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3 Flashcards

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Family Nurse Practitioner (FNP) 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
Q

antivirals are ______ during pregnancy

A

safe

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26
Q

Antifungals are _______, not fungicidal

A

They can’t kill fungus, but they limit its ability to reproduce

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27
Q

Antifungals can be

A

teratogenic
increased r/f SA or CHDs in pregnancy
hard on liver

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28
Q

Lazy eye, aka…

A

amblyopia

usually d/t strabismus
corrected in infancy

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29
Q

On a normal FE exam, retinal arteries are

A

thinner & lighter in color than veins

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30
Q

Flame hemorrhages

A

specific to HTN

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31
Q

On a normal FE exam, red reflex is

A

present

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32
Q

On a normal FE exam, disc margins are

A

sharp

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33
Q

Papilledema

A 
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

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34
Q

AV nicking

A

d/t HTN

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35
Q

Copper wire arteries

A

arteries turn red/copper

d/t HTN

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36
Q

Cotton wool spots

A

d/t diabetic retinopathy

white/yellow fluffy patches on retina

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37
Q

blot hemorrhages

A

d/t DM retinopathy

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38
Q

“feels like a curtain is being pulled over my eye”

A

Retinal detachment

usually painless
sudden floaters
blurry 
flashes of light
refer ASAP
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39
Q

arcus senilus

A

gray halo d/t hyperlipidemia

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40
Q

allergic conjunctivitis

A

stringy/rope-like
starts bilateral
cervical LAD

often itchy

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41
Q

viral conjunctivitis

A

stringy/rope-like
spreads one eye to other
preauricular + submandibular LAD

usually not itchy

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42
Q

Adenoviral conjunctivitis

A

Pink eye

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43
Q

Bacterial conjunctivitis

A

Purulent drainage (others were serous)
spreads from one eye to other
usually no LAD

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44
Q

Herpes karatitis

A

HSV infection of cornea

tx w/ antivirals

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45
Q

Dx under black lamp when you see “fern-like” lines on cornea

A

Herpes keratitis

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46
Q

dark patches in central vision

A

scotoma

seen w/ macular degeneration

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47
Q

cataracts make it hard to

A

drive at night

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48
Q

“BEFAST”

A

Stroke evaluation

Balance
Eyes
Face
Arm
Speech
Time
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49
Q

Go to test to determine type of stroke

A

CT

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50
Q

A-fib increases r/o ______ stroke, while HTN increases r/f _______ stroke.

A

ischemic; hemorrhagic

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51
Q

Wernickey-Korsakoff Syndrome

A

D/t acute deficiency in vitamin B1
common in alcoholics

altered LOC / abnormal EOMs / altered gait & balance

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52
Q

Tx for Bell’s

A

steroids w/in 72h

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53
Q

Temporal arteritis, aka…

A

“giant cell arteritis”

unilateral / temple pain + pulsing / cord-like temporal artery
Jaw claudication
visual impairment - can be permanent

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54
Q

Temporal arteritis dx & tx

A

DEFINITIVE DX= temporal artery bx by optho or vascular
also see elevated ESR + CRP

Tx = long-term steroids (>1 month)
sx usually resolve quickly

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55
Q

DX criteria for migraine w/out aura

A

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
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56
Q

DX criteria for migraine w/ aura

A

Hx of 2+ migraines but with clear description of how aura presents

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57
Q

mainstay prophylactic migraine tx

A

BBs

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58
Q

other prophylactic migraine tx

A

tricyclics (s/a amitriptyline)
Topamax
valproic acid

can do SNRIs but not SSRIs

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59
Q

abortive tx for mild migraines

A

ASA
caffeine
NSAIDs
tylenol

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60
Q

Abortive tx for severe migraines

A

Triptans

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61
Q

Who should not take triptans?

A

CAD or uncontrolled HTN

on MOAIs / serotonin meds

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62
Q

Only take triptans ___ days/week or increase r/f rebound h/a

A

2

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63
Q

Dopamine agonists

A

Tx for PDz

ex: Ropinirole
s/e: decreased impulse control / leg edema / hypoTN

use until you can’t put off Levo-Carb anymore

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64
Q

Call 911 if seizure lasts more than

A

5 minutes

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65
Q

CN name pneumonic

A

“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
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66
Q

CNs sensory/motor pneumonic

A

“Some Say Marry Money, But My Brother Says Big Boobs Matter More”

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67
Q

Trigeminal neuralgia tx

A

Tegretol

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68
Q

In a normal Rinne, AC is

A

2x longer than BC

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69
Q

A weber test in which sound lateralizes to the bad ear indicates

A

conductive hearing loss

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70
Q

A weber test in which sound lateralizes to the good ear indicates

A

sensorineural hearing loss

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71
Q

Examples of conductive hearing loss

A 
cerumen impaction
cholesteatoma
otosclerosis
TM rupture
FB
malformation
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72
Q

An abnormal Rinne indicates

A

conductive hearing loss

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73
Q

Meniere’s Dz

A

sensorineural HL

c/b b/u of fluid in inner ear labyrinth

biggest concern = permanent hearing loss (esp. of higher pitched sounds)

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74
Q

Tx for Meniere’s Dz

A

No cure

meds, diet, therapy

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75
Q

S/S of Meniere’s Dz

A

VERTIGO
TINNITUS
HL PROVEN BY AUDIOMETRY

ear pressure
sometimes nystagmus

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76
Q

Black box warnings for tegretol

A

agranulocytosis
SJS

major r/f bone marrow suppression so do CBC prior to start and q3 mos in 1st year

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77
Q

Tx for isolated systolic HTN

A

DHPs like amlodipine

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78
Q

Tool to assess functional capacity

A

Katz index

Ranks 6 categories, get a point for each 1 they can do independently

  • feeding
  • continence
  • toileting
  • transferring
  • bathing
  • dressing
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79
Q

TUG test score that indicates fall risk

A

over 13.5 sec

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80
Q

Dementia w/ Lewy Bodies

A

presents like PD

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81
Q

MMSE

A

max score: 30

0-10: severe impairment

10-20: moderate cognitive decline

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82
Q

Mini-cog

A

remember 3 words

draw a clock @ specific time

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83
Q

Patient who remembers no words on Mini-Cog

A

dementia

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84
Q

Patient who remembers 1-2 words + draws normal clock on Mini-Cog

A

normal

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85
Q

Patient who remembers 1-2 words + draws abnormal clock on Mini-Cog

A

dementia

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86
Q

Score on PHQ-9 that indicates possible depression

A

5 or higher

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87
Q

Prozac

A 
long 1/2 life (bad for elderly)
s/e of jitteriness (bad for anxiety)
weight neutral (good for bulimia)
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88
Q

SSRI that’s good for anxiety

A

Lexapro

works quickly
safe in elderly

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89
Q

Zoloft

A

SSRI

safe in elderly

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90
Q

most sedating SSRI

A

Paxil

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91
Q

Best SSRI for OCD

A

Paxil

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92
Q

SSRI that’s worse about inducing ED

A

Paxil

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93
Q

SSRI w/ off-label use for menstrual problems / menopause

A

Paxil

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94
Q

Does Paxil make you gain weight

A

yes

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95
Q

SNRI that helps w/ neuropathic pain/postherpatic neuralgia

A

Cymbalta

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96
Q

Effexor causes

A

BP issues / HTN

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97
Q

Who do we avoid SNRIs in

A

HTN & liver dz

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98
Q

What do you do before starting patient on tricyclics?

A

cardiac workup (baseline EKG) in anyone over 40

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99
Q

Major concerns with tricyclics

A

weight gain
slowed cardiac conduction (can cause heart block)

OVERDOSE - only takes 5x normal dose

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100
Q

Common offenders of serotonin syndrome (aka don’t use these together)

A 
SSRIs
SNRIs
triptans
St. John's Wort
MAOIs

tricyclics

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101
Q

Refractory or atypical depression

A

Atypical antipsychotics and MAOIs

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102
Q

What do we avoid when taking MAOIs?

A

foods w/ tyramine (can l/t HTNive crisis)

  • aged cheese
  • fermented meat
  • cured meat
  • yogurt

grapefruit
other antidepressants

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103
Q

What lithium level is toxic and what will you see?

A

> 2.0; hyperactive DTRs

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104
Q

Long-term s/e of lithium

A

goiter
hypothyroid
renal probs

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105
Q

primary tx for PTSD

A

SSRIs

paxil, zoloft, celexa

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106
Q

Who doesn’t have the CYP2C19 enzyme and what does this mean?

A

Asians; can’t metabolize pain meds

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107
Q

Anxiety screening

A

GAD-7

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108
Q

How long does it take buspar to work?

A

about 4 weeks

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109
Q

Is buspar controlled?

A

no

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110
Q

How should patients take buspar?

A

consistently and with food

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111
Q

Normal fasting total cholesterol:

A

< 200

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112
Q

Normal fasting triglycerides:

A

< 150

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113
Q

Normal fasting HDL:

A

40-60+

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114
Q

Normal fasting LDL:

A

< 100

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115
Q

ASCVD cutoff to start statins

A

7.5%

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116
Q

What do you do before starting statins?

A
  • Baseline CK
  • Ask about preexisting muscle pain
  • Baseline LFTs
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117
Q

Rhabdomylisis

A

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

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118
Q

Statin-induced hepatitis

A

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

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119
Q

Desired BP according to JNC8

A

< 140/90

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120
Q

JNC8: Goal BP for patients over 60

A

150/90

initiate tx if over this

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121
Q

JNC8

Goal BP for patients under 60 or who have CKD and/or DM

A

140/90

initiate tx if over this

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122
Q

AHA/ACC

Normal BP:

A

< 120 / < 80

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123
Q

AHA/ACC

Elevated BP:

A

120-129 / < 80

Tx = 3-6mos. of lifestyle changes and keeping BP log, then re-eval

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124
Q

AHA/ACC

Stage 1 HTN:

A

130-139 / 80-89

ASCVD risk < 10% = lifestyle changes
ASCVD risk > 10% = initiate meds

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125
Q

AHA/ACC

Stage 2 HTN:

A

> 140 / > 90

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126
Q

AHA/ACC

Goal BP:

A

< 130 / < 80

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127
Q

When do you d/c an ACEI?

A
  • 30+% increase in Cr
  • GFR < 30
  • angioedema
  • dry cough
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128
Q

Preferred of the thiazides

A

Chlorthalidone b/c it d/c CVD risks

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129
Q

What bad things do thiazides cause?

A

increased uric acid
increased triglycerides
increased glucose
renal dz

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130
Q

What good things do thiazides cause?

A

stimulate osteoblasts to make bone and help retain calcium (good for osteo)

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131
Q

Some possible cross-sensitivity b/t thiazides and

A

sulfa abx

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132
Q

Name the 2 NDHPs

A

verapamil and diltiazem

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133
Q

Who do we not give CCBs to?

A

GERD pts

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134
Q

Who do we not give NDHPs to?

A

pts w/ heart block

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135
Q

How do CCBs work?

A

dilate coronary arteries

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136
Q

Lasix can be _____ if given too quickly

A

ototoxic

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137
Q

Dx criteria for metabolic syndrome

A

(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
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138
Q

saw-tooth pattern on EKG

A

atrial flutter

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139
Q

prolonged PR interval an indicate

A

heart block

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140
Q

EKG that is rapid, regular, has P waves, with peaked QRS

A

SVT

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141
Q

How do you dx HF?

A

BNP + EKG + echo (EF < 40% is HF)

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142
Q

When should a patient with HF call PCP?

A

weight gain of 2kg (4.4#) in one day

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143
Q

RT-sided HF

A

backs up into body

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144
Q

LT-sided HF

A

backs up into lungs

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145
Q

What will you see on CXR in patient w/ HF?

A

cardiomegaly

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146
Q

retinal hemorrhages w/ white center

A

Roth’s spots

r/t endocarditis

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147
Q

What should patients w/ Raynaud’s avoid?

A

vasconstrictors s/a Imitrex

vasodilators s/a metoprolol

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148
Q

What do you treat Raynaud’s with?

A

CCBs and trigger avoidance

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149
Q

Dx testing for CVI

A

D-Dimer + Doppler

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150
Q

Only heart sound heard at the base

A

S2

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151
Q

Split S2 only normal if heard on

A

inspiration

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152
Q

When do we hear an S4?

A

uncontrolled HTN or LVH

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153
Q

Where do we hear an S4?

A

heard best @ apex w/ pt. side-lying (LT side down) and LT arm raised

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154
Q

How big should the heart be on CXR?

A

no more than 1/2 width of chest

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155
Q

Cardiomegaly can be d/t

A

HF
uncontrolled HTN
cardiomyopathy

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156
Q

Intermittent claudication is a sx of

A

PAD

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157
Q

PAD s/s

A

purple & shiny
pain relieved w/ rest & dangling
cool to touch
decreased pedal pulses

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158
Q

CVI s/s

A 
warm
red/brown
edema
varicose veins
sometimes itchy
sometimes ulcers
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159
Q

Avoid Digoxin in

A

heart block

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160
Q

Therapeutic dig level

A

0.5-0.8

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161
Q

What do patients need to monitor at home when on Dig?

A

HR

< 60 bpm, hold dose and call HCP

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162
Q

green/yellow halo

A

specific to dig toxicity

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163
Q

other sx of dig toxicity

A

fatigue
bradycardia
sometimes weakness
increasing toxicity = increased r/f dysrhythmia (v-tach, v-fib)

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164
Q

What can induce or worsen Dig toxicity?

A

hypokalemia

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165
Q

Amiodarone is contraindicated in

A

ANY type of thyroid dz

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166
Q

Amiodorone

A

used to prevent life-threatening arrhythmias (A-fib and ventricular arr.)

reduce anticoagulants by 30-50% when on this

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167
Q

How long are pts usually on anticoagulants after DVT?

A

6+ months

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168
Q

How do anticoagulants work on clots?

A

Only dissolve future clots, not ones already formed

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169
Q

Heparin antidote

A

protamine sulfate (prosulf)

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170
Q

How do you prescribe Eliquis for DVT?

A

10mg bid x7 days, then 5mg bid

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171
Q

How do you prescribe Pradaxa for DVT?

A

150mg bid x5-10 days until LMWH is started

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172
Q

How do you prescribe Xarelto for DVT?

A

15mg PO bid x21 days, then 20mg qd

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173
Q

How do you prescribe Warfarin for DVT?

A

add it to LMWH until warfarin is at therapeutic level then d/c LMWH

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174
Q

Therapeutic INR on warfarin for A-Fib:

A

2-3

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175
Q

Therapeutic INR on warfarin for heart valve issues:

A

2.5-3.25

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176
Q

Stop warfarin ______ days before surgery

A

5+

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177
Q

INR 5-10 w/out active bleed

A

hold Warfarin, do not give vitamin K yet

watch and wait

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178
Q

INR > 10 w/out active bleed

A

PO vitamin K

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179
Q

INR > 10 w/ active bleed

A

IV vitamin K

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180
Q

Foods that contain vitamin K

A 
collard greens
turnip greens
spinach
parsley
kale
brussel sprouts

beef liver
soy oil
conola oil
mayo

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181
Q

Black box warning for Lovenox (LMWH)

A

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

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182
Q

How do anticoagulants work?

A

slow ability to make clots by literally thinning the blood

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183
Q

How do antiplatelets work?

A

stop platelets from clumping together to form a clot

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184
Q

ASA is an…

A

antiplatelet

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185
Q

Plavix

A

antiplatelet preferred after stents

Use if ASA allergy

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186
Q

Do not take ASA w/in ____ after _____

A

1-2h; drinking ETOH

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187
Q

Do we like ASA in pregnancy?

A

No

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188
Q

Leading c/o infant death (w/in first year of life)

A

congenital defects

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189
Q

Leading c/o death ages 1-4:

A

drownings

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190
Q

Leading c/o death older children:

A

MVC

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191
Q

When do posterior fontanels close?

A

2-3 mos.

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192
Q

When do anterior fontanels close?

A

12-18 mos.

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193
Q

NBs lose ______% of BW after delivery

A

7-10

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194
Q

Infants regain BW by

A

2 weeks

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195
Q

BW doubles @

A

6 mos.

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196
Q

BW triples @

A

12 mos.

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197
Q

NB scalp swelling usually d/t pressure from vaginal delivery

A

caput succedaneum

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198
Q

When can babies have ibuprofen?

A

6 mos.

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199
Q

True hand dominance is a red flag before what age?

A

10-11 mos.

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200
Q

When does potty training start and how long does it take?

A

2 years; can take 1-2 years to complete

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201
Q

When can kids have Doxy?

A

After 8 y/o

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202
Q

Precocious puberty

A

before 9 in males

before 8 in females

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203
Q

Delayed puberty

A

after 14 in males

after 13 in females

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204
Q

Concerned if no menarche by 15 years or

A

if not w/in 3 years of start of puberty

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205
Q

Tanner stage 2

A

start of puberty (BOTH)

breast budding & fine pubic hair (F)

straight, fine pubic hair + scrotum/testes enlarge (M)

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206
Q

Tanner Stage 3

A

one mound + acne + armpit hair (F)

growth spurt + penis grows most in length (M)

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207
Q

Tanner Stage 4

A

2 mounds + menarche (F)

curly pubic hair + penis grows in width + scrotum/tests enlarge more and darken (M)

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208
Q

When do females usually reach full height?

A

once period starts

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209
Q

HBV vaccine

A

First does at birth

3 dose series

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210
Q

1-2 month vaccines

A 
Polio (IPV)
Hib
PCV13
RV
DTaP
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211
Q

First inactivated flu

A

@ 6 mos. - not a day early

2 doses: 2nd dose 4 weeks after first

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212
Q

HPV vax can be given up to age

A

26

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213
Q

You can give MMR and varicella on same day, otherwise they need to be _______ apart.

A

4 weeks

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214
Q

MMR + Varicella combo vaccine

A

can be done, but increases r/f febrile seizures when given as first dose

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215
Q

Do not get pregnant w/in ____ weeks of MMR vax

A

4

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216
Q

“It’s Time for Many Happy Vaccines”

A

catch up vaccines

IPV
Td
MMR (and maybe meningitis depending on age)
HBV (and maybe HPV depending on age)
Varicella
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217
Q

Bilirubin 12-14 w/ sx

A

(jaundice, poor feeding, fatigue)

have mom increase feeding to 8-12+ times per day

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218
Q

Bilirubin of 15+

A

initiate phototherapy

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219
Q

Autism screening tool

A

M-CHAT

usually dx b/t 18-24 mos.

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220
Q

ADHD tx < 6 y/o

A

therapy and behavioral management

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221
Q

ADHD tx < 6 y/o

A

same tx as before, but can add stimulants

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222
Q

RFs for hip dysplasia

A

breech
low fluid in pregnancy
FMH

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223
Q

Hip dysplasia dx early

A

Pavlik harness x1-2 mos.

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224
Q

Hip dysplasia dx late

A

CR & spica

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225
Q

Genu varum usually resolves by

A

2-3 yrs

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226
Q

Genu valgum usually resolves by

A

7 y/o

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227
Q

Fractures that occur along growth plate

A

Salter Harris Fractures

treat promptly to prevent growth stunting

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228
Q

Mild Salter Harris Fractures (Grade 1-2)

A

usually just need cast or splint

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229
Q

Severe Salter Harris Fractures (Grade 3+)

A

surgery

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230
Q

Radial head subluxation

A

aka Nursemaid’s

CR in office
Can resume normal activity
Kids will start to use arm w/in 15-20 min

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231
Q

condition d/t repetitive pulling of quad on patellar tendon and tibial tubercle

A

Osgood-Schlatter

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232
Q

Can patients with Osgood-Schlatter continue activity?

A

Yes, unless in severe discomfort

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233
Q

Shin splints are aka…

A

medial tibial stress syndrome

  • overuse injury
  • can l/t tibial stress fracture
  • tx = RICE
  • pain relieved w/ rest
  • pain over tibial area
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234
Q

osteonecrosis of femoral head

A

Legg Calve Perthes

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235
Q

Legg Calve Perthes usually occurs in kids aged

A

4-8 y/o

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236
Q

Positive trendelenburg

A

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

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237
Q

Slipped Capital Femoral Epiphysis

A

femoral head slips out

This can damage the growth plate = considered Salter Harris type 1 if this occurs

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238
Q

RFs for Slipped Capital Femoral Epiphysis

A

adolescents
growth spurts
trauma
overweight

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239
Q

widened physis on XR

A

Slipped Capital Femoral Epiphysis

refer to ortho

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240
Q

Keloid vs hypertrophic

A

BOTH = red & raised

Only Keloid extends to surrounding tissue

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241
Q

Hypertrophic scars grow rapidly (_____) but usually improve within _________.

A

6 mos; 12-18mos.

242
Q

Hemangiomas usually resolve by

A

age 4

243
Q

Mongolian spots usually resolve by _____ and are more common in _______.

A

5 years; Af-Ams

244
Q

Mono is linked to increased r/f developing:

A

Hodgkin’s or Burkett’s lymphomas

245
Q

Tx for concurrent strep + mono

A

anything that is not a PCN

Macrolides
Cephalosporins
***PCN VK (only PCN that doesn’t cause rash)

246
Q

What is it called when you see a white pupillary reflex on FE instead of a red reflex?

A

leukocoria

247
Q

What can leukocoria indicate

A

in kids: retinoblastoma or congenital cataracts

in adults: cataracts

248
Q

What usually causes AOM?

A

strep pneumo

249
Q

How do you treat AOM?

A

Delay ABX 2-3 days

If not resolved, Amoxicillin

250
Q

Why would a patient get Augmentin for AOM

A
  • ABX w/in last 30 days

- fever >102.2F

251
Q

What do you give someone with AOM who has a PCN allergy?

A

Rocephin

252
Q

Bacteria usually responsible for OE?

A

pseudomonas

253
Q

“white keratinized growth that resemble cauliflower”

A

cholesteatoma

refer to ENT asap

254
Q

Coarctation of the aorta

A

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
Q

When do we start routinely checking BP?

A

once @ birth; then start at 3 yrs

256
Q

CF is usually dx before age

A

2

257
Q

S/S of CF

A
  • foul smelling, greasy stool
  • coughing, wheezing, SOB
  • lots of mucus
  • slow growth
  • salty skin
  • possible meconium ileus
258
Q

Causes of meconium ileus

A
  • CF (d/t mucus block from fluids being so thick
  • GI obstructive complaints
  • hypothyroidism
259
Q

Dx for CF

A

sweat chloride test + genetic test

260
Q

Average CF lifespan

A

30 years

261
Q

Goal in CF tx

A

prevent infection

262
Q

CF is _________ for lung CA

A

not a risk

263
Q

RSV

A

usually self-resolves in 2 weeks

264
Q

steeple sign on CXR

A

croup

265
Q

barky seal cough d/t swelling of upper airways/neck

A

croup

266
Q

How does pertussis present?

A

Mild @ first (runny nose, cough)

Progresses to severe coughing that can induce vomiting

267
Q

How do treat pertussis?

A

Best tx = prevention aka vaccination

most patients end up hospitalized

ABX shorten length of contagion, but not length of sx
(macrolides like azithro)

268
Q

Drooling + muffled voice + stridor + tripoding

A

Epiglottitis: upper airway swelling

other sx = odynophagia (painful swallowing), possible cervical LAD

269
Q

thumb print sign on XR

A

(tracheal swelling)

d/t Epiglottitis

270
Q

How do we prevent epiglottitis?

A

Hib vaccine

271
Q

CRASH & BURN

A

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
Q

Tx for Kawasaki’s

A

IVIG & high dose ASA (doesn’t matter what age, B>R)

273
Q

Reye’s syndrome

A

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
Q

S/S pyloric stenosis

A 
Olive-shaped mass (dx w/ US)
Projectile vomiting
Mucousy, frequent stools
belching
other sx of dehydration (sunken fontanelles, etc.)

Refer to ED

275
Q

When do we usually see intussusception?

A

before 2-3 years

276
Q

S/S intussusception

A

crampy stomach pain
jelly, bloody, mucousy stools
vomiting
sausage-shaped mass**

need US; refer to ED

277
Q

Tx for encopresis, aka…

A

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
Q

How long should you try an acne treatment before switching?

A

8-12 weeks

279
Q

only occurs in females; have 1 X chromosome missing

A

Turner’s

280
Q

webbed neck, aka…

A

“pterygium colli”

Also seen in Turner’s syndrome:
short stature
delayed puberty
fertility problems

281
Q

Turner’s syndrome increases r/f

A 
hearing loss
liver enzyme problems
HTN
DM
osteoporosis
renal dz
hypothyroidism
282
Q

Biggest concerns with congenital hypothyroidism

A

(it slows all growth: mental, sexual, physical)

short stature
intellectual disability
delayed puberty

283
Q

extra X chromosome that causes a testosterone deficiency

A

only in males

Klinefelter’s

284
Q

S/S Klinfelter’s

A

big head
delayed milestones
mental disabilities

285
Q

Marfan syndrome affects

A

connective tissue

286
Q

S/S Marfan syndrome

A

Tall & thin
Limbs appear too long for body
Arm span exceeds height

287
Q

Major concerns w/ Marfan syndrome

A

Cardiac problems

  • MVP w/ click
  • aortic regurge
  • aortic root dilation***
  • AA***
288
Q

Do kids w/ Marfan syndrome have cognitive delay?

A

no

289
Q

Down’s Syndrome increases r/f

A
  • sleep apnea
  • heart defects
  • eye/ear probs
  • hypothyroid
  • early onset Alz.
  • childhood leukemia
290
Q

atlantoaxial instability, aka…

A

cervical spine instability commonly seen in Down’s

need XR before sports participation

291
Q

Down’s s/s

A 
flat face
small/low ears
almond-shaped eyes
palmar crease
short neck
vision problems like strabismus
292
Q

When do you go to ED if child is having febrile seizure?

A

can’t decrease fever
child appears ill
breathing issues
seizure lasts > 5 mins

293
Q

Duchenne’s Muscular dystrophy

A

muscles progressively weaken over time

impacts cognitive fx

large calves d/t scar tissue b/u

waddling gait

294
Q

Measles, aka..

A

Rubeola

295
Q

When do Koplik’s spots appear?

A

2-3 days after other sx and before rash

296
Q

3 Cs of measles

A

cough
congestion (coryza)
conjunctivitis

297
Q

Rubeola is highly contagious and spread via

A

airborne transmission

298
Q

3-day measles

A

aka German measles

aka Rubella

299
Q

Rubella

A
  • more mild sx

- very serious if caught while preggo

300
Q

6th Dz

A

Roseola

301
Q

what causes roseola

A

2 strains of HSV

302
Q

high fever, THEN rash + rose-colored blanchable papules

A

Roseola (6th dz)

303
Q

When are you no longer contagious w/ 6th dz?

A

when rash appears

304
Q

Is there a vaccine for Roseola?

A

no

305
Q

Erythema infectiosum, aka..

A

5th Dz

306
Q

what causes 5th dz

A

Parvo B19

307
Q

FEVER FIRST, then

slapped cheek + lacy net-like rash on body

A

5th dz

308
Q

When are you no longer contagious w/ 5th dz?

A

when rash appears

309
Q

What causes HF&M?

A

coxsackie virus

310
Q

rash/ulcers appear in mouth and spread to hands and feet

A

HF&M

may or may not be painful

311
Q

Is there a vaccine for HF&M?

A

no

312
Q

Normal Hgb

A

12-18 (men, higher; women lower)

***Hbg is low in anemia

313
Q

Normal Hct

A

36-54% (men, higher; women lower)

***Hct is low in anemia

314
Q

Lead intoxication

A
  • microcytic
  • abnormal lead levels = >5
  • cognitive delay, behavior probs
315
Q

RFs for IDA

A
  • 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
Q

S/S of IDA

A
  • 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
Q

How do you take iron supplements?

A

On empty stomach or w/ acidic drinks

increases absorption

318
Q

B9, aka

A

folate

319
Q

Causes of B12 deficiency

A

long-term metformin
s/p gastrectomy
alcoholism
vegan diet

320
Q

B12 anemia s/s

A

Glossitis (beefy red tongue)

Neuro sx

321
Q

Alpha-Thalassemia is most common in

A

SE Asians

322
Q

Beta-Thalassemia is most common in

A

Mediterranean people

323
Q

inherited blood dz in which body doesn’t make enough Hgb

A

thalassemia

324
Q

Patients w/ Thalassemia are at high r/f for ______; why?

A

Iron overload

increased intestinal iron absorption & transfusion dependence

325
Q

What is another differential for iron overload?

A

hemachromotosis

326
Q

When do you give HBV vaccine?

A

24h after birth
1 month of age (1 month after first)
6 months of age (6 months after first)

327
Q

How do you treat a person exposed to HBV who is not known to be vaccinated?

A

Vaccine + immunoglobulin w/in 24h

328
Q

How do you treat a person exposed to HBV who is vaccinated?

A

immunoglobulin w/ in 24h

329
Q

body is making way too many blood cells

A

polycythemia vera

330
Q

Is there a cure for PCV?

A

No, they require lifelong tx

Blood is thick/viscous
Can take ASA as thinner

331
Q

Mainstay of tx for PCV

A

Require regular phlebotomy until Hct is < 45%

332
Q

PCNs cover the gram _____ except ______

A

positives; staph

333
Q

Coverage of cephalosporins by generation

A

1st: gram pos.
2nd: gram pos & neg
3rd: gram neg, weak gram pos, B-lactamase
extended 3rd: pos & neg, B-lactamase

334
Q

Examples of 1st gen cephalosporins:

A

Keflex

Duricef

335
Q

Examples of 2nd gen cephalosporins:

A

Ceftin
Ceflor
Cefzil

336
Q

Examples of 3rd gen cephalosporins:

A

Cedax

Suprax

337
Q

Examples of extended 3rd gen cephalosporins:

A

Rocephin
Cefdinir
Spectracef
Cefpodoxime

338
Q

What ABX do we use for listeria?

A

macrolides

339
Q

What does e-mycin cover?

A

atypical bacterias

340
Q

What ABX do we avoid in patient on warfarin and why?

A

Sulfas

b/c warfarin inhibits CYP2C9

341
Q

Bactrim is great for

A

UTIs & below waist skin infections

342
Q

rare disorder that can occur after taking ABX (like Bactrim)

starts w/ flu-like sx, then rash develops, then turns into blisters

A

SJS

emergent!

343
Q

What do tetracyclines cover?

A

gram neg
atypicals
MRSA

344
Q

3 alerts r/t tetracyclines

A
  • can cause severe photosensitivity
  • can stain kids teeth (drink through straw)
  • contraindicated in pregnancy
345
Q

Clindamycin has high r/f developing

A

superinfection, then severe colitis

346
Q

What do we watch for w/ vanc?

A

ototoxicity & nephrotoxicity

347
Q

What is Red man’s syndrome?

A

diffuse pruritus + erythematous rash occurring 15-30 min of vanc admin

can pre-medicate w/ Benadryl

348
Q

What are 2 drugs that make secretions (specifically urine) turn red?

A

Pyridium and Rifampin

349
Q

Intermittent asthma (1)

A

< 2x per month

FEV1 > 80%

Tx = LICS + LABA prn

350
Q

Mild asthma (2)

A

> 2x / month, but less than daily

FEV1 > 80%

Tx = LICS + LABA daily

351
Q

Moderate asthma (3)

A

Sx on most days OR waking d/t asthma 1x per week

FEV1 60-80%

Tx = LICS + LABA daily OR LICS + LTRA daily

352
Q

Severe asthma (4)

A

Sx on most days or waking up d/t asthma > 1x per week

FEV1 < 60%

REFER; tx w/ MICS + LABA in meantime

353
Q

3 factors that impact peak flow

A

“HAG”

Height
Age
Gender

354
Q

Why do we never give LABA to asthma patient by itself?

A

increased r/f asthma-related death

355
Q

What do we base asthma step-down on?

A

***PFTs
lessened triggers
decreased rescue use

356
Q

Dx FEV1/FVC ratio for COPD

A

anything < 0.7%

357
Q

functional test to determine how much COPD is affecting daily life

A

CAT

score > 10 = significant daily disruption

358
Q

COPD s/s

A
  • barrel chest
  • finger clubbing
  • hyperresonance
  • chronic cough
  • sputum production
  • dyspnea
359
Q

What do you test for if you dx COPD in a young person?

A

Alpha-1 antitrypsin level

360
Q

COPD tx Group A:

A

CAT < 10

Tx = SABA

361
Q

COPD tx Group B:

A

CAT > 10

LABA

362
Q

COPD tx Group C:

A

CAT < 10 but have been hospitalized at least once for exac.

Tx = LAMA

363
Q

COPD tx Group D:

A

CAT > 10 + hospitalized 1 or more times

LABA/LAMA combo, but ideally REFER to pulm.

364
Q

What helps dx a COPD exacerbation?

A

increased dyspnea
increased sputum production
increased sputum purulence

365
Q

How do we treat COPD exacerbations?

A

Mild: SABA
Mod: SABA + ABX (macrolides or tetras) + steroid
Severe: Hosptial

366
Q

Why does unexplained weight loss in a COPD concern us?

A

Could be lung CA

Could be burning too many calories by working to breathe

367
Q

When do you screen patients for lung CA?

A

adults 50-80 w/ a 20-pack-year smoking hx who currently smoke (or only quit w/in last 15 years)

368
Q

When do you stop screening for lung CA?

A
  • once quit date is > 15 years ago
  • if new onset problem now limits life-expectancy
  • poss. lung transplant
369
Q

What is the most common presenting lung CA sx?

A

chronic cough

370
Q

Is lung CA screening tied to FMH?

A

no

371
Q

How do you assess tactile fremitus and when do we see it increased?

A

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
Q

What will a CXR of pneumonia look like?

A

infiltrates and consolidation

373
Q

1 complication of flu

A

pneumonia

374
Q

Most common cause of CAP that l/t death

A

strep pneumo

375
Q

Pneumonia tx options for healthy, OP adults

A

“MAD”

Macrolides (like azithro)
Amoxicillin
Doxy

376
Q

Pneumonia tx options pts w/ comorbids or who had ABX in last 90 days

A

Resp. quinolones (Levaquin)

OR

Augmentin + macrolide

377
Q

When do you f/u CXR after pneumonia?

A

8 weeks

378
Q

CURB-65

A

(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
Q

What can cause lifelong positive PPD skin tests?

A

BCG vaccine

380
Q

When does a wheal >5mm indicate a positive TB test?

A
  • immunocompromised

- anyone with known exposure

381
Q

When does a wheal >10mm indicate a positive TB test?

A
  • immigrants
  • HCWs
  • homeless people
382
Q

What is a positive TB skin test for the general poplulation?

A

wheal >15mm

383
Q

Can pregnant women have TB skin tests?

A

yes

384
Q

What is another dx test for TB?

A

QuantiFERON-TB Gold

385
Q

Confirm positive wheal results w/

A

sputum culture

386
Q

When do we treat bronchitis, what do we treat with, and why?

A

Only if d/t pertussis; azithromycin; b/c most bronchitis is viral

387
Q

Does azithromycin relieve sx of pertussis bronchitis?

A

Doesn’t shorten sx, but shortens contagion time

388
Q

Recent URI f/b reoccurrence 7-10 days later - how and why are we treating?

A

Bacterial sinusitis can l/t periorbital cellulitis

tx w/ Augmentin

389
Q

tear-drop or grape-shaped nodules that hang low in nasal cavity

usually painless and soft

A

polyps

390
Q

What increases r/f nasal polyps?

A

recurrent sinusitis

391
Q

S/S allergic rhiniits

A
  • dull/retracted TM
  • cobblestoning
  • “allergic shiners”
  • transverse nasal crease
392
Q

Onset and duration of tx of SABAs

A

works w/in minutes, lasts 4-6h

393
Q

Onset and duration of tx of LABAs

A

take longer to work than SABA, but also last longer

394
Q

What are LAMAs?

A

“-pium”

anticholinergic

bronchodilate + dry things up (effect overall breathlessness to prevent attacks)

395
Q

How to ICS decrease inflammation in airway?

A

help alveoli fill w/ O2 to exchange in blood

396
Q

sunken chest

A

pectus excavatum

**think “ex-CAV-atum” as in chest is CAVED in

normal to see poorly-define RT heart border on CXR

397
Q

protruding chest

A

pectus carinatum

398
Q

Findings on normal CXR

A
  • diaphragm curves down
  • heart is 1/2 width of chest
  • RT lung has 3 lobes, LT has 2
  • bone = white
  • tissue = gray
399
Q

1st line tx for URI

A

Decongestants

Work by vasoconstriction of MMs in nose

400
Q

Who should not take decongestants?

A

Patients w/ HTN bc will increase BP more

401
Q

Dependency from overuse of decongestants

A

Rhinitis medicamantosa can occur after just 3 days

402
Q

Expectorants are only for

A

Acute tx

403
Q

BBS can mask sx of

A

Hypoglycemia

404
Q

T1DM is

A

Antibodies destroy all beta cells so they become insulin dependent

405
Q

FPG dx for T2DM

A

126+

406
Q

2h OGTT dx for T2DM

A

> 200

407
Q

HBA1C dx for T2DM

A

6.5% and up

408
Q

Random PG dx for T2DM

A

> 200 w/ sx

409
Q

How does metformin work?

A

Decreases gluconeogenesis

Decrease insulin resistance

410
Q

Mad dose metformin

A

2550/day

411
Q

When do you half a metformin dose?

A

GFR < 46

412
Q

When do you d/c metformin?

A

GFR < 30

413
Q

How many days should you stop metformin before CT w/ contrast?

A

2+

414
Q

Who is at increased r/f lactic acidosis r/t metformin and why?

A

Alcoholics

Metformin increased body’s lactic acid and alcoholics have decreased LA excretion

415
Q

S/e SGLT2s

A

Weight loss

HypoTN

416
Q

Who should not take SGLT2s?

A
  • pts @ increased r/f DKA (alcoholics)
  • amputations/ulcerations
  • incontinence issues
  • frequent UTIs
  • frequent yeast infections
417
Q

How DPP4s effect weight?

A

Cause weight loss

418
Q

What do sulfonylureas do?

A

Stimulate remaining B-cells to secrete insulin

No impact on insulin resistance

419
Q

S/E TZDs

A

Liver toxicity
Cardiac sx
Weight gain
Peripheral edema

420
Q

How sulfonylureas effect weight?

A

Known for weight gain, avoid in HF

421
Q

Who should not take TZDs?

A

HF class 3 or 4

422
Q

“Get Loads Perfect by doing loads with “Tide”

A

GLP1s = “-tides”

423
Q

Who cannot have GLP1s?

A

PMH pancreatitis

PMH or FMH thyroid carcinoma

424
Q

Rapid-acting insulin

A

Onset 15 min
Peak 1h
Duration 2-4h

425
Q

Short-acting (regular) insulin

A

Onset: 30 min-1h
Peak: 2-4h
Duration: 6-8h

426
Q

Intermediate-acting insulin

A

Onset: 1-2h
Peak: 6-12h
Duration: 24h

427
Q

Long-acting insulin

A

Onset: 2h
Peak: None
Duration: 24h

428
Q

Novolog

A

Rapid-acting

429
Q

Humulin-R

A

Regular insulin

430
Q

Humulin-N

A

NPH

431
Q

Lantus

A

Long acting insulin

432
Q

Levemir

A

Long acting insulin

433
Q

Novolin-R

A

Regular insulin

434
Q

Lispro

A

Rapid acting insulin

435
Q

Humalog

A

Rapid acting insulin

436
Q

Novolin-N

A

NPH

437
Q

A1C cutoff to initiate insulin

A

9-10%

438
Q

Normal TSH

A

0.5-5.0

439
Q

Thyroid dosing by weight

A

1.6 mcg/kg/day

440
Q

Thyroid dosing (generic)

A

25-50 normal adult

12.5-25 elderly

441
Q

Too much thyroid hormone long-term can cause

A

Osteoporosis

442
Q

What is something to watch for with Synthroid?

A

Cardiac effects

443
Q

Myxedema coma often precipitated by

A

Lithium or amiodarone

444
Q

Primary tx for hyperthyroid

A

Radioactive iodine

445
Q

S/E radioactive iodine

A

Swollen salivary glands (short-term)

Bone marrow suppression (long-term)
Infertility (long-term)

446
Q

When does 2nd trimester of pregnancy start

A

14 weeks

447
Q

_____ can help with hyperthyroid sx but also cause _______

A

BBs; fatigue

448
Q

Sx thyroid storm

A

HR and BP become dangerously high, l/t lethal dysrhythmias then HF

Agitation & delirium

449
Q

HypERparathyroidism causes

A

HypERcalcemia

450
Q

ChvOstek’s is a sign of

A

HypOcalcemia

Positive when you tap on pt’s face and they scrunch up on one side

451
Q

TrOusseau’s is a sign of

A

HypOcalcemia

Positive when BP cuff is inflated and it draws their arm like involuntary contraction

452
Q

RUQ pain

A

Gallbladder
Liver dz
Hepatitis

453
Q

LUQ

A

Stomach

Pancreatitis

454
Q

RLQ

A

Appendicitis

455
Q

LLQ pain

A

Diveriticulitis

456
Q

GERD sx

A
  • 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
Q

GERD RFs

A 
smoking
obesity
preggo
age
ETOH
458
Q

How do we dx GERD?

A

Usually clinically and/or PPI trial

Dx test = EGD

459
Q

dysphagia / odynophagia / anemia / early satiety / GI bleeding / unintentional WL** / persistent chest pain

A

GERD alarm systems

Send for endoscopy

460
Q

Condition where stomach is trapped above the diaphragm

A

Hiatal hernia

Sometimes mistaken for MI d/t severe chest pain

461
Q

How do H2 blockers help GERD?

A

suppress gastric acid secretion

462
Q

How do PPIs help GERD?

A

decrease acidity of stomach w/out effecting overall gastric emptying

463
Q

What do we monitor w/ H2 blockers?

A

LFTs & CBC (can decrease liver fx & platelets)

464
Q

What do we monitor w/ PPIs?

A

Osteoporosis
B12 anemia
C. Diff

465
Q

How do pts take PPIs?

A

30-60 min before first meal of day for 4-8 weeks

466
Q

high grade esophageal dysplasia

A

Barrett’s esophagus

467
Q

What meds should GERD patients avoid?

A

CCBs

468
Q

most common esophageal CA

A

squamous cell

469
Q

S/S Barrett’s esophagus

A

worsening heartburn
intermittent cough
painful swallow
sore throat

470
Q

pain occurs after eating b/c stomach has to produce more acid to dissolve food

A

gastric ulcers

471
Q

pain relieved immediately after eating, but recurs 1-3h later once gastric emptying has occurred

A

duodenal ulcers

472
Q

RFs of PUD

A

NSAIDs
H. Pylori
stress / smoking / ETOH

473
Q

fecal antigen test

A

Dx H. Pylori

474
Q

urea breath test

A

Dx H. Pylori

but have to stop all H2s/PPIs for 2 weeks prior

475
Q

serum antibody test

A

Dx H. Pylori

shows past or current infection

476
Q

Triple therapy for H. Pylori

A

“CAP”

Clarithromycin + Amoxicillin + PPI

x2 weeks

Can do Flagyl if PCN allergy

477
Q

Quadruple therapy for H. Pylori

A

“Fuck That Bitch Pylori”

Flagyl + Tetracycline + Bismuth + PPI

used more often b/c of increased resistance to ABX in triple therapy

478
Q

responsible for breakdown of carbs and fat

A

amylase & lipase

479
Q

amylase + lipase

A

can be 3x normal when pancreas is inflamed

480
Q

RFs for pancreatitis

A

Alcoholism
Gallstones
Hypercalcemia
High trigs

481
Q

Rovsing sign

A

think “Reverse, Right, Rovsing”

palpate LLQ and pain is elicited on opposite side (RLQ)

positive in appendicitis

482
Q

Markle sign

A

aka heel jar

pain in RLQ when pt hops on 1 foot

positive in appendicitis

483
Q

Blumberg sign

A

rebound tenderness

positive in appendicitis

484
Q

McBurney’s point

A

2/3 distance b/t belly button and anterior iliac crest; positive when tender to pressure

positive in appendicitis

485
Q

Obturator sign

A

positive when internal rotation of RT hip at 90 degrees l/t abdominal pain

positive in appendicitis

486
Q

Psoas sign

A

positive when pt raises leg against resistance in supine position that l/t abdominal pain in RLQ

positive in appendicitis

487
Q

signs that indicate intra-abdominal bleeding

A

Cullen & Grey Turner’s signs

488
Q

Cullen sign

A

think “Cullen = Center of body” (C words)

blue belly button

489
Q

Grey Turner’s sign

A

“Turn patient over” to see bluish discoloration on flanks

490
Q

4 main RFs for cholecystitis

A

Female
> 40 y/o
overweight
fertile

491
Q

acute pancreatitis pain has a _______ onset

A

sudden

492
Q

S/S pancreatitis

A

severe LUQ that may radiate to back
N/V
laying down makes pain worse

493
Q

necrotizing pancreatitis will present with

A

Cullen & Grey Turner’s signs

494
Q

After you’ve dx and fixed cause of pancreatitis, what should have patient do next?

A

Pancreas needs rest. Patient should be NPO so no pancreatic enzymes are being produced

Resume low-fat diet once pancreas is healed

495
Q

Most gastroenteritis is ______ in nature

A

viral

496
Q

Gastroenteritis tx

A

Rehydration
Bland diet (bread, bananas, applesauce)
Antiemetics

497
Q

When do you perform stool studies in pt w/ gastroenteritis?

A

bloody stools
immunocompromised
fever
lingering sx (10-14d of diarrhea)

498
Q

If you do perform stool studies in pt w/ gastroenteritis, which ones?

A

culture
occult blood
C. Diff
Ova & parasites

499
Q

Bacterial gastroenteritis

A

“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
Q

Bacterial gastroenteritis c/b GIARDIA

A

“Get Fucked”

aka what Giardia says to your insides while it’s reeking havoc

(tx Giardia w/ Flagyl)

501
Q

pulsating mass in abdomen

A

AAA

502
Q

feels like tearing/rippling sensation in back and abdomen

A

ruptured AAA

503
Q

Colonoscopy guidelines: start @ ________ and repeat every __________ with __________________.

A

45-50; 10 years; annual FOBT

504
Q

Who is at higher r/f colon CA and therefore needs to start screening earlier?

A

FMH colon CA in FDR

PMH colon CA, Crohn’s, UC, IBD, prior abdominal radiation

505
Q

S/S colon CA

A 
ribbon-shaped thing stools
dark or red blood in stool
decreased appetite
weight loss
fatigue
506
Q

where do most colon polyps occur?

A

descending colon

507
Q

characterized by skip lesions t/o GI tract and possible fistulas and strictures t/o intestines

A

Crohn’s

508
Q

affects anywhere from mouth to anus

A

Crohn’s

509
Q

major offenders in diet of someone w/ Celiac

A

wheat
rye
barley

510
Q

antacids w/ calcium (like TUMS) or aluminum can cause _______

A

constipation

511
Q

antacids w/ magnesium (like Magnesite) can cause _______

A

diarrhea

512
Q

mainstay of tx for duodenal ulcers

A

sucralfate

short-term (< 8 weeks)

513
Q

blocks action of serotonin which can be responsible for N/V

A

zofran

514
Q

What do we worry about w/ zofran and what do we do about it?

A

QT prolongation

EKG before starting

515
Q

Compazine can cause __________ and ___________ effects.

A

anticholinergic & extrapyramidal

516
Q

Phenergan is contraindicated in _______ because it can case _________.

A

kids under 2 yrs; RD

517
Q

Which anti-emetics are sedating?

A

Compazine & Phenergan

518
Q

What is Lactulose and when is it mostly used?

A

osmotic laxative

often given to cirrhosis pts w/ they can’t adequately remove ammonia from system

519
Q

Pts should call HCP before taking anti-diarrheal if they’ve had diarrhea longer than

A

3 days

520
Q

Lomotil

A

potent anti-diarrheal / anticholinergic

atropine component added in hopes to decrease abuse/addition from diphenoxylate component

controlled substance

typically given for IBD

521
Q

Dx testing for Trich

A

wet mount w/OUT KOH

will see flagellated organisms

522
Q

pinpoint hemorrhages on cervix

A

“strawberry cervix”

trich

523
Q

tx for trich

A

flagyl

also tx partners

524
Q

clue cells

A

“epithelial cells w/ blurred edges”

“fuzzy w/out sharp edges”

“stippled/speckled” (resemble peppered eggs)

positive on wet mount for BV

525
Q

BV and trich ______ vaginal pH

A

increase (>5)

526
Q

Normal vaginal pH

A

3.8-4.5

527
Q

primary test for GC/CT

A

NAAT

528
Q

tx for GC alone

A

Rocephin

500mg if < 300#

1000mg if > 300#

529
Q

tx for CT alone

A

aizthro 1g PO once

if PCN allergy: doxy 100mg bid x7 days

530
Q

concurrent GC+CT

A

Doxy + Rocephin

531
Q

eye infections are more commonly seen with GC or CT?

A

GC

532
Q

start antivirals w/in _____ of herpes outbreak

A

48-72h

533
Q

might feel itching or burning in area before sore appears

A

herpes (cold sores)

534
Q

TCA (trichloroacetic acid)

A
  • 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
Q

Dx tests for syphillis

A

RPR or VDRL

536
Q

Syphilis stage 1:

A

pains chancre / 3-6 weeks, then goes away

537
Q

Syphilis stage 2:

A

rash on palms and soles

538
Q

Syphilis stage 3:

A

full body sx

neurosyphilis affects brain and CNS

539
Q

Syphilis tx

A

IM PCN (Bicillin)

dose depends on stage

540
Q

Uncomplicated UTI w/ sx < 7 days

A

tx = 3 days

541
Q

Uncomplicated UTI w/ sx > 7 days

A

tx = 7-10 days

542
Q

Recurrent UTI

A

same ABX but longer tx

543
Q

When do you f/u a UA w/ a culture?

A

positive nitrites, leukocytes, and hematuria

544
Q

wet mount for yeast infection

A

add KOH

will show pseudohyphae spores & bud cells

545
Q

Normal GFR

A

> 90

546
Q

What GFR do we start dialysis?

A

< 15

547
Q

GFR and Cr usually have ________ relationship

A

inverse

548
Q

Normal Cr

A

about 1

549
Q

normal BUN

A

10-20

550
Q

Normal microalbumin

A

< 30

551
Q

most sensitive value on UA

A

microalbumin

552
Q

Af-Ams have slightly ______ GFR

A

HIGHER

553
Q

Dx criteria for CKD

A

[ GFR < 60 or Albuminuria (Alb/Cr ratio > 30) ] x3+ mos.

554
Q

GFR in CKD Stage 1:

A

> 90

555
Q

GFR in CKD Stage 2:

A

60-89

556
Q

GFR in CKD Stage 3:

A

30-59

557
Q

GFR in CKD Stage 4:

A

15-29

558
Q

GFR in CKD Stage 5:

A

< 15

559
Q

ESRF and dialysis occur in what stage

A

CKD stage 5

560
Q

when do we start seeing sx of CKD

A

stage 3

561
Q

What is the tx in first 3 stages of CKD and what is the goal?

A

BP CONTROL

weight management, proper diet

562
Q

Foods high in oxalate

A 
chocolate
spinach
rhubarb
beans & nuts
tangerines
coffee
potatoes/yams
563
Q

osteopenia on DEXA

A

-1 to -2.5

564
Q

osteoporosis on DEXA

A

-2.5 or less

565
Q

meds that can reduce bone density

A

SSRIs
Depo
PPIs

566
Q

Age to start DEXA routine

A

65

567
Q

What is a good med for someone with HTN + osteoporosis?

A

thiazides

568
Q

What do we watch for methotrexate?

A

Folate deficiency

569
Q

Bouchard’s nodes

A

letter B

Bouchards = Both dz = Back set of joints

570
Q

RFs for CTS

A 
pregnancy
female
hypothyroidism
obesity
RA
571
Q

pebble in shoe b/t 3rd and 4th toe w/ numbness+tingling

A

Morton’s neuroma

572
Q

Dx test for Morton’s neuroma

A

MTP squeeze

foot is relaxed, grab around MT heads and squeeze

positive = pain or Mulder’s click

573
Q

Ege’s test

A

WBing of McMurray’s

574
Q

Apley’s Grind test

A

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
Q

Lachman’s test

A

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
Q

SLR = positive when pain is elicited at

A

30-70 degrees

577
Q

evaluate L4 w/

A

squat & rise

knee jerk = diminished

578
Q

evaluate L5 w/

A

heel walking

numbness will present in great toe

579
Q

evaluate S1 w/

A

toe walking

diminished/absent ankle jerk

580
Q

spinal stenosis

A 
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
Q

hook test

A

positive in bicep tear

582
Q

podagra

A

big toe gout

583
Q

acute gout tx

A

1) NSAIDs
2) Steroids
3) Colcrys

don’t start or stop Allopurinol

584
Q

How many tender points must be present for dx of fibromyalgia?

A

11/18

585
Q

sprain at base of toe common in athletes

A

turf toe

586
Q

angle of severity dx for hallux valgus

A

15 degrees

587
Q

other dx for fibromyalgia

A

[pain + cumb. fatigue + waking up unrefreshed + cognitive probs]

x3 mos. w/ no other explanation

588
Q

condition that affects MPJ #1 where pt can’t dorsiflex

A

hallux limitus

589
Q

high arch foot

A

pes cavus

590
Q

flat foot

A

pes planus

591
Q

heel pain that is usually worse in morning or when activity is stopped. Occurs commonly in runners

A

PF

592
Q

max Tylenol dose per day

A

3g

used to be for but noticed too much hepatotoxicity

593
Q

Tylenol antidote

A

N-acetylcysteine

594
Q

primary tx for chronic pain

A

Tylenol

595
Q

Cozen’s test

A

dx for tennis elbow

aka

lateral epicondylitis

596
Q

Differential s for frequency, urgency symptoms with

Blood (-)
Nitrites (-)
Leukocytes (-)

A
  • Pregnancy: 1st trimester
  • Vaginitis or STI: esp. HERPES, VVA*
  • UTI: but dilute urine specimen
  • OAB: Overactive bladder
597
Q

___________ are normal in urine. ________ are only present if there’s bacteria.

A

Nitrates; Nitrites

598
Q

Pyuria

A

WBCs in urine

most reliable indicator of infection

599
Q

Leukocyte esterase

A

usually indicates UTI

600
Q

UA shows

Neg blood
Pos Nit
Pos Leuk

A

probably UTI

601
Q

UA shows

Neg blood
Neg Nit
Pos Leuk

A

1) bacteria not a nitrAte user
2) urine not in bladder long enough
3) STI
4) vag contamination

602
Q

UA shows

Pos blood
Neg Nit
Neg Leuk

A

unlikely UTI

probably menses
maybe kidney stone

FNP (4 decks)

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