RR Weakspots cards, neuro and MS

Memory loss, word finding, social withdrawl, concentration dificulties are sx of what and what is the tx?

Sx of Alzeheimers. Rx Donepezil and memantine

painless vision loss, beahvaioral and speech changes that resolve in 24 hours is an example of what? what do you rx for this?

Example of TI and rx statin, ASA/plavix pending on ABCD2

What would you order as part of a work up for a TIA that is non-pharm?

carotid artery US

Shuffled gait, resting pill tremor, masked face, later dementia is an example of what? How would you manage it and what is rx?

manage by reviewing medications for med induced parkinsons i.e antisypch and metoclopramide. Rx carpodopa levodopa, amantadine (antikinesthetic)

PPredator Men are always horny - Explain the pneumonic

Horner syndrome. pain, Pitosis, miosis, anhidrosis, aniscoria

motor weakness from face down, no sensory involvement may indicate what

myasthenia gravis

Tx and how to dx myasthenia gravis

pyridostigamine and dx using ABO labs

Tx for cluster HA options

Abort: oxygen, triptan SC Prevent: Verapamil and prednisone

young adult with sensory and motor changes would indicate? and how to tx? dx

Multiple sclerosis and tx with high dose steroid

Migraine HA options

Abort: NSAID, triptan Prevent: BB, topiramate, CGRP

what is a major concern about giant cell arteritis

inflammation causing permanent vision changes

Trigeminal neuropathy will cause changes to what areas of the face?

V2, V3, lower face, NOT the forehead

what rx would you give for trigeminal neuralgia?

carbamazepine

New medication causing proximal weakness with or without CK elevation would indicate what?

Drug induced myopathy.

what management is considered if suspecting drug induced myopathy?

med review, reduce statin dose, investigate thyroid causes

horizontal nystagmus, unilateral hearing loss, recent URI would indicate what condition and how would you manage the condition?

vestibular labrynthitis - refer after 1 going if symptoms are ongoing

gradual chorea, cognitive decline in a mid adult may indicate what condition? How would you manage the condition?

Huntington. Manage by genetic testing and refer to neurologist

pt has urge to move legs while awake because it helps. What may it indicate? How do you confirm diagnosis?

Restless leg movement. Confirm with plysomnography

what would you treat restless leg movement with?

iron or gabapentin for chronic

Pt has gradual speech and memory loss in addition to personality changes. What may that indicate?

Frontotemporal dementia

how do you tx and manage frontotemporal dementia?

Rx SSRI and behavior support

Crescendo-decrescendo LSB murmur that is a genetic disorder would indicate?

Hypertrophic cardiomyopathy

How do you tx hypertrophic cardiomyopathy

It is essentially HF in a younger person. Restrict activity. Tx with HF meds, non-DHP CCb and BB

What is BECKS triad?

It is classic findings of cardiac tamponade; hypotension, JVD and muffled heart sounds

what would you see in an EKG if you ordered it after noticing Beck’s Triad?

Alternans QRS complex

What is the concern with a cardiac tamponade?

HIGH risk for cardiogenic shock!

If cardiac tamponade is confirmed, what would you expect the tx course to include?

ECG, CXR, Echo and surgery

what is mitral regurgitation?

Mitral regurgitation is when the mitral valve does not close all the way, so blood leaks backward from the left ventricle into the left atrium during systole.

Murmur radiats from apex to axilla, diminished S1 and murmur increases with leg raise but decrease with valsalva, would indicate what condition?

mitral regurgitaiton

what condition can develop as a result of mitral regurgitation?

AFIB

How would you tx and manage mitral regurgitation?

ACE/ARB, tx HF and refer

What is the suffix for CCB-DHP?

-pine (peen)

What 1st line BP medication is preferred for blacks?

CCB DHP, thiazide

what are 1st line BP medication for pt pregnant?

lobetalol and nifedapine (BB and CCB)

what is the difference between angioedema and peripheral edema? whis would you see in an ACE/ARB AR?

angiedema: occurs to deeper, mucosa areas, peripheral is swelling to dependent areas. ACE/ARB=angioedema

how does ACE/ARB cause hyperkalemia?

Decreases the RAAS system (aldosterone) so kidneys cannot excrete potassium

What is the suffix of ACE and what is the suffix for ARB?

ACE- “ils” ARB “tan”

AR to thiazides

sulfa allergies, 65y/o+

HF management meds

BB, diuretic, non DHP CCB

split 2 murmur@ pulmonic area, congenital L to R atrial shunting, respiratory infections would indicate what how would you manage the condition?

Atrial Septal Defect, resolves with age or surgery

What is the evaluation tool for TIA?

ABCD2=age 60+, 140/90 BP, unilateral weak, speech, duration >10min is +1, duration >60min +2, DM +1. If less than 3RF, rx ASA. If >3 rx ASA and plavix

what result from a carotid US would require annual monitoring?

50-79%

what does a murmur louder with inspiration indicate? How would you manage this condition?

Pulmonic stenosis is managed through surgery

What would an austin flint high pitch murmur to LSB with wide pulse pressure

Aortic regurgitation managed through surgery

what patients warrant a high statin?

Clinical ASCVD, LDL>190 and familial hypercholesterolemia

In cholesterol management, what differs in a pt between 40-75 who has DM and who doesn’t have DM?

If pt has DM, give a statin. If pt doesn’t have DM, give a statin if ASCVD risk is >10% or consider if 7.5%+

How does familial hypercholesterolemia present in a PE?

smooth, firm skin nodule attached to tendon or as red/yellow papules on buttock

systolic click, delayed femoral pulse in infant, LVH would indicate what condition? how to manage?

Coarctation of aorta managed through prostaglandin E1 if warranted or surgery

poor dentition, new murmur, drug use would indicate? How would you manage? How would you treat?

Dx: Infective endocarditis. manage with blood cultures. Tx with IV abx

what is the tx for chronic venous insuficiency?

sulodexide- reduces chances of a clot

HR 30-40, hypotensive, QRS far spaced indicates

3rd degree heart block. Refer if asymptomatic. atropine, epinephrine if symptomatic

little hair to BLE, shiny/thin/dry LE, pn w/ walking, decreased pulses, improper healing would indicate? What to rx? What is diagnostic criteria?

Peripheral Artery disease. Rx: cilastozal for PAD with intermittent claudication, Sulodexide, ASA, statin as adjunct to preventing clots. Dx: ABI

Unilateral uneven shoulder or leg, middle back pn and no trauma

what is the suspected dx? How do you confirm the dx?

Dx: scoliosis confirm:XRAY with cobb angle >10 degrees

back pn, urinary retention, decreased rectal tone, weak/NT in LE would indicate? How to confirm dx? what is course of tx?

cauda equina. confirm dx: MRI, Tx: cauda equina

middle aged, uveitis, low back pn worsening at nigh, stiff in AM imporves with movement indicates?

Ankylosing spondylitis

How to confirm ankylosing spondylitis and what is specific about it?

specific: abnormal joint pn at night and stiffness similar to an older person. Confirm with HLA B27 lab, lab for autoimmune disease

What is the tx for ankylosing spondylitis?

NSAID, PT, TNF inhibitor (-mab) medication

What to educate patients on in terms of ankylosing spondylitis and taking a TNF inhibitor (-mab) medication?

Educate on higher risk of infection, maintain health screening for TB and HEP B

older adult with B shoulder, hip stiffness that is worse in the morning and improves with movement indicates?

polymyalgia rheumatica

Difference in clinical assessment between plolymyalgia rheumatica and rheumatoid arthritis?

PR- older, ache/stifff in larger joints, negative for rheumatoid factor and anti CCP labs, associated with GCA. RA- any age, small joings, +RF and antiCCP, imaging erosions

Tx for polymyalgia rheumatica?

High dose steroid

tx for rheumatoid arthrits?

DMARD - methotrexate

What labs would you order for polymyalgia rheumatica?

ESR/CRP, CK -to r/o muscle disease, RF and AntiCCP to r/o rheumatoid arthritis

saddling gait, myalgia, bone pn, increase in falls indicate? how would you tx?

osteomalcia. Tx: vitamin D and calcium

what labs are you ordering if you suspect osteomalacia?

vitamin D and calcium will be low, PTH will be high compensating for low calcium

Bone enlargement, decreased ROM, Crepitus, Joint pn improves with rest, and most common sites are hips, knees and spine indicates what disease? confirm the dx using?

osteoarthritis. confirm w/ XRAY

pharmalogical tx osteoarthritis?

NSAID, Capasaicin progress to diclofenac, tramadol, duloxetine

what management tips would you give for osteoarthrits?

NWB activity and weight management

female 65+ with history of alcohol, steroid and tobacco use is at higher risk for what? how would you manage? how would you tx?

risk: Osteoporosis, manage: DEXA >-2.5, tx: Bisphospohnate on empty stomach, SERM to increase estrogen effects on bonne (raloxifene), calcium, viamin D

B pn in AM for more than 1hr, common in wrist, PIP and DIP but pn improves with activity would indicate what condition?

Indicates rheumatoid arthritis

What labs are you ordering if suspecting rheumatoid arthrits?

anti CCP, RF, ESR/CRP

Difference in pharm tx between osteoporosis and rheumatoid arthritis?

Osteoporosis: SERM and bisphosphonate, RA: DMARD - methotrexate

Rx a SERM for osteoporosis

raloxifene

otta watta knees is a tool used for what?

order XRAY for knee. Includes: 55+, PTT to patella, fibular head, inability fo flex knee to 90 degrees, inability to weight bare x4 steps post injury and in clinic

pt has 180/120+ BP resistant to medications, hematuria, confused, 50+y and weak indicates? and how to confirm the suspected dx?

renal artery stenosis. 😱 using a renal angiograph

pectus deformity, wrist sign, thumb sign indicates? how to dx?

marfan syndrome. Dx: TTE,

How to manage Marfan syndrome?

monitor for aortic regurgitation or aneurysm, monitor aorta, activity restriction

what is essentially the tx of choice for marfan syndrome if the pt develops the risks assoiciated with it?

surgery

Loud S1 snap, low pitch murmur @ apex, young to middle aged with dyspnea may indicate?

mitral stenosis

mitral stenosis tx and management?

tx HF, manage through TTE monitoring and surgical replacement if needed

plastic heart valve management includes…?

antithrombotic- warfarin, ASA.

what is normal INR for someone on warfarin?. Qualities of the blood when INR is high vs low.

2-3INR for someone on warfarin. INR is high=thin and INR low is THICK

leathery scratch, CP radiates to back and worsens with lying down, improves when leaning forward would indicate?

pericarditis

what CV condition is common in children with rheumatic fever?

pericarditis

What is the diagnnostic for pt with pericarditis?

ECG with ST concave elevation and PR depression

what is the tx for pericarditis?

Goal: decrease inflammation. NSAID, steroid, colchicine

young, S3, tachycardic, troponin can be elevated or not, viral infection would indicate? Tx? how to confirm suspected dx?

endocarditis. tx HF symptoms, supportive. Dx: endomyocardial biopsy

high pitched knock is indicative of what?

constrictive pericarditis

Infant with crescendo murmur radiating to back heard at pulmonic area, wide pulse pressure indicates

patent ductus arteriosus

How would you manage patent ductus arteriosus?

if doesn’t resolve in a few days after birth, consider surgery.

tx for patent ductus arteriosus in infant?

NSAID to close PDA but NOT if needed to survive

tx for chronic venous insufficiency

suldoxide to decrease clot formation and pentoxifylline for leg ulcers

how to dx chronic venous insufficiency

US

how to dx dvt?

US

labs approrpiate for a low risk DVT pt

D Dimer

pharmalogical tx for someone with DVT

warfarin, heparin, lovenox

infant, squat knees to chest, tet spells would indicate? how to confirm?

Tetrology of fallot. Confirm: boot shaped XRAY of heart

qualitites of tetrology of fallot?

pulmonary stenosis, R ventricular hypertrophy, overriding aorta, ventricular septal defect

pharyngitis, sore throat, migrating joint pn, new murmur would indicate?

acute rheumatic fever

what is the treatment course for pt with rheumatic fever?

penicillin or azithromycin (if allergic to penicillin) x 10 years or 21 with carditis, x5 years w/o carditis. choose the longer course. Lincosamide/clindamycin for break through.