DAY9 Flashcards
most immediate life threatening emergency?
- cough and green mucus
- cough and fever, chills, night sweats, chest pain with deep breath or cough
- cough and wheezing, SOB, unintentional weight loss
- cough and pink frothy sputum, SOB, noisy, bubbly bbreathing
- is pulmonary edema and the most immediate emergency
- bronchitis
- TB
- lung cancer
postural hyptension, orthstasis, head rush, dizzy spell, best time to check?
after standing 3 minutes
decline of >20mmhg in systolic or >=10 mmhg in diastolic after 3 minutes of standing
if a victim remain unresponsive….
diall 911 and start CPR
treatment of type 1 DM.. exception
- insulin replacemtn
- exercise
- healthy diet
- surgery
surgery..
Type 1 DM is not producing insulin
Type 2 secretion is inadequate..
increase temperature, increase heart rate, increase breathing, decreased blood pressure, muscle cramps headache, unexplained tiredness…
dehydration
treatments for emphysema..
smoking cessation
inhaled bronchodilators (B2 agonist ex albuterol)
corticosteroids
supplemental oxygen
thickening of the nipple and loss of elasticity…
- possible breast fibroadenoma
- suggests prolactinoma
- suggests breast cancer
- suggests insufficinet lactation
possibly prolactinoma… most likely benign tumor in anterior pituitiary increasing the hormone prolactin
CAD (coronary artery disease) vs CVD (cerebral vascular disease)
CAD: narrowing of artery in HT
CVD: stroke (brain)
sign of peripheral artery disease..
- pulse present
- ankle soreness
- intermittent claudication pain
- lower leg edema
- intermittent claudication pain..
lower leg edema is periperhal vascular disease affecting the veins
Hypoglycemia.. HE IS TIRED
HEadache Irritable Sweating Tachycardia Irritible Restless Excessive hunger Dizzy
which muscles are related to the HIP FLEXOR..
- iliopsoas
- Gluteus maximus
- Gluteus medius and gluteus minimus
- Adductor longus and brevis
iliopsoas.. contracting these muscles causes flexing.. also rectus femoris
extension - glueteus maximus
adduction - adductor longus and brevis
abduction gluteus medius and glueteus minimus
common side effect of Egotamine (migraines)…
- nausea, cold fingers and toes.. (it narrows blood vessels)
myalgia s/e statins
GI bleeding s/e nsaids
tinnitus s/e aspirin
flushing s/e niacin
sign of raynaud’s
fingers go from white, blue, red
bruerger’s disease is associated with use of…similar to raynaud’s in that it is diminished blood supply to hands and feet..
tobacco. .. (pics of black fingers with cigs)
which of the following is a generic name... 1. n-(4-hydroxyphenyl) acetamide 2. acetaminophen 3. tylenol 4 panadol
acetaminophen is the genric name
- chemical
3 and 4 are brand names
sildenafil (viagra) when used with this other drug increases the risk of potentially life threatening HYPOtension
Nitroglycerin.. both vasodilate
elevated triglyceride levels are associated with increased risk of heart disease.. can be a sign of metabolic syndrome.. it is associated with?
- pancreatitis
- alcoholism
- myocardial infarction
- malnutrition
it is associated with all of them except malnutriton Normal is less than 150.. borderline high is 150 to 199 high is 200 to 499 very high is >500
itching bloody nipple discharge with superficial erosion and ulceration
- ductal carcinoma (non invasive breast cancer)
- invasive ductal carcinoma
- invasive lobular carcinoma
- paget disease of the nipple
paget disease..<1% of breast cancer…redness of nipple, itchy, scaly
most commonly ignored early warning sign of lung cancer…
- persistent cough
- coughing blood
- weight loss and weakness
- clubbing of the fingernails
most commonly ignored…persistent cough
how to monitor effectiveness of iron therapy…
hemoglobin and reticulocyte levels (immature RBC)
adverse effect from salicylate (aspirin) except…
- ringing in the ears
- gastric ulcers
- increase risk of hemorrhagic stroke
- myalgia
myalgia..this is s/e of statins
ringing in the ears
gastric ulcers inhibits cox1 that is for gastric lining
increase risk of hemorrhagic stroke
corticosteroids are used forinflammation.. if used for a long time and stopped suddenly without a taper…
all of the following are adverse effects of corticosteriod long term use..
adrenal insufficiency
osteoporosis
exogenous cushings syndrome
hyperglycemia
increased skin fragility, easy bruising..
stopping with a taper would have the most impact on adrenal insufficiency
early signs of hypertension…
headache , spntaneous nosebleeds
sulfonamide is an …
antibiotic and has the s/e of sulfa allergies
adverse effect of B3…
facial flusing .. b3 deficiency causes pellagra.. dermatitis, diarrhea, dementia
parasympathetic (rest and digest) involved in the stimulation of…
pupil constriction… (pin point)..
sympathetic is.. brochodialation, increased heart rate, vasoconstriction.. (fight or flight)
communicable disease…
must be reported to the health department
NSAIDS work by inhibiting…
the formation of prostaglandins..
statins are..
HMG CoA reductase…
how does allpuroinal work…
this is for gout.. prevents the production of xanthine oxidase
combining Valium with antihistamines have what impact…
increases the central depressive effects.. s/e of antihistamines is drowziness
“more of the drug will be required to achieve the same effect in the future”
- tolerance
- physical dependane
- withdrawal symptoms
- addiciton
tolerance.. the effectiveness of the drug has decreased due to chronic administration.
dependant patterns of drug self administration without making a distinction between physical or psychological dependence..
addiction
alcohol abuse is associated with all of the following except…
- flushed face
- spider veins
- tremors
- palmar pallor
- suicides and violent acts
palmar pallor is not a side effect.. there is more redness in the body
permissible for a doctor to breach patient confidentiality..
concern for the safetyof other specific persons and with certain communicable disease
excessive use of cortiocosteroids can cause any of the follwing except.. moon face, buffalo hump hirsutism, easy bruising obesity. abdominal striae exophthalmos, goiter
exophthalmos, goiter is from grave’s disease.. hyperthyroidism
boas’s sign is located….
right scapula.. the phrenic nerve C3 C4 C5, goes to the diaphragm .. if GB is irritated that there will be a radiating pain to the shoulder area…
median nerve which is involved in carpal tunnel syndrome innervates.. except..
- Palmar aspect of the distal thumb
- palmar aspect of the index
- palmar aspect of the middle finger
- dorsal aspect of the distal middle finger
- palmar aspect of the little finger..
it does not include the little finger
normal adult mouths had how man permanent teeth..
32…
deciduous teeth is 20
transient ischemi attack (TIA) .. short lived or mini stroke.. in less than 60 minutes the symptoms are gone.. the least common symptom is…
- temporary loss of vision
- difficulty speaking
- weakness of one side of the body
- numbness and tingling
- impairment of consciousness
- amaurosis fugax
- aphasia
- hemparesis
- parasthesis..
5 is the exception
“curtain coming down vertically into thefield of vision in one eye”
amaurosis fugax (TIA)
cataracts.. clouded lens
glaucomo - open and closed angle
retinal disorders - problem with nerve in the back of the eye
macular degeneration - disease that destroys sharp and central vison (will start to complain of only seeing peripherally)
medical emergency that requires prompt advance life support…
V-fibrillation… this is the bottom part of the heart..they can flat line
A fibirillation - top part of the heart and is hasty pulse
ventricular tachycardia.. not treatment
first degree AV block.. between atrium and ventricular.. not treatment
electrical impulses move through AV node slower than normal. Heart rate and rhythm are normal. No treatment is generally needed.
first degree AV block…
2nd degree.. may need pacemaker wenchebach
2nd degree.. type 2 mobitz III
3rd degree… pace maker
impulses move.. SA node.. AV node.. bundle of hiss.. septum
tobacco smoking can cause…
lung cancer, bladder cancer, coronary artery disease, spontaneous abortion…
BUT not seizures
spinal disc herniation pain is worsened from…
coughing and sneezing
screening exam for a female over 50... exception.. general check up every year mammogram every other year pap smear every three years abdomina CT scan every year
no abdominal CT scan.. this is a lot of radiation..
symptomps of otitis externa (swimmers ear)…
ear pain, foul smelling discharge, itching and irritation around ear canal..
an inflammation of the outer ear and ear canal.. similar to otitis media and called an earache..
most commonly caused by pseudomonas aeruginosa and staphyloccoccus aureus
structure of the ear from internal to external…
semicircular canal and cochlea.. inner
eardrum and malleus and incus.. middle
ear canal … outer
test for thoraci outlet syndrome…raise arm, turn head and check pulse
Adson’s test..
Apley’s scratch test.. ROM
Drop arm test rotator cuff
speeds test .. beceps tendonitis
rotator cuff test... speeds test empty can test drop arm test lift off test
speeds test is for biceps tendoinitis
empty can test is for supraspinatus
drop arm test.. patient required to lower arm slowly without pain
lift off test.. similar to appleys test but for internal rotation
arm is flexed at elbow, supine, practioner bends arm with patient resisting.. pain is felt…
biceps tendon.. speeds test (also yergason’s test)
de quervain syndrom (pain on the tendons of the thumb side of the wrist)
finkelstein test..with thumb and ulnar and deviates the hand sharply)
carpal tunnel syndrome tests…
prayer test (reverse phalen), phalen test, tinels test
test for sciatic nerve compression…
straight leg raising test (lasegue’s test)
FABRE/Patrick - hip joint
obers test - IT band
lachman’s test - ACL
trendelenburg’s test - pushing leg out from the body…
test the gluteus medius which abducts the leg
Patricks test ?FABERE test…
used to assess pathology of the sacroiliac and hip joint, expecially for osteoarthritis of the hip Flexion AB duction External Rotation Extension
test to examine the length of the muscles involved in hip fexion…
Thomas test…
most accurate test for ACL stability..
Lachman’s test.. hold leg above and below and pull.. a soft endpoint is positive
tests for tears in the meniscus of the knee…
mcmurray’s test..
also valgus and varus test..valgus is for medial meniscus, varus is for lateral meniscus
characteristics of urine in a patient with Diabetes INSIPIDUS
diluted urine.. DIABETES INSIPIDUS.. imbalance of water and urine.. cause by damage to the hypothalamus or pituitary gland..
central diabetes insipidus involves a deficiency of..
VASOPRESSIN.. antidiuretic hormone ADN, fucntions are retain water in the body and constrict blood vessel..so the drink alot and pee alot
hamstring muscle is…
biceps femoris, semitendinosus, semimembransous..
Rectus femoris is the quad
quadricep muscles…
rectus femoris, vastus medialis, vastus intermedius, vastus lateralis…
most common fracture in a child is…
greenstick fracture.. because the bones of a child are more likely to bend then break the fracture is not complete..
suspected infant abuse is confimed with a..
skeletal survey
treatment for allergic reaction or anaphylaxis..
IM epinephrine, histamine blocker, steroid
2nd degree burns are characterised by…
red wet painful blisters…
4 th degree there is no pain because of the depth of the burn into the epitherlial layers
pink eye is..
viral conjuctivitis. and no treatment..
allergic conjunctivitis.. topical antihistamine
bacterila conjunctivitis.. antibiotics
chemical conjunctivitis.. irrigation
modaility for carotid stenosis and deep vein thrombosis…
duplex ultrasound … looks at blood vessels..
NOT CT, MRI, ULTRASOUND
radiology used for AAA, appendicitis, gallstones, scrotal pathology, pregnancy…
ultrasound..
Kidney stones use CT scan other wise uric acid stones will not show up
modality for esophageal obstruction..
barium swallow..
modality for brain/spinal tumor/infection, joint imaging, MS, osteomyelitis and spinal fracture..
MRI
radiology for head trauma, intracranial bleed, and nephrolithiasis..
CT scan without contrast.. (only way uric acid KD stones show up)
conductive hearing loss.. outer and middle ear…
cerumen impaciton, otitis externa, tumor or mass..
sensorinueral hearing loss..inner ear
otitis media, barotrauma perforation of the typanic membrane, presbycusis, drug induced
weber and rinne test…determine if conductive or sensorinural (inner ear) hearing loss…
by comparing air conduction to bone conduction..
incorrect match..
macule = flat
large cicumscribed solid located deep in tissue is a tumor..
pustule is circumscribed, elevated, purulent..
flat >.5 patch
elevated >.5 plaque
elevated, fluid filled >.5 bullae
hypertension..
grade 1 140 to 159/90 to 99
grade 2 160 to 179/100 to 109
grade 3 >180/>110
what lowers LDL and increases HDL (YEAH)
niacin (nicotinic acid)
statin lower ldl
cholesterol absorpiton inhibitors lower ldl
fibrates lower triglycerides
bie acid binding resins lower ldl
hypothermia is …
core body temperature <95 degrees.. normal is 98.6
DKA… ketoacidosis is a complication of…
TYPE 1 DM..
Type 2 complication.. hyperglycemi hyperosmolar state
euthanasia is legal in…
is not legal anyway.. physician assisted suicide is legal in some states.. Washington for example
GERD is lower esophaheal sphincter weakness .. rsik factors are..
alcohol, caffeine, chocolate..these decrease tone..
increased pressure comes from hiatal hernia, obesity, collagen vascular disease, pregnancy
crohn’s disease vs ulerative colitis.. (both are inflammatroy bowel disease)…
crohn’s … skip lesion…involves ileum.. nonbloody..
ulcerative colitis… involves the rectum.. bloody diarrhea.. continuous, unifor involvement with a lead pipe appearnce on imaging
lower GI bleeding vs Upper GI bleeding..
diverticulosis…
UGI..
peptic ulcer disease.. varices (from cihrosis of liver)…mallory-weiss syndrome (excessive vomiting)
IMPORTANT: ligament of treitz divide upper and lower
usually lower GI bleed but possibly severe upper GI Bleed…
heatochezia.. blood in the stool.. usually bright red and from lower GI bleed (hemmorhoids) but can come from upper GI bleed (above the ligament of treitz..
melena.. tarry black stool.. lower..
hematemesis is vomiting blood..
hematuria - blood in urine..
most common cause of cirrhosis in US…
alcohol abuse..
cirrhosis symptom is caused by portal hypertension…
liver cell dysfunction and portal hypertension (from cirrhosis)…
LV cell dysfunction.. spider angioma, gynecomastia, ascites..
Portal hypertension.. caput medusa (vein enlargement, esophageal varices, splenomegaly…
factors that cause increases homocysteine and increased methylmalonic acid (MMA).... 1 . folate deficiency 2. B12 deficiency 3. Iron deficiency anemia 4. thalassemia
folate deficincy.. normal MMA
B12 deficiency… increased homocysteine and MMA
Macrocytic anemia is increased homocyteine..
risk factor for renal cell carcinoma…
cigarette smoking.. (renal cell and bladder)
cervical cancer HPV infection first and then smoking also…
tumor markers for ovarian cancer…
CA125..
CA 19-9 pancreatic
CEA GI cancer, colon
AFP LV cancer, testicular
PSA prostate cancer
diagnosis for eating non nutritive non food substances…
PICA
temporary amnesia for one’s own identity.. and last for hours to days.. also sudden expected travel… wakes up somewhere far from home..
dissociative fugue
dissociative identify disorder.. multiple personality disorder previously..
using lithium what organs must be monitored…
renal thyroid..
narrow therapuetic index…
a narrow margin over or under will cause side effects… ex. Lithium
barking cough…
croup (laryngotracheobronchitis) - viral infection - wind pipe has a swollen airway..
pertussis.. whooping cough…
lead to life threatening airway obstruction…
CN10 - epiglottitis… bacterial infection, inflammation of epiglotis
mutation of the CFTR gene..
cystic fibrosis.. long term issues.. difficutly breathing, coughing up mucous, lung infections..
phagocytes for internal parasites…
parasites.. EOSINOPHIL…
neutrophil - most prominent.. bacteria, fungi, some viruses
lymphocytes - bcells and tcells
monocytes - ingest bacteria
eosinophils -
basophils - histamine and heparin reactions
most common benign breast disorders…
fibrocystic changes..med to moderate pain in brest +/- lumps.. fibroadenoma.. tumor intraductal papilloma mastitis abscess (complication from mastitis) fat necrosis - firm tender
most common tumor in mensturating women <25 years of age..
fibroadenoma. . small firm unilateral non tender mass, freely moveable and slow growing..
test: ultrasound.. 30% disappear..
