Class 9

Question 1

Public health

Answer 1

Specific field of medicine
Mission is to assure conditions in which the community can be healthy
Includes health promotion and prevention

Question 2

Prevention

Answer 2

intervention with high risk populations

Question 3

Evidenced based psychiatry

Answer 3

Multi-faceted approach to treating mental health: pharmacotherapy, education, ressource linkage and psychotherapy
Requires referalls and collaboration

Question 4

Role of NPs

Answer 4

Team work, evaluation and dx, pharmacotherapy, team leader

Question 5

Determinants of health

Answer 5

Health services, gender, financial and social status, culture, biology and genetic, healthy child development, personal health practices and coping skills, social support networks, physical environments, education and literacy, employment/ work conditions,

Question 6

Hypertension

Answer 6

sustained bp over 135/ 85

Vast majority is idiothic.

Question 7

Malignant hypertension

Answer 7

extremelyhigh blood pressurethat develops rapidly with or without some type of organ damage. A person withmalignant hypertensionhas ablood pressurethat’s typically above 180/120.Malignant hypertensionshould be treated as a medical emergency.

Question 8

Hypertension consequences

Answer 8

coronary artery disease, heart failure or left ventricular dysfunction, left ventricular hypertrophy, aneurysmal subarachnoid hemorrhage, carotid artery disease, intracerebral hemorrhage, ischemic stroke or transient ischemic attack, vascular dementia, intermittent claudication, lower extremity tropics changes, albuminuria, chronic kidney disease

Question 9

Psych rx that causes hypertension

Answer 9

TCAs and FGAs have anticholinergic effects that may be responsible for increases in blood pressure. Weight gain associated with antipsychotics or other psychotropic medications may also mediate changes in blood pressure. venlafaxine, MAOI, amphetamines

Question 10

Psych rx that causes hypotension

Answer 10

clozaril , second generation antipsychotics, benzos

Question 11

Betablockers and psych complications

Answer 11

fatigue sedation depression

Question 12

ACE inhibitors and psych complications

Answer 12

Ace can induce delirium/ mania very rarely

Question 13

Ca channel blockers and psych complications

Answer 13

fatigue and sedation

Question 14

Diuretics and psych complications

Answer 14

can indirectly cause neuropsychiatric effects due to electrolytes and effects an Li excretion

Question 15

Clonidine and psych complications

Answer 15

fatigue, sedation, dep

use to trx ADHD and tourettes

Question 16

Questions to know if he needs to go to ER

Answer 16

chest pains, palpitations, shortness of breath, facial drooping, arm weakness, asymmetry, speech difficulty rule out MI and stroke and then (not medical emergency) loss of vision, pain in legs when walking, difficulty urinations, erectile dysfuntion

Question 17

Irritable bowel syndrome

Answer 17

functional disorder of the gastrointestinal tract characterized by chronic abdominal pain and altered bowel habits.Affects more commonly women and people over 50 yo.

Question 18

IBS dx

Answer 18

r/o celiac
r/o IBD
Use a positive dx strategy: careful clinical history, focus on key sx of abdo pain and altered bowel habits, absence of alarm features, more than 6 mo
ROME IV criteria:
Recurrent abdo pain on average 1 day a week in the last 3 mo, associated with 2 or more of the following criteria
1.Related to defecation
2.Associated with change in stool frequency
3.Associated with a change in the form/ appearance of stool
For at least 3 mo with sx onset 6 mo ago

Question 19

Trx IBS

Answer 19

FODMAP, soluble fiber, no more antispasmodics, peppermint oil for pain, no probiotics, no PEG, chloride channel activators for IBS-C, guanylate cyclase activators for IBS-C, rifaximin for IBS-D or mixed opioid antagonist-agonist, TCAs, gut directed psychotherapy

Question 20

Inflammatory bowel disease

Answer 20

Inflammatory bowel disease (IBD) is comprised of two major disorders: ulcerative colitis and Crohn disease. Ulcerative colitis affects the colon, whereas Crohn disease can involve any component of the gastrointestinal tract from the mouth to the perianal area. These disorders have somewhat different pathologic and clinical characteristics, but with substantial overlap; their pathogenesis remains poorly understood. Ulcerative colitis is a chronic inflammatory condition characterized by relapsing and remitting episodes of inflammation limited to the mucosal layer of the colon. It almost invariably involves the rectum, and the extent often involves more proximal portions of the colon in a continuous fashion. Crohn disease is characterized by transmural inflammation and by skip areas of involvement (ie, segments of normal-appearing bowel interrupted by areas of disease). The transmural inflammatory nature of Crohn disease may lead to fibrosis and strictures and to obstructive clinical presentations that are not typically seen in patients with ulcerative colitis. Transmural inflammation may also result in sinus tracts, giving rise to microperforations and fistula formation.

Question 21

Dx IBD

Answer 21

Stool cultures to RO other causes of diarrhea
Labs to assess severity in the acute phase
Colonoscopy with biopsy

Question 22

IBS and psych

Answer 22

About 50–90% ofIBSpatients also have associatedpsychiatricailments; most commonly anxietydisordersand depression.

Question 23

Red flags IBS

Answer 23

blood in stool, weight loss, fevers chills fatigue, low appetite, mucus in stool

Question 24

Menopause

Answer 24

Permanent cessation of menstrual periods as determined retrospectively after a women has experienced 12 mo of amenorrhea without any other obvious pathological or physiological cause. Average age is 52 yo

Question 25

Sx menopause

Answer 25

hot flash. Women may experience a number of other symptoms whose association with the menopausal transition is well established, including vaginal dryness, sleep disturbances, and new-onset depression, sexual dysfunction, cognitive changes, joint pain, breast pain, insomnia, menstrual migraine. Once in menopause (you haven’t had aperiodfor12 months) and on into postmenopause, the symptoms may continue for an average offour to five years, but they decrease in frequency and intensity.

Question 26

True or false metformin can cause diarrhea

Answer 26

true

Question 27

Trx menopause

Answer 27

hormone replacement therapy, little risk of MI, of pulmonary edema, blod cots, breast cancer for about 5 years, rapid decrease in sx. Effexor

Question 28

The most frequent psychiatric manifestations of the connective tissue diseases are

Answer 28

benign behavioural changes, emotional instability and sleep impairment.Linked to chronic pain

Question 29

Connective tissue disorders

Answer 29

rheumatois arthritis, scleroderma, lupus, ankylosing spondylitis, reynaud’s phenomenon

Question 30

psych effects of Opioids

Answer 30

aggressive behavior, agitation,cognitive dysfunction, confusion. Depression, dysphoria, euphoria, hallucination, mood changes , panic attack, paranoia, suicidal ideation