1 Flashcards
Exercise & A1C
8+ weeks of exercise shown to decrease A1C by 0.6% in T2DM even if no weight loss occurs.
DM Exercise Recommendations
light activity q30 mins while awake for BGC
Initial T2DM Management
1) Set A1C goal
2) Reduce CV RFs
3) Evaluate use of metformin
4) PE & monitoring
Which medications are associated with an increased r/f development of T2DM?
- Glucocorticoids
- HCTZ
- Atypical antipsychotics
- HMG Co-A reductase inhibitors
- & more!
ADA goals for A1C in T1DM
< 6%
Fibromyalgia body sites
widespread pain index
neck jaw shoulder girdle upper & lower arm chest abdomen upper & lower back upper & lower leg hip (trochanters)
Kyphosis
- Older adults can lose 1-3” of height
- Height loss c/b compression fractures of vertebrae
- Most commonly occurs after 70 y/o
- Generally caused by osteoporosis of vertebrae
- Appears as “hump” in thoracic region
- Most common in elderly females
- Sx that may occur with severe cases include: difficulty breathing, fatigue, and back pain.
Scoliosis
abnormal lateral curvature that occurs most often during the growth spurt just before puberty
Lateral Epicondylitis
AKA “tennis elbow”
• Inflammation of tendon insertion of the extensor carpiradialis brevis muscle.
• Associated with lateral tenderness at insertion site
• Pain worsens with grasping or
twisting
Medial Epicondylitis
AKA golfer’s elbow
• Associated with pulling pain
hyperextension
Elbow pain with extension is indicative of hyperextension
Probenecid (Probalan)
- Uricosuric agent used to increase renal excretion of uric acid in you patients.
- Does not affect formation of uric acid.
- Uric acid is not metabolized; it is excreted.
Scoliosis Curvature
- Curvatures >40° requires surgical implant of Harrington rod.
- Curvatures 5-20° should be monitored for changes.
- Curvatures 20-40° require bracing.
Avascular necrosis
lack of blood flow to bone(s) causes bone death
Colles’ fracture
- Most common type of wrist fracture
* AKA “dinner fork fracture” because of the appearance of arm and wrist fracture.
Diagnostics for ankylosing spondylitis (AS)
• MRI & XR to assess for changes in joints and bones.
• HLA-B27 is a genetic marker present in 95% of those with the disorder.
• CRP & ESR = markers of inflammation; however, not present in all AS cases
patients.
Baker’s cyst
swelling caused by fluid from the knee joint protruding to the back of the knee
positive Kernig’s sign
Patient will resist leg straightening when hip is flexed as a result of painful hamstrings from lumbar nerve root inflammation.
positive Brudzinski sign
patient’s neck is passively flexed and there is flexing of the hips and knees to relieve pressure and pain
Nuchal rigidity
touching the chin to the chest causes pain
positive Babinski reflex
toes fan when the plantar surface is stroked from the heel to the great toe. Adults should have a negative Babinski reflex
Polymyalgia Rheumatica
• Treated with oral corticosteroids s/a prednisone.
• A hallmark of the disorder is dramatic improvement of sx after starting oral prednisone.
• Usually, sx can be controlled with long-term (2-3 years) low-dose oral prednisone, which can be tapered when sx are under
control.
• Usually a self- limiting illness (a few months to 3 years).
The fat pads on an infant’s feet can mimic ___ ______.
pes planus
Bruised kidney
S/S: • back pain • Muscle spasms • N/V • Direct hit to the side of the body
Appendicitis
Typically begins with anorexia and N/V for the first 12-24h. Diffuse abdominal pain = late sign. Usually diffuse at first and gradually localizes to RLQ.
ruptured vertebral disc
Manifests as pain and muscle spasm without N/V
Suspected cauda equine
syndrome
• New-onset saddle anesthesia • Worsening sciatica • Decreased DTRs of lower extremity on affected side. • Initial action = order MRI ASAP • Patient needs to f/u with a neurologist ASAP
pain medication for a child <12 years
Regular-strength Tylenol = safest
Grade III ankle sprain
• Possible complete rupture of some of the ligaments. • Unable to bear weight and walk • Lots of ecchymoses with malleolar tenderness. • Needs XR plus possible US and/or MRI). • Refer to ED
most common RFs for development of polyneuropathy
DM and ETOH abuse
Transillumination of hydrocele
will show that light glow is much larger and brighter on the affected scrotum, compared with the unaffected one
drugs that cause ED
1) SSRI (Paxil = worst)
2) ACEIs
3) CCBs
4) BBs
5) benzodiazepines
6) antihistamines
Risk factors for breast CA
- obesity (BMI of 30+
- older age
- moderate-to-high intake of ETOH
- first pregnancy at age 30 or older
- early menarche (before age 12)
- late menopause (55 or older)
- hx of breast mass w/ atypical hyperplasia
- positive FMH
- genetic mutations (BRCA 1 & 2)
Etonogestrel implant (Nexplanon)
progesterone-only
What is the is priority action when a patient presents with any eye complaint that is not an emergent situation?
Snellen (visual actuity)
Aspirin toxicity
- vomiting, confusion, and tinnitus
- immediately discontinue
presbycusis
- Normal, age-related hearing loss
- sensorineural hearing loss
Sensorineural hearing loss would show as a Weber test that lateralizes to the __________ ___.
unaffected ear
Acute closed angle glaucoma
- Sudden, severe onset unilat. eye pain + decreased visual acuity
- Blurry / impaired vision
- Eye is firm to touch
- DX = tonometry to test for increased IOP
- Refer to ED ASAP if suspected b/c of r/f permanent vision loss
- May see halos or rings
pterygium
- Overgrowths of conjunctiva
- Frequently present as eye redness and irritation.
- **Encroaches onto the cornea
- Patients usually don’t seek tx until discomfort or vision changes
In conductive hearing loss, sound lateralizes to the ________ ___ during a Weber test.
affected ear
chalazion
- presents as painless, localized eye swelling.
- distinguishing factor b/t a chalazion and hordeolum: chalazion = painless, without erythema
- Tx = moist, warm compresses to the area several x/day
What ABX route is needed to tx MRSA?
oral (at least)
Contact dermatitis is usually _____ onset and not usually ___________.
acute; symmetrical
Varicella vaccine, like most vaccines is not
100% effective at prevention.
What can Kerley B lines on XR indicate?
pulmonary edema or malignancy
Who should consider getting varicella titers drawn?
- HCPs and their families
- immunocompromised persons
Clostridium tetani
- gram positive
- found in soil (esp. manure)
Hep A
- transmitted fecal-oral (shed in stool)
- vaccine is not live
- peak infectivity = 2 weeks before jaundice onset or increase in liver enzymes
- RFs = MSM, travel (food prep)
- usually self-limiting
Polio transmission
fecal-oral
Major s/e of Chantix (varenicline)
- mood changes
- depression
- agitation
- suicidal ideation
Bells’ Palsy is r/t viruses such as:
- HSV
- Herpes zoster
- EBV
- cytomegalovirus
- adenovirus
- Rubella
- mumps
Hypochromic anemia
- Hypochromic RBCs = pale in color
- microcytic anemias are hypochromic in nature
How does metformin improve sx of PCOS?
Metformin decreases insulin resistance and increases insulin sensitivity. This leads to hormone reduction, thus improved cycles.
What condition will show “string of pearls” on US?
PCOS: characteristic multiple small follicles seen on TVUS while visualizing ovaries
Speed’s test assesses what 2 conditions?
- labral tears
- biceps tendonitis
What are we concerned about in a patient with a hx of smoking who has new onset throat pain and hoarseness lasting longer than 3 weeks?
Laryngeal CA; Refer them to ENT.
Anemia of chronic disease
Usually normochromic, normocytic.
normal MCV level
80-100 fL
What interventions can help prevent the osteopenia from developing into osteoporosis?
- Aldrenonate (Fosamax) to increase bone density
- Lifestyle interventions (WB exercise)
- Calcium 1200mg + Vit D 800-1000IU daily
DEXA scans
Start @ 65 (younger in pts w/ incidence of low-trauma frax)
Normal: > -1.0
Osteopenia: -1.0 to -2.5
Osteoporosis: < -2.5
weight-bearing exercises
Walking or jogging / weight lifting / yoga
What doesn’t count? Biking and swimming
dopamine agonists (medications that increase dopamine)
Pramipexole, Ropinirole, or Rotigotine
Heberden’s nodes
- Seen at DIPJs
- Only seen in OA
Test to evaluate RCT:
Drop-arm test: abduct arm laterally to 90° and have patient lower it back down to waist slowly. Positive if arm drops suddenly to side (weakness).
Test to evaluate shoulder impingement:
Neer’s test: stabilize patient’s scapula w/ 1 hand, while passively flexing arm while it is internally rotated. Positive if pain in this position.
Hawkin’s test: place patient’s arm in 90° of shoulder flexion w/ the elbow flexed to 90° and then internally rotate the arm. Positive if pain with internal rotation.
Oral Steroids for COPD Exacerbations
- Shorten recovery time
- Improve lung fx (FEV,) & arterial hypoxemia (PaO2)
- Reduce the r/f early relapse, tx failure, and hospital LOS
- Recommended 40 mg pred qd x5d
goal INR of a patient who has had a
stroke
2.0 to 3.0
Goal INR of a patient with A-Fib
2.0 to 3.0
goal INR of a patient with prosthetic valve
2.5 to 3.5.
AHA/ACC Dyslipidemia Recommendations
1) Hx CHD/CVA need 50% reduction
2) LDL > 190 need 50% reduction
3) DM; 40-75 y/o; LDL 70-189 need 30-49% reduction
4) ASCVD 10y risk score ≥ 7.5% need 30-49% reduction
50+% = High potency 30-49% = Moderate potency
Thiazides drop SBP by _________.
≈ 2-8 points.
Systems adversely affected by NSAIDs:
- CV
- Integumentary (e.g., SJS)
- Hematopoietic (b/c ASA affects platelets)
ABX & myasthenia gravis
Contraindicated:
•E. Mycin & telithromycin
• b/c of r/f respiratory collapse
Birth control & tetracycline
• Use backup method when taking
and for one pill cycle afterward
• The meds don’t have to be
taken separately
Avoid prescribing these drug classes to patients with sulfa allergies:
- thiazides
- loop diuretics
- some protease inhibitors (e.g., darunavair, fosamprenavir),
Reye’s syndrome
A rare condition that can develop in
children & young adults recuperating from febrile viral infections who ingest ASA or salicylate meds.
The condition can progress quickly.
Stage 1) sx = severe vomiting, diarrhea, lethargy, stupor, and elevated ALT + AST.
Stage 2) personality changes, irritability, aggression, and HYPERactive reflexes.
Stages 3-5) confusion, delirium, cerebral edema, coma, seizures, and death.
Side effects of thiazide diuretics
- hyperglycemia,
- hyperuricemia
- hypertrigs
- renal dz
- hypokalemia
- hyponatremia
- hypomagnesemia
Chlamydia trachomatis
- positive NAAT
- Treat both the patient & partner
- Preferred tx = azithromycin 1g PO x single dose
Can also do: doxycycline 100mg PO BID ×7 days
digoxin toxicity
• N/V, confusion, and yellowish
green halos in the patient’s vision.
• Can cause hypokalemia and
hypercalcemia.
Lithium toxicity
- Seizures
- Slurred speech
- Increased urination
- Increased thirst
“Seizing & slurring, drinking & peeing”
Phenytoin (Dilantin) toxicity
- nystagmus
- ataxia
- confusion
Carbamazepine (Tegretol) toxicity
skin rash & jaundice
Thiazide diuretics ________ calcium
excretion by the kidneys and _________
osteoblast production.
decrease; stimulate
Which med can be prescribed to manage both HTN and BPH?
Terazosin (Hytrin) = a quinazoline
Chronic use of NSAIDs is associated with increased risk of:
• ulcers • perforation • bleeding of the GI tract • heart attacks • CV damage • strokes • acute interstitial nephritis & kidney injury • liver damage. • can also affect lungs in those w/ asthma or underlying ASA sensitivity, causing bronchospasm
Levothyroxine (Synthroid) interactions
- anticoagulants
- tricyclic antidepressants
- antacids
- calcium, iron, multivitamins
- PPIs
- estrogens
- statins
- metformin.
Certain foods interfere with
absorption. Avoid taking them together and space these
foods and drugs several hours apart:
- calcium-fortified foods
- dietary fiber
- walnuts
- soy
ABX for cat/dog/human bite in patient w/ PCN allergy:
Bactrim
combination of a statin with niacin raises the risk of:
drug-induced hepatitis & rhabdomyolysis
first-line ABX tx for an infant with pertussis:
macrolides
(azithromycin, erythromycin,
clarithromycin)
Tx for first episode of primary genital herpes
Acyclovir (Zovirax)
400 mg PO tid x7-10 days
Tx for primary syphilis (chancre),
secondary syphilis, or early latent syphilis (<1 year):
Benzathine penicillin G 2.4
mU IM in a single dose
Podofilox (Condylox) 0.5%
• gel or cream • recommended tx for condylomata acuminata (genital warts), which may appear on the vagina, external genitals, urethra, anus, penis, nasal mucosa, oropharynx, or conjunctivae. • BID x 3 consecutive days
Hydrochlorothiazide (Procardia XL) can cause________________________, leading to ___________.
bone marrow suppression; neutropenia
Average benzodiazepine half-lives:
Triazolam (Halcion) ≈ 2h
Alprazolam (Xanax) ≈ 12h
Lorazepam (Ativan) ≈ 15h
Clonazepam (Klonopin) ≈ 34h
best choice for an elderly patient with insomnia
Zolpidem (Ambien)
Quick onset (15 min) Short half-life (2h)
What type of electrolyte should an
individual with primary HTN increase in their diet?
Potassium: aim for 3,500-5,000mg per day preferably from dietary sources.
Foods high in potassium include: • avocados • sweet potatoes (yams) • coconut water • bananas • oranges • watermelon / cantaloupe /honeydew •apricots • grapefruit • dark leafy vegetables (spinach / broccoli) • edamame
After antihypertensive therapy is initiated, when should a patient’s BP be rechecked?
F/u in 1 month after initiating/adjusting an antihypertensive.
When under control, f/u can be in 3 months.
Ethnic groups at higher risk for heart disease & T2DM:
Mexican Americans
African-Americans
South Asians (e.g., India, Pakistan)
most common cause of death for
people with DM
Heart disease
Common to hear a _____ __ heart sound over the ________ ____ of the heart with ___________. As long as it disappears with _________, with no other abnormal sx, this is a normal finding.
The sound is caused by the splitting of the ______ & _________ components.
split S2; pulmonic area; inspiration; expiration
aortic & pulmonic
Initial Warfarin dosing for A-fib:
patients > 70 years = 2.5 mg,
younger patients = 5 mg
Still’s murmur
- benign murmur, common in school-age children, usually resolves by adolescence
- murmur sound = musical quality with minimal radiation
Homan’s sign
calf pain at dorsiflexion of the affected limb
A sign of a DVT, but not definitive.
S4 sounds like…
“Tennessee”
S4 is aka atrial gallop or atrial kick
best heard @ apical area using the bell
S3 sounds like…
“Kentucky.”
S3 is aka ventricular gallop or S3 gallop
In coarctation of the aorta, BP is higher in the _______ than in the _______ because of the _______ in the aorta.
Arms; legs; narrowing
Test to evaluate SLAP tears:
O’Brien’s test:
1) Patient can sit or stand. Arm is placed in 90° of shoulder flexion and 10-15° of horizontal adduction.
2) Patient fully internally rotates shoulder & pronates elbow.
3) Examiner provides a distal stabilizing force as patient is instructed to apply an upward force.
4) Repeat in a neutral shoulder and forearm position.
Positive when pain is reproduced or clicking in the shoulder with the first position and reduced/absent with the second position.
Superficial pain usually = ACJ sx
Deep pain usually = labral sx
Keratosis pilaris is often d/t skin getting too dry and follicles getting plugged. What do you do?
Exfoliate (with something like a karyolitic) to prevent clogging
&
moisturize to prevent dryness
Siolithiasis can cause:
- pain and swelling of face, jaw, and neck tht is worse before/during eating (when saliva production increases)
- dry mouth
- foul taste/smell
Parotitis can occur with:
- mumps
-sialolithiasis
bulimia
S/S of erysipelas
- fever
- chills
- h/a
- malaise
are may be raised and/or have central clearing
Anthrax
Starts off as small, itchy bumps that progress to painless ulcer with black center that scabs over.
TX = ABX x7-10 days (cipro or doxy)
When do you close face wounds?
within 24h
When do you close extremity/trunk wounds?
within 12-18h
Tx for cat/dog/human bites
- clean
- empiric ABX (augmentin)
- do not close
When can you close a wound?
- Once you’ve ensure there are no RFBs (check with XR if unable to visualize fully)
- Once they’re clean
- If they do not involve deep structures (tendons, joints, etc.)
What type of acne are closed comedones without papules/pustules?
non-inflammatory / mild
How do you treat non-inflammatory / mild acne?
Benzoyl peroxide
Blepharitis
Inflammation of eyelids. They become red & itchy. Often produce scales on lashes.
Usually r/t inflammatory processes s/a rosacea, AD, seborrheic derm
Tx for bacterial conjunctivitis
- otic macrolide (e-mycin): ointment or drops
- once on ABX x24h, no longer contagious
- wash everything thoroughly
Lifestyle changes for macular degeneration
- quit smoking
- control BP
- Mediterranean diet
- weight loss to tx correlating dz processes
- utilize larger print and brighter lights
Corneal abrasion sx
- acute onset eye pain
- excessive tearing
- photophobia
- “something is stuck in my eye”
Corneal abrasion dx
fluorescein stain = orange dye put in eye and blue ligt used to detect damage/FB
Corneal abrasion tx
NSAIDs & moisturizing drops
Iritis, aka…
“anterior uveitis”
- inflammation of uvea (middle layer of eye)
- pupil might be painful and firm to touch
“Dry” ARMD
- slow
- unilateral or bilateral
- notice most change when driving
- need brighter lights, larger prints
- blurry spots
- straight lines look bent/wavy (metamorphosia)
“Wet” ARMD
- often sudden vision changes/loss
- usually starts unilateral
- metamorphosia typically more severe
Herpes zoster (shingles) outbreak on face and near eyes. What is our concern?
CN5 has an ophthalmic branch that when infected with shingles virus can l/t permanent blindness
Examples of cholinesterase inhibitors:
Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)
What do cholinesterase inhibitors do and when do we use them?
Prevent breakdown of acetylcholine (works in PNS)
Used to tx mild to moderate dementia
What is ginkgo biloba used for?
memory and cognition
**sometimes menopause sx
What is evening primrose used for?
Menopause sx
***sometimes in pregnancy to soften cervix
What is kava kava used for?
anxiety
What is valerian root used for?
insomnia
What is echinacea used for?
immune support
What area of the brain controls balance and coordination? What are some tests to evaluate it?
Cerebellum
Romberg / rapid arm movement
CN1
olfactory
CN2
otic
visual acuity (snellen)
CN3
oculomotor
focus / EOM motor / pupillary response
CN4
trochlear
CN5
trigeminal
CN6
abducens
outward EOM by LR muscle
CN7
facial
puff out cheeks, raise eyebrows, smile, etc.
CN8
vestibulocochlear
hearing & balance
CN9 & CN10
9) glossopharyngeal: innervates tongue and throat
10) vagus
9&10 often tested together by watching uvula rise and fall with pronation
CN11
accessory
CN12
hypoglossal
movement of tongue
Why should people with GI disorders be cautious when taking anticholinergics?
They slow down gastric emptying and can further aggravate GI dz
ex: PUD, UC, etc.
Wellbutrin is an ____
NDRI
What is one serious s/e of Wellbutrin?
can in crease likelihood of seizures
Which BBs are lipophilic?
Propranolol and metoprolol
Which BBs are hydrophilic?
Atenolol and sotalol
Initial tx for SVT
Valsalva: stimulates vagus nerve and slows down conduction through AV node, which lower overall HR
Cardiac causes of pulsus parodoxus:
- cardiac tamponade
- severe hypovolemia
- pericarditis
Pulmonary causes of pulsus parodoxus:
- COPD exacerbation
- PE
- OSA
- status asthmaticus
Aortic regurge
- high-pitched
- early diastolic crescendo
- LICS #3
- at end expiration when leaned forward
What do all newborns get at birth?
vitamin K & HBV vaccine
Who gets surfactant and why?
Primis born before 32 weeks that weigh less than 1300g get surfactant at birth to help with lung development (open alveoli).
What can we give to pregnant moms of primis to help stimulate surfactant in baby?
injectable betamethasone
false menses
- pink-red spotting in diaper
- d/t drop in maternal hormones
- usually resolves in 3-4 days
- benign
Varicella vaccine
- Life vaccine
- 2 doses: 1 @ 12 mos. & again @ 4-6 yrs.
- If rash develops after vax, stay away from immunocompromised/pregnant people until it clears
- primary prevention for shingles later
TDaP indications
- 11 to 12 y/o who previously completed DTaP
- 7 y/o if missed some or all of DTaP
- adults > 19 get it when:
- – pregnant or going to be around newborn
- – 65+
- – HCP
Female athlete triad
1) irregular menses/amenorrhea
2) decreased bone density (osteoporosis)
3) restrictive eating
Levels of prevention
P = “P”rimary: action to “P”revent a dz/dx
S = “S”econdary: “S”creening and early dx
T = “T”ertiary: “T”reatment/actions after dx is established
Sabbath
- sundown Friday to sundown Sunday
- no work or technology
- only worship and rest
- Orthodox Jews
- 7th Day Adventists
ASA pregnancy category
D
positive fetal risk, but sometimes B > R
Cipro pregnancy category
C
fetal affects in animals, but unknown in humans
Threatened abortion
vaginal bleeding w/in 1-20 weeks
cervical os = closed
Inevitable abortion
vaginal bleeding w/in 1-20 weeks
cervical os = open
Incomplete abortion
vaginal bleeding w/in 1-20 weeks
cervical os = open
partial passage of products of conception
Complete abortion
vaginal bleeding w/in 1-20 weeks
cervical os = closed
complete passage of products of conception
uterus = contracted
Septic abortion
spontaneous abortion w/ infected uterus
cervical os = open
purulent cervical discharge
none or incomplete passage of products of conception
uterus = tender to palpation
GDM puts patient at risk for:
- large gestational baby (macrosomia)
- HTN (preeclampsia)
- stillbirth / neonatal morbidity
- increased risk for mom developing T2DM
- increased risk for obesity and development of DM of child
A patient with HF should be advised to restrict sodium to________ and fluids to________.
2 to 3g/day
1.5 to 2L/day
S3 heart sound is sometimes referred to as an opening snap
- occurs early in diastole
* normal variant in children, healthy young adults, and athletes
Bibasilar crackles in lung bases and the presence of S3 heart sounds
classic findings of CHF
Calculate ABI
ABl = highest SBP of certain ankle divided by highest SBP of both arms
Guidelines for lipid screening
q2-3years in patient over 40
Acute bacterial endocarditis
- serious bacterial infection of the heart valves and the endocardial surface.
- usual bacteria = Staph & Strep
• 3 blood cultures obtained at
separate sites 1h apart are used to
identify the causative organism.
•RFs: damaged prosthetic valves, hx of rheumatic fever, injection drug use
CMs Acute bacterial endocarditis
- Osler’s nodes = SQ red, painful nodules on finger pads
- Subungual splinter hemorrhages on the nail beds c/b microemboli.
- Janeway’s lesions c/b bleeding under skin (usually on palms and soles) = painless red papules and macules.
- conjunctival hemorrhages
- petechia
- cardiac friction rubs
- arrhythmias
- murmurs
Mitral valve prolapse (MVP)
• systolic murmur accompanied by
midsystolic click located at apical area
• most cases asymptomatic
• detect with echo with Doppler imaging
PMI
• loudest point of the heartbeat • heard at left ventricle • to auscultate place stethoscope at left side of chest, midclavicular line down to 5th ICS • PMI is relevant for kids >7 years
recommended statins for patients >75 years with ASCVD
moderate-intensity
recommended statins for patients
21 - 75 years with ASCVD
high-intensity statins like
atorvastatin (Lipitor) or rosuvastatin
(Crestor).
Grade I murmur
very quiet and can be heard in quiet conditions
Grade II murmur
mildly to moderately loud
murmur that can be heard in
normal environments
Grade III murmur
loud murmur that is easily heard when the stethoscope is placed on the chest
Grade IV murmur
louder, and a thrill is present
upon palpation
Approximately ____ of children have murmurs, ____ of which are benign.
50%; 90%
notifiable diseases
- Pertussis
- Anthrax
- Lyme disease
NOT herpes simplex
Most cases of cervical cancer are caused by HPV ____ & ____.
16 & 18
Trichomoniasis symptoms
- dysuria
- severe vaginal pruritus
- malodorous vaginal discharge.
- wet prep shows pear-shaped trichomonads with several flagella that have whiplike tails at one end
trichomoniasis tx
single-dose metronidazole
Sufficient Paps must have:
both squamous epithelial cells and endocervical cells
If lacking either type of cell, specimen is incomplete, must be repeated.
Sperm and aging
Sperm production decreases
volume of the semen produced decreases
relative concentration of sperm remains consistent in the semen
What can falsely elevate PSA?
- urinary retention
- UTI
- after a DRE
vigorous exercise and Ejaculation w/in 48h should be discouraged before testing because they will also falsely elevate the PSA levels.
Fitz-Hugh-Curtis syndrome
complicated GC/CT infection
Treat with
Ceftriaxone 500mg IM once +
doxycycline 100mg BID x14d +
metronidazole 500mg BID x14d
How do you treat a pregnant patient
with confirmed uncomplicated gonorrheal & chlamydial infections?
ceftriaxone 500mg IM once + azithromycin 1g PO once
two types of antibodies that are positive in Hashimoto’s thyroiditis
Antithyroid peroxidase antibodies &
antithyroglobulin antibodies
most common cause of hypothyroidism in the US
Hashimoto’s thyroiditis
Vaginal douching
increases risk of
pelvic inflammatory disease (PID)
What things increase the risk of
UTIs in women?
• frequent sexual intercourse (honeymoon bladder) • pregnancy, • spermicide use (w/ diaphragm or alone) • immune compromise • diabetes
Wilms’ tumor
• congenital tumor of kidney that should never be palpated once dx to avoid spread of the tumor
cells.
• May see microscopic or gross hematuria
• mass is nontender and smooth, and rarely crosses midline of abdomen.
Pregnancy-induced HTN (preeclampsia)
Classic triad =
[HTN+ proteinuria+edema]
that occur after 20 wks & up to 4wks PP
• Rapid weight gain of 2-5# per week and edema is most obvious in the face around the eyes and on hands.
CCs are contraindicated in patients with ___________ and ___________.
bradycardia; 2° or 3° heart blocks
sinus bradycardia
HR <60 bpm
Regular rate.
P wave is identical before each QRS
first-degree heart block
regular rate and rhythm
PR >0.20 second
QRS >0.12 second
second-degree heart block
P waves are intermittent
PR is increasingly prolonged
QRS falls into a repeated pattern
third-degree heart block
No PR interval
QRS is not applicable
No relationship between P and QRS
paroxysmal atrial tachycardia
rapid, regular heart rate that begins and ends very quickly.
atria are beating at a very fast rate, but it is not life-threatening.
Ventricular tachycardia
usually associated with heart disease
occurs when ventricles are beating
rapidly and inefficiently
can lead to death if not treated
V-fib
occurs when the heartbeat is
rapid and chaotic, and death will occur if the condition is not treated
“Worst headache of my life!”
Subarachnoid hemorrhage
EMERGENT
After receiving the inactivated influenza injection, how much time does it take for antibodies to develop in the body?
Takes up to 2 weeks to build immunity
after flu vaccine.
RFs for colon cancer
- IBDs s/a UCA and Crohn’S
- overweight and obesity
- tobacco use
- positive FMH
- low-fiber, high-fat diet
sensitivity
high sensitivity is very good at identifying individuals who have the
disease; therefore, fewer cases of the disease are missed.
Specificity
high specificity = ability of
the test to correctly identify an individual who does not have the disease.
An infant with a cold can be immunized as long as the infant’s temperature is not higher than _____
100.4°F
What does a “clunk” sound mean when heard while performing the Ortolani maneuver?
positive finding and signifies a possible hip abnormality (hip dysplasia)
Refer to pediatric orthopedist.
When do babies learn to “ cruise” or hold onto furniture while walking?
12 months
salmon patches
Flat pink patches found on forehead, eyelids, and the nape of the neck
of infants
typically fade by 18 months.
Condylomata acuminata
aka genital warts
c/b HPV
spread by skin-to-skin contact
Confirmation of Turner’s syndrome is done with:
karyotype analysis to confirm the partial or complete absence of the second sex chromosome
live attenuated influenza vaccine (LAIV)
• administered via nasal spray for patients 2-49yrs • not recommended for those with a hx of wheezing in last 12 mos. or those with underlying lung disease.
6 month vaccines
Hep B
Hib
rotavirus (PRV, RV5)
Lupus is 2-3x more prevalent
among women of:
African American, Asian, Hispanic, and Native American
Cancer Mortality Rate in Adults (All Ages/Genders) from
Highest (1) to Lowest (4)
1) lung
2) colorectal
3) pancreatic
4) breast
Puncture wounds of the foot may become infected with ________ (gram negative) by the foam material from sneakers, ultimately causing_______.
P. aeruginosa; cellulitis
What lifestyle modifications should be recommend to an overweight young adult?
• 30 min of daily aerobic exercise
• healthy balanced diet (veggies/fruits/lean proteins/complex
carbs/low in sodium/low fat)
- limit red meat
- control portions
- strength training 3-4 days per week, not daily.
4-year-old milestones
- trace simple objects
- run
- climb steps
- throw a ball, maybe catch
- stack objects
- perform several ADLs with little or no assistance
Fetal alcohol syndrome
microcephaly
narrow eyes
thin lips
smooth philtrum
Ranges from severe intellectual disability to ADHD
Down syndrome
flat, round face
low-set ears
macroglossia
hypotonia
FTT is most likely diagnosed:
in the first few months of life when there is a weight decrease over 2 or more major percentile lines (90th, 75th, 50th, 25th, and 5th).
FTT can be caused by
inadequate nutritional intake
neglect
poor maternal bonding
Abnormally low levels of alpha fetoprotein and estriol and high levels of HCG
Do US to evaluate Down’s and/or
fetal demise
Signs and symptoms of Klinefelter’s
syndrome
- gynecomastia
- long limbs
- lack of secondary sex characteristics
- testes usually small
- infertility is major concern
If treated early, may have normal sexual/reproductive system in future.
TORCH
Toxoplasma gondii Other infections Rubella Cytomegalovirus Herpes
What test detects the presence of
antibodies to HCV, indicating exposure to HCV?
HCV RNA
qualitative and used to distinguish between a current and past infection
may also be ordered after tx is complete to see whether the virus has been eliminated
most common type of cancer in children
Acute lymphoblastic leukemia
a malignancy of the bone marrow
more common in boys aged 2-4
Aplastic anemia
bone marrow suppression (not
cancer) usually caused by medications or a viral infection
ELISA and Western blot tests are used to detect:
HIV antibodies
hordeolum tx
begin with hot compresses to the affected eye until the abscess drains
Many will spontaneously drain within the first 48h
Peritonsillar abscess
severe sore throat difficulty swallowing trismus muffled "hot potato" voice displaced uvula
high-risk factors for hearing loss
(HEARS)
Hyperbilirubinemia Ear infection frequency low Apgar scores exposure to Rubella/cytomegalovirus/toxoplasmosis Seizures
risk of DM is 2-3x higher in ________ Americans than in________ Americans.
Mexican; non-Hispanic
minimum number of days to quarantine an animal suspected of rabies
10 days
carbuncle
group of abscesses that form a large boil with several heads
Treat with doxy or
minocycline PO BID x10d
or
clinda TID-QID x10d if MRSA is suspected.
Patient should return within 48h, to ensure improvement
Persistent urinary and vaginal infections may indicate
underlying glucose metabolism disorders and DM
acne rosacea
chronic inflammatory disease of the
cheeks, chin, and nose, with dry, reddened eyes.
1° tx = determine triggers such as spicy foods and alcohol.
RMSF
caused by the bite of a dog tick that is infected with the parasite Rickettsia ricksettsii.
Larva migrans
results from infection with the eggs of parasites (worms) that are commonly found in the intestines of dogs & cats
Children are at high risk of developing this infection if they come in contact with dirt that is contaminated with
dog or cat feces.
Eating foods that are grown in contaminated soil and / or raw liver are other means of transferring the infection.
Roseola infantum
common viral rash that is caused by HSV
most common ages of onset are b/t
6 mos & 2 years
rashes are maculopapular that first appear on the trunk and spread to the extremities.
Lice nits that are more than ¼ inch from the scalp
nits that are more than ¼ inch from the scalp are usually not viable
use a nit comb after spraying the child’s hair with white distilled vinegar, wait for 15 minutes, and then rinse the hair
BPPV (benign paroxysmal positional
vertigo)
most common cause of vertigo in US
caused by calcium carbonate crystals in the semicircular canals
initial tx is the Epley maneuver
Dix-Hallpike
gold-standard test for BPPV
Positive if classic rotary nystagmus
seen with latency (limited duration)
1° tx for allergic rhinitis
topical nasal steroid spray, once or twice per day.
Presbycusis initially affects
ability to hear higher-pitched sounds of speech (or high frequency)
gradual onset, and over time it affects lower frequencies.
subconjunctival hemorrhage
blood that is trapped between the sclera and conjunctiva
RFs = anticoagulation, HTN, DM
first permanent teeth to develop
first molars; appear at ≈ 6 years
normal pathway of sound wave
transmission (hearing) through the ear
1) Sound waves are collected in the pinna 2) Nerve impulses are stimulated in the inner ear 3) Transmission of vibrations through the hammer, anvil, and stirrup 4) Vibrations are transmitted to the cerebral cortex auditory center 5) Sound is interpreted by the cerebral cortex
Hand, foot, and mouth disease (HFMD)
caused by the coxsackievirus
virus is found in the saliva, sputum, nasal mucus, feces, and blister fluid
transmitted through direct contact of the secretion or in fomites
Sx of Pathologic GERD
- Heartburn
- Dysphagia
- Hoarseness
- Chest pain
- Nausea
- Excessive salivation
- Feeling of lump in throat (“globus”)
Infectious Diarrhea
- Acute = < 2 weeks
- usually viral
- Incubation usually 48-72h
- D, N, V, HA, abdominal cramps, malaise, fever
- Self-limiting
Bacterial Infectious Diarrhea
- Usually: Staph aureus (creamy foods) •Onset sx = 6h
- Duration ~ 12h
- D, N, V, HA, cramps, malaise, fever
Watery diarrhea: Salmonella typhi,
C. difficile (History is important!)
Otitis Media with Effusion (OME)
- TM is often retracted and full
- usually occurs after AOM resolves or is d/t poor eustachian tube function
- usually does not require ABX
- refractory/recurrent cases should be referred to ENT
Visual acuity (Snellen)
- should be 20/20 by 6 years old
- difference of > 2 lines b/t eyes = referral
strabismus
can be normal until 4-6 mos.
Nasal FB
- unilateral foul smelling drainage
- epistaxis
- sneezing
- facial swelling and pain
- mouth breathing
Rupture TM can cause
acute suppurative drainage (purulent)
VUR Grading
1) reflux fills ureter
2) reflux fills ureter & collecting system, but doesn’t cause dilation
3) mild dilation begins
1&2 usually self-resolve by 5y
Refer out grade 3+
Fragile X
- genetic disorder d/t changes in FMR1 gene
- FMR1 gene makes protein FMRP needed for brain development
- Sx = macrognathia (large jaw), scoliosis, pectus excavatum
Functional constipation (Rome IV Criteri)
Must meet 2+ criteria for dx
- hx of withholding stool
- hx painful/large BMs
- hx large diameter stool
- large fecal mass in abdomen
- 2 or less BMs in toilet per week
- 1+ episodes of fecal incontinence per week
Hemolytic anemia
- premature destruction of RBCs
- Dx w/ direct Coomb’s test
- commonly seen in Lupus
Immune Thrombocytopenia (ITP)
- usually s/p URI
- usually in 2-6 y/o
- no splenomegaly
- rash/petechiae (usually legs)
- mild gum bleeding
Hemochromotosis
- genetic
- presents in middle age
- l/t iron overload, then severe organ damage
- complications = DM, hyperpigmentation, arthritis
- tx = phlebotomy
HIV testing
Used to be ELISA + Western blot
Now we use HIV1/HIV2 antigen/antibody immunoassay
If pos. f/u with HIV1/HIV2 antibody differentiation immunoassay
Can also confirm w/ NAT (nucleic acid test)
What are beta-lactams?
ABX with beta-lactam rings
ex: PCN and cephalosporins
Augmentin is a/an_________ & ___________. It does ________ cover MRSA.
extended-spectrum PCN &
beta-lactamase
Does not
Sx of polycythemia vera (PCV)
- h/a
- parasthesias
- distended retinal veins
- plethora (flushing)
- erythromelalgia (burning sensation)
***gait is usually normal (not unsteady) despite other neuro sx
Pneumocystits jirovecii pneumonia (PJP)
Life-threatening infection occurring in immunocompromised pts.
Bactrim = ABX of choice b/c it’s cheap and effective
Other options: Mepron, Aczone, Pentam
MAIN gram positives
Staph
Strep
Enterococcus
Staphylococcus
GRAM POSITIVE
Aureus (skin)
MSSA (skin)
MRSA (skin)
epidermis (skin)
saprophyticus (GU)
Enterococcus
Faecalis & Faecium (UTI)
do not confuse w/ E. Coli, that is different
Atypical gram positives
- Listeria
- diphtheria
- botulism
- tetani
- C. Diff
- Anthrax
- Acne
What will TB XR show?
consolidation in upper lobes
Is TB a reportable dz?
Yes
How long is someone being treated for TB contagious?
No longer contagious (usually) after 2 weeks of ABX
Latent TB
- asymptomatic
- perform PPD + CXR (XR may or may not show anything)
- no need for sputum culture
- not contagious
- treat with multi-drug regimen to prevent turning into active TB
Multi-drug TB regimen options
***usually will require 3 agents, for at least 6-9 mos.
Rifampin (RIF)
Isoniazid (INH)
Pyrazinamide (PZA)
Ethambutol (EMB)
S/S hyperparathyroid
- abdominal pain
- N/V
- confusion
- fatigue
- muscle weakness
- bone pain
TX for hyperthyroidism while waiting to start radioactive iodine or other?
BBs
S/S Addison’s Dz
- fatigue
- weight loss
- N/V
- abdominal pain
- myalgia
- hypoTN
- hyperpigmentation
- most all labs are low except potassium & BUN
- low sodium, low sugar
Addison’s dx test
- Midnight cortisol
- Steroid suppression
- 24h urine cortisol
Cushing’s S/S
- irregular menses
- weight gain
- “moon face”
- hirsutism
- HTN
- fatigue
- muscle weakness
Most sensitive dx test for appendicitis?
CT
Diverticulitis
- mild cases can be treated OP
- sx that don’t improve in 48-72h on ABX and clear liquid diet need to report ED
- S/S = LLQ pain, bowel changes, N/V
- Choice ABX = augmentin, OR cipro + flagyl
Giardia
-common s/p visit to rural area or exposure to human/pet who has it
- Sx can last 2-4 weeks
- –N/V/D
- –abdominal pain
- –gas
- –decreased appetite
Dx w/ stool sample
Ulcerative colitis (UC)
- only affects colon
- bloody diarrhea (often w/ mucus)
- abdominal pain
- weight loss
- fatigue
When should asymptomatic patients be screened for Celiac dz?
Those with PMH or FMH in FDR of:
- T1DM
- Down’s
- Thyroiditis
- Turner’s
- Selective IgA deficiency
Trichomanias s/s
***strawberry cervix
lower abdominal pain
green, yellow, frothy, malodorous discharge
pain and itching around vagina
Describe clue cells
“epithelial cells w/ blurred edges”
“fuzzy w/out sharp edges”
“stippled/speckled” (resemble peppered eggs)
BV tx
Flagyl 500 mg PO bid x7 days
Drugs that increase r/f kidney stones
- topiramate
- Rocephin
- cipro
- ephedrine
- antivirals
- sulfa ABX
Painless hematuria can indicate what?
bladder CA
S/S nephrolitiasis
colicky flank pain that is intermittent, lasting 20-60 minutes
Tx for kidney stones
- hydrate
- NSAIDs
- strain urine to catch, then bring stone to office for eval
- can do Tamulosin maybe
- ED for severe sx (these should pass in 48h)
Ankylosing spondylitis on XR
- continuous spine lesions
- vertebral squaring
- joint space stenosis
- sacroiliitis (usually first finding, usually symmetrical & bilateral)
Primary tx for Ankylosing spondylitis
NSAIDs and steroids as adjunct PRN
DMARDs = second line
Anatomic snuff box
triangle shaped depression on lateral aspect of back of hand
best seen/felt when thumb is extended
Valgus stress
Assess MCL
Place one hand on ankle and one hand over femur while trying to rotate tibia externally
Positive SLR
- probable LS root nerve irritation
- highly sensitive for low lumbar disc herniation
Piriformis screen
Piriformis is muscle that rotates femur when hip extends.
Tests for tightness of muscle across sciatic nerve.
Tx for RCT
PT
Oral NSAIDs
steroid injections
surgery reserved for full-thickness tears
Polymyalgia rheumatic (PMR)
- inflammatory (will see elevated CRP & ESR)
- affects women more than men
- stiff/sore hips and shoulders
- tx = prednisone (rapid results)
Bursitis
fluid-filled sac b/t bone and soft tissue
often resolve w/ RICE and anti-inflammatories
Ankle sprains
ankle = most commonly sprained spot
usually an inversion sprain (ankle rolls inward)
Grade 1 ankle sprain
microscopic tear
mild, resolves w/ rest
Grade 2 ankle sprain
larger, partially through ligament
Grade 3 ankle sprain
complete tear of ligament, cannot WB
refer
Watson’s test
evaluates instability in wrist near scaphoid
Waddell’s sign
developed to evaluate lumbar pain
positive set is indicative of psychogenic cause of pain
Atopic dermatitis (eczema):
Chronic inherited skin disorder marked by extremely pruritic rashes that are located on the hands, flexural folds, and neck (older child to adult)
class II heart disease
(Ordinary physical activity results in fatigue, exertional dyspnea)
First-line medication for stable HF
ACEI or ARB
An adult (21–75 years) with any type of ASCVD (e.g., CAD, PAD, stroke, TIA) is given _________ statins such as .
high-intensity
atorvastatin 40-80 mg or rosuvastatin 20-40 mg
An adult with LDL >190 mg/dL (without ASCVD or DM) is a candidate for _________ statin dosing.
high-intensity
For a patient who has markedly high triglycerides (500+), do what?
lower triglycerides first (niacin or fibrate) before treating the high cholesterol and LDL
metabolic syndrome criteria
abdominal obesity
HTN
hyperlipidemia or elevated triglycerides and low HDL
elevated fasting glucose >100
NAFLD is associated with _________________. Look for slight elevation of ____________ (not related to alcohol or medications) and negative ____________.
metabolic syndrome and/or obesity
ALT and AST
hepatitis A, B, and C.
Abdominal obesity in males
> 40 inches [102 cm]
Abdominal obesity in females
> 35 inches [88 cm]
If SABA are not controlling symptoms, next step is to:
start patient on a long-acting (LAMA or LABA) based on patient preference. Continue using SABA as needed.
top 2 bacteria in CAP are:
S. pneumoniae
H. influenzae
top 2 bacteria in atypical pneumonia are:
Think “AMC, like the movies. It’s very atypical of me to want to go to the movies.”
Atypical
Mycoplasma
Chlamydia
Rust-colored or blood-tinged sputum
likely from S. pneumoniae
COPD/smoker with pneumonia:
More likely to have H. influenzae bacteria
Outpatient CAP: Diagnosis is based on
presentation, S/S, and CXR.
Do not order sputum for C&S; instead, order CXR.
CXR of a person with healed pulmonary TB
pulmonary nodules and/or cavitations (round black holes) on the upper lobes with or without fibrotic changes (scars).
For CXR of right middle-lobe pneumonia, look for
consolidation (white-colored area) on the right middle lobe, which is located at about the same level as the right breast on the front of the chest.
factors needed to figure out PEF
height + age + gender
use HAG mnemonic
Severe respiratory distress:
Tachypnea disappearance of or lack of wheezing accessory muscle use diaphoresis exhaustion
What do PCR tests test for?
presence of viral RNA (s/a hep C or HIV)
positive result means that the virus is present.
***NOT antibody tests
How do we prevent hepatitis D?
A person must have hep B to become infected with hep D. There is no vaccine for hep D, but hep B vaccination will prevent acquisition of hep B and therefore hep D
What do large numbers of squamous epithelial cells in the urine sample mean?
contamination
What is hemoglobin electrophoresis dx for?
thalassemia and sickle cell anemia
Pernicious anemia results in:
Vitamin B12–deficiency anemia
Macrocytic
normochromic
Neurologic symptoms
Pernicious anemia is
macrocytic
Ketorolac (Toradol)
NSAID
limited to 5 days of use.
first dose is given IM or IV
signs and symptoms of depression
SIG-E-CAPS
o Sleep o Interest o Guilt o Energy o Concentration o Appetite o Psychomotor o Suicide
Cushing’s syndrome
associated with delayed puberty and growth failure
excess of androgens
Gynecomastia
When evaluating a patient with polycystic kidney disease, pay close attention to which area of the kidney?
basic functional units of the kidney are nephrons containing glomeruli and renal tubules
Pyuria
increased presence of white blood cells in urine
Amaurosis fugax
temporary loss of vision in one or both eyes due to a lack of blood flow to the retina
Anomia
language specific disturbance arising after brain damage whose main symptom is the inability of retrieving known words
xerosis
Dry skin
Trigeminal neuralgia, aka
tic douloureux
lifestyle factor associated with secondary polycythemia vera
Smoking b/c secondary PCV is associated with chronic hypoxia
most common cause of bacterial pneumonia is
Streptococcus pneumoniae
Rovsing’s sign
deep palpation of the lower left quadrant of the abdomen
Markle test involves
having the patient raise their heels and drop them suddenly
Psoas test
positive when the patient experiences abdominal pain while flexing the hip and knee
indicates appendicitis
Basal cell carcinoma
small
translucent papules with a central ulceration
telangiectasis
rolled borders
amaurosis fugax
major complication temporal arteritis (giant cell arteritis) causing transient blindness of the affected eye
Still’s murmur
Still’s Murmur = SM
“Systolic, School-age, Self-resolves”
&
“Musical, Minimally radiates, Monitor”
benign murmur common in school-age children; usually self-resolves by adolescence
musical quality with minimal radiation
monitor on annual physical exam
Heberden’s nodes
nodules on DIPJs
only with OA
Which topical ear medications should be avoided in patients with perforation of the TM?
Aminoglycoside drops s/a (gentamycin, tobramycin) b/c they are are ototoxic
ear drops with alcohol, benzocaine, or olive oil should be avoided
Swimming or water inside the ear should be avoided until the TM is healed
Which topical ear medications can be given in patients with perforation of the TM?
topical quinolone drops
brown recluse spider bite
begin with burning at the site, followed by blanching with a red halolike center
reddened skin area that may be followed by a blister that forms at the bite site
mild-to-intense pain and itching for 2-8h after bite
central area of the bite becomes necrotic, and black eschar forms
Cardiac complication of rheumatic fever
damage to mitral valve, leading to mitral valve regurgitation early or late in life
EndomeTRITIS: subjective and objective findings associated with
painful sexual intercourse
pain when urinating
healthy appearance of the internal and external genitalia
lower abdominal and cervical motion tenderness in response to palpation
EndomeTRITIS:
most commonly associated PID or invasive gyn procedures in nonobstetric pts
to determine the appropriate tx, obtain cervical culture to identify bacteria
Type 1 tic douloureux (trigeminal neuralgia)
extreme, shock-like facial pain that lasts from a few seconds to 2 mins per event and can last up to 2h total.
Type 2 tic douloureux (trigeminal neuralgia)
constant, aching, burning facial pain with less intensity
more common in women and peaks in their 60s
can also be r/t secondary neurologic disease s/a MS or HSV-1
symptom of occipital neuralgia
Shooting pain at the base of the head
Is there an association between lead poisoning and iron deficiency in children?
Yes
both diagnoses are common in patients of lower socioeconomic status
Iron deficiency has also been shown to increase lead retention in the tissues, leading to increased absorption and toxicity
Normocytic anemia results from
long-term chronic disease; generally occurs in older adults rather than children
Spirometer readings are used to:
assess a patient’s personal best
Spirometer readings zones:
Green zone =80% - 100% expected volume
Yellow zone = 50% - 80% expected volume
Red zone = below 50% of expected volume
Reiter’s syndrome
immune-mediated reaction secondary to chlamydia
causes red, swollen joints; ulcers on the skin of the glans penis; and urethritis
resolves on its own
Tx = NSAIDs, comfort measures, and ABX for underlying chlamydia
insulin used on a sliding scale to work from meal to meal
Lispro (rapid-acting)
Minimum duration of tx of complicated UTIs in males, uncontrolled DM, immunocompromised, and pregnant or elderly women
minimum of 7 days
Meglitinides
stimulate pancreatic release of insulin and are indicated for patients with postprandial hyperglycemia
Thiazolidinediones should not be used with patients who have a history of
bladder cancer or heart failure
Tx for atypical pneumonia in patient with no comorbidities or antibiotic resistance
azithromycin (Z-Pak) daily × 5 days
Tx for atypical pneumonia in patient with possible comorbidity and/or those at risk for antibiotic resistance
monotherapy with a fluoroquinolone (e.g., levofloxacin or moxifloxacin)
or
combination therapy of Augmentin + a macrolide or doxycycline
UTI is defined as
presence of 100,000 organisms/mL of urine in asymptomatic patients
or
> 100 organisms/mL of urine w/ pyuria (>7 WBCs/mL) in a symptomatic patient
reticulocyte count reflects
the efficiency of the bone marrow’s response to illness in a patient with sickle cell disease
Bowen’s disease
squamous cell cancer (SCC) of epidermis that has not yet invaded the dermis
Curettage & electrodessication is an efficient, cost-effective method with low complication rates
Doxycycline should not be prescribed for children younger than
9 years
quinolones and should not be administered to children younger than
18 years
Bactrim DS
appropriate for treating gram-negative bacteria s/a Escherichia coli
also appropriate for patients older than 2 mos.
CHD screening O2 sat of ≥95% in the right hand or foot with a ≤3% absolute difference between the right hand and foot is considered a ______ screen, and screening would _____.
passed; end
A failed CHD screen is if
any O2 saturation measure is <90% (in initial screen or in repeat screens)
or
O2saturation is <95% in the right hand and foot on 3 measures, each 1 hour apart
or
a >3% absolute difference exists in O2 saturation b/t right hand and foot on 3 measures, each 1 hour apart
A failed CHD screen is if
any O2 saturation measure is <90% (in initial screen or in repeat screens)
or
O2saturation is <95% in the right hand and foot on 3 measures, each 1 hour apart
or
a >3% absolute difference exists in O2 saturation b/t right hand and foot on 3 measures, each 1 hour apart
Common s/s of pregnancy-induced HTN
edema of face and the upper extremities weight gain blurred vision elevated BP proteinuria h/a
Chordee
presence of ventral shortening and curvature of the penis
commonly associated with a more proximal urethral defect
Initiate phototherapy in NB whose
bilirubin level is >5 mg/dL,
Tx for OE
Use aluminum acetate solution PRN
Keep water out of the ear during treatment
Apply polymyxin B–neomycin-hydrocortisone suspension drops QID × 7 days
and/or ofloxacin otic drops BID × 7 days
betablocker
contraindicated for a patient with emphysema
contraindicated in patients with sulfa allergies
Thiazides (hydrochlorothiazide and indapamide)
loop diuretics (furosemide and bumetanide)
24-hour urine collection measures
creatinine clearance to assess for proteinuria, albuminuria, and glomerular filtration rate
Restrictive airway diseases
Trouble filling lungs on inspiration
TB
Pneumonia
PE
Sarcoidosis
Obstructive airway dz
Difficulty exhaling
Asthma
CF
COPD (or emphysema/ chronic bronchitis separately)
Bronchiolitis
Diabetes insipidus
overproduction of antidiuretic hormone
does not create ketones in the blood
False-positive results in ovulation tests that detect the urinary luteinizing hormone (LH) can occur w/
menopause
PCOS
endometriosis
ovarian insufficiency
When a nurse practitioner percusses over the lungs, resonance is heard over
normal lung tissue
Hyperresonance is heard wit
emphysema
Recommended empiric treatment of suspected UTI children younger than 24 months
bactrim
pathogen that commonly causes meningitis
gram-positive
Streptococcus pneumonia
EKG reading for someone who took too much amitriptyline (Elavil) would show
sinus tachycardia
Recommended care for women diagnosed with preeclampsia includes
bed rest with bathroom privileges
weight and BP monitoring
closely following urine protein and serum protein, creatinine, and platelets
***oral meds are not used first-line
What condition is coming to see with ankylosing spondylitis?
UC
15-40%
