AANP

Lab values

Know cardiac murmur mnemonics, cranial nerves, and common lab result values; AANPCB lists values only if asked in the question.

Evidence-Based Medicine studies

Strongest: meta-analysis, systematic review, RCTs/Cochrane; weakest: expert opinion/specialty society.

Basal cell carcinoma is? s/sx? dx?

Pearly, waxlike, shiny lesion with telangiectasia/central ulceration; most common skin cancer; biopsy is gold standard.

Squamous cell carcinoma: what does it look like and what is the precursor?

Smooth, hyperkeratotic, or ulcerated papules/plaques/nodules; precursor is actinic keratosis.

Actinic keratosis

Crusty/scaly lesion on scalp, hands, or face; precancerous to SCC; often treated with cryotherapy.

Lung cancer screening

Annual low-dose CT for ages 50-80 with 20-pack-year history, current smoker, or quit within 15 years.

Breast cancer screening

Start age 40, every 2 years until 74; BRCA: yearly MRI + mammogram starting age 30.

Colorectal cancer screening

Start age 45 until 75; annual FIT or colonoscopy every 10 years; generally stop by 85.

Sensitivity

Identifies disease when disease is present; few false negatives; SnNout.

Specificity

Identifies absence of disease when disease is absent; few false positives; SpPin.

Primary prevention

Prevent disease before it occurs (vaccines, counseling, risk reduction).

Secondary prevention

Screen for early disease (mammogram, Pap, colonoscopy, low-dose CT).

Tertiary prevention

Treat existing disease to reduce complications (rehab, PT/OT, support groups).

Influenza vaccine

OK with egg allergy; live vaccine only for ages 2-49 if healthy/nonpregnant; avoid if Guillain-Barré within 6 weeks.

Td/Tdap vaccine

Give every 10 years; dirty wound: booster if 5 or more years since last dose; DTaP is for children under 7.

Pneumococcal vaccine

PCV20 is commonly recommended in adults; PPSV23 may still be used depending on age/risk/schedule.

Shingrix

2 doses 2-6 months apart; do not restart series if delayed.

Pharmacodynamics

What the drug does to the body.

Pharmacokinetics

What the body does to the drug: absorption, distribution, metabolism, excretion.

CYP450 inhibitors

Raise drug levels: macrolides, azole antifungals, cimetidine, protease inhibitors, grapefruit juice.

Thiazide diuretics SE

Cause low K, low Mg, high Ca, low Na, hyperuricemia, photosensitivity; diminished effect if CrCl <30.

ACE inhibitors CI & SE

SE: cough, angioedema, hyperkalemia, AKI; CI: pregnancy, renal artery stenosis, prior angioedema.

Beta blockers CI & SE

CI: asthma/COPD, bradycardia, AV block; SE: bronchospasm, fatigue, depression, ED, masks hypoglycemia.

Tetracyclines Avoid in? SE?

Avoid in pregnancy and most children under 8; SE: photosensitivity, esophagitis, tooth discoloration.

Macrolides common ones, SE & CI

Azithromycin, Clarithromycin, Erythromycin, and Fidaxomicin. SE: GI upset, hepatotoxicity, QT prolongation; CI: myasthenia gravis; interact with warfarin, statins, CCBs.

Cephalosporins caution w/? what are 1st/3rd used for?

Use cautiously with true penicillin anaphylaxis; 1st gen for skin/soft tissue, 3rd gen for CNS/GU infections.

Fluoroquinolones BBW/AE

BBW: tendon rupture, aortic dissection risk; avoid in pregnancy, MG, and most children; may prolong QT.

Sulfonamides

TMP-SMX is teratogenic in 1st trimester; avoid in G6PD deficiency, newborns <2 months, porphyria; major warfarin interaction.

Clindamycin uses & risk

High risk for C. difficile; used for skin, bone/joint, anaerobic, BV.

NSAIDs CI/long term AE

Avoid in HF, severe renal disease, GI bleed risk, and late pregnancy; long-term use raises MI, stroke, GI bleed, AKI risk.

Statin adverse effects

Can cause myalgias, rhabdomyolysis, hepatitis, and cognitive complaints; check baseline LFTs.

Digoxin toxicity

Early sign is GI symptoms; can cause bradycardia/arrhythmias; treat with DigiFab/Digibind when indicated.

Warfarin

Vitamin K antagonist; not pregnancy safe; INR goal usually 2-3 (2.5-3.5 for mechanical valve).

DOACs what is it? examples?

First-line anticoagulants for many patients without valvular heart disease.

Apixaban (Eliquis), Rivaroxaban (Xarelto), Dabigatran (Pradaxa), Edoxaban (Savaysa / Lixiana), Betrixaban (Bevyxxa

Most common cause of death overall

Heart disease.

Most common cancer in women

Breast cancer.

Most common cancer in men & most common cause of cancer death in men

Prostate cancer.

Lung for death

Most common skin cancer

Basal cell carcinoma.

Deadliest skin cancer

Melanoma.

Most common cause of death in adolescents

Motor vehicle accidents.

Breast cancer risk factors

Age 50+, BRCA mutation, chest radiation, early menarche, late menopause, nulliparity, obesity.

Cervical cancer screening age 21-29

Pap cytology every 3 years.

Cervical cancer screening age 30-65

Pap/HPV cotesting every 5 years.

No cervical cancer screening

After hysterectomy unless done for CIN 2+ or cervical cancer.

Prostate cancer screening age range

Age 55-69 individualized decision.

Routine screening NOT recommended

Testicular cancer, skin cancer, ovarian cancer.

AAA screening

One-time ultrasound for men age 65-75 who have ever smoked.

PPIs long term risks

Long-term risks: fractures, pneumonia, C. diff, low Mg, B12/iron malabsorption, kidney disease.

Bisphosphonates precautions

Take with full glass of water and stay upright 30 minutes; avoid with major esophageal disorders.

Atypical antipsychotics examples? AE

Risperidone, olanzapine, quetiapine can cause weight gain, metabolic syndrome, T2DM.

BEERS high-risk meds

Diphenhydramine, doxylamine, chlorpheniramine, tramadol, some anticoagulants, antipsychotics.

Heart failure meds to avoid

Non-dihydropyridine CCBs (verapamil/diltiazem) and TZDs can worsen HF.

HCTZ starting dose

12.5 mg daily.

Chlorthalidone uses, dosage, and pearl

thiazide diuretic, Good HTN option; limited added effect above 25 mg; avoid with lithium.

Spironolactone what is it? risk of?

Potassium-sparing diuretic; risk of hyperkalemia and gynecomastia.

Loop diuretics AE

Cause low K, low Mg, low Na, low Cl and possible ototoxicity.

Losartan what is it? AE

ARB; can cause hyperkalemia and AKI.

Amlodipine what is it? SE?

Dihydropyridine CCB; common SE: ankle edema, flushing, headache. Can also be used to tx Raynauds

Verapamil/Diltiazem uses & CI

CCBs that slow HR and lower BP

Avoid in bradycardia, AV block, HFrEF; verapamil often causes constipation.

Alpha blockers

Can cause orthostatic hypotension; useful for BPH; start at bedtime.

Doxycycline uses

Acne, chlamydia, atypical pneumonia, RMSF, Lyme, some tick-borne disease.

Tetracycline administration pearl

Avoid within 4 hours of antacids, iron, calcium, magnesium, zinc, dairy.

Azithromycin: what is it?

Macrolide with fewer drug interactions.

Nitrofurantoin used for? complications w/ long-term use?

Used for uncomplicated cystitis; long-term use can cause pulmonary, hepatic, neuropathic toxicity.

Afrin

Use no more than 3 days to avoid rebound congestion.

Pseudoephedrine/phenylephrine: uses, caution in?

Decongestants

Avoid or use cautiously in HTN/CAD; can cause palpitations/tremor/anxiety.

Dextromethorphan what is it? Increases risk of?

Anti-tussive. Can increase serotonin syndrome risk with MAOIs/SSRIs/SNRIs.

classic sign of aspirin toxicity

Tinnitus is classic sign.

Acetaminophen toxicity is most common cause of?

Most common cause of acute liver failure from overdose.

Topical steroid potency

class 1 is highest potency to class 7 is lowest potency

Palms/soles need stronger steroids; face/eyelids/genitals need low potency only briefly.

Drugs to avoid in pregnancy

Warfarin, isotretinoin, finasteride, misoprostol, methimazole, thalidomide, live vaccines.

Lithium toxicity s/sx

Seizures, slurred speech, polyuria, polydipsia.

Phenytoin toxicity

Nystagmus, ataxia, confusion; gingival hyperplasia is chronic adverse effect.

St. John’s wort

Used for mild depression; avoid with SSRIs, triptans, HIV protease inhibitors.

Ginkgo biloba

used for brain function/memory/ blood circulation

May increase bleeding risk and should be stopped before surgery.

Down syndrome newborn features

Upslanting palpebral fissures, macroglossia, single palmar crease, hypotonia, poor Moro reflex.

Cryptorchidism

Undescended testis; increases risk of testicular cancer; refer/repair within first year if persistent.

Port-wine stain

Usually unilateral, persists/grows with child; if around eye, refer to ophthalmology.

Diaper dermatitis candida looks like?

Involves skin folds and has satellite lesions.

Red reflex abnormality

Leukocoria/white reflex requires urgent pediatric ophthalmology referral.

Vitamin D for breastfed infant

400 IU daily.

No cow’s milk

Avoid in first year of life.

Pathologic jaundice

Jaundice within first 24 hours of life is always pathologic.

PDA murmur

Continuous machine-like murmur at left infraclavicular area.

PFO (patent foramen ovale) what is it? murmur?

It is a small, flap-like opening between the upper two chambers of the heart (the atria) that fails to close naturally after birth: asymp

Does not produce a murmur.

VSD murmur

Typically systolic.

ASD murmur

midsystolic, Ejection murmur with fixed split S2.

Milestones 2 months

Coos and smiles.

Milestones 6 months

Rolls both ways, transfers objects hand-to-hand, babbles, good eye contact.

Milestones 9 months

Stranger anxiety, pat-a-cake, peek-a-boo.

Milestones 12 months

First words, may begin walking.

Neuroblastoma what is it?

Fixed firm abdominal mass that usually crosses midline; adrenal origin is common.

Wilms tumor

Flank-to-midline abdominal mass that usually does NOT cross midline; do not palpate.

Epiglottitis s/sx

Hot potato voice, tripod positioning, drooling; emergency.

Orbital cellulitis s/sx

Pain with eye movements, fever, proptosis, abnormal EOMs; send to ED.

Child abuse red flag

Posteromedial rib fractures.

Kawasaki disease s/sx & tx

Fever 5+ days plus mucosal changes, conjunctivitis, rash, extremity changes, cervical node; treat with IVIG + aspirin.

Reye syndrome

Encephalopathy and liver failure after viral illness plus aspirin use.

Still’s murmur

Benign vibratory/musical systolic murmur louder when supine or febrile.

Impetigo

Honey-colored crusted lesions; usually staph or strep.