve distribution
4 major organs affected by HTN
1. HTN 2. EYES 3. KIDNEY 4. CNS
Specific therapy for use in patients with infectious bacterial diarrhea
1. REHYDRATION 2. Treat underlying cause (meds/foods) 3. AB if infectious by 24 hours -CIPRO (floroquinolone) 5 day course -METRONIDAZOLE cdiff infection; redox reaction, absorbed by bacteria and reduces derredoxin and decreases pyruvate synthesis.
#1 Cause: -Symptoms: -Treatments;
#1 cause = VIRAL accounts for primary for that majority of inflammed bronchi -lab tests are NOT indicated unless PNA suspected