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NP License Exam > Final NP Exam Review > Flashcards

Final NP Exam Review Flashcards

1
Q

G6PD deficiency anemia’s Sx

A

African American
Jaundice, hemolysis anemia
Could be asymptomatic

Can be triggered by having sulfa drug or eating fava beans

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2
Q

What are sulfa drugs (8)

A

3S+ b+ c+ 2d+ n

S: sulfonylurea (glyburide, glipizide).
S: sulfazalazine
S: sumatriptan

B: bismuth subsalicylate
C: COX-2 inhibitor: celecoxib
Diuretic: laxis, thiazide diuretic,
Nitrofurantoin

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3
Q

Sulfonamide

Coverage
Drugs
Interaction
ADR
Contrandication

A

Gram negative and some +
Bactrium/septra

Interaction: Wa
—warfarin
—astemizole

ADR:
–fever, no blistering rash
—Steven-Johnson syndrome

Contrandication:
—hypersentive to sulfa drugs
—G6PD anemia (genetic hemolytic anemia)
—< 2 months
—pregnancy >=32 weeks (increase bilirubin, hemolytic anemia)

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4
Q

Sx of digoxin toxicity (5)

A

Hag VC

GI (N/V),
High K
Arrhythmia (HR could be high or low)
Visual change
Confusion

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5
Q

ACEI, ARB and pregnancy, lactation

A

Don’t give it

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6
Q

PDE5 and when don’t give it

Don’t mix with what

A

If MI or stroke within 6 months

Nitrate: isosorbide, nitroglycerin, alpha blocker

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7
Q

What’s reverse agent for plavix

A

No reversible agent; can give plasma

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8
Q

Ketorolac

Drug class
What to watch

A

NSAID
Don’t use it more than 5 days

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9
Q

Thiazide diuretic and DM?

A

Thiazide diuretic increase A1C

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10
Q

If patient has sulfa allergy, what diuretic can they use

A

K- sparing diuretics

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11
Q

Spirinolactone ADR

A

Gynecomastia and high K

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12
Q

How loop diuretic affect Na, K, Mg, Cl

A

Decrease all of them

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13
Q

What does angiotensin 2 do

A

Potent vasoconstrictor
Promote release aldosterone

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14
Q

ANRI

If switching ACE or ARB to this, how long do u have to wait?

A

Sacubitril/ valsartan

Don’t use it within 36 hours switching from to ACEi

Don’t use it if hx of angioedema

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15
Q

For DM patients, what BP meds is preferred

A

ACEi, ARB,

But

If eGFR< 60, don’t use it, will cause AKI

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16
Q

1st line treatment for reduced HF and left ventricular dysfunction

A

ACEi

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17
Q

Captopril is associated with

A

Agranulocytosis: reduce neutrophil (< 100)

So monitor CBC

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18
Q

After starting ACEi, ARB, when do you check kidney functions

A

3 days after

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19
Q

Verapamil cannot mix with

Contradication

A

Erythromycin, clarithromycin

Contradication:
– AV block
–bradycardia,
—reduced HF

ADR:

Reflex tachycardia

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20
Q

In patient with reduced HF, avoid use

A

Non-DHP CCB

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21
Q

What drug is preferred to treat angina and post MI

A

BBB

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22
Q

Don’t combine PDE5 inhibitors with what

A

Alpha blocker
Using nitrate
Recent, post MI
Post stroke, TIA
Major surgery
Any condition that exertion

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23
Q

Can DM patient with micro vascular disease take oral combined contraceptive?

A

No; higher risk of thrombosis; take progestin- only OC

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24
Q

What cause hand, foot, and mouth disease

A

Coxsackie virus

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25
Q

What is dacryostenosis

A

Obstruction of lacrimal duct

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26
Q

What cause oral hairy leukoplakia

A

EBV

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27
Q

Meclizine

A

First generation antihistamine to help motion sickness

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28
Q

What is pulsus paradoxus

A

SBP drops with inspiration;
Commonly occur with people with asthma

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29
Q

bronchiolitis
Cause
Sx

A

Caused by RSV
During winter/ spring
Infants and young children
Fever
Inspiratory/ expiration wheezing with clear drainage

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30
Q

Tracheobronchitis

A

Start with dry cough, then become productive cough

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31
Q

Croup

Is it viral or bacterial
Sx?
Fever?

A

Viral infection: parainfluenza most common
Barking cough
Runny nose
Usually no fever

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32
Q

What’s second line treatment for CAP

A

1at line is amoxicillin
2nd line: doxycycline, or macrolide

If patient has comorbiditries>=65 yr: 1st line is clavulin

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33
Q

Chronic bronchitis is defined as

A

Coughing with excessive mucus production for >=3 months, for minimum >=2 more consecutive years
Light coloured sputum
Dry to productive cough

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34
Q

What pathogen cause atypical PNE

Best treatment

A

Mycoplasma pneumoniae

Macrolide: azithromycin x 5 days

Second: quinolone
Or
Clavulin+ macrolide/ doxycycline

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35
Q

If I see consolidation in CXR, could it be what PNE

A

Bacterial PNE

Atypical PNE doesn’t show consolidation (malaise, headache, muscle pain, hemolysis in blood work)

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36
Q

PCOS have higher risk of

A

They have excessive estrogen

Higher risk for:
- CHD
- breast and endometrial CA, endometrial hypersplasia
- nonalcoholic fatty liver disease
-depression
- OSA

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37
Q

In atrophic vagina, FSH and LH level

A

Higher

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38
Q

Is BV STI?

A

No. But risk factor include sexual activity, new or multiple sex partner, and douching

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39
Q

Normal vaginal PH

A

4-4.5

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40
Q

If women find out having BV, do we treat partner

A

No. It’s not STI

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41
Q

BV’s education

A

No sex until treatment is done

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42
Q

Drugs that interact with oral contraceptive

A

cart has AD

Anticonvulsant
Antifungal
HIV/ HCV protease inhibtor: Indinavir, boceprevir
ampicillin,
tetracycline,
rifampin,
clarithromycin
St. John worst: might lead to breakthrough bleeding.
Dilatin

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43
Q

Risk factors of breast cancer (10)

A
  • BRCA1 & 2 mutation
  • late menopause: > 55yr
  • mom took DES
  • not physical active
  • fat
  • take hormone pills last> 5 years
  • pregnancy at >=30 yr
  • not breastfeeding
  • never give birth to kid
  • mod- high alcohol intake
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44
Q

Pharmacokinetic

A

Drug movement in body: absorption, bioavailability. Distribution, metabolism, excretion

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45
Q

Pharmacodynamic

A

What drug does to our body: physiologic & bio-checmical

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46
Q

Drugs that high risk of drug interaction

A

MACC+ PA
Macrolide
Antifungal
Cimetidine
Citalopram
Protease inhibtor: Navir
Antipsychotic: cloaxapine, Olanzapine, Quetiapine

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47
Q

MRSA treatment

A

Septra

Clindamycin

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48
Q

Mastitis treatment

A

Leik: dickoxacin, cephalexin

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49
Q

Patient feels nausea after taking erythromycin

A

Normal reaction for erythromycin. Not allergic reaction

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50
Q

Streptococcal pharyngitis
Treatment

A

Peter cough mucus

Adult:
1st line: oral penicillin V x 10 days

Kids:
1st line: oral penicillin V or amoxicillin

2nd line: clindamycin
Macrolide

Make sure to repeat culture after treatment

If Centro score>=2: get culture

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51
Q

Lithium toxicity (4)

A

SISI
Seizure
Slurred speech
Increased urination
Increased thirst

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52
Q

Dilatin toxicity

A

Nystagmus
Ataxia
Confusion

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53
Q

Carbamazepine toxicity

A

Skin rash
Jaundice

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54
Q

What drug should be cautious to use with erythromycin ?

A

Erythromycin is a potent 3A4 inhibtor;

Use cautious with warfarin

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55
Q

Does chronic use NSAIDs affect respiratory system?

A

Yes

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56
Q

Treatment for gonorrhea, chlamydia infection

A

Gonorrhea: ceftriaxone( add doxycycline if you can’t rule out chlamydia

Chlamydia: Doxycycline: 100mg BID x 7 days, or Azithromycin single dose ( if pregnant)

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57
Q

Treatment for syphilis

A

Benzathine penicilllin G IM single dose

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58
Q

Treatment for genital herpes

A

Acyclovir x 7-10 days

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59
Q

Hydrochlorothiazide ADR

A

Suppress bone marrow–> neutropenia

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60
Q

Nifedipine watch

A

Suppress cytokine-induced activation of neutrophils

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61
Q

Antihistamine affect on elders

Does it cause bradycardia or arrhythmia?

A

Confusion
Urinary retention
Incontinence
Sedation

No affect on heart: bradycardia, arrhythmia, etc..

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62
Q

Patient is on tetracycline while taking oral contraceptive

A

Tetracycline reduce oral contraceptive effectiveness; so use condom, and additional contraceptive method while on tetracycline

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63
Q

What antibiotic should not be give to kids < 9 yr

A

Tetracycline

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64
Q

Ramelteon is

A

Melatonin receptor agonist

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65
Q

Pregnancy drug category

A

A: human & animal show no risk
B: animal show no risk; no human data
C: bad animal result
D: evidence of fetal risk: but you consider; can use if benefit> risk
X: evidence of fetal risk: risk> benefit

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66
Q

Antibiotic that is safe to use during pregnancy

A

Macrolide (except for clarithromycin)
Penicillin

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67
Q

Drugs to avoid during 3rd trimester

A

NAS S

NSAID
Aspirin
Salicylate: bismuth (pepto)
Sulfa drugs: Septra

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68
Q

Why can’t use sulfa drugs during 3rd trimester (5)

A

High bilirubin
Jaundice
Kernicterus (brain damage)
Oligohydramnios
Premature closure ductus arteriosus

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69
Q

Signs of pregnancy

A

Positive: confirmed pregnancy: can see, can feel, can hear
Probable: mod evidence: beg cuh
—ballotement
—enlarged uterus
—Goodell’s sign: soft cervix
—Chadwick: vagina and cervical becomes blue
–uterine or blood pregnancy test positive
– Hegar: soft uterus isthmus

Presumptive: lowest: things that aren’t here

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70
Q

When can we hear fetal heart sound

A

10-12 weeks

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71
Q

Fundal height marking date

A

12 week: above symphysis pubis
16 week: between symphysis pubis and umbilicus
20 week: umbilicus
Starting at 20 - 35 weeks: fundal height should= gestation week+- 2cm

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72
Q

BP. Meds that can be used during pregnnacy

A

Methylopa

Labetalol

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73
Q

Who can’t have methylopa

A

Alpha 2 agonist:

Active liver problem, so after starting this, check LFT periodically

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74
Q

What are the signs to discontinue methyldopa

A

Fever
Jaundice
Abnormal LFT

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75
Q

When should we consider phototherapy when 2 day old baby has jaundice

A

Bilirubin level> 5 mg/dL

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76
Q

What is diagnostic for diverticulitis

What is the Sx

Treatment

A

LLQ pain+ leukocytosis

Some patient don’t have Sx
Might have bloody stool, but mucus, pus is not common

Uncomplicated diverticulitis: bed rest, clear fluid x 2-3 days
Complicated: (signs of sepsis): fs, fc, c
—–flagyl+ septra
——flagyl+ ciprofloxacin
—–clavulin

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77
Q

Kawasaki disease

Phases
Diagnostic

A

Common 1-2 yr
Infectious disease, but we don’t what infectious agent is
Primarily affect mucocutaneoous & lymphatic system: affect cardiac system, increase risk of coronary aneurysm, pericarditis, MI, myocarditis
Not contagious
3 phases:
1. Acute arteritis: marked neutrophil infiltration and necrosis of all vessels layers
2. Subacute, or chronic vasculitis: start weeks, months, or years after the fever
3. Liminal myofibroblastic proliferation: cause coronary artery stenosis

Diagnostic: out of exclusion; lab isn’t diagnotic
Persistent fever>=5 days+ >= 4 of the following:
– bilateral conjunctival injection
–change of lip and oral cavity
–unit lateral cervical lymphadenopathy
–polymorphous exanthema (疹子)
–swelling of hands, feet, or perineal area
–labs:
———-low albumin: <=3
Urine>= 10 WBC
Platelet: >=450,000 7 days after fever
Anemia
Total WBC>=15000
High ALT

Stages:
—acute phase: eye, rash, extremeties edema, lymphadenopathy
—-subacute phase: above subsides, joint pain, heart disease+ finger skin becomes flaky+ thrombocytosis.

Treatment: hospital

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78
Q

Appendicitis Sx

A

Pain staring from periumbilical to RLQ
nausea, vomiting, cramping, anorexia
Could have peritonitis

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79
Q

When a patient with PUD say their abdomen is no longer painful

A

Perforated ulcer

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80
Q

Pyloric stenosis
Sx
Diagnosis
Treatment
Prognosis

A

Abdominal distension
Dehydration
Projectile vomiting: immediately after feeding; emesis can contain blood
Failure to thrive
Unable to satisfied: weight loss, insatiable

Diagnosis: Sx + olives mass felt on epigastrium+ abdominal US
Management: surgery (pyloromyotomy)+ correct lyte & fluid

Vomiting can still happen a few days after surgery, but as not as bad as before. Feeding should be started slowly

Prognosis: excellent

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81
Q

IBS treatment

A

Diarrhea: tel: TCA, eluxadoline ( anyimotility): loperamide, CBT, hypnotherapy, low FODMAP diet

Mixed: TCA, probiotic, low FODMAP diet, CBT, hypnotherapy

Constiaption (SLL): linaclotide ( increase intestinal secretion); SSRI, Lubiprostone (no low FODMAP diet, no hypnotherapy)

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82
Q

Traveler diarrhea

What cause it
Treatment

A

E.coli most causative pathogen

Occur up to 10 days after travel
Self-limited:
Oral hydration+ PRN Imodium up to 16mg/ day; PRN bismuth subsalicylate

If abx: ciprofloxacin, azithromycin

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83
Q

Parkinson disease
Diagnosis
Management

A

Bradykinesia+ >=2 Sx: rrar
- resting tremor
-rigidity
-asymmetric
-responsive to levodopa

Management: if mild, don’t need treatment
See picture

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84
Q

Duodenal ulcer vs gastric ulcer

A

Peptic ulcer includes duodenal and gastric ulcer

Duodenal ulcer: pain gets better after eating, then 2-5 hours later, it get worse

Gastric ulcer: pain becomes worse when eat

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85
Q

Where in abdomen hurt when pancreatitis

A

Epigastric

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86
Q

If mom has hx of GDM
how often do we check DM

A

Check DM 1-3 month postpartum+ lifelong DM checking q 3 years

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87
Q

Screening for GDM and diagnosis of GDM

A

Check it at first visit & if no risk, check @ 24-28 week gestation

Diagnostic:
1. 1 step method
2. 2 step method

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88
Q

DM high in 1st trimester is

A

DM2. GDM has to be diagnosed in 2-3 trimester

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89
Q

Treatment of breastfeeding mastitis (lactational mastitis )

A

Dicloxacillin x 10-14 days

If high risk of MRSA: septra , or clindamycin

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90
Q

Preeclampsia.
Sx
Risk factor

A

Think about HELLP
Headache
RUQ pain
Acute kidney failure
Blurred vision
DIC
PE
Stroke
Liver rupture

Risk factor:
HTN
Hx of preeclampsia
1st time or many babies already
Old >35
Fat
Kidney problem

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91
Q

Diagnostic criteria of preeclampsia

A
  1. BP >140/90
    2.edema: fast edema and weight gain > 2lb per week. Edema mostly on face, eyes hands
  2. Proteinuria: > 0.3G protein in 24 hr urine specimen.
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92
Q

Treat preeclampsia

A

Refer to OB

Only cure is deliver the baby

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93
Q

Preeclampsia vs chronic HTN

A

Abp>140/90 before 20 week is chronic HTN

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94
Q

How to prevent placenta abrupt

A

Don’t smoking
Control BP
No cocaccine
Seatbelt

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95
Q

Sx of placenta abrupt

A

Sudden vaginal bleeding with abd or back pain
Rigid uterus: hypertonic
Uterus ve try tender
Painful uterine contraction

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96
Q

Sx of placenta previa

A

Placenta implant too close to cervix

Sudden vaginal bleeding
Mild contraction
Uterus no tender and very soft

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97
Q

When suspect placenta previa

A

Nothing goes into vagina or rectum

Don’t do digit exam.

Only abdominal US, not even transvaginal US

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98
Q

If oligohydramnios

Normal AFI

A

Refer to OB

Normal AFI 5-25cm

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99
Q

Polyhydramnios

A

AFI > 25cm
Very rare
Often due to genetic problem: fetal anomalies is the most common cause

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100
Q

RhoGAM

What is it for
Doses? When do we give it

A

It’s a IgG antibody against Rh factor
It kills the Rh factor across placenta from baby
So it prevent mom develop antibody ( because during this process it will cause baby hemolysis &anemia)

We give 2 doses to all mom who is Rh negative. Regardless if they successful deliver the baby or not.

1st dose: 28 week: 300mcg IM
2nd dose: within 72 hours after delivery.

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101
Q

Spontaneous abortion

A

Loss the fetus before it’s livable < 20 weeks.

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102
Q

Stillbirth

A

Loss baby after 20 weeks. Or weight loss>= 350g

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103
Q

Threatened abortion

A

Vaginal bleeding. But cervical os is closed.

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104
Q

We don’t need parental consent if

A

STD testing or treatment
Birth control

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105
Q

Treat genital wart during pregnancy

What causes wart

A

Wart is safe during pregnnacy
Only treat it if problematic
Trichloroacetic acid (topical), or CO2 laser, or surgical

Wart is caused by HPV (6, 11).

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106
Q

Diagnose HPV infection

A

No test available. We can only check for cervical cancer via Pap smear

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107
Q

HPV vaccine for pregnancy

A

Gardasil: can’t get it until 6 week postpartum; against 16,18,6,11 (all). 100% protection. Give before sex. Both male and female can get it

Ceravix: against 16,18; both male and female can get it; give it before sex

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108
Q

Do we need to swab wart for HPV

A

No

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109
Q

When we do rectal STI swab, watch for what

Goal is what

A

Make sure no poop on it; goal is to get epithelial cells

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110
Q

Treatment of syphilis

What if pregnnacy women who can’t have penicillin

A

Treatment for early syphilis: primary, secondary, early latent): x1 dose.

1st line: if have it less than 1 yr duration: Benzathine penicillin G IM x 1 dose: all people can have it

If late latent, or tertiary: same drug weekly x 3 doses

If CNS is involved: neurosyphilis: penicillin G IV

2nd line: doxycycline x 2 weeks;

If they can’t have penicillin: desensitization penicillin

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111
Q

Treatment for Chlamydia

What do we do after completing abx?

A

Often no Sx

Deao:

Doxycycline (x 7 days: preferred for non-pregnant)
Azithromycin (x1 dose): 1g x 1 dose: preferred for pregnant
Erythromycin
Oxofloxacin (all quinolone is fined 7 days).

Make sure to
1. Test 1 month after completing abx to see if it’s cured
2. Then retest after 3 months after finishing treatment for re-infection

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112
Q

Treatment for HSV-1 & 2

If severe?

A

Need to give treatment within 72 hours after Sx onset

Acyclovir
Fam
Valvyvlocir

If severe, IV

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113
Q

Treatment for recurrent HSV

A

Start treatment asap see lesion

Famciclovir
Valvacyclovir
Acyclovcir

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114
Q

Chancreoid Sx & treatment

A

Lesion that start after exposure can grow more pustular lesions; lesion can be painful

CC

Ceftriaxone IM
Ciprofloxacin

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115
Q

Can pregnnant get acyclovir?

A

Yes. Safe

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116
Q

Screen all pregnant women what at their first visit

A

HIV
Syphilis
Hep B& C
ABO
1hr OGTT

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117
Q

Do we give prophylactic treatmetn for gonorrhea if we find out the patient has chlamydia?

A

Usually no; unless the situation indicated

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118
Q

What is reactive arthritis

caused by what

A

Rare complication of STI infection
Often caused by Chlamydia
Occur in young people
Self limited within 6 month - 1 year: supportive treatment

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119
Q

Is herpes simplex STI?

How does it transmit

A

Yes. Transmitted by direct contact

HSV-1: often oral
HSV-2: often genital

But both can be oral and genital

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120
Q

Sx of herpe simplex

Primary infection

A

General Sx: acute onset of small vesicles on red base; that rupture easily then becomes a painful ulcers;
HSV-1: lip/ mouth (gingivostomatitis), eye, throat:
HSV-2: genital

Primary infection: when has vesicular fluid and crust: most contagious.

Each reoccurrence usually become less severe

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121
Q

If suspect acute or early HIV infection, what diagnostic test do we order

A
  1. 4th generation: aka combination antibody/ antigen assay
  2. Viral load test
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122
Q

Pneumocystis PNE

A

Complication from HIV infection
Treatment: 1st line: Septra
If severe allergic to sulfa: Dapson (sulfones is the drug class; abx)+ trimethoprim

Before starting dapson: make sure the patient doens’t have G6PD anemia due to potential hemolysis

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123
Q

What is the most common CNS infection in AIDs patients
How to treat it?

How to prevent it from happening

A

Toxoplasma gondii infections (protozoa)

Can lead to brain infection, problem
1st line: septra
2nd line: dapsone+ pyrimthamine+ leucovirin

Prevention: avoid clean cat litter & eat uncooked meat

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124
Q

For HIV infection patient, what are the treatment

A

ART: to promote CD4+ count (means better immunity) & reduce HIV viral load

After starting treatment: follow up with viral load (aka HIV RNA)

1st viral load: 2-8 weeks after starting treatment
2nd viral load: q 1-2 months until viral load becomes undetectable
3rd vital: then watch CD4+ & CBC q 3-4 months for the first 2 years of ART

For prevention HIV:
– get all the not active vaccine: HPV (after 21yr), pneumococcal, Tdap, hep A & B
–pap smear every year: if 3 negatives, then do it q 3 years
–avoid cat litter & eat uncooked meat: toxoplasma
–no amphibian 两席动物: turtle, snake…: salmonella
–no bird stool: histoplasmosis
–take ART as instructed

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125
Q

pre exposure prophylaxis treatment for HIV

Who is it for
What do we do before we order it

A

For the people with high risk of HIV infection

Must check HIV infection before starting med: and recheck HIVB q 3 month after

Take the drug everyday

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126
Q

Basic HIV test (school)
Treatment for HIV

A

Baseline HIV tests:
CD4 count
Lymphocyte
Viral load
Hepatitis ABC
Rule out other infection

Treatment: antiretroviral therapy (ART): reduce viral load & delay disease progression: (ADR: dizziness, headache)

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127
Q

HIV screening test

A
  1. EIA test (enzyme immune assay)–> not- reactive–> no HIV
  2. If reactive–> repeat EIA x2 times–> >=2/3 tests are reactive—> confirmatory test—–>
  3. If confirmatory test is non-reactive–> no HIV
  4. If confirmatory test is reactive—> positive HIV
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128
Q

Common Sx of HIV

A

General lymphadenopathy
Rash
Thrush
Mucosal ulceration

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129
Q

If give post exposure prophylaxis HIV treatment, when do we give it

A

Don’t wait for the result to be back
Must give it within 72 hours after exposure, otherwise, it’s useless
Duration could be 4 weeks

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130
Q

Pregnant women with HIV infection

What specific treatment recommended for pregnant women? Can we give it to infant?

Name of the drug
What do we watch for the treatment

A

Start ART anytime during pregnnacy, but best start right after known pregnant status: signicaint reduce viral load given to the baby

Preferred treatment for both mom and baby: (best give it within 8 hours after birth): Zidocudine (Retrovir)

Before start the drug: check CBC with differential (get baseline because this drug suppress bone marrow)
Then watch CBC with differentials

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131
Q

What is Gardasil 9

Get pregnant women get Gardasil?

A

A HPV vaccine
Recommended age: 11- 26 years; give it before sex

Less benefit after 26 years, but they can get it if at risk

Vaccine usually good tolerated
2 doses if 1st dose get it before 15yr: 0.6-12. Months
3 doses if 1st dose get it. After 15 yr: 0, 1-2, 6 months

Pregnancy women can’t get it until 6 week postpartum

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132
Q

Treatment of genital wart

A

Some methods that patient can self-administered at home. These are:
1. Podophyllotoxin: pregnancy contrandicated
2. Imiquimod: pregnnacy contrandicated: leave it on for 6 hours then wash it off: stimulate local interferon and cytokines production: can cause hypopigmentation, irritation, ulcer.
3. Sinecatechins: pregnnacy can use it; also make sure to wash it off before sex. Only external use: not for vagina or anus; can weaken condom & diaphragms

Provider- method: TCA & cryotherapy are common for small wart (< 1cm); if bigger, surgical

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133
Q

Pelvic inflammatory disease Sx (6)

What’s pelvic inflammatory disease?
Common cause
Diagnosis
Sx
Complication:
Tests to order:

A

PID means when infection spread up to the upper genital tract;

Common cause by gonohhea, or chlamydia
Diagnosis is clinical: even NAAT comes back negative for both, we still treat it. This disease, it’s better over treat it than leave it.
Sx:
–adnexal tenderness: most sensitive for PID
- acute onset of lower abdominal or pelvic pain (could be one side or both)
- new vaginal discharge+- bleeding
- painful sex
- cervical motion tenderness
- fallopian, ovaries might be painful on palpation

Complication: perihepatitis: RUQ tenderness
Tests: (5).
–pregnancy test
–NAAT
–syphilis
–HIV
–inflammatory markers

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134
Q

Treatment for PID

When should you expect improvement

A

Outpatient (FCD): ceftriaxone 500mg IM x 1 dose+ doxycycline x 14 days + flagyl x 14 days

Within 72 hours

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135
Q

Who is more likely to get PID;

A

Young patients

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136
Q

What is most characteristics of syphilis

A

Primary: painless chancre: heal in 9 weeks if not treated
Secondary: have systemic Sx (because syphilis can actually affect heart, nerve, and gum)
Latent: no Sx. But positive tire
Tertiary: affect cardiovascular. Gum, and nerve: this happen at least 1 year after primary infection

Other characteristics Sx in secondary syphilis: rash
– condyloma lata: white papules that look like wart grow on moisturd areas: mouth, perineum
–Maculopapular rash: this rash happen the whole trunk., extremeties and hands. NOT itchy

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137
Q

Syphilis diagnosis

A

NAAT culture of chancre, oral and lesions
Syphilis serology testing: RPR

Patient with hx of syphilis: positive nontreponemal test means new infection, evolving respond to treatment, or treatmetn failure

Patient with no hx of syphilis: both nontreponemal and treponemal tests are reactive to diagnose.

Make sure to use RPR to monitor treatment responds.

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138
Q

What are the screening test for syphilis

A

RPR: rapid plasma reagin

And

VDRL: venereal disease research lab

This means either one could be the initial test if you suspect someone have syphilis, if positive: you order the confirmatory test: treponemal test (FTA-ABS).

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139
Q

If the pregnancy women have high risk of syphilis, when do we screen them

A

1st visit, then 28-32 week, then at delivery

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140
Q

Do we follow up after starting syphilis treatmetn? Do we treat partner if their RPR is negative

A

Yes. We treat partner regardless the result
We follow 6 month and 12 months after treatment; we should expect at least fourfold decrease in pretreatement and post treatment. Most patients their titre will go down after treatmetn, but some people will have high titre for the rest of their life.

For chancre: follow up in 3-7 days after penicillin. : should expect start healing.

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141
Q

What do you do patient starting to be diaphoretic, hypotensive, headache,e Malawi, fever, chill after starting syphilis treatment?

A

This is called Harisch-Herxheimer reaction; it’s normal after syphilis treatmetn. Self limited. Management is supportive

We can’t prevent this from happening.

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142
Q

After the patient receive gonorrhea and chlamydia treatmetn, NAAT remains positive, what do you do

A

It’s normal to remain positive 2-3 weeks after treatmetn due to dead organism.

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143
Q

What can cause false positive syphilis

A

Plac
Pregnancy
Autoimmune
Lyme
Chronic acute problem

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144
Q

Chlamydia vs gonorrhea

A

Chlamydia Sx usually at GU system

Gonorrhea Sx can be systemic

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145
Q

What STD can cause liver problem

A

PID

Can lead to perihepatitis/ Fitz-Hugh-Curtis Syndrome

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146
Q

When should we refer when teenager don’t have testicular development (by what age)

A

14 yr old

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147
Q

What’s oxybutynin for?

A

Anticholinergic: treat urinary incontinence

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148
Q

Chlamydial ophthalmia neonatorum

Diagnostic test

A

Baby eyelid becomes red, swelling, discharge (purulent, bloody at the end);
Diagnostic: swab conjunctiva (for epithelial cells)
Must: rule out chlamydia pneumonia

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149
Q

How does Down syndrome look (7)

ear?

A

Small AP head diameter
Up-tilted parental fissures
Big tonge
Short neck
Small ear
Simple transverse palm crease
Short finger and small palm

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150
Q

When does retina mature

A

6 year

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151
Q

Infant vision

A
  1. Neonate/ 1 month: basically blind: 20/200- 20/400: no tear, prefer human face, blue-gray eye is normal: can briefly fix on human face
    —if one eye always turns inward or outward: refer
  2. 3 months:
    –hold hands out to see your face
    —see bright, follow and fixate for seconds
  3. 6 month:
    —eye contact
    —-turn head
  4. 12 months:
    —prolonged eye contact, observe surround and people for long time
    —recognize self and favourite people in long distance
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152
Q

Down syndrome baby has higher risk of

A
  1. Feeding
  2. Cataract
  3. Heart problem
  4. TSH problem
  5. Hearing

Others: AD, atlantoaxial, IQ

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153
Q

Hypospadias vs epispadias

A

Hypospadias: urethral meatus is ventral (lower) aspect of penis： 龟头后侧

Epispadias: …. dorsal aspect (upper): 龟头前侧

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154
Q

Who can’t have flu vaccine (4)

A

–hx of anaphylaxis of egg ( less severe egg allergy can still have influenza)
–hx of Giuliani garre (immune damage CNS nerve, cause if unknown, people usually recover from it)
– if moderate- severe illness with fever: wait until recovery to get vaccine
–<= 6 months (can’t get it before that; immune is not mature enough).

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155
Q

If the patient get DTaP before 7 year

A

Doesn’t count;

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156
Q

Tdap vaccine before 7yr

A

Before 7 yr: DT

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157
Q

Can lactation get Tdap

A

Yes

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158
Q

Who can’t have Tdap

A

– hx of Brian problem within 7 days after getting previous DT vacccine that is not caused by other brain problem
– severe allergic to Tdap

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159
Q

Family hx of seizure
Family hx of SID
Fever that is < 40.5 C or 105 F

Can they get Tdap?

A

Yes they can

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160
Q

What’s abnormal and you should watch about Tdap?

A
  1. Fever> 40.5 C/ 105 F within 2 days after getting Tdap
  2. Seizure within 3 days
  3. Collapse or shock like within 2 days
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161
Q

What can baby 9 months do

A
  1. Pincher grasp
  2. Clap
  3. Wave bye bye
  1. Pull themselves up: bear weight well
  2. Crawl
  3. ## Cruises
  4. Play peek-a boo
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162
Q

When is marked stranger anxiety noted? (Age)

A

They start to aware their world: stranger apprehension @ 9 months

But seperation anxiety starts at 12 months and last until kid is 2-3 year old

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163
Q

What can kid 1 yr do

A

sir ssek f (sir sick as F)

  1. Can stand independently
  2. Cruise: Start to cruise: move from one piece of furniture to next for support
  3. Use sip cup
  4. 1-2 word+ repetitive sounds+ 感叹号 (exclamations) (Uh-Oh!)
  5. Know first name
  6. ## Follow simple directions: such as pick up the toy
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164
Q

When growth rate slows down

A

1 yr

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165
Q

Can parents heat the formula in the microwave?

A

No

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166
Q

How to prevent choking

A

Remove object smaller than 2 inch: grapes, raw carrots, hot dogs, latex balloons, coins, buttons.

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167
Q

When can we give kid hard candy

A

After 6 years

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168
Q

How long the kid should have rear- facing seat?

A

Until 2 yr

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169
Q

Can we put kid in frontseat?

Why?

A

Not until 13 yrs

Air bags can cause serious brain or neck injury

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170
Q

Car safety seats

A

2yr
8yr
12yr

Back—harness—booster seatbelt

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171
Q

At what age the kid can say single syllable?

A

6 months

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172
Q

At what age the kid can play pat-a-cake

A

9 months

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173
Q

What cause acute dacryocystitis

Sx
Diagnosis:
Treatment?

A

Chronic dacryostenosis+ bacterial growth in lacrimal sac

Sx: purulent eye discharge without other signs of infection
Dx: culture the discharge+ systemic abx x 7-10 days: prevent orbital cellulitis

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174
Q

When do we use Barlow and Ortolani test to check congenital hip displasia

A

Until chid is weight-bearing /walking

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175
Q

If you suspect hip dysplasia

A

Order hip US+ refer to ortho

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176
Q

What temp is considered fever in newborn & infant

A

> =38 C (100.4 F)

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177
Q

How old of kid who is ill looking likely need to send to hospital

A

Younger than 90 days

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178
Q

When infant colic, make sure to rule out

A

Formula allergy

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179
Q

Bilirubin pathway

A

Unconjugated bilirubin: RBC breakdown: toxic : fat soluable

Conjugated bilirubin: new bilirubin processed by liver: water soluble

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180
Q

What’s pathological jaundice

A
  1. Bilirubin increase too fast: > 5mg/dL per day
  2. Total bilirubin > 17mg/dL
  3. Jaundice of full term infant after 2 weeks of age;
  4. Jaundice before 24 hr : alway pathologic
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181
Q

When pathologic jaundice you evaluate

A

TORCH

Toxoplasmosis
Others: syphilis, hepatitis B
Rubella
Cytomegalovirus
Herpes simplex
Bleeding

182
Q

Full term baby that has been jaundice > 3 week with exclusive breastfeeding

A

Consider breastfeeding jaundice; which is no pathological

183
Q

Physiologic jaundice

When is the physiologic jaundice usually resolve?

A

Jaundice occurs after 24 hour,
Self limited and resolve without intervention by 2-3 weeks

Usually total bilirubin can peak 7-9 for white & black
Asian can peak up to 14mg/dL

184
Q

Breast milk jaundice

A

Show 4-5 days, peak 1-2 weeks, can take more than 1 month to resolve

Temporary stop breastfeeding: like 12 hours
Total bilirubin can > 20 mg/dL
Some need phototherapy

185
Q

What do you do if pathological jaundice

A
  1. Use transcutaneous bilirubin testing first: finger poke
  2. Serum fractionated bilirubin level
  3. Coombs test
  4. CBC
  5. Reticulocyte count
  6. Peripheral smear
  7. Breastfeed q 2-3 hours

First line treatment: phototherapy & follow up in 5 days

186
Q

What’s physiologic anemia in infancy

A

Hgb drop to 90-110 at 2-3 months; due to high O2 in body, so lower Hgb production

187
Q

When can the baby turn from front to back

A

4 month

188
Q

When can the baby play peek- a- boo

A

9 months

189
Q

When should we expect the strawberry hemangioma will resolve

A

2 yrs;

Watch and wait
Benign lesion

190
Q

If the baby has fever of 37.8, can you give vaccine?

A

As long as it’s not> 38, you can give it

191
Q

Hepatitis B schedule infant

A

Totally 2 doses; 1st one right after delivery; second dose give within 2 month old

192
Q

What does Coomb test do

A

Test if you have antibodies against your own RBC

193
Q

Who is contraindicated phtotherapy

A

Phtotherapy helps to make unconjugated bilirubin becomes directed bilirubin, so the baby can pee it out;

So NEVER give if their direct bilirubin is already high

194
Q

When can the baby hold head unsupported

A

4 month

195
Q

Miosis is

A

Excessive constriction of pupils

196
Q

What’s common Sign of child abuse; and what NP do?

A
  1. Postiomedial rib fractures (back and mid of body)
  2. Spinal fracture
  3. Metaphysical avulsion (force) fractures
  4. Bruises that are different stages of healing
197
Q

What’s the common pathogen causing epiglottis is

A

Before vaccine, is Hib

After vaccine: staphyl aureus, or strep pyrogen, fungi

198
Q

Common pathogen cause septic joint

A

S. Aureus

199
Q

Umbilical hernia resolve by

A

2 yr old

200
Q

Inguinal hernia noted at infancy

A

Need surgery

201
Q

Sacral dimple

A

Need spinal US

202
Q

Bowl leg until

A

18 months

203
Q

Anterior vs posterior frontanelle

A

Posterior close by 2 month

Anterior close 1-2 yr old

204
Q

RBR chart until

A

5 yr old

205
Q

Uncoordinated eye movement will resolve

A

By 6 month

206
Q

Heart murmur in infant

A

Common in newborn, but should disappear in a few hours; signicant murmur is not normal

207
Q

First stool must be passed

A

Within 2 days after birth

208
Q

Hydrocele should resolve by

A

1 yr; longer than that is not normal

209
Q

Cutis marmorata

A
210
Q

When does physiologic jaundice resolve by from school

A

12 days

Jaundice last > 14 days is not normal.

211
Q

Signs of bilirubin toxicity to brain

A

Kernicterus

Loss Moro reflex
Poor feeding
Lethargy
Hypotonia

212
Q

To prevent SIDS, how long the infant should be supine until

A

6 month

213
Q

When the chest and head circumference becomes the same

A

6 month

214
Q

Age
Neonate
Infant
Toddler
Preschool
Preterm
Low birth weight

A

Neonate: < 28 day
Infant: 1 month to 1 yr
Toddler: 1-3 yr
Preschool 3-5 yr

Preterm: < 37 week
Low birth weight: < 2.5kg

215
Q

Mom’s IgE will protect the baby for how long

A

3 month

216
Q

When is the growth spurt that baby wants to eat a lot

A

6-8 week

217
Q

Routine child visit

A

1,2,4,6,9,12 month

218
Q

Weak cry

A

Myasthenia gravis

219
Q

Hoarseness cry

A

Hypothyrodism

220
Q

Edinburgh postpartum depression, what score should be referred

A

> =13

221
Q

When does kid pee incontinence at night is abnormal

A

> = 5 yr

222
Q

When do we screen for autism

A

18 month:
We watch for 5 signs:
1. No point/ show/ reach, or babbling by 12 month
2. Don’t say 1 word by 16 month
3. Don’t say 2 word phases on their own by 1 year
4. Loss language or social skills at any age

223
Q

What stuttering is not normal

A

Last>=6 months
>=5 yr

224
Q

Kawasaki disease

Sx
Treatment

A

Commonly patient is < 5 yr
Sx usually resolve within 3 weeks

Fever (> 40C) x >=5 days+ >=4 of the folllowing:

  1. Swollen hands and feet
  2. Neck lymadenopathy
  3. Bright red rash
  4. Strawberry tongue: or oral mucosa change
  5. Bilateral conjunctivitis without discharge

Treatment: high dose aspirin + IV gamma globulin+ refer to pediatric cardiologist because those consequences will happen once kid is older.

Watch: close follow up because can have serious consequences: aortic dissection, aneurysms/ dilation of coronary artery, or hearing loss.

225
Q

Signs of child leukemia

A
  1. Signs of bleeding
  2. Fatigue
  3. Weak
  4. Pale
226
Q

What;s most common leukemia in kid and what cause it

Sx
Cure?

A

ALL: acute lymphocytic leukemia: fast growing cancer of lymphoblast (immature lymphocytes)

Sx: (WBC, Hgb, platelet) neurtropenia+ anemia+ thrombocytopenia

Girl has higher chance of cure than boys

227
Q

Acute myelogenous leukemia (AML)

Pathology

Cure?

A

Fasting growing cancer of bone marrow that affect immature or precursor blood cells, such as myeloblast (WBC), monoblast (macrophages ), erythroblast (RBC), and megakaryoblast (platelet)

Better chance of cure:
1. Down syndrome
2. < 4 yr old

228
Q

Marfan syndrome risk to participate sport

A

May disqualify

Claj

Aortic aneurysm
Cardiac death
Lense eye disaplcement
Joint hypermobility

229
Q

Thing that may disqualify youth from sports participation

A

1 ham meaf pib

  1. 1 kidney (solitary kidney)
  2. Hypertrophic cardiomyopathy
  3. Mitral valve prolapse
  4. Marfan syndrome : eye displacement, aortic aneurysms, cardiac death, joint hyper mobility
  5. Ehlers-Danlos syndrome: vascular form: joint hypermobility. Spondylolisthesis, cerebral, cervical artery aneurysm
  6. Atlantoaxial instability
  7. Fever: dehydration, hypotension, increased heart lung input
  8. Pink eye
  9. Infectious diarrhea
  10. Bleeding disorder
230
Q

Fragile X syndrome

Features

A
  1. Long face
  2. Prominent forehead & Jaw
  3. Large/ protrude ears
  4. Large body with flexible flat feet
231
Q

Hand foot mouth disease

A

Small blister on hand, feet, mouth, around rectum; mouth, tonsil, throat, tongue can have small ulcers,

232
Q

Measles Sx

How the rash spread

A

-Koplik spots. Inside cheek
-Maculopapular rash start on face and spread from head to feet without getting to palms and soles.
-

233
Q

Varicella skin Sx

A

Generalized rash with different stages. New lesion appear daily for 5days.
Papule
Vesicles
Pustules
Crust
Pruretic.
Very contagious.

234
Q

Molluscum contagiosum

Sx
Cause

A

Smooth
Wax like
Round: doom shaped

Cause by poxvirus

235
Q

Maculopapular rags that at webs of hand feet axilla… super itchy. But more at night

A

Scabies.

236
Q

Scarlet fever

A

Sandpaper rash with sore throat.

237
Q

Pediculosis capitis

A

Aka. Head lice

Red papules initially located a hairline behind neck and ears.

238
Q

Piaget stages.

A
239
Q

HPV vaccine at youngest age can get is

A

9

240
Q

Most common cancer in children
Most common cancer in teens

A

In children is ALL

In teens 15-19yr is : Hodgkin’s lymphoma, germ cell tumour ( such as testicular and ovarian cancer)

241
Q

Hodgkin’s lymphoma

A

—Large lymph node with fever
—-Those big lymph nodes might become painful after drinking alcohol
— night sweat & other signs of cancer

242
Q

Testicular cancer

Age
Sx

A

15-35yr

Heavy feeling scrotum with a firm mass that is painless

243
Q

So to testicular torsion. It will loose function by what time

A

24 hours. If no surgery is done.

244
Q

With torsion of appendix testis. What’s the UA

How to manage it

A

UA is normal

Self limited. Elevate acronym, bed rest, ice, NSAID

245
Q

Tanner stage

Don’t memorize the pubic hair changes; only know the breast change for girl and genital changes for boys

A

Only memorize 2-4

Precocious puberty:
For girl: before 8
For boys: before 9

Delayed puberty:
For girls: no breast development by 12y.
For boys: no testicular enlargement by 14 yr

246
Q

Mittelschemerz

A

Ovulation pain

Unilateral; caused by big follicle

247
Q

Menarche

First onset
Sx after

Breast bud vs menarche

A

Average starts at 12 yr

Then 1-2 yr after, period becomes irregular due to irregular ovulation

After breast bud, first period starts within 2 years.

248
Q

Normal period

A

Every 28+- 7 days

Last: 2-7 days

1st day spotting, then 2-3 days of heavy bleeding, then becomes light bleeding

249
Q

Dysmenorrhea associated with prostaglandin level

A

High prostaglandin level

250
Q

Most fertile day

A

3 days before and during ovulation (11-14day).

251
Q

Adolescent top cause of death

A

AAS:
1. Accident
2. Assault/ homocide
3. Suicide

252
Q

When the teenage doesn;’t need parental consent

A
  1. They don;t need for contraceptive, STI to begin with
  2. Legally married
  3. Active duty in armed force
  4. Live separately from parents or self- supporting
253
Q

When can you break the confidentially

A
  1. Gunshot wound, stab wound: report police
  2. Suicidal idea or attempt: tell parents or hospital
  3. Homocide idea
254
Q

Anorexia nervous binge-purging type vs bulimia

A

Bulimia can’t control; eat a lot within short amount of time, then they use stuff to get it out

255
Q

What weight loss you should start consider anorexia?

A

Weight loss> 10% of body weight

256
Q

Idiopathic adolecent scoliosis

Who likely to get it
What have worse outcome
Screening
Diagnosis
Treatment

A

Girls like to get it

Kid starts to have curvy spine during bone spurt
Physical exam:
—Adam’ forward bend test: patient bend forward with both arms handling free: watch assymmetry of spine, scapula, thorax, and lumbar curvature
—order X-ray to get Cobb angle (curve degree)

Treatment:
–< 20 degrees wait and watch
–20-40: brace: Milwaukee brace
> 40 degree: surgery

257
Q

Tanner stage 1

Aka?

A

Prepubertal

258
Q

When gynecomastia is normal

A

Before 14 yr

259
Q

Tylenol toxicity

A

First 24 hr: could be no Sx.
24-72hr: high liver test, high renaltest, high Prothrombin

3-4 days: low sugar

260
Q

What drug myasthenia gravis patients can’t have?

A

Macrolide

261
Q

At what year the patient can’t have tetracycline

A

<9 yr old

262
Q

What drugs that is not ototoxic that can be used on perforated TM

A

Ofloxacin

All the mycins are ototoxic

263
Q

What’s meningococcmia

Treatment

Prophylaxis treatment

A

Blood infection caused by Neisseria Meningitis

1st line Ceftriaxone

Prevention treatment: Rifampin

264
Q

Rocky Mountain spotted fever

A

Fly like first ( include joint and muscle pain)

2-5 days later have small red dot petechiae at wrist ankle.

Treatment: doxycycline.

265
Q

What nerve does shingle affect

A

Trigrminal

266
Q

Is tinea versicolour itchy?

A

No

267
Q

Signs of pityriasis rosea

A

Herald patch—-> collarette scaling patch—> Christina’s tree ( rash on cleavage)

268
Q

What Rocky Mountain spotter fever caused

A

Rickettsia tick bite.

Sudden high fever, severe headache, joint muscle pain rashes at ankle wrist

269
Q

Spider bite treatment

If kid has systemic Sx?

A

Abx on wound
Cold pack
NSAID

If kids with systemic Sx: hospital due to hemolysis risk

270
Q

Pseudofolliculitis barbae

A

Barber’s itch.

Caused inflammation from curly hair grow back into the skin

Treatment. Let the beard grow 3-4 weeks.

271
Q

What’s this

A

Melasma

272
Q

Skin tags

A

Acrochordon

273
Q

Steroid potency

A
274
Q

Acne treatment.

A

Mild: comedones papules: topical retinoids ( retin-A 0.25% cream is lowest strength), benzo peroxide, topical abx

Moderate: papules, pustules: topical+ antibiotic.

   Oral isotretinoin: 
    Oral antibiotic 
    Oral hormonal therapies ( oral contraceptive, spirinolactone) 
    Topical ( includes azelaic acid) + systemic is good

Severe: nodular severe. Extensive
1st line: oral isotretinoin +_ oral glucocorticoid.
2nd: add oral abx (tetracycline x3-4 months)
Tetracycline is contraindicated for kid< 8 yr old

Limited some dairy. Such as skim milk.

275
Q

What bacteria causes acne

A

Cutibacterium acnes

276
Q

Anthrax

A
277
Q

Smallpox

A
278
Q

For mild onychomycosis

A

Start with topical antifungal: ciclopirox, efinaconazole

279
Q

Moderate to severe onychomycosis

Finger vs toes

A

Oral terbinafine
Finger: 6weeks
Toe: 12 weeks.

280
Q

Lyme disease tick pathogen

A

Borrelia burgdorferi

281
Q

Diagnostic tests and treating Lyme disease.

A
282
Q

Once you remove the tick and find tick is engorged

A

Give 1 dose of doxycycline. 200mg

283
Q

What’s this
What do you do

A

Necrotizing fasciitis

Send to ED

284
Q

What’s this

What do u do about it?

A

Pityriasis rosea

Cleavage 卵裂lines
Christmas tree pattern
Herald patch
Maybe itchy

Self limited within 1 month
May caused by viral infection

285
Q

Korbner phenomenon

A

In psoriasis paitent;

Psoriasis formed after a skin trauma

286
Q

Auspitz sign

A

Bleeding if you peel psoriasis skin scale

287
Q

Treatment of psoriasis

A

1st line: topical steroid+ emollient

Others:
1. Topical retinoids : tazarotene
2. Tar preparation: psoralen drug
3. Topical vitamin D
4. Anthralin: natural product from tree

If severe: MTX, TNF, phototherapy…

288
Q

What’s about topical tacrolimus

A

Can cancer, but rare

Don’t use it in immune bad paitents

Make sure use sunscreen when on it

289
Q

What’s this

A

Guttate psoriasis:

Drop-shaped lesion

Caused by beta-hemolytic streptococcus infection:

Usually due to strep throat

290
Q

What’s this

A

Pustular psoriasis

Can associated with life-threatening situation, such as other body organ dysfunction, or infection

291
Q

Rocky Mountain spotted fever

Cause
Dx
Tests
Tx
Sx
Complication

A

Caused by Rickettsia rickettsii infection caused by dog tick/ wood tick bite
Risk: woody area, high grass, expose to dogs, southeastern or south central state
Diagnosis: clinical+ hx (risk factors).
—–definitive Dx: indirect fluorescent IgG antibodies IFA assay: check in 2, and 4 week you see values x 4 increase ; result will stay elevated for months after Sx resolved.
Tx: doxycycline start best within 5 days since Sx onset
Report the disease

  • red spot starts on hand/palm/ feet+ fever, headache, muscle pain

Complication: death, neuro problem: hearing loss, neuropathy

292
Q

If the patient has Sx of Rocky Mountain sported fever + risk factor but result is negative, do you treat it?

A

Yes; antibody often negative in early infection

293
Q

How to properly remove tick

A
294
Q

What’s this.
That’s the treatment

A
295
Q

Scabies treatment
Can you apply on kids? Face? Scalp

A
296
Q

What pathogen causes tinea versicolour

A
297
Q

Treatment of tinea versicolour

A
298
Q

Shingle vs chickenpox

A

Shingle is the reactivation of chickenpox

299
Q

What’s this

A

Shingle

300
Q

Complication of herpe zoster

A
301
Q

Phases of wound healing

A
302
Q

Wound care for superficial and partial thickness (burn)

A
303
Q

When do you think about tetanus shot when wound occurs

A

If last dose > 5 yrs, get one

304
Q

Don’t suture what wound

A
305
Q

Can immune compromised patient get shingrix?

A

Yes. When they r getting treatment. Must be >50 years

306
Q

Molluscum caused by what

A

Poxvirus

307
Q

If many skin lesions of impetigo, what’s your treatment

A

If limited number: topical mupirocin

If many: oral cephalexin, or dicloxacillin

308
Q

What’s virus causes herpetic whitlow

A

Heroes simplex

309
Q

Degree of burn and where it damage

A

Superficial: epidermis
Superficial partial thickness: blister between epidermis and dermis
Deep partial thickness: dermis & hair follicles and granular tissue
Full-thickness : all dermis and often fat tissue

310
Q

Carbuncle vs furuncle

A

Carbuncle: combined several inflamed follicles into a single inflammatory mass with orient drainage

Furuncle: well circumscribed, painful, supportive inflammatory nodule that involves hair follicles and often for preexisting folliculitis

311
Q

First line treatment for psoriasis

A

Mild: topical corticosteroids and emollient

312
Q

Paronychia treatment

A

If have access: incision and drainage

No abcess: topical abx and warm water or antiseptic soaks

313
Q

Skin changes associated with bacterial/ infectious endocarditis

A

Subungual hemorrhage
Petechiae on palate
Painful violet nodes on finger or toes ( Osler nodes)
No tender red spots on palm or soles( janeway lesions)

Eye exam shows Roth Spots ( retinal bleeding)

314
Q

Typical Sx of infectious endocarditis

Common pathogen

1st line diagnostic test

A

Fever chill
New murmur
Anorexia
Weight loss

Pathogen: Staphyl aureus

1st test: ECHO

315
Q

Aortic stenosis is systolic or diastolic murmur

A

Systolic.

316
Q

For the exam, what murmur that radiates.

A

Systolic.

317
Q

Murmur quality

What radiate to axilla
What rumbles

A

Mr: radiate to axilla or base

Ms: rumble

318
Q

What murmur is very bad

A

Aortic stenosis

Harsh and noisy

Refer to cardiologist
Avoid physical exertion—> sudden cardiac death

319
Q

What murmur you can listen when patient is at a special position

A
320
Q

What murmur you use bell to hear?

A

Ms
Use bell

Best heard at mitral
Also called opening snap

321
Q

Risk factors of endocarditis

A

Oral problem or procedure
Fake valve
Congenital valve problem

322
Q

What abx do you give as prophylaxis endocarditis going to an oral procedure.

A

Give amoxicillin 2g one time dose 1 hour before procedure.

If allergic to penicillin: cephalexin or clarithromycin.

323
Q

What’s this

A

A-fib

No P wave
Irregularly irregular

324
Q

What’s this

A

Anterior wall MI

Elevated ST at V2 to V 4

Looks like tombstone

325
Q

What’s this

A

Ventricular tachycardia

Jagged irregular QRS

326
Q

Lentigines

A

Aka liver spots. Brown coloured macules located at hands and forearms

Benign

327
Q

Neurofibromatosis is associated with what

A
328
Q

Should the patient see breast specialist first or get biopsy first

A

See specialist first.

329
Q

What’s Russell’s sign and Telogen effluvium

A
330
Q

Drugs that increases warfarin

A
331
Q

DOAC associated bleeding is treated by what

A
332
Q

Anticoagulation and INR

A
333
Q

High Vitamin K food

A
334
Q

What’s this

A

Paroxysmal supraventricular tachycardia

ECG: peaked QRS with P wave

One type is called Wolff-Parkinson-White ( WPW)—- short PR interval+ wide QRS+ paroxysmal tachycardia —->high risk of death: refer

Comes and go

Refer to cardiologist for catheter ablation.

335
Q

Can pregnant women have warfarin?

A

No

336
Q

Chest x ray shows Kerley B lines

A

Right heart failure.

337
Q

Normal jugular vein distension

A

<= 4 cm

338
Q

Classification of HF

A
339
Q

Does low carb diet help HTN?

A

Yes

340
Q

Lifestyle change for dyslipidemia (5)

A

Reduce sugar & simple carb
Avoid alcohol
Eat finish with omega 3 ( salmon, sardines)

Weight loss
Increase Aerobic exercise

341
Q

What intensity of statin to use

A
342
Q

Statin intensity reduction

A
343
Q

Atorvaststin and rosuvastatin dose and intensity

A
344
Q

Risk factor of ASCVD

A
345
Q

Which statin has higher drug interaction, and what do u watch

A
346
Q

If patient has Sx of rhabdomyolysis

A

Stop drug and go to ER ( risk of acute kidney injury)

347
Q

Avoid order statin for what patient

A

Alcoholic

348
Q

When pregnant women tends to have S3 and it’s normal

A

3rd trimester

349
Q

How to diagnose HTN

A
350
Q

Eyes changes associated with HTN

Clinical significance of these changes

A
  1. AV nicking: vein ( the thicker one) stop abruptly at the side of artery
  2. Copper
  3. Bleeding: flame or dot shape, cotton wool spots, hard exudate
  4. Microaneurysm
  5. Arteriolar narrowing and wall thickening

If you see these: need to get their BP down now!

351
Q

Renal artery stenosis

Age
Sx

A

Common in young adults

Sx: HTN+ bruit @ epigastric, abdomen, or flank

352
Q

Polycystic kidney Sx

A

Large kidney with cystic renal mass+ HTN

353
Q

HTN+ increased creatinine + decreased GFR

A

Renal insufficiency or acute kidney failure.

354
Q

Secondary HTN cause and age

A

Young adult : renal stenosis
Middle age: endocrine
Old: CKD

355
Q

Hypertensive emergency vs hypertensive urgency

A

Urgency doesn’t have target organ damage: often caused by not taking meds. If no damage: make sure they take their meds and close follow up

Emergency has target organ damage ( systemic Sx): ER

356
Q

DM eye change

A
  1. Neovascularization
  2. Cotton-wool spots
  3. Microaneurysm
357
Q

Why does AV nicking happens

A

When a retinal vein is compressed by arteriole and cause the vein to collapse

358
Q

When assess orthostatic hypotension. What’s the time range

A

See the reduction within 2-5 min

359
Q

With stage 1 HTN. What do u do

A

Depends on their FRS

If < 10%: lifestyle and reassess in 3-6 month

If >10%: lifestyle and drug.

360
Q

For stage 1 and 2 HTN, what’s your goal BP

A

<130/80

For stage 2HTN, If not at goal BP 1 months after current intervention, switch a different BP med

361
Q

About DASH diet

A
362
Q

Where do u get Ca, Ma, K, Omega3

A
363
Q

What’s contraindication of thiazide diuretic

A

Lithium treatment

364
Q

What loop diuretic potential drug interaction

A

This diuretic might change excretion of lithium and salicylates.

365
Q

What do you think before prescribing diuretic

A

Sulfa allergy
Anuria ( kidney failure) can’t have loop diuretic.

366
Q

What’s bumetanide

A

Loop diuretic.

367
Q

k sparing diuretic

Side effects
Contraindication

A
368
Q

How thiazide helps osteopenia

A

Slow down Ca loss& stimulate osteoclasts

369
Q

What’s BBB role in migraine?

A

Use a prophylactic only.

370
Q

How to treat essential tremor

A

No selective BBB: propranolol

371
Q

What’s non-selective BBB

A

Propranolol
Timolol
Pindolol

372
Q

BBB that’s has both alpha and beta blocking action

A

Labetalol
Carvedilol

373
Q

Non-DHP CCB vs DHP CCB

A
374
Q

Contraindication of CCB

A
375
Q

Can you give ACEI or ARB to patient with renal artery stenosis

A

No. Will cause acute renal failure

376
Q

Cotton wool look eye means

A
377
Q

What Microaneurysm looks like in fundal exam

A
378
Q

What alpha -1 blocker is

A

Potential vasodilator

Relax bladder neck and prostate gland smooth muscle.

379
Q

SE of alpha blocker

A

Orthostatic hypotension

380
Q

Can tamulosin help with BP?

A

No. Only BPH. But other alpha blocker reduce BP and help BPH

381
Q

What MVP sounds like

A

Click+ holosystolic murmur

382
Q

Marfan’s syndrome

A

Hypermovable joint
Long arm
Pectus excavatum
Might have MVP

383
Q

What do you do if you find the patient has MVP

A

If they don’t have Sx, don’t need treatment

MVP often benign.

Lifestyle change:

Avoid caffeine, stimulants, alcohol, cigarette
Aerobic exercise training
Reduce stress

384
Q

ARNI meds side effect

A

Same as ACEI

385
Q

Does loop diuretic affect uric acid?

A

Yes. It increases it

386
Q

MVP with palpitation. What do u do?

A

Treat it with BBB

387
Q

If you suspect MVP, do you order any test?

A

Yes. ECHO. Even if they have family he of MVP.

MVP associated with higher risk of severe MR, arrhythmia, bacterial endocarditis

388
Q

BMI

A
389
Q

What is is:

Leg pain when walk and instantly relieved by rest

A

PAD

390
Q

What’s diagnostic for PAD

A

ABI<= 0.9

391
Q

How to measure ABI

A
392
Q

What drugs can increase serum concentration of anti platelet

A

Grapefruit
Diltiazem
Omeprazole if taken together

393
Q

PAD increases risk of

A

Carotid plaque

So check carotid bruits

394
Q

Pulses paradoxus

How much does it drop

A

Pericarditis
Cardiac tamponade
Asthma
Emphysema

395
Q

What Raynaud syndrome
Sx
Treatment
Drug therapy
Complication

A

Caused by reversible vasospasm of peripheral arterioles response to cold or emotional stress

Primary: no autoimmune diseases
Secondary: has autoimmune disease

Treatment: keep warm, avoid any stimulants ( caffeine), stop smoking, manage stress is very important

Initial drug: CCB + avoid vasoconstriction drugs ( triptan, ergot, decongestant, amphetamine

Complication: ulcers

396
Q

What’s this
What’s your management

A

Order US to rule out DVT

Treatment: warm compression+ NSAID+_ anticoagulant depends on patient’s risk for VTE

397
Q

When do we need to give infectious endocarditis prophylactic antibiotic?

A
398
Q

Supraventricular tachycardia

Definition
Diagnostic
Treatment

A
399
Q

What’s the definitive diagnostic test for right heart failure

A

Cardiac catheterization

400
Q

What’s this

What’s your management

A

Atrial flutter

Rapid, regular atrial depolarization
Super fast HR
Sawtooth
No P wave

Treatment: rate control: non-DHP CCB, or BBB

401
Q

Can a patient with second degree AV block use CCB?

A

No. Contraindicated. 1st degree is fine.

402
Q

What’s the risk enhancing factors for ASCVD

A
  1. CRP >= 2
  2. CKD
  3. Persistent high LDL>= 160mg/dL
  4. Hx of preeclampsia
  5. Premature menopause
  6. Metabolic syndrome
  7. Family hx of early ASCVD
  8. PAD
403
Q

Breath sounds

A
404
Q

COPD treatment

A
405
Q

Insulin time

A
406
Q

What’s this

A

Soft exudate : infarct
Neovascularizatoon
Microaneurysm: red dots: bleeding
Hard exudate: protein leaking.

407
Q

What’s this

A

Hypertension:

Silver/ copper wiring
Arterovenous nicking

408
Q

What’s this

A

Pretibial myxedema

Rare Sx seen in Graves’ disease

Thickening skin usually at shin and give an orange peel appearance.

409
Q

What’s this

A

Addison disease

Tanning
Freckles
Pigmented crease
Scant axillary and pubic hairs

410
Q

Problematic drugs that tends to have drug drug interactions

A
411
Q

Drugs interact with grapefruit

A
412
Q

Quinolone SE

A
413
Q

Quinolone contraindication

A
414
Q

What drugs that need eye exam

A
415
Q

What’s this

A

Orbital cellulitis

416
Q

What’s this

A

Candida rash

417
Q

What’s this?

A

Smallpox: flu like Sx + this papules.

418
Q

What define supraventricular tachycardia

A
419
Q

Asthma stages and treatment

A
420
Q

Canadian COPD management

A
421
Q

COPD and asthma treatment and stages s

A
422
Q

Pneumonia treatment

Atypical
CAP

A
423
Q

TB reading

A
424
Q

FSH and LH role

A
425
Q

Adrenal problem: primary secondary tertiary

A
426
Q

Hepatitis A reading

A

IgM anti-HAV: IgM antibody hepatitis A virus

427
Q

Hepatitis B reading

A

HBsAg: surface antigen
Anti-HBs: antibody
HBeAg: “e” antigen
HBcAg: core antigen

428
Q

Hepatitis C reading

A

Anti-HCV: antibody

429
Q

Hepatitis D reading

A
430
Q

Liver enzyme interpretation

A

AST: in liver, ST ( heart), spread ( muscle)
ALT: liver ( liver 特别）
GGT: many places: alcoholic, drug, biliary, pancreas
ALP: a bone (*), liver, placenta

431
Q

GGT elevated alone

A

Alcoholic

432
Q

GGT elevated with other liver enzymes

A

Liver disease or biliary obstruction

433
Q

Canadian treating c-diff colitis

A
434
Q

Anti-HBc

A

Core antibody: start to have this at onset of Sx and will persist for life

435
Q

Atypical squamous cell

A

Women under 24 yr has strong cervical immunity. So if we find abnormal cells, we give them time to recover: repeat PAP at 12 month ( if not positive)

But after 24 yr our cervical immunity declines, so if positive: colposcopy.

436
Q

Buds andpseudohyphae
Clue cells
What are they?

A
437
Q

Canadian oateoporosis screening

A
438
Q

US va mammogram when screening for breast cancer

A

<30yr or pregnant: do US

> 30yr: mammogram

439
Q

Scheduled pregnancy visit

A
440
Q

Second trimester time

A

14-28 week

441
Q

What do we do in second trimester screening

A
442
Q

What STI do we screening during pregnancy

A

Hepatitis B (HBsAG)
HIV
Gonorrhea and chlamydia
Syphilis
HSV1-2

443
Q

Syphilis stage and treatment

A
444
Q

Tdap vaccines

A
445
Q

Hip dysplasia assessment

A
446
Q

Piaget stage

A
447
Q

What drug can’t mixed with nitrate

A

PDE5

448
Q

nephrology consultation (6)

A

pregnancy
eGFR < 30
persistent protein to creatinine ratio >500
ACR > 300mg/ g
abnormal urine microscopy
hx of SLE or mutiple myeloma

449
Q

Gonorrhea treatment

A
450
Q

Odynophagia

A

Pain when swallowing

NP License Exam (1 decks)

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