COMBANK Random 2 Flashcards
Which part of Medicare covers inpatient hospital care, skilled nursing, hospice, and home health care?
Medicare part A
Which part of Medicare covers outpatient care, doctor’s services, physical therapy, and occupational therapy?
Medicare part B
What part of Medicare is called Medicare advantage plan and what is it combined of?
Medicare part C - combination of A and B
What part of Medicare is for prescription drug coverage?
Medicare part D
What are neoplastic polyps known as
adenomas
What are 3 characteristics that increase cancer risk in adenomas?
- greater than 1 cm
- contain substantial villous component
- high-grade dysplasia
What shape/structure of polyp is more likely to be cancerous?
sessile polyps with broad-based attachments are more likely to be malignant than pedunculated polyps attached to a stem
What are the 3 histologic types of colon adenomas?
tubular, villous, and tubulovillous
Which histologic type of adenoma is most likely to be associated with cancer and where are they commonly located?
Villous adenoma - located in sigmoid/rectal region
What is the appearance of a villous adenoma?
larger and flatter with a velvety, cauliflower-like appearance
What is the most common type of polyp?
Tubular adenoma
What is the appearance of a tubular adenoma?
small, pedunculated, and carry little risk for malignant transformation (can have malignant foci, esp in larger tubular polyps)
What is the appearance of a tubulovillous adenoma?
Most resemble tubular adenomas but have surface covered in villi - malignancy is greater than tubular but less than villous
Where is the most common location for colorectal cancer to metastasize and why?
Liver d/t dual blood supply via hepatic artery and portal vein allowing for hematologic spread as well as liver’s ability to filter blood
-~60-70% people with colorectal cancer will develop a liver tumor
Other than colon, what are 7 other cancers that commonly metastasize to the liver?
- breast
- esophagus
- stomach
- pancreas
- lungs
- kidneys
- skin (melanoma
What are 3 cancers that commonly metastasize to bone?
prostate, breast, and lung
What are 3 common cancers that metastasize to the brain?
lung, breast, and genitourinary
What are 6 cancers that metastasize to the lungs?
breast, colon, prostate, bladder, neuroblastoma, and sarcomas
What nonspecific marker can be increased in pancreatic cancer, gastric cancer, breast cancer, thyroid medullary carcinoma, ulcerative colitis, pancreatitis, cirrhosis, COPD, Crohn, and chronic smokers?
CEA - found in adenocarcinomas
What does AFP serve as a tumor marker for?
hepatocellular carcinoma, germ cell tumors, and metastatic cancers of the liver
What do pts with FAP have an autosomal dominant mutation in?
APC - tumor suppressor gene on chromosome 5
What diseases is ALP elevated in?
metastatic bone disease, biliary disease, and Paget disease of the bone
What is a nonspecific tumor marker that can confirm the Dx of colorectal cancer, monitor for tumor recurrence, and monitor response to therapy?
CEA
Which bleeding disorder is commonly associated with easy bruising, skin bleeding, prolonged bleeding from mucosal surfaces, trivial wounds, and excessive menstrual bleeding?
von Willebrand Disease
What are the lab values of vWD and why?
normal platelet count, increased bleeding time, normal PT, and slightly increased PTT
-vWF normally protects factor VIII from degradation; low levels of vWF correspond to low levels of factor VIII
What assay is diagnostic for vWD?
ristocetin-induced platelet agglutination (RIPA)
What platelet disorder is caused by a deficiency of GpIb leading to decreased platelet count and normal PT/PTT?
Bernard-Soulier syndrome
Why is Hemophilia B unlikely to be in females?
It is a an X-linked recessive disorder
What clotting factors is Vitamin K important for the synthesis for?
intrinsic and extrinsic: II, VII, IX, and X
What is the Tx for mild vWD and what is the MOA?
desmopression acetate - increases pt’s own levels of vWF by increasing its release from Weibel-Palade bodies in endothelial cells
Which populations are at risk for Vitamin K deficiency?
newborn infants, bulimics, and pts on Warfarin
What antibiotic can increase PT levels in a pt on warfarin therapy?
Sulfonamides - displace warfarin in plasma proteins so more warfarin circulates in the blood and decreases hepatic synthesis of factor II, VII, IX, and X via vitamin K antagonism
What is the MOA of Vitamin K?
activates clotting facotrs II, VII, IX, and X by adding carboxyl groups to key glutamic acid residues within the proteins’ structure
What is the most common Sx of Dupuytren contracture?
inability to extend 4th and 5th digits as the fascia loses its elasticity
What is the drug of choice (and its MOA) for PTSD
SSRI - blocks presynaptic serotonin receptors which increases availability of serotonin in synaptic cleft
What type of drug is a reuptake inhibitor of serotonin and norepinephrine?
TCA (amitryptiline and clomipramine)
What is the MOA of haloperidol? What can it be used as a non-first line therapy for?
blocks postsynaptic D1 adn D2 receptors and depresses teh release of hypothalamic and hypophyseal hormones
- can be used to suppress tics of Tourette
- can also be used for psychosis, delirium, postop nausea and vomiting, and tranquilization of severely agitated pts
What are firsr-line pharm Txs for Tourette disorder?
dopamine receptor antagonists: fluphenazine, pimozide, and tetrabenazine - they depress the reticular activating system
What does scaly thickened skin on anterior legs in a pt’s with hyperthyroidism indicate and what condition is it exclusive for?
pretibial myxedema - exclusive for Graves’ disease
What causes pretibial myxedema?
infiltration of lymphocytes and glycosaminoglycans (especially hyaluronic acid) into dermis
What is the drug of choice for pregnant women with hyperthyroidism in pregnancy?
PTU
Where is the Chapman point for sigmoid colon?
lateral though within the IT band close to the greater trochanter
What UE lesion can occur in a newborn during delivery wiht traction on the neck in attempt to free a trapped shoulder during shoulder dystocia and how does it present?
Erb-Duchenne palsy: adducted, medially rotated, and pronated
What neoplasisa are associated with MEN1/Werner syndrome?
- associated wtih genes on chromosome 11
- pituitary adenomas, parathyroid adenomas, and non-beta islet cell tumors of the pancreas
(i. e. prolactinoma, PUD d/t gastrinoma, insulinoma, kidney stones)
What neoplasias are associated with MEN Type 3 (2B)?
pheochromocytoma, thyroid medullary carcinoma, mucosal neuromas, and marfanoid physical features
What neoplasias are assocaited with Men-2A/Sipple syndrome?
- chromosome 10
- pheochromocytoma, thyroid medullary carcinoma, and parathyroid adenomas
What is the difference between complex regional pain syndrome-1 and complex regional pain syndrome-2?
there is no evidence of nerve damage in type 1 and there is nerve damage in type 2
What are the characteristics of CRPS-1?
severe, burning pain at site of injury, muscle spasm, joint stiffness, restricted mobility, rapid hair and nail growth, and vasospasm causing edema and skin changes
What are the characteristics of CRPS-2?
widespread edema, diminished hair growth, cracked and brittle nails, severe and diffuse osteoporosis, and muscle atrophy
What is the MOA of metoclopramide and what are SE?
It stimulates peristalsis by antagonizing D2 receptors; SE include parkinsonism and dystonia
