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3 Flashcards

1
Q

ABX for UTI in prengnancy

A

“CAMP”

Cephalosporins & Clindamycin
Amoxicillin & Augmentin
Macrobid
PCN

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2
Q

PSA referral cutoff

A

4

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3
Q

Never do what on a DRE for prostatis

A

MASSAGE

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4
Q

Prehn’s sign

A

relief of pain when scrotum is lifted

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5
Q

Prehn’s sign is positive ine

A

Epididymitis

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6
Q

Orchitis

A

inflammation of one or both testes, often preceded by mumps

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7
Q

ABX for bullous impetigo

A

Augmentin
Doxy
Keflex
Diclox

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8
Q

basal cell carcinoma

A

shiny / waxy / pearly / telangiectasias

most common form of skin CA

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9
Q

seborrheic keratosis

A

“lesions are pasted on”

waxy

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10
Q

Auspitz sign

A

pinpoint bleeding of psoriasis plaques after they’re scratched

auSPitz

“you Scratched your Psoriasis”

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11
Q

Koebner’s phenomenon

A

trauma to skin l/t psoriasis plaque formation

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12
Q

Shingrix can be given regardless of timing of last outbreak unless

A

outbreak is current/happening now

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13
Q

Molluscum contagiosum

A

small, painless, flesh-colored bumps w/ umbilicated center

in groin/inner thigh, consider sexual abuse

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14
Q

anthrax tx

A

cipro or doxy

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15
Q

Biggest RFs for hidradenitis suppuritiva

A

Smoking & obestiy

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16
Q

ABX for purulent cellulitis

A

Bactrin
Clinda
Doxy

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17
Q

ABX for non-purulent cellulitis

A

Keflex or PCN

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18
Q

geographic tongue often preceded by

A

spicy/hot food

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19
Q

“white plaques w/ erythematous base”

A

key finding in oral candida

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20
Q

Enterobiasis, aka…

A

“Pinworms have ENTERed the chat aka your body”

Pinworm

scotch tape test
perianal itching, worse @ night
TX = mebendazole or albendazole x1; then again 2 weeks later

Pinworms = Perianal

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21
Q

Lichen on skin

A

red/purple flat-top bump that itches

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22
Q

Lichen on MMs

A

lacey & white

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23
Q

Examples of low-potency steroids

A 
1% Hydrocort (7)
alclometasone dipropionate (6)
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24
Q

Example of high-potency steroids

A

clobetasol

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25
antivirals are ______ during pregnancy
safe
26
Antifungals are _______, not fungicidal
They can't kill fungus, but they limit its ability to reproduce
27
Antifungals can be
teratogenic increased r/f SA or CHDs in pregnancy hard on liver
28
Lazy eye, aka...
amblyopia usually d/t strabismus corrected in infancy
29
On a normal FE exam, retinal arteries are
thinner & lighter in color than veins
30
Flame hemorrhages
specific to HTN
31
On a normal FE exam, red reflex is
present
32
On a normal FE exam, disc margins are
sharp
33
Papilledema
``` optic disc w/ blurred margins sudden onset vison changes s/a: -blurry -double -flickering -loss ``` lasts a few sec @ a time d/t increase ICP/IOP EMERGENT
34
AV nicking
d/t HTN
35
Copper wire arteries
arteries turn red/copper d/t HTN
36
Cotton wool spots
d/t diabetic retinopathy | white/yellow fluffy patches on retina
37
blot hemorrhages
d/t DM retinopathy
38
"feels like a curtain is being pulled over my eye"
Retinal detachment ``` usually painless sudden floaters blurry flashes of light refer ASAP ```
39
arcus senilus
gray halo d/t hyperlipidemia
40
allergic conjunctivitis
stringy/rope-like starts bilateral cervical LAD often itchy
41
viral conjunctivitis
stringy/rope-like spreads one eye to other preauricular + submandibular LAD usually not itchy
42
Adenoviral conjunctivitis
Pink eye
43
Bacterial conjunctivitis
Purulent drainage (others were serous) spreads from one eye to other usually no LAD
44
Herpes karatitis
HSV infection of cornea | tx w/ antivirals
45
Dx under black lamp when you see "fern-like" lines on cornea
Herpes keratitis
46
dark patches in central vision
scotoma seen w/ macular degeneration
47
cataracts make it hard to
drive at night
48
"BEFAST"
Stroke evaluation ``` Balance Eyes Face Arm Speech Time ```
49
Go to test to determine type of stroke
CT
50
A-fib increases r/o ______ stroke, while HTN increases r/f _______ stroke.
ischemic; hemorrhagic
51
Wernickey-Korsakoff Syndrome
D/t acute deficiency in vitamin B1 common in alcoholics altered LOC / abnormal EOMs / altered gait & balance
52
Tx for Bell's
steroids w/in 72h
53
Temporal arteritis, aka...
"giant cell arteritis" unilateral / temple pain + pulsing / cord-like temporal artery Jaw claudication visual impairment - can be permanent
54
Temporal arteritis dx & tx
DEFINITIVE DX= temporal artery bx by optho or vascular also see elevated ESR + CRP Tx = long-term steroids (>1 month) sx usually resolve quickly
55
DX criteria for migraine w/out aura
Hx of 5+ h/a lasting 4-72h that have at least 2: - unilateral - pulsating - mod/severe - aggravated by regular activity AND at least 1: - N/V - photophobia - phonophobia
56
DX criteria for migraine w/ aura
Hx of 2+ migraines but with clear description of how aura presents
57
mainstay prophylactic migraine tx
BBs
58
other prophylactic migraine tx
tricyclics (s/a amitriptyline) Topamax valproic acid can do SNRIs but not SSRIs
59
abortive tx for mild migraines
ASA caffeine NSAIDs tylenol
60
Abortive tx for severe migraines
Triptans
61
Who should not take triptans?
CAD or uncontrolled HTN on MOAIs / serotonin meds
62
Only take triptans ___ days/week or increase r/f rebound h/a
2
63
Dopamine agonists
Tx for PDz ex: Ropinirole s/e: decreased impulse control / leg edema / hypoTN use until you can't put off Levo-Carb anymore
64
Call 911 if seizure lasts more than
5 minutes
65
CN name pneumonic
"Oh Oh Oh To Touch And Feel A Girl's Vagina, Ah Heaven!" ``` Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Auditory (vestiulocochlear) Glossopharyngeal Vagus Accessory Hypoglossal ```
66
CNs sensory/motor pneumonic
"Some Say Marry Money, But My Brother Says Big Boobs Matter More"
67
Trigeminal neuralgia tx
Tegretol
68
In a normal Rinne, AC is
2x longer than BC
69
A weber test in which sound lateralizes to the bad ear indicates
conductive hearing loss
70
A weber test in which sound lateralizes to the good ear indicates
sensorineural hearing loss
71
Examples of conductive hearing loss
``` cerumen impaction cholesteatoma otosclerosis TM rupture FB malformation ```
72
An abnormal Rinne indicates
conductive hearing loss
73
Meniere's Dz
sensorineural HL c/b b/u of fluid in inner ear labyrinth biggest concern = permanent hearing loss (esp. of higher pitched sounds)
74
Tx for Meniere's Dz
No cure meds, diet, therapy
75
S/S of Meniere's Dz
VERTIGO TINNITUS HL PROVEN BY AUDIOMETRY ear pressure sometimes nystagmus
76
Black box warnings for tegretol
agranulocytosis SJS major r/f bone marrow suppression so do CBC prior to start and q3 mos in 1st year
77
Tx for isolated systolic HTN
DHPs like amlodipine
78
Tool to assess functional capacity
Katz index Ranks 6 categories, get a point for each 1 they can do independently - feeding - continence - toileting - transferring - bathing - dressing
79
TUG test score that indicates fall risk
over 13.5 sec
80
Dementia w/ Lewy Bodies
presents like PD
81
MMSE
max score: 30 0-10: severe impairment 10-20: moderate cognitive decline
82
Mini-cog
remember 3 words | draw a clock @ specific time
83
Patient who remembers no words on Mini-Cog
dementia
84
Patient who remembers 1-2 words + draws normal clock on Mini-Cog
normal
85
Patient who remembers 1-2 words + draws abnormal clock on Mini-Cog
dementia
86
Score on PHQ-9 that indicates possible depression
5 or higher
87
Prozac
``` long 1/2 life (bad for elderly) s/e of jitteriness (bad for anxiety) weight neutral (good for bulimia) ```
88
SSRI that's good for anxiety
Lexapro works quickly safe in elderly
89
Zoloft
SSRI safe in elderly
90
most sedating SSRI
Paxil
91
Best SSRI for OCD
Paxil
92
SSRI that's worse about inducing ED
Paxil
93
SSRI w/ off-label use for menstrual problems / menopause
Paxil
94
Does Paxil make you gain weight
yes
95
SNRI that helps w/ neuropathic pain/postherpatic neuralgia
Cymbalta
96
Effexor causes
BP issues / HTN
97
Who do we avoid SNRIs in
HTN & liver dz
98
What do you do before starting patient on tricyclics?
cardiac workup (baseline EKG) in anyone over 40
99
Major concerns with tricyclics
weight gain slowed cardiac conduction (can cause heart block) OVERDOSE - only takes 5x normal dose
100
Common offenders of serotonin syndrome (aka don't use these together)
``` SSRIs SNRIs triptans St. John's Wort MAOIs ``` tricyclics
101
Refractory or atypical depression
Atypical antipsychotics and MAOIs
102
What do we avoid when taking MAOIs?
foods w/ tyramine (can l/t HTNive crisis) - aged cheese - fermented meat - cured meat - yogurt grapefruit other antidepressants
103
What lithium level is toxic and what will you see?
> 2.0; hyperactive DTRs
104
Long-term s/e of lithium
goiter hypothyroid renal probs
105
primary tx for PTSD
SSRIs paxil, zoloft, celexa
106
Who doesn't have the CYP2C19 enzyme and what does this mean?
Asians; can't metabolize pain meds
107
Anxiety screening
GAD-7
108
How long does it take buspar to work?
about 4 weeks
109
Is buspar controlled?
no
110
How should patients take buspar?
consistently and with food
111
Normal fasting total cholesterol:
< 200
112
Normal fasting triglycerides:
< 150
113
Normal fasting HDL:
40-60+
114
Normal fasting LDL:
< 100
115
ASCVD cutoff to start statins
7.5%
116
What do you do before starting statins?
- Baseline CK - Ask about preexisting muscle pain - Baseline LFTs
117
Rhabdomylisis
Safety concern w/ statins Muscle proteins start to break down & are released into blood stream New onset intense muscle pain dark urine fatigue CK will at least 5, up to 10x normal level; draw a Cr
118
Statin-induced hepatitis
LFTs prior to starting and again @ 12 weeks New onset jaundice Abdominal pain Dark urine Clay-colored stool D/c statin if LFTs are 3x normal
119
Desired BP according to JNC8
< 140/90
120
JNC8: Goal BP for patients over 60
150/90 initiate tx if over this
121
JNC8 Goal BP for patients under 60 or who have CKD and/or DM
140/90 initiate tx if over this
122
AHA/ACC Normal BP:
< 120 / < 80
123
AHA/ACC Elevated BP:
120-129 / < 80 Tx = 3-6mos. of lifestyle changes and keeping BP log, then re-eval
124
AHA/ACC Stage 1 HTN:
130-139 / 80-89 ASCVD risk < 10% = lifestyle changes ASCVD risk > 10% = initiate meds
125
AHA/ACC Stage 2 HTN:
> 140 / > 90
126
AHA/ACC Goal BP:
< 130 / < 80
127
When do you d/c an ACEI?
- 30+% increase in Cr - GFR < 30 - angioedema - dry cough
128
Preferred of the thiazides
Chlorthalidone b/c it d/c CVD risks
129
What bad things do thiazides cause?
increased uric acid increased triglycerides increased glucose renal dz
130
What good things do thiazides cause?
stimulate osteoblasts to make bone and help retain calcium (good for osteo)
131
Some possible cross-sensitivity b/t thiazides and
sulfa abx
132
Name the 2 NDHPs
verapamil and diltiazem
133
Who do we not give CCBs to?
GERD pts
134
Who do we not give NDHPs to?
pts w/ heart block
135
How do CCBs work?
dilate coronary arteries
136
Lasix can be _____ if given too quickly
ototoxic
137
Dx criteria for metabolic syndrome
(must have 3 or more) ``` FPG > 110 waist size: (> 35" in W; > 40" in M) trigs > 150 HDL: (< 50 in W; < 40 in M) BP > 130/85 ```
138
saw-tooth pattern on EKG
atrial flutter
139
prolonged PR interval an indicate
heart block
140
EKG that is rapid, regular, has P waves, with peaked QRS
SVT
141
How do you dx HF?
BNP + EKG + echo (EF < 40% is HF)
142
When should a patient with HF call PCP?
weight gain of 2kg (4.4#) in one day
143
RT-sided HF
backs up into body
144
LT-sided HF
backs up into lungs
145
What will you see on CXR in patient w/ HF?
cardiomegaly
146
retinal hemorrhages w/ white center
Roth's spots r/t endocarditis
147
What should patients w/ Raynaud's avoid?
vasconstrictors s/a Imitrex | vasodilators s/a metoprolol
148
What do you treat Raynaud's with?
CCBs and trigger avoidance
149
Dx testing for CVI
D-Dimer + Doppler
150
Only heart sound heard at the base
S2
151
Split S2 only normal if heard on
inspiration
152
When do we hear an S4?
uncontrolled HTN or LVH
153
Where do we hear an S4?
heard best @ apex w/ pt. side-lying (LT side down) and LT arm raised
154
How big should the heart be on CXR?
no more than 1/2 width of chest
155
Cardiomegaly can be d/t
HF uncontrolled HTN cardiomyopathy
156
Intermittent claudication is a sx of
PAD
157
PAD s/s
purple & shiny pain relieved w/ rest & dangling cool to touch decreased pedal pulses
158
CVI s/s
``` warm red/brown edema varicose veins sometimes itchy sometimes ulcers ```
159
Avoid Digoxin in
heart block
160
Therapeutic dig level
0.5-0.8
161
What do patients need to monitor at home when on Dig?
HR < 60 bpm, hold dose and call HCP
162
green/yellow halo
specific to dig toxicity
163
other sx of dig toxicity
fatigue bradycardia sometimes weakness increasing toxicity = increased r/f dysrhythmia (v-tach, v-fib)
164
What can induce or worsen Dig toxicity?
hypokalemia
165
Amiodarone is contraindicated in
ANY type of thyroid dz
166
Amiodorone
used to prevent life-threatening arrhythmias (A-fib and ventricular arr.) reduce anticoagulants by 30-50% when on this
167
How long are pts usually on anticoagulants after DVT?
6+ months
168
How do anticoagulants work on clots?
Only dissolve future clots, not ones already formed
169
Heparin antidote
protamine sulfate (prosulf)
170
How do you prescribe Eliquis for DVT?
10mg bid x7 days, then 5mg bid
171
How do you prescribe Pradaxa for DVT?
150mg bid x5-10 days until LMWH is started
172
How do you prescribe Xarelto for DVT?
15mg PO bid x21 days, then 20mg qd
173
How do you prescribe Warfarin for DVT?
add it to LMWH until warfarin is at therapeutic level then d/c LMWH
174
Therapeutic INR on warfarin for A-Fib:
2-3
175
Therapeutic INR on warfarin for heart valve issues:
2.5-3.25
176
Stop warfarin ______ days before surgery
5+
177
INR 5-10 w/out active bleed
hold Warfarin, do not give vitamin K yet watch and wait
178
INR > 10 w/out active bleed
PO vitamin K
179
INR > 10 w/ active bleed
IV vitamin K
180
Foods that contain vitamin K
``` collard greens turnip greens spinach parsley kale brussel sprouts ``` beef liver soy oil conola oil mayo
181
Black box warning for Lovenox (LMWH)
Do not give w/ spinal anesthesia b/c of increased r/f hematoma Lovenox is preferred choice in pregnancy, but ***pregnant ladies planning CS need to stop it 24h before***
182
How do anticoagulants work?
slow ability to make clots by literally thinning the blood
183
How do antiplatelets work?
stop platelets from clumping together to form a clot
184
ASA is an...
antiplatelet
185
Plavix
antiplatelet preferred after stents Use if ASA allergy
186
Do not take ASA w/in ____ after _____
1-2h; drinking ETOH
187
Do we like ASA in pregnancy?
No
188
Leading c/o infant death (w/in first year of life)
congenital defects
189
Leading c/o death ages 1-4:
drownings
190
Leading c/o death older children:
MVC
191
When do posterior fontanels close?
2-3 mos.
192
When do anterior fontanels close?
12-18 mos.
193
NBs lose ______% of BW after delivery
7-10
194
Infants regain BW by
2 weeks
195
BW doubles @
6 mos.
196
BW triples @
12 mos.
197
NB scalp swelling usually d/t pressure from vaginal delivery
caput succedaneum
198
When can babies have ibuprofen?
6 mos.
199
True hand dominance is a red flag before what age?
10-11 mos.
200
When does potty training start and how long does it take?
2 years; can take 1-2 years to complete
201
When can kids have Doxy?
After 8 y/o
202
Precocious puberty
before 9 in males | before 8 in females
203
Delayed puberty
after 14 in males | after 13 in females
204
Concerned if no menarche by 15 years or
if not w/in 3 years of start of puberty
205
Tanner stage 2
start of puberty (BOTH) breast budding & fine pubic hair (F) straight, fine pubic hair + scrotum/testes enlarge (M)
206
Tanner Stage 3
one mound + acne + armpit hair (F) growth spurt + penis grows most in length (M)
207
Tanner Stage 4
2 mounds + menarche (F) curly pubic hair + penis grows in width + scrotum/tests enlarge more and darken (M)
208
When do females usually reach full height?
once period starts
209
HBV vaccine
First does at birth 3 dose series
210
1-2 month vaccines
``` Polio (IPV) Hib PCV13 RV DTaP ```
211
First inactivated flu
@ 6 mos. - not a day early 2 doses: 2nd dose 4 weeks after first
212
HPV vax can be given up to age
26
213
You can give MMR and varicella on same day, otherwise they need to be _______ apart.
4 weeks
214
MMR + Varicella combo vaccine
can be done, but increases r/f febrile seizures when given as first dose
215
Do not get pregnant w/in ____ weeks of MMR vax
4
216
"It's Time for Many Happy Vaccines"
catch up vaccines ``` IPV Td MMR (and maybe meningitis depending on age) HBV (and maybe HPV depending on age) Varicella ```
217
Bilirubin 12-14 w/ sx
(jaundice, poor feeding, fatigue) have mom increase feeding to 8-12+ times per day
218
Bilirubin of 15+
initiate phototherapy
219
Autism screening tool
M-CHAT usually dx b/t 18-24 mos.
220
ADHD tx < 6 y/o
therapy and behavioral management
221
ADHD tx < 6 y/o
same tx as before, but can add stimulants
222
RFs for hip dysplasia
breech low fluid in pregnancy FMH
223
Hip dysplasia dx early
Pavlik harness x1-2 mos.
224
Hip dysplasia dx late
CR & spica
225
Genu varum usually resolves by
2-3 yrs
226
Genu valgum usually resolves by
7 y/o
227
Fractures that occur along growth plate
Salter Harris Fractures treat promptly to prevent growth stunting
228
Mild Salter Harris Fractures (Grade 1-2)
usually just need cast or splint
229
Severe Salter Harris Fractures (Grade 3+)
surgery
230
Radial head subluxation
aka Nursemaid's CR in office Can resume normal activity Kids will start to use arm w/in 15-20 min
231
condition d/t repetitive pulling of quad on patellar tendon and tibial tubercle
Osgood-Schlatter
232
Can patients with Osgood-Schlatter continue activity?
Yes, unless in severe discomfort
233
Shin splints are aka...
medial tibial stress syndrome - overuse injury - can l/t tibial stress fracture - tx = RICE - pain relieved w/ rest - pain over tibial area
234
osteonecrosis of femoral head
Legg Calve Perthes
235
Legg Calve Perthes usually occurs in kids aged
4-8 y/o
236
Positive trendelenburg
Seen in: Legg Calve Perthes & Slipped Capital Femoral Epiphysis kid can't stand on one leg w/out tilting pelvis; leg swings forward and hip moves down and out at same time
237
Slipped Capital Femoral Epiphysis
femoral head slips out This can damage the growth plate = considered Salter Harris type 1 if this occurs
238
RFs for Slipped Capital Femoral Epiphysis
adolescents growth spurts trauma overweight
239
widened physis on XR
Slipped Capital Femoral Epiphysis refer to ortho
240
Keloid vs hypertrophic
BOTH = red & raised Only Keloid extends to surrounding tissue
241
Hypertrophic scars grow rapidly (_____) but usually improve within _________.
6 mos; 12-18mos.
242
Hemangiomas usually resolve by
age 4
243
Mongolian spots usually resolve by _____ and are more common in _______.
5 years; Af-Ams
244
Mono is linked to increased r/f developing:
Hodgkin's or Burkett's lymphomas
245
Tx for concurrent strep + mono
anything that is not a PCN Macrolides Cephalosporins ***PCN VK (only PCN that doesn't cause rash)
246
What is it called when you see a white pupillary reflex on FE instead of a red reflex?
leukocoria
247
What can leukocoria indicate
in kids: retinoblastoma or congenital cataracts | in adults: cataracts
248
What usually causes AOM?
strep pneumo
249
How do you treat AOM?
Delay ABX 2-3 days If not resolved, Amoxicillin
250
Why would a patient get Augmentin for AOM
- ABX w/in last 30 days | - fever >102.2F
251
What do you give someone with AOM who has a PCN allergy?
Rocephin
252
Bacteria usually responsible for OE?
pseudomonas
253
"white keratinized growth that resemble cauliflower"
cholesteatoma refer to ENT asap
254
Coarctation of the aorta
Birth screen reveals BP is higher in the arms, and lower in the legs at birth and they have decreased or absent femoral pulses
255
When do we start routinely checking BP?
once @ birth; then start at 3 yrs
256
CF is usually dx before age
2
257
S/S of CF
- foul smelling, greasy stool - coughing, wheezing, SOB - lots of mucus - slow growth - salty skin - possible meconium ileus
258
Causes of meconium ileus
- CF (d/t mucus block from fluids being so thick - GI obstructive complaints - hypothyroidism
259
Dx for CF
sweat chloride test + genetic test
260
Average CF lifespan
30 years
261
Goal in CF tx
prevent infection
262
CF is _________ for lung CA
not a risk
263
RSV
usually self-resolves in 2 weeks
264
steeple sign on CXR
croup
265
barky seal cough d/t swelling of upper airways/neck
croup
266
How does pertussis present?
Mild @ first (runny nose, cough) Progresses to severe coughing that can induce vomiting
267
How do treat pertussis?
Best tx = prevention aka vaccination most patients end up hospitalized ABX shorten length of contagion, but not length of sx (macrolides like azithro)
268
Drooling + muffled voice + stridor + tripoding
Epiglottitis: upper airway swelling other sx = odynophagia (painful swallowing), possible cervical LAD
269
thumb print sign on XR
(tracheal swelling) d/t Epiglottitis
270
How do we prevent epiglottitis?
Hib vaccine
271
CRASH & BURN
Dx criteria for Kawasaki's ``` Conjunctivitis (non-purulent) Rash (morbilliform) Adenopathy (cervical, unilateral) Strawberry tongue Hands (palmar erythema/swelling/induration/peeling) ``` Burn = high fever lasting 5+ days
272
Tx for Kawasaki's
IVIG & high dose ASA (doesn't matter what age, B>R)
273
Reye's syndrome
rapidly progressive encephalopathy with hepatic dysfx often begins several days after apparent recovery from a viral illness (esp. varicella or flu A or B)
274
S/S pyloric stenosis
``` Olive-shaped mass (dx w/ US) Projectile vomiting Mucousy, frequent stools belching other sx of dehydration (sunken fontanelles, etc.) ``` Refer to ED
275
When do we usually see intussusception?
before 2-3 years
276
S/S intussusception
crampy stomach pain jelly, bloody, mucousy stools vomiting sausage-shaped mass** need US; refer to ED
277
Tx for encopresis, aka...
fecal incontinence high fiber diet toilet training (regular toileting at least bid) toileting 20 min after meals increased water teach them not to hold it in and not bear down small** amount of fruit juice
278
How long should you try an acne treatment before switching?
8-12 weeks
279
only occurs in females; have 1 X chromosome missing
Turner's
280
webbed neck, aka...
"pterygium colli" Also seen in Turner's syndrome: short stature delayed puberty fertility problems
281
Turner's syndrome increases r/f
``` hearing loss liver enzyme problems HTN DM osteoporosis renal dz hypothyroidism ```
282
Biggest concerns with congenital hypothyroidism
(it slows all growth: mental, sexual, physical) short stature intellectual disability delayed puberty
283
extra X chromosome that causes a testosterone deficiency
only in males Klinefelter's
284
S/S Klinfelter's
big head delayed milestones mental disabilities
285
Marfan syndrome affects
connective tissue
286
S/S Marfan syndrome
Tall & thin Limbs appear too long for body Arm span exceeds height
287
Major concerns w/ Marfan syndrome
Cardiac problems - MVP w/ click - aortic regurge - aortic root dilation*** - AA***
288
Do kids w/ Marfan syndrome have cognitive delay?
no
289
Down's Syndrome increases r/f
- sleep apnea - heart defects - eye/ear probs - hypothyroid - early onset Alz. - childhood leukemia
290
atlantoaxial instability, aka...
cervical spine instability commonly seen in Down's need XR before sports participation
291
Down's s/s
``` flat face small/low ears almond-shaped eyes palmar crease short neck vision problems like strabismus ```
292
When do you go to ED if child is having febrile seizure?
can't decrease fever child appears ill breathing issues seizure lasts > 5 mins
293
Duchenne's Muscular dystrophy
muscles progressively weaken over time impacts cognitive fx large calves d/t scar tissue b/u waddling gait
294
Measles, aka..
Rubeola
295
When do Koplik's spots appear?
2-3 days after other sx and before rash
296
3 Cs of measles
cough congestion (coryza) conjunctivitis
297
Rubeola is highly contagious and spread via
airborne transmission
298
3-day measles
aka German measles | aka Rubella
299
Rubella
- more mild sx | - very serious if caught while preggo
300
6th Dz
Roseola
301
what causes roseola
2 strains of HSV
302
high fever, THEN rash + rose-colored blanchable papules
Roseola (6th dz)
303
When are you no longer contagious w/ 6th dz?
when rash appears
304
Is there a vaccine for Roseola?
no
305
Erythema infectiosum, aka..
5th Dz
306
what causes 5th dz
Parvo B19
307
FEVER FIRST, then slapped cheek + lacy net-like rash on body
5th dz
308
When are you no longer contagious w/ 5th dz?
when rash appears
309
What causes HF&M?
coxsackie virus
310
rash/ulcers appear in mouth and spread to hands and feet
HF&M may or may not be painful
311
Is there a vaccine for HF&M?
no
312
Normal Hgb
12-18 (men, higher; women lower) ***Hbg is low in anemia
313
Normal Hct
36-54% (men, higher; women lower) ***Hct is low in anemia
314
Lead intoxication
- microcytic - abnormal lead levels = >5 - cognitive delay, behavior probs
315
RFs for IDA
- women of child-bearing age - pregnant women (25%) - elderly - kids 12-24 mos. (d/t diet and new allowance of cow's milk) * **cow's milk before 12 mos. = greats r/f IDA development
316
S/S of IDA
- nail pitting/brittle nails - Pica (specific to IDA) - spoon-shaped nails (koilonychia) - dry hair/skin - tachycardia - hair loss - RLS (decreased iron l/t decreased dopamine which l/t RLS)
317
How do you take iron supplements?
On empty stomach or w/ acidic drinks | increases absorption
318
B9, aka
folate
319
Causes of B12 deficiency
long-term metformin s/p gastrectomy alcoholism vegan diet
320
B12 anemia s/s
Glossitis (beefy red tongue) | Neuro sx
321
Alpha-Thalassemia is most common in
SE Asians
322
Beta-Thalassemia is most common in
Mediterranean people
323
inherited blood dz in which body doesn't make enough Hgb
thalassemia
324
Patients w/ Thalassemia are at high r/f for ______; why?
Iron overload increased intestinal iron absorption & transfusion dependence
325
What is another differential for iron overload?
hemachromotosis
326
When do you give HBV vaccine?
24h after birth 1 month of age (1 month after first) 6 months of age (6 months after first)
327
How do you treat a person exposed to HBV who is not known to be vaccinated?
Vaccine + immunoglobulin w/in 24h
328
How do you treat a person exposed to HBV who is vaccinated?
immunoglobulin w/ in 24h
329
body is making way too many blood cells
polycythemia vera
330
Is there a cure for PCV?
No, they require lifelong tx Blood is thick/viscous Can take ASA as thinner
331
Mainstay of tx for PCV
Require regular phlebotomy until Hct is < 45%
332
PCNs cover the gram _____ except ______
positives; staph
333
Coverage of cephalosporins by generation
1st: gram pos. 2nd: gram pos & neg 3rd: gram neg, weak gram pos, B-lactamase extended 3rd: pos & neg, B-lactamase
334
Examples of 1st gen cephalosporins:
Keflex | Duricef
335
Examples of 2nd gen cephalosporins:
Ceftin Ceflor Cefzil
336
Examples of 3rd gen cephalosporins:
Cedax | Suprax
337
Examples of extended 3rd gen cephalosporins:
Rocephin Cefdinir Spectracef Cefpodoxime
338
What ABX do we use for listeria?
macrolides
339
What does e-mycin cover?
atypical bacterias
340
What ABX do we avoid in patient on warfarin and why?
Sulfas b/c warfarin inhibits CYP2C9
341
Bactrim is great for
UTIs & below waist skin infections
342
rare disorder that can occur after taking ABX (like Bactrim) starts w/ flu-like sx, then rash develops, then turns into blisters
SJS emergent!
343
What do tetracyclines cover?
gram neg atypicals MRSA
344
3 alerts r/t tetracyclines
- can cause severe photosensitivity - can stain kids teeth (drink through straw) - contraindicated in pregnancy
345
Clindamycin has high r/f developing
superinfection, then severe colitis
346
What do we watch for w/ vanc?
ototoxicity & nephrotoxicity
347
What is Red man's syndrome?
diffuse pruritus + erythematous rash occurring 15-30 min of vanc admin can pre-medicate w/ Benadryl
348
What are 2 drugs that make secretions (specifically urine) turn red?
Pyridium and Rifampin
349
Intermittent asthma (1)
< 2x per month FEV1 > 80% Tx = LICS + LABA prn
350
Mild asthma (2)
> 2x / month, but less than daily FEV1 > 80% Tx = LICS + LABA daily
351
Moderate asthma (3)
Sx on most days OR waking d/t asthma 1x per week FEV1 60-80% Tx = LICS + LABA daily OR LICS + LTRA daily
352
Severe asthma (4)
Sx on most days or waking up d/t asthma > 1x per week FEV1 < 60% REFER; tx w/ MICS + LABA in meantime
353
3 factors that impact peak flow
"HAG" Height Age Gender
354
Why do we never give LABA to asthma patient by itself?
increased r/f asthma-related death
355
What do we base asthma step-down on?
***PFTs lessened triggers decreased rescue use
356
Dx FEV1/FVC ratio for COPD
anything < 0.7%
357
functional test to determine how much COPD is affecting daily life
CAT score > 10 = significant daily disruption
358
COPD s/s
- barrel chest - finger clubbing - hyperresonance - chronic cough - sputum production - dyspnea
359
What do you test for if you dx COPD in a young person?
Alpha-1 antitrypsin level
360
COPD tx Group A:
CAT < 10 Tx = SABA
361
COPD tx Group B:
CAT > 10 LABA
362
COPD tx Group C:
CAT < 10 but have been hospitalized at least once for exac. Tx = LAMA
363
COPD tx Group D:
CAT > 10 + hospitalized 1 or more times LABA/LAMA combo, but ideally REFER to pulm.
364
What helps dx a COPD exacerbation?
increased dyspnea increased sputum production increased sputum purulence
365
How do we treat COPD exacerbations?
Mild: SABA Mod: SABA + ABX (macrolides or tetras) + steroid Severe: Hosptial
366
Why does unexplained weight loss in a COPD concern us?
Could be lung CA | Could be burning too many calories by working to breathe
367
When do you screen patients for lung CA?
adults 50-80 w/ a 20-pack-year smoking hx who currently smoke (or only quit w/in last 15 years)
368
When do you stop screening for lung CA?
- once quit date is > 15 years ago - if new onset problem now limits life-expectancy - poss. lung transplant
369
What is the most common presenting lung CA sx?
chronic cough
370
Is lung CA screening tied to FMH?
no
371
How do you assess tactile fremitus and when do we see it increased?
increased tactile fremitus noted when vocal sounds are increased during palpation when you put hands on pt. back and have them say "99" indicates consolidated or inflamed lung tissue like is present in PNEUMONIA
372
What will a CXR of pneumonia look like?
infiltrates and consolidation
373
#1 complication of flu
pneumonia
374
Most common cause of CAP that l/t death
strep pneumo
375
Pneumonia tx options for healthy, OP adults
"MAD" Macrolides (like azithro) Amoxicillin Doxy
376
Pneumonia tx options pts w/ comorbids or who had ABX in last 90 days
Resp. quinolones (Levaquin) OR Augmentin + macrolide
377
When do you f/u CXR after pneumonia?
8 weeks
378
CURB-65
(criteria for pneumonia admission; 1 point per criteria) ``` Confusion bUn > 19 RR > 20-30 Bp < 90/60 age > 65 ``` 2 points = consider admission 3 points = absolute admission
379
What can cause lifelong positive PPD skin tests?
BCG vaccine
380
When does a wheal >5mm indicate a positive TB test?
- immunocompromised | - anyone with known exposure
381
When does a wheal >10mm indicate a positive TB test?
- immigrants - HCWs - homeless people
382
What is a positive TB skin test for the general poplulation?
wheal >15mm
383
Can pregnant women have TB skin tests?
yes
384
What is another dx test for TB?
QuantiFERON-TB Gold
385
Confirm positive wheal results w/
sputum culture
386
When do we treat bronchitis, what do we treat with, and why?
Only if d/t pertussis; azithromycin; b/c most bronchitis is viral
387
Does azithromycin relieve sx of pertussis bronchitis?
Doesn't shorten sx, but shortens contagion time
388
Recent URI f/b reoccurrence 7-10 days later - how and why are we treating?
Bacterial sinusitis can l/t periorbital cellulitis tx w/ Augmentin
389
tear-drop or grape-shaped nodules that hang low in nasal cavity usually painless and soft
polyps
390
What increases r/f nasal polyps?
recurrent sinusitis
391
S/S allergic rhiniits
- dull/retracted TM - cobblestoning - "allergic shiners" - transverse nasal crease
392
Onset and duration of tx of SABAs
works w/in minutes, lasts 4-6h
393
Onset and duration of tx of LABAs
take longer to work than SABA, but also last longer
394
What are LAMAs?
"-pium" anticholinergic bronchodilate + dry things up (effect overall breathlessness to prevent attacks)
395
How to ICS decrease inflammation in airway?
help alveoli fill w/ O2 to exchange in blood
396
sunken chest
pectus excavatum **think "ex-CAV-atum" as in chest is CAVED in normal to see poorly-define RT heart border on CXR
397
protruding chest
pectus carinatum
398
Findings on normal CXR
- diaphragm curves down - heart is 1/2 width of chest - RT lung has 3 lobes, LT has 2 - bone = white - tissue = gray
399
1st line tx for URI
Decongestants Work by vasoconstriction of MMs in nose
400
Who should not take decongestants?
Patients w/ HTN bc will increase BP more
401
Dependency from overuse of decongestants
Rhinitis medicamantosa can occur after just 3 days
402
Expectorants are only for
Acute tx
403
BBS can mask sx of
Hypoglycemia
404
T1DM is
Antibodies destroy all beta cells so they become insulin dependent
405
FPG dx for T2DM
126+
406
2h OGTT dx for T2DM
> 200
407
HBA1C dx for T2DM
6.5% and up
408
Random PG dx for T2DM
> 200 w/ sx
409
How does metformin work?
Decreases gluconeogenesis | Decrease insulin resistance
410
Mad dose metformin
2550/day
411
When do you half a metformin dose?
GFR < 46
412
When do you d/c metformin?
GFR < 30
413
How many days should you stop metformin before CT w/ contrast?
2+
414
Who is at increased r/f lactic acidosis r/t metformin and why?
Alcoholics Metformin increased body’s lactic acid and alcoholics have decreased LA excretion
415
S/e SGLT2s
Weight loss | HypoTN
416
Who should not take SGLT2s?
* pts @ increased r/f DKA (alcoholics) * amputations/ulcerations * incontinence issues * frequent UTIs * frequent yeast infections
417
How DPP4s effect weight?
Cause weight loss
418
What do sulfonylureas do?
Stimulate remaining B-cells to secrete insulin No impact on insulin resistance
419
S/E TZDs
Liver toxicity Cardiac sx Weight gain Peripheral edema
420
How sulfonylureas effect weight?
Known for weight gain, avoid in HF
421
Who should not take TZDs?
HF class 3 or 4
422
“Get Loads Perfect by doing loads with “Tide”
GLP1s = “-tides”
423
Who cannot have GLP1s?
PMH pancreatitis | PMH or FMH thyroid carcinoma
424
Rapid-acting insulin
Onset 15 min Peak 1h Duration 2-4h
425
Short-acting (regular) insulin
Onset: 30 min-1h Peak: 2-4h Duration: 6-8h
426
Intermediate-acting insulin
Onset: 1-2h Peak: 6-12h Duration: 24h
427
Long-acting insulin
Onset: 2h Peak: None Duration: 24h
428
Novolog
Rapid-acting
429
Humulin-R
Regular insulin
430
Humulin-N
NPH
431
Lantus
Long acting insulin
432
Levemir
Long acting insulin
433
Novolin-R
Regular insulin
434
Lispro
Rapid acting insulin
435
Humalog
Rapid acting insulin
436
Novolin-N
NPH
437
A1C cutoff to initiate insulin
9-10%
438
Normal TSH
0.5-5.0
439
Thyroid dosing by weight
1.6 mcg/kg/day
440
Thyroid dosing (generic)
25-50 normal adult 12.5-25 elderly
441
Too much thyroid hormone long-term can cause
Osteoporosis
442
What is something to watch for with Synthroid?
Cardiac effects
443
Myxedema coma often precipitated by
Lithium or amiodarone
444
Primary tx for hyperthyroid
Radioactive iodine
445
S/E radioactive iodine
Swollen salivary glands (short-term) Bone marrow suppression (long-term) Infertility (long-term)
446
When does 2nd trimester of pregnancy start
14 weeks
447
_____ can help with hyperthyroid sx but also cause _______
BBs; fatigue
448
Sx thyroid storm
HR and BP become dangerously high, l/t lethal dysrhythmias then HF Agitation & delirium
449
HypERparathyroidism causes
HypERcalcemia
450
ChvOstek’s is a sign of
HypOcalcemia Positive when you tap on pt’s face and they scrunch up on one side
451
TrOusseau’s is a sign of
HypOcalcemia Positive when BP cuff is inflated and it draws their arm like involuntary contraction
452
RUQ pain
Gallbladder Liver dz Hepatitis
453
LUQ
Stomach | Pancreatitis
454
RLQ
Appendicitis
455
LLQ pain
Diveriticulitis
456
GERD sx
- chronic cough - sx worse when supine - postprandial fullness - pain worse after large meal - sour/acidic breath - dyspepsia - sore throat - regurge - heart pain - sometimes chest pain
457
GERD RFs
``` smoking obesity preggo age ETOH ```
458
How do we dx GERD?
Usually clinically and/or PPI trial Dx test = EGD
459
dysphagia / odynophagia / anemia / early satiety / GI bleeding / unintentional WL** / persistent chest pain
GERD alarm systems Send for endoscopy
460
Condition where stomach is trapped above the diaphragm
Hiatal hernia Sometimes mistaken for MI d/t severe chest pain
461
How do H2 blockers help GERD?
suppress gastric acid secretion
462
How do PPIs help GERD?
decrease acidity of stomach w/out effecting overall gastric emptying
463
What do we monitor w/ H2 blockers?
LFTs & CBC (can decrease liver fx & platelets)
464
What do we monitor w/ PPIs?
Osteoporosis B12 anemia C. Diff
465
How do pts take PPIs?
30-60 min before first meal of day for 4-8 weeks
466
high grade esophageal dysplasia
Barrett's esophagus
467
What meds should GERD patients avoid?
CCBs
468
most common esophageal CA
squamous cell
469
S/S Barrett's esophagus
worsening heartburn intermittent cough painful swallow sore throat
470
pain occurs after eating b/c stomach has to produce more acid to dissolve food
gastric ulcers
471
pain relieved immediately after eating, but recurs 1-3h later once gastric emptying has occurred
duodenal ulcers
472
RFs of PUD
NSAIDs H. Pylori stress / smoking / ETOH
473
fecal antigen test
Dx H. Pylori
474
urea breath test
Dx H. Pylori but have to stop all H2s/PPIs for 2 weeks prior
475
serum antibody test
Dx H. Pylori shows past or current infection
476
Triple therapy for H. Pylori
"CAP" Clarithromycin + Amoxicillin + PPI x2 weeks Can do Flagyl if PCN allergy
477
Quadruple therapy for H. Pylori
"Fuck That Bitch Pylori" Flagyl + Tetracycline + Bismuth + PPI used more often b/c of increased resistance to ABX in triple therapy
478
responsible for breakdown of carbs and fat
amylase & lipase
479
amylase + lipase
can be 3x normal when pancreas is inflamed
480
RFs for pancreatitis
Alcoholism Gallstones Hypercalcemia High trigs
481
Rovsing sign
think "Reverse, Right, Rovsing" palpate LLQ and pain is elicited on opposite side (RLQ) positive in appendicitis
482
Markle sign
aka heel jar pain in RLQ when pt hops on 1 foot positive in appendicitis
483
Blumberg sign
rebound tenderness positive in appendicitis
484
McBurney's point
2/3 distance b/t belly button and anterior iliac crest; positive when tender to pressure positive in appendicitis
485
Obturator sign
positive when internal rotation of RT hip at 90 degrees l/t abdominal pain positive in appendicitis
486
Psoas sign
positive when pt raises leg against resistance in supine position that l/t abdominal pain in RLQ positive in appendicitis
487
signs that indicate intra-abdominal bleeding
Cullen & Grey Turner's signs
488
Cullen sign
think "Cullen = Center of body" (C words) blue belly button
489
Grey Turner's sign
"Turn patient over" to see bluish discoloration on flanks
490
4 main RFs for cholecystitis
Female > 40 y/o overweight fertile
491
acute pancreatitis pain has a _______ onset
sudden
492
S/S pancreatitis
severe LUQ that may radiate to back N/V laying down makes pain worse
493
necrotizing pancreatitis will present with
Cullen & Grey Turner's signs
494
After you've dx and fixed cause of pancreatitis, what should have patient do next?
Pancreas needs rest. Patient should be NPO so no pancreatic enzymes are being produced Resume low-fat diet once pancreas is healed
495
Most gastroenteritis is ______ in nature
viral
496
Gastroenteritis tx
Rehydration Bland diet (bread, bananas, applesauce) Antiemetics
497
When do you perform stool studies in pt w/ gastroenteritis?
bloody stools immunocompromised fever lingering sx (10-14d of diarrhea)
498
If you do perform stool studies in pt w/ gastroenteritis, which ones?
culture occult blood C. Diff Ova & parasites
499
Bacterial gastroenteritis
"when you're CAMPing, you might catch a SALMON, SHIt in a hole, and get Extra-COLd at night" campylobacter / salmonella / shigella / E. Coli "and while you're camping, you might Fish for MACkrel" fluoroquinolones / macrolides
500
Bacterial gastroenteritis c/b GIARDIA
"Get Fucked" aka what Giardia says to your insides while it's reeking havoc (tx Giardia w/ Flagyl)
501
pulsating mass in abdomen
AAA
502
feels like tearing/rippling sensation in back and abdomen
ruptured AAA
503
Colonoscopy guidelines: start @ ________ and repeat every __________ with __________________.
45-50; 10 years; annual FOBT
504
Who is at higher r/f colon CA and therefore needs to start screening earlier?
FMH colon CA in FDR PMH colon CA, Crohn's, UC, IBD, prior abdominal radiation
505
S/S colon CA
``` ribbon-shaped thing stools dark or red blood in stool decreased appetite weight loss fatigue ```
506
where do most colon polyps occur?
descending colon
507
characterized by skip lesions t/o GI tract and possible fistulas and strictures t/o intestines
Crohn's
508
affects anywhere from mouth to anus
Crohn's
509
major offenders in diet of someone w/ Celiac
wheat rye barley
510
antacids w/ calcium (like TUMS) or aluminum can cause _______
constipation
511
antacids w/ magnesium (like Magnesite) can cause _______
diarrhea
512
mainstay of tx for duodenal ulcers
sucralfate short-term (< 8 weeks)
513
blocks action of serotonin which can be responsible for N/V
zofran
514
What do we worry about w/ zofran and what do we do about it?
QT prolongation EKG before starting
515
Compazine can cause __________ and ___________ effects.
anticholinergic & extrapyramidal
516
Phenergan is contraindicated in _______ because it can case _________.
kids under 2 yrs; RD
517
Which anti-emetics are sedating?
Compazine & Phenergan
518
What is Lactulose and when is it mostly used?
osmotic laxative often given to cirrhosis pts w/ they can't adequately remove ammonia from system
519
Pts should call HCP before taking anti-diarrheal if they've had diarrhea longer than
3 days
520
Lomotil
potent anti-diarrheal / anticholinergic atropine component added in hopes to decrease abuse/addition from diphenoxylate component controlled substance typically given for IBD
521
Dx testing for Trich
wet mount w/OUT KOH will see flagellated organisms
522
pinpoint hemorrhages on cervix
"strawberry cervix" trich
523
tx for trich
flagyl also tx partners
524
clue cells
"epithelial cells w/ blurred edges" "fuzzy w/out sharp edges" "stippled/speckled" (resemble peppered eggs) positive on wet mount for BV
525
BV and trich ______ vaginal pH
increase (>5)
526
Normal vaginal pH
3.8-4.5
527
primary test for GC/CT
NAAT
528
tx for GC alone
Rocephin 500mg if < 300# 1000mg if > 300#
529
tx for CT alone
aizthro 1g PO once if PCN allergy: doxy 100mg bid x7 days
530
concurrent GC+CT
Doxy + Rocephin
531
eye infections are more commonly seen with GC or CT?
GC
532
start antivirals w/in _____ of herpes outbreak
48-72h
533
might feel itching or burning in area before sore appears
herpes (cold sores)
534
TCA (trichloroacetic acid)
- treats genital warts (c/b HPV 6&11) - apply small amount to each wart - can leave white coating & cause irritation to surrounding skin - just wash area w/ soap & water
535
Dx tests for syphillis
RPR or VDRL
536
Syphilis stage 1:
pains chancre / 3-6 weeks, then goes away
537
Syphilis stage 2:
rash on palms and soles
538
Syphilis stage 3:
full body sx neurosyphilis affects brain and CNS
539
Syphilis tx
IM PCN (Bicillin) dose depends on stage
540
Uncomplicated UTI w/ sx < 7 days
tx = 3 days
541
Uncomplicated UTI w/ sx > 7 days
tx = 7-10 days
542
Recurrent UTI
same ABX but longer tx
543
When do you f/u a UA w/ a culture?
positive nitrites, leukocytes, and hematuria
544
wet mount for yeast infection
add KOH will show pseudohyphae spores & bud cells
545
Normal GFR
> 90
546
What GFR do we start dialysis?
< 15
547
GFR and Cr usually have ________ relationship
inverse
548
Normal Cr
about 1
549
normal BUN
10-20
550
Normal microalbumin
< 30
551
most sensitive value on UA
microalbumin
552
Af-Ams have slightly ______ GFR
HIGHER
553
Dx criteria for CKD
[ GFR < 60 or Albuminuria (Alb/Cr ratio > 30) ] x3+ mos.
554
GFR in CKD Stage 1:
> 90
555
GFR in CKD Stage 2:
60-89
556
GFR in CKD Stage 3:
30-59
557
GFR in CKD Stage 4:
15-29
558
GFR in CKD Stage 5:
< 15
559
ESRF and dialysis occur in what stage
CKD stage 5
560
when do we start seeing sx of CKD
stage 3
561
What is the tx in first 3 stages of CKD and what is the goal?
BP CONTROL weight management, proper diet
562
Foods high in oxalate
``` chocolate spinach rhubarb beans & nuts tangerines coffee potatoes/yams ```
563
osteopenia on DEXA
-1 to -2.5
564
osteoporosis on DEXA
-2.5 or less
565
meds that can reduce bone density
SSRIs Depo PPIs
566
Age to start DEXA routine
65
567
What is a good med for someone with HTN + osteoporosis?
thiazides
568
What do we watch for methotrexate?
Folate deficiency
569
Bouchard's nodes
letter B Bouchards = Both dz = Back set of joints
570
RFs for CTS
``` pregnancy female hypothyroidism obesity RA ```
571
pebble in shoe b/t 3rd and 4th toe w/ numbness+tingling
Morton's neuroma
572
Dx test for Morton's neuroma
MTP squeeze foot is relaxed, grab around MT heads and squeeze positive = pain or Mulder's click
573
Ege's test
WBing of McMurray's
574
Apley's Grind test
tests meniscal tears patient = prone NP flexes knee to 90 and puts knee into back of thigh; push down on foot and rotate tibia medially and laterally
575
Lachman's test
most sensitive for ACL tears pt = supine put 1 hand on lower thigh, and other on lower leg; bend to 20, pull lower leg forward while keeping thigh stable too much movement = positive
576
SLR = positive when pain is elicited at
30-70 degrees
577
evaluate L4 w/
squat & rise knee jerk = diminished
578
evaluate L5 w/
heel walking numbness will present in great toe
579
evaluate S1 w/
toe walking diminished/absent ankle jerk
580
spinal stenosis
``` low back pain relieved by sitting weakness/foot drop burning of butt/thigh often d/t OA abnormal reflexes more common in 50+ people pain = dull/aching ```
581
hook test
positive in bicep tear
582
podagra
big toe gout
583
acute gout tx
1) NSAIDs 2) Steroids 3) Colcrys don't start or stop Allopurinol
584
How many tender points must be present for dx of fibromyalgia?
11/18
585
sprain at base of toe common in athletes
turf toe
586
angle of severity dx for hallux valgus
15 degrees
587
other dx for fibromyalgia
[pain + cumb. fatigue + waking up unrefreshed + cognitive probs] x3 mos. w/ no other explanation
588
condition that affects MPJ #1 where pt can't dorsiflex
hallux limitus
589
high arch foot
pes cavus
590
flat foot
pes planus
591
heel pain that is usually worse in morning or when activity is stopped. Occurs commonly in runners
PF
592
max Tylenol dose per day
3g used to be for but noticed too much hepatotoxicity
593
Tylenol antidote
N-acetylcysteine
594
primary tx for chronic pain
Tylenol
595
Cozen's test
dx for tennis elbow aka lateral epicondylitis
596
Differential s for frequency, urgency symptoms with Blood (-) Nitrites (-) Leukocytes (-)
* Pregnancy: 1st trimester * Vaginitis or STI: esp. HERPES, VVA* * UTI: but dilute urine specimen * OAB: Overactive bladder
597
___________ are normal in urine. ________ are only present if there's bacteria.
Nitrates; Nitrites
598
Pyuria
WBCs in urine most reliable indicator of infection
599
Leukocyte esterase
usually indicates UTI
600
UA shows Neg blood Pos Nit Pos Leuk
probably UTI
601
UA shows Neg blood Neg Nit Pos Leuk
1) bacteria not a nitrAte user 2) urine not in bladder long enough 3) STI 4) vag contamination
602
UA shows Pos blood Neg Nit Neg Leuk
unlikely UTI probably menses maybe kidney stone

FNP (4 decks)

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