Final Exam ANP1 Flashcards
1
Q
FHypoglycemia can be defined as?
A
Blood glucose <60
2
Q
What are 9 things that can cause hypoglycemia?
A
Can occur with diagnosis of diabetes (typically type 1)
medication use
illness
skipping or delaying meals
increase in physical activity
excessive alcohol consumption
decrease in carbohydrate intake
insulin overproduction
hormone deficiencies (in children, the growth hormone).
3
Q
What is the criteria for level 1 hypoglycemia?
A
Glucose 54-70
4
Q
What is the criteria for level 2 hypoglycemia?
A
Glucose <54
5
Q
What is the criteria for level 3 hypoglycemia?
A
A severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia
6
Q
What are 5 sign/symptoms of a severe/emergent hypoglycemic event?
A
Visual disturbances, blurred vision
Confusion
Loss of consciousness
Seizures
Death
7
Q
What are 9 sign/symptoms of a mild/moderate hypoglycemic event?
A
Hunger
Shakiness
Irritability
Anxiety
Diaphoresis
Skin Pallor
Fatigue
Arrythmia
Crying out during sleep, Nightmares
8
Q
What are the top 5 ethnicities that are at risk for diabetes in children and adults?
A
African American
Latino
Native American
Asian American
Pacific Islander
9
Q
What BMI are Asian Americans considered obese therefore at higher risk for diabetes?
A
> 23
10
Q
What 3 medical conditions put you at greater risk for developing diabetes?
A
CVD
PCOS (Polycystic Ovarian Syndrome)
HIV
11
Q
What age group would you start screening for Diabetes?
A
Over 35
12
Q
What lipid levels would you test for diabetes?
A
HDL <35
Triglycerides >250
13
Q
In diabetic screening for adults would you screen if the patient has a 1st or 2nd degree relative with diabetes?
A
1st degree
14
Q
An adult that is inactive should be screened for diabetes T or F?
A
True
15
Q
The main criteria in screening for diabetes in children is?
A
Youth that are overweight or obese
16
Q
What are 2 screening criteria for diagnosing diabetes in children related to family history?
A
Maternal history of GDM
1st or 2nd degree relative with diabetes
17
Q
What are 4 medical conditions associated with a need for screening children for diabetes?
A
Acanthosis nigricans
HTN
PCOS
Small for gestational age birth weight
18
Q
At what age or stage should you screen children for diabetes?
A
10 or onset of puberty, whichever comes first.
19
Q
How often should you repeat screen for diabetes in children if their first screening is normal?
A
3-year intervals, more often if BMI increases
20
Q
What are the HgbA1C values for non-diabetic, pre-diabetic, and diabetic?
A
non-diabetic <5.7
prediabetic 5.7-6.4
diabetic > or = to 6.5
21
Q
What are the FBS values for non-diabetic, pre-diabetic, and diabetic?
A
non-diabetic <100
prediabetic 100-125
diabetic > or = 126
22
Q
What are the 2 hour glucose tolerance test values for non-diabetic, pre-diabetic, and diabetic?
A
non-diabetic <140
prediabetic 140-199
diabetic > or = 200
23
Q
What is the random blood sugar for diabetic?
A
> or = 200
24
Q
To make a definitive diagnosis of diabetes you need to have?
A
2 positive tests or 1 positive lab and be symptomatic
25
Treatment of severe/emergent hypoglycemia includes?
IV D50 (Dextrose 50g)
IM or SQ Glucagon 0.5-1mg
Monitor LOC
Continuous infusion of glucose
Food if tolerated
26
Treatment of mild/moderate hypoglycemia includes?
Eat or drink 15 grams of glucose or carbohydrates (1/2 cup of soda, juice, 1 tablespoon of honey, sugar)
Recheck glucose level in 15 minutes, if still low then repeat 15 grams of glucose or carbohydrates
Repeat steps until glucose level returns to normal
Eat snack if next meal is more than an hour away
27
What is necessary to prevent recurrence of hypoglycemia?
To determine and treat the underlying etiology
28
How are most children diagnosed with diabetes?
The initial presentation of DKA
29
Define Diabetic Ketoacidosis
High levels of blood acids called ketones are produced.
30
What are 9 contributing factors in diabetic ketoacidosis?
Illnesses
surgeries
infections
medications
illicit drug use
pregnancy
bleeding disorders
ischemic incidents
31
What signs/symptoms in DKA are severe/emergent?
Deep, rapid breathing (Kussmaul respirations)
Tachycardia
Hypotension, orthostatic
Alteration of consciousness, decreased alertness
32
What signs/symptoms in DKA are considered moderate?
Fruity breath odor
Abdominal pain
Nausea and vomiting
Headache
Muscle stiffness or aches
Flushed face
33
What signs/symptoms in DKA are considered mild?
Frequent urination
Excessive thirst
Dry skin and mouth
34
Testing for Severe/emergent or moderate DKA includes?
Point of care blood glucose testing
Urinalysis
Electrocardiogram
CBC
CMP or electrolytes
35
Testing for mild DKA includes?
Point of care blood glucose testing
Urinalysis
Complete blood count
Compete metabolic panel
36
What is a characteristic that applies to type 1 diabetes (DM1)?
Significant hyperglycemia and ketoacidosis results from lack of insulin
37
Heredity and obesity are major risk factors for which type of DM?
DM2
38
You consider prescribing insulin glargine (Lantus) because of its:
extended duration of action
39
The onset of lispro (Humalog) occurs in
less than 30 mins.
40
You see an obese 25 year old male with acanthosis nigricans and consider ordering
ESR
41
Hemoglobin A1C best provides information on glucose control over the past:
64-90 days
42
In caring for a diabetic patient, how often should you obtain a urine microalbuminuria measurement?
Yearly
43
T or F In Alcoholic ketoacidosis significant hyperglycemia is present?
False
44
A patient with alcoholic ketoacidosis is at risk for developing?
Torsades de Pointes
45
Treatment for alcoholic ketoacidosis in Severe/moderate emergencies includes?
IV fluids, dextrose and saline solutions
Thiamine before dextrose in alcoholic patients
Potassium replacement
Phosphate replacement
Magnesium replacement
46
Name 17 symptoms that can be see with hypothyroid disease.
Fatigue
Increased sensitivity to cold
Constipation
Dry skin
Weight gain
Puffy face
Hoarseness
Muscle weakness
Elevated blood cholesterol level
Muscle aches, tenderness and stiffness
Pain, stiffness or swelling in your joints
Heavier than normal or irregular menstrual periods
Thinning hair
Slowed heart rate
Depression
Impaired memory
Enlarged thyroid gland (goiter)
47
Myxedema Coma symptoms include? (6)
Hypothermia
Variable blood pressure, hypotension when advanced
Bradycardia
Hypoventilation
Peripheral edema
Mental status change, coma
48
Low TSH High T4
Hyperthyroidism
49
High TSH low T4
Primary Hypothyroidism
50
Low TSH Low T4
Secondary Hypothyroidism
51
Thyroid (T4) replacement medications and usual dose range?
Synthroid (brand)
Levoxyl
Levothyroid
Unithiroid
generic levothyroxine for all
75-125mcg of levothyroxine
52
What disease is a common cause of hyperthyroidism?
Graves Disease
53
Excess circulating hormone from the thyroid gland resulting in hyperfunction is considered?
Primary Hyperthyroidism
54
Excess production of thyroid releasing or thyroid stimulating hormones in the hypothalamus and pituitary is considered?
Secondary Hyperthyroidism
55
Name 16 signs and symptoms of Hyperthyroidism.
Unintentional weight loss
Tachycardia
Arrhythmia
Palpitations
Increased appetite
Nervousness, irritability, anxiety
Tremors
Sweating
Changes in menstrual patterns
Increased sensitivity to heat
Changes in bowel habits, frequent bowel movements
Enlarged thyroid gland (goiter)
Fatigue, muscle weakness
Difficulty sleeping
Skin thinning
Fine, brittle hair
56
Name 18 signs and symptoms of Thyroid Storm.
Agitation
Change in alertness, consciousness
Seizure
Confusion
Diarrhea
Abdominal pain
Jaundice
Increased temperature
Tachycardia, palpitations
High systolic/low diastolic
Arrhythmia
Elderly:
Congestive heart failure
Atrial fibrillation
Restlessness
Shaking
Sweating
Weakness
Fatigue
57
Excess circulating thyroid hormone originating from any source is known as?
Thyrotoxicosis
58
A rare hypermetabolic state induced by excessive release of thyroid hormones that is acute, severe, and life threatening is known as?
Thyroid Storm
59
What is the most common precipitating cause of thyroid storm?
Infection
60
Treatment for Hyperthyroidism which is usually ordered by the Endocrinologist includes?
Anti-thyroid medication
Radioactive iodine
Beta blockers
Surgery, thyroidectomy
61
Hypothyroidism most often develops as a result of:
Autoimmune thyroiditis
62
Physical exam findings in patients with Graves’ disease include:
Eyelid Retraction
63
Thyroid stimulating hormone is released by the:
Anterior lobe of the pituitary
64
TSH of 24; free T4 of 3 is indicative of
Hypothyroid
65
TSH of <0.15; free T4 of 79 is indicative of
Hyperthyroid
66
Chronic, insufficient production of the hormones cortisol and aldosterone from the adrenal gland is known as?
Adrenal Insufficiency (Addison’s Disease)
67
Primary insufficiency is caused by?
Intrinsic adrenal gland dysfunction
68
Secondary insufficiency is caused by?
Inadequate adrenocorticotropic (ACTH) production due to hypothalamic-pituitary dysfunction.
69
What condition can be caused by a sudden withdrawal of oral steroids?
Adrenal Crisis
70
What is adrenal crisis?
An acute life threatening condition where there is a reduction of cortisol production.
71
What are 12 signs and symptoms of Adrenal insufficiency?
Extreme fatigue
Weight loss and decreased appetite
Darkening of the skin (hyperpigmentation)
Low blood pressure, even fainting
Salt craving
Low blood sugar (hypoglycemia)
Nausea, diarrhea or vomiting (gastrointestinal symptoms)
Abdominal pain
Muscle or joint pains
Irritability
Depression or other behavioral symptoms
Body hair loss or sexual dysfunction in women
72
What are 9 signs and symptoms of Adrenal Crisis?
Severe weakness
Confusion, delirium
Pain in lower back or legs
Severe abdominal pain, vomiting and diarrhea, leading to dehydration
Reduced consciousness or delirium
Low blood pressure
Circulatory collapse
Dehydration
High potassium (hyperkalemia) and low sodium (hyponatremia)
73
What is the treatment for Adrenal Insufficiency?
Hydrocortisone - Cortisol replacement
74
Which of the following is a mineralocorticoid?
A. Cortisol
B. Aldosterone
C. Insulin
D. Hydrocortisone
B. Aldosterone
75
A 40 year old man presents to the ED in acute adrenal crisis, and is experiencing nausea, vomiting, hypotension. Cyanotic and confused. Treatment is an injection of:
A. Epinephrine
B. Insulin
C. Adrenaline
D. Hydrocortisone
D. Hydrocortisone
76
Signs and symptoms of Hypercalcemia?
Increased thirst
Bone Pain
Muscle weakness
confusion
fatigue
upset stomach
nausea /vomiting
Constipation
77
A condition in which one or more of your parathyroid glands become overactive and release (secrete) too much parathyroid hormone (PTH) is known as?
Hyperparathyroidism
78
SIGECAPS Pneumonic
Sleep: insomnia or hypersomnia
Interest: reduced, with loss of pleasure
Guilt: often unrealistic
Energy: mental and physical fatigue
Concentration: distractibility, memory disturbance, indecisiveness
Appetite: decreased or increased
Psychomotor: retardation or agitation
Suicide: thoughts, plans, behavior's.
79
What are the rules of 7's in Major Depressive Disorder (MDD)?
1 in 7 persons with MDD commit suicide
70% of suicides have seen a PCP within 6 weeks
7th leading cause of death
80
Name 8 disorders that may cause depression.
CHF
Diabetes
Anemia,
Asthma
Hypothyroidism
Menopause
Chronic Diseases
Cancer
81
Name 6 drugs that may cause depression.
Antihypertensives
Corticosteroids
Hormones (progesterone and prednisone)
Antianxiety (Valium)
Birth Control Pills
GI (Reglan)
82
Criteria for diagnosis of major depressive disorders per DSM-V
Must have 5+ of following symptoms during two weeks (must include either depressed mood or anhedonia) in addition to:
Weight loss/gain
Increase/decrease in sleep
Increase/decrease psychomotor activity
Loss of energy
Feeling of guilt
Decreased ability to concentrate
Suicidal ideation/suicidality
83
DIGFAST pneumonic
Distractibility - poorly focused, multitasking
Insomnia - decreased need for sleep
Grandiosity - inflated self esteem
Flight of Ideas - complaints of racing thoughts
Activity - Increased goal directed activities
Speech - pressured or more talkative
Thoughtlessness - risk taking behaviors (sexual, financial, travel, driving)
84
What psychiatric medication can cause a rash that can lead to Stevens-Johnson Syndrome?
lamotrigine (Lamictal)
85
7 Common Disorders That May Cause Anxiety
Hyperthyroidism
Asthma
Alcoholism
Hypoglycemia
Delirium
Cardiac arrhythmia
MVP
86
5 Drugs That May Cause Anxiety
Amphetamines
Caffeine
Steroids
Appetite Suppressants
Drugs (street)
87
Criteria for diagnosis of schizophrenia per DSM-V
2+ symptoms must be present for one month and at least one must be 1., 2. or 3.:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized behavior
5. Negative symptoms
88
A screening tools that is used at every office visit for depression.
PHQ-9
89
A screening tools that is used for anxiety (General Anxiety Disorder), PTSD, Panic Disorder, Social Phobia.
GAD-7
90
A patient presents with symptoms ranging from Mild depression to Hypomania what type of bipolar is this?
Cyclothymia
91
A patient presents with symptoms ranging from major depression to Hypomania what type of bipolar is this?
Bipolar Type 2
92
A patient presents with symptoms ranging from Major depression to Mania what type of bipolar is this?
Bipolar Type 1
93
Name 5 SSRI's used to treat depression.
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil, Pexeva)
Sertraline (Zoloft)
94
What are some side effects associated with SSRI'S?
Nausea
Agitation
Sexual Dysfunction
Weight Gain
Insomnia
Hyponatremia
95
What SSRI is linked to the risk of dementia?
Paroxetine
96
What SSRI has a high risk of causing QTc prolongation?
Citalopram
97
What SSRI has an increased risk of problematic withdrawals and is harder to wean a person off of?
Paxil
98
Trazodone name 5 side effects.
Nausea (5-HT)
Priapism (α1)
orthostatic hypotension
headache
blurred vision
99
Circumscribed area of change in normal color, with no skin elevation or depression; may be any size is a?
Macule
100
Solid, raised lesion up to 0.5 cm in greatest diameter is a?
Papule
101
Similar to papule but located deeper in the dermis or subcutaneous tissue is a?
Nodule
102
What is the first line treatment for pyelonephritis?
Fluroquinolone to include
Ciprofloxacin 500 mg po BID X 7 days
Levofloxacin 750 daily x 7 days
2nd line is Bactrim DS 1 BID x 10-14 days
103
What assessment finding can you expect in a patient with pyelonephritis?
Positive CVAT
104
Signs and symptoms of pyelonephritis can include (7)
UTI
Fever
Chills
Nausea
Vomiting
Back or Flank Pain
Hematuria
105
Pyelonephritis usually presents at what age range in women?
18-40 years
106
Preferred treatment for UTI includes
Macrobid 100 mg BID x 5 days (best for pregnant women)
Bactrim DS 1 BID x 3 days
107
The preferred treatment for Epididymitis is?
Rocephin 500 mg IM x 1 and
Doxycycline 100 mg po bid x 10 days
Males >35 having anal sex Rocephin 500mg IM x 1 and
Levaquin 500 mg po x 10 days
Scrotal elevation and NSAID's
108
What are 2 scrotal conditions that have a positive cremasteric reflex?
Epididymitis
Torsion of appendix of testis
109
This scrotal condition has a negative cremasteric reflex.
Testicular torsion
110
In males <35 years old the most common pathogen is?
Chlamydia and Gonorrhea
111
What condition appears with a blue dot as a Key feature?
Torsion of appendix of testis
112
Which scrotal condition has a gradual onset of pain?
Acute Epididymis
113
Which scrotal condition is associated with trauma?
Testicular torsion
114
Which scrotal condition presents with nausea and vomiting?
Testicular torsion
115
Which scrotal condition presents with fever and dysuria?
Acute Epididymis
116
What is the preferred imaging study for scrotal pain?
Testicular ultrasound
117
What is the leading cause of acute scrotal pain in children?
Torsion of appendix of testis
118
The 3 most common pathogens in acute prostatitis.
E. Coli
Pseudomonas
Klebsiella
119
What STI presents as a single painless lesion 10-21 days after being infected?
Syphilis
120
The preferred treatment for syphilis is?
Penicillin shot 2.4 g
121
The most common STI in the USA?
Chlamydia
122
In women the most common pathogen that causes Bartholin gland abscess is?
0
123
First line treatment for Chlamydia is?
Doxycycline 100 mg BID x 7 days
124
What is the most common pathogen in female UTIs?
E. coli
125
Is E. coli a gram negative or gram positive bacteria?
Negative
126
What is the treatment of the female UTI?
Bactrim DS 1 tab PO BID x 3 days or Macrobid 100mg PO BID x 5 days.
127
After how many UTIs would you refer your patient to the urologist?
3 infections in a 6 month period
128
What is a telltale symptom of vulvovaginitis?
External burning
129
How does atrophic vaginitis present?
Thin, dry, pale mucosa
130
What findings will present and in what population is significant for interstitial cystitis?
UTI symptoms but UA is negative and seen in middle aged women
131
What are the 4 pathogens associated with pyelonephritis?
E. coli, Klebsiella, Proteus mirabilis, Enterobacter
132
What is the second most common disorder in children?
UTI
133
Name 4 clinical presentations of UTI in infants.
Fever, irritability, failure to thrive, loss of appetite
134
How can UTIs present in toddlers?
abdominal pain
135
What are two congenital malformations in children that can lead to UTIs?
dysplastic kidney and hydronephrosis
136
What is a major structural abnormality associated with UTI and kidney damage?
Vesicoureteral reflux (VUR)
137
What is the treatment for an uncomplicated UTI in pediatrics?
Cephalexin 50mg/kg/day PO divided TID or Bactrim 4-5 mg/kg PO BID for 7-10 days
138
What are 3 pathogens that make up most of the vaginitis infections?
Trichomonas vaginalis, Candida, and bacterial vaginosis (BV)
139
What are 5 complaints in vaginitis?
Vaginal itching, discharge, burning, painful intercourse, or foul odor
140
What are 3 pathogens responsible for cervical infections?
Chlamydia, Gonorrhea, Herpes Simplex Virus
141
What is a tell-tale sign of BV?
Fishy odor (positive Whiff test)
142
In diagnosing BV, what is seen on microscopy?
Clue cells
143
What is the pH in BV, trich or atrophic vaginitis?
>4.5
144
What is the color of discharge seen in BV?
thin white/grey
145
What is the treatment for BV?
Flagyl 500mg PO BID x 7 days or Flagyl vaginal cream 1 applicator vaginally nightly for 5 days
146
What is the pathogen responsible for yeast vaginitis?
Candida
147
What is the main complaint of yeast vaginitis?
vaginal itching
148
What does the discharge look like in yeast vaginitis?
white and curdy
149
How does yeast vaginitis present on microscopy?
Budding/branching (spaghetti and meatballs)
150
What is the treatment of yeast vaginitis?
Diflucan 150 mg PO once or may repeat in 4-7 days OR Monistat OTC and start probiotics
151
What is the classic look of testicular torsion on ultrasound?
snail sign or whirl pool sign
152
What are 5 signs of BPH?
Frequency, hesitancy, nocturia, urgency, and weak stream
153
Is dysuria present in BPH?
no
154
Is hematuria present in BPH?
sometimes
155
What age group has the highest incidence for BPH?
Greater than 80 years old
156
What would be performed to assess the prostate size or presence of a nodule?
Digital rectal exam (DRE)
157
What diagnostic tests will be performed for BPH?
PSA, U/A with culture, BUN, Creatinine, post void residual
158
At what point do you consult urology for BPH?
Failure of treatment, age < 45 or abnormal DRE
159
What two classes of medications are used to treat BPH?
Alpha blockers and 5 alpha-reductase inhibitors
160
What would you educate your patient about when taking meds for BPH?
They can cause hypotension so they must be cautioned about sudden position changes and adequate hydration
161
In what age group are most testicular cancer cases seen?
20-34 years old
162
What are 4 risk factors of testicular cancer?
Positive FH, cryptorchidism (undescended testicle), HIV, or previous testicular cancer in the other testicle.
163
What are 6 signs and symptoms of testicular cancer?
hard lumps or nodules
change in testicle appearance
scrotal swelling
dull ache in lower abdomen or scrotum
feeling of heaviness or pain
gynecomastia
164
What test would you encourage your male patient to perform in regards to testicular cancer?
Monthly testicular exam
165
What is the clinical presentation of gynecomastia?
breast tissue swelling
166
Does gynecomastia mean a patient has breast cancer?
No, but breast cancer must be ruled out.
167
What are 5 causes of gynecomastia?
Testicular tumors, breast cancer, cirrhosis, malnutrition, and drugs
168
What is an example of a medication that can cause gynecomastia?
spironolactone
169
What is the treatment for gynecomastia?
Stop offending drugs
170
What is hypospadius?
Congenital anomaly of the male urethra resulting in the ventral placement of the urethral opening
171
In testicular cancer, is the nodule painless or painful?
painless
172
What are 10 patient complaints in testicular cancer?
weight loss, fever, nausea, vomiting, abdominal pain, SOB, headaches, lumbar pain, bone pain, and unilateral leg swelling
173
What are the three stages of syphilis?
Primary, secondary, and tertiary
174
What 2 body systems does tertiary syphilis affect?
Cardiovascular and nervous systems
174
How does secondary syphilis present?
If untreated, about 2 months after exposure a nonpruritic, maculo-papular rash involving palms and soles with generalized lymphadenopathy.
175
What is the diagnostic tests for syphilis?
RPR
176
What does Gardasil protect against?
A vaccine for HPV
177
What is the most common STD in young adults?
HPV
178
What is Peyronie's disease?
Curvature of the erect penis caused by fibrous scar tissue
179
Do you need to obtain a urethral swab to test for gonorrhea or chlamydia?
No, you can perform a urine test
180
What is the treatment for gonorrhea?
Rocephin 500 mg IM once
181
What STD causes non-gonococcal urethritis (NGU)?
Chlamydia
182
Are males or females more likely to have complicated UTIs?
Males
183
Name 4 acute urinary symptoms that need to be evaluated?
Hematuria, dysuria, proteinuria, or incontinence
184
What are 5 common causes of acute kidney injury?
Volume depletion, nephrotoxin exposure, urinary obstruction, profound diarrhea and over diuresis
185
What are 4 risk factors for nephrolithiasis?
Genetics, low fluid intake, high oxalate intake, and prior bariatric surgery
186
What is the clinical presentation of nephrolithiasis?
severe flank pain, abdominal pain, nausea, vomiting and hematuria
187
Name 6 rashes that always present with itching.
Atopic dermatitis, urticaria, insect bites, scabies, chickenpox, and pediculosis
188
Name 4 rashes that may itch.
Psoriasis, impetigo, tinea, and pityriasis rosea
189
Name 3 rashes that never itch.
Warts, vitiligo, nevi
190
What does the term cetripetal mean when describing a rash?
Spreading towards the center
191
What does the term centrifugal mean when describing a rash?
Spreading outward from the center
192
What does the term caudal mean when describing a rash?
Spreading downward
193
Name some ways to classify rashes.
Whether or not it itches, how it spreads, if there is pain or burning, known exposures or triggers, new soaps, lotions, meds, clothing, detergents or any recent travel. Also note initial presentation or any illnesses at the time.
194
What is the signature look for fifth's disease?
Slapped cheeks
195
What are characteristics of Rubeola (Measles)?
Erythematous, maculopapular rash that begins on the face and spreads to the body.
196
What are characteristics of Scarlett fever?
Fine erythematous rash that blanches. Sandpaper feel. Neck, axillary folds, and groin have Pastia's lines (petechiae)
197
What childhood rash presents with a strawberry tongue?
Scarlet fever
198
A scarlet fever rash presents after which bacterial infections?
Strep pharyngitis
199
What is another name for measles?
Rubeola
200
Describe the appearance of Koplik's spots.
Gray and white, grainy dots on red base on buccal mucosa opposite lower molars, 2 days before rash appears
201
What disease is associated with Koplik's spots?
Measles
202
What two pathogens causes impetigo?
S. aureus and Strep pyogenes
203
What virus causes hand-foot-and-mouth disease?
Coxsackievirus A16
204
Describe the appearance of chicken pox.
Rash begins along hairline of face with crusted vesicles, then over trunk, and extremities are last.
205
Describe impetigo.
Honey-colored crusts from vesicles or pustules that rupture. Bullous or pustular forms.
206
Describe hand-foot-and-mouth disease.
painful mouth ulcers followed by painful white vesicles with surrounding eythema on fingers, palms, toes, and soles.
207
Describe shingles.
clustered vesicles surrounded by an erythematous base with discrete lesions that later crust.
208
What is another name for hydradenitis suppurative?
perifolliculitis
209
What gland is affected in hydradenitis suppurative?
Apocrine glands
210
What is the most common pathogen to cause hydradenitis suppurative?
staph aureus
211
What is the antibiotic of choice for hydradenitis suppurative?
Augmentin
212
What two pathogens cause osteomyelitis?
S. Aureus or strep pyogenes
213
What two pathogens cause cellulitis?
S. aureus and group A beta-hemolytic strep
214
What antibiotics can be used to treat cellulitis?
Keflex, e-mycin, dicloxacillin. May also give a dose of cefazolin or ceftriaxone
215
What parts of the body are affected by intertrigo?
under breasts, inner thighs, axilla, and perianal areas
216
What is the treatment for Lyme disease?
Doxycycline/tetracycline 100 mg BID x 14-21 days
217
What is a classic sign of Dengue fever?
Retro-orbital pain
218
What part of the body is affected by a rash in Rocky Mountain Spotted Fever?
Wrists and ankles also involving the palms and soles
219
Where on the body are scabies typically found?
Axillae, webs of fingers and toes or groin
220
What antidepressant does not cause sexual dysfuction?
Bupropion (Wellbutrin)
221
What are some presentations of serotonin syndrome?
Rapid onset that progresses from diarrhea, restlessness, agitation, hyperreflexia, to later symptoms of seizures, hyperthermia, uncontrolled shivering and muscle rigidity and ultimately it can lead to delirium, coma, CV collapse and death
222
What is the treatment for serotonin syndrome?
Immediate cessation of offending drug and supportive care (may include benzos)
223
What is the only FDA approved antidepressant for the treatment of bulimia?
Fluoxetine (prozac)
224
If a patient is at high risk of suicide, what class of meds would you avoid?
tricyclics
225
What are your first line of drugs for panic attacks or OCD?
SSRI/SNRI-- fluoxetine, paroxetine, or sertraline
226
What medication can be given to increase appetite?
Mirtazapine
227
What SSRI is safe for use while pregnant?
Sertraline (zoloft)
228
What medications can cause dyspepsia?
ASA, NSAIDs, antibiotics, DM meds, antihypertensives, cholesterol meds, pysch meds, anti parkinson meds, steroids, estrogen, digoxin, iron, and opiods
229
What are 8 causes of dyspepsia?
PUD, GERD, gastric cancer, gastroparesis, lactose intolerance, malabsorptive problems, parasites, and pancreatic CA and chronic pancreatitis
230
What are 7 critical signs of dyspepsia?
N/V, hematemesis or melena, weight loss, persistent vomiting, severe pain, dysphagia
231
What disorder experiences relief of symptoms with food?
PUD (peptic ulcer disease)
232
Describe dyspepsia.
Gnawing or burning epigastric or upper abdominal pain that occurs with an empty stomach, alcohol intake or stress
233
What stressors can cause dyspepsia?
domestic violence, anxiety, home or school problems, prior psychological problems
234
What is the treatment for H pylori?
combination of antisecretory meds (omeprazole or lansoprazole) and antibiotic.
235
What is the most common cause of lower GI bleeding?
diverticulosis
236
What are some symptoms of diverticulitis?
Sudden, localized abd pain, fever, elevated WBC and ESR, n/v/d or constipation, guarding or rebound pain, rectal bleeding, flatulence or gas
237
What is the gold standard test for diverticulitis?
Contrasted abdominopelvic CT
238
How would the abdomen present in a patient with diverticulitis?
Rigid or distended with tympanny. Could also be tender, firm, mass in left side. Decreased bowel sounds or increased if obstructed.
239
What are two assessment tests that can be performed to support the diagnosis of diverticulitis?
iliopsoas test and obturator sign
240
What is the antibiotic treatment for diverticulitis?
Flagyl 500 mg PO Q8 hours and ciprofloxacin 500 mg PO BID for 7 to 10 days.
Alternative is levofloxacin 750 mg daily along with Flagyl
Alternative is Augmentin 875/125 PO TID or Septra DS BID along with Flagyl
241
Elevation of skin occupying a relatively large area in relation to height
Plaque
242
Circumscribed elevation of skin containing purulent fluid of variant character
Pustule
243
Circumscribed, elevated, fluid containing lesion less than 0.5 cm in diameter
Vesicule
244
Circumscribed, elevated, fluid containing lesion more than 0.5 cm in diameter
Bulla
245
Child present to the office with a fever greater than 101.3 for 5 days with no know reason. What could this be indicative of?
Kawasaki's Disease
246
Name other criteria for diagnosing Kawasaki's Disease:
Conjunctivitis
Cervical lymphadenopathy
Swollen hands and feet
Red palms and soles
Strawberry tongue with rough red spots
mucositis (very red swollen cracked lips)
Peeling of fingers and toes
Irritability and fussiness
vomiting
diarrhea
abdominal pain
cough
headache
runny nose
joint pain
247
What is the Gleason score used for?
Prostate Cancer tissue grading
T=tumor tissue size
N= amt of nodal involvement
M= spread (metastasis) within the pelvic region
Each letter is associated with a number as well
248
Most common pathogen in Epididymitis:
< 35ys of age: Chlamydia trachomatis and Neisseria gonorrhoeae
Older males: E. Coli, Pseudomonas, & other coliform bacteria
249
For the lungs the x-ray film has to show what?
The Apex to the costophrenic.
250
X-ray of the cervical spine needs to show what areas?
C7 to T1
251
What view for an x-ray is best for the cervical spine?
Lateral
252
Visualization of long bones which view do you want on your x-ray?
AP, lateral, and oblique
253
What would you do for a long bone injury in the pediatric population?
Refer to Ortho
254
For determining a foreign body in soft tissue, what test is the best?
Ultrasound
