Eent Flashcards
What do you see in the eye with hypertension?
That AV nicked my copper wire and burst into flames.
AV nicking.
Copper wire.
Flame hemorrhages
Cotton wool spots
What do you see in the eye with diabetes mellitus?
Blot had a micro amount of new cotton candy
Cotton wool spots.
Micro aneurysms.
Neuro vascular
Blot hemorrhage
In the eye what size are the retinal vessels and veins?
Arteries are brighter, red and narrow than veins with artery and vein having a 2 to 3 or 4 to 5 ratio
What does the Snellen eye chart mean?
2020 means that the patient can see at 20 feet with a normal person can see at 20 feet the larger the denominator of the poor of the patient’s vision.
Hyperopia
Farsightedness.
We’ll see in an older person
An example would be an older person, reading the newspaper, and having to move back the newspaper to view the words
Myopia
Nearsightedness, we’ll see in younger people
Presbyopia
Common after age 40, results and greater difficulty maintaining a clear focus at a near distance due to the lessening of flexibility of the crystalline, lens and weakening of the Solari muscle which controls Lens focus
Arcus senilis
Cloudy appearance of the cornea with a gray white arc or circle around the limbus due to deposition of lipid material the arcus has no effect on vision could indicate hyper lipidemia
Arcus senilis
Cloudy appearance of the cornea with a gray white arc or circle around the limbus due to deposition of lipid material the arcus has no effect on vision could indicate hyper lipidemia
Pterygium
Raised, wed shaped growth of thin, non-cancerous tissue over the conjunctiva normally seen in dry climates or surfers
HORDEOLUM or stye
Acute inflammation caused by staphylococcus aureus
Signs and symptoms include abrupt onset, accompanied with pain and erythema of the eyelid. Localized tender mass developing an eyelid.
Management, hot compresses for 10 minutes for two times a day. Next line if needed oral antibiotics for preseptal cellulitis, which include clindamycin, Bactrim, augmentin. Or cefdinir
CHALAZION
Be nodule on the eyelid, infection, or retention cyst of the meibomian gland usually on the upper eyelid.
Symptoms: swelling on the eyelid, eyelid, tenderness, sensitivity, to light, increase tearing, if very large may cause astigmatism due to pressure on the cornea.
Management, warm compresses, and referral for surgical removal
Blepharitis
Staphylococcus infection of seborrheic dermatitis of the lid edge
Signs and symptoms: red, scaly, greasy flakes. Thickened, crusted lid margins. Burning. Itching. Tearing.
MANAGEMENT, hot compresses. Topical antibiotics such as bacitracin or erythromycin. Vigorously, scrub lashes and lid margins with eyes closed and follow with thorough rinsing .
Conjunctivitis
Pink eye, resulting from allergies, chemical, irritation, bacterial, viral, or Gyno cockle or chlamydia infections.
What does bacterial conjunctivitis look like in symptoms and what is the treatment?
Purulent discharge.
Self limiting: antibiotic ointment are drops which include floxicins and mycins
If recurrent refer to ophthalmologist
What does gonococcal conjunctivitis look like? Is it an emergency? And what do you do?
Yes, it is an emergency.
The discharge is copious and purulent.
Referred to ophthalmologist, ceftriaxone 1 g IM plus azithromycin 1gm single dose
What is chlamydia conjunctivitis and what do you do?
Doxycycline 100 milligrams twice a day for 10 days or azithromycin 1gm single dose
What is allergic conjunctivitis look like and what do you do?
Stringy discharge, increase tearing.
Oral antihistamines, refer to allergist or ophthalmologist. Steroids are not ordered in primary care because of the possible increase intraocular pressure and activation of herpes simplex virus.
What does viral conjunctivitis look like and what do you do?
Watery discharge.
Symptomatic care: preservative, free, artificial tears, cool compresses with washcloth, and NSAIDS
What does herpatic conjunctivitis look like? And what do you do?
Bright red eyes and irritated.
Referred to ophthalmologist, treatment includes course of oral antivirals, such as aCyclovir and long-term follow up
When do you screen for glaucoma?
Recommended by age 40 by tonometry
What are the symptoms of open angle glaucoma?
Asymptomatic
elevated intaocular pressure.
Cupping of the disc,
Construction of visual fields
What are the signs and symptoms of closed angle glaucoma?
It is acute
Extreme pain.
Blurred vision.
Halos around lights*
Pupils dilated or fixed
What is the normal intraocular pressure
10-20
What is the treatment for closed angle glaucoma?
Diamox
Osmotic diuretics mannitol
Surgery
What is the definition of cataracts?
Clouding and opacification of the normally clear lens of the eye.
Highest cause of treatable blindness, most common surgical procedure in patience 65 and older is senile cataracts
What are the signs and symptoms of cataracts?
Painless
Clouded, blurred, or dim vision.
Halos around light.
Difficulty with vision at night.
Sensitivity to light and glare.
Fading yellowing of colors.
Double vision in a single eye.
The need for brighter light for reading and other activities.
No red reflex
Opacity of the lens
What are the sides and symptoms of retinal detachment?
Flashes of light PHOTOPSIA, especially in peripheral vision.
Floaters in the eye.
Blurred vision.
Shadow or blindness in a part of a visual field of one eye
REFERRAL for surgery
Otitis externa
Inflammation and or infection of the external auditory canal and or auricle and tympanic membrane
Symptoms of acute local otitis externa or furunculosis
Cause: staphylococcus aureus
Pustules in the outer third of the ear canal.
Severe pain otalgia with area of cellulitis
Itching
Erythema
Scaling
Crusting
Fishering
Possible exudates
What is the management for otitis externa?
Cleansing and debridement of the ear.
Topical OTIc drops: hydrocortisone/neomycin/polymyxin or Cortisporin ear drops
NSAIDs
What is the treatment for acute otitis media and serous otitis media if suspected bacteria
Augmentin or a cephalosporin such as cefdinir, cefpodoxime, or cefuroxime
When doing a Weber test with suspected conductive hearing loss where does the sound lateralizes to the affected ear or the unaffected ear?
Sound lateralizes to the affected ear
When doing a RINNE test which ear would be abnormal?
It would be abnormal in the affected ear, which means air conduction would be less than bone conduction
When doing a Weber test with suspecting SENSORINEURAL hearing loss where does the sound lateralize?
The sound lies to the unaffected ear
Rinne is only abnormal in the conductive hearing loss? True or false
True
Pharyngitis/ tonsillitis signs and symptoms
ANTERIOR CERVICAL ADENOPATHY-strep
MACULOPAPULAR RASH-strep
Lab test for pharyngitis/tonisillitis
Rapid strep
MONOSPOT
CBC
Antibiotics for strep infection
Penicillin V or amoxicillin
If allergic to PCN which drug would you chose for strep throat
Cephalexin
Cefadroxil
Clindamycin
Azithromycin
Clarithromycin
Mono is caused by which virus
Epstein Barr
Signs and symptoms of mono
POSTERIOR CERVICAL ADENOPATHY
WHITE TONISILAR EXUDATES
FEVER CHILLLS ANOREXIA
Which test do you do for mono?
Mono spot positive
Increase WBC with relative lymphocytosis and neutropenia
Which antibiotic do you use for bacterial sinusitis?
Augmentin or doxycycline if penicillin allergy
Impetigo describe and treatment
Honey colored crusts at the edge.
Infection of the skin classically caused by staph aureus
Primary lesion is a thin walled vesicle that breaks easily.
Treatment; mupirocin cream or ointment
If widespread can use oral abts: dicloxacillin, cephalexin, or clindamycin
Squamous cell carcinoma
They arise out of actinic keratoses
Firm regular popular or nodule.
Develop over a few months 3 to 7% metastasize.
Prolonged sun, exposed areas and fair skin people.
Keratotic, scaly bleeding
Treatment biopsy
Seborrheic keratoses
Benign, not painful lesions
Beige, brown or black plaques.
Stuck on appearance”
3 to 20 mm in diameter.
Treatment: liquid nitrogen
Actinic keratosis
Small patches occurring on some exposed parts of the body.
Premalignant lesions progressed to squamous cell carcinoma
Asymptomatic
Rough FLESH colored, pink or hyperpigmented
Basal cell carcinoma
Most common skin cancer.
Slow growing lesion, one to 2 cm after years.
Waxy, PEARLY, appearance may be shiny red
Central depression, or rolled edge.
May haveTelangiectatic vessels
Malignant melanoma
ABC DEE
Asymmetry.
Border irregularity
Color variation
Diameter, greater than 6 mm
Elevation.
Enlargement
Eczema also known as a topic dermatitis what does it look like and what is the treatment?
Chronic skin condition caused by intense itching.
Acute flareups look like red, shiny, or thicken patches.
Inflamed, scabbed lesions with redness and scaling.
Dry, LEATHERY lichenifications
Treatment: topical steroids CLOBESTASOL CREAM
Explosive onset of psoriasis, test for what?
HIV
Auspitz sign
Droplets of blood when scales are removed.
Seen in psoriasis
Treatment for psoriasis
For scalp: tar/salicyclic shampoo
Topical steroids- bethamethasone
UVB LIGHT EXPOSURE
Pityriasis Rosea description
Mild and acute inflammatory disorder.
More common and females during spring and fall.
Itchy rash found on trunk and proximal extremities.
HAROLD patch which is the initial lesion measuring 2 to 10 cm
Follows a Christmas tree pattern.
Eruption last 4 to 8 weeks
Laboratory and diagnostic test for PITYRIASIS ROSEA
Serology test for syphilis should be performed. If colon lesions are not itching, lesions are present on hands and feet, lesions are few and perfect.
Xanthelasma
Yellow plaques under eye from high cholesterol
What is the treatment for Lyme disease and Rocky mounted spotted fever
Doxycycline
What is the treatment for Lyme disease and Rocky mounted spotted fever
Doxycycline
What test do you do for limes disease initial and confirmatory
Initial test is the ELISA.
The confirmatory test is Western blot
What test do you do for Rocky mounted spotted fever
PCR
IHC staining
IFA
Physical findings in acute bronchitis
Upper airway Rhonchi cleared with coughing
Resonance to percussion normal
No evidence of lung consolidation
Physical findings in acute bronchitis
Upper airway Rhonchi cleared with coughing
Resonance to percussion normal
No evidence of lung consolidation
How to differentiate bronchitis from pneumonia?
Ask patient to cough into tissue when osculating will be clear with bronchitis, but not pneumonia
Hyper resonance to percussion is what diagnosis
COPD or asthma
Antibiotics used to treat acute bronchitis only for bacterial infections are?
Macrolides.
Doxycycline.
Bactroban
Is asthma broncoconstriction?
Yes
Signs and symptoms of asthma
Pulse greater than 110
Pulses, paradox greater than 12 mmHg (intrathoracic pressure)
Hyperresonance
Laboratory signs for asthma
Slight WBC elevation with esosinophillia
PFT reveal abnormalities typical of obstructive dysfunction
Initially respiratory alkalosis with mild hypoxemia on ABGs
Chest x-ray is unnecessary and less to rule out other conditions may show hyper inflation
Laboratory signs for asthma
Slight WBC elevation with esosinophillia
PFT reveal abnormalities typical of obstructive dysfunction
Initially respiratory alkalosis with mild hypoxemia on ABGs
Chest x-ray is unnecessary and less to rule out other conditions may show hyper inflation
Treatment for chronic bronchitis and emphysema or COPD
A: bronchodilator
B: LABA + LAMA
E: LABA + LAMA
— consider adding ICS if blood eosinophils greater than 300
Pneumonia, signs and symptoms and most common agent found in community acquired pneumonia
Streptococcus pneumoniae
Fever/chills
Purulent sputum
Lung consolidation in physical exam
Malaise
INCREASED FREMITIS
Atypical pneumonia signs and symptoms
(Walking pneumonia)
More ENT involvement
Cough.
Headache.
Sore throat.
Excessive sweating.
Fever
Soreness, of chest
Treatment for low severity outpatient CAP( healthy, no use of antimicrobials within the past three months, no core abilities or risk factors for Mersa or pseudomonas aeruginosa
One period amoxicillin 1 g TID or
Doxycycline 100 mg b.i.d. or macrolide such as azithromycin and clarithromycin
Treatment for moderate to high severity outpatient CAP includes patient with comorbiditues or risk factors for resistant organisms
- Augmentin or cephalosporin plus macrolide or doxycycline OR
- Mono therapy with levaquin 750 or moxifloxicin
Medication regimen for TB
Rifampin
Isonaizid
Pyrazinamide
Ethambutol
Person with HIV should be treated for 9 months
Shortest amount of time on drugs is 6 months
Patients taking ethambutol should be tested for___________ and ______ ______ ________-
Visual acuity and red green color perception
Chvostek sign
Hypothyroidism
Sustained cheek blinking
Trousseau
Hypothyroidism
Carpal pedal spasm from BP cuff
Trousseau sign
Hypothyroidism
Carpal pedal spasm from BP CUFF
Biguanide class
Metformin
Glucophage
Drug of choice for a starter drug for most patients with type two diabetes
Lowers basal and postprandial glucose levels by affecting glucose absorption and hepatic glucogenesis
Weight loss and reduce LDL’s
Discontinue one to two days before receiving contrast
GLP-1 agonist
Dulaglutide
Exenatide
Semaglutide (ozempic)
Semaglutide(Rybelsus) tablet
Black box warning- thyroid cancer and pancreatitis
Diabetic ketoacidosis
Symptoms
Seen in type 1 DM
state of INTRACELLULAR, dehydration, as a result of elevated blood glucose levels
Signs and symptoms include polyuria, polydipsia, weakness, fatigue, nausea, and vomiting, Kusum, all breathing, which is rapid breathing, altered level of consciousness, fruity breath, blowing off CO2, hypotension, and tachycardia poor skin turgor
Labs in DKA
BG- 250-300
Ketoanemia or ketonuria
Metabolic acidosis- less than 7.30
Elevated hct, BUN, cr, potassium and osmolality
HHS
Signs and symptoms
State of greatly elevated serum glucose, hyper, osmolality, and severe intracellular dehydration.
Seen in type two diabetes.
PolyuriA
Weakness
ALTERED LOC
HYPOTENSION
Tachycardia.
Poor skin TURGOR.
Labs and diagnostic in HHS
Greatly elevated serum glucose 600 to 1000
Hyper osmolality
Elevated Bun and creatinine
Elevated hemoglobin A1c.
Relatively normal pH
Normal anion gap
Which drug is used for symptomatic relief of hyperthyroidism
Propanolol 10 mg may go up to 80 mg four times daily
Treatment for hyperthyroidism
Tapazole 30 to 60 mg every day in three divided doses.
PROPYLTHIOURACIL – PTU– 300 to 600 mg daily and four divided doses.
Radioactive iodine 131 – I used to destroy goiters.
Thyroid surgery.
LUGOL solution 2 to 3 drops every day for 10 days
Hyperthyroidism lab values
TSH mostly low
Serum, T3, T4, thyroid, resin, uptake, and free thyroxine index increased.
Sometimes T4 is normal, but T3 is elevated 80 to 230
Hyperthyroidism lab values
TSH mostly low
Serum, T3, T4, thyroid, resin, uptake, and free thyroxine index increased.
Sometimes T4 is normal, but T3 is elevated 80 to 230
Hypo thyroidism laboratory values
TSH is elevated.
T4 is low or low normal.
T3 is decreased.
Signs and symptoms of hyper parathyroidism
Asymptomatic,
Fatigue,
Depression,
Bone, joint pain.
Muscle weakness
Anorexia vomiting.
Kidney stones
Laboratory values, and hyperparathyroidism
Elevated intact plasma parathyroid, hormone with elevated calcium and decreased phosphorus
What is the only known cure for hyper parathyroidism
Parathyroid ectomy
Signs and symptoms of hypo parathyroidism
Patchy hair loss,
Fatigue
Anxiety or depression.
Painful menstruation.
Horses or dyspnea.
Paresthesia in fingertips, toes, and or perioral
Tetany, and feet legs, arms, and or abdomen which are involuntary contractions or muscle cramps
Chvostek sign or trousseau sign
Laboratory value in hypoparathyroidism
Decrease calcium increased phosphorus, and a decrease in parathyroid hormone
Laboratory values in Cushing syndrome
High blood sugar, high sodium
low potassium
Leukocytosis.
Elevated plasma cortisol in the morning
What is the treatment for Cushing?
Depends on cause discontinue medication’s inducing symptoms, a transphenoidal resection of the pituitary adenoma.
Surgical removal of adrenal tumors.
Management of electrolyte balance
What are the laboratory values for Addison’s disease?
Hypoglycemia
Hyponatremia
Hyperkalemia,
Elevated ESR
Lymphocytosis.
Cosyntropin= to rule in or out addisons
Treatment for Addison’s
Mineral corticoid = androgen plus aldosterone
Hydrocortisone
fludroCortizone acetate
Which kind of ulcer is relieved by eating?
Duodenal
Which kind of ulcer is relieved by eating?
Duodenal
Which kind of ulcer does the pain worsen with eating?
Gastric
Which kind of ulcer happens with a physical finding of coffee ground emesis
Duodenal ulcer
Which kind of ulcer happens with a physical finding of coffee ground emesis
Duodenal ulcer
Long-term use of PPI is associated with which illnesses and what is the black box warning
B12 deficiency
Dementia
Cdiff
Chronic kidney disease.
Blackbox warning: increase incident of osteoporosis, specifically hip fractures
How long do you wait for an endoscopy after treatment of peptic ulcer disease?
8 to 12 weeks of treatment
H2 blockers end in
-dine
PPI end in
Prazole
H. Pylori treatment
TWO ABTS AND A PPI - 7-14 days of antibiotics and additional 6-8 weeks with PPI
MOC
AOC
MOA
Education for mucosal, protective agents, such as Pepto-Bismol, cytotec , Maalox, Mylanta, milk of magnesia include?
Give two hours apart from other medication‘s
What do you do if gastroenteritis is persistent longer than 72 hours or blood is noted in the stool
Stool for culture, WBC’s and ova and parasites.
Stool may be guiac positive if a bacterial infection is present
HBsAg, HBeAg, Anti-HBc, IgM
Active Hepatitis B
HBsAg, Anti-HBc, Anti-HBe, IgM, IgG
Chronic Hep B
Anti-HBc, Anti-HBs
Recovered Hep B
Anti-HAV, IgM
Active hep A
Anti-HAV, IgG
Recovered hep A
What do you order to differentiate prior exposure from current?
PCR
What lab will you have if successfully vaccinated from hepatitis b?
Anti-HBs- hepatitis b surface antibody
Anti-HCV, HCV RNA
Acute hep C
Anti- HCV, HCV RNA
chronic hepatitis c
Same as acute. Order pcr
Which quadrant is diverticulitis?
Left lower quadrant tenderness to palpation
Why is a plain abdominal obtained in diverticulitis and what are we looking for?
Looking for evidence of free air, which would indicate a perforation
What dietary consideration would indicate diverticulitis
Individuals with low dietary fiber intake
What is the Murphy sign and what would it indicate as a diagnosis?
Deep pain and inspiration while fingers are placed under the right rib cage and it would indicate cholecystitis
What is the Murphy sign and what would it indicate as a diagnosis?
Deep pain and inspiration while fingers are placed under the right rib cage and it would indicate cholecystitis
What is cholecystitis and what is it often associated with?
Inflammation of the gallbladder, associated with gallstones and 90% of the cases
What is cholecystitis and what is it often associated with?
Inflammation of the gallbladder, associated with gallstones and 90% of the cases
What are the signs and symptoms of cholecystitis?
Often after a large or fatty meal
Sudden appearance of steady, severe pain in the epigastric or right hypoChondrium
Vomiting in many clients afford relief
What are the signs and symptoms of cholecystitis?
Often after a large or fatty meal
Sudden appearance of steady, severe pain in the epigastric or right hypoChondrium
Vomiting in many clients afford relief
What are the physical findings in cholecystitis?
Murphy sign.
Right upper quadrant tenderness to palpation.
Fever
Muscle guarding and rebound pain
What are the physical findings in cholecystitis?
Murphy sign.
Right upper quadrant tenderness to palpation.
Fever
Muscle guarding and rebound pain
What are the Lab values in cholecystitis and what is the gold standard in effective image testing?
Elevated white count, Billy Rubin, AST, ALT, LDH, amylase.
Ultrasound is the gold standard
What is the management for cholecystitis?
NG tube
IV
G.I. consult
pain management
What is the definition of ulcerative colitis?
Idiopathic inflammation characterized by mucosal inflammation of the colon it involves the rectum and may extend upward involving the whole colon
What is the definition of ulcerative colitis?
Idiopathic inflammation characterized by mucosal inflammation of the colon it involves the rectum and may extend upward involving the whole colon
Signs and symptoms of ulcerative colitis
Bloody diarrhea is a hallmark symptom.
Rectal TENESMUS or the feeling like they have to have a bowel movement
Laboratory or diagnostics for ulcerative colitis
Stool studies are negative
Sigmoidoscopy establishes the diagnosis
Management for ulcerative colitis
Mesalamine(Canasa) suppositories or enema for 3 to 12 weeks.
Hydrocortisone, suppositories and enemas
What is often a sign and symptom of colon cancer
Changes in bad habits, specifically, thin stools, or ribbon stools that originate from the descending colon cancer.
Weight loss
Diagnostics for colon cancer
Stool may be guiac positive
Colonoscopy
CBC
CEA elevated
Non-smokers less than 2.5
Smokers less than 5
Which quadrant is the appendicitis in?
Right lower quadrant
McBurney’s point tenderness
1/3 the distance from the anterior superior iliac spine to the umbilicus
Acute appendicitis
McBurney’s point tenderness
1/3 the distance from the anterior superior iliac spine to the umbilicus
Psoas sign
Pain with right thigh extension
Only right thigh
Appendicitis
Obturator sign
Pain with internal rotation of flexed right knee
Positive rovsing sign
Right lower quadrant pain when pressure is applied to the left lower quadrant
What is suspected in appendicitis when the fever is very high
Perforation or another diagnosis
Tanner stage one for girls
Pre-adolescent breast
Tanner stage two for girls
Breast buds with Ariola enlargement
Tanner stage three for girls
Breast enlargement without separate nipple contour
Tanner stage three for girls
Breast enlargement without separate nipple contour
Tanner stage four for girls
Ariola and nipple project as secondary mound
Tanner stage five for girls
Adult breast: Ariola recedes, nipple retracts
Low grade squamous intraepithelial lesion
Cervical intraepithelial neoplasia (CIN) 1- HPV OR MILD DYSPLASIA
High grade squamous intrepithelial lesion
CIN 2: Moderate dysplasia
CIN 3: severe dysplasia
REFER PATIENT
High grade squamous intrepithelial lesion
CIN 2: Moderate dysplasia
CIN 3: severe dysplasia
REFER PATIENT
CIS
Carcinoma in situ
Trichomoniasis
Malodorous, frothy, yellowish green discharge, itchy, vaginal erythema, strawberry patches on cervix (colpitis macularis) and vagina, painful sex, painful urination
Bacterial vaginosis
Watery, gray, fishy, smelling discharge, vaginal spotting
Candidiasis
Thick, white, curd like discharge Vulvovaginal redness with itching
Testing for trichomonas, bacterial vaginosis, candidiasis
Microscopic wet prep may use NAAT or vaginal culture
Description of diagnostic testing with trichomonas
Normal saline mixture shows motile trichomonads low sensitivity, compared to culture
Description of diagnostic testing with bacterial vaginosis
Normal saline mixture shows irregularly shaped vaginal epithelial cells also known as clues cells: potassium hydroxide KOH added to culture produces characteristic odor also called the whiff test
Description of diagnostic testing for candidiasis
KOH mixture shows pseudoHyphae
Description of diagnostic testing for candidiasis
KOH mixture shows pseudoHyphae
Treatment for trichomonas
Metronidazole
500mg po for 7 days women
2gm orally x1 men
Treatment for bacterial vaginosis
Metronidazole 500mg x7 days
Or
Gel intravaginally x 5 days
Or
Clindamycin cream intravaginally at bedtime x 7 days
Or tinidazole orally or Clindamycin orally
Treatment for candidiasis
OTC ZOLE INTRAVAGINALLY OR
FLUCONAZOLE ORAL x1
Symptoms of pelvic inflammatory disease
Positive cervical motion, tenderness,
Adnexal tenderness- area over ovaries tenderness
Fever
Treatment of PID
Ceftriaxone 500mg IM plus doxy and metronidazole x 14 days
Or
Cefoxitin 2g IM with probenecid orally with doxy and metro x 14 days
If bleeding is uterine, determine the caused by the PALM – COEIN pneumonic
Polyps
Adenomyosis
Leo myoma
Malignancy and hyperplasia.
Coagulopathy.
Ovulatory dysfunction
Endometrial causes.
Iatrogenic causes next line not yet classified
Breast cancer, symptoms, and history
Non-tender painless mass.
Asymptomatic – later symptoms include pain, erythema, dimpling, ulceration, nipple retraction
Physical examination for breast cancer
One – nontender with poorly defined borders.
2 fixed and firm
3 may also find dimpling, nipple reactions, bloody discharge, lymphadenopathy
4 may have bloody nipple discharge
Intraductal papilloma
Benign and may have serosanguinous discharge from nipple
At what age do you start breast cancer screening and how often do you do it?
Screening will start at age 40 and will be annually for the ages of 45 to 54 and then every two years after the age of 55.
You can stop at age 75
What non-hormonal treatment is used in the symptoms of menopause?
Paroxetine 7.5 mg per day or SSRI ssnri
Why does anorexia lead to osteoporosis?
Because the excess exercise or eating disorder leads to amenorrhea, which leads to decrease amount of estrogen resulting in bone loss
What is the other name of osteopenia?
Low bone mass
When taking supplement for osteoporosis, which drug should you avoid?
Avoid aluminum containing antacids because the calcium binds with aluminum
What is the other name of a butterfly rash?
Malar rash
What is the management for lupus?
Sun protection.
Rest
NSaIDS, Hydroxycholoquines, glucocorticoids
Sensitivity
Positive shows positive
Specificity
Negative shows negative
Antibiotic for uncomplicated cystitis of lower UTIs
Macrobid 100mg bid x 5 days
Or
Bactrim bid x 3 days
Or
Fosfomycin 3mg x 1
Which drug can you not give a pregnant person after 36 weeks gestation for an uncomplicated UTI
Macrobid
During pregnancy which antibiotic should be considered for an uncomplicated UTI (4)
Amoxicillin, Augmentin, Macrobid under 36 weeks, Keflex
What is the other name of an upper UTI?
Pyelonephritis
Signs and symptoms of an upper UTI
Flank, low back or abdominal pain.
Fever and chills.
Nausea, vomiting.
Mental status changes in the elderly
Laboratory values for upper UTI
White blood cell cast seen on urinalysis
ESR elevated with pylon nephritis
Treatment for upper UTIs
Cipro 500 mg by mouth twice a day for seven days if uncomplicated
Levofloxacin
Ceftriaxone 1gm IV EVERY 24 hours for 14 days
Management for stress incontinence
Timed voids to prevent full bladder
Pessary.
Surgery
Management for stress incontinence
Timed voids to prevent full bladder
Pessary.
Surgery
Management for urge incontinence
Urge suppression/distraction.
Quick pelvic contractions.
Medication
Tanner stage one in boys
Pre-adolescent testes, scrotum, penis
Tanner stage one in boys
Pre-adolescent testes, scrotum, penis
Tanner stage two in boys
Enlargement of scrotum and testes: scrotum, roughens and reddens
Tanner stage two in boys
Enlargement of scrotum and testes: scrotum, roughens and reddens
Tanner stage three in boys
Penis elongates
Tanner stage three in boys
Penis elongates
Tanner stage four in boys
Penis enlarges in breath and development of glands; rugae appears
Tanner stage 5 in boys
Adult shape and appearance
What is the common cause of epididymitis in men less than 35 years of age?
Chlamydia
What are the symptoms of epididymitis?
UTI symptoms plus scrotal edema
Cremasteric reflex
Rub the thigh and scrotum goes up
Normal in epididymitis and absent in testicular torsion
Cremasteric reflex
Rub the thigh and scrotum goes up
Normal in epididymitis and absent in testicular torsion
Physical examination in epididymitis
Enlarged and tender epididymitis.
Urethral discharge may be evident positive PREHN sign
Diagnostic test for epididymitis
STD testing
Culture of urine
Scrotal ultrasound to rule out testicular torsion
Treatment for epididymitis
For a cute epididymitis, most likely caused by sexually transmitted, chlamydia and gonorrhea.
Ceftriaxone 500 mg Im times one + doxycycline 100 mg b.i.d. for 10 days
Can also use levofloxacin 500 mg oral once a day for 10 days
Acute bacterial prostatitis cause
Usually caused by gram-negative bacteria, especially E. coli.
Non-bacterial prostatitis, mostly in young men caused by chlamydia
Acute bacterial prostatitis cause
Usually caused by gram-negative bacteria, especially E. coli.
Non-bacterial prostatitis, mostly in young men caused by chlamydia
Signs and symptoms of acute bacterial prostatitis
Fever or chills
Low back pain
Dysuria.
Urgency, and frequency.
Nocturia
Physical examination of acute bacterial prostatitis
Edema of the prostate may be warm and tender or boggy to palpation and will have pain
Diagnostic testing for acute bacterial prostatitis
Urinalysis.
Urine culture as usually positive for causative agent
Treatment for acute bacterial prostatitis
Antibiotic.
Single dose ceftriaxone 250 mg I M or single-dose cefixime 400 mg orally or Cipro Floxin 500 mg orally twice a day for 10 to 14 days or level Floxin 500 mg to 750 mg oral daily for 10 to 14 days. Next line sits back three times a day for 30 minutes each treatment.
Which herbal agent is effective in BPH
Saw Palmetto
What would a physical examination of someone that has BPH look like
Bladder dissension may be present.
Prostate is nontender with either asymmetry or symmetrical enlargement.
Smooth, rubber consistency with possible nodules
What are the advanced stages of prostate cancer?
Bone pain
What are the physical examination of prostate cancer?
Adenopathy.
Bladder distention
Prostate palpate harder than normal with obscure boundaries and nodules may be present
Normal values of PSA
40-49- less than 2.5
50-59 less than 3.5
60-69 less than 4.5
70-79 less than 6.5
When does the sero conversion process of converting HIV negative to HIV positive happen to look like and how long does the process take?
Looks like flu like symptoms and an approximately takes three weeks to six months
Aids occurs when the CD4 count is what
Less than 200
What is the first test for HIV?
HIV 1/2 antigen/antibody combination immunoassay
If HIV 1/2 antigen/antibody combination immunoassay is positive, which test do you do?
HIV-1/HIV -2 antibody differentiation immunoassay
If HIV 1/2 antigen/antibody combination immunoassay is positive, which test do you do?
HIV-1/HIV -2 antibody differentiation immunoassay
What is the normal CD4 count
500-1200
What is the normal CD4 count
500-1200
Antibiotic for pneumocystis pneumonia and toxoplasmosis
Bactrim
Antibiotic for pneumocystis pneumonia and toxoplasmosis
Bactrim
Antibiotic for Mycobacterium avium
Azithromycin
Chancroid signs and symptoms
Women are usually asymptomatic. Next line men: single or multiple superficial PAINFUL ulcer, surrounded by edematous halo.
Ulcers may be necrotic or severely erosive
How to diagnose chancroid
Probable diagnosis is usually matter of exclusion.
Involves genitalia and unilateral bubo or both – swollen inguinal lymph node
Painful, genital ulcers in absence of herpes simplex virus with coexisting, tender, inguinal lymphadenopathy.
Treatment for chancroid
Azithromycin 1 g by mouth for one dose. Or
Rocephin 250 mg Im x1
Or
Cipro 500 mg BID for three days
Or
Erythromycin 500 mg three times a day for seven days
Signs and symptoms of chlamydia in women
Females often asymptomatic
Dysuria
Spotting
Postcoital bleeding
Dyspareunia
Vaginal discharge
Signs and symptoms of chlamydia and men
Dysuria.
Thick, cloudy penile discharge.
Testicular pain.
Rectal Tenesmus
Laboratory and diagnostic test for chlamydia
Nucleic acid amplification test NAAT to detect bacteria, DNA or RNA
Women – vaginal or cervical swabs optimal or first void urine
Men first void urine or urethral swab
Treatment for chlamydia
Doxycycline 100 mg BID times seven days
Alternatively – azithromycin 1 g PO times one dose or levofloxacin 500 mg daily times seven days
Genital warts (condyloma Acuminata) signs and symptoms
Single or multiple soft, fleshy, papillary, painless, keratinized, growth around anus, Vulvovaginal area, penis, urethra, or perennial
Genital warts- HPV 6&11
At what age do you give the Gardasil vaccine and how is it administered?
Given at age 15 to 45 years of age and given in three dose schedule at zero, two months, and six months
At what age do you give the Gardasil vaccine and how is it administered?
Given at age 15 to 45 years of age and given in three dose schedule at zero, two months, and six months
Signs and symptoms of gonorrhea in women
GG
Often asymptomatic
Dysuria.
Urinary frequency.
MUCOPURULENT VAGINAL DISCHARGE(green)
Lower abdominal pain
Fever
Dysmenorrhea
Signs and symptoms of gonorrhea in men
Dysuria
Frequency
White/yellow GREEN penile discharge.
Testicular pain
Laboratory testing for gonorrhea
NAAT using urine sample.
POC NAAT GeneXpert
Culture using modified THAYER – Martin media, Endo, cervical and females and urethral in male
Laboratory testing for gonorrhea
NAAT using urine sample.
POC NAAT GeneXpert
Culture using modified THAYER – Martin media, Endo, cervical and females and urethral in male
Treatment for gonorrhea
Ceftriaxone 500 mg IM for one dose less than 150 kg next line if chlamydia infection not ruled out doxycycline hundred milligrams POBID times seven days
HSV type one
Found on lips, face, and mucosa
HSV type two
Found on the genitalia
HSV 2 signs and symptoms
Headache, fever, bodyaches, malaise, joint pain.
First outbreak is usually the worst the first 2 to 3 weeks: reoccur with additional outbreaks, but less severe and shorter distance next line triggers, other viral, or bacterial infections, menstrual periods, stress
HSV 2 signs and symptoms
Headache, fever, bodyaches, malaise, joint pain.
First outbreak is usually the worst the first 2 to 3 weeks: reoccur with additional outbreaks, but less severe and shorter distance next line triggers, other viral, or bacterial infections, menstrual periods, stress
Laboratory test for HSV type one and type two
NAAT from lesion
Culture from lesion
Lymphogranuloma Venereum signs
2-3mm PAINLESS vesicle, bubo(swollen inguinal lymph node) or nonindurated ulcer
Regional ADENOPATHY follows in approximately one month and is the most common finding.
Stiffness and aching, and groin followed by unilateral swelling of the inguinal region
Treatment for LGV
Doxycycline 100 mg twice a day for 21 days
Alternatives.
Azithromycin 1 g once per week times three weeks or myosin 500 mg four times a day for 21 days
Molluscum Contagiosum signs and symptoms
Lesions1-5 millimeters, smooth, rounded, firm, shiny flash colored to PEARLY, white papules commonly seen on the trunk and anogenital region
Treatment for Molluscum Contagiosum
Cryo anesthesia with liquid nitrogen.
Symptoms of syphilis in the primary stage
Chancre present at the side of infection common at three weeks after exposure.
chancre indurated and painless
Regional Lymphadenopathy
Symptoms of syphilis in the primary stage
Chancre present at the side of infection common at three weeks after exposure.
chancre indurated and painless
Regional Lymphadenopathy
Signs and symptoms of syphilis in the secondary stage
Occurred 2 to eight weeks later.
Flu like symptoms.
Generalized lymphadeneopathy next line generalized MACULOPAPULAR RASH, especially on the palms and soles
Signs and symptoms of syphilis in Latent stage
Seropositive, but asymptomatic
Signs and symptoms of syphilis in the tertiary stage
Leukoplakia
Cardiac insufficiency
Infiltrated, tumors of the skin, bones, liver.
Central nervous system, involvement, such as meningitis, hemiplegia hemiparasis
Serology testing for syphilis
VDRL and or rapid plasma REAGIN
Confirmed with TREPONEMAL test, which is
-Treponema pallidum particle agglutination assay( TP-PA)
- Florescent treponemal antibody absorption (FTA-ABS)
- chemiluminescence immunoassay CIA
Treatment for primary, secondary, or early late syphilis
Penicillin G 2.4 million units in one dose
Treatment for penicillin in late latent or tertiary stage
Penicillin G 2.4 million units weekly times three weeks
If allergic to penicillin, what is the treatment for syphilis?
Doxycycline 100 mg b.i.d. for 14 days or tetracycline 500 mg four times a day for 14 days
Normal value for TIBC
250-450
Normal serum iron
50-150
MCH value
26-34
MCHC
32-36
Iron deficiency anemia description and lab value
Pica
Dyspnea with mild exercise
Weakness
Tachycardia
Labs
Low hemoglobin
Low hct
Low MCV
low MCHC
Low RBC
LIW SERUM IRON, ferritin
HIGH TIBC
HIGH RDW
What drug should not be taken with iron and which juice is better to take with iron because it increases absorption?
Antacids and juice that has vitamin C
Thalassemia labs and treatment
Decreased hgb
Low MCV
Low MCHC
normal TIBC
NORMAL FERRITIN
No treatment, RBC TRANSFUSION FOR MORE SEVERE CASES
Folic acid deficiency signs and symptoms
Fatigue.
Dyspnea on exertion
Glossitis – inflamed tongue/beefy
APHTHOUS ULCERS-stress ulcers on lips
Lab values for folic acid deficiency
Hct and hgb decreased
MVC increased
MCHC NORMAL
SERUM FOLATE DECREASED
Treatment for folic acid deficiency
Folate 1gm every day
Pernicious anemia signs and symptoms
Weakness
Glossitis
Palpitations
PositiveRomberg
Positive Bobinski
Loss of fine motor control.
Loss of vibratory sense
Pernicious anemia signs and symptoms
Weakness
Glossitis
Palpitations
PositiveRomberg
Positive Bobinski
Loss of fine motor control.
Loss of vibratory sense
Lab values for pernicious anemia
Hemoglobin, hematocrit, and RBCs decreased
MCV increased
Serum B12 decreased or less than 0.1
Anti-– IN anti-parietal cell antibody test firm a deficiency
Management of pernicious anemia
B12 100 IM daily times one week then maintenance shots every month
Sickle cell crisis symptoms
Sudden onset of severe pain in extremities, back, chest, and abdomen.
Aching joint pain.
Weakness.
Dyspnea
Lab values for sickle cell anemia
Hemoglobin decrease.
Peripheral smear show, classic distorted, sickle cell shaped.
Cellulose, acetate, and citrate a guard gel electrophoresis to confirm hemoglobin genotype
Polycythemia signs and symptoms and lab values
Fatigue.
Weakness
Visual disturbances.
Headache
Hemoglobin greater than 18.5 in men and greater than 16.5 in women
Management for polycythemia
Phlebotomy.
Aspirin.
Referral
Hemochromatosis signs and symptoms and treatment
Fatigue, joint pain, pain, and knuckles of pointer and middle fingers.
Get an iron panel test.
Management: iron chelation and do not eat food high in iron
Hallmark sign of acute lymphocytic leukemia
Pancytopenia with circulating blast.
All levels are low, including platelets, hemoglobin, and RBCs
What is the Hallmark sign of chronic lymphocytic leukemia?
Lymphocytosis or elevated WBCs
What is the hallmark sign of chronic myelogenous leukemia?
Philadelphia chromosome seen in leukemic cells
What are the signs and symptoms of leukemia?
Maybe asymptomatic
Fatigue
Weakness
Anorexia.
GENERALIZED lymphADENOPATHY
Weight loss
Lab values for leukemia
CBC with normal RBCs and neutrophil.
ELEVATED ESR.
A peripheral blood smear, usually distinguishes, acute and chronic leukemia, but a bone marrow aspiration is required to confirm the diagnosis
Stage one of lymphoma
Disease localized to a single lymph node or group
Stage one of lymphoma
Disease localized to a single lymph node or group
Stage two of lymphoma
More than one lymph node group involved, but confined to one side of the diaphragm
Stage three of lymphoma
Lymph nodes or the spleen involved, but occurs on both sides of the diaphragm
Stage three of lymphoma
Lymph nodes or the spleen involved, but occurs on both sides of the diaphragm
Stage four of lymphoma
Liver or bone marrow involvement
Non-Hodgkin’s lymphoma
Often presents with lymphadenopathy next line increased incident in elite 50s
Hodgkin’s disease
Younger lymphoma average age is 32 years old.
Usually presents with cervical adenopathy and spreads in a predictable fashion along lymph node groups.
Characteristic REED Steinberg cells differentiate from non-Hodgkin’s disease
TNM classification
T- 0-4
N-0-3
M-0/1
Meniscus tear characteristics
Locking
Giving away
Acute swelling- grapefruit size
Crepitus
Positive MCMURRAY
McMurray test
An audible/palpable click when the knee is raised slowly with 1 foot externally rotated (knee is flexed and then quickly straightened): and peas hand rest on the joint line: test is positive for medial meniscus injury
Lachman’s test
Drawer test to assess for anterior/posterior cruciate ligament tear
Place knee in 20 to 30° flexion, grasp leg with one hand with anterior force to proximal tibia to stress the ACL/PCL while the opposite hand stabilizes the thigh : grade 1+ to 3+ grade of displacement as an example of a positive positive test
Lachman’s test
Drawer test to assess for anterior/posterior cruciate ligament tear
Place knee in 20 to 30° flexion, grasp leg with one hand with anterior force to proximal tibia to stress the ACL/PCL while the opposite hand stabilizes the thigh : grade 1+ to 3+ grade of displacement as an example of a positive positive test
Apley’s grind test
Flex knee 90° with the patient PRONE put pressure on heel with one hand while rotating the lower leg internally and externally: pain or click is positive for medial or lateral collateral ligament damage and or meniscus injury
Grade one ankle sprain
Mild, localized, tenderness, normal range of motion, no disability
Grade one ankle sprain
Mild, localized, tenderness, normal range of motion, no disability
Grade 2 ankle sprain
Moderate/severe pain with weight-bearing: difficulty walking, swelling, and ecchymosis. Pain immediately after injury.
Grade 3 ankle sprain
Unable to ambulate, resist any emotion of the feet: egg shaped swelling within two hours of injury
Grade 3 ankle sprain
Unable to ambulate, resist any emotion of the feet: egg shaped swelling within two hours of injury
Diagnostics for bursitis
Aspiration with gram stain and culture and sensitivity.
WBC, if elevated suggested of bacterial infection
Plain x-ray is to rule out other bone/joint conditions
X-ray findings in osteoarthritis
Narrowing of the joint space
Osteophytes
Juxta-articular sclerosis
Subchondral bone
X-ray findings and rheumatoid arthritis
Joint swelling
Progressive, cortical thinning.
Osteopenia
joint space narrowing
Lab values elevated in rheumatoid arthritis
ESR
USUALLY ANA POSITIVE
What drug class is used for treatment of
Rheumatoid arthritis?
Disease, modifying anti-rheumatic drugs or DMARDS
Positive pelvic rock test
Screens for sacroiliac joint dysfunction: place hands on each of the anterior superior iliac, spines, and attempt to open and close the pelvis. The test is positive if the patient feels pain in either or both sacroiliac joints.
L3-L4 disk pathology
Quadriceps, muscles, weak, and or a trophic.
Pain, radiating into medial malleolus, numbness along the same path, especially medial aspect of the knee.
DIMINISHED or absent patella reflex.
Screening exam: have patient squat and rise
L4-L5 disk pathology
Weakness of the dorsiflexion mechanism of the great toe and foot.
Pain radiating into lateral calf: numbness of the dorsum of the foot and lateral calf. screening exam: have patient walk on heels of feet.
L5-S1 disk pathology
Weakness of the planter flexion of the great toe and foot
Pain along buttocks, lateral leg, and lateral malleolus: numbness to the lateral aspect of the foot and in posterior calf
DIMINISHED or absent Achilles reflex
Screening : have patient walk on toes
Osgood Schlatter disease
Painful limp with pain below the kneecap.
Pain is exacerbated with running, jumping, and climbing stairs
Medial tibial stress syndrome is also known as what
Shin splints
Finkelstein test
The hand is kept in a fist position with the fingers wrapped over the thumb. The wrist is moved up and down mimicking a handshake. If pain is felt, the test is positive for TENOSYNOVITIS.
De Quervain Tenosynovitis
Polymyalgia Rheumatica signs and symptoms
May be associated with temporal arthritis.
Stiffness in neck, shoulders, and hips.
Loss of range of motion in affected areas.
Fatigue, anemia, and mild fever
Polymyalgia Rheumatica signs and symptoms
May be associated with temporal arthritis.
Stiffness in neck, shoulders, and hips.
Loss of range of motion in affected areas.
Fatigue, anemia, and mild fever
Diagnostic labs and test for polymyalgia rheumatica
ESR
X-ray, as needed to rule out other conditions
Management for polymyalgia rheumatica
Cortical steroids.
Symptomatic management
Stable causality
It will always be this way
Stable causality
It will always be this way
Global thinking
Everything is ruined
Global thinking
Everything is ruined
Internal versus external causes
It’s all my fault
One of the two symptoms must be present along with five more symptoms in a two week period to represent major depressive disorder
Depressed mood most of the day, nearly every day or markedly diminish, interest, or pleasure in almost all activities, which is also also known as anhedonia
What are the five stages of grief?
Denial
Anger,
Bargaining
Depression
Acceptance
Tricyclics such as elavil , doxepin, nortriptyline have a black box warning of?
Prolonged QT
Which drug class causes a hypertensive crisis, if used with wine and cheese
MAOI
What are the three tests used for cellebellar function?
Romberg
Finger to nose test.
Heel to shin test
Cranial nerve pneumonic for motor or sensory
Some say Mary money, but my brother says big bras matter most
Cranial nerve 1
Olfactory smell
Cranial nerve 2
Optic
Vision
Cranial nerve 3
Oculomotor
Most EOMs,
Opening eyelids, pupillary construction
Cranial nerve 4
Trochlear.
Down and inward I movement
Cranial nerve 5
Trigeminal
Muscles of mastication, sensation of face, scalp, cornea, mucus, membranes, and nose
moving jaw
Cranial nerve 6
Abducens
Lateral eye movement
Cranial nerve 7
Facial
Move face, close mouth and eyes, taste, saliva and tears secretion.
Puff cheeks
Cranial nerve 8
Acoustic.
Hearing and equilibrium
Cranial nerve 9
Glossopharyngeal
Phonation, gag, reflex, carotid reflex, swallowing, taste. Gag reflex.
Cranial nerve 9
Glossopharyngeal
Phonation, gag, reflex, carotid reflex, swallowing, taste. Gag reflex.
Cranial nerve 10
Vagus
Talking, swallowing, general sensation from the carotid body, carotid reflex
Cranial nerve 11
Spinal accessory
Movement of the trapezius and sternomastoid muscles.
Shrug shoulders
Cranial nerve 12
Hypoglossal
Moves the tongue.
Tension, headaches, signs, and symptoms
Vice or tight quality
Usually generalized.
Maybe most intense about the neck or back of head next line no associated focal neurological symptoms.
Usually last several hours
Temporal area soreness
Migraine headaches are which cranial nerve
Cranial nerve five – trigeminal
Migraine signs and symptoms
Unilateral, lateralized throbbing headache that occurs episodically.
Throbbing
Positive neuroscience
Macy, stars, zigzag of light, or sparks, may have photophobia or phonophobia
Management of acute attack of migraine
Rest in dark quiet room
Simple analgesics taken right away to provide some relief.
Imitrex 6 mg subQ at onset may repeat in one hour for a total of three times per day next line
Imitrex 25 mg orally at onset of headache
Cluster headaches, signs, and symptoms
Unilateral. Around eye. Last about two hours. Pain occurring daily for several weeks.
Treatment for cluster headaches
If oral drugs unsatisfactory then inhalation of 100% oxygen may help
Imitrex 6mg SQ or other triptans
Amaurosis fugax
Ipsilateral monocular blindness
Altered vision
Amaurosis fugax
Ipsilateral monocular blindness
Altered vision
Homonymous hemianopia
Half vision
Simple partial seizure
No loss of consciousness.
Rarely last greater than a minute.
Motor symptoms often start in a single muscle group and spreads the entire part of the body.
Paresthesia, flashing lights, vocalization, hallucinations common
Simple partial seizure
No loss of consciousness.
Rarely last greater than a minute.
Motor symptoms often start in a single muscle group and spreads the entire part of the body.
Paresthesia, flashing lights, vocalization, hallucinations common
Complex partial seizure
Any simple, partial seizure, followed by impaired level of consciousness. May have aura, staring, automatisms such as lipsmacking and picking at clothing
Complex partial seizure
Any simple, partial seizure, followed by impaired level of consciousness. May have aura, staring, automatisms such as lipsmacking and picking at clothing
Absent or petite mal seizure
Sudden arrest of motor activity with blank stare. Commonly discovered in children/adolescence: begin and end suddenly.
Absent or petite mal seizure
Sudden arrest of motor activity with blank stare. Commonly discovered in children/adolescence: begin and end suddenly.
Tonic clonic or grand MAL seizure
May have aura.
Begins with tonic contractions, which are repetitive involuntary contractions of the muscle, loss of consciousness, then clonic contractions, which are involuntary contractions of the muscle.
Usually last 2 to 5 minutes
Incontinence may occur.
Followed by post ictal period
Tonic clonic or grand MAL seizure
May have aura.
Begins with tonic contractions, which are repetitive involuntary contractions of the muscle, loss of consciousness, then clonic contractions, which are involuntary contractions of the muscle.
Usually last 2 to 5 minutes
Incontinence may occur.
Followed by post ictal period
Status epilepticus
A seizure that lost longer than five minutes, or having more than one seizure within a five minute period without returning to normal level of consciousness.
Medical emergency
Status epilepticus
A seizure that lost longer than five minutes, or having more than one seizure within a five minute period without returning to normal level of consciousness.
Medical emergency
What is the most important test and determining seizure classifications
EEG
Maintenance drug for seizure
Carbamazepine( Tegretol)
Phenobarbital
Phenytoin( Dilantin)
Valproic acid (Depakene)
Myerson sign
Repetitive tapping over the bridge of the nose, produces a sustained blink response.
Glabellar reflex
Cullen sign
Periumbilical bruising indicating pancreatitis
Which of the following assessment findings is consistent with pheochromocytoma?
Hypertension
erysipelas
A tender, warm-to-the-touch, unilateral, raised, erythematous, patchy rash with clearly defined borders involving the pinna
uveitis
constricted pupil and haziness with anterior-chamber leukocytes on slit-lamp examination.
Red eye
uveitis
constricted pupil and haziness with anterior-chamber leukocytes on slit-lamp examination.
Red eye
lichen sclerosus
Genital pruritus and porcelain-white plaques with atrophic vulvar skin
A patient presents reporting severe paroxysms of pain that occur along the distribution of cranial nerve V while chewing, talking, or brushing their teeth. What is the first-line treatment for the suspected condition?
Carbamazepine (Carbatrol)
The Brudzinski sign
indicative of meningitis, but it consists of flexion of the hips and knees when supine with the neck flexed.
The Brudzinski sign
indicative of meningitis, but it consists of flexion of the hips and knees when supine with the neck flexed.
Kernig sign
the patient cannot fully extend the left knee while lying on their back with the left hip at 90°. The patient reports low back pain with this maneuver.
Meningitis
Age related macular degeneration
reports poor vision in low lighting, a decrease in central vision, and distortion of straight lines.
Age related macular degeneration
reports poor vision in low lighting, a decrease in central vision, and distortion of straight lines.
A 68-year-old patient presents with a 2-day history of a red right eye with pain, clear discharge, and photosensitivity. The nurse practitioner suspects herpes keratitis. Which of the following physical exam findings would best support this diagnosis?
Dendritic lesion on fluorescein exam
A 68-year-old patient presents with a 2-day history of a red right eye with pain, clear discharge, and photosensitivity. The nurse practitioner suspects herpes keratitis. Which of the following physical exam findings would best support this diagnosis?
Dendritic lesion on fluorescein exam
Which of the following assessment findings is consistent with lateral epicondylitis?
Pain elicited with wrist extension while the elbow is extended
Which of the following assessment findings is consistent with lateral epicondylitis?
Pain elicited with wrist extension while the elbow is extended
medial epicondylitis or golfer’s elbow.
Tenderness with palpation of the proximal wrist flexor muscles
medial epicondylitis or golfer’s elbow.
Tenderness with palpation of the proximal wrist flexor muscles
Myasthenia gravis definition
Auto immune disorder, resulting in the reduction of the number of acetylcholine receptors at the neuromuscular junction
Agnosia
the impaired ability to process sensory information, such as not recognizing things or people who were previously familiar.
Apraxia
involves difficulty performing motor tasks.
What is the first-line pharmacological treatment for COPD patients with minimal symptoms and no exacerbations leading to hospitalization according to the GOLD guidelines?
Long- or short-acting bronchodilator
Cataracts
worsening blurred vision. The patient reports no ocular pain
Diagnostic and labs for myasthenia gravis
Antibodies to acetylcholine receptors a ACHR – AB are found in the serum
Blumberg sign
Patients will often present with right lower quadrant (RLQ) abdominal tenderness. This pain is often made worse with the removal of pressure during the abdominal examination.
This sign is called rebound tenderness
Alzheimer’s is a deficiency in what?
Acetylcholine
Treatment for myasthenia gravis
PROSTIGMIN
Immunosuppressive.
Plasmaparesis
Definition of multiple sclerosis
Auto immune disease marked by numbness, weakness, loss of muscle, coordination, and problems with vision, speech, and bladder control.
The bodies immune system attacks, Mylin, Keith substance that serves as a nerve insulator and helps in the transmission of the nerve signals
Diagnostic testing for multiple sclerosis
MRI
CSF with a lumber puncture.
Blood test to rule out other causes such as infection
Treatment for Bell’s palsy
Prednisone 60 mg divided into 4 to 5 doses daily and tapered over 7 to 10 days
Acyclovir when Bell’s palsy is caused by varicella zoster infection
Lubricating eyedrop‘s and patch at night if unable to close
Trigeminal neuralgia definition and treatment
Nerve disorder that causes a stabbing or electrical shock like pain in parts of the face
Treatment include anti-seizure drugs, such as carbazepine, muscle relaxants such as soma or Flexeril and tricyclic antidepressants like amitriptyline
Trigeminal neuralgia definition and treatment
Nerve disorder that causes a stabbing or electrical shock like pain in parts of the face
Treatment include anti-seizure drugs, such as carbazepine, muscle relaxants such as soma or Flexeril and tricyclic antidepressants like amitriptyline
S1
Mitral/tricuspid. AV valves closure: aortic/pulmonic semilunar – valves open
S2
Aortic/pulmonic or semilunar valve closure: mitral/tricuspid or AV valves open
S2
Aortic/pulmonic or semilunar valve closure: mitral/tricuspid or AV valves open
. Between S1 and S2.
Systole
. Between S1 and S2.
Systole
Period BetweenS2 an S1.
Diastole
Period BetweenS2 an S1.
Diastole
Grade one murmur
Barely audible
Grade 2 murmur
Audible but faint
Grade 3 murmur
Moderately loud or easily heard
Grade 4 murmur
Loud : associated with a thrill
Grade 5 murmur
Very loud: heard with one corner of the stethoscope off the chest wall
Grade 5 murmur
Very loud: heard with one corner of the stethoscope off the chest wall
Grade 6 murmur
Loudest murmur
Mitral stenosis
Diastolic murmur. Loud S1 murmur, low pitched, mid diastolic : apical crescendo rumbling.
Mitral stenosis
Diastolic murmur. Loud S1 murmur, low pitched, mid diastolic : apical crescendo rumbling.
Mitral regurgitation
Systolic murmur at fifth intercostal midclavicular line (Apex)May radiate to base or left axilla: blowing or high-pitched may follow an S3
Aortic stenosis
Systolic, blowing, rough, harsh murmur at second right intercostal space usually radiating to the neck
Aortic regurgitation
Diastolic, blowing murmur at second left intercostal space
Where are the mitral murmurs usually located?
Fifth intercostal space aka Apex
Where are the aortic murmurs located?
Second or third ICS also known as base
Signs and symptoms of left heart failure
Acute
Dyspnea at rest
Overall long fields.
Wheezing, frothy cough.
Appears generally healthy, except for a cute event.
Three gallop.
Murmur of mitral regurgitation
Signs and symptoms of right heart failure
Chronic
JVD
Hepatomegaly, splenomegaly
Dependent edema, which is a result of increase capillary hydrostatic pressure.
Paroxysmal nocturnal Dyspnea
Appears chronically ill.
Fatigue on exertion.
S3 and or S4
Management for congestive heart failure
Sodium restriction.
Activity balance
Weight reduction
Pharmacological
1. Ace inhibitors are the standard of care.
2. Diuretics
3. Beta blocker
4. Entresto to get rid of fluid
5. Digoxin
Ace or arb
Ace better
Stage 1 hypertension
130-139 or 80-89
Stage 1 hypertension
130-139 or 80-89
Stage 2 hypertension
Sbp greater than 140 or DBP greater than 90
Management of blood pressure for non-African-American
Thiazide
Ace or arb
CCB
Management of hypertension for African-Americans
First line thiazide diuretics
Then calcium channel blockers
Management for hypertension in adults older than 18-year-old with chronic kidney disease
Ace
Do not use an ACE and ARB together because it could put you at risk for what?
Hyperkalemia
Continue to assess blood pressure__________ until goal is reached
Monthly
What is the benefit of thiazide type diuretics?
They are usually recommended for the first line treatment, and they may also protect against osteoporosis by reducing the amount of calcium expelled in the urine
Levine’s sign
Clenched fist sign describing angina
Prinzmetal angina
Variant/vasospastic: occurs at various times, including rest could show ST elevation in all leads with the treatment being calcium channel blockers
Prinzmetal angina
Variant/vasospastic: occurs at various times, including rest could show ST elevation in all leads with the treatment being calcium channel blockers
What is the treatment for prinzmetal angina?
Calcium channel blockers
What is the LDL goal for patients with diabetes or documented coronary artery disease?
Less than 70
What are the two high intensity statin therapies?
Atorvastatin 40 to 80 mg or
Rosuvastatin 20 to 40 mg
Lateral MI is shown on the EKG by peaked waves, ST elevation, Q wave development in which leads
I and aVL
Inferior MI is shown on the EKG by peaked waves, ST elevation, Q wave development in which leads
2,3, and aVF
Anterior MI is shown on the EKG by peaked waves, ST elevation, Q wave development in which leads
V leads( precordial) or V3 and V4
Anterior MI is shown on the EKG by peaked waves, ST elevation, Q wave development in which leads
V leads( precordial) or V3 and V4
Pericarditis signs and symptoms and physical findings are
Pericardial friction rub characteristically present.
Very localized, retro sternal, chest pain, politic nature.
Pain increased, deep, inspiration, coughing, swallowing, recumbent
Pain is relieved by sitting forward
Pericarditis signs and symptoms and physical findings are
Pericardial friction rub characteristically present.
Very localized, retro sternal, chest pain, politic nature.
Pain increased, deep, inspiration, coughing, swallowing, recumbent
Pain is relieved by sitting forward
What would an EKG look like in pericarditis?
ST elevation in all leads
Depression of PR segment highly indicative of pericarditis
What would an EKG look like in pericarditis?
ST elevation in all leads
Depression of PR segment highly indicative of pericarditis
What lab value would be increased in pericarditis
ESR
What is the treatment for pericarditis?
NSAIDS are the main state of treatment
Examples are indomethacin, Toradol, ibuprofen.
Antibiotics for cases of bacterial infection.
Cortical steroids are only indicated when there is a total failure of high dose and over several weeks with relapsing pericarditis
What is the treatment for pericarditis?
NSAIDS are the main state of treatment
Examples are indomethacin, Toradol, ibuprofen.
Antibiotics for cases of bacterial infection.
Cortical steroids are only indicated when there is a total failure of high dose and over several weeks with relapsing pericarditis
What are the signs of cardiac tamponade?
Hypotension, JVD, muffled/distant heart sounds, pulses paradoxus
What is the most definitive test for peripheral vascular disease?
Arteriography
But would also do ABI
What is the treatment for peripheral vascular disease?
Cilostazol(pletal) in combination with aspirin or plavix
Stop smoking
Walk to develop collateral circulation
Billings test
Cervical mucus test – record changes and cervical mucus spinnbarkeit over a 3 to 4 month period
Billings test
Cervical mucus test – record changes and cervical mucus spinnbarkeit over a 3 to 4 month period
Xulane warning
Increases the risk for serious cardio, embolic events, such as MI, CVA, PE
Which birth control can you take? If you are previous smoker, history of CVA, history of MI
DEPO- provera DMPA
Surgical abortion, vacuum, D and C
Up to 16 weeks after last menstrual period
Surgical abortion, D & E
After 14 weeks
What are the signs and symptoms of placenta previa?
Painless bleeding.
May occur immediately after vaginal intercourse
What are the signs and symptoms of placenta previa?
Painless bleeding.
May occur immediately after vaginal intercourse
What are the signs of abruptio placentae?
Severe abdominal pain.
Bright red bleeding is heavy if unconcealed
May be minimal to moderate bleeding if abruption is concealed
Uterus is rigid in concealed abruption
Fetal distress/absent fetal heart tones
Which ethnicity believes in hot and cold and wet and dry concepts
Hispanic/Latin X
Which ethnicity believes in hot and cold and wet and dry concepts
Hispanic/Latin X
Which ethnicity thinks illness may be caused by mal de ojo
Hispanic/Latin X
Which ethnicity believes that health is a result of forces that rule the world yin=cold yang=hot
Chinese
Which ethnicity believes that health is a result of forces that rule the world yin=cold yang=hot
Chinese and
Filipino
The office for civil rights enforces that HIPAA, which protects the
Privacy of individually, identifiable, health record, and HIPAA security rule which sets national standards for the security of electronic protected health information
Under title, one of HIPAA it protects health insurance coverage for workers and their family when the change or loss of jobs. What is that called?
COBRA
What is incident to billing?
Service bill under physicians provider number to get the full physician fee or 100% given the following rules.
The physician must perform the initial service and subsequent service of a frequency which reflects his or at her active participation in the management of the course of treatment.
Incident billing is not allowed in the hospital setting an NP must bill under his or her provider number
6 QSEN Initiative: quality, and safety education for nurses
Patient centered care.
Teamwork, and collaboration.
Evidence, base practice.
Quality improvement.
Safety.
Informatics
Veracity
The duty to be truthful
Justice
The duty to be fair
Fidelity
The duty to be faithful
Autonomy
The duty to respect and individuals thoughts, and actions
Utilitarianism
The right act is the one that produces the greatest good for the greatest number i.e. mass casualty
Utilitarianism
The right act is the one that produces the greatest good for the greatest number i.e. mass casualty
Nonmaleficense
The duty to do no harm
Beneficence
The duty to prevent harm and promote good
The highest level of evidence in research
Meta-analysis of random controlled trials
PICOT
Patient or population
Intervention, i.e. treatment
Comparison, i.e. control
Outcome, i.e. results.
Timing duration of the measure/data collected
Type one error
False positive: incorrectly rejecting the true null hypothesis
Type two error
False negative, failing to reject a no hypothesis, which is false
Meta-analysis
Test hypothesis by using a QUANTITATIVE study to systematically assess the result of previous research
Meta-analysis
Test hypothesis by using a QUANTITATIVE study to systematically assess the result of previous research
Meta synthesis
Analyzes data across QUALITATIVE studies in order to build new theories
CLAS
Culturally and linguistically appropriate service
It is established to help with communication with people that don’t speak English
Validity
The degree to which a variable measures what it is intended to measure
Incidence
The frequency with which a disease or disorder appears in a particular population or area at a given time the rate
Prevalence
Percentage. The proportion of a population that is affected by the disease or disorder at a particular time.
Prevalence
Percentage. The proportion of a population that is affected by the disease or disorder at a particular time.
