BOARD Flashcards
1
Q
The hemagglutination inhibition (HAI) test
A
detect immunity to rubella and to diagnose rubella infection.
1: 10 or greater indicate immunity to rubella
1: 64 or greater may indicate current rubella infection
2
Q
HVP vaccination
A
first dose : Now
second dose: 2 months
third dose : 6 months
3
Q
Pubertal events
A
breast development
pubic hair & axillary hair
increase height
menses
4
Q
Bronchitis lungs sound
A
Rhonchi - low pitched snoring quality adventitious lungs sound that may be heard when air passes over thick secretions in the large airways
5
Q
normal lungs field sound
A
vesicular with inspiratory lungs lasting longer than expiratory sounds
6
Q
percussion to find the liver
A
percussing downward in midclavical line to find the upper border of the liver will change from resonance when over the lung fields to dull when over the liver
resonace to dullness
7
Q
predominate estrogen after menopause
A
estrone _“rhyme with hormones”
8
Q
chronological events during ovulation
A
LH surge
ovulation
rise in BBT
thickened cervical mucus
9
Q
Levonorgesterel EC
A
may have reduced effectiveness in obese women
10
Q
systemic lupus erythematous should not use combination oral contraceptives
A
if she has positive antiphospholipid antibodies. they have higher risk for both arterial and venous thrombosis and should not use combination hormonal contraceptives.
11
Q
recommendation for vitamin D dose after 50 years old
A
800 to 1000 IU daily
12
Q
estrogen of pregnancy
A
estriol
13
Q
how long does genital herpes shows up in blood test
A
1 to 2 months to determine whether she has herpes antibodies
14
Q
bariatric surgery for reproductive age woman
A
no contraceptive methods are specifically contraindicated if she has a restrictive procedures (laparoscopic adjustable gastric band)
15
Q
diaphragm vs cervical cap
A
diaphragm no more than 24 hours
cervical cap may be left in place up to 48 hours
16
Q
menopausal woman experiences
A
decreased vasocongestion and decreased vaginal expansion
17
Q
main mechanism of misopristol
A
stimulating uterine contractions
18
Q
NP with medicare provider status
A
In fee for service medicare
NPs are reimbursed at 85%
CNM at at 100% of physician fee for the same service
19
Q
correlational research
A
relationships but not examine the causes and effect
20
Q
managed care organization (MCo)
A
capitated system of payment
opportunity for service bundling
some finanical risk assumed by the provider
21
Q
Medicaid requirements
A
pregnant women
children under 6
childern younger than 19
adult under 65 w/o dependent children, and adults with short term disability
if they meet specificed income eligibility requirement
22
Q
claims made policies
A
the incident must happen and be reported while the polity is in force to be covered
23
Q
certification :
A
is the formal process by which a private agency or organization certifies (usually by examination) that an individual has met standards as specified by that profession. Almost all states require national certification for nurse practioners and CNM
24
Q
occurrence-based policy
A
provides coverage for any incident that occured during the same time of the policy was in effect.
25
claims made policies
cover the individual for any suit filed while the policy is in effect
26
tail coverage extends claims
into the future to cover claims filed after the basic claims coverage period
27
integrated delivery system/managed care organizations
strive to provide high-quality, cost-effective care through coordination of services; there is a shift in emphasis from fee-for service strategy to one in which a network of providers assumes some responsibility for provision and cost of care
28
medicare part A vs part B
monthly premium requirement for part B
part B is supplementary medical insurance available to individuals for a monthly premium if they are eligible for part A. Part B covers provider services, outpatient care, diagnostics, and durable medical equipment.
29
where does ARNP obtained their National provider identifier (NPI)
Centers for medicare and medicaid services (CMS)
30
Battery
actual, intentional, and unlawful touching or striking of another person against the will of another
ex: place an IUD in an intellectually disabled patient who is not able to give informed consent
31
incident to billing
billing for medicare services provided by ARNP under the supervision of a physician and does not include initial visits or subsequent visits with a new problems. Billing as a medicare provider rather than incident to promotes the visibility and status of ARNPs
32
definition of primary care
context in which care is provided
33
major role of review board
evaluate the ethical considerations r/t proposed or ongoing research study in order to protect human service.
ensure the rights of human subjects are being protected.
34
chronic fatigue syndromes diagnose
severe fatigue for longer than 6 months
at least 4 symptoms: sore throat, short term memory loss/impairment, tender cervical or axillary lymph nodes, headaches of new type, pattern, or severity; unrefreshing sleep, postextertional malaise lasting more than 24 hours, multijoint pain w/o swelling or inflammation; and muscle pain.
35
common side effect of nicotinic acid
flushing and pruritus
takes 325mg of aspirin or 200mg ibuprofen 30-60 minutes prior to taking nicotinic acid
nicotinic acid - treat dyslipidemia
36
action of saline laxative (MOM)
draw water into the intestinal lumen, causing fecal mass to soften and swell; swelling stretches the intestinal lumen and simulates peristalsis.
37
agorophobia
anxiety disorder that includes avoidance of places or situations in which the ability to leave suddenly may be difficulty in the event of having panic attack. The recurrence of these panic attacks and fear r/o their possible occurence are considered panic disorder
38
cycle of violence
tension building
acute battering
honeymoon
39
labs to diagnose mononucleosis
elevated liver enzymes
elevated basophils and eosinophils
presence of heterophil antibodies
40
s/sx appendicitis
acute onset of pain starts in epigastrum or periumbilical area migrates to RLQ
low grade fever, anorexia, nausea, vomiting are common
abdominal rigidity
41
diagnosis of SLE
4/11 criteria
presence of specific dermatologic symptoms: arthritis, serositis, renal, neurologic, and hematologic condition. positive ANA test , and other immunlogogic positive tests.
42
macrocytic anemia
B12 deficiency
folate deficiency
liver disease
hypothyroidsm
43
when stool culture indicated
if symptoms (diarrhea persists) more than 24 hours or client has fever, or bloody stools
44
Hashitomoto thyroiditis
hypothyroidsm
tx: levothyroxine : which has a half life of 6 days and slow rate of achieving steady state. Adjust dose every 6 weeks until TSH normalizes
45
anorexia nervosa
```
emanciation
dry skin
fine body hair
wasting muscle
peripheral edema
bradycardia
arrhythmias
hypotension
delayed sexual maturation, and stress fractures.
```
46
lumbosacral strain
stretching or tearing of muscles, tendons, ligaments, and fascia d/t trauma or repetitive mechanical stress.
47
antiretrovial therapy
| monitoring
response to drug therapy is monitored by HIV RNA levels.
48
referral for neurological evaluations
focal neurological findings
specific secondary diagnosis is suspected
chronic headaches develop new features
new headaches in individuals older than 50 years.
49
psoriasis features
erythematous base with scaly silvery white papules and plaques that are adherent.
tiny pinpoint bleeding points are revealed if the scale is removed. Common sites: elbows, knees, scalp, genitals, and cleft of the buttocks. Lesions are asymptomatic, although some degree of itching may occure.
50
first line treatment of community acquired pneumonia whether viral or bacterial
macrolide : azithromycine
51
when should antibiotic initiated for acute sinusitis
when s/sx persists 10 days or more after onset of URI or if symptoms improve then then within 10 days they worsen again
52
diagnose acute cholecystitis
ultrasound
53
sumatriptan
abortive therapy
beneficial effect of relieve nausea
should NOT used if ergotamine preparations have been used in the past 24 hours.
does not carry a risk for addiction
54
migraine
begins in adolescent decline after 4o years old.
| typically : unilateral throbbing, last up to 72 hours accompanied by nausea/ photophobia
55
side effects of SSRI
anxiety, insomnia/hypersomnia, HA, n/v, anorexia, and sexual dysfunction
56
indication for rapid streptococcal antigen test
fever, lack of cough, tonsillar exudates, tender anterior cervical adenopathy
57
most common cause of community acquired bacterial pneumonia
S. pneumonia
58
temporal arteritis or giant cell arteritis
sharp throbbing or aching pain localized to the temporal area.
other symptoms: scalp tenderness, jaw pain with chewing anorexia, wt loss & fatigue. The individual may have a known hx of polymyalgia rheumatica. Physical examination findings may include : fever tenderness over a nodular temporarl artery, decreased pulsation of artery, diminished or absent pulses in upper extremities. unilateral blindness may occur if untreated. the age of onsest usualy olver than 50 y.o.
labs: ESR - greater than 50mm/hour
59
metabolic syndrome
```
3/5 risks
- abdominal obesity/waist circumference greater than 35
triglyceride 150mg or greater
HDL less than 50mg
BP 130/85 or greater
fasting glucose 110 or greater
```
60
osteoarthritis vs SLE
osteoarthritis - joint pain in asymmetric fashion
| SLE- inflammatory & symmetrically distributed
61
leading killer of women in US
Coronary heart disease
62
active TB symptoms
night sweat fever malaise weakness anorexia weight loss
| pulmonary symptoms: productive cough, hemoptysis, chest pain, dyspnea
63
contact dermatitis
pruritus or burning at the site of contact of an irritant.
| lesions: oozing vesicles
64
fungal infection
affects scalp, trunk, limbs, face, groin, or feet
| erythematous, scaling plaques
65
cellulitis
diffuse sharply defined erythema
| red streaks run from the cellulitis toward regional lymph nodes.
66
scabies
minute vesicles and linear runs or burrows often found in digital webs, palms, wrists, gluteal folds, buttocks, and toes.
67
allergic rhinitis symptoms
horizontal crease along the lower bridge of nose from the patient pushing nose upward and backward because of itching and nasal discharge.
68
most gallstones composed of
cholesterol
69
disease modifying antirheumatic drugs (DMARD)
preferred therapy for long term management of rheumatoid arthritis.
methotrexate a nonbiologic DMARD is cat X
70
bacterial pharyngitis s/sx
sudden onset of severe sore throat pain with swallowing fever w/ chills.
headaches, n/v
does not typically have cough, rhinitis, conjunctivitis, or myalgia
typical findings: fever, marked erythema of throat and tonsils, patchy discrete white or yellow exudate, petechiae at junction of hard and soft palates, and tender anterior cervical lymphadenopathy.
71
PE s/sx
sudden onset of SOB, localized pleuritic chest pain, apprehension, bloody sputum, diaphoresis, fever, hx of conditions causing risk for emboli.
prolonged immobilization as may occur with long periods of air travel poses a risk.
physical exam: restlessness, fever, tachycardia, tachypnea, dim. breath sounds, crackles, wheezes, pleural friction rub.
72
innocent murmurs
soft medium pitch systolic murmurs
best heard when supine & disappear with standing or straining
increase with increase cardiac output, for example pregnancy exercise or fever
73
s/sx mitral valve prolaps
mid or late systolic click is usually caused by mitral valve prolapse.
late systolic murmur may be present if there is mitral valve regurgitation
74
s/x asthma
hyperresonance with percussion, wheezing, prolonged expiratory phase, and dim. breath sounds tachypnea, and dyspnea
75
PPD test
5mm or greater skin rx is consider positive with individual who are HIV pos, immunocompromised, abnormal CXR consist with healed TB lesions, or recent close contacts with TB infected person
76
gamma glutamyl transferase (GGT)
elevated indicate heavy or chronic alcohol uses
77
what is the most common type of anxiety disorder
```
specific phobia 25%
social phobia 13%
PTSD 12%
generalized 5%
panic 3%
```
78
squamous cell carcinoma
presents on sun-exposured surfaces such as head, neck & hands
pink tan or grayish papule (actinic keratosis) progress to scaly, roughened area that bleeds easily when scraped.
79
basal cell carcinoma
firm nodule or papule with raised shiny appearance and often firm pearly elevated borders.
80
characteristic of malignant melanoma
A symmetry of borders
B order irregularity or notching
C olor variation
D iameter greater than 6mm
malignant melanoma is seen in young middle aged and older adults.
81
risk factor of SLE
AA or hispanic
| first degree relative w/ SLE
82
GERD
intermittent burning retrosternal pain that radiates to back
symptoms are noted 30-60 minutes after eating and are relieved quickly by use of antacid.
83
osteoarthritis s/sx
degenerative disease of cartilage joints
chronic
asymmetric joint pain & stiffness that improves throughout the day.
joints involved typically include the distal and proximal interphalangeal joints, hips, knees, and cervical and lumbar spine.
PE: crepitus and limited ROM of joints. the joints feel cool with bony enlargement
no constitutional signs
84
lyme disease
annular & erythematous w/ central pallor at site of tick bit
lesions usually start about 5cm and grows to 20cm rapidly.
appears w/in 1 week to 1 month after tick bite and nonpuritic
constitutional symptoms: fatigue, myalgias, arthralgias, HA and fever
85
Tinea corporis
central clearing surrounded by advancing red, scaly, elevated border. IF tinea found on the body it is classified as tinea corporis.
86
tretinoin cream (retin A)
first line treatment for comedones
| open & closed & few scatted papules.
87
asthma exacerbations during pregnancy causes:
perinatal mortality
preterm birth
low birth weight
88
Basal cell carcinoma clinical variants :
waxy semitranslucent nodules with rolled borders that may have central ulcerations and telagectasias. they are slow growing lesions.
89
Virchow's triad
stasis
hypercoagulability
endothelial damage
90
fibromyalgia
unexplained widespread pain or aching, persistent fatigue, generalized morning sickness, non refreshing sleep, and multiple tender points.
pain over specific point sites can elicited with digital pressure over these areas.
findings are bilateral and involve both upper and lower body.
changes in ROM swelling in the joints, and abnormal neurologic findings are NOT characterics of fibromyalgia.
91
IgG anti-HBs indicated
recovery and IMMUNITY from hepatitis B visu infection . Ig anti HBs also develops in person who has been successfully vaccinated against hepatitis B.
92
first evidence of infection with hep B
HBs Ag
93
psoriasis lesions are-
bilateral rarely symmetric
94
incident of MVP
2-4% population
| more in young women
95
Group A beta hemolytic streptococcus
tonsillar exudates, anterior cervical adenopathy fever, no cough occur in cluster is high probability of GBS pharyngitis.
treatment : penicillin
96
mononucleosis (Epstein Barr virus)
gradual onset of fatigue, sore throat, fever, posterior cervical adenopathy, palatine petechiae, in about 30% cases hepatosplenomeagaly.
97
chronic allergy - nasal mucosa shows
boggy pale & grayish
98
bell palsy
self limiting
complete recovery usually occurs in several weeks or months in the majority of cases. there is no suppressive therapy, however acyclovir may order
prednisone will shorten the recovery period & hep with symptoms.
99
walking pneumonia common bacteria
Mycoplasma pneumonia
| treatment : azithromycin.
100
treatment for traveler's diarrhea
cipro
101
Rovsings
deep palpation over LLQ with sudden unexpected release of pressure (rebound tenderness)
102
psoas signs
when patient instructed to try lift the right leg against gentle pressure applied by the examination
103
obturator
when patient with right hip and knee flexed experiences pain when examiner slowly rotates right leg internally, which stretches the obturator muslce.
104
mcburney signs
pressure is applied halfway between the umbilicus and anterior spine of ilium
105
absorption
enhaced by rapid drug dissolution, high lipid solubility of drug, large surface area for absorption, and high blood flow at the site of administration
ex: IV has the highest absorption rate
106
distribution
Distribution is defined as the movement of drugs throughout the
body.
In most tissues, drugs can easily leave the vasculature through spaces between the cells that compose the capillary wall. The term blood-brain barrier refers to the presence of tight junctions between the cells that compose capillary walls in the central nervous system (CNS). Because of this barrier, drugs must pass through the cells of the capillary wall (rather than between them) in order to reach the CNS.
The membranes of the placenta do not constitute an absolute barrier to the passage of drugs. The same factors that determine drug movements across all other membranes determine the movement of drugs across the placenta.
107
metabolism
to less active (or inactive) forms, conversion of drugs to more active forms, conversion of prodrugs to their active forms, and conversion of drugs to more toxic or less toxic forms. Some drugs can induce (stimulate) synthesis of hepatic drug-metabolizing enzymes, and can thereby accelerate their own metabolism and the metabolism of other drugs. The term first-pass effect refers to the rapid inactivation of some oral drugs as they pass through the liver after being absorbed.
108
excretion
Most drugs are excreted by the
kidneys. Renal drug excretion has three steps: glomerular filtration, passive tubular reabsorption, and active tubular secretion.
Drugs that are highly lipid soluble undergo extensive passive reabsorption back into the blood, and therefore cannot be excreted by the kidneys (until they are converted to more polar forms by the liver).
Drugs can be excreted into breast milk, thereby posing a threat to the nursing infant.
109
half lives
The half-life of a drug is defined as the time required for the amount of drug in the body to decline by 50%. Drugs that have a short half-life must be administered more frequently than drugs that have a long half-life. When drugs are administered repeatedly, their levels will gradually rise and then reach a steady plateau. The time required to reach plateau is equivalent to about four half-lives. The time required to reach plateau is independent of dosage size, although the height of the plateau will be higher with larger doses. If plasma drug levels fluctuate too
much between doses, the fluctuations could be reduced by (1) giving smaller doses at shorter intervals (keeping the total daily dose the same), (2) using a continuous infusion, or (3) using a depot preparation.
For a drug with a long half-life, it may be necessary to use a loading dose to achieve plateau quickly. When drug administration is discontinued, most (94%) of the drug in the body will be eliminated over four half-lives.
110
round ligament pain
stretching of ligaments supporting uterus -
they become thin & stretched like rubber bands
brief, sharp or dull ache, unilateral or bilateral
most in 2nd trimester common with sudden change of position, cough, rolling over in bed
RX : apply heat to the area
knees to chest to shorten ligament change position slowly reassurance of normalcy.
111
causes of constipation during pregnancy
progesterone - slow down GI
causing cramps
RX: high fiber exercise increases fluids, prunes, eliminate iron supplements, OTC bulking agent like metamucil
NO LAXATIVES
112
causes of bloating during pregnancy
increased gas formation d/t decreased GI motility
Sharp, severe, one sided short lived or lasting for a while.
CHECK FOR LACTOSE INTOLERANCE in AA
RX: side lying to allow gas to pass decrease gas forming foods, exercise increase GI motility & regularity
113
Braxton Hicks RX
RX: hydration rest, reassurance of normalcy
114
heartburn of pregnancy
progesterone relaxed the esophageal sphincter delayed gastric emptying
pain after meals located in substernum epigastric area
RX: watch food choice
antacids, reassurance of normalcy
115
corpus luteum cyst
corpus luteum makes progesterone to support pregnancy
usually resolve early 2nd trimester w/o problem
may seen on USN 2-6cm
sometimes cyst rupture causing hours of several pain
resolve quickly no residual problem
116
miscarriage
1st trimester
intermittent uterine cramping colicky increasing in severity over time
accompanied by bleeding
117
ectopic pregnancy
```
6-9 weeks
unilateral sharp pain
intermittent or constant (rupture)
perceived higher than round ligament pain
50% also have bleeding.
```
118
preterm labor
```
3rd trimester
above pubic bone (cervix) occurring at regular intervals though can be perceived as back pain
increasing in severity over time
may see increase vaginal discharge
accompanied by cervical change.
```
119
abruption
3rd trimester
constant increase over time or sudden if trauma
perceived in back at first if placenta posterior
accompanied by uterine rigidity
bleeding may be later sign for some
120
UTI
occurs anytime
perceived as fairly constant suprapubic discomfort
often accompanied by urgency dysuria
121
Appendicitis
most common cause of prenatal surgery
1/1000
rupture is more common in pregnancy d/t of diagnosis
presents as vague right sided pain
muscle guarding and rebound tenderness may or may not be present
122
intestinal obstruction
can be r/t pica
| constant or episodic abdominal pain, vomiting, no bowel movements (obstipation)
123
cholecystitis
usually caused by cystic duct obstruction from gallstone
4/10,000 pregnant women
often presents as colicky RUQ pain after fatty meals or spontaneously
symptoms: diaphoresis, nausea vomiting tachycardia, + Murphy's sign
124
HELLP syndrome
epigastric substernal pain similar to heartburn
| others : general malaise, n/v, HA, visual changes.
125
Adolescent pregnancy potential problems….
```
late to prenatal care
infant mortality
preterm labor
preeclampsia
anemia
STD's - chlamydia
substance abuse
```
```
Limited education
persistence of poverty
unstable family structure
poor parenting
repeated pregnancy
```
126
common risk factors for PTB
```
MULTIPLE GESTATION
infection
stress
bleeding
nutrition
excessive physical activity
PRIOR PRETERM BIRTH
uterine factors: CERVICAL LENGTH contractions anomalies distention
ancestry and ethnicity
```
127
GHTN
This has replaced the term “pregnancy induced hypertension” or, PIH. BP ≥ 140/90 mm Hg for the 1st time during mid pregnancy No proteinuria BP returns to normal within 12 weeks postpartum Final diagnosis made postpartum Fifty percent of women diagnosed with gestational hypertension between 24 and 35 weeks
develop preeclampsia.
128
Mild pre E
systolic >140 or Diastolic ≥ 90 mm Hg On 2 BP readings 4-6 hours apart Proteinuria ≥ 300mg/24-hour urine or ≥ +1 on dipstick on 2 specimens (on 2 samples 4-6 hours apart) Occurs after 20 weeks gestation
may see : elevated reflexes elevated hemoglobin d/t hemoconcentration
mild edema
129
severe pre E
Systolic ≥ 160mm Hg or Diastolic ≥ 110 mm Hg On 2 BP readings 4-6 hours apart Proteinuria ≥ 5 g/24-hour urine or
≥ +3 on dipstick (on 2 samples 4-6 hours apart) Occurs after 20 weeks gestation
May see:
Epigastric pain Visual disturbances Headaches Clonus Diminished renal function (↑BUN; serum creatinine>1,2 mg/dl; decreased creatinine
clearance)
thrombocytopenia
oliguria
edema
130
Eclampsia
grand mal seizures that cannot be attributed to other causes in a woman with pre E
occurs in 0.1% with pre E
causes: fetal distress placental abruption maternal death
131
chronic HTN
Occurs before 20 weeks gestation BP ≥ 140/90 (mild) BP ≥ 180/110 (severe) Often taking anti-hypertensives prior to pregnancy Does not resolve postpartum Proteinuria, headache, visual changes and lab changes often absent in chronic HTN Often see signs of longer term HTN on opthalmic exam
132
HTN increases risk for
```
FGR
preterm birth
pre E
placental abruption
pulmonary edema
renal failure
perinatal mortality 3-4 times greater
```
133
HELLP syndrome
Hemolysis
EL elevated serum liver transaminase
LP low platelets
** variant of pre-E, though not all women with HELLP have increased BP
134
risk factors for pre E
```
nulliparity
multifetal gestation
age extremes 15 or 35
AA
diabetes
hx pre E
family hx HTN or pre E
obesity
limited exposure to partner sperm (new partner)
```
135
objective pre E
```
BP
urine for protein
chart review
sudden weight gain (edema)
pedal or facial edema
DTR
epigastric tenderness/liver margins opthalmic exam for papilledema
```
136
subjective pre E
Headaches
dizziness
blurry vision
epigastric pain
137
labs for pre E
CBC includes platelets
24 hour urine or albumin to creatine ratio
liver enzymes (AST LDH, ALT)
renal function tests ( creatine clearance serum uric acid, BUN, serum creatinine
coagulation studies (PTT, fibrinogen, PT) if low platelets
138
Renal labs
```
proteinuria of >300mg/24h
urine dip >1+
protein/creatinine ratio >0.3
serum uric acid >5.6mg/dL
serum creatinine > 1.2
```
139
low platelet /coagulopathy labs
platelet
140
hemolysis labs
abnormal peripheral smear
indirect bili >1.2 mg/dL
lactate dehydrogenase >600 U/L
141
elevated liver enzymes labs
serum AST >70 u/L
142
Blood test for pre E
hematocrit increase d/t hemoconcentration
| platelet count
143
liver damange d/t subscapsular hemorrhage
```
function test increase
LDH ALT AST
```
144
renal damnage d/t subcapsular hemorrhage
damage d/ vasospasm & capillary swelling
serum creatinine increases
serum uric acid increases
creatininine clearance decreases
urine protein increases
145
seizure management
```
call for help
prevent injury ; side rail up, pad sides
turn on side prevent aspiration
insert padded tongue blade
clear airway
administer oxygen
IV access for MgSO4
assess fetal status after seizure over
```
146
HELLP syndrome common s/x
```
general malaise feel like flu
epigastric pain or RUQ pain
n/v
hypertension
proteinuria - may be severe or absent
```
classic labs : elevated liver enzymes low platelet count (best indicator) and anemia
147
half life of a drug
determine the time required to reach steady state and dosage interval
148
Femring
release estrogen for 90 days
treatment for vaginal and vasomotor symptoms because it delivers estrogen doses that reaches systemic level .
needs PROGESTERONE if woman has a uterus
149
Estring
treatment for local vaginal symptoms
| release estrogen for 90 days as well.
150
what fruit juice need to be avoid while taking statins
grapefruit juice
151
drug elimination during pregnancy
increase glomerular filtration rate during pregnancy makes drug elimination faster
152
diaphragm rules
should be left in place for at least 6 hours after intercourse and no longer than 24 hours
153
patch rules
if patch has been partially or completely detached for more than 24 hours, start new patch and use back up for 7 days.
if she has had sexual intercourse w/in 120 hours she may want to consider EC
154
continuous combined HT
estrogen and progestin are taken every day
| lower cumulative dose of progestin
155
continuous cycle HT
estrogen is taken every day
| and larger doses of progestin are added in days 10-14
156
recommendations for TOC after treatment for chlamydia with doxycyline
3 mos
157
Jarisch-Herxheimer reaction
acute febrile rx with headache and myalgia that may ocur w/in 24 hours after any therapy for syphilis. It occurs most commonly in individuals with early syphilis.
Antipyretics may be recommended for symptomatic relief. it is not an allergic rx to medication.
158
Adenomyosis
growth of endometrial tissue in the myometrium
| dysmenorrhea may begin up to 1 week before menses and persist until after the period is over.
159
urge incontinence
detrusor irritability
c/o frequent voiding, urgency nocturnal enuresis
"overactive bladder "
160
advantage of LEEP over cryosurgery or laser vaporization
excised tissue is suitable for further histologic examination
cryosurgery and laser vaporization destroy the transformation zone so a specimen is not available for further dx evaluation
161
midcycle pelvic pain is offen associated with
rupture of ovarian follicle at the time of ovulation
162
management of urge incontinence
```
bladder retraining w/ schedule voiding
biofeedback
Kegel exercises
avoidance of bladder irritants
surgical removal of obstruction,
use of anticholinergic agents (oxybutynin or tolterodine )
```
163
dermoid cyst
benign cystic teratoma.
| most common ovarian germ cell tumor
164
intraductal papilloma
benign lesion of the lactiferous duct found commonly in perimenopausal 35-50 years old and is the most common cause of pathologic nipple discharge.
165
hypothalamic dysfunction causes
```
chronic disease
anorexia nervosa
stress
excessive exercise
malnutrition
or rarely an anatomic lesion
```
166
common side effect of clomiphene citrate
hot flashes
167
androgen insensitivity sydrome
or adrogen resistance syndrome - genetically transmitted androgen receptor defect.
the individual is genotypic male (46XY) but phenotypic female or has both female and male characteristic,
AKA testicular feminization
168
what can affect prolactin level
breast stim
exercise
stress
patient should fast for 12 hours prior blood drawn
several medications can impact the prolactin level. Ibuprofen is not considered one of them
169
primary amenorrhea
no period by age 14 in absence of secondary sexual characteristic
OR
no period by age 16 regardless of presence of secondary sexual characteristics.
170
molluscum contagiosum (mun coc?) treatment
cryotherapy with liquid nitrogen
171
tamoxifen increases woman risk for :
endometrial cancer
| deep vein thrombosis
172
GnRH agonist drugs : leuprolide acetate common side effect
hypoestrogenic state - because it decrease estrogen --hot flashes and bone mineral depletion is common....
173
secondary syphilis presents
localized or diffused mucocutaneous lesions in the palms, soles, mucous patches, and condyloma lata and with generalized lymphadenopathy along with flu like symptom
174
yeast in pregnancy treatment
Terconazole vaginal cream x7 days only topical azoles should be used to treat pregnant women
175
uterine fibroids
heavier longer uterine bleeding
pelvic pressure
PE: enlarged irregular nontender uterus
176
lichen sclerosus
easily traumatized, bruised and purpura, blisters, ulceration, severe itching and burning, lesions that do not correlate with discomfort skin of vulva that is think and wrinkled and obliteration of the clitories.
