eesohbel's version from 2016-03-23 20:57


Question Answer
DEEP IN Dementia, Eyes, Ears, Physical Performance, Incontinence, Nutrition
DemenitaMini-coh, MIS
DepressionPHQ-2 and if positive PHQ-9
Eyessingle question and if positive snellen
Earswhisper test
Fallsfall last year
Performancechair rise, rapid out and back gait, timed get up and go
animal namingless than 12 is abnormal
IADLSmedication management, money, transportation telephone, shopping
ADLSDress, Eat, Ambulate, Transfer/Toilet, Hygiene
Falls risk factorstaking 4 or more medications, gait disorder, postural hypotension, vision impairment, foot pain
spinal stenosis painrelieved by sitting down and bending forward
disc herniationmade worst by coughing, sneezing, leaning forward or sitting
straight leg testsciatica test
T score of osteopenia1- to -2.5
T score for osteoporosis-2.5
1st line treatment for osteoporosisbisphosphonates
Buckman's 6 step guide to bad newsSPIKES (Setting, Perception, Invite, knowledge transmission, expore, summarize)
NURSEnaming, understanding, respecting, supporting, exploring
fundamental skillsask-tell-ask, tell me more, i wish statements
animal naming test abnormalless than 12/min
chair rise can't do40% lose 1ADL (bathing and dressing are most complex) in a year
can't do chair rise in less than 10 sec35% chance to loose ADL
can do chair rise in 10 seconds4% chance of loosing ADL in a year
PSA values high likelihood of BPHbetween 0 and 4
PSA values high likelihood of prostate cancervalue of 10 or higher
timed get up and gogreater than 19 second moderate to high risk for falls. higher score lose ADL in next year
functional reachscore of less than 8 inches indicated of limited functional balance

preventive medicine

Question Answer
top causes of deathheart disease, malignant neoplasms, chronic lower respiratory disease
top preventable causes of deathtobacco smoking, overweight and obesity, alcohol
breast cancer screeningmammo every 2 years women 50-74
screening for cervical cancer21 to 65. 21 to 30 every 3 years of after 30 every 5 years with cytololgy and HPV testing
cervical cancerstop at 65 if 3 consecutive negative and most recent within past 5 gears
colorectal cancerstarting at 50. fecal occult annual, sigmoidoscopy (every 5 years), colonoscopy (every 10 years)
HTNevery 2 years
hyperlipidemiaevery 5 years
DEXAat least 2 years, maybe 4 years
CMPnot indicated in asymptomatic persons
colorectal screening stops75
hyperlipidemia men35 every 5 years
hyperlipidemia womenover 45 if increased risk every 5 years
lung canceradults age 55 to 80 annual screening if have a 30 pack year history and smoke or quit within past 15 years
aspirin menmen 45 to 79
aspirin womencould consider starting at 55
screening for DMII USPSTFeveryone over 45
ADA screening for DMIIall adults with BMI over 25 and one or more risk factors
chlamydia and gonorrhea screeningall sexually active non-pregnant woman 24 and younger and older women at increased risk
pap smear21 to 65 every 3 years; 30 to 65 can do HPV with cytology every 5 years
AAA screeningmale active or former smoker aged 65-75 w/one time abdominal ultrasound
HIV screeningadolescents and adults age 15 to 65
testicular cancershould not screen
annual screening for adults over 65height, weight, BMI, BP screening, lipid profile, vision, depression
if patient's life expectancy is less than 5 yearssurvival benefit from cancer screening not documented

screening for patients at average risk

Question Answer
breast cancer age50-75
breast cancer test and intervalmammogram every 2 years
cervical cancer agewomen 21-65
cervical cancer test and intervalpap smear every 3 years
colon cancer age50-75
colon cancer test and itnervalfecal occult blood test yearly or colonoscopy every 10 years
HIV age15-65
HIV test and intervalHIV antibody screen 1 time
hyperlipidemia agemen 35 plus and women 45 plus. screen younger if have increased risk
hyperlipidemia test and intervallipid panel every 5 years
hypertension age18 and up
test and panel hypertensionblood pressure every 2 years
osteoporosis agewomen 65 and up
test and interval osteoporosisDEXA
aspirin45 to 79 in men


Question Answer
HPV vaccinationrecommended 11-12. if did not recieve initial vaccine recommended through age 26 for woman and 21 for men
Tdaprecommended beginning at 11 with Td every 10 years thereafter. give Tdap during each pregnancy
Tdap vaccineafter primary series booster dose q10; those aged 19 and older should recieve 1 booster dose of Tdap in replacement of Td
meningococcal if high riskgiven every 5 years
PPSV23administer to adults less than 65 with predisposing conditions (eg. chronic heart, lung disease, DM, cirrhosis)
PPSV23relatively T-cell independent B-cell response
pneumococcal vaccine in HIV patientsPCV13 once, and PPSV23 8 weeks later, then every 5 years
adults over 651 dose of PCV13 followed by PPSV23 6-12 months later

BP rules JNC-8

Question Answer
target BP for less than 60, CKD, diabetesless than 140/90
target BP for older than 70less than 150/90
initial treatment for african americans for BBPthiazide or CCB
all ethnicites with CKD or diabetesACEI or ARB
antihypertensive medications contraindicated in pregnancythiazides, ACEi, CCB and ARBS. Beta blockers and hydralazine are safe
diagnose HTN over2 BP readings over span of 4 weeks
side effects of thiazideshypergluc plus hypokalemia
ace-ihyperkalemia, dry cough, angioedema, skin rash
CCBamlodipine, peripheral edema. verampamil: heart block

cholesterol treatment

Question Answer
clinical ASCVDhigh intensity statin
LDL greater than 190high intensity statin
diabetic pateints 40-75 with LDL 70-189statin
nondiabetic patients 40-75 with LDL 70-189 and ASCVD risk greater than 7.5statin

Smoking Cessation

Question Answer
5A'sask, advice, assess, assist, arrange
NRT contraindicatedrecent MI (2 weeks) and serious cardiac issues
long standing NRTnicotine-patch
contraindications for nicotine inhalerCOPD/asthma, sinus, allergies, allergy to menthol
contraindications for buproprionpatients with uncontrolled depression, anxiety of psychosis, bulimia/anorexia, seizure disorder
moa of varenclinepartial antagonist and agonist at the nicotinic acetylcholine receptor
side effects of vareniclinesuicide risk, nausea, insomnia, CV events
pack yearnumber of cigarettes smoker per day X number of years smoked
what do you want to ask before starting bupropionhistory of seizures, alcohol intake, eating disorder, pregnancy-category C

DM medications

Question Answer
meformin a/emcc GI side effects. rare lactic acidosis
sulfonyureas a/ehypoglycemia, weight gain
TZDS (ploglitazone) a/eweight gain, edema/HF, bone fractures
DPP-4 inhibitors (liptins) advantagesno hypoglycemia
DPP-4 inhibitors (liptins) a/eangioedema, acute pancreatitis, HF hospitalizations
cost DPP-4 inhibitorshigh
SGLT-2 inhibitors (flozins) a/eGU infections, polyuria, volume depletion
cost SGLT 2 inhibitorshigh
GLP-1 receptor agonists (Tide) a/eGI side effects, increased HR, acute pancreatitis
goal BP in DMless than 140/90
fasting plasma glucosediagnostic greater than 126
random plasma glucosegreater than 200 in a person with symptoms
2 hour post-prandial glucosegreater than 200 after administration of 75g glucose load
Hemoglobin A1Cgreater than 6.5% criteria for DM
screen for microalbuminuriaat least once per year
BUN and creatinineat least once per year
eye screeningyearly
feetevery visit
give statins in diabeticsLDL above 100
give ACE or ARB in diabetics if BPgreater than 130/80
aspirindaily in all diabetics over age 30
pneumococcal vaccinegive to all diabetics
weight lossGLP-1 receptor agonist ex. exenatide, SGLT-2 inhibitors ex. flozins, amylin mimetics
spot-urine albumin creatinine ratio when in DM1 vs. DM2annual testing with type 1 within 5 years and type 2 at time of diagnosis
rapid acting insulinslispro, aspart, glulsiline
short acting insulinshuman regular
intermediate acting insulinsNPH
basal insulinglargine, determir, degludec


Question Answer
T-scorecomparison of patient's bone density to mean peak bone density of young health adult
Z-scorecomparison of patients to mean aged matched bone density
osteoportic t-score-2.5 or more
estrogen deficiencysevere loss of trabecular bone (spine)
disorders of calciumreduce cortical bone (forearm)
a/e bisphosphonaterenal tox, GI, ONJ
raloxifene moaestrogen agonist/antagonist
a/e raloxifeneincreases risk of DVT< increases risk of hot flashes
normal t-score-1.0 or above
low z-score-1.5 or below
best site for screening for bone loss peri-menopausal womanspine
best site for screening for bone loss in the elderlyhip
total spine densitymeasures primarily trabecular bone. loose bone from here first
forearmcortical bone loose from here last


Question Answer
FEV mortality cut off.75, 95% of the people will die within 10 years
intermittent asthmaday time symptoms less than 2 X a week and night time less than 2X a month
treatment intermittent asthmabeta agonists
mild persistent asthmaday time symptoms greater than 2X a week and night 3-4X month
treatment mild persistent asthmashort acing beta agonist plus low dose corticosteroid inhaled
moderate persistent asthmadaily symptoms, weekly night time, and FEVI 60-80% if predicted
treatment moderate persistent asthmabeta agonist, low dose corticosteroid, and long acting beta agonist
severe persistent asthmadaily symptoms, frequently night time wakenings, and FEV1 less than 60%
treatment severe persistent asthmashort acting beta, high dose inhaled steroid, long acting beta can add oral steroid
mainstay of treatment for COPDbeta agonist plus anti-cholinergic (muscarinic) (like ipratropium(
if mainstay not enough addlong acting anticholinergic (tiotropium)
if not enough long acting antichol not enoughadd inhaled steroids

ACC Nutrition and MI

Question Answer
modifiable risk factors for CVDobesity and unhealthy diet
obese BMIgreater than or equal to 30
overweight BMI25-29.9
healthy weight BMI18.5-24.9
DASH Dietfruits, vegetables, whole grains, low-fat or fat free milk
sodium in DASH diet2,300mg

Urinary Incontinence

Question Answer
normal PVR0-50 cc normal; 0-100 inormal as age
urge incontinence typebladder moving
HX urge incontinencelots of urge, pee constantly not that much comes out
PVR urge incontinencelow
non-pharm mgt for urge incontinencebladder training
pharm mgt for urge incontinenceanti-cholinergic (oxybutynin) and TCAS (impramine)
overflow (neurogenic bladder) typebladder doesn't contract
HX/PE overflow (neurogenic bladder)rarely pee, all comes out t once
PRV for neurogenic bladderhigh
non pharm mgt neurogenic bladderself-catheter
stress incontinence hxconstant dribble (cough, laugh, sneeze etc)
non-pharm mgmt stresskegel
kegel60-80 times daily. should see result in 6 to 8 weeks, max ben 3 months
type overflow 2nd to obstructionsphincter closed
pharm mgmt overflow 2nd to obstructionalpha blocker
innervation of detrusor muscleparasympathetic (cholinergic)
innervation of sphinctersympathetic (alpha)


Question Answer
blepharitisinflammation of the eyelid staph aureus
episcleritisinflammation of vessels lining the episclera.
scleritisinflammation of the sclera. associated with RA
exam of scleritissignificant eye pain on palpation
acute anterior uveitis clinical findingsciliary flush, blurred vision, pain and photophobia
herpes simplex keratitislook for classic dendritic ulcer on the cornea. irreversible vision loss if not treated

GI disease

Question Answer
test of choice for dyspepsiaendoscopy
GERD plus dysphagiapeptic stricture
endoscopy with biopsy in GERD ifheartburn refractory to treatment or accompanied by dysphagia, odynophagia, or GI bleeding
gold standard for GERD24 hour pH monitoring
mc electrolyte abnormality w/severe diarrheametabolic acidosis and hypokalemia
vomitting electrolyte abnromailtyhypokalemia with metabolic alkalosis


Question Answer
neurogenic claudicationspinal stenosis manifests as pain, cramping, numbness or paresthesia worst with walking and relieved with sitting
patellofemoral paincommon cause anterior knee pain. worst with climbing and descending stiars.
rotator cuff tenditismcc shoulder pain. lidocaine injection will reduce pain opposed to tear
lateral epicondylitistennis elbow.
hip OAgroin pain
De Quervain'spain at radial aspect of the wrist
radiographic findings in OAjoint space narrowing, osteophytes, subchondral sclerosis, subchondral cysts
pharm management OA1st line acetampinophen
tenderness over lateral area of hiptochanteric bursitis
1st line treatment for osteoporosisbisphosphonates
lidocaine injection w/rotator cuff tearrelief of pain but persistent weakness
lidocaine injection w/rotator cuff tendinopathyrelief of pain and normal strength
lidocaine injection w/adhesive capsulitisno improve in pain or ROM
whenever an elderly patient is beginning to rely more on assistive devicesconsider cervical stenosis and order an MRI
patellofemoral paincommon cause of anterior knee pain. worst with climbing and descending stairs
treatment for ankle sprainsRICE (rest, ice, compression, elevation)
weakness on shoulder abductionrotator cuff tear should be suspected
tinel signtap over median nerve at wrist crease: causes paresthesias in median nerve distribution'
phalen testpalmar flexion of the wrist for 1 minutes; causes paresthesias in median nerve distribution
OA findings on X-rayjoint space narrowing, osteophytes, sclerosis, subchondral cysts

MSK disease treatment

Question Answer
RA pain controlNSAIDS
DMARDS for RAmethotrexate
Felty syndromeanemia, neutropenia, splenomegaly and RA
acute goutNSAIDS or colchicine
prophlactyic goutallopurinol
pseudogout acuteNSAIDS
OA pharm treatmentacetaminophen first line can also use NSAIDS
osteoporosis pharm therapybisphosphonates (1st line) or PTH therapy


Question Answer
conducive hearing lossotitis externa, cerumen impaction, tmpanic membrane performation, otosclerosis
sensorineural hearing losspresbycusis, durg induced hearing lss, meniere, acoustic neuroma
conducive hearing losscan hear loud noises well
sensorineural hearing lossdifficulty hearing loud noises
pathology of senorineural hearing lossdegneration of sensory cells and nerve fibers at the base of the cochlea

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