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What are common symptoms of hypertension?

May be asymptomatic or occipital headache, headache upon waking, blurry vision

What are non-pharmacological interventions for hypertension?

Weight loss, 30 mins aerobic exercise 5x/week, smoking cessation, alcohol cessation, diet improvement (avoid salt)

What are pharmacological interventions for hypertension?

Start with Thiazide Diuretic- HCTZ

CCB- Amlodipine

ACE/ARB- Lisinopril

What labs would you check for a patient with hypertension?

CBC, CMP, fasting glucose, lipid panel, UA

What diagnostics would you check for a patient with HTN?

EKG

Who would you refer a patient with hypertension to?

Cardiology if EKG is abnormal.

When would you follow up with a patient with hypertension?

2-4 weeks

What are common symptoms of hyperlipidemia?

Usually asymptomatic. Xanthelasma (fat deposits around eyes) or Corneal arcus in patients under 50.

What non-pharmacological interventions can be done for a patient with hyperlipidemia?

Diet and exercise to raise HDL.

What pharmacological interventions can be done for a patient with hyperlipidemia?

Statins. Pravastatin, Simvastatin, Atorvastatin, Rosuvastatin.

If muscle pain try Ezetimibe or Colesevelam.

What labs would you check for a patient with hyperlipidemia?

Lipid panel, CBC, CMP, UA and creatinine (check for nephrotic syndrome), TSH (hypothyroidism)

When would you follow up for a patient with hyperlipidemia?

6-8 weeks

Who would you refer a patient with hyperlipidemia to?

Nutritionist

What are common symptoms of Type 2 Diabetes?

Polydipsia, polyuria, polyphagia. Obesity, nervousness, blurry vision, fatigue. A1C of 6.5% or higher on two tests or fasting BG greater than 126.

What are non-pharmacological interventions you would do for a patient with T2DM?

Lifestyle modification, diet, exercise.

Monitor BG at home.

Avoid alcohol and smoking.

What are pharmacological interventions you would do for a patient with T2DM?

Start with metformin combined with dietary changes.

Sulfonylureas (Amaryl, Glucotrol XL)

SGLT2 (Jardiance, Farxiga)

Etc. and add insulin if PO medication is insufficient.

What diagnostics would be done for a patient who has T2DM?

CBC, CMP, A1C, TSH, fasting glucose, urine for microalbumin, lipid panel

When would you follow up for a patient with T2DM?

2-4 weeks

Who would you refer a patient with T2DM to?

Ophthalmology, Podiatry, Diabetic Educator

How does a patient with back pain typically present?

C/O pain may be localized, referred or radiating. OLDCARTS.

What are some contributing factors of back pain?

Trauma, surgery, pre-existing condition, jobs

What is the gold standard for diagnosing back pain?

CT or MRI

What imaging would you get if a patient with back pain experienced trauma?

X-RAY to rule out fracture or degeneration

What labs would you check for a patient with back pain?

CBC, CMP, UA

What is non-pharmacological management that can be done for a patient with back pain?

Avoid heavy lifting.

Apply heat for 20-30 minutes a few times per day.

Weight loss.

Gradually resume activity.

What is pharmacological management that can be done for a patient with back pain?

NSAIDs like naproxen or ibuprofen.

Muscle relaxer like cyclobenzaprine.

When would you have a patient with back pain follow up?

If severe 24-48 hours. If not severe 7-10 days.

Who would you refer a patient with back pain to?

Physical therapy

What are the common symptoms of anxiety?

tachycardia, sweating, trembling, palpitations, fatigue, sleep disturbances.

Somatic complaints such as dizziness, palpitation, near syncope

What labs would you do for a patient presenting with anxiety?

TSH, CBC, CMP, UA, urine drug screen, glucose, EKG

What scales can be used to assess for anxiety?

Hamilton Anxiety scale (>18 is positive), GAD-7

What are non-pharmacological treatments for anxiety?

Psychology/counseling, exercise, stress relief, healthy diet

What are pharmacological treatments for anxiety?

SSRIs

Buspar, Klonopin

What medication class should only be used short-term for anxiety?

Benzodiazepines due to addiction/abuse potential

When should you follow up on a patient with anxiety?

2-4 weeks

Who would you refer a patient with anxiety to?

Psychologist/Psychiatrist

What are the common symptoms of a patient with depressive disorder?

Loss of interest, excessive sleeping, suicidal ideation possible

What labs would you do for a patient with depressive disorder?

CBC, CMP, TSH, urine drug screen, EKG, vitamin D, B12, folate

What PHQ-9 score indicates depression?

5 or more

What are non-pharmacological treatments for depressive disorder?

Counseling, sleep hygiene, home safety, offer hotline resources

What are pharmacological treatments for depressive disorder?

SSRI

Sertraline, Prozac

When should you follow up on a patient with depressive disorder?

2 weeks. May need up to 8 weeks for medication to be therapeutic.

Who would you refer a patient with depressive disorder to?

Psychologist/psychiatrist

What are the common symptoms of a patient with obesity?

Excessive fat accumulation

What labs would you do for a patient presenting with obesity?

CBC, CMP, TSH, lipid panel, fasting glucose, A1C, lipase, EKG (baseline for adipex/phentermine)

What BMI is considered obese?

greater than 30

What are the non-pharmacological treatments for obesity?

Diet and exercise (lifestyle modifications)

What are pharmacological treatments for obesity?

Adipex-P/Phentermine; consider GLP-1 if risk factors

When would you follow up on a patient with obesity?

2-4 weeks.

Who would you refer a patient with obesity to?

Nutritionist

What are common symptoms of a patient presenting with reflux esophagitis (GERD)?

Heartburn, cough, burning beneath sternum, regurgitation, chest pain neck pain

What labs would you do for a patient with GERD?

CBC, CMP, EKG (to rule out cardiac cause)

How is GERD diagnosed?

Hx and clinical impression, barium swallow (hiatal hernia, loss of LES tone)

How can GERD be managed non-pharmacologically?

Remove trigger foods like coffee, spices, or chocolate

Small frequent meals

Sit up for 2 hours after eating

Do not eat before bedtime

What is the pharmacological management for GERD?

Omeprazole daily

When would you follow up for a patient with GERD?

2-4 weeks

What are common symptoms of allergic rhinitis?

sneezing, rhinorrhea, pruritus, nasal congestion/edema, pale boggy turbinates, red conjunctivae, sore throat, palpable lymph nodes

What are some non-pharmacological measures that can be taken to lessen allergic rhinitis symptoms?

Avoid allergens

Frequent vacuuming, dusting

Remove feather/down materials from bedding

Remove carpet or house plants

What are pharmacological measures that can be done for treatment of allergic rhinitis?

Claritin (antihistamines) then if those don't work alone add intranasal corticosteroid such as flonase

When would you follow up on a patient with allergic rhinitis?

1-2 weeks if symptoms persist

What are common symptoms of an upper respiratory infection?

Nasal stuffiness, sneezing, scratchy throat, hoarseness, irritated nasal mucosa with clear or yellow discharge, malaise, headache, cough, possible low grade fever

What are most common URI causes?

Rhinovirus or adenovirus

What are diagnostics used for a URI?

Nasal washing/flu wash

What are non-pharmacological interventions for a URI?

Increase fluid intake and rest, humidifier, lozenges, saline nose rinse, hand washing

What are pharmacological methods for treatment of URI?

Tylenol/ibuprofen for fever and body aches

Saline nasal spray

Antibiotic if illness lasts longer than 10 days

When would you follow up on a patient with a URI?

If symptoms persist over 10 days.

What are common symptoms of hypothyroidism?

Fatigue, constipation, weight gain, hoarseness, headaches, arthralgia (joint pain), edema, brittle hair/fingernails

What labs would you do for a patient with hypothyroidism?

TSH, T4, T3, CBC, CMP, lipid panel, EKG

What would labs show if a patient has hypothyroidism?

High TSH, low T4, possibly decreased T3

What nonpharmacologic methods can be used to manage hypothyroidism?

High fiber diet to prevent constipation, diet for weight loss, educate on medication compliance, report signs of infection, toxicity or cardiac symptoms

What are signs of thyroid medication toxicity?

Anxiety, nervousness, tremors, insomnia, rapid heart rate, palpitations, elevated BP, sweating, heat intolerance, weight loss, fatigue

What pharmacologic methods can be used to manage hypothyroidism?

Levothyroxine on an empty stomach. Start with low dose and titrate upward.

When would you follow up for a patient with hypothyroidism?

6 weeks.

What are common symptoms for a patient presenting with osteoarthritis?

Very generalized disease, ASYMMETRIC joint pain, morning stiffness. Usually develops insidiously or follows physical activity.

What would you assess for in a patient with osteoarthritis?

Morning stiffness lasting less than one hour, stiffness resumes at end of day or after activity. Look for crepitus or bunions. Look for site redness or warmth.

What diagnostics would you do for a patient presenting with osteoarthritis?

X-Ray (joint space narrowing); CBC, CMP, ESR, rheumatoid factors

What are non-pharmacolocial treatments for osteoarthritis?

Weight loss, braces to stabilize joints, heat/cold

What are pharmacological treatments for osteoarthritis?

Acetaminophen for pain, voltaren cream as needed

When would you follow up on a patient with osteoarthritis?

2-4 weeks

Who would you refer a patient with osteoarthritis to?

Physical therapy

What is the common presentation of a patient with fibromyalgia/myositis?

Chronic, widespread body pain. Almost always accompanied by fatigue, memory difficulties, sleep and mood disturbances. Physical exam is usually normal but may have areas of tenderness.

What diagnostics should be done for a patient with fibromyalgia?

ESR, C-RP, TSH, CBC, rheumatoid factor, ANA, vitamin D

What are non-pharmacological treatments for fibromyalgia?

Patient education, exercise, CBT, sleep hygiene

What are pharmacological treatments for fibromyalgia?

Tricyclic antidepressant (Amitryptyline), Flexeril

When would you follow up on a fibromyalgia patient?

2-4 weeks

Who would you refer a patient with fibromyalgia to?

Psychologist for CBT, pain clinic

What are the common symptoms of BPH?

Frequency/urgency, weak stream, hesitancy, straining to begin stream, postvoid dribbling, sensation of incomplete bladder emptying.. Caused by enlargement of the prostate narrowing the urethral lumen

What diagnostics would you do for a patient with BPH?

UA, creatinine, PSA, PVR, US, DRE

A score greater than 8 on the AUA questionnaire warrants what?

Pharmacological management

What are non-pharmacological methods to treat BPH?

Decreased fluids before bed, void frequently, avoid caffeine, sit to urinate for better emptying

What pharmacological management can be done to treat BPH?

Tamsulosin

When would you follow up on a patient with BPH?

2-4 weeks

Who would you refer a patient with BPH to?

Urology

What are common symptoms of a patient presenting with knee pain?

Pain with ambulation etc., pain at rest

What would you assess for in a patient complaining of knee pain?

Assess for trauma to knees (blunt force or twisting).

Posterior drawer then anterior drawer to test for ACL injury.

What diagnostics would be done for knee pain?

X-Ray to rule out fracture, MRI to diagnose soft tissue injury

What are non-pharmacological treatments for knee pain?

RICE

Physical therapy

What are pharmacological treatments for knee pain?

Tylenol, naproxen. Pain greater than 5/10- Tramadol

When would you follow up on a patient with knee pain?

1 week

Who would you refer a patient with knee pain to?

Physical therapy; ortho if needed