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1928 Cards in this Set
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Define: Mean Corpuscular Volume (MCV)
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Size of erythrocyte
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Where are growth hormones secreted
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Anterior pituitary gland
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Define: Mean corpuscular hemoglobine
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amount of hemo in each erythrocyte by weight
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Give s+s of acromegaly
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excessive acral growth, facial features, sweating, HA, peripheral neuropathy, decrase energy osteoarthitis, depression, galactorrhea
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Define: mean corpuscular hemoglobin concentration
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concentration of hemo in each erythrocyte
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Give physical exam of acromegaly
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earliest most common: facial puffiness, broad nose, furrow brow, skin thickening
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Define: Hemoglobin electrophoresis
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% of different types of hemo in erythrocytes
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What is the Diagnostic for acromegaly
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Definitive test is the oral glucose tolerance test: GH secretion should be suppressed by oral glucose load
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Obtain Serum ferritin determination to:
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ID depletion of iron in body
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Define transferring saturation and disease which it might be abnormal:
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% transferring saturated w Fe
acute hemorrhage, sideroblastic, anemia, IDA, thalassemia |
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Acromegaly and patient education
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life long chronic progressive disease, physical changes don't remit w/ therapy. But may slow down or stop just cant reverse.
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When may you find a abnormal neutrophil count ie >than 0
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myeloproliferative disorders, hematopoietic disorders, hemolysis, infection, immune deficient
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What is Total Iron binding capacity (TIBC) and when might you find it abnormal?
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amount of Fe in serum plus amount of transferring available in serum
IDA: TIBC: High due to low Fe we have high capacity low Fe ACD: Low: less transferrin (more ferritin) |
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Addisons (adrenal gland disorder): define
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destruction or reduction in adrenal gland
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When do expect to see a rise in lymphocyte
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infection lymphocytosis, mononucleosis, anemias, leukemia, hodgkins
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S+S of Addison disease
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N/V, hypotension, acute shock (trauma or illness). Chronic: n/v, dizzy, chronic abd pain, hyperpigment, lethargy weakness
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When would you see an abnormal plasma cell count
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mononucleosis, monocytic leukemia, plasma cell leukemia
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PE how do patients with addison look
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chronically ill, dehydrated
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What diagnostic test are needed for Addison disease
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Elevated ACTH and suppressed cortisol, hyponatremia, hypercalemia (CMP), CXray (exclude TB)
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plasma cell count
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mononucleosis, monocytic leukemia, plasma cell leukemia
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Management of Addison disease (chronic)
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oral hydrocortisone 20-30mg/d (restore diurnal pattern) and fludrocortisone (0.05-0.2mg/d) correct renal and hypotension.
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Describe Erythropoietin patho
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secreted by kidney response to tissue hypoxia--> increase production of RBC
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What is the management of acute adrenal insufficiency
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IV hydrocortisone 100mg q 6hr for 24hr then taper. hypotension, hypovolemia, hypoglycemia ICU
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Neutrophil should be the same as adults at what age
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same as adults by 2 wks
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What is patient education of Addison Disease
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med adjust w/ fever and common illness (hydrocortison doubled quickly) never stop steroids quickly
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when do eosinophil and monocytes reach the level of adults in the body?
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high first year same as adult by 1 yr
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Define Cushings (basic)
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Over production of cortisol (adrenal disease)
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What are characteristics of RBC: deficient B12 or folate
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macrocytic-normochromic anemaia (megoblastic)
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What are S+S of chronic changes of Cushings disease
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weight loss, loss of menses, libido, depression ,insomnia, bruising
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pernicious anemai most commonly due to
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B12 deficient: typcially chronic gastritis (DM1, thryroid, graves, myasthenai gravis, alcohol, h. pylori)
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What do you find on PE of Cushings disease
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exogenous/central obesity, moon face, thickening facial fat, buffalo hump
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Discuss folate
Macrocytic-normochromic |
Vit B for erythrocyte production, absorbedin upper intestin
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What diagnostic do you perform for Cushings
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24hr urine cortisol levels repeated 2-3x
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Sx of deficient folate
Macrocytic-normochromic |
scales, fissures in lips, corners of mouth , stomatitis, sores ulceration of buccal and tounge swelling
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What is the management of Cushings
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Depends on source of hypercortisolism: pituitary resection, Chemo,
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Most common anemia and cause
also microcytic -hypochromic |
iron deficient: diet, ASA, NSAID, GI surgery, pica craving
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What do you find on PE of pheochromocytoma:
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HTN >170systolic, arrythmias, tachy or brady
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Sideroblastic anemia (SA) are rare: Symptoms include
microcytic-hypochromic |
Sx: iron overload erythropoietic hemochromatosis = splenomegly and hepatomegaly
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Initial eval of alcoholic would include what
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CAGE
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Aplasic anemia (AA) cell type
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normocytic-normochromic anemia
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What part of an alcoholics life is usually affect last between family, health, realtionships, work.
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Work is affected last
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Define Aplastic Anemia: normocytic-Normochromic and risk associated w/ disorder
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absence of all three blood cells, rapid progression high risk of death form infection, bleedin, ulceration fo mouth pharynx
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What are the 5 stages of Prochaska's change framework
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1. Precontemplation: not interested in change
2. contemplation: consider change & pos/neg aspects 3. Preparation: makes some change to behaviors or thoughts but feeling of no tools to proceed 4. action: ready to make change 5. maintenance/relaps: learns to continue the change and deal w/ backsliding |
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Anemia of Chronic Disease (ACD) cell type?
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normoctyic -normochromic anemia
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What are the 3 steps for alcohol screening according to NIH
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1. ask about use
2 assess for alcohol problems 3. advise appropriate action 4. monitor patient progress |
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ACD (anemia of chronic disease) may be caused by:
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AIDS, RA, SLE, malaria, Hepatitis, CHF: patho: decrease life span, suppressed erythropoietin, Fe metabloism
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How soon after stopping do alcohol w/ drawals begin, and peak.
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begin in 12 hrs after last drink and peak 24-48hrs w/ abatement over few days.
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ACD (anemia of chronic disease) Evaluation
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unable to repsond to Fe replacement, low TIBC, high serum ferritin
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What are sx of alcohol w/drawal
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agitation, hallucination , disorientation, seizures
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Anemia Hemaglobin values
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<14 male, < 12 female, no sx till < 6 in healthy adult
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What medication is useful for alcohol w/drawals:
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benzodiazepines: ativan.
also tx dehydration, malnourishment, infection |
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Anemia: sx
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fatigue, malaise, dyspnea decrease exercise tolerance
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What are some inpatient detox criteria for the alcoholic?
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other acute illness (infection, cardiac), alcohol related sx prior to detox, prior w/drawal sx of delirium tremors or seizures, coexisting mental health like depression
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Anemia: sx
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wide pulse pressure, midsystolic murmur, brittle nails, cheilitis, atrophy o ftongue, spoon shaped nails, pallor
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What benzodazapine should be used on an alcoholic w/ hepatic dysfunction
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lorazepam (or other short acting)
if no hepatic deficiency then valium |
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Anemia: Diagnostic
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CBC w/ platlet, RBC morphology, periphera smear, reticulocyte count (decrease production or increase loss)
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What role do antipsychotic play in managing w/drawal of alcohol
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no role, they are not used in alcohol w/drawals
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What does changes in reticulocyte mean for Anemia Diagnostic test results?
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>100 normal responding marrow to anemia
<75 impaired RBC production, low reticulocyte count MCV most useful to ID reticulcytosis or decrease reticulocyte count |
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What medication is used for the physical sx of alcohol w/drawal such as tachycardia or tremors?
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beta blocker (propanolol, atenolol)
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Anemia: norms of Serum Fe males and females
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40-150 for males and 40-160 for females
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What do you use for nutritional deficencies in alcoholics
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high dose B vitamin and supplement of thiamine, pyridoxine, folic acid and vit C
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RBC size anemia: list disease with Microcytic (MCV <80)
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Fe deficiency, thalassemai, ACD, sideroblastic
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Which is more specific for hepatic damage: ALT or AST
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ALT: more specific to liver due to limited concentration in other organs. U should ID the ration of AST/ALT in alcoholics
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RBC size: list disease w/ Macrocytic (MCV >100)
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Megaloblastic andema (B12 and folate deficent)
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How many criteria must be met diagnose substance abuse?
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three of the following:
-tolerance (need for increase intake to produce same result) -Withdrawal (substance needed to stop w/drawal sx) -use amount or duration of use greater than intended -repeat attempts to stop w/o success -to much time spent using, recovering or trying to obtain -reducing or abandoning social, occupation, rec activities due to use -cont use despite knowing it causes problems |
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RBC size: list disease w/ normocytic (MCV 80-99)
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sicle cell, anemia, chronic disease, aplastic anemia, hemplytic anemias
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Who have higher rates of misuse of prescription medication? men or women
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women: thought to be due to higher use of health system
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Discuss causes of Microcytic anemia
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most common, GI or menorrhagia blood loss, IDA , need 15mg/day Fe or 30mg/d if pregnant. Fe absorbed in duodenum
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Which benzodiazapine has a higher abuse potential: short or long acting
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rapid-onset or as needed basis increase abuse potential.
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Discuss microcytic anemia Sx/PE
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Fe store depletion, parestesia, sore tongue brittle nails (koilonychias) Pica, pallor of conjunctiva
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Name on benzodiazapine that has long half life and slow onset...which also decreases risk of dependence
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clonazepam
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What is the first dosing step to discontinue benzodiapine in a patient that is psycholigically dependent
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reduce dose by 25% per week.
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Microcytic anemia: diagnostic
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fall in feriting level --> Fe depletion, first change is decrease hemoglobin
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How quickly does the onset of w/drawals begin with benzos
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a few days w/ shorter half life (lorazepam) and up to 3 wks w. longer half life (clonazepam)
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Microcytic anemia Tx
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oral Fe prep: 150-200mg/d, 4-6months until serum ferritin exceeds 50mcg then stop
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What are physical sx of benzo w/drawals?
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HTN, tachycardia, diarrhea, nausea, hyperthermia, restlessness, myalgia, lacrimation , rhinorrhea
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Fe patient education
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30 minutes before meals w/ ascorbic acid (OJ) to aid absorption
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What alpha-adrenergic antagonist help minimize opiod w/drawal
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clonidine (also works on HTN)
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Lifespan: When should you use Fe supplements. What is the best indicator of deficit
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Fe supplements during prego especially last two trimesters. Ferritin level best indicator of IDA
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What is a medication that is used in the tx of w/drawal of heroin but also has addictive qualities
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methadone
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Thalassemia patho and risk
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inherited, at risk: middle east, asisan, med, africa
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What are risk associated w/ chronic marijuana use
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COPD, driving impairment
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polycythmia vera: sx
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ruddy, red face, hands feet, ears, engorgement of retinal cerebral vessels
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What drug class is Rohypnol
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benzodiazapines
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How do you tx Polycythema vera
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ASA..50% die w/in 18 m of sx if no tx
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What is the DSM-IV criteria for anorexia nervosa:
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inability or refusal to maintain body weight
-85% normal weight for height -intense fear of gaining weight and becoming fat, -perception of body weight and shape |
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Define Leukopenia and when you might find it
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WBC <1000, > risk infection
Causes: radiation, shock, SLE, chemo |
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what r the 2 types of anorexia demonstrated:
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restricting (intake) and no binge and binge-purge in cycles (not secretive like bulimia nervousa
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Define Leukocytosis and when might you find it;
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>11K, infection, exercise, surery, prego, drugs also polycythema
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Treating anorexia nervosa includes both
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cognitive-behavioral and pharm
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During an infection cycle, when will you see Granulocytosis or neutrophilia?
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in the early stages of infection
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What medication can be used to increase appetite and reduce anxiety in anorexia
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Cyproheptadine (Periactin): 1st gen Antihistamine
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define neutorpenia
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Decrease in circulating netraphils: low <2000, <500= agranulocytosis
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DSM-IV criteria for bulimia nervosa
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eating excessive for a discrete period w/ lack of control then binge, laxative, diuretic or fasting
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Acute leukemias (ALL, AML) patho
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AML: most common adult: decrease apoptosis --> splenomegaly and hepatomegaly
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Sx of bulimia
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hypokalemia, dental enamel erosion, parotid gland enlargement
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Hodgkins lyphoma: cause
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no apoptosis of B cell nor immunoglobin gene: eBV
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Sx of anorexia
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lanugo, dysrhythmias, hepatomegaly, cheilosis, gum disease, dry skin, hypotension w/ bradycardia, hypothermia
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Non-hodgkin lymphoma: cause
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too many abnormal WBC build up in spleen, bone marrow, liver resulting in cancers
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What r the pharm tx of bulimia
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antidepressants: SSRI
Wellbutrin should not be used may increase bingeing or seizure |
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Hodgkin lymphoma: sx
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fever, night sweats, weakness, weight loss
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What are the characteristics of binge eating and how does it differ from bulimia nervosa
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lack of control over amount and type of food, at least 6 months, distress, self anger sham over amount eaten. There is no purging with this type they are usually obese
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Non-hodgkin lymphoma: sx
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fever, night sweats, weakness, weight loss AND pleural effusion, abd pain, spleno and hepatomegaly
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Depression diagnosis typically includes:
a. early morning wakening b. unable to fall asleep c. hyper state d. none |
early morning wakening
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hodgkins and non-hodgkins TX
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radiotherapy, surgery, chemo
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DSM-IV criteria for depression
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5 or more sx for 2 wks:
-mood, diurnal variation (morning worse than later in day) -interest: lack of former pleasure -eating: increase or decrease w/ weight change -sleep: waking at 3-4am w/ inability to fall back asleep -motor activiy: agitated or retarted -fatigue: lack of energy -self-worth: inappropriate guilt -concentration: difficulty, indecisiveness -repeated thoughts about death or suicide -depressed mood or decrease interest must be one of them |
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Thrombocytopenia definition
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platelet count <100,000: decrease platelet production increase consumption
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What are the difference between depression and dementia
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dementia: cognitive changes slowly over years w/ depression much shorter
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What leads to acquired thrombocytopenia:
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viral infection, drugs, nutritional deficiency, CRF, aplastic anemia
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What would u consider the dx in a person taking benzo for anxiety but feeling worse
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depression
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Disseminated intravascular coagualtion (DIC)
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clotting and hemorrhage simultaineously occur
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psychomotor agitation w/ fidgeting and irritabilty found in patients w/ depression: what age group is this found
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kids and adolescents and Type A adults
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DIC: Diagnostic and Tx
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D-Dimer test most reliable and specific. TX: underlying causes
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What are the combined approach for depression tx:
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interpersonal therapy and pharm: interpersonal alone has 60% relapse
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Cell description consistent w/ IDA
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low MCV, low MCH or microcytic, hypochromic
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Dysthmia: define
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low -level daily depression w/ at least two previously ID depressive sx in 2 years (adults) 1yr (child)
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Hematocrit at 23% tx w/ Fe what labs change should you see.
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reticulocytosis (fitzgerald)
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A change in feeling such as "feelig good to be alive for the first time" would be found in what dx
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dysthmic
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What happens when you take cipro and Fe together
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inactivate drug compound may be formed (fitzgerald)
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What is the dx of major depression (criteria)
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depressed mood >3m after death or loss
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What supplement prevents neural tube defect in prego
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Folic acid
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chronic ingestion of over cooked food make you at risk for
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folate deficent anemia (fitzgerald)
what type of anemia is that? |
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What is the tx for adjustment disorder
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interpersonal therapy
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SSRI: Paxil what are the indications, A/Rxn,
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: panic disorder, depression, OCD
A/Rx: sedating (HS best), constipation, antihistamine increase appetite, comments: good if hepatic dysfunction, good in elderly due to short T1/2 life. use slow tapering to decrease w/drawal effect |
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pernicious anemia caused by
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lack of intrinsic factor (fitzgerald)
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SSRI: Zoloft: indication, adverse rxn
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depression, panic, OCD:
Adverse: GI upset, sleep disturbance comment: take w/ food to enhance absorption |
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SSRI: Celexa and Lexapro: indication, Adverse rxn
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Depression,
Rxn: somnolence and insomnia, agitation and anorexia comment: lexapro has better adverse rxn profile vs celexa |
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PE of pernicious anema
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stocking glove neuropathy (fitz)
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SSRI: Prozac: indication, rxn
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depression, OCD, bulimia
rxn: energizing, anorexia common comment: am dosing, long 1/2 life bad for elderly, weight loss not sustained |
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Asian: hbg: 9.1L, Hct 28%L, RBC 5, MCV 68L, RDW 13 = Dx
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thalessemia: asian and anemic also look at RDW:
Iron Deficiency Anemia: usually presents with high RDW with low MCV Folate and vitamin B12 deficiency anemia: usually presents with high RDW and high MCV Recent Hemmorrhage: typical presentation is high RDW with normal MCV |
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What is the mechanism of action of antidepressants
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increase availability of selected neurotransmitter (serotonin, norepinephrine, dopamine)
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57y/o female w/ RA Hgb=10.5, Hct 33%, MCV88 = Dx
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anemia of chronic disease (ACD): normal Hct: 36-46, Hem: 12-16, MCV: 80-100
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How long do SSRI S/E usually last.
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2-6wks,
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Unilateral throbbing HA w/ difficulty chewing and tender noncompressible temporal artery
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giant cell arteritis
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Tricyclics: Effexor: indication, rxn
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depression
stimulant in larger amounts, need trazodone to help w/ sleep, Nausea at high dose, increase dystolic by 5 comment: SSRI in low doses, dopamine effect at high dose |
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Tx of giant cell arteritis
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systemic corticoid therapy
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What antidepressant is useful in those with substance abuse too
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wellbutrin (dont use in anorexia)
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Most serious complication of giant cell arteritis
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blindness
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What are some tricyclic antidepressants
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nortriptyline, desipramine
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What is agnular chelitis
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fissuring and cracking at corners of mouth:
caused by fungal or deficient B12 or Fe |
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Sx of SSRI w/drawal syndrome
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dizziness, paresthesia, anxiety, nausea, sleep disturbance, insomnia
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Tx of angular chelitis
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nystating (fungal infection)
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Serontonin activity on 5-HT1A receptor sites is used to Tx:
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antidepressant, OCD, antipanic, antisocial
comment: action site basis of most antidepressant, antipanic |
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What causes bilaterally itchy, red eyes, tearing throughout year, rope eye discharge (think basic)
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allergen
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Which antidepressants should be used in place of tricyclics if there is risk of suicide
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SSRI and atypcial antidepressants due to their increase safety profile
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suppurative conjunctivitis TX
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bacitracin- polymyxin B, cirprofloxacin or erythromycin (dont use a penicillin)
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Required length of pharm intervention in depression per AHCPR guidelines
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6-9m:
-acute phase tx to bring sx under control may last 3m -cont med for minimum of 6m after depression remission -relapse highest in first 2 m after discontinuation of therapy consider maintenance as w/ any chronic illness |
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Acute recurrent allergic conjunctivits
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cromoly opthalmic gtts, oral antihistamies
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What are some risks in depression relapse
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dysthmia preceding episode (feeling great life is best)
-poor recovery between episodes -current episodes >2yrs -onset depression <20yrs or >50yrs -FHx of depresssion -severe sx such as suicide or psychosis |
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Sx of angle-closure glaucoma
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sudden HA pain in left eye, blurred vision, pupil dilated, firm eyeball
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Seotonin receptor site: 5-HT1C, 5-HT2C: activity when stimulated
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influence CSF production, cerebral circulation, regualtion fo sleep. perception of pain, cardio function
comment: reason tachycardia, dizziness, alteration of sleep pattern and change in pain perception occurs w/ SSRI |
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Sx: vision change w/ dull pain, photophobia, effected pupil is small irregular: What is the ocular disease.
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anterior uveitis
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Serotonin receptor site: 5-HT1D activity when stimulted (triptans)
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antimigraine activity; triptan preparation works by stimulating receptor site, TCA works at this site
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what happens if you dont tx primary open angle glaucoma
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peripheral vision loss
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Serotonin receptor site: 5-Ht2 activty when stimulated
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agitation, akathisia, anxiety, panic, insomnia, sexual dysfunction, excessive upregulated in those w/ depression
receptor site highly stimulated in activating SSRI such as fluoxetine. causes sexual dysfunctioni n SSRI, -nefazodone and trazodone antagonize action at this site and tx of anxious depression and have more favorable sexual profile |
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Who is at risk of developing primary open angle glaucoma (POAG)
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african, DM2 advanced age
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Serotonin receptor site: 5-HT3 activity when stimulated
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nausea, GI distress, diarrhea, HA
stimulated w/ antidepressant w/ poor GI side effect profile. Zofran blocks activity at site (5-HT3 antagonist) |
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What is the tx for primary open angle glaucoma?
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beta adrenergic antagoinst, alpha agonist, prostaglandin: opthamology referral emergent
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Which class has more side-effects: TCA or SSRI
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TCA but are superior to SSRI when depresion is moderate to severe also w/ patients w/ pain
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Sx: pimple to eyelid, pustule, eye lid margin: what is the dx
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hordeolm
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Depression w/ episodes of mania is dx w/:
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bipolar I disorder
Mania: -grandiosity or exaggerates self esteem -reduced need for sleep -increased talkativeness -flight of ideas or racing thoughts -easy distractibility -psychomotor agitation -poor judgement for at least 1 wk |
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sx: bump on eyelid, hard, nontender swelling lateral border: what is the dx
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chalazion
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Bipolar 1 disorder is most common in: Men or women
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Women: onset around puberty
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Tx of hordeolum
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oral antimicrobial
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Dx of Bipolar 2 is made if
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depression has episodes of mania lasting less than 4 days w/ little social incapacitation (remain productive)
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Prevention of meniere disease
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avoid ototoxic drug (ending in mycin), protect load noise, limit sodium
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Cyclothymic disorder includes:
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mood disorder present 2yrs w/ episodes of mania lasting less than 4 days
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define dizziness
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perception of altered equilibrium
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If a TCA is given to a person with bipolar disord what do 15% develop?
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mania
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define vertigo
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perception of person or environment moving
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define nystagmus
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rhythmic oscillation of eyes
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What is the onset rate of benzodiazepine:
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rapid onset
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define tinnits
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perception fo abnormal hearing or head noises
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Buspiorn (BuSpar) has: high, moderate or low abuse potential?
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low abuse potential
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Tx of otits external
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analgesic (T3), VolSol (acid), steroid w/ an antibiotic like neomycin or florquinolone
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|
|
New onset of panic disorder findings would include:
|
peak sx 10min, hx of agoraphobia, chest pain during attack
|
|
|
PE of otits external
|
tragus pain on palpation, possible conductive hearing loss, drainage
|
|
|
What med is used for panic disorder
|
Paxil (SSRI antidepressant)
|
|
|
PE of acute otitis media
|
tympanic membrane immobility
|
|
|
Diagnostic criteria for generalized anxiety include
|
difficulty concentrating apprehension, irritability
|
|
|
Tx of patient with acute otits media but allergic to PNC
|
clarithromycin (macrolide)
|
|
|
According to the AHCPR tx guidelines pharm tx for anxiety should be continued for how long
|
6m AFTER remission is achieved
|
|
|
Tx of otits media not improved after 4 d of amoxicillin would be what antibiotic:
|
Erythromycin (if PNC allegeric)
Augementin (beta-lactam) Zithromax (macrolide) cefuroxime (Second gen cephlasporin) |
|
|
Which medication may mimic anxiety disorder:
|
sympathomimetic
|
|
|
M. catarrhalis results from
|
high beta-lactamase production (PNC worthless)
|
|
|
Rapid w/drawal of lorazapam will result in what side effect
|
tremors and hallucinations
|
|
|
What is Centor Criteria for pharyngitis
|
Hx of fever, tonsillar exudates, tender anterior cervical adenopathy, absence of cough
|
|
|
Risk of benzodiazepine misuse minimized if a: longer, shorter or rescue (PRN) dose is perscribed
|
longer duration of action
|
|
|
PTSD may report having:
|
agoraphobia (panic attack), feeling of detachment, hyperarousal
|
|
|
Define Primary Prevention
|
measures to prevent onset of targeted condition
|
|
|
Pharm tx for PTSD include
|
Buspirone (BuSpar): low abuse potential
|
|
|
Example of Primary Prevention
|
immunization, health education, seat belts...most cost effective form of healthcare
|
|
|
Pharm Tx for irritability and impulsiveness in PTSD
|
carbamazepine: Tegratol (anticonvulsant)
|
|
|
Define Secondary Prevention
|
identify and treat asymptomatic person who already have disease but not apparent; alter natural course of disease
|
|
|
OTC herbal used for sx of depression
|
St. John Wart
|
|
|
Example of Secondary Prevention
|
screening test; colonoscopy, mammography
|
|
|
Tx resistant panic disorder may respond to
|
monoamine oxidase inhibitor: caution due to many S/e of medication
|
|
|
Define Tertiary Prevention
|
Care of established disease to restore highest function while minimize neg effect..primary prevention has been unsuccessful
|
|
|
Define Specificity
|
proportion of negative which are correctly identified
|
|
|
Tx of pt w/ panic disorder using SSRI w/ the goal being?
|
reduction in number and severity of panic attacks is the goal
|
|
|
Example of specificity
|
% of HEALTHY people correctly identified as NOT having a certain condition: Ex: A sore throat that does not have strep has a negative rapid strep, that is specific.
|
|
|
DSM-IV criteria GAD (generalized anxiety disorder)
|
-excessive anxiety or worry most days for 6m
-difficulty controlling worry, physical or mental distress -problems cannot be attributed to med or alcohol, disease or other condition -3 of the following: muscle tension, restlessness, fatigue, difficulty concentrating, irritability, difficulty initiating sleep |
|
|
Define Sensitivity (statistical)
|
proportion of actual positives which are correctly identified as having condition (sore throat w/ strep actually has positive rapid strep: that is sensitive)
|
|
|
Depression w/ anxiety reports: which first
|
nervous feeling after onset of depressed mood
|
|
|
Example of sensitivity (statistical)
|
% of SICK people who are correctly identified as HAVING the condition
|
|
|
Cardinal presenting signs of anxiety disorder:
|
tachycardia, hyperventilation, palpitation, tremors, sweating, difficulty falling asleep
|
|
|
define p-value; statistical significance
|
Represents PROBABILITY of error. Higher P value the less reliable P- 0.5 is borderline acceptable level of error
|
|
|
What mechanism of action do benzo have for anxiety disorders
|
enhance GABA function and products that enhance availablity of serotonin
|
|
|
define veracity
|
health professionals honest and full disclosure. Obstain from deceit report lapses in standard of care...ie honesty (medical-dictionary.com)
|
|
|
Which benzo are more lipophilic and why is this important in tx of anxiety
|
valium or clonazepam: enter brain more rapidly and igniting effect promptly (may feel intoxicating)
note: longer half life left in fat. |
|
|
Define nonmalficence
|
avoid harming others (medical-dictionary.com)
|
|
|
Why is it important to know which benzo are more hydrophilic?
|
slower onset of action less intoxicating same therapeutic effect
|
|
|
Define beneficence
|
the act of doing good, kindness (medical-dictionary.com)
|
|
|
Which benz may be better for tx anxiety in the elderly
|
Serax: short half life
|
|
|
Define automony
|
the act of being independent or self governed
|
|
|
When working to reduce amount of benzo used how much should you decrease it:
|
25% per wk
|
|
|
Define justice
|
fairness, up holding what is just
|
|
|
What are sx of w/drawal of benzo w/ rapid removal of med
|
tremors, hallucination, seizures, delirium tremors
|
|
|
Define fidelity
|
Faithfulness to obligations, duties, or observances.
|
|
|
What is the average onset age of panic disorders
|
27 years rare after 45 more common in women if also agoraphobia
|
|
|
Power (analysis) statistics
|
test ability to reject null hypothesis when actually false. Max is 1 min is 0. should be close to 0 to have high power. determines sample size estimation
|
|
|
What is the tx of choice for panic disorders
|
SSRI: low side effects better than TCA
|
|
|
Define reliability (truthfulness)
|
degree consistency which instrument measures variable. Reliable if measurements today are same tomorrow
|
|
|
What is the saying when starting SSRI treatment for panic attach
|
start low and go slow: Paxil is a good starting w/ low side effect
|
|
|
Define variables (stats)
|
things measured, controlled or manipulated
|
|
|
What medication is used in PTSD w/ hyperarousal:
|
clonidine and propanolol: trazadone for sleep
|
|
|
Define correlation as related to research.
|
Do not influence variables only assess their relation
|
|
|
OTC Herb: St. Johns wort: Are similar to what medications
|
like MAOI/SSRI, TCA:
less anticholinergic effect, wieght gain than TCA -similar potential for energizing such as fluoxeting (SSRI) -TId or QID dosing needed; avoid concurrent use w/ SSRI, TCA or MAO |
I
|
|
Define experimental research
|
manipulate some variable then measure the effects: casual relation between variables
|
|
|
What does the BATHE Model stand for (used in emotionally distressed)
|
B: background
A: affect, anxiety T:trouble H: handling E: empathy |
|
|
Define dependent ( stats)
|
only measured or registered NOT manipulated
|
|
|
What are the progestatinal effects when taking oral contraceptives
|
inhibit ovulation by suppressing lutenizing hormone (LH), thickening endocervical mucus and hampering implantation by endometrial atrophy
|
|
|
Define independent variables (stats)
|
those that are minipulated
|
|
|
What are the estrogenic effects when taking oral contraceptives
|
ovulation inhibited by suppression of follicle stimulating hormone (FSH) and LH by alteration of endometrial cellular structure
|
|
|
Define retrospective (historical cohort) and give example
|
look back at events: ex: review health records to find trends.
|
|
|
How long after discontinuing oral contraception should you wait to conceive.
|
you do not have to wait
|
|
|
Define prospective (cohort) study
|
follows group over time of similar individuals who differ on certain factors under study: ex: middle age truck drivers and smoking habits and lung cancer in 20 years
|
|
|
what are non-contraceptive benfits of oral contraceptives
|
1. lower rates of benign breast tumors and dysmenorrhea,
2. menstral volume reduced 60%, 3. decreased rates of Fe deficiency anemia, 4. decrease endometrail , ovarian, breast cancer if used >5yrs, 6. less PID due to increase endocervical lining, 7. acne, hirsutism, ovarian cyst, PMS, rheumatoid arthritis sx |
|
|
Internal validity
|
approximate truth about inferences regarding causes and effect or causal relation
|
|
|
What should you do if you vomit w/in 2hrs of taking oral contraceptive
|
retake dose
|
|
|
Define external validity
|
generalizing, the approximate truth of conclusion: degree to which the conclusions in your study would hold for other persons in other places and at other times
|
|
|
If you miss taking an oral contraceptive of 30-35ug, what should you do to ensure continued prevention of pregnancy?
|
if using 30-35ug
-1 or 2 active pill then: tak as soon as possible and continue taking daily (no additional protection needed. -Missed >3d ro start a pack 3 day late: take active hormonal pill ASAP an dcontineu pills daily and use condoms or abstain until 7 days of active pills |
|
|
S. pyogenees pharyngits failure rate w/ tx with IM PNC
|
20% similar to oral tx
|
|
|
If missed oral contraceptiv of 20ug or less ethinyl estrodiol
|
missed 1 active pill then:
take active pill ASAP and continue pills daily (no other protection) Missed >2d or start 2d late then: take hormonal pill ASAP use condom for 7 d |
|
|
Expect onset when using nasal corticosteroid spray
|
a few weeks
|
|
|
A women with seizures would do better on what type of contraception
|
depo-provera: due to progestin protection against seizures.
|
|
|
What is a drug of choice for allergic rhinits
|
claritin
|
|
|
What class of contraception have potassium sparing qualities
|
drospirenone in yasmin (progestin) use w/ caution in hepatic or renal dysfunction
|
|
|
What receptors do antihistamines effect
|
H1 receptors
|
|
|
What additional medication can reduce breakthrough bleeding when using depo
|
ibuprofen, naproxen BID for 3-5 days
|
|
|
What are the action of decongestants
|
vasoconstriction
|
|
|
what supplement should be encouraged when taking depo:
|
calcium at 1000-1500mg/day
|
|
|
What medication is used for relief of acute nasal puritis
|
oral antihistamine
|
|
|
What is the soonest that a diaphragm may be removed after sex
|
6hrs should use a spermacide with the diaphragm
|
|
|
ARIA (Acute Rhinitis and Impact on Asthma) guidelines : best relief of acute nasal congestion
|
decongestant spray
|
|
|
A woman w/ recurrent UTI would or would not be a good candidate for a diaphrahm:
|
would not due to the need for spermacide
|
|
|
ARIA: least control of rhinorrhea
|
Cromoyln nasal spray
|
|
|
WHO precaution for OC
|
DVT, CHD, CVA, heart disease, breast cancer, prego, laction <6wk pp, hepatitis, HA w/ neuro sx, >35, smoker>20cig day known thromboic mutation factor V Leiden
|
|
|
What are the pathophysiological effects of Cromolyn (tx for asthma)
|
mast cell stabilizer
|
|
|
What percentage of women experience hot flashes during menopause
|
80% have hot flashes and night sweat
|
|
|
What are the effects of leukotriene modifiers (Singular)
|
inflammatory inhibitor (allergy medication used to decrease airway inflammation and mucus production)
|
|
|
Estrogen deficient vaginitis: what lab finding would u find
|
vaginal pH >5
|
|
|
GLORIA (global resource in allergy): Tx of allergic conjunctivitis
|
topical mast cell stabilizer (Cromolyn) w/ topical antihistamine
|
|
|
53y/o on hormone therapy w/ conjugated euqine estrogen having vaginitis sx should also take what topical and where
|
topical estrogen to the vagina
|
|
|
One common method to control allergies especially at night
|
dust mite control
|
|
|
relative contraindication to postmenopausal HT include:
|
seizure disorder, dyslipidemia, migraine headache
|
|
|
Acute bacterial rhinosinusitis Dx
|
URI >7-10 or worsening in 5-7 days
|
|
|
Absolute contraindication to postmenopausal HT
|
endometrial cancer
|
|
|
What sx do you find on acute bacterial rhinosinusitis (ABRS)
|
maxillary tooth ache, colored nasal discharge, URI
|
|
|
When advising perimenopausal women about HT you consider a benefit to include:
|
HT helps preserve bone density and reduce risk of osteoporosis
|
|
|
first line tx of acute bacterial rhinosinusitis
|
amoxicillin
|
|
|
post menopausal HT effects on bones include:
|
reduction in frequency of spinal and hip fx
|
|
|
Failure of treatment of acute bacterial rhinosinusitis after 72 hrs progress to:
|
augmentin
|
|
|
Progestin component of HT is given to:
|
minimize endometrial hyperplasia
|
|
|
What is the next Tx of acute bacterial rhiniosinusitis if already tx with doxycycline and a (PNC allergy)
|
levofloxacin (quinolone)
|
|
|
Selective estrogen receptor modulator therapy (Evista) helps:
|
in the reduction of osteoporosis and breast cancer risk
|
|
|
acute bacterial rhinosinusits that appears moderaly ills
|
tx with high dose augmentin
|
|
|
during perimenopause sx will most likely:
|
be in the week before the onse to menses
|
|
|
blephritis: sx; tx
|
ocular burning, eye lid margins red w/ scaling or crusting: + pain
|
warm compress, daily lid scrub, erythromycin or bacitracin ophthalmic
|
|
What is noted in short=term <1-2yrs HRT use in post menoausal
|
HRT can minimize menopausal sx
|
|
|
cellulits orbital Sx and Treatment
|
localized tenderness, erythema, edema, fever, proptosis; + pain
|
referral, IV antibiotics
|
|
What body area has highest estrogen receptor sights
|
vulva
|
|
|
dacryosystitis
|
chronic tearing, eyelash crusting, tenderness, circumscribed erytheema; + pain
|
warm compress, gentle massage, systemic antibiotics
|
|
What sx are tx when using black cohosh use in menopause?
|
decreased frequency and severity of hot flashes
|
|
|
What are the sx of chalazion
|
nontender chronic lesions, locaized erythema, edema of eyeids no pain
|
warm compress, daily lid scrubs, lid massage
|
|
Adding androgen to HT may well be suited for woman w/
|
sever hot flashes in spite of maximized estrogen therapy
|
|
|
hordeolum
|
tenderness, erythema, edema, internal lesion; +pain
|
warm compress, lid scrub for recurrence, topical antibiotic
|
|
typical HT regimen containts---of estrogen dose of oral contracetpive
|
1/4th
|
|
|
angle-closure glaucoma, sx, tx
|
sever pain, n/v, halos around lights, photophobia, cornea cloudy w/ decrease vision, conjuctival.
emergent refereal to opthomologist, pilocarpine |
|
|
Black cohosh during perimenopause will likely do what physiologically:
|
bind to estrogen receptors decreasing side effects of premenopause
|
|
|
conjunctivits allergic, sx tx
|
pruritus, conjnctival hyperemia, chemosis, watery or stringiy discharge; no pain
|
avoid allergens, cold compresses, topical and systemtic medications
|
|
Why do menopausal women get hot flashes
|
Lutinizing Hormone surge/flucuations in estrogen in 80% of women. surgical menopausal women have more sever sx
|
|
|
conjunctivitis bacterial, sx tx
|
photophobial w/ blepharospasm, mucopurulent discharge w/ eyelash matting edema, hyperemia, preauricular adenopathy only w/ hyperacute disorder: may or may not have pain: topical antibiotic gtts, systemic antibiotics if gonococcal or chlamydial
|
|
|
What deficiency during menopause increase risk of osteoporosis
|
estrogen
|
|
|
conjunctivitis viral sx,tx
|
acute onset w/ systemic illness, photophobia or foreign body sensation, preauricular adenopathy, hyperemia, chemosis, water discharge classic dendritic corneal lesion w/ herpes:
Tx; supportive tx, cool compress, topical artifical tear, referral if herpatic |
|
|
Why do you use progestin during HT versus just estorgen:
|
endometrial cancer risk and breast cancer (contraindicated in hx of breast cancer)
|
|
|
Which of the following are absolute contraindication to postmenopausal estrogen therapy?
a. unexplained vag bleed b. breast cancer c. acute liver disease d. all of the above |
-unexplained vag bleed
-acute liver disease -thrombotic disease -endometrial cancer -neuro-opthalmologic vascular -breast cancer |
|
|
What are sx associated w/ corneal foreign body, abrasion, or an ocular ulcer
|
intense pain, photophobia, conjunctival hyperemia, decrease acuity, ulcers, prior hx f trauma w/ abrasion but not erosion
|
topical antibiotics systemic pain relief for abrasion and after foreign body
|
|
What are relative contraindication to postmenopausal estrogen therapy
|
seizure disorder, dyslipidemia, migraine, thromobophlebitis, gallbladder disease. absolute: vag bleed, coagulation disorder until corrected
|
|
|
What are sx of episcleritis or scleritis and how do you manage them.
|
mild to sever pain, circumscribed erythema of affected sclera, vision unaffected
|
episcleritis self limiting, scleritis referral
|
|
Tamoxifin is a SERM that locks out estrogen effects on what body part
|
breast
|
|
|
What are sx of iritis or uveitis?
|
pain, photophobia, conjunctival hyperemia, pupil constriction, no discharge: urgent referral
|
|
|
urge incontinence define and intervention
|
involuntary loss of urine: behavioral, voiding schedule
|
|
|
What are sx of keratitis
|
pain photophobia corneal cloudiness w/ stromal involvement
urgent referral |
|
|
What medication is used for urge incontinence
|
terodiline (selective muscarinic receptor antagonist) relaxes smooth muscle and bladder pressure
|
|
|
Disease that cause sudden eye sight loss
|
acute angle-closure glaucoma, central retinal vessel occulsion , hyphema, irtitis, meningitis, migraine, optic neuritis
|
|
|
urge incontinence: most common in elderly: what is the Sx, Tx
|
sensation need to empty bladder cant be controlled, involuntary loss
Tx: avoid stimulants, gental bladder stretch by delay void, reduce bladder contration w/ detrol or ditropan |
|
|
disease cause gradual loss
|
cataracts, corneal opacities, glaucoma, macular degeneration, pituitary tumore, retinal detachement
|
|
|
What Sx, Tx of stress incontinence:
path: weak pelvic floor and urethral muscle. Found in women rare in men: |
Sx: sneeze, exercise, cough results in urine loss.
Tx: kegel, support w/ vag tampon, urethral stent, pessary use. Topical estorgen, phenylpropanolamin (alpha agonist) |
|
|
Cataracts; SX, Tx
|
blurry vision, film, dull red reflex, opaque pupil, Tx: glasses, light, stop night driving, surgical when need exceeds vision
Peds: tx immediate risk of amblyopia |
|
|
Urethral obstruciton: of outflow (prostatic, stricture, tumor. Older men: sx tx
|
dribbling post-void and urge incontinence on presentation
Tx: treat urethral obstruction |
|
|
What is the tx for chalazion, hordeolum, blepharitis
|
Tx: Warm compresses, bacitracin, erythromycin or Cipro if chronic
hordeolum: children chalazion: adults |
|
|
transient incontinence results from what underlying process:
|
delirium, UTI, medication, restricted activity (bed ridden). tx underlying process, discontinue offending medication
|
|
|
cardiac: AAA: what increase risk of rupture
|
>6.0 cm, rapid expansion, female, smoking, COPD, FHx, asymmetrical AAA
|
|
|
What is common in women during reproductive years:
|
vag pH of 4.5 or less
-lactobacillus predominant vag organism -thick, white vag secretion during luteal phase |
|
|
AAA: PE
|
75% asymptomatic..pulsating mass (knees flexed), back pain
|
|
|
What does vag discharge appear during ovulation?
|
stingy and clear
|
|
|
AAA: Dignostic
|
Abd US (screenin an dconfirmation
|
|
|
Vaginal itch w/ perineal excoriation, erythema, white, clumping discharge: microscope would reveal
|
hyphae (yeast in budding form)
|
|
|
AAA: TX
|
prevent rupture: size best predictor
|
|
|
Bacterial vag presents w/
|
malodorous discharge
|
|
|
AAA: refer
|
>4.0 cm to vascular surgon
|
|
|
tx of vulvovaginitis by Candida albicans:
|
clotrimazole cream (lotrimin) antifungal : tx thrush, ringworm, athletes foot
|
|
|
A-fib: PE
|
palpitation (shorten diastole and vent filling), drop in BP, CO, light headed, dizziness, fatigue, SOB
|
|
|
1wk thin, green-yellow vag discharge w/ perivag irritation; vag eryth, petechial hem on cervix, WBC, motile organ what is the dx
|
trichomoniasis
|
|
|
A-fib: PE sx
|
if hyptensive and tachy immediate care
|
|
|
Tx of trichomoniasis
|
metronidazole (flagyl) antibiotic: Tx also C. diff, H. pylori other parasitic infection
|
|
|
A-fib Heart sounds
|
possible systolic ejection murmur, if S3 then impending heart failure
|
|
|
Tx for bacterial vaginosis:
|
oral metronidazole (flagyl), clindamycin cream, oral clindamycin (Cleocin)
|
|
|
A-fib: diagnostic
|
ECG, holter (24-48hr), provocative test (exercise ECG), ECHO for initial work up on all arrhythmias to determine left atrial and ventricular size
|
|
|
w/o sx but partner has dysuria w/o discharge, she has friable cervix covered in thick yellow discharge what is the infection
|
chlamydia trachomoatis
|
|
|
what is the heart rate of PSVT
|
140-240bpm
|
|
|
Tx for N. gonorrhoeae
|
Ceftriaxone (Rocephin), or cefixime (suprax): used also in ear and throat infections
|
|
|
Torsades de Pointes
|
QRS morpholgical pattern, TX: magnesium
|
|
|
Gonococal infections are symptomatic in most males: true or false
|
false: most are asymptomatic
|
|
|
A-fib tx:
|
tx causes: rheumatic heart, mitral valve, HTN, CHD, hyperthyroid, acute alcohol, stimulant ect
|
|
|
Complications of Gonococcal and chlamydial GU infection in women include:
|
PID, tubal scarring, peritonitis
|
|
|
A-fib tx:
|
uninterrupted anticoagulants for 4 wks prior and post conversion
|
|
|
Initial complaints in women w/ HPV-2
|
painful ulcer, inguinal lymphadenopathy, thin vaginal discharge
|
|
|
A-fib tx:
|
anticoagulant: warfarin: INR between 2-3 if contraindicated then ASA and if <60y/o
|
|
|
Tx for HHV-2 genital infection
|
famciclovir: also used to tx herpes zoster (shingles)
|
|
|
first degree AV block
|
PR>20
|
|
|
What would you prescribe for chlamydia infection
|
doxycycline, erythtromycin, azithromycin (best) efficacy
|
|
|
Second degree type I: mobitz type 1
|
pregressive prolongation of PR interval until not conducted by ventricle
|
|
|
What is the incubation of Gonnorrhea: how do women infected present
|
1-5days: dysuria, milky purulent blood tinged discharge
|
|
|
What do you expect to see on the ECG w/ Second degree type II: mobitz II
|
constant PRI interval (normal) until P wave is not conducted: more severe vs type I. Fails to conduct through the ventricles.
|
|
|
Lymphogranuloma venerum: clinical presentation and tx
|
vesicular or ulcerative leasion on external genitalia w/ inguinal lymphadenitis or buboes
Tx: doxycycline 100mg BID x 21d or E-mycin 500mg QID x 21d |
|
|
Third degree AV block
|
no relaiton between P and QRS, fatal
|
|
|
nongonococcal urethritis and cervicitis (not pregnant): PE and Tx
|
-PE: cervicitis, irritative void sx, mucopurulent discharge
-Tx: Azithromycin 1 g PO single dose or doxy 100mg BID x7d alt: E-mycin 500mg QIDx7d or levofloxacin 500mg QD x7d |
|
|
What is included in a diagnostic work-up for A-fib?
|
ECG, holter (24-48hr), provocative test (exercise ECG), ECHO for initial work up on all arrhythmias to determine left atrial and ventricular size
|
|
|
Gonococcal urethritis (not pregnant): PE and Tx
|
irritative void sx, purulent discharge
single dose for uncomplicated: -cefixime 400mg po, cetriaxone 125mg IM or cipro concurrently tx w/ Azithro 1g x1, doxy 100mg bid if chlamydial infection not ruled out. may consider spectinomycin |
|
|
PSVT: rate
|
140-240bpm
|
|
|
Pelvic inflammatory disease: PE and Tx
|
irritative void, fever, Cervical motion tenderness
TX: a: ofloxacin 400mg bid or levo 500mg QD w/ or w/o metronidazole 500mg BID x 14d B: ceftriaxone 250mg IM plus doxy100mg BID x 14d w/ or w/o metronidazole 500mg bid x 14 |
|
|
Describe the wave pattern of Torsades de Pointes and the tx?
|
QRS morpholgical pattern, TX: magnesium
|
|
|
trichomoniasis: PE and Tx
|
dysuria, itching, vulvovaginal irritation, dyspareunia, yellow-greeen vag discharge, cervical petechial hemorrhage (strawberry spots), motile organism and WBC on microscope
TX: metronidazole 2 g x1, metronidazole 500mg BID x 7 d |
|
|
A-fib tx:
|
tx causes: rheumatic heart, mitral valve, HTN, CHD, hyperthyroid, acute alcohol, stimulant ect
|
|
|
Bacterial vaginosis PE and Tx
|
clue cells, pos whiff test,increase volume discharge: thin, gray, buring, pruritis: pH >4.5, few WBC
-CDC: metronidazole (flagyl) 500mg Bid x 7d, 1 applicator 5g intravaginally QD x 5d or clindamycin cream 2%, 1 applicator intravag at HS x 7d |
|
|
A-fib tx:
|
uninterrupted anticoagulants for 4 wks prior and post conversin
|
|
|
candidiasis: PE and tx
|
PE: itching, burning, thick white to yellow discharge, vulvovaginal excoriation, erythema: HYphae, pH<5
Tx: miconazole (antifungal), fluconazole, terconazole |
|
|
A-fib tx:
|
anticoagulant: warfarin: INR between 2-3 if contraindicated then ASA and if <60y/o
|
|
|
chancroid: PE and tx
|
painless genital ulcer
Azithro (macrolide) 1g oral x1 or ceftriaxone (cephlasporin/Rocephin) 250mg IM x1, or cipro 500 BIDx3d or Emycin (Macrolide) 500tidx7d |
|
|
What finding on an ECG would help dx first degree AV block?
|
PR>20
|
|
|
Genital Herpes: PE and tx
|
PE: painful ulcerated lesion, lymphadenopathy, thin vag discharge if lesion near vagina or introitus.
- Tx: inital: acyclovir 400tidx7-10d or famciclovir 250tidx7-10d or valacyclovir 1g bidx7-10d |
|
|
Second degree type I: mobitz type 1
|
pregressive prolongation of PR interval until not conducted by ventricle
|
|
|
genital warts (condyloma acuminata): PE and tx
|
verruca-form lesions or may subclincial unrecognized
tx: podofilox 0.5% solution or imiquimod 5%: cryotherapy, tricholroacetic acid, surgical |
|
|
Second degree type II: mobitz II
|
constant PRI nterval until P wave is not conducted: more severe vs type I
|
|
|
Pelvic inflammaotry disease presents w/
|
dysuria, cervical motion tenderness, diffuse abd pain abnormal vag bleed, GI, fever
|
|
|
what do you expect to see on the ECG w/ Third degree AV block
|
no relation between P and QRS, fatal
|
|
|
Blood pressure norms
|
<140/90; <130/80 if heart failure or renal
|
|
|
Most common pathogen in pelvic inflammatory disease
|
c. trachomatits
|
|
|
lipid norms
|
LDL <100; reduced saturated fats < 7% calories
Triglycerides <150 mg |
|
|
Tx for Pelvic inflammatory allergic to PNC:
|
ofloxacin w/ metronidazole
|
|
|
How much physical activity is suggested
|
30 min, 7 days week
|
|
|
What labs should be obtained w/ Pelvic inflammatory
|
elevated ESR or C-reactive protein, leukocytosis w/ neutrophilia
|
|
|
weight norms
|
BMI: 18.5-24.9; waist M <40 W<35
|
|
|
Tx of pelvic inflammatory may include
|
ceftriaxone 250mg IM x 1, followed by doxy 100bidx2wks
|
|
|
What lab finding is diagnostic for diabetes mellitus
|
A1C: >6.5%
|
|
|
sequelae to genital condyloma may include
|
cervical carcinoma
|
|
|
meds used for CAD; ASA if
|
75-162mg PO QD; if contra then clopidogrel or warfarin. May be combined
|
|
|
Describe condyloma lesions
|
verruciform: Shaped like a wart or warts
|
|
|
Meds used for CAD: Beta blocker if:
|
If MI, ACS, left ventricular w/ or w/o HF
|
|
|
meds for CAD: ACE-I if:
|
Ventricular ejection fraction <40% and w/ HTN, DM or CKD
|
|
|
meds for CAD: Influenza vaccine
|
all CAD
|
|
|
variant angian patho
|
spasm most right coronary and left descending: focal and reproducible at same location
|
|
|
% of anogenital and cervical cancer caused by HPV
|
95%
|
|
|
Mechanism of action of imiquimod (aldara)
|
immune modulator condyloma acuminatum
|
|
|
PMI define
|
point of maximum impulse
|
|
|
HPV type cause condyloma
|
HSV 6 and 11
|
|
|
Where do you expect to find PMI w/ cardiomegaly
|
downward or laterally displaced
|
|
|
HPV most often in cervical cancer
|
HPV 16 and 18
|
|
|
what is present w/ primary syphilis
|
painless ulcer, palpable inguinal nodes, spontaneously healing lesion
|
|
|
define xanthomas or early arcus senilis
|
elevated cholesterol seen around iris as hazy whiteness: assess peripheral circulation
|
|
|
% of anogenital and cervical cancer caused by HPV
|
95%
|
|
|
What is present in secondary syphilis
|
generalized rash, arthraligia, lymphadenopathy
|
|
|
Ventricular gallop (S3) indicates possible
|
heart failure
|
|
|
What is imiquimod (aldara) used for?
a. actinic keratosis b. superficial basal cell carcinoma c. genital and anal warts d. all of the above |
D. actinic keratosis, basal cell carcinoma, genital warts:
It is an immune response modifier |
|
|
What is present in tertiary syphilis
|
Gumma (lesions found on liver, heart, brain, skin)
|
|
|
atrial gallop (S4) indicated possible
|
HTN, MI , resistance of ventricular filling
|
|
|
HPV type cause condyloma
|
HSV 6 and 11
|
|
|
Sx usually present after how many weeks upon contact w/ syphilis
|
2-4 wks after contact
|
|
|
what is first line tx of syphilis
|
penicillin
|
|
|
systolic mitral regurgitation murmur indicates
|
ischemic papillary muscle
|
|
|
HPV most often in cervical cancer
|
HPV 16 and 18
|
|
|
what is present w/ primary syphilis
|
painless ulcer, palpable inguinal nodes, spontaneously healing lesion
|
|
|
What is the pathophysiology of pericardial friction rub:
|
inflammation around pericardial sac
|
|
|
% of anogenital and cervical cancer caused by HPV
|
95%
|
|
|
What is present in secondary syphilis
|
generalized rash, arthraligia, lymphadenopathy
|
|
|
Name on diagnostic test for coronary artery disease (CAD)
|
exercise tolerance test (stress test)
|
|
|
Mechanism of action of imiquimod (aldara)
|
immune modulator condyloma acuminatum
|
|
|
What is present in tertiary syphilis
|
Gumma (lesions found on liver, heart, brain, skin)
|
|
|
In coronary artery disease w/ previous myocardial injury what changes to the ST segment on the ECG do you expect to find?
a. ST depression b. ST elevation |
depression >1mm high likelihood of unstable angina
|
|
|
Sx usually present after how many weeks upon contact w/ syphilis
|
2-4 wks after contact
|
|
|
Cardiac markers: CPK-MB norms
|
rises 3-12, peak: 24hr, normal 48hr after injury
|
|
|
what is present w/ primary syphilis
|
painless ulcer, palpable inguinal nodes, spontaneously healing lesion
|
|
|
What is present in tertiary syphilis
|
Gumma (lesions found on liver, heart, brain, skin)
|
|
|
Endocarditis: causes
|
streptococcal (70% if not IV drug use),
|
|
|
what is first line tx of syphilis
|
penicillin
|
|
|
What is the name of a fertilized ovum?
|
Zygote
|
|
|
What is the "baby" called up to 2 weeks postconception?
|
blastocyst: stage prior to embryo forming, lots of cell division
|
|
|
Endocarditis: diagnosis
|
consider for all patients w/ murmur and fever of unknown origin
|
|
|
Stage: 8-12wks post conception is called
|
Embryo
|
|
|
A nongravida uterus would be the size of a
|
large lemon
|
|
|
An 8 weeks uterus woudl be the size of a
|
tennis ball/ orange
|
|
|
Cardiac markers: myoglobin norms
|
rises 1-3 hrs, peak 3-4 hrs, normal 24 hrs after injury
|
|
|
At 10 wks uterus would be the size of a
|
baseball
|
|
|
Peripheral venous insufficiency: DVT: causes
|
prolonged inactivity, estrogen, recent surgery, trauma
|
|
|
cardiac markers: troponin, norms
|
rises 3-12 hr, peak 3-4 hr, 14d
|
|
|
At 16wks the fundus of the uterus would be in what location
|
halfway between the symphysis pubis and umbilicus
|
|
|
What causes Endocartitis?
|
streptococcal (70% if not IV drug use),
|
|
|
At 20 wks the fundus should be at what land mark
|
the umbilicus
|
|
|
Endocarditis: sx
|
fever main sx (unless old, immuno), heart murmur, janeways lesion, osler nodes: palms of hands, soles due to septic embolization
|
|
|
What % of babies are in the vertex position by 36th wk of preg
|
95%
|
|
|
Endocarditis: tx:
|
high dose bactericidal IV: PNC G r ceftriaxone and an aminoglycoside
|
|
|
What is recommended weight gain durign pregnancy w/ normal BMI
|
25-35lbs
|
|
|
When would endocarditis be part of your differential diagnosis?
|
Consider for all patients w/ murmur and fever of unknown origin
|
|
|
Normal BMI: what is the average daily intake ontop of normal calories during pregnancy
|
300 kcal
|
|
|
Heart Failure: Sx
|
S3 or s4 murmurs and lateral displacement of apical impulses, S4 due to over distention of ventricles
|
|
|
Normal BMI: waht is daily calorie requirement on top of normal diet when lactating:
|
500 kcal
|
|
|
Heart Failure: Diagnostic: lab
|
BNP: brain natriuretic peptide: secreted due to elevation of end diastocli pressure: BNP >400= CHF Dx
|
|
|
Waht is the recommended Ca intake during pregnancy
|
1200-1500
|
|
|
Heart failure: Diagnostic: rad
|
Echocardiogram
|
|
|
Maternal Fe is greatest in what part of pregnancy
|
second and third trimester
|
|
|
What are causes of Peripheral venous insufficiency: DVT
|
prolonged inactivy, estrogen, recent surgery, trauma
|
|
|
What is the most common acquired anemia during pregnancy:
|
iron deficiency
|
|
|
DVT sx:
|
leg edema, calf tenderness, pain on dorsiflexion of foot (Homans sign), 50% no sx
|
|
|
Give an example of neural tube defect:
|
anencephaly, spina bifida, encephalocele
|
|
|
DVT diagnostic: Rad: none unless superficial phlebitis
|
duplex ultrasound to ensure no DVT
|
|
|
What is the leading causes of preventable fetal mental retardation
|
fetal alcohol syndrome
|
|
|
DVT diagnostic: Lab
|
D-Dimer: marker for coagulation activiation and fibrinolysis
|
|
|
risk associated with Pica intake:
|
constipation, bowel obstruction, nutritional deficiency
|
|
|
DVT: common location
|
femoral veins
|
|
|
How much does blood volume increase at 42 wks. 25%, 50%, 75%
|
50%
|
|
|
DVT: Tx
|
superfical phlebitis: elevation of leg, compression w/ ace bandage, NSAIDS, antibiotics
|
|
|
Drop in diastolic BP is most notable in what trimester
|
second
|
|
|
DVT: Tx
|
heparin immediatley to prevent PE, hospitalization: 500u boluse then 800-1400u/hr--> PTT >2x normal for 2 days
|
|
|
S1 heart sound become louder or quieter during pregnancy
|
Louder
|
|
|
DVT: Tx
|
coumadin w/in 24 hrs, pt discharged when INR 2-3 and continued for 3-6m
|
|
|
What type of murmur becomes evident during pregnancy
|
physiologic systolic ejection
|
|
|
Foods that decrease effectiveness of warfarin:
|
high in vitamin K
|
|
|
What happens to the renal collecting system during pregancy:
|
it dialates
|
|
|
Chronic venous stasis: TX
|
compression stocking, normal saline wet to dry topical antibiotics for ulcers
|
|
|
Is it common to find physiologic glucosuria and proteinuria during pregnancy
|
Yess: it is common to find glucosuria and proteinuria
|
|
|
chronic venous stasis: Tx
|
stocking if eczema from sever stasis the 0.5% hydrocortisone
|
|
|
What happens to the transvers thoracid diameter and diaphragmatic contraction
|
it increases in size
|
|
|
Varicose: causes
|
pooling blood in large varicose veins
|
|
|
What happens to the lower esophageal sphincter during pregnancy
|
the lower sphinchter relaxes
|
|
|
varicose: sx
|
heavy discomfort when standing increase bleed when older
|
|
|
What happens to the intestines regarding motility during pregnancy
|
the intestine slows down
|
|
|
Varicose: Tx
|
asymptomatic, refer if poorly tolerated
|
|
|
What happens to the gallbladder during pregancy
|
the gallbladder doubles in size
|
|
|
Venous stasis ulcer sx include:
|
most sever complication of post phlebitic syndrome: ulcer above medial malleousl, wound infected, pulses not palpable due to swelling
|
|
|
What happens to insulin levels during pregnancy
|
they increase 2-10 fold
|
|
|
venous stasis ulcer tx;
|
bed res, wet-dry, ulcer debridment, oral antibiotics, compression w/ ACE
|
|
|
What happens to fasting plasma glucose during pregnancy
|
It should remain the same, test for gestational diabetes
|
|
|
Venous stasis: things to know
|
occur around ankle, hx of phlebitis, sx of venous stasis, painful when infection, improved w/ elevation
|
|
|
What is Hegars Sign in pregnancy
|
uterine isthmus become soft and compressible
|
|
|
venous ischemia: things to know
|
occur at tips of extremities/heel, Hx of cluadicating, very painful WORSE with elevation, absent pulse, secondary infection spread quick
|
|
|
What is Chadwicks sign
|
Cervix color and texture change becoming cyanotic
|
|
|
Where and when do you expect to find venous neuropathic (diabetic)
|
occur at pressure points, painless but co-exist neuro pain, present after infection
|
|
|
What is Goodwells sign
|
Cervix becomes less firm
|
|
|
Murmurs: things to know
|
timing is most improtant, mitral regurg best heard apex or 5th intercoostal, S1 loudest at apex and lower left sternal border
|
|
|
What happens to the breast during pregnancy
|
nipples, areolae darken and increase in size. Venous congestion
|
|
|
Murmurs: things to know about S4 and atrial kick
|
S4: atrial kick into noncompliant ventricle
|
|
|
What happens to breast tissue during pregnancy
|
increase nodules due to proliferation of lactiferous glands
|
|
|
Aortic stenosis: location, PE, Tx
|
right sternal border, CP< syncope, dyspnea, surgical
|
|
|
What happens to the blood during pregnancy
|
volume increases by 40-50% peak at 32 wks, RBC production increase by 33%
|
|
|
mitral regurgitation: locatin, PE, tx
|
apex, asymptomatic, then fatigue, dyspnea on exertion. if acute: Iv antibiotic, preventative for dental or surgical
|
|
|
Why does dilutional physiologic anemia occur during pregnancy
|
the RBC increase by 33%
|
|
|
Mitral valve prolapse: where can you hear it, what are the sx and what is the tx?
|
lower left sternal, PE: asymptomatic, then CP, palpiation,dyspnea, fatigue. Tx: none except echo q 3-5yr; antibiotic for dental
|
|
|
What happens to the renal system during pregnancy
|
increased blood flow and GFR, dilation of renal collecting
|
|
|
Where do you listen to hear tricuspid regurg
|
lower left sternal listening point
Also: ventricular septal defect |
|
|
Why does the physiologic glucosuria and proteinuria occur during pregnancy
|
The GFR increases so renal cant reabsorb glucose and protein
|
|
|
aortic regurg
|
lower left sternal, asymptomatic, then acute CHF, Tx; antibiotic prevent endocarditis, valve replace
|
|
|
What happens to tidal volume and residual volume late in pregnancy
|
Tidal volume increases and residual volume is reduced
|
|
|
mitral stenosis
|
apex left lateral, class 1: asymptomatic, Class 2: dyspnea w/ exertion. Tx: if A-fib then w/ anticoagulants
|
|
|
What happens to the digestive system during pregnancy
|
lower esophageal sphincter relaxes due to pressure, intestine and stomach slow to allow absorption on nutrients
|
|
|
HTN: BP ok
|
<120-90
|
|
|
What happens to the gallbaldder during pregnancy
|
it doubles in siz, dilute bile and increase risk of stones
|
|
|
Prehypertension
|
120-139/80-89
|
|
|
What account for weight gain in a health pregnancy
|
first half: maternal weight change
Second half: components of pregnancy |
|
|
Stage 1 HTN
|
140-159/90-99
|
|
|
When should the triple screen be done: wks
|
16-20 wks
|
|
|
What are the parameters for Stage 2 HTN
|
>160/>100
|
|
|
How often are visits during 28-32 wks
|
every 2 wks
|
|
|
Primary HTN: Patho
|
renin-angiotension: inappropriate feed back loop--> constant vasoconstriction
|
|
|
List the appropriate weight gain during pregnancy at
<19wks, 19-26, 26-29, >29wks |
a. 28-40lbs
b. 25-36lb c. 15-25lb d:15+lbs |
|
|
Primary HTN: Patho: vascular
|
hypertrophy<-- excess insulin, catecholmines, natriuretic hormone-->increase peripheral resistance
|
|
|
What prenatal care: first visit:
|
pap smear, rubella titer, PPD, VDRL, RPR, HIV, Blood type, antibody screen, GC/chlamydia, Hg electrophoresis (african, asian), UA urin C&s
|
|
|
Primary HTN: path: obesity
|
central-->increased sympathetic nervous system output
|
|
|
Fetal loss occurs in 1 in ____ amniocentesis
|
1:200 deaths
|
|
|
HTN: diet
|
DASH: fruits, veg, low-fat dairy, Sodium: increase circulatory volume
|
|
|
What may be causes of an elevated Alpha-fetoprotein (AFP)?
|
underestimated gestational age, open neural tube defect, meningomyelocele
|
|
|
HTN prevention: How does alcohol increase BP?
|
increase BP due to SNS, RAS decrease peripheral vascular tone
|
|
|
What are some pregnancy test from 16-20 wks
24-28wks 28-32 wks |
16-20: triple marker/screen US
24-28: 1-hr glucose load; if Rh neg, T&Screen 28-32: Hg, STI testing as indicated (HIV, HBsAg, GC, chamydia) RhoGram |
|
|
Renal artery stenosos HTN: PE, screen
|
<30->50, Hx arterhosclerosis, Screen: UA, creatinine
|
|
|
What are the pregnancy care test: 32-36wks, 35-37 wks, 40-42wks, 41+wks
|
32-36 fetal presntation, kick count (fetal movements ?4 in 1 hr;>10 in 2 hr)
35-37: grp B stretpococcus culture (rectal and vag) 40-42: vag exam to assess cervical ripness, fetal station 41+ Nonstress test, biophysical profile |
|
|
HTN: pheochromocytoma: PE Screen
|
5 H: HTN< HA, hyperhidrosis, hypermetabolic, DM
Screen: spot UA, 24hr UA |
|
|
Edwards syndrome is from trisomy:
|
18
|
|
|
renal artery stenosis HTN: Diagnostic, TX
|
ateriogram: Tx: B-blocker, AVOID ACE-I, angioplasty, bypass
|
|
|
Edward syndrome most kids live a full life: true or false
|
false: most affected infants die during first year of life
|
|
|
HTN: pheochromocytoma: diagnostic, TX
|
CT abdomen, Tx; A-blocker, then B-blocker, or both
|
|
|
what is a major risk factor for being born w/ down's syndrome
|
born to women older than 35yrs
|
|
|
Hyperaldosteroinism: PE, Screen
|
weakness, HA, fatigue, HTN, hypokalemai: Screen: unprovoked hypokalemia
|
|
|
Downs syndrome is from trisomy
|
21
|
|
|
thyroid HTN: , Screen
|
wekness, HA, fatigue, HTN, hypokalemia, Screen: aldosterone levels w/ saline challenge
|
|
|
What are the components of the triple screen test in pregnancy
|
AFP, hCG, unconjugated estriol
|
|
|
Thyroid HTN: Diagnostic,
Tx |
thyroid binding, Tx: disorder, control HTN
|
|
|
What are two test to assess for congenital defects in utero
|
amniocentesis or chorionic vilus sampling
|
|
|
Renal parenchmal disease: polycystic kidney: PE, screen, diagnostic, Tx
|
edema, nocturis, diabetes, Screen: 24hr UA, protein, creatinine renal US, DM test control volume, diurectis, ACE-I if diabetic
|
|
|
What are the physical findings of edward syndrome
|
low birth weight, mental retartation, cranial, cardiac renal malformation
|
|
|
Cushing Syndrome HTN: PE, screen, diagnostic, Tx
|
hirsutism, edema, buffalo hump, moon face, truncla obesity, screen: 24 hr UA free cortisol, Diag: dexamethasone, suppression test, pituitary MRI, Tx; surgery
|
|
|
What are examples of neural tube defects:
|
meningomyelocele, anencephaly, spina bifida
|
|
|
JNC7 f/u for initial BP w/o end organ if : normal <120/<80
|
f/u in 2 yrs
|
|
|
Where is alph-fetoprotein synthesized in fetus
|
yolk sac, GI tract, liver
|
|
|
JNC7 f/u for initial BP: preHTN
|
1yr
|
|
|
What can lead to misinterpreted AFP test: it can be higher in earlier pregnancy
|
underestimate gestational age
|
|
|
JNC7 f/u for initial BP: stage 1 HTN
|
confirm in 2 months
|
|
|
What is the most sensitive marker for detecting trisomy 21
|
increase hCG level: Low hCG indicates trisomy 18
|
|
|
JNC7 f/u for inistial BP: stage 2 HTN
|
eval or refer for care w/in 1 m
|
|
|
Triple screen is not diagnostic they are used in pregnacy to...
|
assess for risk of nural tube defect
|
|
|
HTN PE:
|
papilledema, buits, neuro deficit, skin thinning, loss of extremity hair, striae
|
|
|
Medication most commonly pass through placenta via:
|
passive diffusion
|
|
|
What diagnostic test should u obtain for a new HTN patient?
|
UA, CBC, glucose, CMP, BUN< creatinine, uric acid, TSH, 24-hr urine cortisol if cushing syndrome suspect
|
|
|
Osteoarthritis Sx
|
pain, stiffness and limited ROM, metacarpal joints of thumbs and interphalangeal joints initial impact
|
|
|
What is the category for safe for use in pregnancy:
|
cat: a
|
|
|
Osteoarthritis: Tx
|
APa primary 1 g 4x dayily, Tramadol nonopiod pain may be used w/ NSAID, glucosamine w/ or w/o chondroitin for OA of knees
|
|
|
Med that cause teratogenic in humans but benefit outweights risk of use in life threat assigned cat
|
cat: D
|
|
|
Osteoarthritis: non-pharm Tx
|
aerobic for cardio, weight reduction, PT and or OT, strength training to fix contractures
|
|
|
Which of medication is pregnacy risk D: Misoprostol, Captopril, Cefuroxime, regular insulin
|
Captopril (ACE-I) HTN HF med (capoten)
|
|
|
Osteoarthritis: Diagnostic
|
xray films normal early; later narrowed asymmetric joint space
none systemic disease so no serologic markers, labs to rule out other diseases |
|
|
Drugs cause teratogenic in animals but not in human assign preg risk:
|
Cat: C
|
|
|
Osteoarthritis: Injections limits
|
3 injections per year and max of 12 per joint (may accelerate joint deterioration)
|
|
|
Preg at 38wks w/ UTI may tx w/
|
Amoxicillin w/ clavulanate
|
|
|
What are the Sx of Acute Gout/Hyperuricemia
|
rapid onset, at night wakes from sleep, warmth, red, swell, decrease ROM, monoarticular, First metatarsophalangeal big toe (podagra)
|
|
|
Preg w/ asthma; when may bronchospasm worsen?
|
29-36wks
|
|
|
What are sx of chronic Gout (tophaceous)
|
typically>10yrs firm swelling, digits of hands and feet
|
|
|
Preg w/ acute bacterial rhinosinusistis may tx w/
|
amoxicillin, cefuroxime, azithromycine but NOT levofloxacin
|
|
|
What increase risk of Gout flare up?
|
trauma, overeating, alcohol, fasting.
|
|
|
according to IDSA duration for antibiotics for tx of UTI during preg is:
|
7 days
|
|
|
What is the non-pharm prevention and tx of Gout flare up
|
diet is key: avoid diuretics weight gain, alcohol (lowers purine, protein), TX: cold compress
|
|
|
SSRI w/ drawal syndreom best characterized as
|
bothersome but not life threatening
|
|
|
How do you dx Gout
|
joint aspiration: 6-13 minor or 1 major crystals in synovial fluid or tophus for Dx
|
|
|
The placenta is best able to transport what type of substance
|
Lipophilic
|
|
|
What is the pharm Tx of ACUTE Gout
|
NSAID: (unless risk: >65yrs, creatinine <50ml/min, CHF, peptic ulcer, anticoagulant, hepatitis) High dose in first 24-48hrs.
-If ONLY 1-2 joints consider intra-articular injection -if multiple joints or NSAIDS not tolerated use corticosteroid taper dose 7-14d -colchicine 1mg then 0.5 q2h until absent sx or GI problems: only effective in first 12-24hrs..contra if GFR>10 |
|
|
2nd trimester w/ migraine Ha best tx would be
|
Ibuprofen
|
|
|
What is the pharm Tx of Chronic Gout
|
Maintain serum Urate <6 (below normal), DO NOT start urate lowering during acute attack start 6-8wks after: (lengths attack)
-NSAIDS -allopurinal 100mg until SU<6 Colchinicine 0.5-1mg to prevent rebound gout -Febuxostat: 40mg/d -probenecid (if contra allopurinal) |
|
|
SSRI during preg: study has shown the affects on infants later in life
|
had no observable difference
|
|
|
Tennis Elbow Sx
|
Medial epicondylitis (GOLFERS) pronators
Lateral epicondylitis (TENNIS) supinators -Tinel's sign: tapping over ulnar groove reproduces pain/numb to 4-5th fingers |
|
|
SSRI w/ longest half-life:
|
Fluoxetine (Prozac)
|
|
|
What is the prevention of Tennis elbow
|
overuse, proper techinques, lighter tools, less grip
|
|
|
Most commonly used medication during 1st trimester in pregnancy
|
antibiotics
|
|
|
What is the diagnostic of Tennis elbow
|
xray, AP, joint aspiration for crystals
|
|
|
Benzodiazipine w/ drawal risk includes
|
Seizures
|
|
|
What is the managment of Tennis elbow
|
NSAID, RICE 2 wks; consider steroid injections.
|
|
|
Tx of chronic asthma in patients that are preg is:
|
short-acting beta agonist
|
|
|
Other elbow injuries: things to know
|
Radial head fx: RICE, posterior splint elbow flexed at 90
-Ulnar neurtitis: rest affected hand, elbow pads, wrist-elbow splint, neutral position -Olecranon bursisits: ray, aspirate bursa for dx, hosp if septic |
|
|
24wks preg w/ acute asthma flare should be given:
|
montelukast (singulair): a leukotriene receptor antagonist (LTRA)
|
|
|
What are the modifiable risk factors of Osteoporosis
|
low body weight <58kg,BMI<20, Ca or Vit D, inadequate physical activity, smoking, alcohol, corticosteroid, heparin
|
|
|
Drug know to be harmful to fetus given cat
|
X
|
|
|
What are the non-modifiable risk factors of Osteoporosis
|
advaced age >65, female, caucasion, asian, FHx, traumatic fx
|
|
|
Sertraline is preg risk cat;
|
cat: D (pos evidence of fetal risk) may is specific cases still be used. Doxy, ARB, ACE-I
|
|
|
Osteoporosis prevention
|
Ca 1200mg and vit D 700 IU/d. Screen all women >65 or 60 w/ risk factors
|
|
|
Clonazepam in preg is cat: B,C,D,X
|
cat: D (pos evidence of fetal risk)
|
|
|
Osteoporosis diagnostic test
|
Dexa of lumbar and Hip is GOLD standard for dx, T-score >-1 normal Osteopenia = T -1 to -2.5, osteoporosis T <-2.5
|
|
|
Bupripion (wellbutrin, zyban) during preg is cat:
|
cat: B (none in animal but no study in humans (PNC, cephalosporins, Acetaminophen)
|
|
|
What is the non-pharmacologic management of Osteoporosis?
|
adequate Ca and Vit D, weight bearing exercise avoid smoking and excessive alcohol: 1000-1200 mg D Ca
|
|
|
Tricyclic antidepressants during preg are cat risk:
|
cat: D
|
|
|
Osteoporosis managment pharm:
|
T score <2.5, bisphosphanates and teriparatide. estrogen w/ or w/o progesterone raloxifene, risedronate. take on empty stomach w/ 6-8 water 30min before eating or lying down or w/ other meds. SQ PTH is anabolic bone agent
|
|
|
Antimicrobial that is Cat B used in preg infection is:
|
erythromycin
|
|
|
Fibromyalgia diagnostic criteria
|
3 or more months of MS apin above and below waist line bilaterally, w/ pain on palpation of tender points, profound fatigue, sleep disturbance rare after 55
|
|
|
PNC are preg cat risk:
|
Cat: B
|
|
|
Fibromyalgia signs and sx
|
>3m sx unexplained w/ other dx, fatigue, sleep disturbance, female 20-65, impared socail occupationa, depressive/anxiety, exclude statin causes
|
|
|
What uropahtogens are capable of reducing urinary nitrates to nitrites
|
E. Coli, Proteus spp., Klebsiella pneumonia
|
|
|
Fibromyalgia Points of tenderness
|
suboccipital muscle, middle upper trapezius, under lower stemomastoid near 2nd constochondral junction, origin of supraspinatus, 2 cm distal to lateral epicondyle, upper outer glueal, greater trochanter, medial fat pad of knee
|
|
|
In Preg asymptomatic bacteruria should be:
|
Tx to avoid complicated UTI
|
|
|
Fibromyalgia diagnostic test
|
ESR, C-reactive protein, CK, TSH, CBC, renal Nd LFT
|
|
|
Common UTI organism in preg
|
E. Coli
|
|
|
Patient with medial knee pain and dx of arthritis would have pain..
|
medially along the joint line
|
|
|
Length of antimicrobial for preg w/ asymptomatic bacteria
|
3-7d
|
|
|
The most common site of osteoarthirits is what part of the hip
|
Anterior especially if it radiates into the groin
|
|
|
What does teratogenic?
|
substance that has potential to create a characteristic set of malformation in fetus
|
|
|
What is the classic finding in de Quervain's tenosynovitis (extensor and flexor tendons of the thumb)
|
Positive Finkelstein test.
pain may radiate up the forearm |
|
|
When is the teratogenic period:
|
between day 31 and 81 following last menstral period: organanogenis is taking place
|
|
|
Findings of RA included
|
Morning stiffness, postitive rheumatoid antigen, antinuclear antibodies
|
|
|
What are three factors in drugs passing through the placenta
|
lipohilicity (higher the easier)
Molecular weight <500g/mol maternal drug levels |
|
|
What does the "get up and go" test in elderly test.
|
Fall risk through musculoskeletal function
|
|
|
Can a preg receive insulin or heparin?
|
Yes because they have higher molecular weight that can not pass through the placenta
|
|
|
Osteoarthritis pain first line of treatment
|
exercise if this doesnt work then tylenol for pain: NSAID work better but have higher S/E risk an dshould no be used
|
|
|
Which is better during preg: benadryl or claritin (loratadine)
|
Claritin: more hydrophilic so causes less S/E to fetus
|
|
|
SPRAINS Grade
Stage I Stage II Stage III |
I- mild tenderness and edema able to bear weight.
II-moderat pain edema, tenderness, ecchymosis, weight barin painful but can walk III: tear of ligament, joint instability, sever pain ,unable to weight bear. XRAY |
|
|
Define Preg Cat B, C, D, X
|
B is best , C w/ caution, D for danger, X (cross the drugs off the list)
|
|
|
Ottawa ankle rules help determine
|
whether x-ray is needed w/ suspected ankle injury
|
|
|
Why is bronchospasm worse between 29-36 wks in preg?
|
increase esophageal irritation from GERD: esophageal sphincter loosens due to increase pressure
|
|
|
Anterior Drawers Test for what
|
ACL injury laxity or movement
|
|
|
What cat are inhaled (and oral) corticosteroids and Beta agonist in preg: B, C, D, X
|
cat: C no proof human injury but some in animals
|
|
|
Which of the rotator cuff is most susptible to injury
|
Suproaspinatus (arm drop test)
|
|
|
What is the preventative tx for N/V in preg
|
tx H. pylori, ginger, Ca antacid q2hr for 2-3d. B6 is preventative
|
|
|
The mainstay for initial treatment of early OA
|
Tylenol max of 4g/d unless on warfarin then 2500mg
|
|
|
What is the tx for migraines in preg
|
tylenol and nsaid (except term due to risk of antiplatelet effect)
|
|
|
What is another pain medication that is a non-steroidal used for moderate pain in OA
|
Tramadol (Ultram)
|
|
|
What can be used for migraine during preg to attenuate HA sx
|
lidocaine 4% to affected nostril
|
|
|
What common GYN medication is used to decrease osteoporsis
|
Estrogen w/ progesterone if they still have uterus
|
|
|
What meds can be given to preg w/ major depression?
|
serotonin and dopamine receptor modulators, tricyclic and benzo
|
|
|
What medication reduces the risk of methotrexate hepatotoxicity
|
Folic acid
|
|
|
Bupropion (dopamine receptor modulator) is a cat B , SSRIs are cat C. Should you switch to bupropion during preg.
|
No. switching can increase depression
|
|
|
Injuries to the ends of bone versus sprains is most common in what age
|
children
|
|
|
How do you taper down SSRI to prevent w/drawal syndrome
|
taper 25% of total dose over a week
|
|
|
What is the best screening for Osteoporosis
|
bone mass densitormetry usin DEXA
|
|
|
What are the S/E of SSRI w/drawal:
|
jitteriness, nausea, sleep disturbance: worse w/ fluoxetine (longer half life)
|
|
|
What does the spurling Test test for in a MS examination
|
cervical radiculopathy
|
|
|
How long can effects of SSRI last in fetus
|
30days may cause w/drawal such as irritability protracted crying shivering
|
|
|
Who should initiate immunosuppressive therapy (mehtotrexat) for an RA Patient
|
rheumatologis for diagnosis confirmation and initiation of DMARDS.
|
|
|
Tricyclics and benz are what cat for preg
|
Cat D rarely prescribed during preg
|
|
|
What Gout medication is better for those with renal impairment
|
Uloric and lower doses are needed to achieve resuls
|
|
|
Taper dose down all benzo prior to preg by 25% week to prevent
|
w/drawals of tremors, hallucination, seizures, delirium termens
|
|
|
What diagnostic is used in suspected spinal stenosis
|
MRI of the spine
|
|
|
What are sequela events that can occur from asymptomatic bacteriuria, in preg
|
acute cystitis, pyelonephritis, UTI
|
|
|
What is the heart sound of soft first heart sound, w/ pansystolic apical murmur that radiates to axilla
|
mitral regurgitation
|
|
|
Why should a urine culture be obtain in all women early in preg?
|
Risk of UTI from asymptomatic bacteriuria.
|
|
|
Abdominal exam: high, midline abdominal pulsation of low amplitude that are directed forward indicates:
|
a normal finding
|
|
|
Define Hales lactation risk cat:
L1 and L2 |
L1: safest (cromolyn, APAP, depo (1m post birth)
L2: safer, limited study: nitrofuratoin, cephalosporins, 2nd gen antihistamines, prednisone, SSRI |
|
|
Swollen, non-tender scrotum for 1 wk w/ mass in tunica vaginalis transilluminates is a:
|
hydrocele
|
|
|
Define Hales lactation risk cat:
L3 and L4 |
L3: mod safe, no controlled studies or limited: TMP-SMX, Fq antibiotics, 1st gen antihistamines
|
|
|
Generalized, non pururitic skin eruption intermittent exacerbation for years. erythematous plaque on gluteal fold scales and fissuring:
|
psoriasis
|
|
|
Define hales lactation risk cat: L5
|
contraindiated: radioactive isotopes, cocaine
|
|
|
Depressed mood, characteristics of nonpsychotic depression include:
|
early morning awakening and slowed thinking
|
|
|
What wk in preg is preeclampsia noted?
|
20th
|
|
|
Woman 24wks pregnant what is the fundal height
|
24cm or 3cm above umbilicus
|
|
|
What are risk factors for preeclampsia?
|
age <16->40, first preg or first pre w/ new partner, pregestational diabetes, presense of collagen vascular, HTN, Renal, FHx,
|
|
|
Drug most likely to increase lipoprotein levels
|
hydrochlorothiazide: older beta blockers increase lipids
|
|
|
What are sx of severe preeclampsia?
|
BP >160/110, proteinuria (>5), hepatic, renal or CNS damage
|
|
|
Most common type of joint disease in US
|
asteoarthtitis
|
|
|
What are the components of HELLP in preeclampsia?
|
Hemolysis, elevated liver, low platelet and eclampsia
|
|
|
Sx of left ventricular heart failure
|
third heart sound, cough , bibasilar rales
|
|
|
What is the most important intervention of preeclampsia?
|
High suspicion w/ high risk: the OB consult: rest,monitor, antiHTN, anticonvulsant
|
|
|
Eval of rapid, alternating movements of hands assess
|
cerebellar functioning (assess dysdiadochokinesa)
|
|
|
what is the definitive tx of eclampsia?
|
Birth
|
|
|
Colic infants patient education: colic will diminish w/:
|
Time
|
|
|
When does grp B streptococcus colonize typically in preg and when does it trnsfer to fetus?
|
during 1st wk of preg, and when water breaks or onset of labor
|
|
|
Plantar fat pads on 2y/o child
|
normal
|
|
|
When should Group Beta Testing in preg occur?
|
35-37wks: trnsf to baby when labor begins
|
|
|
Test to determine clearance of digoxin.
|
creatinine clearance estamate
|
|
|
Define Chronic HTN vs Gestational HTN:
|
chronic: HTN prior preg, prior to 20th wk, persist >6wks post
gestational: HTN after 20 wk but resolving w/in 6wks post |
|
|
Beta blockers are not contraindicated in ......any more but calcium channel blockers are?
|
heart failure
|
|
|
Define:
Preeclampsia, Eclampsia |
- PreEclampsia: HTN after 20wk w/ protein uria >300mg/24hr and edema
- Eclampsia: PreEclampsia sx w/ tonic-clonic seizures or alt mental status |
|
|
Low back pain tx
|
mild activity w/ motrin and rice
|
|
|
HTN Cat in Preg:
HELLP |
PreE w/ elevated hepatic enzyme levels and low platelets
|
|
|
In heart failure tx
|
HCTZ (lasix light), aldactone (spironolactone): aldosterone, angiotension effects.
|
|
|
Are plantar fat pads on 2y/o child?
a. abnormal b. normal c. sign of cancer d. none of the above |
b. normal
|
|
|
What does the acronym BATHE stand for in domestic violence?
|
B:background: home work
A: affect, anxiety: feel T: trouble: worries H: handling: support, intervention E: empathy: |
|
|
Do diuretics affect pre load or afterload
|
Pre-load: by decreasing amount of fluid results in heart not working as hard to move blood.
|
|
|
define inevitable abortion?
|
US w/ viable preg but +vag bleed
|
|
|
What are uses of aldasterone
|
hyperoldosteronis
|
|
|
Test to determine clearance of digoxin.
|
creatinine clearance estamate
|
|
|
define threatened abortion?
|
uterine contents process being expelled
|
|
|
Burn to hands require a referral to a specialist: true or false
|
true
|
|
|
Beta blockers are not contraindicated in ......any more but calcium channel blockers are
|
heart failure
|
|
|
Define incomplete abortion?
|
some portion of product remain in uterus but no longer viable
|
|
|
what is the degree of sedation for antihistamines: atarax
|
better itch relief and sedation (SE)
|
|
|
Low back pain tx
|
mild activity w/ motrin and rice
|
|
|
Quantitative serum HcG doubles every ___hrs the 1st wk of pregnancy?
|
48 hours
|
|
|
Fe anemia before it is tx reticulocytes are (high or low), upon tx it will be (high or low)
|
low, high (fast 1-2wks)
|
|
|
In heart failure tx
|
HCTZ (lasix light), aldactone (spironolactone): aldosterone, angiotension effects.
|
|
|
Where are 95% of ectopics located?
|
fallopian tubes
|
|
|
Do diuretics affect pre load or afterload
|
Pre-load: by decreasing amount of fluid results in heart not working as hard to move blood.
|
|
|
What is the classic triad of ectopic pregnancy?
|
abd pain, vag bleed, adnexal mass: but in only 50% of women w/ ectopic
|
|
|
What are uses of aldasterone
|
hyperoldosteronis
|
|
|
What are the diagnostic for ectopic?
|
Urine, serum (neg r/o ectopic), see a decrease in expected quant number for age, also US.
|
|
|
Burn to hands require a referral to a specialist: true or false
|
true
|
|
|
What is salpingectomy (in ectopic preg)
|
opening of tube and removal of content
|
|
|
what is the degree of sedation for antihistamines: atarax
|
better itch relief and sedation (SE)
|
|
|
What is definition of spontaneous abortion
|
ending prior to 20 wks: 60% due to chromosomal defect
|
|
|
Fe anemia before it is tx reticulocytes are (high or low), upon tx it will be (high or low)
|
low, high (fast 1-2wks)
|
|
|
What is the longest part of labor?
|
latent phase (2-3days)
|
|
|
When does the first stage of active labor start?
|
at 3-4 cm cervix
|
|
|
Which are more infections: human, dog, rat
|
human
|
|
|
When should a preg women be instructed to go the hospital?
|
when contractions r occuring q 5min.
|
|
|
bouchard nodes versus heberden nodes: define differences
|
Heberdens are at DIP joint and Bouchards (less common) are at the MIP joint: both are bony "bumps". sign of osteoarthitis
|
|
|
What is the second stage of labor?
|
the actual birth
|
|
|
Glucocorticoid help with all itis
|
cellulitis
|
|
|
What is the third stage of birth
|
when placenta is delivered
|
|
|
which situation would be associated w/ macrocytic anemia
|
B12 and folic acid
|
|
|
How long is avg labor for first mother?
|
9hrs, 6 for 2nd and beyond.
|
|
|
what bite would require viral medication
|
monkey bite
|
|
|
What is a characteristic of type 1 DM: ie what is the blood glucose level and insulin
|
hyperglycemia and ketoacidosis from lack of insulin (pancreas isnt makin it or enuff)
|
|
|
What is a characteristic of type 1 DM: ie what is the blood glucose level and insulin
|
hyperglycemia and ketoacidosis from lack of insulin (pancreas isnt makin it or enuff)
|
|
|
Qualitative research:
|
does not mearsure only states lived experience
|
|
|
What characteristic apply to Type 2 DM: think main risk factors
|
heredity and obesity
|
|
|
Quantitative research
|
uses numbers and statistics
|
|
|
insulin G (Lantus) has a short or extended duration of action?
|
extended duration of action
|
|
|
Independent variable
|
First thing: it is not being influenced is being manipulated (type of diet)
|
|
|
Lispro (humalog) onset of action occurs in what time:
|
less than 15min
|
|
|
Dependent variable
|
change measured in dependent variable: weight is dependent on diet (independent)
|
|
|
What diabetic med should be used w/ caution in sulfa allergy
|
glyburied (sulfonylureas)
|
|
|
Function of IRB (institutional research board)
|
review research, be patient advocate, advised of risk and benifits.
|
|
|
What vaccines are required at 4 months?
|
DTaP
Hib IPV PCV Rota |
|
|
What is a characteristic of type 1 DM: ie what is the blood glucose level and insulin
|
hyperglycemia and ketoacidosis from lack of insulin (pancreas isnt makin it or enuff)
|
|
|
What is metformins (glucophage) Mech of action
|
increases insulin action in peripheral tissue reduces hepatic glucose production
|
|
|
How often does ADA guideline for testing type 2 in asymptomatic >45yrs old
|
every 3 years
|
|
|
Who can receive live attenuated flu vaccine (nasal spray)
|
Healthy non pregnant: 2-49
|
|
|
how often does ADA guideline for testing type 2 in <45 years?
|
only if hx of high-density lipoprotein <35mg or other risk factors
|
|
|
insulin G (Lantus) has a short or extended duration of action?
|
extended duration of action
|
|
|
What is a characteristic of type 1 DM: ie what is the blood glucose level and insulin
|
hyperglycemia and ketoacidosis from lack of insulin (pancreas isnt makin it or enuff)
|
|
|
Which vaccine is contraindicated in pregnancy? Injectable Flu, Td, MMR, Hep B
|
MMR
|
|
|
Lispro (humalog) onset of action occurs in what time:
|
less than 15min
|
|
|
What characteristic apply to Type 2 DM: think main risk factors
|
heredity and obesity
|
|
|
What is a criteria for dx of type 2 DM:
|
plasma glucose level 126mg or higher after 8hr fast on more than one occasion...also now A1C>6.5
|
|
|
What percent of acute Hep B will develop Chronic?
|
5%
|
|
|
insulin G (Lantus) has a short or extended duration of action?
|
extended duration of action
|
|
|
Rosiglitazones (TZD) thiazolidinedione mech of action
|
insulin sensitizer making cells more responsive to insulin: Avandia
|
|
|
What diabetic med should be used w/ caution in sulfa allergy
|
glyburied (sulfonylureas)
|
|
|
What should be given if some has exposure to Heb B?
|
HBV and shot of HBIG
|
|
|
What has increase risk of suicide? rifampin, accutane, acyclovir, advair
|
accutane
|
|
|
Lispro (humalog) onset of action occurs in what time:
|
less than 15min
|
|
|
What is metformins (glucophage) Mech of action
|
increases insulin action in peripheral tissue reduces hepatic glucose production
|
|
|
What type of contraception is useful to control acne?
|
estrogen/progesterone: controls hormone flucuation
|
|
|
What diabetic med should be used w/ caution in sulfa allergy
|
glyburied (sulfonylureas)
|
|
|
Amniodarone has toxicity to what organ?
|
lungs
|
|
|
how often does ADA guideline for testing type 2 in <45 years?
|
only if hx of high-density lipoprotein <35mg or other risk factors
|
|
|
What is metformins (glucophage) Mech of action
|
increases insulin action in peripheral tissue reduces hepatic glucose production
|
|
|
Which vaccine is effective after one dose? Hep A, Hep B, Gardisil, Herpes Zoster
|
Herpes Zoster
Gardisil=3shots Hep B= 2 shots |
|
|
What is a criteria for dx of type 2 DM:
|
plasma glucose level 126mg or higher after 8hr fast on more than one occasion...also now A1C>6.5
|
|
|
What is primary Prevention and give an example?
|
Prevent onset or acquisition of disease:
Ex: immunization, education, use to seatbelts |
|
|
how often does ADA guideline for testing type 2 in <45 years?
|
only if hx of high-density lipoprotein <35mg or other risk factors
|
|
|
What is secondary Prevention and give an example?
|
identify and tx asymptomatic persons who have risk factors for given disease:
Ex: screening, Blood pressure, lipid profile |
|
|
What is a criteria for dx of type 2 DM:
|
plasma glucose level 126mg or higher after 8hr fast on more than one occasion...also now A1C>6.5
|
|
|
What is tertiary Prevention and give an example?
|
Goal of minimize disease complications and negative health from effects:
Ex: meds, lifestyle modification, tx |
|
|
Rosiglitazones (avandia) (thiazolidinedione) mech of action
|
insulin sensitizer
|
|
|
What is the incubation period of influenza?
|
1-4days
|
|
|
Insulin: onset, peak duration of action:
Lispro, Humalog |
O: 15min, P: 30-90min, D: <5hr
ultra short-acting, rapid onset |
|
|
How long are you infectious w/ influenza?
|
Adults: 5days, Children 10days
immunodeficient shed virus of 3wks |
|
|
Insulin: onset, peak, duration of action: Regular; Humulin R
|
O: 1/2-1hr, P: 2-3hr, D: 4-6hr
short-acting |
|
|
Who is at highest risk of death w/ influenza?
|
<2 and >65y/o
|
|
|
Insulin: onset, peak, duration of action: Humulin N, NPH
|
O: 2-4hr, P: 4-10hr, D: 14-18hr
Intermediate acting |
|
|
What ages can receive the trivalent influenza vaccine?
|
6months and older and all pregnant women
|
|
|
Insulin: onset, peak, duration of action: Humulin L, Lente
|
O: 3-4, P: 4-12 hr, D: 16-20: intermediate acting (medicinet.com)
|
|
|
Insulin: onset, peak, duratation of action: Lantus
|
O: hours, P: none, D: >24hrs
Insulin glargine |
|
|
Who can receive the Live Attenuated Influenza vaccine?
|
2years -49 y/o and healthy
|
|
|
What medication can you consider when tx a HTN and DM:
|
ACE-I: like fosinopril : nephroprotective features
|
|
|
How many doses do <9y/o need for initial influenza vaccine?
|
2 doses over 4 wks for TIV and 6wks for LAIV
|
|
|
What should be monitored when prescribing biguanide; ie, metformin (glucophage)
|
creatinine
|
|
|
What are the four antiviral meds approved by the FDA for influenza?
|
amantadine (Symmetrel), rimantadine (Flumadine), zanamivir (Relenza), oseltamivir (Tamiflu)
|
|
|
what percent of the body's insuline mediated glucose uptake takes place in the muscle
|
80%
|
|
|
What influenza medication are approved for influenza A?
|
amantadine (Symmetrel), rimantadine (Flumadine)
|
|
|
Exercise reduces Insulin Resistance by _____% w/ effects lasting _____Hrs
|
40% and 48hrs
|
|
|
What influenza antivirals can be used for A and B strains?
|
Zanamivir (Relenza), oseltamivir (Tamiflu)
|
|
|
What amount of cholesterol does the ADA recommend
|
300mg or less
|
|
|
What are side effects of zanamivir (Relenza) and how is it administered?
|
Used to tx the flu:
S/E: bronchospasm (w/ asthma or chronic lung) Administered via inhalation |
|
|
What is the Somogyi effect
|
when insulin induces hypoglycemia and triggers excess secretion of glucagon and cortisol which leads to hyperglycemia
|
|
|
What are the side effects of relenza (Tamiflu) and how is it administered?
|
GI, n/v; PO take w/ food
|
|
|
What is the dawn phenomenon as it relates to diabetes?
|
reduced insulin sensitivity 5am-8am due to earlier spikes in growth hormone.
|
|
|
How far apart should MMR be given and how many doses are required?
|
1m apart 2 doses (live attenuated virus)
|
|
|
sulfonylureas act on what in diabetes
|
stimulate insulin release from functioning beta cells and enhance insulin sesitivity
|
|
|
Can an MMR be given during pregnancy?
|
NO
|
|
|
What amount of weight loss is expected w/ metformin
|
3-5kg in first months of use
|
|
|
What are sequelae illnes of Measles and mumps?
|
Measles: encephalitis and pneumonia
Mumps: orchitis |
|
|
What is another advantage of metformin besides DM
|
It can help improve lipid profile (decrease LDL and triglycerids while increasing HDL)
|
|
|
Can MMR be given when breastfeeding?
|
YES
|
|
|
What is the major adverse effect of metformin
|
GI upset: increase dose slowly
|
|
|
How many doses of Tdap should be administered and at what interval?
|
5 doses: 1st two one month apart 3rd - 5th- 6m apart. Then q 10 yrs
starting at 6wks |
|
|
What indicated nephropathy in DM patients
|
Proteinuria: microalbumin (obtain in the morning due to false positive later in the day)
|
|
|
What age should Dtap be administered after entering school?
|
11-12 y/o
|
|
|
What is the goal of A1C and BP in DM, per 7th JNC report of joint national committe.
|
<7% and <130/<80
|
|
|
What is the max recommended age for receiving the HIib vaccination
|
5 years old
|
|
|
Sulfonylurea: M of action and caution
|
insulin secretagogue
sulfa allergy, renal dysfunction |
|
|
What immunization should be given at birth?
|
Hep B
|
|
|
Thiazolidinedion (TZD): M of Action and caution
|
insulin sensitizer
monitor ALT; hypoglycemia when used w/ sulfonyl or insulin but not solo |
|
|
List the immunization given at 6wks?
|
Rotovirus, Dtap, Hib, Pneumococcal, polio
|
|
|
Biguanides (metformin): M of Action, caution
|
Insulin sensitizer and decrease live glucose production
Caution: Monitor creatinine lactic acidosis risk w/ eleveated CR, hypoglycemia when used w/ sulfony, GI side effect |
|
|
List immunization started at 12months?
|
MMR, varicella, Hep A
|
|
|
A-gulucosidase inhibitors: M of action, caution (Precose, glyset)
|
delay intestinal carb absorption:
Taken w/ meals, help manage postprandial hyperglycemia, GI S/E |
|
|
When should the final dose of polio be given if not 6m after initial dose?
|
On or after 4 yrs old
|
|
|
meglitinides: action caution
|
Short acting insulin secretagogue
Quick insulin burst, before meals, helps postprandial |
|
|
When should the HPV vaccine be offered and how many doses?
|
13-18 y/o: 3 doses
|
|
|
Dipeptidyl peptidase -4 (DPP-4) inhibitor: Januvia, Onglyza: MoA?
|
increase level of insulin, increase sythesis and release of insulin from pancreatic beta cells and decrease release of glucagon from alpha cells.
Dose adjust for renal impair, little hypo risk, use w/ metformin |
|
|
What does pneumococcal vaccine protect you from?
|
Invasive disease like meningitis, septicemia from S. pneumonia (leading cause of death from CAP)
|
|
|
What are risk factors of lactic acidosis when using metformin?
|
renal insufficiency, dehydration, radiographic contrast dye
|
|
|
What medication should an HIV patient receive and how soon after diagnosis?
|
antipneumococcal vaccine as soon as diagnosis is made
|
|
|
What are medications that causes secondary hyperglycemia
|
Niacin, corticosteroids, thiazide diuretics
|
|
|
How long after first pneumococcal should second pneumococcal be given?
|
5 years
|
|
|
How do meglitinide anaologs help w/ DM2:
|
prevent postprandial hyperglycemia
|
|
|
Which of the following allergic rxn should not receive the Hep B vaccination? egg, bakers yeast, neomycin, streptomycin
|
bakers yeast
|
|
|
What is the most common adverse effect of alpha-glucosidase inhibitor?
|
flatulance
|
|
|
When should pregnant women be screen for HBsAg?
|
At first prenatal visit regardless of HBV hx
|
|
|
Intervention in microalbumin for DM include:
|
improved glycemic control, strict dyslipidemia control, use of ACE-I or angiotensin receptor blocker.
ACE-I have some nephroprotection |
|
|
When should a booster dose of HBV be admistered and to whom?
|
when anti-HB is <10mIU/ml and only for immunocompromised patients
|
|
|
Drugs whose names end in "-pril" and reduce efferent arteriolar pressure are from what class:
|
ACE-I:
|
|
|
What vaccination should be given to someone exposed to Hep B?
|
If previously vaccinated: single HBV booster
If no vaccination: HBV and HBIG w/in 24hrs of exposure |
|
|
What class of meds end in "sartan" and help preserve renal function in DM
|
Angiotensin receptor blockers
|
|
|
How is small pox spread?
|
droplets: nasal, oral, pharyngeal
|
|
|
What medications increase your risk of heat stoke?
|
Med: tricyclic antidepressants (triptylines), beta blockers (lol), vasoconstrictors like decongestants.
Note: meds change the bodies ability to regulate core temp by negating increase CO and vasodilaiton |
|
|
When is small pox most contagious?
|
onset of rash: may be w/ fever
|
|
|
What lab should be gotten in a patinet w/ heat stroke
|
CK to assess muscle damage --> release of electrolyte tissue damage, hyperkalemia
|
|
|
What are sx of small pox?
|
rash to tongue, open sores, rash to skin all over w/in 24hrs
|
|
|
What can heat stroke lead to..before death?
|
polycythemia due to volume constriction and hyponatremia w/ Na <120 and stress induced leukocytosis
|
|
|
How long is smallpox contagious?
|
until all crusts have fallen off
|
|
|
Tx of Heat Stroke
|
cooling w/ tepid spray and fan vs ice (may cause vasoconstriction decrease ability to lose heat from core), Rhabdomyolysis-->acute renal failure, Ck, creatinine
|
|
|
What is the tx of small pox?
|
supportive: vaccinate w/in 3 days of exposure lessens severity
|
|
|
62y/o HTN, smoke, Trigly:280, HDL:38, LDL:135 what med is best (class)
|
multi drug therapy is needed
|
|
|
What age has the greatest mortality from varicella? 2-10, 30-50, 60-80
|
30-50 years old (fitzgerald)
|
|
|
46y/o HTN smoke, Trig: 110, HDL: 48, LDL: 192, on low-cholest diet what is next best step?
|
HMG-CoA (coenzyme A reductase inhibitor) (lipitor, zocor, pravistatin) statins
|
|
|
Where does the VZV lie dormant?
|
sensory nerve ganglia (later causes shingles...dermatone)
|
|
|
64y/o HTN DM2, Trig: 180, HDL 38, LDL: 135. Meds: sulfonylurea, TZD, biguanide, ACE-I, thiazide diuretic what next?
|
lipid-lowering drug therapy initiated.
|
|
|
What age is varicella vaccine started?
|
after the 1st birthday and second between 4-6 y/o
|
|
|
What lab should be check w/ taking HMG-CoA reductase inhibitor (Statin) ?
|
aspartate aminotransferase (liver function), CK
|
|
|
When should pregnant women recieve the first dose of varicella if no immunity?
|
after delivery and before discharge
|
|
|
What changes are expected when taking fibrates?
|
increase in HDL: only medication that actually document increase in HDL
|
|
|
What can be given if no immunization but contraindication for vaccination?
|
VZIG post exposure
|
|
|
What CD4 count in HIV should you withhold live virus?
|
< 200 cell/uL
|
|
|
How is diphtheria (gram-negative bacillu) transmitted?
|
usually contaminated liquids ie milk
|
|
|
When prescribing Zetia what should you expect to see?
|
reduction in LDL
|
|
|
What is the initial sx of diphtheria?
|
pseudomembranous? pharyngitis
|
|
|
What are risk factors for statin induced myostitis?
|
advanced age, low body weight, high statin dose
|
|
|
What should you give a patient exposed to tetanus but no immunization?
|
Tetanus IG
|
|
|
What is the average LDL reduction when only diet is modified in lowering cholesteral tx?
|
5-10%
|
|
|
How is Hep A transmitted?
|
fecal oral route: self limiting rarely fatal
|
|
|
When taking atorvastatin and cholestyramine advise the patient to take the medicaiton?
|
separeate cholestyramine from other meds by 2hrs (affect absorption)
|
|
|
What should clotting factor disorder patinets be immunized with?
|
Hep A
|
|
|
What medication is most effective against lipoprotein?
|
niacin
|
|
|
How is polio transmitted?
|
fecal oral: OPV no longer used in US due to risk of paralytic poliomyelitis
|
|
|
What are secondary causes of hypertriglyceridemia?
|
hypothyroidism, poorly controlled DM or excessive alcohol
|
|
|
Which would presents > risk for tetanus?
A. puncture while gardening B: lac while cutting beef C: human bite D: abrasion from sidewalk |
Puncture wound while gardening
|
|
|
HMG CoA reductase inhibitor (statin)? Effect, comments
|
lower LDL by 18-55%
Increase: HDL by 5-15% lower Trig by 7-20% check AST prior to initiation, & periodically; check CK initiation. not needed further unless sx; A/E: rhabdo, myositis, increase when combined w/ fibrate, renal impairment |
|
|
Resin (cholestyramine, colestipol, colesevelam): benefits and adverse rxn
|
low LDL:15-30%
increase HDL: 3-5% nonsystemic w/ no hepatic monitoring required, minimal effect on Trig (may increase if trig >400) A/E: GI, constipation, decrease of other meds absorption take >2hrs after |
|
|
18y/o w/ no primary tetanus should receive what tetanus immunzation?
|
Tdap now then Td in 1 and 6 months
|
|
|
Niacin (class: antihyperlipidemia): benifits, Use, adverse effects,
|
increase HDL: 15-35%
decrease Trig: 20-50% decrease LDL: 5-25% Highly effective against atherogenic lipoprotein A/E: flushing (take ASA 1hr prior to reduce), hyperlgycemia, hyperuricemia, GI, hepatotoxicity Contra: active liver disease, gout, peptic ulcer |
|
|
50y/o who hasnt had tetanus vaccination in 10 years should receive what tetanus?
|
Tdap
|
|
|
Fibric acid derivatives: gemfibrozil (lopid), fenobribrate (tricor): what should you expect to see w/ tx and A/E
|
increase HDL
decrease Trig: 20-50% decrease LDL 5-20% (if normal Trig) May raise LDL w/ high Trig A/E: dyspepsia, gallstones, myopathy if taken w/ statin Contra: sever renal or hepatic disease |
|
|
What is the most common source of Hep A infection?
|
contaminated drinking water
|
|
|
What does Ezetimibe (Zetia) do and what are A/Rxn
|
decrease LDL-C
increase HDL-C -minimal effect on Trig, prescribe w/ another lipid lowering agent to enhance LDL A/E: few due to no limited systemic absorption |
|
|
Which of the following should be tx for acute Hep A? A: interferon-alfa,
B: ribavirin C: acyclovir D: supportive care |
supportive care
|
|
|
Sedondary hyperlipidemia:
What does inactivity result in |
decrase HDL
|
|
|
What age should women start breast exams?
|
>20y/o if they want
>40 y/o annually |
|
|
Sedondary hyperlipidemia:
What does Alcohol abuse result in |
increase triglycerides, increase HDL increase LDL
|
|
|
What age should women start having mammogram?
|
40y/o. if high risk annually if low then yearly not recommended
|
|
|
Sedondary hyperlipidemia:
What does DM result in |
increase Trig, decrease HDL, increase total cholesterol
|
|
|
When should cervical screening be initiated?
|
3yrs after intercourse
30y/o q 3yrs after 3 normal Total hysterectomy: none |
|
|
Sedondary hyperlipidemia:
What does Hypothyroidism result in |
increase Trig increase Total TC
|
|
|
When should endometrial cancer be discussed?
|
at menopause: report any unexpected bleeding
|
|
|
Secondary hyperlipidemia:
What does High dose thiazide diuretics result in |
increase TC, LDL, Trig
|
|
|
What are the five A of tobacco counseling?
|
Ask, Advise, Assess, Assist, Arrange
|
|
|
Sedondary hyperlipidemia:
What does Chronic renal result in |
increase TC and Trig
|
|
|
What medications are used in tobacco cessation?
|
bupropion (Wellbutrin), varenicline (Chantix)
|
|
|
Metabolic syndrome dx includes:
|
abd obesity, trig levels higher than 150, HDL less than 40 in men and 50 in women
|
|
|
What does ABRS stand for w/ ENT?
|
Acute Bacterial Rhinosinusitis
|
|
|
What is characteristic of Metabolic Syndrome related to insulin?
|
Insulin resistance is present
|
|
|
Things that point to bacterial versus viral sinusitis?
|
Sx > 4 days, Purulent discharge, tooth or facial pain, maxillary sinus tenderness unilateral, sx worsen after improving.
|
|
|
Describe plasminogen activator inhibitor:
|
increased levels in atherosclerotic lesion
-inhibits fibrin degradation by plasmin -enhances clot formation |
|
|
Purpose of giving decongestant w/ sinusitis is to..?
|
Promote drainage
|
|
|
Define metabolic syndrome:
|
3 or more: obesity, blood pressure, dyslipidemia, glucose intolerance
|
|
|
Patient 875mg amoxicillin for sinusitis but worsen after 5days what is the bug? What should you do
|
it is probably a beta lactam and should use augmentin, tirid gen cephlasporin
|
|
|
What is insulin resistance:
|
a reduced sensitivity in the tissue to insulins action at given concentration -->subnormal effect on glucose metabolism
|
|
|
Amoxicillin for sinusitis develop hives what should you do?
|
Stop amoxicillin. Start doxycycline or other none PNC/Ceph
|
|
|
Metabolic syndrome Guidelines:
|
abd men >40 inches, W >35
-Trig >150, HDL<40 BP: >130/85 Fasting glucose >110 |
|
|
If a patient has anaphylactic on PNC what other antibiotic should not be given?
|
cephlasporin
|
|
|
Insulin resistance is inversely related to decrease urine clearanc of what
|
Uric acid (gout)
|
|
|
Adult w/ common cold takes fexoaphenadine (allegra) and fluticosone nasal spray for allergies...what should you do?
|
keep her on allergy and add oral decongestant. Dont add guifenisin (it wets and fexoaphenadine is trying to dry up)
|
|
|
Tx of insulin sensitizing medication for pt w/ polycystic ovary syndrome can lead to
|
resumption fo ovulation, fertility, reduced hirsutism
|
|
|
What will oral decongestants exacerbate?
|
(Psuedofed)...urge incontenance, blood pressure, mitral valve prolapse, BPH
|
|
|
What are some disadvantages to apple shaped (central abd fat)
|
metabolically active fat, high insulin levels, IR, free fatty acids and high insulin (increase hunger)
|
|
|
What would contraindicated use of topical decongestant? ie affrin
|
it is a vasoconstrictor: dont use in hypertensive patient
|
|
|
IR contribute to prothromotic and proatherogenic state because
|
Plasminogen activator inhibitor: inhibits fibrin degradation enhancing clot formation
|
|
|
What is the modified CENTOR score to determine giving an antibiotic for pharyngitis?
|
fever >100.4, no cough, anterior cervical nodes, tonsilar exudate swelling.
Also: ages 3-14 more likely >45y/o subtract a number |
|
|
Seeing a gradual climb in glucose level over years you should consider risk for
|
metabolic syndrome and DM2
|
|
|
16y/o patient w/ acute pharyngitis and sinus sx but no sore throat only sinus sx but you get positive strep?
|
PNC 10 days: prevent rheumatic fever
|
|
|
Insulin resistance leads to HTN by increase in:
|
renal sodium resabsorption-->expand cir volume and incrase vascular resistance
|
|
|
Pt unable to swallow due to throat pain and in sniffing position w/ fever 103, and is spitting? what is the likely dx
|
epiglotitis
|
|
|
Insulin resistance leads to cardiovascular effects of:
|
Hypertension through an increase vascular smooth muscle, greater response to angiotensin II and greater sympathetic activation
|
|
|
What is the tx of epiglotitis in a FP clinic?
|
call 911
|
|
|
Aerobic exercise can reduce IR by what percent
|
40% and last 48hrs, reduces BP and improves lipids
|
|
|
What the likely hood of having enlarged spleen w/ mono?
|
50% have enlarged spleen palpate w/ flat part of hand not finger tips
|
|
|
What medication improves insulin sensitivity and metablic parameters like lipids and BP
|
TZD (pioglitazone, rosiglitazone)
|
|
|
What are mono sx?
|
FFFL: fatigue, fever, (f)pharyngitis, lymphadenopathy
|
|
|
What does daily ASA do for BP, lipids
|
counter act proinflammatory and prothrombotic effects of IR
|
|
|
Sx suggestive of mono but mono spot is negative? what should you do?
|
repeat mono spot in 5-7 days if cont sx. <2% w/ two negative test. Dont do epstein barr virus due to low sensitivity and high cost
|
|
|
What does the WHO define as obesity ___kg/M2 or more
|
30 Kg/M2
|
|
|
What is kiesselbach plexus?
|
Anterior nose likely to bleed 90% of nose bleed
|
|
|
How do you treat epistaxis?
|
topical vasocontrictor (phynlephrine spray), cotton saturated w/ vasocontrictor, insert in nasal opening
|
|
|
What does orlistat do for weight loss
|
reduc dietary fat absorption by 30%. Results in diarrhea if you eat fats
|
|
|
What if you have epitaxis in rural clinic w/o other resources?
|
silver nitrate: anesthesia first.
|
|
|
What does Meridia due for weight loss
|
acts on brain control for mood an dwell being and appetite
|
|
|
Allergic Rhinitis: management
|
first line: nasal steroid (fluticasone), then add antihistamine, then add decongestant, then add leukotriene blocker
|
|
|
When can someone consider Bariatric surgical:
|
100lbs or more over ideal or >40BMI
|
|
|
What is the difference in first gen and send gen antihistamines?
|
second gen is less drowsy and last 24hrs:
zyrtec is 2nd gen but does cause drowsines |
|
|
What are risk factors for pancreatitis:
|
hyperlipidemia, abd trauma, thiazid diuretic use, alcoholism, gallbladder stones,
|
|
|
Patient w/ insect sting and allergic sx of runny nose, erythema, puritis at sight what should you use to tx sx?
|
systemic tx: diphehydramine liquid (absorbed faster than tablet)
|
|
|
What lab is obtained to determine acute pancreatitis
|
serum lipase level w/ amylase
|
|
|
Patient dx w/ Otitis externa what is a classic sx?
|
tragus pain, otic discharge, diminished hearing...should NOT have fever (not a systemic disease)
|
|
|
What is the most reliable test for pancreatic cancer
|
MRI is the most reliable diagnostic.
|
|
|
What is care of pancreatitis
|
parenteral hydration , analgesia, gut rest, tx underlying cause
|
|
|
Cermumen impaction would produce what type of hearing lose?
|
Conductive hearing loss (as does any obstruction)
|
|
|
How does a pancreatic cancer present:
|
abd pain , weight loss, anorexia, N/v, jaundices
|
|
|
What is a sensorineural hearing loss?
|
8th cranial nerve, effects inner ear, involves nerve
|
|
|
Amylase in Acute Pancreatitis will appear ______ and return back to normal ______. What % are due to cholelithiasis vs % due to alcoholic pancreas
|
* appears 2-12h after sx onset
* back to normal w/in 7d of pancreatitis resolution * Amylase level >1000 U/L *80%=Dx cholelithiasis *6% = Dx alcoholic pancreatitis |
|
|
What is presbycusis?
|
hearing loss from age...bilateral
|
|
|
Amylase: What effects amylase levels
Nonpancreatic amylase: |
*salivary glands
* ovarian cysts * ovarian tumors * tubo-ovarian abscess * ruptured ectopic preg * lung cancer |
|
|
What does the Webber test detect?
|
unilateral conductive and sensioneural hearing loss
Riene (mastoid bone then air) Webber (top of head) |
|
|
What steps should be taken for eye complaints?
|
Visual acquity, slit lamp, if only a light look at the side for smooth round globe, flouresceine stain for break in cornea
|
|
|
Lipase in Acute Pancreatitis:
Lipase appear how soon after onset and peaks at what time frame |
* appears 4-8h after sx onset
* Peaks at 24h, decreases 8-14d of pancreatitis resolution |
|
|
What is associated w/ cataracts?
|
decrease night vision, decrease vision, double vision, decrease color vision.
|
|
|
What non pancreatic reasons would result in elevated Lipase?
|
* renal failure
* perforated duodenal ulcer * bowel obstruction * bowel infarction |
|
|
Conjuctivits: why are meds given?
|
only to get back to work or school earlier...they will clear on own
|
|
|
Hyperthyroidism: signs and sx
Characteristics (patho) |
excessive energy release, rapid cell turnover
|
|
|
What is a pinguecula?
|
non-cancerous growth of the clear, thin tissue (conjunctiva) that lays over the white part of the eye (sclera)
|
|
|
Hperthyroidism: signs and sx
Causes (disease names) |
Graves, thyroiditis, metabolically active thyroid nodule
|
|
|
Corneal arcus is what?
|
seen in older patients, may indicate elevated cholesterol
|
|
|
Hperthyroidism: signs and sx
Neurologic: sx |
Nervousness, irritability, memory problems
|
|
|
Hyphema is what?
|
bleeding in anterior chamber (emergency) caused by trauma
|
|
|
Hperthyroidism: signs and sx
Weight |
weight loss (modest only in 50%)
|
|
|
What is a chalzion?
|
hard nontender nodule on eyelid
|
|
|
Hperthyroidism: signs and sx
Enviornmental response |
Heat intolerance
|
|
|
What is a stye or hordoleum?
|
bump on eyelid that starts off tender
|
|
|
Hperthyroidism: signs and sx
Skin |
Smooth, silky skin
|
|
|
Hyperthyroidism: signs and sx
Hair |
fine hair w/ freq loss
|
|
|
RUQ abdominal pain is associated w/?
|
Liver disease, choly, pneumonia
|
|
|
Hyperthyroidism: signs and sx
Nails |
thin nails that break w/ ease
|
|
|
What is the LES tone related to GERD?
|
Lower esophageal sphincter, becomes relaxed which results in gastric juice back flow
|
|
|
What is Barretts esophagitis?
|
Pre malignant condition of the esophagus: a differential of GERD tx w/ PPI: age 50 get scoped, or not responsive to PPI, pain or bleeding get scoped too
|
|
|
Hyperthyroidism: signs and sx
GI |
frequent, low-volume, loose stools
|
|
|
GERD tx?
|
Remain upright 2-3hrs after they eat (clear stomach), pH should be elevated when reflux is expected
|
|
|
Hyperthyroidism: signs and sx
Menstrual |
Amenorrhea or low-volume menstral flow
|
|
|
Hyperthyroidism: signs and sx
Reflexes |
Hyperreflexia w/ "quick out-quick back" action
|
|
|
What pharm tx is used in GERD?
|
antacid (reduces pH) (short term 30min but reacts fast),
2nd: H2 blocker (histamine blocker) decrease acid production (dont change pH but work for 12-24hrs) 3rd: PPI the best aggressive tx: (not PRN drug) prescibed for 1 month |
|
|
Hyperthyroidism: signs and sx
Muscle strength |
Proximal muscle weakness
|
|
|
H. pylori is gram negative: causes what?
|
ulcers in stomach or esophagus,
|
|
|
Hyperthyroidism: signs and sx
Cardiac |
Tachycardia
|
|
|
38y/o w/ suspect C-dif (gram neg) what is a classic description of stool?
|
bloody and watery
|
|
|
What infectious organism is common if under cooked poultry is consumed?
|
salmonella ( also on pet turtles)
|
|
|
Hyorthyroidism: signs and sx
Characteristics: physiological |
Reduced energy release, slow cell turnover
|
|
|
Hypothyroidism: signs and sx
Causes (disease state) |
Post thyroididits >90%, primary pitutuary failure (rare), thyroid removal
|
|
|
IBS is dx by:
|
Rome 3 criteria:
recurrent abd pain 3d/m in last 3m w/ 2 of the following: relief w/ defecation onset associated w/ frequency of stool onset associated w/ form and appearance of stool |
|
|
Hypothyroidism: signs and sx
Neurologica |
lethargy, disinterest, memory problems
|
|
|
54y/o states blood on tissue after BM: what should be done first?
|
examine rectum, next send to GI
|
|
|
Hypothyroidism: signs and sx:
Weight |
Weight gain (5-10lbs)
|
|
|
C/o bloody nocturnal diarrhea w/ fever and cramping: what should you think of dx?
|
ulcerative colitis (classic sx) inflammatory disease
|
|
|
What age should you start asking about risk of colorectal cancer?
|
30-40 if high risk then screen q 5 yrs
|
|
|
Hypothyroidism: signs and sx
Environmental response: |
chilling easily, cold intolerance
|
|
|
Hypothyroidism: signs and sx
Skin |
Coarse, dry skin
|
|
|
Diverliculosis means you have some diverticula when they become inflamed you have diverticulitis: where is the pain?
|
left lower quadrent
|
|
|
Hypothyroidism: signs and sx
Hair |
thick, coarse hair w/ tendency to break
|
|
|
What is the diagnostic test for diverticulitis?
|
CT w/ contrast IV or oral
|
|
|
Hypothyroidism: signs and sx
nails |
thick, dry nails
|
|
|
Pt has inspiratory pain on palpation of RUQ: what is it and what is the dx?
|
Murphys sign, cholycystitis
|
|
|
Hypothyroidism: signs and sx
GI |
constipation (slow down everything)
|
|
|
In classic appendicitis the point of maximum tenderness is called?
|
McBurneys point
|
|
|
Hypothyroidism: signs and sx
Menstrual |
Menorrhagia
|
|
|
What exam should be performed in 26y/o female w/ RLQ pain?
|
rectal and pelvic exam
|
|
|
Hypothyroidism: signs and sx
Reflexes |
hyporeflexia: Slow relaxation phase, "hung up" reflex
|
|
|
Liver function test include:
|
ALT, AST, (just looking at the liver).
PT, albumin (how well liver is making things). |
|
|
Hypothyroidism: signs and sx
Muscle strength |
no change
|
|
|
What does ALT and AST mean if elevated?
|
if alt is the higher of the two then they have hepatitis.
If ast is higher think (acetominophen, statins and tequila) both are elevated (things consumed |
|
|
Hypothyroidism: signs and sx
Cardiac |
bradycardia (in severe cases
|
|
|
Pt feels bad he has fever and malaise: AST is higher what is the likely cause
|
acetominophen, statins or tequila (alcohol abuse)
|
|
|
Pt lab values of ALT 290, AST 100 what is the probable dx?
|
viral hepatitis
|
|
|
Hyperthyroidism: signs and sx
Hair |
fine hair w/ freq loss
|
|
|
75y/o w/ multiple myoloma (long bone pain elevated Ca) could exhibit what?
|
2/3 found after fx: anemic, dump protein in urine (elevated alkaline phos) : liver enzyme elevated due to cancer of bone cancer of liver, bone disease (unless adolescent or pregnant then alkaline phos is elevated)
|
|
|
Hyperthyroidism: signs and sx
Nails |
thin nails that break w/ ease
|
|
|
5 causes of viral hepatitis are what?
|
Hepatitis A&E transmitted from food, water
Hepatitis BCD transmitted from blood (can be chronic) |
|
|
Hyperthyroidism: signs and sx
GI |
frequent, low-volume, loose stools
|
|
|
Mechanism of transmission of A is?
|
fecal oral
|
|
|
Hyperthyroidism: signs and sx
Menstrual |
Amenorrhea or low-volume menstral flow
|
|
|
Hyperthyroidism: signs and sx
Reflexes |
Hyperreflexia w/ "quick out-quick back" action
|
|
|
Hepatitis marker: immunogobulin: IGM (minute you get infected you make it) IGg (after infection gone) (antibodies)
|
learn this
|
|
|
Hyperthyroidism: signs and sx
Muscle strength |
Proximal muscle weakness
|
|
|
What does it mean if Igg is positive?
|
it means they r immune
|
|
|
Hyperthyroidism: signs and sx
Cardiac |
Tachycardia
|
|
|
What does it mean if IgM is positive?
|
they have an infection (what ever your messuring ) right now
|
|
|
Hyorthyroidism: signs and sx
Characteristics: physiological |
Reduced energy release, slow cell turnover
|
|
|
What does it mean if IgM and IgG are both negative?
|
no immunity no illness: if vaccine give it.
|
|
|
Hepatitis B sx typically?
|
asymptomatic: hepatocellular carcinoma (80% w/ hepatitis B)
|
|
|
Hypothyroidism: signs and sx
Causes (disease state) |
Post thyroididits >90%, primary pitutuary failure (rare), thyroid removal
|
|
|
Hypothyroidism: signs and sx
Neurologica |
lethargy, disinterest, memory problems
|
|
|
Who/what must develop protocols governing APN practice: Texas?
|
Delegating physician and APN using 5 factors
1. texas law 2. experience 3. consulation availability 4. input of delegating physician 5. federal regulation |
|
|
Increased thyroid disorder risk increase in what age grp
|
elderly
|
|
|
Who must sign protocols?
How often are they reviewed |
delegating physician and APN
reviewed and signed annually |
|
|
Which of the below is a CHD risk equivalent:
a. HTN b. Cigarette smoke c. Male>45 d. DM |
DM: also symptomatic CAD, PD, AAA >risk of CHD
|
|
|
What lab value for TSH fT4 is most consistent w/ hypothyroidism
|
normal fT4 and elevated TSH Levels (somthing is wrong w/ the thryoid and the pituitary is trying to compensate by giving more TSH)
|
|
|
Screened for hyperlipidemia via blood draw should be told to:
a. fast 12-14hrs b. fast 6-8hrs c. black coffee allowed d. non-fasting not necessary |
a: fast 12-14hrs:
maximum effect of eating on tryclycertide leve at 3-4 hrs but peak during 12hr |
|
|
what is Hashimoto's disease
|
hypothyroidism from an autoimmune response (most common) resulting in thyroidistis destroying large amounts of thyroid
|
|
|
Class of Med will normalize lipid elevation?
a. niacin b. fibric acid c. statin d. bile acid sequestrants |
c: Statin:
|
|
|
What is the most common causes of hypothyroidism
|
autoimmune thyroiditis next is surgical
|
|
|
What lab value do you expect to find in Graves disease
|
Low TSH level (thyroid overproduction makes pituitary slow down in production of TSH w/ feed back mechanism)
|
|
|
Which test listed below may exclude secondary cause of hyperlipidemia?
a. cbc b. urine C&S c. TSH d. fasting glucose |
C: TSH:
and diabetes, renal failure, hypothyroidism |
|
|
What is a physical finding in graves related to the eyes
|
Eye LID retraction (appears eye are bulging)
|
|
|
How often are statins taken to lower lipids?
a. twice daily b. always w/ food c. w/ ASA d. in conjunction w/ diet and exercise |
D: in conjunction w/ diet and exercise:
(only once daily) |
|
|
What is the mechanism of action for radioactive iodine in tx of Graves
|
destroy overactive thyroid
|
|
|
Pt taking lovastatin for 3m for hyperlipidemia w/ muscle aches in thigh. What should be done?
a. stop lovastatin immediatly b. check liver enzymes c. order CPK d. ask about night cramps |
c. order CPK: c/o myalgias consider rhabdomyolysis if elevated THEN stop lovastatin immediately
|
|
|
HTN pt most likely to have adverse BP effect from excessive Na?
a. 21 asian b. 35 menstruating female c. 55 post menapausal d. 70 african American male |
d: african American male:
|
|
|
What is useful in tx tremor in hyperthyroidism?
|
propanolol (beta blocker)
|
|
|
T4 for elderly dose should be what compared to middle age adult
|
75% or less
|
|
|
HT and MI 6yrs ago w/ mild SOB today. takes quinapril, ASA, metoprolol, statin: What sx is NOT indicative of CHF exacerbation?
a. fatigue b. HA c. Orthopenea d. cough |
b: HA:
|
|
|
What do you suspect on thyroid scan that reveals thyroid mass (cold spot):
|
thyroid cyst
|
|
|
CHF on ACE-I. W/ cough. What finding distinguish etiology of cough from CHF?
a. dry nonproductive b. wet worse w/ recumbence c. purulent and tachycardia d. SOB after cough |
b. wet and worse: usually worse at night too
|
|
|
What lipid value do you find in untreated hypothyroidism
|
hypertriglyceridemia
|
|
|
SOB w/ CHF. What test would help determine this?
a. Echo b. BNP c. EKG d. BUN |
b: BNP: >80% pg/l = 98% chance of CHF
|
|
|
Class of med used to tx systolic dysfunction post-MI:
a. loop diuretic b. beta blocker c. ACE-I d. thiazide diuretic |
c. ACE-I: prevent LV hypertrophy, dilation and dysfunction = prevent HF
|
|
|
U find painless thyroid mass and TSH level less than 0.1 (low) what is the causes
|
autonomously functioning adenoma
|
|
|
Ramipril initiated at low dose in patient w/ CHF. What is most important to monitor in about one wk:
a. HR b. BP c. EKG d. K level |
d; potassium level:
ACE-I work on kidney and may impair renal excretion of K: monitor BUN, Cr one wk after starting |
|
|
Fixed, painless thyroid mass w/ s of hoarsness and dysphagia what should you consider:
|
thyroid malignancy
|
|
|
What med could exacerbate CHF?
a. metoprolol b. furosemide c. metformin d. acetaminophen |
a. metoprolol: cardioselective BB slow HR, inhibit pt w/ CHF to have increase HR to compensate decrease CO.
|
|
|
What is cost effective to determine malignancy from benign thyroid nodules
|
fine-needle aspiration biopsy
|
|
|
What is a side effect of excessive levothyroxine (synthroid)
|
Bone thinning
|
|
|
75y/o HTN takes ACE-Ithiazide diuretic daily. BP 128/88, p: 98. Has dyspnea on exertion and peripheral edema:
a. need better BP manage b. development of CHF c. noncomplinace w/ medications d. fluid or Na excess |
b: development CHF:
|
|
|
When should TSH be reassessed when tx w/ synthroid (levothyroxine) is altered
|
6-8wks
|
|
|
Medication which produce exercise intolerance w/ HTN is:
a. HCTZ b. amlodipine c. metoprolol d. fasinopril |
c. metoprolol: decrease HR = exercise intolerance HR cant increase for CO
|
|
|
U find 3cm round mobile thyroid mass, US reveals fluid filled structure dx is
|
thyroid cyst
|
|
|
Pt w/ HTN has allergy to sulfa. Which med is contraindicated in pt?
a. ramipril b. metoprolol c. HCTZ d. verapamil |
c: HCTZ: sulfa med also avoid loop diuretics
|
|
|
Which is best choice of anti-HTN?
a. BB for 38y/o DM b. ACE-I for pt on K sparing diurectic c. BB in 46y/o w/ migraines d. diurectic pt w/ gout |
c: BB in 46y/o migraines: Beta Blocker can be used on migraines
|
|
|
A patient w/ downs syndrome should periodically be monitored for what endocrine disorder
|
hypothyroidism
|
|
|
What do you expect to find in elderly w/ hyper or hypothyroidism
|
atypical presentation: typically lab values identify disease
|
|
|
Pt poorly controlled HTN for 10yrs. Indicate mostly likely position of his point of max impluse:
a. 5th incercostal mid-clavicular b. 3rd ICS MCL c. 5th ICS, left of MCL d. 6th ICS, right MCL |
c. 5th ICS, left MCL: left vent hypertrophy may displace apical impulse
|
|
|
What is the purpose of thyroid hormone physiologically (basic)
|
assist cell in energy releasing activities
|
|
|
Pt newly dx w/ HTN taking rampiril. What test would be important to monitor?
a. INR b. Ca c. K level d. ALT/AST |
c: potassium level
|
|
|
Pt w/ HTN takes 25mg HTCZ QD for 4wks. BP decrease from 155/95 to 145/90. What should you do next?
a. cont HCTZ b. increase HCTZ c. add another class to current HCTZ dose d. stop HCTZ start different class |
c. add drug from another class to current med
: still need to decrease BP: combo effects decrease BP |
|
|
What medication can causes a alteration in iodine metabolism=hypothyroidism
|
lithium, amiodarone
|
|
|
enlarged atrium or ventricle is important w/ audible murmur. Which study helps eval hypertrophy?
a. chest xray b. ECG c. Echo d. doppler US |
c: ECHO
|
|
|
What is the most sensitive and specific thyroid test
|
TSH (produced by anterior pituitary)
|
|
|
Valve most commonly involved in chronic rhematic heart disease?
a. aortic b. mitral c. pulonic d. tricuspid |
b: mitral most common, aortic 2nd most common, pulmonic 3rd most common
|
|
|
What is the negative feedback loop in thyroid pituitary function
|
TSH output is determined by amount of circulating T4
|
|
|
Pt w/ audible diastolic murmur best heard in mitral listening point no click. Murmur is probably?
a. mitral valve prolapse b. acute mitral regurg c. chronic mitral regurg d. mitral stenosis |
d. mitral stenosis:
audible click typical in MVP |
|
|
What is the most helpful test in confirmation of an abnormal TSH level
|
fT4- it reflects the function of the thyroid gland. So TSH first the T4 (usually obtained together) but too many things cause variation in T4 to for it to be significant by itself
|
|
|
28y/o grade 3 mumrur. Which one needs referral?
a. fixed split b. increase in splitting win inspiration c. split S2 w/ inspiration d. changes in intensity w/ position |
a. fixed split is ALWays abnormal
|
|
|
Is TSH increase or decreased in hypothyroidism
|
Increased (it is trying to compensate due to decrease feedback of T4)
|
|
|
Is TSH increased or decreased in hyperthyroidism
|
Decreased (thyroid is putting off extra T4 so pituitary decreases amount of TSH)
|
|
|
25y/o w/ aortic stenosis. Etiology of AS is probably?
a. congenital b. rheumatic c. acquired calcific d. unknonw |
a. congentialt: most likely w/ age
b. rheumatic: 2nd most common c. acquired: >65y/o normal |
|
|
How do you confirm hyperthyroidism if TSH is low or undetectable?
|
obtain fT4:
(if it is high then the feedback is decreased) |
|
|
Most common arrhythmia resulting in valvular heart disease?
a. a fib b. SVT c. VF d. heart block |
A: A-fib:
|
|
|
Pt dx w/ tina pedis. Microscopic exam would reveal?
a. hyhae b. yeast c. spores d. comboof hyphae and spores |
a. hyphae: also in corpus and cruris
|
|
|
What medication is given w/ low T4 (hypothyroidism)
|
synthroid (levothyroxine)
|
|
|
What is the age of onset of Graves
|
20-40 years
(may have underlying like pernicious anemai, myasthenia gravis, DM) |
|
|
Test used to dx shingles if clinical is questionable?
a. Tzanck prep b. viral load c. rapid herpetic d. CBc |
a: txanck prep: taken from blister: most blistering eruptions are herpatic until proven otherwise
|
|
|
What is the clinical presentation of graves?
|
diffuse thyroid enlargement, exophthalmos, nervousness, tachycardia, heat intolerance
|
|
|
Most common skin cancer?
a. squamous cell carcinoma b. basal cell carcinoma c. malignant melanoma d. cutaneous carcinoma |
b. basal cell carcinoma:
|
|
|
Poison ivy x 3 d. She asks about spreading it to family. you state:
a. yes, after crusting occurs b. yes, fludi in blister can be transmitted c. no, transmission does not occur d. no, you'b progressed beyond transmission |
c. no: exposure is from contact of plant
|
|
|
What does a thyroid scan reveal in Graves?
|
Large (hot) gland w/ heterogeneous uptake
|
|
|
Topical hydrocortisone cream most appropriate in pt dx w/
a. psoriasis b. impetigo c. atopic dermatitis d. eczema |
d. eczema:
a. topical not strong enough to penetrate psoriasis b. contraindicated in impetigo c. emollient best for atopic |
|
|
What are tx of graves:
|
Methimazole, propylthiiouracil or radioactive iodine or removal of thyroid
(then tx hypothyroidism) |
|
|
Skin lesion fluoresces under Woods lamp. What microscopic findings is consistent w/ this?
a. clue cells b. herpes simplex c. spores d. leukocytes |
c: spores = fungal infection
|
|
|
What do you expect the lab values to be in hypothyroidism
|
Elevated TSH and normal fT4 (subclinical)
|
|
|
When should u initiate tx of hypothyroidism?
|
When TSH rise above 10mU/L (normal 0.5-4) even in presence fo normal fT4
|
|
|
17y/o w/ nodulocystic acne employed as cook. What is greatest positive impact in managing acne?
a. retin a plus minocycline b. benzoyl peroxide plus erythromycin c. isotretinonin d. change occupation |
c. isotretinonin (accutane)
|
|
|
What is the initial dose of synthroid in tx of hypothyroid
|
75-125 ug (75% or less in elderly)
|
|
|
Pt w/ atopic dermatitis will also have:
a. allergic rhinitis and anaphylaxis b. asthma and allergic rhinitis c. nasal polyps and asthma d. allergic conjunctivitis and wheeze |
b. asthma and allergic rhinitis: atopic dermatitis = atopic triad
|
|
|
What do you do if you find a palpable thyroid nodule:
|
watch and wait if no changes to TSH (may obtain fine-needle biopsy to determine malignancy)
|
|
|
Pt willl take oral Lamisil for fingernail fungus. NP knows:
a. will cure 95% of time b. topical antifungal w/ work if nail matrix involved c. Lamisil is potent inhibitor of CYP 3A4 d. toenail fungus resolves faster than fingernail fungus |
c: lamisil is potent inhibitor of CYP: caution w/ liver if >2.5 above normal stop
|
|
|
Pt w/ tick one month ago w/ red circle and white center. Now c/o numbness, peripheral paresthesias, poor concentration. what lab test can dx Lyme disease?
a. CBC b. lyme titer c. ELISA d. CSF for spirochete |
c. ELISA
|
|
|
BPH affects approx ___% of men by age of 60
|
50 (90% by 85y/o)
|
|
|
What are sx of BPH
|
increase frequency decrease force of output, nocturia, sensation incomplete bladder
|
|
|
Herald patch is hallmark finding of what derm dx?
a. erythema infectiosum b. pityriasis rosea c. seborrheic keratosis d. atopic derm |
b: pityriasis rosea
|
|
|
What medication cause urinary retention in men complicating BPH
|
tricyclic, first gen antihistamines (anticholinergic effect)
|
|
|
Pt w/ silvery scales on extensor surface of elbows, knees, back: plaques are red: dx?
a. plaque psoriasis b. guttate psoriasis c. atopic dermatitis d. staph cellulitis |
a. plaque psoriasis
|
|
|
Cancer society: pneuomic ABCDE: B stands for?
a. bleed b. black c. border d. benign |
c. border
|
|
|
What non pharm causes bladder irritation after intake of:
|
caffeine and artifical sweetners: do not use if incontence or bladder disorders
|
|
|
Skin lesion which is sold mass described as:
a. macule b. papule c. vesicle d. bullae |
b: papule: 1.0cm
|
|
|
What class of med can be helpful in BPH:
|
alpha1 receptor antagonist (alpha blockers) (note: if HTN too then only added to existing therapy
|
|
|
Pt burned w/ hot water. Has several large fluid filled lesions. What r they called?
a. vesicles b. bullae c. erosions d. dermal abrasions |
b. Bullae
|
|
|
What medication helps reduce the size of the prostate by blocking conversion of testosterone to dihydrotestosterone.
|
Finasteride
|
|
|
Lesion w/ folliculitis might be filled w/?
a. blood b. pus c. fluid d. serum |
b. pus
|
|
|
When should surgical intervention be considered in BPH.
|
recurrent UTI, recurent or persistent gross hematuria, bladder stones, renal insufficiency
|
|
|
Impetigo is characterized by:
a. honey-colored crust b. silvery scales c. marlbe lesions d. wheals |
a. honey colored crust
|
|
|
Chancroid is a
|
(soft chanker) STI: from bacteria H. Ducreyi
|
|
|
Best means to observe for jaundice:
a. skin in diffuse light b. scarp skin to ID KOH pos lesion c. observe skin in direct sunlight d. note the patients sclera |
d. note sclera: to see jaundice easily
|
|
|
Treatement of Chancroid is:
|
Azithromycin (macrolide)
ciprofloxacin (2nd gen fluorquinolone) ceftriaxone (cephalosporin) |
|
|
Which following lesions never blanches when pressure applied?
a. spider angioma b. spider vein c. pupura d. cherry angioma |
c. purpura; and petichia never blanch due to extravation of blood under skin
|
|
|
What other disease do you expect to find when testing for chancroid (STD)
|
herpes simplex
|
|
|
60y/o w/ clubbing of fingers. What might this indicate?
a. CAD b. Cirrhosis c. lead tox d. IDA: iron deficent anemia |
a. CAD: associated w. hypoxia
|
|
|
What does Chancroid look like?
|
vesicular pustular lesion painful, soft ulcer w/ necrotic base at point of inoculation.
|
|
|
Pt w/ spoon shaped nails. What lab test should u obtain?
a. LFT b. CBC c. Hep B antigen d. ABG |
B: CBC for IDA
|
|
|
What is the causative organism in lymphogranuloma venereum
|
C. trachomatis 1&3
|
|
|
Which med will not increase photosensitivity?
a. amoxicillin b. sulfa drugs c. fluoroquinolones d. doxycycline |
a. amoxicillin: all other will
|
|
|
What are the physical findings w/ lymphogranuloma venereum
|
lesions fuse and create multiple draining sinuses mainly in the groin
|
|
|
Pt w/ psoriasis w/ topical hydrocortisone cream for years. Now states cream doesnt work? What has happened?
a. rebound b. tachyphylaxis c. tolerance d. lichenification |
c. tolerance
|
|
|
What is the tx for lymphogranuloma venereum
|
tetracycline
|
|
|
Chancroid: causative organism
presentation |
H. ducreyi
painful genital ulcer, mult lesion, inguinal lymphadenitis |
|
|
Pt w/ seborrheic dermatitis. What vehicle most appropriate in hairline?
a. ointment b. cream c. lotion d. powder |
c. lotion: due to cooling, drying effect
|
|
|
Chancroid Tx
|
Azith 1g oral or
Ceftriaxone 250 IM or Cirpo 500 BID x 3d |
|
|
What derm area has greatest percutaneous absorption?
a. sole of foot b. scalp c. forehead d. genitalia |
d: genitalia
|
|
|
Which of the following is inconsistent w/ otitis externa?
a. tragal pain b. otic discharge c. otic itching d. fever |
d. fever (swimmers ear): pseudomonas; local infection
|
|
|
Genital Herpes: organism, presentation
|
HSV2
Painful ulcerated lesion (w/ primary |
|
|
Sx triad common w/ infectious mono?
a. fever, pharyngitis, lymphad b. fatigue, pharygitis, fever c. splenomegaly, fever, body aches d. tonsillar exudates, lymphad, HA |
a. fever, pharyngitis, lymphad (Centor criteria)
|
|
|
Genital Herpes: Tx
|
Initial: acyclovir 400 Tidx7-10 or
famciclovir 250 tid x7-10, episodic: acyclovir 400 tid x 5d famciclovir 125 bid x 5d Suppression acyclovir 400 bid |
|
|
Med to avoid w/ mononucleosis:
a. azithromycin b. ampicillin c. acetaminophen d. topical lidocaine |
b: ampicillin: beta lactam (PCN) causes rash
|
|
|
Lymphogranuloma venereum: oragnism presentation
|
C. Trachomatis:
vesicular ulcer lesion, external genitalia w/ inguinal lymphadenitis or buboes |
|
|
Most common complication of influenza?
a. cough b. bacterial pnumonia c. viral pneumonia d. bronchitis |
b. bacterial pneumonia: streptococcus pneumonia
|
|
|
Lymphogranuloma venereum: tx
|
Doxy 100 Bid x 21d
|
|
|
Nongonococcal urethritis and cervicitis: organism presentation
|
C. trachomatis
cervitiss, irritative void, mucopurelent discharge |
|
|
Older adult w/ cerumen: what type of hearing loss?
a. sensorineural b. conductive c. presbycusis d. cholesteratoma |
b. conductive:
Sensorioneural = inner ear or 8th cranial, presbycusis = loss w/ aging >60y/o |
|
|
nongonococcal urethritis and cervicitis: tx
|
azith 1g PO or dox 100 bid x7d
|
|
|
70y/o w/ hearing loss. which is typical of presbycusis?
a. inability to hear consonants b. asymmetrical loss c. inability to hear low pitched d. pulsatile noise |
a. inability to hear consonants
|
|
|
Gonococcal urethritis: organism presentation
|
N. gonorroeae
irritative void, purulent discharge |
|
|
Which statement is correct about OM w/ effusion?
a. OME needs tx w/ antibioltic b. OME precede or follow OM c. OM is more common than OME d. OM and OME have fever |
b. OME can precede or follow OM
|
|
|
Gonococcal urethritis: Tx
|
Single dose uncomplicated of Cefixime 400mg PO or ceftriaxone (rocephin) 125mg IM, tx w/ azith 1g single or doxy 100 bid x 7 in chlaymida not ruled out
|
|
|
Which is dx w/ AOM?
a. decreased mobility of TM b. visible bubbles behind TM c. fluid an dbulging of TM d. marked redness of TM |
c. fluid and bulging of TM
|
|
|
What do you treat concurrently w/ gonococcal urethrits (GC)
|
Chlamydia (azith 1g or doxy x 7d)
|
|
|
Pt TM is chalky white mark w/ no complaints is probably?
a. normal TM b. scarring of TM c. chronic inflammation d. pus |
b. scarring
|
|
|
Epididymitis (epidimymoorchitis) organism and presentation
|
N. gonorrhoeae, C. trachomatis
irritative void, fever painful swell epidiymis and scrotum |
|
|
Which finding is an emergency?
a. fiery red epiglottis b. sudden hoarseness c. purulent drainage from ear d. tragal tenderness |
a. fiery red epiglottis
|
|
|
epididymitis: tx
|
ceftriaxone (rocephin) 250mg IM PLus doxy 100mg bid x 10d
|
|
|
Pt w/ fever and phyryngitis has negative rapid strept test. TC is normal: The patient:
a. has strept and should be tx b. has bacterial pathogen c. has pharyngitis but undetermined etiology d. tx'd w/ PNC due to sx |
C. pharyngitis
|
|
|
Trichomoniasis: organism presentation
|
T. vaginalis:
none or dysuria, strawberry cervix (punctate hemorrhages) |
|
|
45y/o spinning sensation for hrs before stopping w/ n/v and HA. Which is not sx of benign positional vertigo?
a. length of duration b. N/v c. Ha d. sensation of spinning |
c. HA
|
|
|
trichomoniasis: tx
|
Metronidazole (flagyl) 2g onetime
|
|
|
Pt dx w/ allergic rhinitis. Which sx is NOT associated w/ allergic rhinitis?
a. paroxysmal sneez b. rhinorrhea c. nasal congestion d. facial pain |
d. facial pain: indicates infection
|
|
|
Which is most typical w/ allergic rhinitis?
a. normal nasal turbinates b. cough c. post nasal drip d. sx associated w/ expsure to cates |
d. sx exposure to cats: dx base on exposure.
a. typically pale boggy b. common but not all c. not all |
|
|
Genital warts (condyloma acuminata): orgnanism presentation
|
HPV
verruca form lesions or subclincial |
|
|
Nasal congestion upon exiting building. Occur in spring and summert. Dx?
a. seasonal allergic rhinitis b.perennial allergic rhinitis c. chronic non-allergic rhinitis d. rhinitis medicamentosa |
c. chronic non-allergic: tx w/ topical azelastine
a: tree, grass mold b. dust mite, animal dander |
|
|
Genital warts (condyloma acuminata): tx
|
patient applied: polofilox 0.5% or imiquimod 5% cream:
Provider: liquid nitrogen, tricholoacetic acid, surgical or podophyllin resin |
|
|
Epistaxis most common occure:
a. in women b. at kiesselbach plexus c. posterior septum d. pt on anticoagulant |
b. kiesselback plexus: 3 artery
a: more in men c. 80% anterior d. common but not most |
|
|
Acute bacterial prostatitis <35y: organism presentation
|
N. gonorrhoeae, C. trachomatis
irritative void, suprapubic, perinal pain, fever, tender boggy prostate |
|
|
40y/o in good health w/ 0.5 white plaque on oral mucosa. no pain. What should you do next?
a. benign lesion: monitor b. mechanical trauma: monitor c. biopsy d. referred to dentist |
c. biopsy: leukoplakia precancerous
|
|
|
acute bacterial prostatitis: Tx
|
Ofloxacin 400mg x1 then 300BIDx10d or
Ceftriaxone (rocephin) 250mg IM then doxy 100mg bid x 10 |
|
|
Pt dx w/ acute rhinosinusitis: etiology?
a. strept b. staph c. viral d. mycoplasma |
c. viral: only 2% r bacterial
|
|
|
Acute bacterial prostatits: organism and presentation >35y
|
Enterobacteriaceae (coliforms)
void, suprapubic perinaeal pain, boggy prostate, leukocytosis |
|
|
Sx of bacterial sinusitis vs viral?
a. discolored nasal discharge b. worsenign sx after improve c. facial pressure d. nasal conge |
b. worse after improvement:
|
|
|
acute bacterial prostatis: tx >35
|
Ciprofloxacin 500mg bid or ofloxacin 200mg PO qD x 14
|
|
|
Pt w/ healthy eval. States woke this am cant hear out of left ear. Exam is normal: what next?
a. Rx antihistamine & nasal decongestant b. send to audiologist c. refer to eNT d. initiate steroids and consider referral in 1 wk |
c. refer to ENT: need MRI: diff dx: acoustic neuromea
|
|
|
Chronic bacterial prostatis: organism presentation
|
enterobacteriaceae
void, dull,poorly localized suprapubic perineal pain |
|
|
Pt w/ ears stopped up, blew out forceful after pinching ears. Dx w/ TM rupture. What would indicate this?
a. bright red blood b. pain c. clear fluid d. absence of hearign |
a. bright red blood
d: hearing muffled |
|
|
What is the difference in epididymitis in younger vs older men
|
older men: secondary to prostatitis
younger: STI: C. trachomatis or N. gonorrhoeae |
|
|
Pt w/ sensation of something in throat. normal exam. What dx?
a. factition sore throat b. pseudo pharyngitis c. globus d. Gerd |
c. globus: most common cause is GERD
|
|
|
What is Prehn sign in epididymitis?
|
reduction in pain when scrotum is elevated above symphysis pubis
|
|
|
Pt w/ viral URI cannot spread to others via?
a. hand contact b. droplet transmission c. fomites d. urine or stool |
d. urine or stool
|
|
|
What is epidiymoorchitis:
|
both testicles involved swelling so two cannot be distinguished
|
|
|
Pt dx w/ strept throat tx w/ amoxicillin. No improvement in 48hrs. What next?
a. wait 24 more hrs b. change to 1st gen cephalo c. macrolide should be Rx d. PNC or cephlo w/ beta lactamase should be considered |
d. PNC w/ beta lactam
c. macrolide has poor resistance to strept |
|
|
epidiymoorchitis: mainly caused by UTI: What is the diagnostic test to determine tx?
|
urine culture
|
|
|
Pt given PNC V 3xd for 10 d sore throat. On day 9, feeling better but puritic full body rash? What is clinical finding?
a. rash will be fine and popular b. hives c. large, splotchy, non-pruritic d. rash will not blanch |
b: hives: puritic, circumscribed, raised red w/ central wheel
|
|
|
37y/o w/ gram neg cocci, dysuria, urethral discharge what is likely organism:
|
N. gonorrhoeae
|
|
|
Pt w/ PNC allergy. Which would help determine whether to give cephalosporin?
a. ever taken cepholosporin b. how long ago was rxn c. what kind of rxn d. what form of PNC |
c. kind of rxn: 2% w/ PNC rxn have cephlo rxn
|
|
|
Tx option for gonococcal proactitis is
|
ceftriaxone, 125 IM
|
|
|
Pt hospitalized w/ CHF. Now c/o hearing loss. Which med caused it?
a. digoxin b. furosemide c. ramipril d. metoprolol |
b. furosemide: also aminoglycosides, vanco, e-mycin, loop diurectics, antimalaria..
|
|
|
CDC recommends what single dose for uncomplicated urethritis by N. gonorhoeae?
|
cefixime (cephlasorin )suprax
|
|
|
29y/o return from camping. Hx of DM1 and migraines. 2d hx of n/v. Whichis least likely cause?
a. migrain Ha b. DKA c. AGI d. Giardia infection |
d: giardia infection: causes dirrhea
|
|
|
Risk of transmission from infected woman to male is what percent if single coital act?
|
20-30%: 60-80% chance man to women
|
|
|
46y/o female low-grade fever and nausea pain at McBurneys pont. Nex action:
a. order a CBC b. refer to ER c. prescribe a laxative d. obtain pregnancy test |
b. refer to er for CT scan
|
|
|
What is the incubation period of N. Gonorrhoeae
|
1-5d
|
|
|
Pt w/ inguinal hernia c/o colicky abdominal pain, n/v: it is likely:
a. hernia that is strangulated b. gastroenteritis c. chronic constipation d. unrelated to his hernia |
a. hernia strangulated: emergency surg in 4-6hrs.
|
|
|
Because gonorrhoeae produces beta-lactamase what is the best antibiotic
|
cephalosporin: ceftriaxone and cefixime
|
|
|
Pt w/ supsected hernia examined:
a. lying down b. standing c. side-lying d. while squatting |
b. standing
|
|
|
Tx of chronic bacterial prostatitis should consider treating a gram ____ _____ organism
|
gram negative rods (e. coli or pseudomonas)
|
|
|
Pt dx w/ Hep A. Most common risk factor:
a. drinking contaminate water b. eating contaminated food c. traveling internationally d. IV drugs |
C: traveling international (most)
a & b: most unable to confirm D: hep C |
|
|
What are sx of acute bacterial prostatitis:
|
perineal pain, irritative void, fever
Low back pain in chronic BP |
|
|
Most pt w/ acute Hep A are:
a. males b. acute ill c. varied clinical presentation d. develop subsequent cirrhosis |
c. varied clinical
|
|
|
What does the prostate feel like on exam w/ acute bacterial prostatitis
|
boggy
|
|
|
Pt w/ following laboratory value. Waht does this mean? Hepatitis A: (+) IgG:
a. has hep A b. Has immunity to hep A c. Has no immunity to hep A d. more data needed |
B: has immunity (IgG is antibody
|
|
|
How long should the tx of chronic bacterial prostatitis last and what med is best:
|
ciprofloxacin for 4wks may need 12 wks.
|
|
|
Pt dx w/ Hep B. Most common risk factor?
a. drink water b. eat food c. travel international d. sexual exposure |
d. sexual exposure
|
|
|
What is the best diagnostic test to ID offending organism in bacterial prostatitis
|
urine culture
|
|
|
Most pt w/ actue hep B:
a. females b. acute ill c. varied clincial presentations d. develop subsequent cirrhosis |
c. varied presentation
a: = to males b: fever, nausea, flu-like |
|
|
What does a digital rectal exam of prosate cancer find
|
prostatic induration
|
|
|
Pt w/ pos Hep B surface antibody: means:
a. acute hep B b. chronic hep B c. immune to hep B d. needs immunization to hep B |
c. immune to hep B
|
|
|
A PSA will ____ w/ prostate cancer
|
double in serial annual test w/ normal prostatic exam
|
|
|
Pt w/ Hep C:
a. receive imminization for hep A b. receive immun for hep b c. receive immun for A&B d. neither A or B |
c. receive immun for A&B
|
|
|
Risk factors for prostate cancer
|
African, FHx, high fat diet
|
|
|
83y/o dx w/ diverticulitis. Most common complaint:
a. rectal beed b. bloating and crampiness c. LLQ pain d. frequent belching and flatulence |
c. LLQ pain
|
|
|
Average American __% life time risk of prostate cancer
|
40 %
|
|
|
GERD and physiologic reflux simalar except physiolgic reflux:
a. produce mucosal injury b. nerver occures at night c. occurs on ly postproandial d. usually asymptomatic |
D: asymptomatic
A: is GERD |
|
|
What are the findings on testicular torsion?
|
scrotal pain unilateral loss of cremasteric reflex, swollen tender
|
|
|
What diagnostic test is used in assessing testicular torsion
|
doppler to determine blood flow: (will be decreased if severe)
|
|
|
Which drug/class most liley to produce rapid relief of heartburn?
a. antacid b. H2 blocker c. PPI d. sucralfate |
a: antacid 20-30min
b and c: hrs to work d: adheres to mucosal wall |
|
|
Most important risk factor in duodenal ulcer disease:
a. cigarette smoking b. spicy food c. coffee consumption d. inffection w/ H. pylori |
d. infection w/ H. pylori: peptic ulcer disease gastric adenocarcinoma and lymphoma
|
|
|
What is orchiopexy and when is it used
|
Tacking the testicles low in the scrotum to prevent re-occurrence of testicular torsion
|
|
|
Pt w/ gall bladder disease has classic sx. Which sx below is NOT classic of gallbladder?
a. intense, dull pressure mid abd b. pain radiates into chest, back or right shoulder blade c. pain worsen after fatty meal d. pain occurs w/ fasting |
d. pain occurs w/ fasting:
|
|
|
Variocele presents w/
|
"bag of worms" mass in scrotum dissappears when lying down
|
|
|
Which would be unusual in pt w/ uncomplicated gallbladder disease?
a. fever b. guarding c. Postive murphys d. nausea |
a. fever: not typical
|
|
|
What is a lab finding w/ variocele
|
decreased sperm count w/ increase abnormal forms (similar to varicose veins in the legs...weak valves result in increase swelling of veins)
|
|
|
42y/o dx w/ ulcerative colitis years ago. Last colonscopy 5yrs. What screenign is neded for colon cancer?
a. at age 50 w/ colonoscopy b. now w/ fecal occult c. now w/ colonoscopy d. at age 45 w/ colonoscopy |
c. now w/ colonoscopy: 45 then every 1-2 yrs
|
|
|
What is tx of variocele ( like varicose veins in scrotum)
|
scrotal support
|
|
|
Relation betweel colon polyps and colon cancer:
a. polyps all become malignant b. polyps slow progression to cancer c. polyps rapid progression to cancer d. no relationship |
b. slow progression
|
|
|
Primary syphilis: presentation, tx
|
painless ulcer, indurated: lymphadenopathy.
PNC G 2.4m IM if allergy then Doxy 100mg Bid x 2w - also tx for secondary syphilis or latent syphilis of <1yr |
|
|
Single stool specimen during rectal exam is:
a. adequate fro screening cancer b. detect presence of polyps c. inadequate to screen cancer d. adequate for low risk patient to screen cancer |
c. inadequate for cancer: need 3
|
|
|
Secondary syphilis: presentation, Tx
|
diffuse maculopapular rash palms and soles, lymphadenopathy. fever, malaise
Tx: PNC G 2.4M IM allergey to PNC Doxy 100mg BID or Tetra 500 QID x2wk |
|
|
Hemorrhoids is unusual if?
a. bleed or itch b. 45-65 y/o c. 20-30y/o d. more common in pregnant |
c. 20=30y/o not very common
|
|
|
Later or tertiary: presentation, slide 3 tx
|
Gumma (granulomatous lesions involveing skin, mucous membranes, bone) aortic insufficiency, aortic aneurysm, Argly Roberttson pupil seizures
PNC G 2.4 M IM weekly x 3 wk or if allergic like secondary: doxy 100mg BID x 2 wks |
|
|
70y/o bright red blood on toilet this am after BM. Most likely?
a. hemorrhoids b. diverticulosis c. colon cancer d. colon polyp |
a. hemorrhoids
|
|
|
When do lesions present in syphilis
|
2-4 wks after sexual contact.
|
|
|
50y/o hx of 3-4 alcoholic drinks daily w/ weekend binge has elevated liver enzymes. which is most likely?
a. AST=200, ALT=75 b. AST=100, ALT=90 c. AST=100, ALT=200 d. AST=30, ALT = 300 |
a: Remember: elevated
AST = actaminophen, statin, toxic, ALT = liver --> Hepatitis |
|
|
What is a sequelae of HPV
|
anorectoal carcinoma
|
|
|
37y/o routine blood work during exam shows Elevated liver enzymes. Physical Exam reveals large tender liver: what next?
a. repeat liver enzymes today b. order hep panel c. RTC in 1 wk for recheck d. order CBC |
b. hepatitis panel
|
|
|
What best describes a condyloma acuminatum lesion
|
verruciform
|
|
|
Pt had acute RUQ pain lasted 3days. Low grade fever. What should be suspected if serum amylase elevated?
a. cholecystitis b. peoptic ulcer disease c. diverticulitis d. pancreatitis |
d. pancreatitis: days of pain = enzyme increase 6-12hr after injury
|
|
|
Tx w/ condyloma acuminatum:
|
imiquimod (aldara) or podofilox
|
|
|
What 2 states are most common w/ pancreatitis?
a. gallstones and alcoholism b. hypertriglyceridemia and cholecystitis c. appendicitis and renal stones d. diabetes and cholecystitis |
a. gallstones and alcoholism
|
|
|
What age should you receive HPV for colorectoal carcinoma prevention
|
13-18
|
|
|
Joints most commonly involved in OA:
a. fingers b. wrist c. hips d. knees |
a. fingers
|
|
|
What are common risk factors for ED
|
HTN, DM, smoking (anything): testosterone deficiency is NOT a risk factor
|
|
|
X-ray of right nee w/ joint space narrowing. What does this mean?
a. patient aging b. gout c. normal d. cartilage is breaking down |
d. cartilage is breaking down: risk: advance age, obes, jioint injuries
|
|
|
What is the result of using sildenafil (what is it)
|
Erection: although sexual stimulation will still be needed to achieve erection: (viagra)
|
|
|
Which test if po is part of criteia for SLE?
a. ANA b. Rheumatoid factor c. RPR d. ESR |
ANA: also: butterfly face rash, disoid rash, sun-related rash, painless oral ulcerations, joint pain two or more, heart or lung inflammation
|
|
|
What is the most probable cause of ED in 70y/o
|
some underlying cause
|
|
|
What medications can causes ED
|
anti HTN, antidepressants, cimetidine (tagament)
|
|
|
60y/o former college football c/o medial knee pain. Has arthritis in knee. What would pain be located?
a. medially, radiating into upper thigh b. medially, alnong joint c. inch above medial knee joint d. inch below medial knee joint |
b: medially along joint line: classic arthritis pain. tears in medial collateral and meniscal.
|
|
|
Pt undiagnosed w/ RA. Which finding should cause suspect RA?
a. morning stiffness, pos RA antigen and antinuclear antibody b. fever, symmetrical jiont involvement, normal sed rate c. asymmetrical joint, male pain d. nodular lesion on elbow, neg sed, pos, antinuclear |
a. morning stiffness >1hr, rhematoid nodules, bone erosion on xray, pos sed rate
|
|
|
How does sildenafil or vardenafil work?
|
enhance effects of nitric oxide: chemical relaxes smooth muscle in penis and allows increase blood flow (take 1hr prior to sex)
|
|
|
The "get up and go: test in elderly used to eval:
a. risk for falls b. lower extremity strenght c. mental acuity d. driving safety |
a. risk of falls
|
|
|
What should not be taken w/ sildenifil (viagra)
|
a nitrate (NTG)
|
|
|
81y/o active w/ OA in R knee. c/o pain. What is 1st line tx. per American colleg of rhematology?
a. exercise b. acetaminophen c. ibuprofen d. propoxyphene |
a. exercise
|
|
|
What drug can be injected into the penis for erection or what drug can be inserted in the urethra (ouch)
|
alprostadial (caverject) or Muse
|
|
|
84y/o femal w. OA to right hip. C/o daily pain. What med is first line tx?
a. naproxen b. acetaminophen c. Ibuprofen d. propxyphene |
b. acetaminophen up to 1000mg 4xd
|
|
|
Describe the effects of asthma on the airway
|
chronic airway inflammation w/ superimposed bronchospasm
|
|
|
Adolescent athlete injured his ankle playing basketball. Right ankle pain,ecchymosis, significant edema, unable to bear weight at time of exam: least likely:
a. avulsion fracture b. grade 1 sprain c. grade 2 sprain d. grade 3 sprain |
b. grade 1 sprain
|
|
|
What do you expect to find in an acute asthma flared managed in a primary care (physical exam not lung sounds)
|
hyperresonance on thoracic percussion
|
|
|
Ottawa ankle rules determine when:
a. inversion ankle injury occured b. anterior talofibular fx has occurred c. xray are needed w/ susptected andle fx d. referral to ortho |
c. xray needed: ankle or mid foot pain and bone tenderness. bone tenderness at base of 5th metatarsal or unable to bear weight for four steps when examined
|
|
|
44y/o being tx w/ fluticasone w/ salmeteral (advair) 1puff bid and albuteral 1-2 x wk prn wheeze. Now w/ URI and wheeze what diagnostic should you obtain to assess air flow?
|
peak expiratory flow (PEF): maximum speed of expired air
|
|
|
When should functional rehab occur after ankle or knee sprain?
a. day of injury b. 5 days post injury c. 2-3 wks after injury d. when pain level allows |
a: early function rehabe day fo injury speeds time of recovery and resumption fo activities. : range of motion initially
|
|
|
24y/o asthma flare, using pulmicort and albuterol but cont to have wheeze. PEF 55% baseline you should adjust meds to include
|
adding a prednisone. For long term control a long acting beta 2 agonist can also be used
|
|
|
Initial managment of sprain:
a. xray b. rest, ice, compression ,elevation c. anti-inflammatory med d. activity as toleration |
b. RICE
|
|
|
What do you expect to find on CXR during acute asthma attack?
|
Hyperinflation (think of wheeze trying to escape)
|
|
|
Anterior drawer test assess:
al injury to lateral menisucs b. stability of ACL c. instability of PCL D. stability fo knee |
b. stability of ACL (anterior cruciate ligament): pain not immediate
|
|
|
36y/o w/ asthma and HTN what med should you avoid when tx his HTN
|
beta blocker (propanolol)
|
|
|
Which sx can r/o fx?
a. degree of pain b. extent of mobility c. degree of swelling d. no sx can r/o fx |
d: no sx can r/o fx
|
|
|
Which sx is consistent w/ asthma
|
nocturnal cough, cough or wheeze after exercise, cold that "got to the chest" or tak >10d to clear
|
|
|
Long distance runner dx w/ tibial stress fracture. What should NP recommend initially to speed recovery?
a. casting, b. crutches c. cross-training d. Ca supplement |
c. cross training
|
|
|
What is a corner stone tx of moderate persistent asthma
|
inhaled corticosteroid
|
|
|
What is most prevalent skeletal problem in US?
a. OA b. Stress fx c. osteoporosis d. Rheumatoid arthritis |
a. OA
|
|
|
29y/o female moderate intermittent asthma, not using inhaled corticosteroid but is using albuterol PRN to relieve her cough and wheeze> now using 2 puffs per day you should
|
discuss excessive albuterol use may increase risk of asthma death
|
|
|
75y/o w/ OA and pain. Which increases GI related ulceration?
a. celecoxib b. warfarin c. Thiazide diuretic d. pravastatin |
a. celecoxib
|
|
|
In tx of asthma what should leukotriene inhibitors be used for:
|
inflammatory inhibitors
|
|
|
16y/o play trumpet daily practice for 1 wk. c/o pain to 3-4th toe of left foot. not swollen or red. What is etiology?
a. strain b. bursitis c. stress fx d. tendonititis |
c. stress fx due to over use
|
|
|
How long after inhaled corticosteroids or leukotriene do you expect to see results
|
1-2 weeks
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Pt w/ right shoulder pain 7/10, after acute shoulder injury yesterday. fell against brick wall. pain radiates into upper arm. what rad study should be conducted initially?
a. x-ray b. CT c. MRI D. US |
a. xray
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Xopenex has what improved benefit over albuterol
|
greater bronchodilation w/ lower dose
|
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50y/o reports acute pain to lower back 2wks after yard work. radiates down left leg. self tx nsaids. When should you using imaging?
a. now. b. at 4 wks c. at 8 wks d. never |
b. 4 wks: unlss hx of cancer, >50y/o neuro deficits, pain inconsistent w/ hx
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What are the goals of of asthma care:
|
minimal or no sx like cough and wheeze especially at night
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55y/o sever pain at base of left first toe. Limping but not trauma. which sx is other than gout?
a. pain b. edema c. erythema d. fever |
d. fever: signals infection
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What is the normal circadian variation of PEF
|
10-15% from waking to night: w/ asthma it is >15% at night =nocturnal bronchospasm
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80y/o very active but presents today w/ posterior hip pain for past wk. Which is least likely part fo differential dx.
a. OA b. sacroiliac joint disease c. lumbar radiculopathy d. herpes zoster |
d. herpes zoster
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What is the backbone of mild, moderate or severe persistent asthma therapy (3 slides)
|
use of inflammatory control drug: inhaled corticosteroids (symbicort, fluticasone), mast cell stabilizers (cromyln) and leukotriene modifiers (singulair)
note: Inhaled corticosteroids are the most effective and preferred |
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75y/o knits w/ positive finkelstein test. Dx?
a. gamekeepers thumb b. De Quervains tenosynovitis c. OA of thumg d. trigger thumb |
b. De Quervain tenosynovitis: inflammatoin of extensor and flexor tendon. radiate up forearm
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What are the rescue inhaler and why are they used
|
short acting-beta 2 agnoist (albuterol, levalbuterol) used to relieve acute superimposed bronchospasm
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Extrinsic shoulder pain is LEAST likely produced by:
a. CV system b. abdomen c. infectious organism d. urologic system |
d: urologic system
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In asthma control what is the next treatment when giving a corticosteroid when sx control is not being met:
|
Add a long acting beta 2 agonist: salmetrol, formoterol
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|
Drop arm test used to assess patient w/ suspsected:
a. cervical injury b. torn rotator cuff c. impingement syndrome d. malingering |
b. torn rotator
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beta2 agonist have a "-terol" suffix what are some meds and what are their actions
|
albuterol short acting, and salmetrol long acting: Stimulate beta 2 site causing bronchodilation
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Which is not true regardign cervical whiplash injury?
a. occurs after traumatic event b. may accompany severe pain, spasm c. Identifiable on MRI or CT but not xray d. Occipital pain and HA |
c. It is not identifiable on MRI or xray
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Why should beta-adrenergic antagonist "lol" not be used in asthma?
|
They can precipitate bronchospasm ie propanolol
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NP are certified by:
a. state b. ANA c. state boards d. ANCC or AANP |
d: ANCC or AANP:
state boards license NP |
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|
Corticosteroids have an "-one" or "-ide" suffix: examples
|
fluticasone (flovent), prednisone, budesnide (pulmicort)
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|
Which does not influence scope of practice?
a. code of ethics b. state federal laws gov practice c. reimbursement rate for visits d. nurse practice acte |
c.: scope of practice is established legally, ethically, and by boards of nursing and professional organizations.
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Leukotriene receptor agonist (leukotriene modifiers) have "-lukast" sufix: examples:
|
montelukast (singulair)
|
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|
Standards of practice establised to:
a. regulate and control nurse practitioner practice b. limit liability of NP c. protect NP from frivolous law d. promote autonomous practice |
a. regulate and control NP practice: provide accountability for professionals and help protect the public
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Why is do you hear hyperresonance on percussion and hyperinflation in asthma
|
because of air trapping, decreased PEF
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|
Licensure:
a. another term for certification b. contingent on certification c. used to establish minimal competence d. necessary for reimbursement |
c. used to estab minimal comp
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|
Asthma:
Inhaled Corticosteroids: MoA, indication (three slides) |
inhibit eosinophilc action, potentate effects of beta2 agonist
controller drug, prevention of inflammation: must be used consistently to help |
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|
Certification:
a. required by all 50 states b. validates competence c. recognized by all 50 states d. required for reimbursement |
b. validate competence: in an area of specialty
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Asthma tx:
Cromolyn (intal): MoA and indications |
halts degradation of mast cells and release of histamine (MAST cell stabilizer)
- Controler drug, prevents inflammation: need consistent use but less effect than corticosteriods |
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|
NP has a managed clinic for hosp employee, employed by hosp. This NP is described as:
a. intrapreneur b. entrepreneur c. risk taker d. nurse specialist |
A: intrapreneur: carved out specialty w/in existing organization. Entrepreneur assumes financial and personal risk of owning
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Leukotrien modifier: (montelukast) singulair: MoA, indications
|
M of A: Inhibit action of inflammatory mediator by blocking receptor sites
Indications: controller drug, prevent inflam less effective than corticosteroids best when added on as 2nd tx w/ allergic rhinitis |
|
|
Oral corticosteroids: MoA, indictations (3 slides)
|
inhibit eosinophili and other inflammatory actions
-tx of acute inflamation in asthma and COPD >2wks tx adrenal suppression |
|
|
NP who owns their own clinic?
a. entrepreneur b. intrapreneur c. independent NP d. networker |
a. entrepreneur:
|
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|
Albuterol (ventolin, proventil,xopenex): MoA, indications
|
Beta2 agonist; bronchodilation via stimulation of beta2 receptors
-Rescue drug: acute bronchospasm: onset: 15min, duration 4-6hrs |
|
|
Legal authority to practice as an NP is determined by:
a. state boards of nursing b. state legislature c. fed guidelines d. certification boards |
b: state legist
state boards --> scope of practice Certification board --> met mim requirements |
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|
Long acting beta2 agonist: salmeterol: MoA and indications
|
Beta2 agonist; broncholiation, through stimualation of beta2 receptors
Prevent broncho spasms: Salmetrol: onset 1hr, druation 12hr. |
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|
Name given to subjects in research study who do not have disease or condition?
a. placebos b. controls c. case series d. cross secional |
b. controls: commonly employed
|
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|
Ipratropium (atrovent)
tiotropium bromide (spiriva): MoA and indications |
anticholinergic and muscarinic antagonist, yielding broncholdiation
tx and prevent bronchospasm: onset >30min best used to avoid rather than tx bronchospasm |
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NP decided to study grp of pt trying to quit smoking. All take the same med for 60d and RTC q 1xwk for 60d. What study design?
a. non-research b. cohort study c. case control study d. controlled trial |
b. cohort: observational study that is prospective in nature. Cohort ask "what will happen".
Case control: looks back (retrospective) |
|
|
Theophylline: MoA and indications
|
mild bronchodilation, helps diaphram contract
prevent bronchospasm Narrow theraputic not used often |
|
|
NP has HIV. Employed in private clinic: NP:
a. obligated to inform employer b. obligate to inform pt c. no obligations d. under obligation if performing invasive procedure |
c. non obligation
|
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|
what is the therapeutic action of inhaled corticosteroids when tx COPD
|
reduction in airway inflammation
|
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|
NP works minor care. Pt w/o insurance w/ puncture wound. Dirty needle suspected. the NP:
a. admin Tetanus b. prescribe med for HIV exposure despite no insurance c. no mention possibility of HIV d. offer to buy HIV med at employee discount |
b. prescribe med
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|
What is consistent w/ dx of COPD
|
FEV1/FVC ratio of less than 0.70
|
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|
Elderly dementia in w/ daughter and has bruises on arm and posterior. What should NP do?
a. don not report abuse until certain b. r/o elder abuse c. report to authorities d. ask daughter if she is abusing |
c. report to authorities
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|
What is found in the airway early stages of chronic bronchitis
|
excessive mucus production
|
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|
Pt attacked by cat. 4cm lac to forearm. NP sutured lac which became infected requiring hospitalization. This is?
a. negligence b. unfortunate situation c. malpractice d. poor judgement and malpractice |
a. negligence: one fails to exercise care that reasonable person would.
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|
What is found in the airway of emphysema patients
|
enlargement of air spaces distal to terminal bronchioles
|
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|
NP states he keeps meds and takes them occasionaly? what is your first professoinal responsibility?
a. report to police and owner b. report to state board c. report to state board of pharmacy d. no professional responsibilty |
b. to state board
|
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|
What is the GOLD tx for COPD guidelines for stages II-Iv COPD
|
short-acting inhaled bronchodilators
|
|
|
Liability policy which pays claims only during period that policy is active?
a. claims made policy b. tail coverage c. liability protection d. bobtail coverage |
a. claims made policy
|
|
|
What is the goal of using inhaled corticosteriods in stage III COPD
|
minimize risk of repeated exacerbations
|
|
|
What is the most common place for indirect hernia?
a. Hesselbach triangle b. internal inguinal ring c. outer inguinal ring d. abdominal ring |
b. Internal inguinal ring
|
|
|
Which cortiocsteriod is most potent:
methylprednisolone, 8mg triamcinolone, 10g prednisone 15mg hydrocortisone 18mg |
Prednisone
|
|
|
Which immunizations should a child receive if they have sickle cell?
a. all at a rapid rate b. all at a normal rate c. all at a decelerate rate d. limit the immunization given |
b. all at a normal rate/interval
|
|
|
What is the typical organism in acute chronic bronchitis
|
H. influenzae...also Mycoplasma pneumoniae, Chlamydia pneumoniae, and Streptococcus pneumonia.
|
|
|
What immunization may be given during the first trimester?
a. vaicella and MMR b. Td only c. Pneumococcus d. Hep A&B |
B. Td only: live virus should never be given, pneumococcus given in 2nd or 3rd trimester
|
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|
What is an appropriate antibiotic for a 72y/o HF, acute bacterial COPD who has failed amoxicillin
|
levofloxacin
|
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|
40y/o w/ lab values of: HBsAg(-), HBsAb (+), HBcAb (-). Interpret them?
a. had hepatitis b. has hepatitis c. should immunize d. has been immunized |
d. has been immunized:
1. Neg Hep B antigen (HBAg) = no Hep B 2. He has + Hep B surface antiody (HBsAb)= immune 3. neg Hep B core antibody (HBcAb)=never had Hep B |
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|
What is the appropriate antibiotic for 52y/o w/ acute bacterial COPD exacerbation
|
azithromycin
|
|
|
25y/o w/ sub actue bacterial epididymitis tx w/:
a. oral quinolone b. doxycycline c. anti-inflammatories and analgesic d. ice and scrotal support |
b. oganism is Chlamydia in acute bacterial epididymitis= doxy 100mg BID x 10-14d or longer.
Avoid quinolones: all others will help but not tx |
|
|
What is the definition of chronic bronchitis:
|
report of excessive mucus for >3m per year fro 2 years absence of other causes 80% causes by smoking
|
|
|
What is typical sx of GERD?
a. chest pain b. SOB c. pyrosis d. hoarseness |
c. pyrosis (heartburn)
|
|
|
What is considered the backbone of COPD therapy
|
Bronchodilators: Tioptropium bromide (Spiriva) and ipratropium bromide (atrovent) anticholinergic w/ stage II-IV COPD
|
|
|
70y/o aa male c/o pain to back and trunk. CAD ruled out. Ha normocytic normochromic anemia w/ hypercalcemia: dx?
a. multiple myeloma b. lymphoma c. leukemia d. prostate cancer |
a. multiple myeloma: neoplastic proliferation in bone marrow
|
|
|
What should you advise all COPD patients to avoid
|
noxious agents, smoking, irritants, obtain annual influenza and antipneumococcal vaccine
|
|
|
Pregnant pt w/ asymptomatic bacteriuria. What is likely pathogen?
a. klebsiella b. E. coli c. staph saprophyticus d. no pathogen |
B. E. coli: should tx this w/ Nitrofuratoin
|
|
|
COPD: Stage Characteristic, treatment
Stage 0 |
cough, sputum production, no spirometric abnormalities
tx: COPD risk reduction |
|
|
What is a contraindication to giving MMR:
a. FHx of adverse event after dose b. fever 104 w/in 72hrs c. seizures w/in 7days d. encephalopathy w/in 7 days after immunization |
d. encephalopathy is always a contraindication.
Fever of 105 w/in 48hr would be too |
|
|
COPD: Stage Characteristic, treatment
Stage I Mild |
FEV: FVC ratio <0.70
>FEV >80% of predicted w/w/o sx short acting bronchodilator PRN -albuterol, pirbuterol, levalbuterol |
|
|
An elderly adult w/ appendicitis is unlikely to exhibit:
a. generalized abdominal pain b. Initial WBC elevation c. UTI sx d. low grade fever |
b. initial WBC elevation: kids and elderly do not get an initial rise in WBC
|
|
|
COPD: Stage Characteristic (what diagnostic do you expect on FEV and what is your treatment?
|
FEV:FVC ration >0.70
-50%>FEV <80% of predicted W or w/o sx REg us of >1 long acting bronchodilator: tiotropium,salmeterol -short acting bronchodilator PRN -inhaled corticosteroids if repeated exacerbation -pulmonary rehabilitation |
|
|
What is recommendation of administering MMR and varicella?
a. not given on same day b. given on same day c. cannot be given w/ flu d. can only be given w/ live virus |
b. should be given on same day: increases their titers when given together. if not together the seperate by 30 days
|
|
|
COPD: Stage Characteristic, treatment:
Stage III |
FEV:FVC ratio<0.70
-30%>FEV <50% of predicted Reguires use of >1 bronchodilator -Tiotropium/salmeterol short acting: albuterol Corticoid if repeated Pulmonary rehabilitation |
|
|
Pt w/ 2 fasting glucose of 101 and 114 on 2 seperate days:
a. dx w/ DM2 b. dx w/ impaired fasting glucose c. further testing before dx d. get Hgb A1c |
b. dx w/ impaired fasting glucose
: fasting glucose between 100-125 fits dx. |
|
|
COPD: Stage Characteristic, treatment
Stage IV |
FEV:FVC ratio <0.70
-FEV<30% of predicted or resp failure or HF >1 long acting broncho: triotriopium - short acting: albuteral -cortico if repeat exacerbation -tx of complications -long term o2 therapy -surgical |
|
|
Pneumococcal immunization in infants has:
a. decrease episodes of AOM due to H.flu b. shifted pathogenesis to fewer cases of S. pneumoniae c. eradicated OM due to .s pneum d. improved prognosis of AOM |
b. fewer cases of s. pneumoniae: PCV7 (prevnar), increased case fo H. Flu due to decrease in S. pneu.
|
|
|
Potency of corticosteroids:
Higher potency (equipotent doese): Which is highe potency: Dexamethasone 0.75mg Betamethasone 0.6-.75mg |
Betamethasone 0.6-.75mg
Dexamethasone 0.75mg |
|
|
US in first trimester help estimate gestational age and:
a. ID placental abnormalities b. improve maternal outcomes c. ID fetal malformations d. reduce later US |
c. ID fetal malformations: also detecting multiple fetuses, status of placenta.
|
|
|
Potency of corticosteroids:
Medium potency (equipotent dose) |
Methylprednisolone 4mg
Triamcinolone, 4mg prednisolone 5mg prednisone 5mg |
|
|
Pt w/ diarrhea has WBC in stool sample:
a. a misdiagnosis b. a malignancy c. food indiscretion d. bacterial infection |
d. bacterial infection: Crohns disease or ulcerative colitis also
|
|
|
Potency of corticosteroids
Lower patency (equipotent dose) |
Hydrocortisone 20mg
cortison 25mg |
|
|
Overweight 76y/o recent DM, long term HTN and hyperlipidemia: Now has A-fib. What other risk do u consider?
a. S3 gallop b. CHF c. SOB d. hypothyroidism |
b: HTN and hyperlipidemia increase risk of CHF --> Afib, S3 and SOB r consequences not risk
|
|
|
acute bacterial: COPD: etiology and tx:
|
Gram-pos and neg respiratory pathogen, atypical
amoxicillin or doxy or cephalo, if failure then fluoroquinolone or HD augmentin |
|
|
Pt w/ tinea pedis. What is the microscopic finding?
a. hyphae b. yeast c. spores d. combination of hyphae, spores |
a. hyphae: long, thin= dermatophyic infections
|
|
|
Acute bacterial: Chronic bronchitis: what is the organism: what is the tx
|
Psuedomonas aeruginosa
Tx: Ciprofloxacin, levofloxacin |
|
|
What should you do to a pregnant w/ Type 1 diabetes regarding screening?
a. screen at 24-28 wks b. screen early c. dont screen at all d. send to OB/GYN |
A: screen at 24-28 wks: due to increase placental hormones that increase insulin insensitivity
|
|
|
5MM or larger w/ HIV or other immunosuppression or organ transplant or taking 15mg prednisone = pos or neg TB
|
positive TB
|
|
|
What medication will exacerbate GERD?
a. verapamil b. metformin c. ferrous sulfate d. ceftriaxone |
a. verapamil: CCB: Calcium needed for muscle contraction: lower esophageal sphicter
|
|
|
What is the dx after PPD: 10mm in high risk: immagrants, IV drug, health care, resident housing, correction, homeless, health:
|
Positive TB
|
|
|
Fundoscopic reveals AV nicking on a HTN pt:
a. incidental finding b. indicative of long standing HTN c. Pt should be screened for diabetes d. refer to ophthalmology |
b. indicative of longstanding HTN: when arteries cross veins in eye: Cotton wool exudate = diabetes
|
|
|
15mm or larger in all others including those that appear to have no TB
|
Positive TB
|
|
|
Who is most common risk factor for developing Hep B:
a. homo b. drug injection c. hetero d. body piercing |
c. hetero: any are applicable: but hertero has highest likelihood of disease transmission, most common
|
|
|
Anergy testing in TB
|
giving skin test of substances other than TB determines weakened immune system
|
|
|
Benazepril (ACE-I) should be discontinued immediately:
a. dry cough develops b. pregnancy occurs c. K levels decrease d. gout develop |
b. pregnancy occur: ACE-I: teratogenic effects to renal system
|
|
|
Bacille Calmette Guerin in TB
|
given in many countries: low risk of causing false-pos
|
|
|
Following medications does not warrant monitoring K?
a. fosinopril b. candesartan c. HCTZ d. amlodipine |
d: Amoldipine CCB no need to monitor K:
ACE and ARB cause hyper K HCTZ: cause Hypo K |
|
|
Booster phenomenon in TB:
|
seen in elderly. first TB is neg but next year positive because previous infection long ago boost the immune response
|
|
|
50y/o sensation fo scrotal heaviness. Worse at end of day. Denies pain. Etiology of sx?
a. strangulated hernia b. inguinal hernia c. epididymitis d. hydrocele |
b. inguinal hernia:
w/ pain not relieved w/ lying down = strangulated epididymitis = pain no heaviness Hydrocele = fluid in scrotum |
|
|
MMSE ID pt w/:
a. dementia b. depression c. behavioral changes d. delirium |
a. Dementia: cognitive evaluation for dementia: orientation, recall, attention, calculation, language manipulation
|
|
|
Two step testing TB is used to:
|
distinguish booster rxn (caused by TB infection that occured years ago) from rxn caused by recent infection
|
|
|
What is chemoprophylaxis therapy for pos TB but no sx
|
isonizide therapy and periodic chest xray
|
|
|
Pt who abuses alcohol will exhibit:
a. elevated alkaline phosphatase b. decreased TSH c. elevated ALT, AST, GGT d. elevated AST only |
c. ALT, AST, and GGT: significatn abuse when AST 2.5 x >than ALT: GGT may be elevated when AST/ALT normal
|
|
|
Antibiotic for community acquired pneumonia: No comorbidity
|
azithromycin 5-7d
|
|
|
HCP was stuck w/ neeedle from patient who may have HIV. Rapid HIV was found positive. ?
a. HP is infected w/ HIV b. Pt is infected w/ HIV c. further testing of pt required d. further testing of HP required |
c. further testing pt requried: + ELISA always requires f/u test with Wester Blot: HP would be test to estabish HIV at time of stick.
|
|
|
antibiotic for CAP pt cant take macrolide:
|
doxycycline
|
|
|
How is endocervical specimen collected during PAP smear?
a. after ectocervical w/ broom b. after ectocervical w/ brush c. before ecto w/ broom d. before ecto w/ brush |
B: after ecto cervical w/ brush: minimize bleeding from endocervix sample
|
|
|
Antibiotic for CAP in 78y/o w/ COPD
|
amoxicillin w/ a macrolide
|
|
|
65y/o female w/ breast lump: Normal mammogram 6m ago. What is true about lump?
a. probably breast cancer b. may not be lump at all c. likely a fibroademoma d. probably benign lesion |
d. probably benign lesion: still eval for breast cancer, Fibroadenomas common in younger, cyst throughout lifespan
|
|
|
Antibiotic for CAP in 69y/o w/ HF and DM2:
|
respiratory fluoroquinolone
|
|
|
Topical 5-fluorouracil (5-FU) used to tx:
a. atopic dermatitis b. hepatitis c. thalassemia d. basal cell carcinoma |
d. basal cell carcinoma: only on superficial 5% BID x 3-6wks
|
|
|
Antibiotic for CAP in 58y/o w/ dry cough, HA malaise no recent antibiotic:
|
clarithromycin (biaxin) macrolide, doxy
|
|
|
Pt w/ peptic ulcer disease: sx occure few hours after eating:
a. gastric ulcer b. duodenal ulcer c. gastric or duodenal d. H. pylori |
b. duodenal: 2-5hr after eating. Relief by eating/antacid. contrast w/ gastric w/ sx minutes of eating: less relief from antacids
|
|
|
What is a quality of respiratory fluoroquinolone:
|
activty against drug resistant S. pneumonia (DRSP)
|
|
|
74y/o pt w/ laceration. Last tetanus >10yrs. Completed primary series. What vaccine?
a. tetanus toxoid only b. tetanus and diptheria only c. none primary will protect d. Tetanus, diphtheria, acellular pertussis |
b. tetanus and diphtheria: Dtap is for adolescents not elderly.
|
|
|
Drug resistant S. Pneumonia (DRSP) mechanism of resistance:
|
alteration in protein-binding sites
|
|
|
Pt taking metronidazole for C. Difficile: What should be avoided?
a. excess fluids b. Vit B12 c. grapefruit d. alcohol |
d. alcohol: produced disulfiram rxn w/ metronidazole wait 72hrs after last dose
|
|
|
H. influenzae mechanism of resistance:
|
beta lactamase production
|
|
|
P tw/ diarrhea tested for C. diff. How soon should enzyme yeild results (EIA)?
a. 20min b. 24hrs c. 3d d. <1wk |
b. 24hrs detect C. Diff toxin no organism.
|
|
|
What is a characteristic of macrolide:
|
effective against atypical pathogen also beta lactamase (PNC is not effective against beta lactamase)
|
|
|
Difference between cellulitis and erysipelas:
a. organism b. length of time that infection lasts. c. tx d. area involved |
d. location: erysipelas upper dermis superficial lymphatic: cellulitis: deep dermis
|
|
|
CAP should be tx w/ antimicrobial for how long according to american thoracic society
|
5-7days outpatient
|
|
|
Lower leg wound appears infected. Red, warm edematous. Acute onset of pain, sx low grade fever. What is it?
|
b. Erysipelas: not always upper. Erysipelas has acute onset, cellulitis is slow onset
|
|
|
What are modifying factors for P. aeruginosa
|
corticosteroid use, strucural lung disease, malnutrition
|
|
|
Asymptomatic carotid arteries auscultate for bruits:
a. bruits indicative of impending stroke b. bruit indicative of significant carotid stenosis c. generalized atherosclerosis d. reflective stroke risk |
c. generalized atherosclerosis: symptomatic bruit need immediate attention.
|
|
|
Sudden onset of red eye: sensitivity to light and sensation fo foreign body: no contacts:
a. refer to ophthomolgy b. tx for viral conjunctivitis c. tx bacterial d. observe for 24hrs if visual acuity is normal |
a. refer to ophthomolgy for red eye: photophobic sensation fo foreign body.
|
|
|
What is mechanism of transmission in atypical pneuomonia?
|
cough
|
|
|
What class meds tx benign prostatic hyperplasia and provide immediate relief?
a. Alpha 1 blocker b. 5 alpha reductase inhibitiorss c. diuretics d. analgesics |
a. alpha blockers: terazosin, doxazosin, alfuzosin
|
|
|
Risk factors for pneuomina death:
|
renal insufficency, elderly, comorbidity, immunosupressed
|
|
|
What is an acceptable sputum specimen for gram staining?
|
few squamous epithelial cells and many WBC
|
|
|
Male taking HCTZ for HTN: sever pain to great toe: dx w/ gout: Which med would be contraindicated at this time?
a. allopurinaol b. prednisone c. colchicine d. indomethacin |
a. allopurinol: not for acute gout: only reduces uric acid but cont during attack
|
|
|
52y/o smoker w/ CAP, 3rd day therapy w/o fever, hydrated, feeling better when do you get chest xray
|
7-12 weeks from now
|
|
|
High purine diet exacerbate gout: Which foods are high purine?
a. coffee b. eggs. c. beef d. bread |
c. meat/fish: coffee lower risk, Tea increase gout
|
|
|
62y/o hosp w/ CAP considers what about vaccination
|
influenza and antipneumococcal should be given now
|
|
|
60y/o c/o lower back apin for 5-6wks: 4/10, no relief w/ change of position: dx:
a. sciatica b. ankylosing spondylitis c. disc disease d. systemic illness |
d. systemic illness, like cancer or infection: key is no relief when lying down. old, female >4wks pain.
|
|
|
Why is it labeled community acquired pneumonia?
|
pt resides in comunity not recently hosp and not nursing home
|
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|
NP agreed to participate in medicare healht insurance: Medicare only pays 80% how do you collect the other 20%?
a. bill remainder b. cannot bill remainder c. collect 100# if billed incident o MD d. NP resubmit bill for additional payment |
a. bill remainder:
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What is typical presentation of pneumonia?
|
Cough, dyspnea, sputum production, pleuritic chest pain,
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What med is contraindicated for lone us tx asthma?
a. short acting bronchodilator b. long acting bronchodilator c. inhaled steroid d. oral steroid |
b. long acting bronchodilator only when combined w/ inhaled steroid due to increased risk of sudden death.
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What may CXR reveal in pneumonia pt
|
infiltrate patterns and areas of consolidation w/ S. pneuonia
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Pt w/ Medicare part A only. What does this mean?
a. your visit will be reimbursed by the fed gov b. reimbursed only if you bill incident to a physician c. only hospital visits are covered d. he desires a cost-effective med. |
c. only hospital visits are covered: also covers skilled nursing facilities
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If a smoker w/ pneumonia take CXR 7-12 wks after therapy to assess for ?
|
lung cancer
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20y/o screened for TB? presents w/ cough night sweats weight loss?
a. chest x ray b. TB skin test c. sputum specimen d. questionaire about sx |
B: TB skin test: chest xray after positive TB, sputum sample for dx not screen.
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What is the main organism of smokers w/ pneumonia?
|
H. influenzae (tracheobronchial tree conlonized
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ACE-I specifically indicated in patients who have:
a. HTn DM w/ proteinuria, HF B, DM, HTN, HLD C. asthma, HTN DM d. renal nephropathy, HF, HLD |
A: HTN, DM w/ proteinuria, HF: worsen renal insufficiency
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How are mycoplasma pneumoniae and C. pneumonia transmited
|
via cough, in closed community
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How would u create a therapeutic relationship w/ patient?
a. Tell patient he can trust you b. at end of visit, tell patient you enjoyed taking care of him c. ask open-ended questions d. touch pt during the interview |
c. therapeutic relationship w/ pt can be established in many different ways. Ask open ended questions.
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Tx of CAP:
no comorbidity: |
macrolide: azithro or clarithro
Alt: doxy if macro intolerant |
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Pt who frquently has episodes of gout should avoid which sets of food?
a. beans, rice, tea b. scrambled eggs, milk, toast c. roast beef and rice w/ gravy d. fish and steamed veggies |
C: roast beef and rice w/ gravy
High purine: beef, pork bacon, lamb, seafood, beer, bread: Low: fruits and fruit juices, green veggies, nuts, dairy, chocolate |
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Tx of CAP:
w/ comorbidy : HF, COPD |
Beta-lactam: cepodoxime, augmenten, ceftriaxone+cefpodoxime PLUS
macrolide or doxy or resp fluoroquinolone |
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Pt w/ primary case scabies was probably infected:
a. 1-3d ago b. 1 wk ago c. 2wks ago d. 3-4 wks ago |
d: incubation period for scabies is about 3-4 wks after primary infeciton. worse at night
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What increases risk of death from pneumonia?
|
>65yrs, electrolyte or hem disorder (Na<130, absolute neutrophil <1000) other illness.
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what temp should water heater be set at for elderly?
a. <110 b,<120 c. <130 d. <140 |
B: <120
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What organism is seen mostly in alocholics w/ pneumonia
|
Klebseilla. pneumonia
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AV nicking is ID in pat w/ what disease?
a. glaucoma b. cataracts c. diabetes d. HTN |
D: Hypertension: retinal microvascular changes: early changes, flame hemorrhages or cotton wool indicate severe damage
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40y/o w/ multiple, painful reddened nodules on anterior surface of both legs. Concerned. Associated w/ hx of:
a. DVT b. phlebitis c. ulcerative colitis d. alcoholism |
c. ulcerative colitis: erythema nodosum: in pretibial locations due to infectious agents, drugs systemic inflammatory disease
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What increases Risk of CAP by P. aeruginos:
|
structual lung, corticosteroid, broad spectrum antibiotic in previous month, malnutrition
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Class of medication is NOT used for migraine prophylaxis?
a. beta blockers b. CCB c. triptans d. tricyclic antidepressnats |
c. triptans: sumatriptan: abortive agents not prophylaxis: also lithium, SSRI anticovulsants, ACE, ARB
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What increase risk of resistant microbes:
|
repeat exposure to given agent, underdosing, unecessary prolonged tx period
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Pt has 2 palpable, tender, left pre-auricular nodes that are 0.5 cm in diameter. What might be found in this pt?
a. sore throat b. ulceration on tongue c. conjunctivitis d. ear infection |
c. eye drained partly by pre-auricular lymph nodes
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H. influenzae produces beta-lactamase: what antimicrobial is ineffective against this
|
penicillin
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what antimicrobials are useful when beta-lactams are ineffective (atypical pathogens)
|
macrolides, tetracyclines, respiratory fluoroquinolones
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Pt who has been tx for hypothroidism: TSH 4.1. she feels well: managment?
a. cont current meds b. increase her replacement c. decrease her replacment d. repeat TSH in 2-3m |
d. non symptomatic pt w/ abnormal TSH should be repeated. include a T4 should be included
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What is the best preventative measure to prevent the most fatal form of pneumonia:
|
obtaining a pneumococcal vaccine
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Elderly HTN Pt has osteoporosis. Which anti HTN agen thave secondary effect of improving her osteoporosis?
a. thiazide diuretic b. CCB c. ACE-I d. Beat blocker |
a. thiazide diuretics incrase serum Ca by decreasing fluid.
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Most common polyneuropathy in elderly:
a. charcot b. DM c. urinary incontinence d. Guillain-Barre syndrome |
b: polyneuropathy affects multiple nerves usually periph: burningn, weakness, loss of sensation:
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CNS: I, II, III: control or responsible for ?
|
Olfactory, Optic, Occulomotor (eye movement)
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One wk old infant w/ mucopurulent eye discharge bilaterally. What is the etiology?
a. mother has STD b. Plugged tear duct c. bacterial conjunctivitis d. viral conjunctivitis |
a. mother has STD: chlamydia sx will appear 1-2wks post delivery. Gonorrhea sx in 2-4days
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CNS: IV, V, VI
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Trochlear (ear), Trigeminal (temp, pain, tactile), abducens (eye)
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CNS: VII, VIII, IX
|
Facial (Bells palsy), auditory (vestibulocochlear, rinne test), glossopharyngeal (swallowing)
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Which pt below should be screened for ostoeporosis?
a. 60 y/o male RA b. 50 y/o caucasion female c. 65y/o male otherwise healthy d. 65y/o post menapausal |
a. 60y/o w/ RA: only screen males w/ risk factors, women start at 65y/o
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CNS: X, XI, XII
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Vagus, Accessory (shoulder shrug), Hypoglossal: protrusion of tongue
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Pt w/ c/o sudden decreased visual acuity w/ pupil 4mm fixed. Affected eye is red. What is etiology?
a. stroke b. brain tumor c. glaucoma d. cataract |
c. glaucoma: urgent referral to ophthalmology:acute angle glaucoma: also may have n/v
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Which increases prostate specific antigen (PSA) insignificantly?
a. digital rectal exam b. ejaculation c. prostatitis d. prostate biopsy |
a. digital rectal exam: increase PSA 0.26-0.4 for 48-72 hrs.
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What can be a complication of Lyme disease:
|
bells palsy (need to obtain a titer to verify)
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What lab test should be obtained w/ bells palsy:
|
RPR, veneral disease test, HIV
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4y/o child w/ OM w/ effusion:
a. needs antibiotic b. has viral infection c. just had acute OM d. cloudy fluid in middle ear |
c. just had acute OM; OME precedes or follows AOM. dont tx w/ antibiotic but f/u for later OM
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40y/o w/ lab values of:
HBsAg (-), HBsAb (+), HBcAb (+) a. had hepatitis b. never had hepatitis c. consider immunization d. Pt has been immunized? |
a. had hepatitis:
1. Negative hep B surface antigen (HBsAg)= no hep 2. + hep B surface antibody (HBs Ab)=immune 3. + core antibody (HBcAb)= he has had Hep b |
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Is Neuroimaging needed w/ bells palsy?
|
no due to unilateral CN dysfunction on typical of intracranial neoplasm
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What is tx of Bells palsy:
|
may give corticosteroid if w/in 10days of sx
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Pt w/ medicare part B. What does that mean?
a. fed gov will pay b. only covers outpatient services c. will have co-pay today d. prescriptions will be partly covered |
b. medicate benefit covers out patient services: Prt B pays the examiner: xrya, DME, lab, home health. Charged a monthly fee based on income. There is an initial co-pay
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40y/o 5wk hx recurrent HA at night, last 1hr severe behind left eye w/ lacrimation, nasal discharge what is HA dx:
|
cluster HA
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Which med have unfavorable effect on HTN BP?
a. lovastatin b. ibuprofen c. fluticasone d. amoxicillin |
b. ibuprofen: Na retention: increase BP, lower extremity edema, increase workload of heart, inhibition of prostaglandin
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Agent commonly used to tx pt w/ scabies is permethrin. How often?
a. once b. one QD x 3d c. BID for 3d d. QD x 1 wk |
a. once: single whole body from neck down for 8-12hrs
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Prophylactic tx for migraines HA:
|
Propanolol (beta blocker)
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Proper technique for removing a tick?
a. tweezers b. petroleum jelly c. alcohol d. hot match |
a. tweezers
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55y/o woman hx of angina and migraine: best choice of acute HA tx (called abortive migraine therapy)
|
ibuprofen
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Migraine HA typically presents as a _____ Pain
|
pulsating pain
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Which mitral disorder from redundancy of mitral valve's leaflets?
a. acute mitral regurg b. chronic mitral regurg c. mitral valve prolapse d. mitral stenosis |
c. mitral valve prolapse: and subsequent degeneration of mitral tissue.
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Tension HA typically described as _____ type pain
|
pressing type pain
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Pt was dx today w/ preg. Last preg 3yrs ago. Had protective rubella titer. What should be done about rubella titer today?
a. no need to get one b. Eval to make sure its protective c. vaccinate now d. no need to vaccinate was protective 3 yrs ago. |
d. do not need protective 3y ago: protective titer is 1:10 or greater.
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Tx options in cluster HA include:
|
NSAID, oxygen, triptans (imatrex, maxalt)
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Pt takes Kava Kava for anxiety: What should you evaluate?
a. LFT b. bleeding risk c. thyroid d. colon polyps |
LFT: also tx fibromyalgia, ADHD. Hepatotoxicity reported.
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What has the most rapid analgesic onset?
naproxen, liquid ibuprofen, diclofenac, celecoxib (all nsaids) |
liquid ibuprofen
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Common, early findings in pt w/ chronic aortic regur (AR) is:
a. LVH b. A-fib c. pulmonary congestion d. low systolic BP |
a. LVH: enlarges blood regurg from aorta: A-fib is not typcial or usual in AR: pulmonary congestion is seen later. AR b/p is elevated systolic and decrease dystolic
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Test of choice to confirm and assess developmental dysplasia of hip (DHH) in 3m old:
a. frog leg x ray b. plain hip xray c. US of hip d. CT of hip |
c. US of hip:
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What are limitations to Fioricet (butalbital w/ APAP and caffeine?
|
high rate of rebound HA
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Why should neuroleptic meds in migraines be limited to 3x per week?
|
Their extrapyramidal movement risk:
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Most common place for basal cell carcinoma:
a. scalp b. face c. anterior shin d. upper posterior back |
b: face
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What should the expectation be w/ prophylactic HA tx long term:
|
approx 50% reduction in number
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74y/o dx w/ shingles. NP would prescribe?
a. oral antiviral b. oral antiviral + oral steroid c. oral antiviral and topical steroid d. topical steroid |
oral antiviral: w/in 72hrs of sx onset. steroids limited benifit vs risk
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48y/o monthly 4d premenstrual migraine, poor response to triptans (serotonin receptor agonist) and analgesic w/ hot flashes what next:
|
-use continuous monophasic oral contraceptive
-estrogen patch -triptan prophylaxis |
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Pt w/ non-fasting glucose of 110 and 116:
a. dx w/ DM b. impaired fasting glucose c. get an A1C d. normal values |
d. normal values: for non-fasting: <125 normal values non-fasting
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|
Prophylactic tx for prevention of tension type HA include
|
desipramine (Norpramin) tricylic antidepressant
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|
Which is always present in COPD?
a. productive cough b. obstructed airway c. SOb d. hypercapnia |
Obstructed airwasy: Hypercapnia more common in emphysema (air trapping)
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Pt w/ mono: which lab is usually abnormal?
a. lymphcytosis and atypical lymphocytes b. elevated monocytes c. decrease WBC d. elevated liver enzymes |
a: lymphocytosis and atypcial lymphocytes: monocytes elevation also occur though not as often as are LFT, WBC
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68y/o w/ new HA, bilateral frontal to occipital worse on rising in am and coughing, better mid day. What is causing HA?
|
increased ICP
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|
Clinical presentation:
Tension Ha |
30min-7d w/ >2 of following
-press, nonpulsating -mild to moderate -bilateral - >1 of following then migriane Nausea, photophob,phonophob |
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65y/o dx w/ gout: likely that:
a. have elevated uric acid b. consume too much meat c. joint like hip or shoulder involved d. sever inflammation of single jioint |
d. single joint: typically great toe: not always have elevated uric: especially w/ acute attack
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63y/o male former smoker on simvastatin, rampril, ASA daily. B/P lipids controlled. C/o fatigue and not feeling well. VS normal. What next?
a. CBC and wait a few days b. ID feeling of depression/hopelessness c. CBC, metabolic, TSH, UA d. B12, TSH, CBC, chest xray |
c: CBC, metabolic panel, TSH, UA:
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clinical presentation : migraine w/o aura:
|
5 attacks w/:
B. last 4-72hrs C.two: unilateral, pulsating, mod-severe, activity aggravates -during HA >1 of following N/V photophob and phonophob |
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|
Clinical presentation:
Migraine w/ aura |
HA w/ or after aura
-focal dysfunction of cerebral cortex or brianstem =>aura sx develop over 4min, =>2sx occur in succession: -no aura sx last >1hr. then consider alternative dx |
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Common misconception that pt should avoid MMR if:
a. allergic to eggs b. allergic to neomycin c. FHx allergic to MMR d. taking oral antibiotics |
a. allergic to eggs
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|
Clinical presentation:
Cluster HA |
occur daily in grps (clusters):
-last wks-months, then dissappear m-yrs -occur same time of year equinox, 1-8 episode/d. Mostly 1hr into sleep, (alarm clock) HA -behind one eye w/ steady intense, crescedo pattern 15-3h: Suicide HA w/ lacrimation, conjunctival injection, ptosis, nasal stuffiness |
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Preg pt w/ pos leukocytes and nitrites in urine. What med?
a. doxy b. trimethoprim-sulfamethoxazole c. ciprofloxacin d. nitrofuratioin |
d. nitrofurantoin: good choice tx of UTI in pregnant pt due to coverage: doxy: cat D, TMPS cat C, Cipro: Cat C
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25y/o w/ lower abd pain. Etiology of PID?
a. Pos preg test b. hematuria c. shift to left d. elevated sed rate |
c: a shift to left
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|
In the absence of neurological exam MRI or CT is usually not indicated?
|
Yield little additional information compared to cost
|
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|
Are Migrain w/ or W/o aura more common?
|
without an aura (effects 80% of migraine) assess for warning of agitation, jitteriness
|
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|
70y/o diabetci w/ gait difficulty, cognitive disturbance and urinary incontinence. What is diff dx?
a. diabetic neuropathy b. Normal hydrocephalus c. parkinsons d. MS |
b. normal pressure hydrocephalus: triad: difficulty, cog distrubance, urinary incontinence:
CT reveals enlarged ventricles |
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|
What does SNOOP stand for in HA RED flags
|
S-systemic sx: fever, weight loss, HIV cancer
N-neuro sx: confusion, LOC O- onset: sudden, abrupt O- Old: new onset progressive, >50y/o P- Previous: FHx, different, change in attack and freq, severity, presentation |
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|
Lipid particle w/ greatest atherogenic effect?
a. TC b. HDL c. LDL d. Trig |
c: LDL: low HDL and high trig accelerate atherogenesis
|
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|
Cluster HA are more common in what age
|
middle age men w/ heavy alcohol and tobacco (suicide HA) over several weeks w/ lacrimation, rhinorrhea
|
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|
Pharm tx for children w/ HTN should be initiated:
a. those obese b. Stage I HTN c. diabetic w/ HTN d. asymptomatic stage i or ii HTN |
c: diabetic w/ HTN:
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|
Which statement is true for NSAIDS for LBP?
a. equally efficacious as APAP for pain b. more s/E than APAP c. provide superior relief of sx 1wk d. should not be used to tx acute LBP |
B: s/e are renal impairmetn, ARF, gastritis
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|
What is tx of cluster HA
|
remove trigger: smoking, alcohol, triptans, NSAID, oxygen
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|
Most common cause fo diarrhea in adults:
a. E. coli b. salmonella c. difficle d. viral GE |
D: viral gastroenteritis:
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|
What form of migraine tx has rapid onset but more expensive
|
injectable: sumatriptona, dihydroergotamine: 15-30min. best if GI upset
|
|
|
Most common cause fo diarrhea in adults:
a. E. coli b. salmonella c. difficle d. viral GE |
D: viral gastroenteritis:
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|
What are triptans and why are they used in HA (migraine): Preventative therapy used daily: Imitrex
|
selective serotonin receptor agonist: increase uptake of serotonin which vasoconstrics blood vessels decrease inflammation. (CONTRindicated in Prinzmetal angina or CAD or pregnant, or recent use of ergots)
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|
What are ergotamines and why are they used in HA (migraine but NOT tenstion)
|
vasoconstrictor effects: avoid in hx of CAD
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Pt received antibiotic for 10 d for pneumonia. Resp sx have resolved but now has watery diarrhea, abd cramp, lower grade fever. What next?
a. give anti diarrheal agent b. force fluids c. order stool specimen d. wait 24hrs for resolution of sx |
c. order stool specimen: Hx of antibiotic = C. difficile. If bacterial GE then get stool sample
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|
NSAIDS are useful for what type of HA
|
tension and migrain: inhibit prostaglanding and leukotriene synthesis (use first sx of Ha)
|
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|
3 most common causes fo bacterial diarrha in US are salmonella, campylobacter and:
a. e. coli b. enterovirus c. yersinia d. shigella |
d. shigella:
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|
Which has best relief w/ HA: NSAID or APAP/ ASA
|
NSAID due to improved analgesic effect
|
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|
20y/o reports nocturnal HA of recent onset. What is NOT part of diff dx in patient?
a. migraine HA b. Brain tumor c. hydrocephalus d. cluster HA |
c. Mirgraine HA begin early morning, awaken pt from sleep. Cluster HA are very likely in age and gender. brain tumor always considered. Hydrocephalus not specific to night time
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Pt w/ allergic rhinitis has sinus infection. Takes fexofenadine daily.What should be part of med regimen w/ an antibiotic?
a. stop fexofenadine and add decongestant b. add decongestant and nasal steroid c. cont fexo and antbiotic only d. cont fexo and add a decongestant |
d. cont his fexofenading: adding decongestant promotes drainage, speed resolution of sinus. nasal can be added but only if poor control of allergies
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|
Fioricet w/ caffeine, butalbital and APAP: use and type of HA
|
enhances neurotransmitter action, dependency risk and rebound
|
|
|
Midrin (isomethepetene, APAP, dichloralphenzone: used in and caution
|
migraine and tension HA: Contraindicated if vasoconstriction concern
|
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|
18y/o female pt w/ Fe IDA. Anemia has occurred in past 3-4m. what might be expected?
a. incrased RDW b. decreased rDW c. elevated serum ferritin d. decreased TIBC (total iron binding capacity) |
a. increased RDW: RDW is RBC distribution width. Recent onset iron deficiency anemia. Variation in size of RBC demonstrated by increased RDW. Serum ferritin measure of iron store. TIBC is always increased in pt w/ IDA.
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|
Study listed below is considered experimental study?
a. case series b. cross-sectional study c. cohort study d. meta-analysis |
d. meta-analysis: observation studies are studies where subj r observed. no intervention takes place.
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|
Excedrin Migraine: ASA, APAP, caffeine: OTC: type HA
|
migraine and tension: excessive use may causes rebound
|
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|
Initial med to tx pt w/ initial episode of depression?
a. tricyclic b. MAOI c. SSRI d. no preferred |
c. SSRI: ?? no clear choice on selection for efficacy, however, SSRI are usually first choice due to lower side effects.
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|
Neuroleptics: adjuct therapy to what type HA
|
migraine: control N/V, sedating
|
|
|
What are some examples of neuroleptics used in migraine tx:
|
Compazine, phenergan: used >3xwk increase risk of extrapyramidal effects
|
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|
Preg pt first trimester found to have chlamydia. How should this be managed?
a. tx w/ azithromycin b. tx w/ ceftriaxone by injection c. doxycycline d. do not tx during 1st trimester |
a. azithromycine: 1Gm dose, screen for STD now and prior to delivery due to reinfection.
|
|
|
What are the risks of Opiod use?
|
dependency (habit), sedating use sparingly, respiratory distress if OD
|
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|
Serotonin syndrome from taking SSRI and :
a. dextromethorphan b. loratadine c. pravastatin d. niacin |
a. SSRI and dextromethorphan (triptan): sx of hyperreflexia, clonus, rigid lower extremities, tachy, hyperthermia, HTN, vomiting, disorientation, delirium
|
|
|
What receptor do most HA medication work on?
|
5HT2 receptor: 1-2m use is required to be effective prophylactic
|
|
|
80 y/o w/ BP of 176/80. tx?
a. thiazide diuretic b. ACE-I c. CCB d. ARB |
Pt w/ isolated systolic hypertension (ISH). increase cardiac and cerebral events. Tx w/ long acting CCB (amlodipine, felodipine)
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|
Pt w/ diabetes right lwoer leg edematous, erythematous tender to touch over anterior shin. no evidence of pus leg is warm: dx?
a. DVT b. buergers disease c. cellulitis d. venous disease |
c. cellulitis:
Buergers = inflammation of med size arteries and no shin pain DVT: rare anterior pain |
|
|
What are some HA inducing medications:
|
estrogen, progesterone, vasodilators
|
|
|
Sexually active male pt w/ epidiymitis: likely finding?
a. abnormal urinalysis b. dysuria c. rectn hx heavy exercise d. scrotal edema |
c. recent hx of heavy lifting: no scrotal edema, (hydrocele)
|
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|
HA due to ICP presents w/ c/o
|
worst on awaking but decreases throughout day.
|
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|
Pt w/ glucose 302 w/ sx of diabetes: Tx?
a. return tomorrow to recheck glucose b. start metformin c. start insulin d. start metformin and pioglitazone |
C: start insulin: glucose >200 sx is toxic. oral agents have little effect on his glucose. return tomorrow for recheck of glucose
|
|
|
Tension Ha present w/ c/o
|
worsen as the day progresses
|
|
|
Swimmers ear is dx in pt w/ tragal tenderness. what other sx present?
a. OM b. Hearing loss c. otic itching d. fever |
c. otic itching: tx w/ topical agent and keep dry
|
|
|
18y/o c/o HA fever, + kernig and Brudzinski signs: Dx
|
meningitis
|
|
|
19y/o dx meningococcal meningitis: who should receive prophylactic tx
|
those w/ household type exposure: >4hr/wk exposure
|
|
|
Pt w/ heavy menses. What lab value reflects IDA?
a. elevated TIBC b. decreased TIBC c. norm serum iron d. decrased RDW |
a. elevated TIBC: reduced RBC count and decreased H&H. RDW would increase.
|
|
|
Bacterial meningitis w/ show ____ on CSF
|
glucose at 30% of serum level
|
|
|
Initial pharmacologic approach to pt dx w/ primary dysmenorrhea could be:
a. APAP b. NSAID at time sx begin or menses c. NSAID prior to onset of menses d. combination APA and NSAID |
NSAID at time sx begine or onset of menses
|
|
|
Which is pt w/ acute cholecystitis?
a. pt rolls from side to side on exam table b. pt is ill appearing and febrile c. elderly pt is more likely to exhibit murphys sign d. most are asymptomatic until stone blocks bile duct |
b: pt ill appearing and febrile: pt w/ acute cholecystitis usually complains of abd pain in URQ:
|
|
|
Viral or aseptic meningitis expect to find CSF___
|
predominance of lymphocytes
|
|
|
NP initiates insulin in pt taking oral diabetic med. How much long acting insulin should be initiated in pt who weighs 100kg?
a. 5u b. 10u c. 15u d. 20u |
d: 20u: 100kg x 0.2=20U.
Then 3d AM fasting measurements so AM fasting is at 100-120mg: adjust dose as needed to meet goal |
|
|
Describe Kernig sx
|
pt lying supine - hip flexed 90 degree; knee extension = resistance or pain to lower back or posterior thigh
|
|
|
Pt w/ leukocytosis:
a. has bacterial infeciton b. has viral infection c. infection unknown origin d. does not have infection |
c: infection unknown origin:
Leukocytosis has predominance of WBC in blood. May elevate to viral or bacterial. |
|
|
Papilledema is what:
|
optic disk bulging caused by elevated ICP bilateral
|
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|
Who should the NP obtain a CSF on as part of eval for Fever
|
younger child w/ altered neurologic findings
|
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|
Pt found to have eosinophilia. An expected finding is:
a. asthma exacerbation b. bronchits c. hepatitis d. osteoporosis |
a: asthma exacerbation: or parasitic infections.
|
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What do you expect to find in CSF (WBC) of meningitis:
|
Pleocytosis: WBC >5cells/mm whether: bacterial, viral, tubercular, fungal or protozoan
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3y/o tx for URI but drainage from right nostril persist. What should u suspect?
a. allergic rhinitis b. presence of foreign body c. unresolved URI d. dental caries |
b. foreign body:
1. continued drainage despite tx 2. drainage is unilateral |
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What do you expect to find regarding glucose and protein of CSF in bacterial meningitis
|
decrease normal glucose (<60%), elevated protein levels
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4y/o presents w/ fever, rhinnorrhea, paroxysmal, high pitched whooping cough. This is?
a. bronchiolitis b. croup c. pertussis d. epiglottitis |
c. pertussis: is whooping cough:
3stages: cararrhal phase, paroxysmal and convalescence: |
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|
Most common sx associated w/ gastroesophageal reflux disease are heartburn and :
a. cough b. reguritation and dysphagia c. cough and hoarseness d. belching and sore throat |
3 most common associated sx of GERD are heartburn, post prandial, regurgitation and dysphagia
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What do you expect to find in glucose and protein of CSF in viral meningitis
|
normal glucose, normal protein but +lymphocytosis
|
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|
Niacin is known to:
a. increase fasting glucose b. produce HTN c. decrease trig d. decrease HDL |
a: decrease glucose tolerance: use w/ caution in pt w/ Impaired fasting glucose. Used to increase HDL
|
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What diagnostic should be performed prior to Lumbar puncture on suspected meningitis
|
MRI or CT scan
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Pt dx w/ mononucleosis. Which statement is correct?
a. Likely adolescent male b. spelnomegaly more likely than not c. cannot be co-infected w/ strep d. cervical lymphadenopathy prominent |
d. lymphadenopathy, fever, fatigue, pharngitis (FFFL): mono is common in adolescents and college: it is possible to co-infect: Avoid tx w/ PNC due to rash.
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What are common pathogens in bacterial meningitis adult:
|
S. pneumonia, N. meningitis, staph and H.influenzae
|
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|
Vit B-12?
a. is easily absorbed through GI b. deficiencies are seen in elderly pt only c. low level can result in elevated lipids d. inadequate amounts can produce cognitive changes |
d: B12 is absorbed through GI tract from foods, BUT when supplements taken they are NOT absorbed well in GI. Usually life long once deficiency noted.
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Clinical presentation of bacterial meningitis:
|
classic triad: fever, HA, nuchal rigidity
|
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|
What is brudzinski sign
|
Passive neck flexion in supine => flexion of knees and hips (meningitis)
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|
Pt w. hyperlipidemia:
a. a statin daily b. TSH levels c. second measurement to confirm dx stress test |
b: TSH: elevated TSH may causes eleveated lipids: dont tx lipids until TSH confirmed and decreased to at least 10; then tx lipids
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What does absence of venous pulsation during eye exam indicated?
|
increased ICP
|
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Adolescent female normal menses for 2 yrs, but no menses for last 3m. Dx w/ polycystic ovarian syndrome. What else expected?
a. obesity b. elevated insulin c. +HCG d. HTN |
B: PCOS is a systemic disease of multiple cysts about the ovaries. Overwieght is common. elevated insulin is common in PCOS
|
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How many hr of exposure increase risk of passing meningitis:
|
> 4 hours, wk prior to sx
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|
26y/o female w/ flank pain that waxes and wanes. Urin indicates presence of:
a. blood b. nitrites c. leukocytes d. Ca |
a. sx of pt w/ kidney stones: Blood is always expected in urine. Nitrites and leukcytes ore indicative of UTI.
|
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|
What is antimicrobial options in bacterial meningitis
|
rifampin (antituberculin), ciprofloxacin, ceftriaxone
|
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|
What is the first sign that a male child is reaching sexual maturation?
a. increase testicle size b. enlargement of scotum c. increase length of penis d. scrotal and penile changes |
a. increase testicular size
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Pt w/ suspected plantar fasciitis. What is best way to examine?
a. great toe dorsiflexed b. foot in neutral position c. patient stands d. ankel at 90 degreee |
a. when great toe is dorsiflexed: plantar fascia is easy to palpate due to tightening.
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34y/o dx w/ MS what is the typical pattern
|
variable exacerbations and remissions
|
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|
Young athlete w/ depression of longitudinal arch of both feet. C/o heel pain bilaterally. Normal foot exam and cont activities. What is recomendation for foot pain?
a. xray foot first b. heel support in shoes c. NSAIDs initially d. rigid orthotics |
b. heel support: consider flat foot, tx w/ well support heel counter. NSAIDs wont correct underlying, orthotics may increase pain.
|
|
|
Tx options in MS to attenuate disease progression:
|
interferon B-1B
|
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|
40y/o has aortic stenosis wants to know what sx indicate worsening?
a. palpitations and weakness b. ventricular arrhythmias c. shortness of breath and syncope d. fatigue and exercise intolerance |
c. shortness of breath and syncope:
3 most common sx of AS is angina, syncope, and CHF (dyspnea) |
|
|
What is consistent presentation of parkinson
|
tremor at rest and bradykinesia
|
|
|
What are tx options (pharm) w/ parkinsons
|
levodopa, ropinirole, pramipexole
|
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|
Pt w/ mono has pharyngitis, fever and lymphaadenopathy. Sx started 3 d ago:
a. he will have pos mono b. he normal CBC c. could have neg Mono d. could have pos mono and normal CBC |
c. cough have neg mono:
Monospot detects presence fo heterophile antibodies in mon. If mono spot is too early it will be neg. If pt sx persist repeat mono. Lymphocytosis is normal in mono so pt will not have a normal CBC |
|
|
Pallidotomy is helpful in managment of parkinsion disease associated w/ refactory ______
|
dyskinesia
|
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|
pt w/ pneumonia reports rust colored sputum. What pathogen?
a. mycoplasma pneu b. chlamydophila pneu c. staph aureus d. strept pneu |
d. strept pneu (pneumococcal pneu)
mycoplasma and chlamydophilia has scant or watery sputum Thick discolored is bacterial |
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|
6y/o tx for CAP taking azithromycin for 72hrs. Temp is 102 to 101, what should be done?
a. cont same dose and monitor b. increase dose to high dose azithro c. change to PNC d. viral, stop antibiotic |
c. change to PNC: CAP should improve in 24-48hr: consider high dose amox due to increase incidence of resistant stept
|
|
|
What are common sx of MS:
|
numbness of limb, monocular visual loss, dipolia, vertigo, facial weakness o rnumbness, sphincter disturbance, ataxia, nystagmus
|
|
|
How is MS classified, what are the stages?
|
1. relapsing remitting MS: no neuro effects after remission
2. chronic progressive: episodes do not fully recover and accumulative defest |
|
|
Head circumference shed until a should be measured until what age:
a. 12m b. 18m c. 24m d. 36m |
d. 36m: above the ears
|
|
|
MS typical progression:
|
relapsing-remitting for years later develop chronic progressive
|
|
|
Niacin can:
a. decrease TC and TRig b. decrease Glucose and LDL c. cause flushing and HTN d. increase liver enzymes |
d: increase liver enzymes:
it increases glucose does not cause HTN, hypotension is common |
|
|
Which pt is most likely to have mitral valve prolapse?
a. adolescent male w/ no cardiac hx b. 25y/o male w/ exercise intolerance c. 30y/o female w/ no cardiac hx d. 65y/o male w/ SOB |
c: 30y/o female w/ no cardiac hx: most common in women 14-30: common sx: arrhythmias, and chest pain. most are asymptomatic
|
|
|
Why is MS difficulty to dx:
|
sx of recurrent fatigue, muscle weakness and other nonspecific sx occur w/ mult illness
|
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|
New born w/ hyperbilirubinemia: When would bilirubin be expected to peak?
a. 1-2d b. 3-4d c. 5-7d d. 7-10d |
b: 3-4d: premi: 5-7d
|
|
|
What are then name of maintenace therapy for MS: interferon B-1b
|
Betaseron: reduces exacerbations
|
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|
Grp A strept pharyngitis:
a. single sx b. also has abdominal pain c. no exudative sx d. has inflammed uvula |
b. can be accompained by abd pain:abrupt onset: sore throat, fever, GI: n/v: w/o tx resolves in 3-5d
|
|
|
What immunosuppresive therapy is used in MS
|
methotrexate or mitoxantrone
|
|
|
Most common pathogen in pt w/ pyelonephritis:
a. pseudomonas b. steptococcus c. E. coli d. klebsiella |
E. coli: as a pt age E. coli decrease and Klebsiella increases
|
|
|
What are the six cardinal signs of Parkinson:
|
tremor at rest, rigidity, bradykinesia, flexed posture, loss of postural reflexes, mask like facies (tremor at rest or bradykinesia must be present)
|
|
|
What is typical in Parkinson gait:
|
rapid small steps, turning takes several steps move forward/back
|
|
|
45y/o w/ following:
HBsAg (+), HBsAb (-), HBcAb (-) a. has hepatitis b. had hepatitis c. consider immunization d. results indeterminate |
A: has hep:
+ hep B surface antigen (HBsAg) = has Hep 2. early in desease due to no core (HBcAb) 3. HBsAb should be neg due to HBsAg being positive (+ after immunization) |
|
|
What is the tx of choice in parkinsons and why
|
ropinirole (Requip) and pramipexole (Mirapex) dopamine agonist
|
|
|
table for determination fo max BP values fro children are based on:
a. height %, BMI, gender b. gender age c. height %, gender age d. BMI and gender |
c. height %, gender age:
|
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|
63y/o former smoker, takes simvastatin, ramipril and ASA: BP and lipids controlled, c/o fatigue and not feeling well: VS normal, hep panel neg: What is most likely cause for his elevated liver enzymes?
a. generic version of simvastatin b. alcoholic in denial c. daily grapefruit for 10 days d. rare liver toxicity from usual dose of simvastatin |
c. daily grapefruit: inhibits cytochrom P450. Statins and CCB react w/ grapefruit
|
|
|
What develops after taking levodopa for 5-10 yrs for parkinson
|
dyskinesia (tics of hands, face)
|
|
|
Female pt present w/ tenderness at Mcburney point. Appendicitis is considered. What lab test woud LEAST helpful to Exclude appendicitis?
a. CBC w/ elevated WBC b. UA w/ leukocytes c. Pos serum preg d. Pos pelvic culture |
a: CBC w/ elevated WBC: simply indicates and infection
2. UA to r/o UTI 3. Serum preg for ectopic 4. pelvic culture for PID |
|
|
What is used to reduce dyskinesia
|
Symmetrel: may only be used 1yr.
|
|
|
Why is pallidotomy used:
|
surgical therapy management of dykinesia in parkinsons: removal of gladius pallidum
|
|
|
Pt w/ hep B probably has a predominace of :
a. leukocytes b. lymphocytes c. neutrophils d. eosinophils |
b. lymphocytes: increase w/ viral infections but total WBC will be decreased.
|
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|
Elderly pt w/ urinary frquency and UTI. What drug could produce an arrhythmia?
a. doxy b. amoxicillin c. ciporfloxacin d. macrodantin |
c. ciproflaxacin: (quinolone): prolong QT interval.
|
|
|
Describe absence seizure (petit mal)
|
blank staring 3-50 sec w/ impaired LOC
|
|
|
Pt w/ monoucleosis most likely:
a. lymphcytosis b. eosinophilia c. leukocytosis d. monocytosis |
a. lymphocytosis: viral
eosinophil = parasitic or allergic leukocytosis no specific for mono monocytes rise but not specific for mono |
|
|
Describe simple partial seizure?
|
awake state w/ abnormal motor lasting seconds
|
|
|
Describe tonic-clonic (grand mal)
|
rigid extension of arms and legs then sudden jerking w/ LOC
|
|
|
Which form of BC presents highest risk of STD exposure?
a. intrauterine device b. progestin only pill c. diaphragm d. barrier protection |
a: intrauterine device
|
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|
Pt w/ pos Kernig and brudzinski signs. Dx?
a. hep b. encephalitis c. menigitis d. pneumonitis |
c: meningitis:
Kernig: neck pain and flexion w/ leg extension Brudzinski: passively flex neck --> flexion of legs |
|
|
Describe myoclonic seizure
|
brief, jerking contraction of arms legs or trunk
|
|
|
Atopic dermatitis exacerbation are tx w/:
a. emollients b. topicla steroids c. antihistamines d. antibiotics |
b. topical steroids: eczema: keep well lubricated w/ emollients but for exacerbation --> topical steroids (lowest potency)
|
|
|
Tx for seizure include:
|
carbamazepine (tegratol) phenytoin (dilantin), gabapentin (neurotin), clonazepam, valproic acid (AED)
|
|
|
When taking phenytoin w/ ____ may exhibit toxicity
|
theophylline
|
|
|
Pt presents w/ severe toothache. Sensitivity to hot and cold w/ visible pus around painful areas:
a. pulpitis b. caries c. gingivitis d. perodontitis |
a. Pulpitis:
Caries and gingivitis have no pus. |
|
|
What is the risk of giving phenytoin w/ other high protein bound properties:
|
may result in displacement from protein binding site => increased free phenytoin => toxicity
|
|
|
20y/o B-ball player lands has possible sprain yesterday. c/o ankle and foot pain but limps: management
a. RICE b. non-weight bearing until fx ruled out c. short leg splint d. NSAIDs rest partial non-weight bearing |
b. non-weight bearing till fx r/o
|
|
|
Which is true of tension HA (THA) but not cluster HA (CHA):
a. CHA alwyas bilateral b. THA always bilateral c. CHA always cause nausea d. THA cause photophobia |
b: Tension headache is always bilateral w/ nausea and photosensitivity
cluster are always unilateral w/ red teary eye nasal congestion |
|
|
What are risk factors for TIA
|
Afib, CAD, oral contraceptive
|
|
|
Private NP clinci, presents w/ trichomonas. State law requires reporting of STD Pt request not o report due to husband working at health dept: what do you do?
a. dont report b. tell pt you wont but do it c. report it d. report but w/ little details |
C: report it: names or ID are not part of reporting.
|
|
|
Delirium has acute or insidious onset?
|
acute: usually w/ change to medication w/ anticholinergic
|
|
|
Women who use diaphragm for contraception have increased incidence of :
a. STD b. preg c. UTI d. PID |
c: UTI:
|
|
|
Pneumonic for delirium: DELIRIUMS
|
D: drugs
E: emotion L: low oxygen I:infection R: retention urine or feces Ictal or postictal state U- Undernurished: b12, folate, dehydration M: metabolic (DM, thyroid S: subdural hematoma |
|
|
What is the tx of demintia/alzhiemers
|
Cholinesterase inhibitor (Aricept)
|
|
|
Depression dx on clinical presentation. What time frame distinguishes depressed mood from clincial depression?
a. 1wk b. 2wk c.3wk d. 4wk |
b: 2wks:
|
|
|
Pt w/ cough variant asthma:
a. all wheeze b. all cough c. cough and wheeze d. dyspnea |
b. all cough
|
|
|
Define Primary HA
|
not associated w/ other disease, Migraine, tension type
|
|
|
Pt has fatigue, weight loss, TSH 0.5. What is likely dx:
a. hypothyroid b. hyperthyroid c. subclinical hypothy d. more test r needed |
b. hyperthyroid:
|
|
|
Define Secondary HA
|
Associated w/ or caused by other conditions, does not resolve until cause resolved: ICP, brain tumor, bleed, inflammation
|
|
|
Female should be told to take OCP at bedtime if:
a .weight gain b. HA c. nausea d. spotting |
c. nausea:
|
|
|
When does the evidence suggest to obtain Neuroimaging w/ nonacute HA
|
Hx: dizzy, numbness, HA awakens from sleep, worse w/ valsalva, accelerating, new onset
|
|
|
What might be suggested if patients says "worst HA of my life"
|
Consider hemmorhage.
|
|
|
15y/o female never menstruated. What is most important for NP to assess?
a. stature b. tanner stage c. anemia d. FH of amenrrhea |
b. tanner stage: breast and pubic hair signify pubertal changes of maturation.
|
|
|
What are some lifestyle triggers for migrianes
|
Menses, ovulation, preg, BC, illness, intense activity, sleep to much to little, missing meal, bright light, odors, weather, altitude ,meds, stress
|
|
|
which drug is NOT associated w/ weight gain?
a. insulin b. pioglitazone c. citalopram d. metoprolol |
d. metoprolol: BB
most diabetic med cause weight gain |
|
|
What dieatary triggers infleuence migraine
|
ripened cheese, liver, herring, MSG, chocolate, alsohol, caffeine ect
|
|
|
Primary therapeutic intervention for hives:
a. steroids b. anti-histamines c. CCB d. topical steroid cream |
antihistamine
|
|
|
Kegel exercises helpful for pt w/ what type of incontinence?
a. stress b. urge c. mixed d. overlfow |
a: kegel for stress incontence: 3 sets fo 8-12 slow 3-4xwkly
|
|
|
What strategy is used to slow decline of the Alzheimer type dementia patient?
|
Vit E 10000 IU Bid or selegiline 5mg BID
|
|
|
Pt w/ acute drooping right eye an drooping right upper lip. right side of her face is numb. Otherwise healthy. How do you manage?
a. steroids plus an antiviral agent b. Immediate referral to ER c. antihistamines and steroid d. steroids only |
d. steroids only: bells palsy. prednison 60-80mg/d tapered over a wk w/in 72hrs of onset
|
|
|
AAN: Alz dementia: strategy:
mild to mod, use of cholinesterase inhibit mainstay of tx: what r they |
Donepezil (aricept), rivastigmine (Exelon), time limited benefit 6-12m. Increase acetylcholine in brain. Aricept only tx approved for all stages of alzheimers.
|
|
|
What recommendation for assessment of prostate gland in man who is 40y/o? He should have:
a. screening starting at 50y/o b. PSA now c. PSA and digital rectal d. digital rectal exam only |
d. digital rectal exam only:
50: DRE and PSA Risk: Fhx or race = screen 5yrs earlier |
|
|
What are diff dx of dementia in older adults w/ similar sx:
|
depression, pain, infection
|
|
|
Pt dx w/ mild chronic CHF. Which drug manages sx and improve outcome?
a. verapamil b. digoxin c. furosemide d. monopril |
d. monpril: ACE-I: reduce mortality and morbidity in CHF:
CCB are contraindicated Lasix and dig improve sx but not long term outcomes |
|
|
Physical finding in COPD include
|
decrease tactile fremitus, wheeze, prolonged expiratory phase of forced exhalation, low diaphram, increased AP diameter, reduced forced expiratory volume at 1 sec, reduction in Sats.
|
|
|
Ankle inversion is common complaint from pt w/:
a. medial ankle sprain b. lateral ankle sprain c. severely torn ligament d. fx of medial malleolous |
b. lateral ankle sprain:
|
|
|
NAEPP-EPR-3 Goals of asthma care
|
1. minimal/no chronic sx of cough/wheeze
2. few/no ER visit/hospitalization 3. Minimize air remodeling(inflame) 4. Minimal/no prn short acting beta 2 agonist (<2d/wk w/ beta2 except for sprots 5. no limitation to activity |
|
|
65y/o pt w/ firm, non-tender, symmetrical enlarge prostate gland; PSA 3.9ng/ml:
a. prostate cancer b. BPH c. prostate infection d. perfectly normal prostate gland |
b: BPH:
Infection would have higher PSA |
|
|
What is the most common reason for protracted asthma exacerbation
|
viral URI
|
|
|
Pt w/ asthma w/ acute episode of wheezing, cough, and fever. Wheeze right upper lobe. cough non-productive. Which sx is not relate to asthma?
a. wheeze and fever b. cough and wheeze c. fever cough d. cough fever |
a. wheeze and fever: consider pneumonia if only in right upper lobe and fever
|
|
|
Long term O2 therapy in COPD:
Goal |
- increase baseline PaO2 at rest to >60mm/hg or SaO2 >90% or both
- Indication to intiate long term: PaO2 <55mm or SaO2 <88% w/ or w/o hypercapnia, HF, cor pulmonale, polycythemia |
|
|
60y/o female hx of recent LBP. Gait is antalgic and loss of bladder function since LBP. Tx?
a. physical therapy b. ER c. Refer to neurologist d. keep no-weight bearing until xrays |
b: refer to ER: sx of cauda equina syndrome.
|
|
|
What is a risk specific to females of developing DM?
|
Hx of gestational diabetes
|
|
|
Pt w/ small vesicles on lateral edges of fingers and intense itching. Exam reveals small vesicles on palmar surface of hand. What is this called?
a. seborrheic dermatitis b. dyshidrotic dermatitis c. herpes zoster d. varicella zoster |
b. dyshidrotic dermatitis: is a condition in which small, usually itchy blisters develop on the hands and feet. Symptoms: Small fluid-filled blisters called vesicles appear on the fingers, hands, and feet.
|
|
|
Dx of DM2 can be made by:
|
glucose of 126 and 136:, glucose >200mg and confirmed or glucose tolerance w/ 2 abnormals
|
|
|
Screening for DM2 should be while:
|
fasting
|
|
|
Pt w/ migraine HA and HTN should receive which med w/ caution?
a. BB b. triptans c. pain med d. ACE-I |
b. triptans: produce vasoconstrictions: increase HTN.
|
|
|
Undiagnosed DM may present as what in females
|
vaginal candidiasis (elevated glucose feed yeast)
|
|
|
Female 45y/o urinary frequency. Having to go right now. UA is normal. Differential?
a. diabetes b. lupus c. stress incontinence d. asymptomatic bacteriuria |
a. diabetes: may consider urge incontence or vaginitis. review meds for diurectics or herbal
|
|
|
What is most important screen for diabetic nephropathy
|
Microalbumin: earliest indicate of kidney damage. if + reassess 3-6m
Screen in all DM >12y/o |
|
|
NP not increase dosage of antihypertensive even though pt BP is still 140/90. Might be described as:
a. clinical inertia b. malpractice c. resistant HTN d. lackadaisical attitude |
a. clinical inertia: providers who fail to intensify therapy despite pat not reaching goal
|
|
|
What is the earliest glycemic abnormality?
|
postprandial glucose elevation
|
|
|
NP fundoscopic exam. ID small dull yellowish-whit coloration in retina?
a. cotton wool spots b. microaneurysm c. hemorrhages d. exudates |
a. cotton wool spots: impaired blood flow to retina, diabetes and HTN.
|
|
|
What is the typical presentation of DM2?
|
Insidious onset w/ weight gain. found on screening for fasting glucose
DM1 typical acute onset |
|
|
ADA: what is tx of DM2 after oral meds have failed?
|
intermediate or long acting insulin at bedtime or morning 1xd 10U or0.2/kg. Cont oral unless sulfon or meglit (d/c)
|
|
|
Elevated glucose evening meal indicates what in a DM
|
not enough AM intermediate insulin, increase dose to 2-3U at a time, check sugars 3 d after change. Cont increase 2-3 until at goal
|
|
|
sx that may present as DM2 inlcude:
|
fatigue, athletes foot (glucose), infected mosquito bites
|
|
|
Acanthosis nigricans due to:
|
obese insulin resistance
|
|
|
What should target HR be in new DM
|
120s to 70s, the lower the better (w/in reason)
|
|
|
When do you screen a new DM2 for renal nephropathy
|
at diagnosis
|
|
|
How soon can you determine anti-proteinuric effect of ACE-I
|
6-8wks
|
|
|
What is the next lab if a pos albumin screen?
|
spot albumin w/ creatinine ratio
|
|
|
what is the definition of renal neropathy?
|
>300mg/d of albuminauria on 2 occasion seperated by 3-6m
|
|
|
What are the target lipids for DM according to ADA
|
HDL >50
LDL <100 Trig <150 |
|
|
what increases A1C
|
glucose and alcohol
|
|
|
What is the relationship w/ triglycerides and A1C:
|
Triglycerides w/ increase w/ A1C
|
|
|
How does hyperthyroidism affect blood pressure?
|
increase systolic and diastolic, HR is typically >100
|
|
|
What are some endocrine causes of secondary HTN?
|
pheochromocytoma, Cushings, neuroblastoma,
|
|
|
What is the normal value of TSH?
|
5.0
|
|
|
What lab abnormality is common w/ hypothyroidism? not involving the thyroid or pituitary
|
hypercholesterolema
|
|
|
What is the most sensitive test for majority of hypthyroidism?
|
TSH only
|
|
|
45y/o female TSH 13 then 1m later 15 what is the dx:
|
hypothyroidism
|
|
|
Hx of tx for hyperthyroidism will now likely have?
|
hypothyroidism
|
|
|
Serum free T4 falls TSH will?
|
TSH will rise
|
|
|
Hypercholesterolemia is common when TSH is >than ____
|
10 mU/L: dont tx hyperlipidemia until TSH <10
|
|
|
What are common lab findings in hypothyroidism not associated w/ thyroid or pituitary?
|
hyponatremia, hyperprolactinemia, hyperhomocysteinemia, anemia, elevated creatinine
|
|
|
What are medication and disorders that can increase TSH
|
metoclopramide (reglan), amiodarone, adrenal insufficiency, pituitary, generalized thyroid hormone resistance
|
|
|
what are common sx of hypothyroidism?
|
fatigue, weight gain, dry skin, hair nails that break easily, cold intolerance, constipation, menstrual irregularities
|
|
|
Tx of hyperthyroid has an inverse result of?
|
destroying the gland ability to produce thyroid hormone T3 and T4
|
|
|
What may happen to TSH if synthroid is substitued by a generic med?
|
TSH will vary due to the different bioavailablities of generic meds
|
|
|
How do you determine amount of T4 to replace (synthroid) in a patient?
|
replacement based on weight in Kg and multiply by 1.6 for 1 day.
|
|
|
What do you expect to FSH to do in a menopausal women w/ hot flashes and no period for 12m
|
increase (follicle stimulating hormone) best diagnostic is PE: bleed change, hot flash, sleep disturbance, GU sx
|
|
|
How long before PAP smear should women not have sex, douch, or use tampon
|
48hrs prior to PAP
|
|
|
60y/o w/ small amount vag bleed, postmenopausal x 2 yrs dx would be?
|
atrophic vaginal mucosa (endometrial carcinoma is a concern but rare)
|
|
|
28y/o w/ primary dysmenorrhea OTC motrin, naproxen what next tx?
|
oral contraceptives
|
|
|
Dx of osteoporosis is made when what diagnostic test?
|
BMD bone mineral density 2.5 more from standard or T-score of -2.5 or less
|
|
|
What is the usual age recommendation for HPV test?
|
21yrs or 3years after first sexual intercourse
|
|
|
Primary risk factor for breast cancer is?
|
age
|
|
|
A localized tumor in prostate gland will have what sx?
|
none: but will be indurated on exam
|
|
|
Hematuria is uncommon clinical manifestation in what early male cancer?
|
prostate cancer
|
|
|
30y/o w/ lump to breast during menses what is the next step?
|
advise to return 3-20 days after menstation to reasses, if any concern then mammogram and US
|
|
|
DRE (digital rectal exam): it is not acceptable to perform while: standing, kneeling, lying on side, in lithotomy position
|
kneeling: best way is supine and legs in stirrups
|
|
|
A radical prostatectomy 6 m ago now urinary incontinence what is going on?
|
a common complication, subsides in 2yrs and/or develop ED
|
|
|
What med should be avoided in benign prostatic hypertrophy (BPH)?
|
nasal decongestant: may increase urge to urinate
|
|
|
What age should digital rectal exam be perfromed for prostate cancer, what age should PSA and dRE
|
40 for DRE and 50 for both
|
|
|
When should PSA and DRE be perfromed on blacks?
|
before the age of 50yrs, five yrs prior to other races
|
|
|
What is the most common cause of epididymitis in <35y/o.
|
Chlamydia trachomatois, in older men >35 UTI is most common
|
|
|
Why are truck drivers predisposed to noninfectious epididymitis:
|
reflux of urine into epidimyis from ejaculatory ducts and vas
|
|
|
Inguinal hernia is hernation of what
|
bowel or omentum into scrotum
|
|
|
How does an inguinal hernia present?
|
scrotal pain and a scrotal mass or scrotal swell (abd pain) bowel sounds in scrotum (w/ a stethascope??)
|
|
|
What is Hesselbach triangle?
|
inguinal ligament, rectus muscle and epigastric vessel: Inguinal hernia
|
|
|
patient dx w/ cluster HA should eliminate what?
|
triggers like nicotine and alcohol
|
|
|
Audible carotid bruits indicate?
|
Atherosclerosis: increase probability of death from CVA or CAD
|
|
|
Mini mental status exam assess?
|
mild alzheimers
|
|
|
Differential dx of suspected alzheimers also includes?
|
tumor, cerebral hemmorage, cerebral infarct
|
|
|
what is included in the mini mental exam?
|
orientation, short-term memory-retention, short-term recall, language, attention (does NOT dx alzheimers)
|
|
|
How long after initiating acetylcholinesterase inhibitor should you eval for efficacy
|
6-12m: assess caregiver feedback, repeat mental status, ADL, S/E cost
|
|
|
What increases the risk of and elder being abused?
|
decrease cognative due to caregiver strain, stress depression
|
|
|
What does the snell chart test?
|
distant vision and CNII
|
|
|
Giant cell arteritis: temporal arteritis is best dx by?
|
temporal artery biopsy
|
|
|
What is the typical complaint of temporal arteritis:
|
new onset HA, abrupt visual change, jaw claudication, fever or anemia elevated sed rate 72y/o
|
|
|
Where is carpal tunnel usually felt on the fingers?
|
thumb, index finger middle finger and radial side of ring finger
|
|
|
What structures are directly affected by carpal tunnel?
|
Medial nerve: inflammation of wrist tendeons, transverse carpal ligament
|
|
|
What are 4 prominent features of Parkinson?
|
bradykinesia, muscular rigitdity, resting tremor, postural instability
|
|
|
What is anosmia?
|
inability to smell, CN 1 olfactory nerve (peppermint or coffee)
|
|
|
What CN is responsible for hearing
|
CN 8
|
|
|
What CN is responsible for eye movement
|
III, IV, VI
|
|
|
What CN is responsible for facial sensation?
|
CN V (light touch test)
|
|
|
What may be an indicator of hemorrhagic stroke?
|
headache w/ stroke
|
|
|
What diagnostics does a pt w/ new onset TIA
|
CT and/or MRI, ECG, CBC, PTT< lytes, creatinine, glucose, lipids transcranial doppler US
|
|
|
What should you do w/ a new onset TIA?
|
immediate ER referal
|
|
|
Why is ASA used as an antiplatelet therapy?
|
ASA inhibits enzyme cyclooxygenase adn reduces thromboxane A2 production
|
|
|
Define Secondary prevention?
|
intervention to help prevent second occurrence of deleterious event. ex: ASA after a stroke
|
|
|
What is the criteria for migraine? (5 criteria)
|
1. lasts 4-72hrs
2. HA has 2 of following: unilateral 3. pulsating mod to severe pain aggravated routine activity 4. 5 attacks which fulfill these criteria 5. no underlying illness 6. photophobia, phono |
|
|
Which are most likely triggered by food: migraine or tension
|
migraine: sx nausea, worse w/ activity
|
|
|
Does Bell palsy present w/ pain.
|
NO: sx of sagging eyebrow, impaired blink, mouth drawn up
|
|
|
How long after a rubella should a pt avoid pregnancy
|
1 month (though no documented injury of offspring) safe when breastfeeding
|
|
|
What immunizations can be given in 1st trimester?
|
influenza, tetanus, diptheria
|
|
|
When should varicella be given in pregnancy?
|
Never, no live viruses should be given during pregnancy
|
|
|
What are 3 classic sx of ectopic pregnancy?
|
amenorrhea, vag bleed, abdominal pain
|
|
|
Due dates are used to:
|
Assess fetal growth provide accurate data for screen test if LMP cant be determined do an US to determine fetal age.
|
|
|
What does pregnancy test assess the prescence of...
|
beta hCG: best 1st void in am or anytime if serum
|
|
|
Tx of asymptomatic bacteriuria in pregnancy?
|
Tx w/: nitrofurantoin (Macrobid): prevents pyelonephritis, Ciprofloxacin (quinolone should be avoided in preg), Amoxicillin is poor coverage of E.coli.
|
|
|
Should all pregnant pt be screened for hypothyroidism?
|
No: only if hx of or FHx or symptomatic
|
|
|
What are risk associated with intercourse during pregnancy?
|
STD, preterm labor due to lower uterine stimuli, Oxytocin released
|
|
|
Routine screen of gestation diabetes should occur?
|
at 24 weeks
|
|
|
When should a 1st trimester pt w/ chlamydia and Gonorrhea be tx and rescreened
|
Tx immediately rescreened later even if no sx
|
|
|
what are increased risk of ectopic preg?
|
prior hx of ectopic, IUD use, Hx of PID, abortion
|
|
|
What medication should be used for UTI in pregnancy?
|
Macrodantin safe and most efficacious?
|
|
|
What medication is associated with fetal tooth discoloration? ....really?
|
Doxycycline
|
|
|
Why is ciprofloxacin not recommended during pregnancy?
|
potential problems w/ bone and cartilage formation
|
|
|
What is myperemesis gravidarum
|
persistent vomit results in weight loss of >5% (morning sickness is milder)
|
|
|
What is Anhedonia
|
loss of pleasure in things that use to bring interest, screen for depression
|
|
|
What is the most common S/E of lithium:
|
nephrogenic diabetes insipidus, plyuria and polydyspia
|
|
|
What is searching behavior after the death of a loved one?
|
Imagined hearing or seeing deceased...should resolve in 6m no meds needed
|
|
|
CAGE used for
|
screen for alcohol abuse
|
|
|
CAGE stands for:
|
C" need to cut down
A: Annoyed by criticism G: guilty about amount E: need eye opener. Usually 2 or more |
|
|
What are physcial sx of alcohol abuse?
|
Macrocytosis, due to B12 deficienttremors, HTN, rhinophyma, peripheral neuropahty, telangiectasias, hepatosplenomegaly
|
|
|
What labs are elevated in alcoholics?
|
Liver enzymes: ALT and AST usually 2x higher than ALT
|
|
|
Which of the following is bulimia nervosa?
bing w/o purge pruge must be present loss of control refusal to eat |
loss of control: may involve purge and nonpurge
|
|
|
What are typical S/E of SSRI
|
Nausea, Ha daily
|
|
|
Elderly tx for depression w/ TCA exhibit?
|
cognitive changes and urinary retention
|
|
|
Bipolar disorder is associated with high rates of >>.
|
suicide
|
|
|
What med is indicated for acute mania?
|
Lithium
|
|
|
What should be monitored when taking valproate for manic sx
|
Valporic Acid, platelets, LFT. Assess for thrombocytopenia,
Target valproate levels: 50-125 |
|
|
Tx for depression w/ fluoxetine finds out shes pregnant what should the next step be>
|
Continue w/ medication, let OB and patient make this decision; it does cross placenta
|
|
|
What drugs are associated with a dry cough?
|
ACE-I
|
|
|
What would be part of the differential in cough?
|
CHF, GERD, Asthma, URI, ACE-I
|
|
|
How is M. and C. pneumonia respiratory pathogens spread?
|
via cough
|
|
|
Which patient needs a peak flow?
chronic bronchitis, emphysema, pneumonia, asthma |
Asthma: measures peak expiratory flow; sensitive to resp tube changes.
|
|
|
What does FEV1 stand for:
|
forced expiratory volume in 1 sec. Used w/ emphysema; aveoli are stretched and contain trapped air.
|
|
|
What medications are use to tx COPD? classes
|
long acting bronchodilators (salmeterol), anti-cholinergic (tiotropium), steroids.
|
|
|
Which of the following is most important to assess w/ new onset asthma?
-smoker? -how severe r sx? -How often do sx occur -do you wheeze? |
How often do sx occur? Determines pharm management and frequency.
|
|
|
A 45 yr smoker will most likely have what Chronic respiratory disorder?
|
COPD
|
|
|
Why are narcotic contraindicated in COPD patients?
|
decrease respiratory drive and worsen hypercapnia
|
|
|
What is the most common pathogen in atypical pneumonia?
|
mycoplasma pneumonia
|
|
|
What is the most common pathogen in community acquired pneumonia?
|
Streptococcus pneumonia: usually post influenza in the very young and old
|
|
|
How many metered doses are in an metered dose inhaler?
|
200 doses
|
|
|
What is the next step for a pt that is using MDI >2x wks and needs a refill w/ daily maintenance steroid.
|
Increase the steroid and refill the albuterol. the pt is not well controlled and needs better maintenance
|
|
|
Which of the following is not common in acute bronchitis?
cough, pharyngitis, nasal discharge, fever |
Fever.
Cough is the most common lasting >5d. If fever w/ cough then consider pneumonia. |
|
|
What is the tx for acute bronchitis w/ purulent sputum?
|
anti-tussive only. Only antibiotics if pertussis. Purulent sputum is epithelial cells sloughing which results in colored sputum.
|
|
|
Which of the following meds are needed in acute bronchitis?
-steroids oral -antibiotic -decongestant and antitussive -antibiotic and steroids |
-decongestant and anti-tussive
tx the sx rarely bacterial |
|
|
What is the recommended max amount rescue inhaler should be used w/ proper asthma maintenance
|
2xwk day or 2x month at night
|
|
|
Why should you NOT use Timolol (eye medication) in an Asthma patient?
|
It is a beta-blocker which may precipitate asthma exacerbation
|
|
|
what is essential in dx of COPD
|
PFT = FEV and FVC (forced vital capacity)
|
|
|
Why should ipratropium (atovent) not be used w/ beta blockers unless short of breath?
|
Beta agonist increase side effects like tachycardia and treemors w/o improved efficacy
|
|
|
Why is asthma not listed under COPD diseases?
|
Asthma is reversible COPD is not.
|
|
|
Which organism in pneumonia has rust colored sputum?
|
Strept pneumonia
|
|
|
What major lab is found in pneumonia?
|
leukocytosis: gram stain can be pos or neg: leukopenia is an omnious sign in elderly
|
|
|
What is a typical finding on xray w/ pneumonia?
|
inflitrates: w/ fever, CP, dyspnea, sputum
|
|
|
Mycroplasma pneumoniais present as what type of pneumonia and what are the sx and what does the xray reveal?
|
atypical pneumonia
varied sx xray has: thickened bronchial shadow, streaks of interstitial infiltration and atelectasis |
|
|
What antibiotic can be used empirically w/ pneumonia in otherwise healthy pt
|
azithromycin or augmentin
|
|
|
What are sx of trichomonas in males
|
no sx in males:
Females: itching and discharge Tx w/ metronidazole (flagyl) |
|
|
Chancroid is an STD from H. Ducreyi what is it a co-factor STD w/:
|
HIV and heals slower:
males have pain females dont |
|
|
21y/o w/ HPV lesions on vulva what is the tx:
|
trichloroacetic acid: warts will slough off after 1 or more tx
|
|
|
What test are ordered after + HIV results?
|
CD4 and HIV RNA (viral load): norm CD4 500-1500, at 200 dx w/ AIDS
|
|
|
How often should viral counts (CD4) be monitored?
|
every 3-4 months (2-8 wks when changing therapy) Sx do not affect CD4 counts
|
|
|
What medications are used for trichomoniasis
|
metronidazole
|
|
|
Which risk factor has greatest impact on HIV transmission?
viral load -type of sex -presence of STD -patient gender |
Viral load
|
|
|
How long after a needle stick will seroconversion occure?
|
4-10wks
|
|
|
Pt neg for HIV but exposed 4m ago. When should she be retested?
|
no recommendation for futher testing. Window period is w/in 3 mnths of exposure if neg after then neg
|
|
|
What is the primary reservoir for HIV?
|
lymphatic tissue
|
|
|
If someone has persistent generalized lymphadenopathy what should be tested?
|
HIV
|
|
|
What clincal syndrome is from replacement of normal vaginal flora?
|
bacterial vaginosis
|
|
|
Male patients presents w/ dsyuria what is the likely STD?
|
Chalmydia and gonorrhea
|
|
|
Dx w/ genital herpes, what will be prescribed?
|
valacyclovir
|
|
|
Suspected of syphilis needs a _____ screening
|
serum assessmetn RPR
|
|
|
72y/o early renal insufficiency: what lab do you expect
|
serum creatinine is sligtly elevated: protein would not be specific for renal disease
|
|
|
A pt w/ a long hx of HTN dx w/ chronic renal insufficiency: What would dx test reveal?
|
clear urine & elevated creatinine: clear because kidney cant filter content.
|
|
|
What organ is responsible for erythropoietin production:
|
kidney
|
|
|
When is the only time asymptomatic bacteria treated?
|
During pregnancy to prevent UTI, or other immunosuppressive state
|
|
|
What diagnostic diagnosis a UTI
|
urine bacteria >100,000, midstream, clean catch
|
|
|
What is murphys sign
|
inspiratory arrest w/ deep palpation of upper right quadrant (cholecystitis)
|
|
|
Are males or females more likely to suffer from urolithiasis?
|
males: sx of fever, chills, RBC casts are mucoprotein complexes
|
|
|
24y/o female patient dx w/ uncomplicated UTI. What is important and is least important assessment?
Body temp, abd exam, CVA tenderness, vag exam |
body temp, abd exam, CVA tenderness: Vag exam would not be indication unless vag discharge
|
|
|
How long should a UTI be tx w/ septra?
|
3 days
|
|
|
Male w/ sx of burning w/ urination. what assessment is least important?
|
abd exam would be least important: diff dx: urethritis, epididymitis, prostatitis, STD
|
|
|
Acute Mnt Sickness:
Onset, sx, PE: |
1-6hrs-several days, rapid
Sx: Ha, cough, anorexia, nausea, weakness, insomnia PE: increased HR, decreased BP, fluid retention |
|
|
Acute Mnt sickness:
Tx, Prevention |
Tx: descend >500m, acclimatize, acetazolamide (diamox), emetics, analgesics
Prevention: Ascend slowly, avoid strenuous exertion and rapid ascent, consider acetazolamide 1 day prior and 2 days after ascent, spend night intermediate altitude |
|
|
High-altitude pulmonary edema:
tx |
descent, rest evacuation, nifedipine (CCB), oxygen, hyperbaric bag
|
|
|
High altitude cerebral edema:
Tx |
descent evacuaiton, dexamthasone, hyperbaric bag, BLS, seizure control
|
|
|
What immune response results in anaphylaxis?
|
immunoglobulin E (IgE): bronchospasm, hypoxemia, hypotension. basophil and Mast cells
|
|
|
What immune response indicates severe rxn?
|
facial angioedema, resp distress, vascular collapse
|
|
|
What is a biphasic reaction?
|
Primary rxn 1-45 min after exposure then sec rxn hrs after exposure.
|
|
|
What medication is used for anaphylaxis?
|
IM Epi (0.3-0.5 of 1:1000) q 15min
-0.01mg/kg children (vastus lateralis) -diphenhydramine: 50-100mg Po or IM if severe, -Ranitidine 50mg IV -Hydrocortisone for delayed relief: 100mg q6hr for relapse prevention |
|
|
What test can ID allergens:
|
RAST: radioallergosorbent
|
|
|
Mosquitoes, flies: presentation
|
pruritic, painful papule, secondary infection common
|
|
|
Bedbug, kissing bug: presentation
|
clustered, erythematous, purutic nodules
|
|
|
Fleas: presentation
|
pruritic grouped welts, papules, vesicles, secondary infection common
|
|
|
Lice: presentation
|
pruritus, nits in scalp, body or pubic hair
|
|
|
Centipedes: presenation
|
pain an ditching w. local necrosisi
|
|
|
millipedes: bite presentation
|
brown stain w/ blistering
|
|
|
Scabies: Presentation
|
burrow lesion w/ pruritus, secondary infection, usually in webs of fingers and hands
|
|
|
Chiggers: presentation
|
pruritic papules or vesicles, secondary infection
|
|
|
Ticks: presentation
|
pruritic papules w/ tick present
|
|
|
Tx of lice and scabies includes:
|
1% lindane lotion or Kwell, scbene shampoo 2 consecutive nights, consider permethrin for scabies also
|
|
|
What is a good repellent to prevent outdoor insect bites?
|
diethyltoluamide (DEET) or Indalone
|
|
|
Describe a Brown Recluse and tx:
|
length 5x width, yellow, brwn or black, thin legs, violin shaped marking, supportive tx, or surgical if >2cm
|
|
|
Describe a Black widow and tx
|
female most venmous, black, brwn, tan, may or may not have hour glass, tx: supportive, tetanus, pain relief (calcium gluconate)
|
|
|
What are presentation of coral snake bite sx?
|
salivation, dysarthria, diplopia, dysphagia, dyspnea, seizures- 6hr after bite.
|
|
|
What is the tx for snake bites and scorpion stings?
|
calm, immobilze, minimize physical activity, wipe bite, BLS, tetanus, antivenom for snakes. Observe for 12 hrs
|
|
|
What is the mainstay of GI decontamination in overdose or chemical ingestion?
|
activated charcoal 1-2 g/kg: DONT use in caustic acids, alkalis, alcohols, lithium or heavy metals
|
|
|
What is the tx for ethylene glycol
|
Ethanol 10% in D5W, over 30min, then maintain blood alcohol at 100-150mg/dl
|
|
|
Electric injury: Which is more dangerous AC or DC
|
AC alternating current = tetanic skeletal muscle contraction prevents letting go of engergized source
|
|
|
Acids (toilet cleaner, drain, hydrocholric, sufuric, batter acid)
Sx, Tx |
Sx: burns of oral mucosa, drooling, odynophagia, abd pain
Tx: Sucralfate 1g PO -copiously wash mouth. DO NOT induce vomiting, lavage or administer charcoal |
|
|
Alkalis: Sx, Tx
|
Sx: caustic-burns
Tx: dilution w/ water, DO NOT induce vomit, lavage. Ingest large amounts of waster or milk, avoid emesis |
|
|
Anticholinergic exposure: Sx, Tx
|
Sx: flushing skin, vlurred vision or mydriasis, tachy mucous membrane
Tx: physostigmine, 0.5-2.0 IV or IM |
|
|
Carbon Monoxide: Sx, Tx
|
Sx: HA, cherry lips, altered consciousness, coma
Tx: Oxygen, 100% hyperbaric chamber |
|
|
Ethylene glycol: Sx, Tx
|
Sx: cough, dizziness, HA, abd pain, dullness, N/V
Tx: Ethanol, 10ml/kg of 10% ethanol solution over 30min |
|
|
Isopropyl alcohol: Sx, Tx
|
Sx: Ethyl alcohol-like (ETOH-like) (altered consciouness, stupor, slurred speech) dizzy, GI, coma
Tx: lavage charcoal, no not vomit, lavage w/in 30min ingestion: may require dialysis |
|
|
Methanol: Sx, Tx
|
Sx; cough, dizzy, HA, nausea, dry skin, redness
Tx: Ethanol: same as E. glycol |
|
|
Petroleum products: Sx, Tx of ingestion
|
Sx: vomiting, chest or abd pain, cough, dyspnea, fever, arrhythmia, seizures, LOC
Tx: Prompt lavage, O2, ipecac in alert, intubate |
|
|
Head Trauma: Glasgow coma:
Eye opening scoring |
spontaneous 4
verbal: 3 pain: 2 no response: 1 |
|
|
Head trauma: Glasgow com:
Best motor response |
obeys verbal: 6
localizes pain: 5 movement or w/drawl to pain: 4 flexion to pain (decort): 3 extension to pain (decerb) 2 no response: 1 |
|
|
Head Trauma: Glasgow Coma
Best Verbal: |
A&O: 5
Converse but confused: 4 Nosense/inappropriate words: 3 nonspecific sounds: 2 No response: 1 |
|
|
What is the cascade effect of cerebral edema?
|
increased ICP=> decreased cerebral blood flow => cerebral ischemia
|
|
|
What diagnostics should be used on Head Injuries:
|
xray for cervical, CT for depressed or deteriorating LOC, LOC <5min, amnesia, GCS 12-14, depressed skull
|
|
|
What is the most important time after a head trauma?
|
following the initial stabilization: 24hrs after are the most important for cerebral swelling
|
|
|
What are steps would require a head injury to return to the hospital?
|
drowsiness difficult to awake, continuous nausea, vomiting more than twice, seizures, pupillary changes, weakness, severe HA, dizziness.
|
|
|
What is postparandial hypotension?
|
hypotension after meals (mostly in elderly due to rush of blood to abdomen)
|
|
|
What fluid challenge should you give someone w/ hypovomlemia
|
250-500ml of NS IV
|
|
|
What head elevation should there be in a person sleeping w/ hypotension?
|
10-20 degrees for sleep
|
|
|
Does cocaine interfere w/ reactivity of pupils?
|
no but antichoinergics causes unreactive pupils
|
|
|
What medications cause nystagmus?
|
alcohol, lithium, tergretol, meprobmate, primidone
|
|
|
What medication is given for benzo overdose?
|
Flumazenil (0.2mg q 1min)
|
|
|
Sexual assault: definition
|
sexual act that is forced or coerced w/o consent of victim
|
|
|
What should you do if a patient has been sexually assaulted w/in the last 5 days?
|
defer physical exam and refer to ER if the patient wants to pursue legal action. If > 5d or no legal then manage in the office
|
|
|
What is the time limit to offer pregnancy or STD prophylactics:
|
72 hrs
|
|
|
What STD test should be performed on a sexual assault?
|
gonorrhea, chlamydia most prevelant. Test for HIV/AIDs cannot be doen until 3-6months due to seroconversion
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What percent of sexual assault victims will have PTSD?
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1/3rd
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How are tilts performed:
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lie, sit stand for 5 min each w/ BP and pulse: drop systolic by 20 , diastolic by 10 and increase pulse 20.
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What is passive external rewarming:
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placing patient i warm environment
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What is active external rewarming:
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hot blankets, hot packs, warm bodies, forced air rewarming
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What is core rewarming?
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warem IV fluids, heated and humidified oxygen, body cavity lavage
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What temperature of water should frostbite extremities be warmed?
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98.6-104F: also give motrin, topical alovera to decrease inflammation, Tetanus, IV PNC: at 500kU
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How long does it take to acclimate to warm climates:
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7-14 days
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How does Cushings develop?
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ACTH-secreting tumors of the pituitary or small cell lung carcinomas which elevate Cortisol and ACTH levels.
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What is a pheochromocytoma?
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tumor of chromaffin cells, unilateral --> abnormal production of epi and norepi-->Na retention, reduced hydrostatic..
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What is the exception to Addisons presentation of slow onset?
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inadequate supplement of corticosteroids (chronic users of corticosteroids --> addisons)
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Sx of Cushings:
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sudden weight gain, loss of menses, decreased libido, depression bruising.
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What diagnostic is critical upon the dx of Addision to r/o another disease?
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chest xray to rule out TB
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How is Cushings syndrome most accurately dx?
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24hr excretion of cortisol in urine
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What diagnostic confirms pheochromocytoma?
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elevated catecholamines in 24hr urine
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What sequal events may occur w/ Addisions?
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eating disorders, alcoholism, malnutrition, HYPERTHYROID, diabtes, apathy, depression
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What is the tx of chronic adrenal insufficiency (Addisions)?
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oral hydrocortisone 20-30mg/d (consider mineralocorticoid replacement to correct renal and hypotension.
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What is the first choice in managment of Cushings?
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Pituitary tumor resection w/ chemo
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What are complications of Cushings?
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osteoporosis, hypertension, diabetes
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DM 1 what is the the problem?
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beta cell destruction and requires exogenous insulin
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What is the Problem w/ DM2?
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beta cell dysfunction and/or insulin defect
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What causes fasting hyperglycemia?
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increased hepatic glucose production in the impaired early stage of insulin secretion
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What causes Postprandial hyperglycemia?
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Decreased uptake of glucose from skeletal muscles
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How often should a new or uncontrolled DM1 or DM2 be seen?
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every 3 months, extended to 6 if well controlled
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How often should a diabetic get an A1C?
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ADA: twice a year at a minumum or every 3 months if glucose not controlled
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How often should microalbumin be obtained in DM?
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yearly after 5 yrs of DM1
Yearly after onset DM2 |
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What is the definitive test to assess kidney function?
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24hr creatinine clearance
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What does the basal phase do in glycemic control?
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Inhibits glycolisis and gluconeogenesis and maintains insulin steady state
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What is morning hyperglycemia controlled by? basal or prandial insulin
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Basal insulin
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Why is Symlin used in diabetes?
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it reduces amount of food consumed and slows gastric emptying. Injected before the meal
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What are the recommended before meal glucose readings in DM?
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70-120mg/dl
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What are the postprandially glucose goals in diabetes?
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<140mg/dl 2hr after meal
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What is the recommended begining dose of insulin for DM1?
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20u in morning before breakfast, if fasting of 250 then 5U before bedtime snack.
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What medication mimics the effects of basal insulin?
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Glargine 24hr long acting no peak
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How often should insulin dose be adjusted and when can adjustment stop?
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adjust every 3-4 days until fasting glucose is <110mg/dl; only increase by 2-8U if obese and 1-4 if thin
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What is professional scope of practice?
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Address role, function, population, practice setting. Serve as the initial source to define individual scope of practice (TBON)
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What is the wording used when an APRN directs another nurse to a specific task? Delegating or assigning
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APRN are only allowed to delegate assitive personnel they may assign another nurse
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What is the process of receivign prescriptive authority for controlled substance?
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TBON authority, TDPS registration, DEA registration number.
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What level of controlled substance may an APRN provide?
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schedule III, IV, V
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What is the maximum period that a controlled substance may be prescribed for by an APRN?
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30 days
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Can an APRN refill a prescription?
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Yes but only after consultation and documentation w/ a delegating physician. (TBON)
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What is the minimum age a controlled substance may be prescribed by an APRN?
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2y/o if younger then consultation is required w/ documentation
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If tx migraines w/ abortive therapy what is the max time to use tylenol, NSAIDs?
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2d/wk to prevent analgesic rebound: can make HA daily condition
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What is the tx of urge incontinent (pharm)
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Anticholinergic medicines help relax the muscles of the bladder. They include oxybutynin (Oxytrol, Ditropan), tolterodine (Detrol), darifenacin (Enablex), trospium (Sanctura), and solifenacin (Vesicare).
These are the most commonly used medications for urge incontinence. They are available in a once-a-day formula that makes dosing easy and effective. The most common side effects of these medicines are dry mouth and constipation. People with narrow-angle glaucoma cannot use these medications. Flavoxate (Urispas) is a drug that calms muscle spasms. However, studies have shown that it is not always effective at controlling symptoms of urge incontinence. Tricyclic antidepressants (imipramine, doxepin) have also been used to treat urge incontinence because of their ability to "paralyze" the bladder smooth muscle |
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Addisons, Cushings, and Pheochromocytoma are disorders of what?
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Adrenal Gland
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What is Addison's disease?
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chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid hormones (glucocorticoids and often mineralocorticoids
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What is the tx of addison's?
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Life long replacement of steroids...hydrocortisone and fludrocortisone
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What is found in Addison's Crisis?
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snycope, hypoglycemia, leg pain, low B/P, lethargy, hypokalemia, fever, convulsion
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Why and how long should you avoid alcohol when taking metronidazole (flagyl)?
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24hrs: avoid disulfiram-type rxn (severe n/v)
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What do you do if a pt fails tx on flagyl for trichomoniasis?
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Retreat w/ flagyl 500mg
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What antibiotics are used for acute prostatitis?
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Septra and fluoroquinolones
(PNC and Cephlosporins can not be used because they cant penetrate the prostatic epithelium) |
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What is the most common cause of hyperthyroidism
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Graves disease: abnormal immune response -->thryoid produces too much thyroid hormone T4, T3
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What are sx of B. pertussi?
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paroxysmal cough lasting >2wks
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What population is considered + TB at >5 induration?
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HIV, Recent TB contact, CXR w/ fibrotic change, organ transplant, Immunosuppressed
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What population is + TB w/ >10mm induration?
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<5yr immigrant, IV drug, congregate setting, lab personnel, peds<4y/o, peds exposed to high risk
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What population is + TB w/ >15mm induration?
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Everyone
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Tx of CAP w/ no comorbidity?
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Macrolide: azithromycin, clarithromycin, erythromycin
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Tx of CAP w/ comorbidity?
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Respiratory fluoroquinolone (levofloxacin)
OR advanced macrolide plus beta-lactam: Augmentin, Rocephin, Alternative to macrolide: Doxy |
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How is Legionella for pneumonia spread?
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inhalation of contaminated water
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The most common pneumonia is Streptococcus pneum. What is it resistant too?
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beta-lactams (PNC), Macrolides (emycin, clarithro, azithro), tetracyclines (doxy).
Known as drug-resistant S. pneum (DRSP) |
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What antibiotic should be used against DRSP (drug resistant S. Pneumonia)?
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respiratory fluoroquinolones (levoflaxacine [levaquin])
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What type of pneumonia organism is seen in alcoholics?
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Klebsiella pneumonia
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How do you know if a sputum sample is adequate for testing?
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Few Epithelial cells w/ many WBC (epithelial will come from throat not lungs)
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What medication may be given to latent TB if isoniazid is not tolerated? How long?
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Rifampin (6-9m)
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What is meant by long-term oxygen therapy in COPD?
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>15hrs day w/ oxygen
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If a person has a persistant cough that is controlled by a bronchodilator what is the dx?
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asthma
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Which environment is more likely to induce asthma sx. A warm humid space or a cold dry space?
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Cold dry space
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What are the three components of asthma dx?
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1. episodic sx of airflow obstruction (wheeze)
2. evidence of at least partial reversible (improves w/ med) 3. exclusion of other conditions |
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What diagnostic tool is essential in the dx of asthma?
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spirometry: Should be 80-100% expected:
Volume or speed/flow of air that can be inhaled and exhaled |
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How often should microalbuminuria be obtained in DM w/ neg protein?
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Annually
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When giving biguanide what should you monitor? CK, ALP, ALT, Cr
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Cr-creatinine:
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Secondary causes of hyperglycemia include all except?
niacine, corticosertoids, thiazide, angiotensin receptor blocker |
Angiotensin receptor blocker
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A1C provides info on glucose control over what period of time?
21-47d, 48-63d, 64-90d, 90-120d |
90-120 d...or 3 months
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If taking the following insulin at 8am what time would you expect the peak to occur?
1. Lispor, 2. Reg Insulin 3. NPH insulin, 4. Lantus |
1. Lispor: 30m-1hr
2. Reg Insulin: 2-3hr 3. NPH Insulin: 4-6hr 4. Lantus: no peak (24hr coverage) |
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What do meglitinide minimize in type 2 DM
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Pstparandial hyperglycemia
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What is a common adverse effect of alpha-glucosidase inhibitor:
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Gastrointestinal upset
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What are steps to improve microalbuminuria?
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1. improve glycemic control
2. strict dyslipidemia control 3. use ACE-I or ARBS |
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How often should A1C be checked in those w/ stable glycemic control?
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twice a year (every 6m)
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What is the mechanism of action of sitagliptin (Januvia)?
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Increase incretin -->increase synthesis and release fo insulin from pancreatic beta cells.
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What is the mechanism of action for Byetta?
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Stimulates insulin production in response to increase plasma glucose
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What DM med should be avoided if hx fo gastroparesis?
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exentaide (Byetta): mainly due to its S/E of n/v/d with regular use
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What are recomended tx of HTN w/ type 2 dM?
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Beta blockers, ACE-I, ARBS; NOT alpha blocker
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What do expect to find when giving a fibrate?
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increase HDL
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What do you expect to find when giving niacin for lipids?
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increase HDL
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What do you expect to find when giving Zetia for lipids?
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reduction in LDL
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With Zetia (ezetimibe) what should routinely be monitored?
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No need to monitor labs...little impact on liver or kidney
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Which of the following man not causes statin-induced myositis?
advanced age, use of statin w/ resin, low body weight, high statin dose |
Us of statin w/ resin is not a risk for myositis
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Which of the following is most effective against lipidprotein?
1. HMG-CoA reductase inhibitors 2. Niacin 3. bile acid 4. fibrates |
2. Niacin
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What can untx hypothyroid lead to in lipid profile?
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increased LDL, TC, and Trig
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What should rigorous physical exercise do to lipid values?
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increase HDL, Lower VLDL, Lower Triglycerides
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What should you expect to see when giving fish oil?
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decrease triglycerides
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What should you expect to see when giving Plant stanol and sterold on lipid profile?
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decrease LDL
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How much eicosapentaenoic acid and doccosahexaenoic acid (omega-3) per day should you prescribe?
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1G (preferably from fish oil)
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Obestity is defined as BMI >
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30kg/m2
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When using orilstat (Alli) when should you take the medication?
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w/in one hour of each meal w/ fat
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What is responsible for satiety?
1. norepi 2. epi 3. dopamine 4. serotonin |
Serotonin
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What are adverse effects of sibutramine (Meridia)?
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somnolence
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Which med is associated w/ weight gain?
1. risperidone (Risperdal) 2. topiramate (topamax) 3. metformin 4. phentermine |
Risperidone: tx schizo
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If walking 8000-10000 steps/day what is the milage?
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4-5miles
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What medication is used to reduce craving for alcohol?
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acamproste (Campral)
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What medication is used to modify intoxicating effects of alcohol?
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naltrexone (ReVia)
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What medication results in unplesant adverse effects of alcohol?
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anabuse
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What happens to RBC in alcoholics and why?
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become macrocytic due to reduction in folate
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Define Acromegaly
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Excessive growth hormone: excessive bone and soft tissue growth
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