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This document covers a wide range of musculoskeletal disorders, including variations in insulin sensitivity among ethnic groups, epicondylitis, gout, osteoarthritis, and acne. It provides detailed information on clinical presentation, risk factors, diagnostics, and treatment options. The content covers pathophysiology, epidemiology, and management strategies, making it a comprehensive resource for healthcare professionals and students interested in musculoskeletal health.
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A 24-year-old, otherwise healthy college student presents with c/o cough x 6 weeks. She has tried several OTC cough meds with no improvement. What is the most important information to consider when building your differential diagnoses? A) Her age B) Family hx C) Ineffectiveness of OTC cough medicines D) Length of time she has been coughing - Answer D) Length of time she has been coughing
Why? This information helps you build your ddx Acute cough < 3 weeks: bronchitis, sinusitis, PND, exacerbation of COPD/asthma, pneumonia, pulmonary embolism Chronic cough (>8 weeks) GERD and Asthma are most common causes, also consider infection (e.g. pertussis, atypical pneumonia), ACE inhibitors, chronic bronchitis, bronchiectasis, lung ca) According to the CDC, what drug class is considered first-line treatment for pertussis? A) Sulfonamide B) Tetracycline C) Macrolide D) Beta-lactam - Answer C) Macrolide antiobitic (e.g. Azithromycin, clarithromycin Sulfonamides are second-line
What antibiotics are avoided in CAP caused by atypical pathogens? - Answer Beta-lactams (ineffective) A 38-year old mother of two teenagers recently recovered from Mycoplasma pneumonia a couple of weeks ago. She asks if she should get the "pneumonia shot." She takes levothyroxine 88 mcg daily for hypothyroidism, but is otherwise healthy. How do you respond? A) No, it's too soon after your infection B) No, it's not indicated C) Yes, you can get it in about a month D) Yes you can get it today - Answer B) No, it's not indicated An otherwise healthy adult without immunocompromise or multiple comorbid conditions is not a "vulnerable population" The pneumonia vaccine does not prevent mycoplasma pneumonia According to GOLD, what is required to establish the diagnosis of COPD? - Answer Spirometry (FEV1/FVC ratio < 70%)
How do inhaled anticholinergics work to treat shortness of breath in COPD? A) They cause bronchodilation in the lungs B) They block the action of acetylcholine and prevent bronchoconstriction - Answer B) They block the action of acetylcholine and prevent bronchconstriction Name a short-acting inhaled anticholinergic: - Answer Ipratropium (Atrovent) Name a long-acting inhaled anticholinergic: - Answer Tiotropium (Spiriva) How do inhaled betá-agonists work to treat shortness of breath in COPD? A) They cause bronchodilation in the lungs B) They block the action of acetylcholine and prevent bronchoconstriction - Answer A) They cause bronchodilation in the lungs
What are the only 2 inhaled short-acting beta agonists (SABAs): - Answer Albuterol and levalbuterol Name an inhaled long-acting beta agonists (LABAs): - Answer Salmeterol (Serevent) What are the side effects associated with anticholinergic medications? - Answer Cognitive impairment, confusion, hallucinations, dry mouth, blurry vision, urinary retention, constipation, tachycardia, acute angle glaucoma "Can't see, can't pee, can't spit, can't shit." Name a inhaled combined short-acting anticholinergic/short-acting beta agonist: - Answer Ipratropium/albuterol (Combivent) Name a inhaled combined long-acting beta-agonist/corticosteroid - Answer Fluticasone/salmeterol (Advair)
A patient with asthma symptoms daily with occasional nighttime awakenings has A) Intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma D) Severe persistent asthma - Answer C) Moderate persistent asthma A patient with asthma symptoms more than twice a week, but not daily with occasional nighttime awakenings has A) Intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma D) Severe persistent asthma - Answer B) Mild persistent asthma A patient with asthma symptoms less than twice a week has
C) Hyperkalemia and diabetes D) Hypertension and diabetes - Answer B) Cataracts and osteopenia What medication combination is considered unsafe in a patient with asthma? A) Fluticasone and albuterol B) Mometasone, formoterol, albuterol C) Budesonide and levalbuterol D) Salmeterol and levalbuterol Why? - Answer D) Salmeterol and levalbuterol Salmeterol is a long-acting beta agonist. LABAs MUST be combined with an inhaled corticosteroid (e.g. Advair, Breo, Symbicort) A 30-year old male has persistent asthma. What daily medication regimen would be appropriate?
A) Albuterol B) Low-dose fluticasone, albuterol C) Medium-dose fluticasone D) Budseonide, salmeterol, albuterol - Answer C) Medium-dose fluticasone Albuterol alone is used for intermittent asthma Albuterol should not be used daily (if the patient is using their rescue inhaler more than twice a week --> call the PCM!) Mr. Jones, a 45-year old drug and alcohol counselor, smokes 1 PPD and c/o cough, low-grade fever, and night sweats for the last week. His CXR show bilateral hilar nodes. What should you do next? A) Refer to Pulmonology B) Order a chest CT with contrast C) Order a TB skin test
How would you manager her today? A) Repeat CXR, CBC, and start levofloxacin B) Start azithromycin 5-day pack C) Continue with amoxicillin-clavulanate for another 24 hours D) Stop amoxicillin-clavulanate and start doxcycline 100 mg BID x 7 days
B) Azithromycin 500 mg on day 1, then 250 mg daily on days 2-5, plus amoxicillin 1000 mg BID C) Cephalexin 500 mg PO BID x 5 days D) Doxycyline 100 mg PO BID x 5 days - Answer B) Azithromycin 500 mg on day 1, then 250 mg daily on days 2-5, plus amoxicillin 1000 mg BID Quinolones (e.g. levofloxacin) and tetracyclines (e.g. doxycycline) are teratogenic and should not be given during pregnancy A 63-year old patient w/ COPD c/o a pounding heart after using his inhaler. Which of the following is the least likely culprit? A) Fluticasone B) Albuterol C) Iptratropium D) Salmeterol - Answer A) Fluticasone
An obese 55-year old woman with a history of moderate persistent asthma has a temperature of 101F, bilateral wheezes, mild shortness of breath, and purulent sputum. Her med list includes: fluticasone/salmeterol BID, albuterol PRN, amlodipine 5 mg, levothyroxine 99 mcg daily, and metformin 1000 mg BID. How should she be managed today? A) Treat with azithromycin daily for 5 days B) Treat with ciprofloxacin, nebulized albuterol q4-6 hours PRN for wheezing C) Treat with oral steroid and nebulized levalbuterol q8 hours PRN D) Treat with levofloxacin, nebulized albuterol q4-6 PRN for wheezing - Answer D) Treat with levofloxacin, nebulized albuterol q4-6 PRN for wheezing She is more likely to have Strep pneumoniae and should be treated with a quinolone. Ciprofloxacin is not a respiratory quinolone
An obese 55-year old woman with a history of moderate persistent asthma has a temperature of 101F, bilateral wheezes, mild shortness of breath, and purulent sputum. Her med list includes: fluticasone/salmeterol BID, albuterol PRN, amlodipine 5 mg, levothyroxine 99 mcg daily, and metformin 1000 mg BID. She is being treated for pneumonia with levofloxacin and nebulized albuterol q4- PRN for wheezing. She develops white plaques on the buccal mucosa, palate, and tongue (thrush). What medications are the most likely cause of this? A) Levofloxacin and metformin B) Albuterol and levofloxacin C) Metformin and fluticasone D) Fluticasone and levofloxacin - Answer D) Fluticasone and levofloxacin Anemia is a reduction in one or more of what RBC measurements? - Answer RBC count (4.2-4.9 mil/microL), hemoglobin (12-15 g/dl), or hematocrit (37-51%)
