Final Exam Flashcards
1
Q
safe to give live vacc if CD4 is
A
> 200 for HIV pts
2
Q
tetanus and diptheria
A
booster every 10 years
3
Q
TDAP
A
safe in pregnancy, protect baby from whooping cough
4
Q
MMR
A
obtain titers, give in 2 doses if no immunity
5
Q
varicella
A
2 doses given 4-8 wks apart
6
Q
hep A and B
A
combo given in 3 doses at birth
1-2 mos and 406 mos
7
Q
MMR and varicella
A
live vaccines
not safe during pregnancy
8
Q
HPV
A
dead virus
give males and females starting age 13
9
Q
colon cancer screening
A
age 45 if no fam hx then every 10 years
10
Q
mammogram
A
yearly age 45-54
11
Q
pap smear
A
for cervical ca every 3 years starting age 25
-every 5 years for HPV
12
Q
when to test for TB
A
risk factors- travel, immigration, congregate living
13
Q
positive TB
A
5-15mm sometimes, >15mm always positive
14
Q
latent TB
A
skin test or quantiferon, will have neg cxray
-impaired immunity pts have higher risk of developing active TB from latent
15
Q
HLD screening
A
cholesterol every 5 years starting age 20
16
Q
Ezetimibe
A
lowers LDL
17
Q
Niacin
A
lowers TG, s/e headache and flushing, used for TG >250
18
Q
secondary causes of HLD
A
CKD, obesity, tobacco, alc
19
Q
BMI
A
25-29 overweight, >30 obese
20
Q
DM screening
A
annual aged 45 and older
-higher risk if belly >40 inches
21
Q
eye exam
A
2-4 years
22
Q
most preventable cause of disease in US
A
tobacco
23
Q
diagnosis of asthma
A
FEV1 <80% of predicted or FEV1/FVC <65%
24
Q
Asthma tx
A
- ICS, LABA, LAMA
- leukotriene modifiers
- biologics only for severe disease
25
monitor asthma pt
1-2 mos after starting then every 3-12 mos
| -within 1 wk exacerbation
26
pregnant asthmatics
monitor every 4-6 weeks
27
reversible airway obstruction
12% increase in FEV1 post- SABA tx
28
S/s pna
crackels, bronchial breath sounds, tactile fremitis, egophony, tachycardic
29
low risk pna
can be treated outpt
30
tx PNA
amoxicillin, doxy, macrolide
31
tx PNA with comorbidities
augmentin, cephalosporin/macrolide, doxy, or fluroquinolone
32
sarcoidosis
systemic disease affecting lungs in most cases
33
sarcoidosis s/s
fever, neuropathy, myopathy, blood dyscrasias, hypercalcemia
34
sarcoidsis cxray
bilateral hilar and right paratracheal lymph adenopathy
35
tx sarcoidosis
steroids or immunosuppressants
36
risk factor COPD
tobacco smoke, MJ, pollution, coal miners
37
s/s COPD
SOB, chronic cough, sputum, hx risk factors
38
diagnosis COPD
FEV1/FVC <0.7 after bronchodilator
39
COPD pts should be screened for
Alpha 1 antitrypsin
40
COPD tx
- SABA, LABA
- antimuscarinics- SAMA, LAMA
- ICS
- phosphodiesterase inhibitors
- methylxantines
- oral steroids
41
CAD risk factors
HTN, HLD, smoking, obesity, DM, stress
42
systolic CHF
< 40% EF
43
diastolic CHF
>40% EF
44
CHF risk factors
metabolic syndrome, doxorubicin, fam hx cardiomyopathy
45
stage A CHF
high risk but no structural dx or s/s
| ACEi or ARB, statin when indicated
46
stage b chf
structural dx without signs of HF
| ACEi, ARB, BB
47
stage c CHF
structural dx with current or prior HF
Treat comorbidities, diuresis, revascularization
Diuretics, hydralazine, isosorbide dinitrate, digoxin
Some need ICD, CRT, valve surg
48
stage D CHF
refractory, symptoms at risk, always in hospital
| LVAD, transplant, chronic inotropes, palliative, hospice, turn off ICD
49
CHF classes
o Class I: no limitations
o Class II: slight limitation of physical activity, no sx at rest
o Class III: Marked limitation of physical activity
o Class IV: Inability to carry on any physical activity without discomfort
50
chronic HF tx
Diuretics, ACE, ARB, aldosterone antagonist, BB
in selected pts
• Vasodilators- nitrates, BiDi
• Positive inotrope-Digoxin-monitor K+ levels
• Ivabradine (Corlanor)- not for ADHF or with bradycardia
• Sacubitril/valsartan (Entresto
51
left sided HF
backup into atria and pulm veins, pulm congestion and edema
52
right sided HF
backs into R atria and venous circulation- JVD, hepatomegaly, vascular congestion and peripheral edema
Main cause is RV infarct or PE, chronic pulm HTN
53
A-fib cHADs- stroke risk score
```
CHF history
HTN hx
Age >75
DM hx
Stroke or TIA symptoms previously
```
54
diabetes dx
A1C of 6.5 or higher
o FBG >126
o Oral tolerance test >200
55
prediabetes dx
o Impaired fasting glucose 100-125
| o A1C 5.7-6.4%
56
dysmetabolic syndrome
impaired fasting glucose, elevated triglycerides, low HDL, central obesity, inc BMI, HTN
57
LADA
latent autoimmune diabetes in adults, eventually requires insulin, usually non-obese
58
o Insulin resistance (inc BMI)
Biguanides, thizaolidinediones
59
o Insulin secretory defect
Sulfonylureas, meglitinides, insulin
60
o Excessive hepatic gluconeogenesis
Biguanides, GLP1, DPP4 inhibitors
61
o Excessive consumption of carbs
Alpha-glucosidase inhibitors, biguanides, DPP4
62
gestational DM
insulin resistance and carb intolerance
o Screening at 24 and 24 weeks
o BG >140 abnormal, BG >200 diabetic
o Treat initially with diet/exercise, then metform, glipizide, NPH, Humalog
63
a1c goal
7 or less
64
rapid acting insulin
novolog, apirdra, Humalog
65
short acting
```
regular insulin (Humulin R or Novolin R)
Onset less than 15 min, peaks at 1 hr
```
66
short and intermediate mix
novolin, Humulin
| Usually twice daily dosing
67
long acting
lantus, levemir, Tresiba
| Once or twice daily, peakless, steady release over 24 hrs
68
biguanides
metformin, first line DM2 tx
o Increase glucose uptake by muscle and fat
o Don’t use in renal insufficiency, CHF, sepsis, acidosis, hypoxia, AMI
o Interacts with OCPs, phenytoin, Ca channel blockers
69
sulfonylureas
glyburide, glipizide, glimepiride
o Caution in renal insufficiency and HF
o Elderly at risk of hypoglycemia from glyburide
70
Meglitinides
starlix (okay in renal insufficiency), expensive
71
Thiazolidinediones
pioglitazone and rosiglitazone, increase glucose uptake by fat/muscle
o Black box warning for CHF due to risk of peripheral edema and macular edema
72
• Alpha-Glucosidase inhibitors
- acarbose and miglitol, reduce glucose absorption from small bowel
o GI symptoms—GAS!
73
incretins
GIP, GLP1 (byetta, symlin, Victoza, Trulicity)
| o Stimulate pancreatic B cells to produce more insulin
74
DPP4 inhibitors
januvia, onglyza, tradjenta
o Enhance ability to secrete insulin by raising incretin levels
o Need to monitor renal fxn and dig levels
75
SGLT2 inhibitors
Invokana, Jardiance- reduce glucose reabsorption in kidneys
| o Don’t use in CKD, may increase dig levels
76
Meds causing hyperglycemia
o Corticosteroids, nicotinic acid, phenytoin, alpha interferon, thiazides, pentamidine, diazoxide, protease inhibitors
77
primary hyperparathyroidism
causes hypercalcemia, can cause parathyroid cancer
| o refer to endocrinologist, treatment is removal of gland or medical therapy
78
hypothyroid
```
o primary- most common type of hypo, high TSH, low T4
o subclinical- high TSH, normal T4
o secondary (central)- normal or low TSH, low T4
```
79
causes hypothyroid
autoimmune, iodine deficiency
80
treatment hypothyroid
thyroid hormone, goal is TSH 0.4-3.5 and free T4 0.9-2
81
s/s hyperthyroid
weak, tremor, heat intolerance, weight loss, active bowels, afib, menstrual dysfunction
82
causes hyperthyroid
pituitary adenoma, hyperemesis gravidarum, trophoblastic disease, thyroiditis
83
graves dx (hyperthyroid)
younger population, autoimmune
at risk- high iodine intake, stress, fam history
treatment- beta blocker
• tapazole (methimazole)
• PTU- more liver issues than tapazole, used in pregnancy
84
thyroid storm
life threatening, high fever, tachy, N/V, agitation, coma
85
cushings dx
-too much cortisol
central obesity, weakness, thin skin, facial obesity, bruising, buffalo hump
•
86
addisons dx
- too little cortisol
| - chronic fatigue, weakness, hypotension, hypoglycemia, hyperkalemia
87
PUD
-more common in duodenum
o Can be caused by NSAIDs, other A/C, H pylori
o Higher incidence in COPD, liver dx and renal failure
o Common cause of GI bleed
88
PUD tx
ranitidine, cimetidine, famotidine
89
PPI
inc risk of gastric ca, inc risk H pylori, s/e headache/constipation
90
GERD
o Can develop barretts esophagus- metaplastic columnar replaces squamous epithelium, higher risk of cancer
91
GERD tx
o Treatment- H2 blockers, antacids , avoid laying flat after meals
May need to escalate to PPI
92
GI bleeds can be caused by
SSRI, ASA, NSAIDs, other anticoag
93
primary HTN
essential HTN
| -unknown cause
94
secondary HTN
known cause such as thyroid disease, renin and aldosterone abnormalities, OSA, obesity, cushings, steroid use, hyperthyroid, hyperparathyroid, sympathomimetics
95
normal bp
<120/80
96
elevated BP
120-129 over <80
97
stage 1 HTN
130-139 / 80-89
98
stage 2 HTN
at least 140 over at least 90
99
hypertensive crisis
>180 over >120
100
first line tx for HTN
thiazide, ACEi, ARB, ca channel blocker
101
thiazide (chlorthalidone
monitor K, Na, Ca, uric acid, caution in gout pts
| Caution in diabetics cuz it can increase BG
102
ACEi- “prils”
don’t combine with ARB, increased risk of hyperkalmia in renal pts, may cause angioedema, avoid in pregnancy
103
ARB “-sartans”,
may use 6 weeks after stopping ACEi with angioedema
104
Ca channel blocker-
don’t use with HFrEF, caution in renal impairment
| “-dipine”, diltiazem, verapamil, don’t use with BB d/t risk of bradycardia
105
second line HTN tx
loop diuretics, K sparing diuretics, BB, renin inhibitors, alpha 1 blocker, direct vasodilators
106
Loop diuretics
best for HF and renal failure
107
o K sparing diuretics
avoid if GFR <45, amiloride, triamterene
108
aldosterone antagonist- spironolactone
Good for resistant HTN, primary hyperaldosteronism, K sparing
s/e impotence and gynecomastia
109
o BB- atenolol, metoprolol, bisoprolol
Only first line for ischemic heart disease or HF
| Avoid stopping suddenly
110
o Non-cardioselective BB
| Propranolol, nadalol
avoid with asthma, wean
111
o Direct renin inhibitor- aliskiren
long acting, don’t combine with ace or arb, more risk for hyperkalemia, good for pregnancy!
112
o Alpha 1 blocker
older adults at risk for ortho hypo
Doxazosin, prazosin, terazosin
Good for pts with BPH
113
Centrally acting- clonindine, methydopa
CNS effects, last line drug
114
HTN with comorbidities
<130/80
115
stage 2 HTN tx
rec two first line drugs
116
black HTN pts
ca channel blocker or thiazide
117
DM and HTN
ACE and ARB
118
target organ damage
o Dilated eye exam- hypertensive retinopathy
o Displacement of PMI
o Urine for proteinuria, GFR
119
DASH
low fat and low salt, rich K, Mag, Ca
120
risk factors for kidney stones
sedentary, high temps, diet with salt/animal fat/animal protein/leafy greens. Vasectomy, HTN
o occur because of obstruction, urinary stasis, infection, dehydration, increased ca and vit d, excessive excretion of uric acid, vit a deficiency
121
s/s kidney stones
renal colic, nausea, urinary frequency, hematuria, hx recent UTI
o diagnosis by UA with blood and visualization of stone by imaging
122
UTI- E coli or candida s/s
dysuria, frequency, hematuria, nocturia, lower back or suprapubic pain
o UA may show alkaline, elevated nitrates, leukocyte esterase, sediment of RBC/WBC/mucus
123
UTI tx
Ampicillin and sulfonamides
Nitrofurantoin- gram neg and gram pos cocci
Trimethoprim-sulfamethoxazole 3 day regimen
Fluroquinolones
• Don’t give during pregnancy
124
pregnant UTI
amoxicillin, nitrofurantoin or cephalexin
125
PTSD tx
cognitive behavioral therapy, sertraline and paroxetine, other SSRI
Prazosin to control nightmares
126
agent orange
Vietnam, southeast asia, korea, thailand
127
ionizing radiation registry
• Hiroshima or Nagasaki
128
gulf war registry
unexplained illness
129
other vet issues
open air burn pits, hep c, camp lejune water contamination
130
strep pharyngitis s/s
fever, tonsillar erythema, exudate, tender anterior cervical lymph nodes, sandpaper rash, acute onset
131
tx strep
PCN or azithromycin if allergy
132
acute sinusitis s/s
maxillary pain, poor response to decongestants, colored boogies, low grade temp
-caused by strep, H influenza, Moraxella
133
acute sinusitis tx
Bactrim, amoxicillin/augmentin, ceftin, macrolides (2-3 week treatment)
134
AOM tx
o pain management by Tylenol or ibuprofen
o amoxicillin or augmentin
o can do azithromycin if pcn allergy
135
mono s/s
fever, pharyngeal exudates, posterior cervical lymphadenopathy, petechial rash on palate
136
mono tx
supportive, monitor hepatosplenomegaly, may monitor LFTs, avoid strenuous activity and contact sports
137
geriatric syndromes
o Dysphagia, Incontinence, Sleep disorders, Delirium, Visual disturbances , Dizziness, Syncope , Gait disturbances, Falls, Osteoporosis, Pressure ulcers
138
aphasia
disorder of producing or understanding speech
139
apraxia
inability to execute a voluntary motor despite normal muscle function. Not related to lack of understanding or physical paralysis.
140
Agnosia
inability to recognize & identify objects or persons despite knowledge of characterisitcs.
141
alz stages
o Stage 1- short term memory loss, emotional changes, communication trouble
o Stage 2- worsening stage 1 issues, hallucinations, compulsive, repetitive behavior
o Stage 3- nonverbal, bedbound
o Typical course 7-10 years, can last up to 20 years
142
alz treatment
o Cholinesterase inhibitors- donepezil, rivastigimine, galantamine
o NMDA antagonists- memantine, gingko biloba, caffeine, nicotine
o Behavioral- antipsychotics, antidepressants, mood stabilizers
143
general anxiety disorder
excessive worry over 6 months about multiple concerns
Hyperarousal, insomnia
May have other comorbid mental disorders
Tx- short term benzos, SNRIS, SSRIs, buspirone, TCAs, cognitive behavioral therapy
144
depression
o Risk factors- adolescent and elderly, female, fam hx, chronic pain or stress
o Tx- SSRI, SNRI, DCAs
145
PTSD
lasts longer than 1 month after event, significantly affects personal life
o Tx- CBT, prolonged exposure therapy, SSRI, short term benzos
