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Fitzgerald Review Book > Content 2 > Flashcards

Content 2 Flashcards

1
Q

Most common site of OA

A

Distal interphalangeal joint

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2
Q

Peak age of RA

A

20-40 years

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3
Q

40% of deaths in RA due to

A

CV causes: stroke

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4
Q

Initial dx tests for RA

A

ANA, ESR, CRP, ACPA, RF

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5
Q

Most sensitive lab marker for SLE

A

ANA

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6
Q

Risk factors when on biologics

A

Increased risk of infection

-Get immunized!

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7
Q

Meniscal tear

A

Popping sound
McMurray + Apley test are positive
Squatting and kneeling are impossible
Consider aspiration if no improvement after 2-4 weeks of RICE
Consider arthroscopy if no improvement in 4-6 weeks

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8
Q

Acroparesthesia

A

Awakening at night with numbness/burning in fingers

Carpal tunnel

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9
Q

Sarcoidosis

A

Inflammatory condition that results in production of noncaseating granulomas, predominantly in lungs, lymph nodes, eyes, skin
Fever, fatigue, anorexia, arthralgias, dyspnea on exertion, cough, chest pain, rash, color change and nodules under skin, blurred vision, eye pain, sensitivity to light, red eyes
Dx: biopsy of bronchial

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10
Q

Tx sarcoidosis

A

Mild: NSAIDS
Steroids are mainstay of tx
Other: hydroxychloroquine, methotrexate, azathioprine, infliximab

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11
Q

Risk factors for low back pain

A

Increasing age, overactivity, overweight, obese, spinal stenosis, scoliosis

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12
Q

most common cause of lower back pain

A

Lumbosacral strain

-Sx: stiffness, spasm, decreased ROM, sitting increases pain

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13
Q

Risk factors for lumbar radiculopathy

A

Smoking, DM, spinal infection, obesity, male, increased age

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14
Q

Most common site for lumbar disk herniation

A

L4-L5, L5-S1

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15
Q

Cause of sciatica

A

Herniated disk, spinal stenosis, compression fracture

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16
Q

Most common site for cervical disk lesion

A

C6-C7

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17
Q

Reiter syndrome

A

Reactive arthritis
Acute nonpurulent arthritis complicating an infection elsewhere in the body
Requires 2+ of following: asymmetrical oligoarthritis, dactylitis (sausage shaped finger), enthesitis (toe or heel pain), cervicitis, prostatitis, acute diarrhea, conjunctivitis, urethritis
-Usually seen days to weeks following acute bacterial diarrhea caused by shigella, salmonella, campylobacter or chlamydia
-HLA B27+
-Tx: NSAIDs, steroids, TNF blockers (etanercept or inflximab), steroid injections

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18
Q

Osteoporosis screening

A

> 65 with DEXA scan

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19
Q

Long term use of biphosphonates can cause

A

Atypical femoral fractures

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20
Q

Tendinosis

A

Degradation of tendon’s collagen due to overuse

-NSAIDs and steroids my inhibit repair

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21
Q

most common sites of tendonitis

A

Rotator cuff, elbow, biceps, wrist, heel

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22
Q

Benefits of vitamin D

A

Minimizes abnormal cell proliferation, increases insulin secretion, immunomodulaes and increases renin
-Need 3000-5000IU per day

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23
Q

Drugs that are Vitamin D depleting

A

Phenytoin and phenobarb

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24
Q

Hormonally active form of Vitamin D

A

1,25-Dihydroxyvitamin D

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25
Q

Preferred blood test for Vitamin D

A

Serum 25-hydroxyvitamin D

-Preferred minimum: 34-40

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26
Q

Raynaud’s

A

Paroxysmal digital vasoconstriction that results in bilateral symmetrical pallor or cyanosis

  • Tobacco exacerbates
  • Dihydropyridine CCB and ACEI can be used as tx for vasodilator effect
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27
Q

Secondary Raynaud’s

A

Due to atherosclerosis, collagen vascular disease, scleroderma

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28
Q

Vessel most commonly affected by varicose veins

A

Saphenous vein

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29
Q

Virchow triad

A

Hypercoagulability, Stasis/turbulence, endothelial injury

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30
Q

Risk factors for superficial thrombophlebitis

A

Local trauma, prolonged travel or rest, varicose veins, history of estrogen use, pregnancy, 6 weeks postpartum
Tx: warm packs, compression hose, NSAIDs, ambulation

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31
Q

1st line dx for DVT

A

Compression duplex ultrasound

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32
Q

If healthy person has DVT, what labs to do

A

Protein S and C, antithrombin III, fibrinogen, lupus anticoag, factor V Leiden, prothrombin mutation

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33
Q

Direct thrombin inhibitors

A

Dabigatran

Caution with renal dysfx

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34
Q

Direct factor Xa inhibitors

A

Rivaroxaban

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35
Q

Risk factors for arterial occlusive disease

A

DM, htn, hyperlipidemia, tobacco use

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36
Q

Claudication

A

Caused by inability of diseases vessel to vasodilate during activity

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37
Q

First line dx for arterial occlusive disease

A

Doppler US

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38
Q

Tx arterial occlusive disease

A

Aspirin, Beta blockers, statins, DM meds, clopidogrel

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39
Q

Earliest sign of chronic venous insufficiency

A

Lower extremity edema

-Develops into thin, shiny, atrophic skin with brown pigmentation

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40
Q

insulin resistance is correlated with

A

Gout, PCOS, acanthosis nigricans, LGA, prothrombotic state

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41
Q

FBG screening

A

Recommended every 3 years >45 years

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42
Q

A1C test best measures glucose control in the past

A

28-42 days

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43
Q

Short acting, rapid onset insulin

A

Lispro, Aspart, Glulisine
15-30 mins onset
1-2 hour peak
3-6 hour duration

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44
Q

Short acting, regular insulin

A

Humulin R, Novolin R
30 min-1 hour onset
2-3 hour peak
4-6 hour duration

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45
Q

Intermediate insulin

A

Humulin N, Novolin N
1-2 hour onset
6-14 hour peak
16-24 hour duration

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46
Q

Long acting insulin

A

Glargine (Lantus), Detemir
1 hour onset
No peak
12-24 hour duration

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47
Q

Pre-diabetes labs

A

FBG 100-125
Random glucose 140-199
A1C 5.7-6.4

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48
Q

Most common drug combo for type 2 DM

A

Metformin + Sulfonylurea

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49
Q

Metformin

A

Improves insulin mediated glucose uptake and fibrinolysis
SE: GI distress, rare lactic acidosis
CI: renal impairment, HF, age >80
D/C day of surgery or radicontrast use

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50
Q

Sulfonylureas

A

Glipizide, glyburide, glimepiride
Increases insulin release
Less effective after many years of use

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51
Q

Thiazolidinediones

A

Glitazone
Increases insulin sensitizing in muscles
Rare risk of hepatic toxicity: monitor ALT
Risk of edema: CI in HF
Do not use with insulin or nitrates

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52
Q

GLP1 agonist

A

Exanatide, Liraglutide
Stimulates insulin production in response to increased plasma glucose; inhibits postprandial glucagon release; slows gastric emptying
SE: N/V
CI: Gastroperesis

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53
Q

DPP4 inhibitor

A

Gliptin
Increases levels of incretin; increases release of insulin and decreases glucagon
Monitor for pancreatitis

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54
Q

SGLT2 inhibitor

A

-Flozin

Decreases renal glucose threshold by increasing urinary glucose excretion

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55
Q

Alpha glucosidase inhibitors

A

Acarbose
Decreased intestinal carb absorption by decreasing postprandial absorption
CI: IBD, impaired renal function

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56
Q

Somogyi effect

A

Insulin induced hypoglycemia triggers excess secretion of glucagon and cortisol, leading to hyperglycemia in the morning
-Decrease night time dose of insulin

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57
Q

Dawn phenomeon

A

Decreased insulin sensitivity between 5 and 8am due to spikes in growth hormone causing hyperglycemia
-Increase insulin at night

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58
Q

Metabolic syndrome

A 
Central obesity
Triglycerides >150
HDL <35 men and <39 women
BP >140/90
Microalbuminuria
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59
Q

Exertional heat stroke

A

Illness has been triggered by exercise in a warm environment that adds to thermal load produced by muscular contraction

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60
Q

Non-exertional heat stroke

A

Extreme temp >10 degrees more than is typical for 3 days

-Affects infants and elderly

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61
Q

Risk factors for heat stroke

A

TCAs, beta blockers, vasoconstrictors

-Negate body’s natural attempts to decrease core temperature (increasing CO and vasodilation)

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62
Q

Early heat stroke sx

A

Increased HR, pounding HA, difficulty breathing

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63
Q

Labs in heat stroke

A

Increase in CK, hyperkalemia, transient polycythemia due to volume constriction, hyponatremia, stress induced leukocytosis

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64
Q

Most serious complication of heat stroke

A

Rhabdo

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65
Q

Orlistat

A

Take with meals
Decreases dietary fat absorption by 30%
SE: loose stools

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66
Q

Meds that can cause weight gain

A

Atypical antipsychotics, some antiepileptics, steroids

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67
Q

Meds that can cause thyroid disorder

A

Iodide, amiodarone, lithium, interferon alpha, IL2

68
Q

Menstrual changes in thyroid disorders

A

Hyper: amenorrhea
Hypo: menorrhagia

69
Q

Most helpful test to confirm abnormal TSH

A

Free T4

70
Q

Most common cause of hypothyroid

A

Hashimotos thyroiditis
Diffusely enlarged, firm thyroid with fine nodules, neck pain and tightness
-TPO antibodies present

71
Q

Most common cause of hyperthyroid

A

Graves

Diffuse enlargement of thyroid, exopthalmos, nervousness, tachycardia, heat intolerance

72
Q

Recommended testing interval when adjusting thyroid meds

A

6-8 weeks

73
Q

How much can you decrease LDL with diet alone

A

5-10%

74
Q

4 target groups for statin benefits

A

Clinical ASCVD
LDL >190
DM and LDL 70-189
10 year risk >7.5%

75
Q

High intensity statins

A

Atorvastatin 40-80

Rosuvastatin 20-40

76
Q

Moderate intensity statins

A

Simvastatin 20-40
Atorvastatin 10-20
Pravastatin 40-80
Rosuvastatin 5-10

77
Q

Cortisol effects

A

Maintains glucose control, decreases immune response, helps body respond to stress

78
Q

Aldosterone effects

A

Regulates Na/K balance

79
Q

Addison disease

A

Adrenal insufficiency
Do not produce enough cortisol or aldosterone
Sx: chronic diarrhea, N/V, loss of appetite, patchy skin, muscle weakness, fatigue, slow movements, hypoglycemia, decreased BP, fainting, salt craving
Tx: steroids and Na

80
Q

Cushing syndrome

A

Increased cortisol
Most common cause: long term steroid use
Weight gain + fatty tissue deposits (buffalo hump and moon face), striae, thinning skin, slow healing of cuts, fatigue, anxiety, depression, glucose intolerance, hirsutism
-For endogenous causes, surgery is primary tx choice

81
Q

Cushing disease

A

Due to benign tumor on pituitary gland overproducing ACTH

82
Q

Pre-renal azotemia due to

A

Hypoperfused kidneys due to dehydration, acute blood loss, decreased CO, burns

83
Q

Post-renal azotemia due to

A

obstruction to urine flow

-Uncommon

84
Q

Labs in renal failure

A

hyperkalemia, hypercalcemia, hypernatremia

EPO decreased–leads to normocytic, normochromic anemia with decreased reticulocyte count

85
Q

Glomerulonephritis

A

inflammation of the glomeruli in the kidneys
Sx: pink or cola colored urine due to hematuria, foamy urine due to proteinuria, htn, edema, anemia
-UA shows RBC and RBC casts, WBC and increased protein
-Kidney biopsy needed to confirm dx
-Tx: antihypertensives, antimicrobials if infection suspected, steroids

86
Q

Pyelonephritis sx

A

Back pain, fever, N/V

87
Q

Hemorrhage cystitis

A

Large quantities of visible blood in the urine due to infection, radiation or chemo

  • Irritative voiding sx reported
  • Adenovirus is a common cause and is self limiting
88
Q

UA in UTI

A

Leukocyte esterase, nitrities, protein, blood
Nitrite + leukocyte esterase = G-
>10^5 CFU dx for UTI

89
Q

Topical estrogen and UTI

A

Can restore natural flora and decrease UTI risk

90
Q

UTI prophylaxis

A

> 2 UTI within 6 months or >3 UTI within 12 months

Daily Bactrim for prophylaxis

91
Q

Risk factors for bladder cancer

A

Smoking, family history, male, arsenic exposure, cyclophosphamide, pioglitazone
-Sx: gross, painless hematuria, irritative voiding sx without fever

92
Q

Urge incontinence

A

Overactive bladder
Most common form of incontinence in elderly
Tx: toilet training, decrease fluid intake; anticholinergics–oxybutynin, tolterodine, solifenacin succinate, farifenacin, fesoterodine
Alt meds: mirabegron, botulinum toxin

93
Q

Stress incontinence

A

Weakness of pelvic floor and urethral muscles
Most common form in women
Loss of urine while coughing, sneezing and exercising
Tx: kegal exercises

94
Q

Risk factors for kidney stones

A

Men, family history, poor fluid intake, dehydration, increased protein and sodium and sugar diets, overweight

95
Q

Meds that increase risk of kidney stones

A

Diuretics, antacids, indinavir, topiramate

96
Q

Meds for kidney stones

A

Alpha 1 blocker can be used to relax the muscles in the ureter to pass the stone

97
Q

Anemia sx

A

Usually only occur when hgb <10
Fatigue, HA, decreased exercise tolerance, poor school performance, learning difficulties
-Early sytolic murmur may occur

98
Q

Anisocytosis

A

Variation in RBC size

Increased if <15%

99
Q

Poikilocytosis

A

Variation in RBC shape

100
Q

Normal body response to anemia

A

Reticulocytosis

101
Q

Iron deficiency anemia labs

A

Early: decreased hgb, htc, total RBC, RDW >15%, decreased ferritin

102
Q

Typical adult dose of Fe

A

50-60mg BID 3-6 months

103
Q

What increases absorption of Fe

A

Vitamin C

104
Q

Folic acid deficiecy

A

Increased homocysteine and normal MMA
Tx: 1mg/day
Levels usually return to normal in 1 month

105
Q

Vit B12 deficiency

A

IM 100mcg monthly or PO 1000mcg/day
Usually resolves in 2 months
If neuro issues >6 months, most likely permanent

106
Q

Epi dosage for anaphylaxis

A

0.3-0.5mg adult or 0.01mg/kg child
Give in vastus lateralis (lateral thigh)
Repeat every 5-15 minutes up to 3 injections

107
Q

Alcohol withdrawal

A

Typically starts 12 hours after last drink and peaks at 24-48 hours
Sx: anxiety, depression, fatigue, irritability, jumpiness, mood swings, nightmares
Delirium tremens most serious presentation
Tx: benzodiazepines, beta blockers or clonidine for the tremors

108
Q

How to taper benzos

A

Decrease dose by 25% per week

109
Q

Opioid withdrawal

A

Htn, tachy, diarrhea, nausea, temp dysregulation, fever, papillary dilation, restlessness, myalgia, rhinorrhea
-Not life threatening
Tx: clonidine decreases sx

110
Q

Persistent depressive disorder

A

Low level of depression for at least 2 years in adults or 1 year in children

111
Q

Adjustment disorder

A

Grief >1-3 months

Tx: same as major depression

112
Q

Lethal dose of TCA

A

2 week supply in 1 dose

113
Q

Lethal dose of SSR

A

2 month supply in 1 dose

114
Q

SE SSRI

A

HA, nausea, diarrhea

Usually resolve in 2-6 weeks after use

115
Q

If ED occurs with SSRI

A

Switch to Wellbutrin, SNRI or TCA

116
Q

SE wellbutrin

A

HA, dry mouth, nausea, weight loss, insomnia

117
Q

Conditions that can mimic GAD

A

Thyrotoxicosis, alcohol withdrawal, abuse of sympathomimetic drugs (caffeine, amphetamines, cocaine)

118
Q

Benzos with lowest abuse potential

A

Hydrophilic (lorazapam) and long half life

119
Q

Effects of progesterone in BC

A

Decrease ovulation by decreasing LH, thickening endocervical mucus, hampering implantation by endometrial atrophy

120
Q

Effects of estrogen in BC

A

Ovulation inhibited by decreasing FSH and LH, and altering endometrial cell structure

121
Q

Benefits of COC

A

Decreased rates of benign breast tumors, dysmenorrhea, menstrual volume by 60%, endometrial, ovarian and colon CA, PID rates, acne, hirsutism, cysts

122
Q

Which BC methods do not interfere with AED drugs

A

Depo Provera and Nexplanon

123
Q

Patch and ring BC

A

Patch replace every week
Ring replace every 3 weeks
Increased risk of blood clots

124
Q

how long should you use depo

A

<2 years due to decreasing bone density

125
Q

Vilpristal

A

Ella
Progesterone agonist/antagonist–direct inhibitory effect on follicular development and ovum release
Can be used up to 5 days after unprotected sex

126
Q

Hormones in perimenopause

A

Estrogen normal and FSH elevated

127
Q

Avoid hormonal therapy in women with

A

Hx of CV disease, breast CA, uterine CA, VTE or active liver disease

128
Q

Alternartives to decrease hot flashes if HT CI

A

Low dose SSRI, SNRI, gabapentin

129
Q

Absolute CI to HT

A

Unexplained vaginal bleeding, acute liver disease, thrombotic disease, endometrial CA, breast CA

130
Q

Most common STI

A

Chlamydia

  • Sx: vaginal discharge, dysuria, dyspareunia, post coital bleeding
  • Incubation period 7-14 days
  • Friable cervix and mucopurulent discharge
  • Screen all women <25
  • Tx: Azithromycin 1 dose
  • Re-screen in 3 months
131
Q

Gonorrhea

A

incubation period 1-5 days
Sx: dysuria with milky to purulent discharge
-Tx: IM ceftriaxone and PO azithromycin

132
Q

Genital Herpes

A

HHV 2
Painful ulcerated lesion and inguinal lymphadenopathy + thin, profuse discharge sometimes
-Suppressive therapy decreases frequency of recurrence by 70-80%

133
Q

PID

A

Endometritis, salpingitis, oophoritis

  • Sx: lower abdominal pain, abnormal vaginal discharge, dyspareunia, fever, GI upset, abnormal vaginal bleeding
  • Cervical motion tenderness, uterine tenderness, adnexal tenderness
  • Increased ESR + CRP, Leukocytosis with neutrophilia
  • Tubal thickening with or without free pelvic fluid
  • Tx: Ceftriaxone IM + doxy for 2 weeks with or without flagyl
134
Q

Primary syphilis

A

Painless genital ulcer with clean base and indurated margins and localized lymphadenopathy
Tx: Benzathine Penicillin IM

135
Q

Secondary syphilis

A

Maculopaular rash involving palms and soles, generalized lymphadenopathy, low fever, malaise, arthralgia, myalgia

136
Q

Tertiary syphilis

A

Gumma, aortic insufficiency, aortic aneurysm, seizures

137
Q

Presbycusis

A

Progressive symmetric, high frequency, age related sensory hearing loss likely caused by cochlear deterioration

  • Speech discrimination usually primary problem
  • Limited ability to understand content of speech when in noisy environment
138
Q

Presbyopia

A

Problems with close vision

May have perception of washed out colors, difficulty seeing under low illumination, increased sensitivity to glare

139
Q

Macular degeneration

A

Leading cause of blindness
Loss of central vision
Hx of smoking and excessive sun exposure

140
Q

Pharmacokinetics

A

Absorption, distribution, biotransformation (metabolism), excretion

141
Q

Pharmacodynamics

A

What the drug does to the body

Does not change over lifetime

142
Q

Age related changes in regards to pharmacokinetics

A

Increased 1/2 life of drug, decreased gastric acid production, decreased GI blood flow, decreased gastric motility, decreased gastric emptying, decreased GI surface area, decreased hepatic blood flow and function of enzymes, decreased albumin, decreased GFR and lean muscle mass

143
Q

Risks of long term PPI use

A

Decreased absorption of iron, vitamin B12, etc.
Increased fractures due to decreased Ca absorption
Increased pneumonia and C. Diff

144
Q

Tx urge incontinence in elderly

A

Tolterodine or soliferiacin or mirabegron

-Oxybutynin has systemic effects

145
Q

Potentially treartable causes of urinary incontinence

A

DIAPPERS

Delirium, infection, atrophic vaginitis, pharm, psych, excessive urine output, restricted mobility, stool impaction

146
Q

Risk factors for pressure ulcers

A

High levels of moisture, increased age, decreased BP, smoking, increased body temp, lack sensory perception, weight loss, incontinence, dehydration

147
Q

Most common causes of delirium

A

DELIRIUMS
Drugs, emotional, low PO2, infection, retention of urine, ictal state, under nutrition, metabolic, myocardial problems, subdural hematoma

148
Q

Tx dementia

A

Cholinesterase inhibitors: donepezil, tacrine, rivastigmine, galantamine, memantine

149
Q

Pseudodementia

A

Dementia syndrome with severe depression

150
Q

Stages of human pregnancy

A

Fertilization: zygote
Up to 2 weeks: blastocyst
2-8 weeks: embryo
8-12 weeks to term: fetus

151
Q

Hegar sign

A

Softening of uterine isthmus

152
Q

Goodell sign

A

Softening of vaginal portion of cervix

153
Q

Chadwick sign

A

Blue violet vaginal color

154
Q

When is uterine fundus at umbilicus

A

20 weeks

155
Q

Recommended daily intake of iron when pregnant

A

1000-1300mg

156
Q

Quad screen includes

A

AFP, HcG, Inhibin A, unconjugated estriol levels

157
Q

Increased AFP can be due to

A

open neural tube defects, fetal nephrosis, cystic hydroma, fetal GI obstruction, omphalocele, IUGR, multiple fetus, fetal demise

158
Q

Decreased AFP can be due to

A

Trisomy 21 and 18

159
Q

Inhibin A

A

Produced by placenta

Increased in down syndrome

160
Q

Classic teratogenic period

A

Between 31 and 81 days following LMP

161
Q

What stage of pregnancy is bronchospasm worse for women with asthma

A

Between 29 and 36 weeks

162
Q

NSAIDs in pregnancy can cause

A

premature closure of ductus arteriosus

163
Q

Which SSRI is cat D

A

Paroxetine

164
Q

Cat B abx

A

Amoxicillin, cephalexin, cefpodoxime, cefixime, augmentin, nitrofurantoin (Avoid after 36 weeks)

165
Q

Pre-eclampsia risk factors

A

> 40, <16, first pregnancy with new partner, DM, collagen vascular disease, htn, family hx, multiple gestation

166
Q

HELLP

A

Pre-eclampsia
Increased LFT
Decreased platelets
Eclampsia

167
Q

Classic ectopic pregnancy triad

A

Abdominal pain, vaginal bleeding, adnexal mass

Tx: methotrexate or salpingostomy

Fitzgerald Review Book (2 decks)

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