board vitals Flashcards
electronystagmography
diagnostic test to record involuntary movements of the eye
dx for vertigo, dizziness, balance dysfunction by testing vestibular system
Dx for acoustic neuroma
MRI with gadolinium
BENIGN PARAOXYSMAL POSITIONAL VERTIGO
dizziness that comes and goes - lasts less than a min
-lack of hearing loss
MENIERES DZ
vertigo: mins to hours
hearing loss
tinnitus
Acoustic Neuroma
Vestibular schwannoma
hearing loss, tinnitus, dizziness
Vestibular Neuritis
abrupt severe dizziness
nausea/vomiting
Epley maneuver
vertigo
rotate head 45 degrees to side that causes worst vertigo
lie pt down while maintaining the head position so that head hangs over table
rotate head to 90 degrees
hold position for 30 secs or until vertigo stops
turn head to opposite side and hold again for 30 seconds
magnesium for:
Bromelain for:
MSM for:
CoQ10 for:
decrease muscle hypertonicity and associated spasm
reduce pain if inflammation present
pain relief with osteoarthritis
CoQ10: fatigue, CV disease and reduce deficiency with statin therapy
what test is most indicated to evaluate urethritis caused by gonorrhea or chlamydia
NAAT: nucleic acid amplification test
or dNA probe: but dna probe without amplification requires more invasive testing with a urethral swab
what is indicated to diagnose syphilis
dark field microscopy
chlamydia v. gonorrhea v. syphilis v. candida balanitis
chlamydia: often asymptomatic, can cause urethral inflammation, dysuria, and clear meatal discharge in men
gonorrhea: purulent meatal discharge
syphilis: hard chancre, which later becomes a painless ulcer
candida balanitis: beefy red rash and white patches on the penis with a lot of burning and itching
what is used to tx chlamydia
doxycycline
what is drug of choice for syphilis
penicillin
Benign prostatic hypertrophy
enlarged prostate on DRE
increased urination and urgency
nocturia
Prostatitis
low back pain
fatigue
dysuria
tender and BOGGY prostate
Prostate cancer
avg age 66
induration and asymmetrical nodules of prostate
fatigue, bone pain, weight loss, hematuria, hematospermia
Tamsulosin
BPH
alpha-adrenergic blocking agent
SE: dizziness, headache, rhinitis, abnormal ejaculation
Sildenafil
ED
headache, stuffy nose, and hypotension
Metformin
type 2 diabetes
insulin-sensitizing drug
SE: digestive upset,B12 deficiency, and lactic acidosis
Prostate HERBS
Serenoa repens (saw palmetto): 5-alpha reductase inhibitor used in BPH *5-alpha converts diT to testosterone*
Urtica dioca: prostatic agent used in BPH
Hydrangea: BPH and prostatis
soothing demulcent for urinary tract
prostate size is correlated with
fasting glucose levels
reducing sugar intake and stabilizing blood glucose could be helpful
most helpful * limit caffeine and alcohol*
Acute CLOSED-angle glaucoma
v.
Acute OPEN-angle glaucoma
closed: medical emergency : immediate tx to prevent blindness
unilateral eye pain, blurred vision, halos around light and a dilated and unresponsive pupil
open: no eye pain
blind spots in peripheral or central vision
often affects both eyes
Acute conjunctivitis
profuse tearing
normal pupillary response
mild-burning pain
no change in vision
*eye culture could be helpful
Anterior Uveitis
diminished vision moderate-severe pain redness photophobia pupillary constriction rather than dilation
slit lamp
goinoscopy
used to estimate the width of the angle by shining light beam on the peripheral anterior chamber of the eye
*closed angle glaucoma
tonometry
measures intraocular pressure
in open-angle glaucoma
*not typically used for closed-angle
Amslers chart
macular degeneration
LATANOPROST
*open angle glaucoma
to reduce intraocular pressure
prostaglandin f2alpha analog: increases aqueous fluid outflow
Supplement for glaucoma after stabilized
quercetin
tyrosine kinase inhibitor that relaxes the trabecular meshwork tightening ciliary muscle
can prevent recurrence of glaucoma
tx for plantar fasciitis
ultrasound: decreased inflammation, breaks up adhesions and promotes healing
cold laser treatment
arthritic pain
promotes tissue healing
microcurrent
healing after injury
pain reliever
Lontophoresis with mag sulf
spasms
sprains
strains
herbs for uncomplicated cystitis
zea mays
althea officianalis
arctostaphylos uva-ursi
eupatorium perfolatium
diaphoretic and immune and digestive stimulant
affinity for repiratory and gastro system
vitamin A toxicity
hair loss, liver damage, bone loss
congenital birth defects
beta carotene safer for pregnancy
Actinic keratosis
- can spontaneously disappear or remain stable fo years without progression
- SCC can occur! when penetrates through dermoepidermal junction and into the dermis
60% of SCC develop from AK
ZOLPIDEM `
sedative and hypnotic
- dont take 5-HTP (precursor for serotonin)
can have CNS depressant effects
drowsiness
Acne vulgaris
multiple open and closed comedones with erythema and scarring
face and back
Acne rosacea
inflammatory condition
affects middle aged adults
women
erythema and telangiectasis on the face as well as papules and pustules
central area of the face and face flushing
*alcohol aggravates
ISOTRETINON
acne, scarring
synthetic retinoid that reduces sebum reduction from sebaceous glands
salicylic acid
warts
Hepatoprotective and alterative herbs indicated for inflammatory and hormonal skin conditions (acne)
Articum Lappa
Berberis Aquifolium
Rumex Crispus (yellowdock)
Plantago
demulcent and vulnerary
indicated for dermatitis, wounds, and ulcerations but not best for acne
SYMPHYTUM
demulcent
expectorant
vulnerary
topically for wound healing
SOLIDAGO
“golden rod”
antimicrobial and anticatarrhal
upper URI and urinary tract infections
herpes zoster
50% of pts have prodrome can begin a few days, up to 3 weeks before SHINGLES vesicles become visible
prodromal symptoms include pain, burning, tickling, itching, tingling
elevated temp, lethargy, hyperesthesia
most common ddx to rule out: contact derm
Erythema infectiosum
“fifth disease”
Parvovirus b19
school-aged children
malar rash—> pink lacy rash on trunk and upper extensor surfaces
DECREASES risk of ovarian cancer
oral contraceptive use and multiple pregnancies
-decreased ovulation(?)
INCREASES risk of ovarian cancer
increased age
nulliparous repro history
Ovarian Cancer
women above 60
abdominal bloating, pelvic discomfort, firm adnexal mass
anemia due to blood loss
changes in bowel habits
- vaginal bleeding in postmenopausal women*
ddx: CRC and ovarian cysts
Bisoprolol
beta-1 blocker
negative chronotrope for hypertension and rate control
*TAPER the medication befored/c
sudden cessation= MI, angina, or ventricular arrythmias
DX for ovarian cancer
laparotomy
Diagnostic marker for ovarian cancer
Serum CA-125
specific to ovarian cancer. elevated in 80% of advanced malignant tumors, however, this marker is non-specific to ovarian cancer and can also be elevated in endometriosis, inflammatory bowel disease, and several other conditions.
TRICHOMONIASIS
green frothy vaginal discharge
cervical pain and inflammation
Diagnostic for trich
saline wet mount
pear-shaped flagellated organisms
tx for trich
metronidazole
antiparasitic and antibacterial
(gardnerella= BV)
cyclobenzaprine
flexeril- muscle relaxant
Hypericum
upregulation of serotonin
increasing GABA and dopamine
increase NE
WHIFF TEST
10% potassium hydroxide to microscope slide with discharge
fishy odor= + = trich or BV
flagellated organisms vs clue cells on microscopic exam
flagellated= trich
clue cells= BV
what vaccine is the only immunization conventionally scheduled at birth
HEP B
varicella and MMR: minimum 12 months, 2nd dose at 4-6 years
meningococcal: age 4-6 : high risk
Placenta Previa
painless bright red uterine bleeding without uterine cramping in late stages of pregnancy
implantation of placenta over or close to the cervical internal os
f/u with ultrasound
*hospitalization with rest
fibrocystic breast changes
never been pregnant
early menarche
first birth after age 30
*US for women under 35
dif between solid or cystic lump
what lifestyle factor is closely related to fibrocystic changes
caffeine
vitamin E helps and lymphatic massage of axilla
Vitex agnus-castus
decreases prolactin secretion and increases progesterone
binds to dopamine receptors in the pituitary gland which decreases prolactin
=increased growth of corpus luteum
increases ratio of LH:FSH = balance progesterone to estrogen ratio
good for estrogen dominance
lactational mastitis
infrequent feedinfs and breast pumps
clogged duct and nipple cracking allows bacteria in
tx of lactational mastitis
CEPHALEXIN
first gen cephalosporin to target S AUREUS
breastfeeding
budenoside
corticosteroid
Rifampin
TB
vancomycin
severe infection
reduce re infection in lactational mastitis
frequent feedinfs and improved breast feeding techniques to empty the breast milk
PHYTOLACCA AMERICANA
CONTRAINDICATED for topical use of mastitis
would cause mucosal inflammation and diarrhea
can take orally or remove by washing cause it can be helpdul with mastitis
Galega officinalis and Trigonella
galactagogues improving secretion of milk
ok in pregnancy
echinacea
anti microbial
ok in pregnancy
varicella zoster virus
chickenpox
incubation 10-21 days
varicella lesions: appearance of dewdrop on a rose petal
lesions appear centrally and then spread sitally
what is the test for varicella zoster
direct flourescent antibody test
rapid results
acyclovir
antiviral
clomitrazole
antifungal
penicillin
beta-lactam antibotic
tetracycline
bacteriostatic antibiotic
Basal Cell Carcinoma
*most common skin cancer type
dome shaped nodule with pearly borders
recurrent bleeding and crustinf in a pt with fair skin
hx of working outdoors
SQUAMOUS CELL CARCINOMA
non-healing red scaling or crusting papule or plaque that can have a rough surface
Karposi’s sarcoma
malignancy
HSV 8
usually found in people with AIDs
multiple purple-black macules which grow and coalesce into nodules
SUMATRIPTAN
migraine headaches
works on 5HT serotonin
**c/i in pts with ischemic heart disease due to vasoconstriction
Pityriasis rosea
herald/annular patch with central clearing
christmas tree distribution of macular eruptions
papulosquamous eruption
Pityriasis alba
hyperpigmented scaly 1-4 mm macules on face in children
Classic vs Common Migraines
classic: *must include a visual or sensory aura with the headache
common: must include nausea/vomiting and hypersensitivity to light and noise in addition to headache
TINEA VERSICOLOR
multiple coalescing pale-covered macules, usually on the torse
fungus: Malazzezia furfur : normal part of skin flora
* not contagious*
more common in teens and adults who have a lot of sebaceous secretions, diabetes, pregnancy
KOH prep=”spaghetti and meatballs”
-long curved strands of hyphae and budding yeast cells
fluoresces under Woods Lamp
“dewdrops on rose petals”
chicken pox (varicella zoster)
“chandelier sign”
extreme tenderness on palpation or movement of the cervix = Pelvic inflammatory disease
“orange peel sign”
peau d’orange
dimpling of akin of inflammatory or cancerous breast tissue
IMPETIGO
skin infection with oozing
honey-colored crusting eruptions
TINEA CORPORIS
ring-worm with well-demarcated erythematous oval itchy plaques with raised edges
SCABIES
itchy and highly contagious skin condition
*SARCOPTES SCABEI skin mite which lives in clothing and bedding
THUJA (botanical)
strong anti-fungal topically
TERBINAFINE
anti-fingal
AZITHROMYCIN
macrolide antibacterial drug
DOCUSATE
stool softener for constipation
TEMEZEPAM
benzodiazepine for sleep and anxiety
PACLITAXEL
malignant melanoma
-has been used as monotherapy as well as in combination with CARBOPLATIN
BROMOCRIPTINE
ergot derivative and potent dopamine agonist used to treat hyperprolactinemia-associated dysfunctions, acromegaly, and parkinsons dz
MALIGNANT MELANOMA
ABCDE
“ugly ducking” sign : one mole among many that sticks out and looks different
chronic used of steroids can actually increase risk
refer for full-thickness incisional biopsy
Koebners response or phenomenon
appearance of lesions along the site of injury and can be seen in psoriasis, lichen planus, molluscum contagiosum
Auspitz
punctate bleeding after scraping scales in psoriasis
Nikolskys sign
Pemphigus Vulgaris
normal epidermis seperates from the basal layer when rubbed and blister forms quickly
DERMATITIS HERPETIFORMIS
autoimmune skin condition associated with celiac disease, which is common with type I diabetes and other autoimmune like SLE or sarcoidosis
what is elevated in celiac dz
anti-endomysial antibodies
long-acting form of insulin
insulin glargine
onset 1-2 hours
has effects for 20-24 hours
insulin aspart and insulin lispro
rapid-acting within 10-20 mins before meal and lasts 3 hours
regular insulin
30-60 mins
lasts 5 hours
herb that is an immune modulator with
- affinity to the liver
- some research supporting help with chronic HEP B
SCHISANDRA CHINENSIS
risks of head and neck SQUAMOUS CELL CARCINOMA
knat or tobacco chewing tobacco smoking heavier alcohol consumption EBV HPV
what is BURKITTS LYMPHOMA
rare EBV-associated cancer of the jaw seen mostly in African boys and those who are immunosuppressed
Most common form of non-hodgkins lymphoma
diffuse large B-CELL lymphoma
tx of psoriasis
hydrocortisone
oral prednisone in severe cases
vitamin D: anti-inflammatory and immune modulation
vitamin A: impt in skin conditions: cellular replication and immune function
zinc: necessary nutrient for DNA and protein synthesis : promotes normal keratinocyte production in chronic skin dz
Berberis aquifolium
alterative and hepatoprotective actions
psoriasis
Smilax
alterative and antipsoriatic herb used in chronic skin conditions
psoriasis
Achillea millefolium
yarrow
bitter digestive stimulant
styptic
Centella asiatica
gotu kola vulnerary antipruritic skin brain function
*avoid in liver dz
Calendula off
vulnerary
antipruritic
skin
Matricaria recutita
chamomile
anti-inflammatory
anti-allergic
vulnerary
*atopic derm
Urtica dioica
prostate conditions
Symphytum officinale
demulcent
vulnerary
REYES syndrome
rare but serious - swelling of liver and brain
children and adolescents recovering from viral infection and aspirin use
do not use aspirin during viral infection
metabolic syndrome
waist circum over 35 in triglycerides over 150 hdl under 50 glucose over 100 blood pressure oer 130/85
UBIQUINOL
co - q- 10
important for statin meds
statins inhibit enzyme HMG-CoA reductase, responsible for cholesterol biosynthesis and CoQ10 production in the mitochondria
CoQ10 can help precent adverse effects of myalgia, rhabdomyolysis in patients taking statins
