-
How do you diagnose Asthma?
Episodic symptoms of airflow obstruction that is at least partially reversible, either spontaneously or following bronchodilator therapy
-
At what times in the day are asthma symptoms typically worse?
At night or early in the morning
-
What will you hear on lung auscultation in an asthma patient?
Prolonged expiration and diffuse wheezes on physical examination
-
In an asthma patient, what will pulmonary function testing show?
Limitation of airflow or positive bronchoprovocation challenge
-
What are the treatments of asthma, by stage?
- 1. SABA PRN Persistent Asthma:
- 2. Low-dose ICS
- 3. Above + LABA
- or Med-dose ICS
- 4. Medium-dose ICS + LABA
- 5. High-dose ICS + LABA
- 6. High-dose ICS + LABA + oral corticosteroid
-
How do you distinguish between an acute, chronic and persistent cough?
Acute < 3 weeks, chronic > 8weeks, persistent > 3 weeks
-
When should you get a chest x-ray for a patient with an acute cough? For a persistent or chronic cough?
Any adult with acute cough who shows abnormal vital signs or in whom the chest examination is suggestive of pneumonia. Persistent or chronic- when ACEi and post-infectious cough are excluded.
-
What are the most likely causes of cough when the CxR is normal?
Post-nasal drip, asthma, GERD
-
How do you diagnose diabetes?
A1C > 6.5% or FPG > 126 mg/dL or 2h plasma glucose > 200 mg/dL or in a patient with classic sx of hyperglycemia or hyperglycemic crisis, a random plasma glucose > 200 mg/dL
-
What are the goals of diabetes treatment?
A1C < 7% and
Preprandial capillary plasma glucose: 70-130 mg/dL
- Peak post-prandial (1-2 h after start of meal) < 180
- mg/dL
-
What is normal HTN?
120/80
-
What is pre-HTN?
120-139/80-89
-
What is Stage 1 HTN?
140-159/90-99
-
What is Stage 2 HTN?
> 160/100
-
What labs will you order for a patient who has just been diagnosed with HTN?
UA, blood glucose, Hct and lipid panel, serum K, Cr, Ca. EKG
-
What is the goal BP for a patient with Stage 1 or 2 HTN without CKD or DM?
140/90
-
What is the goal BP for a HTN patient with CKD or DM?
130/80
-
What is the DASH diet?
A diet rich in fruits, vegetables, and low-fat dairy foods and low in saturated and total fats, has been shown to lower blood pressure.
-
How would you explain what 2 grams of sodium looks like to a patient?
1 teaspoon full
-
How much EtOH would you suggest for HTN men? How about HTN women or lighter-weight people?
No more than 2 per day for men, no more than 1 for women and lighter people
-
When should loop diuretics be used in the treatment of HTN?
When there is kidney dysfunction (Cr > 2.5)
-
How will you develop an anti-hypertensive regimen?
With the AB/CD rule. For persons younger than 55 and not black- ACEi or ARB, then add C or D. For persons 55 and older or black, CCB or diuretic, then add ACEi or ARB.
-
What are some adverse effects of ACEi?
Cough, hypotension, dizziness, kidney dysfunction, hyperkalemia, angioedema; taste alteration and rash, rarely proteinuria, blood dyscrasia. Contraindicated in pregnancy.
-
What are some adverse effects of ARBs?
Hyperkalemia, kidney dysfunction, rare angioedema. Contraindicated in pregnancy.
-
What will you use for resistant hypertension?
Spirinolactone
-
When developing an anti-hypertensive regimen, what are some compelling indications that would influence the drugs you choose?
HF, hx of MI, high cardiovascular disease risk, diabetes, CKD, hx of stroke
-
How do you treat an acute tension headache?
Acetaminophen, NSAIDs
-
How do you treat a chronic tension headache?
Amitriptyline
-
How do you treat a cluster headache?
Oxygen 100% at 10-12 L/min for 15-20 min
-
How do you shorten a cluster headache?
Sumitriptan SC
-
How do you prophylax for a cluster headache? Or migraine?
Ergotamine
-
How can you treat a chronic daily headache?
Amitriptyline 1 mg/kg, or anticonvulsants like topiramate or gabapentin.
-
What is your differential for back pain?
SPRM. Muscular strain, primary spine disease (disk herniation, degenerative arthritis), systemic diseases (mets), and regional diseases (aortic aneurysm)
-
For the posterior chest physical exam, at how many points will you test for tactile fremitus?
1-4
-
For the posterior chest physical exam, at how many points will you percuss?
1-7
-
What elements will you perform in the auscultation part of the posterior chest physical exam?
Auscultation: Listen at points 1-7, pt breaths through an open mouth. "99", "eeee", whispered "1-2-3"
-
For the anterior chest- what makes up the palpation part of the exam?
Chest expansion and tactile fremitus (1-3)
-
Anterior chest PE- how many points to percuss?
1-6
-
How many points to auscultate on anterior chest PE?
1-6
|
|
