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FNP practice 2021-2022 > fitz > Flashcards

fitz Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

What is early term in pregnancy? Full-term? Late-term? Post-term

A 
Early = 37 - 38.6 
Full = 39 - 40.6 
Late = 41 - 41.6 
Post = 42 >
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2
Q

During 3 - 8 weeks of human development/gestation, what is this most known for?

A

organ development aka organogenesis

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3
Q

A teratogenic medication affects the targeted organ at any given time during fetal development? T/F

A

False - the teratogenic medication is either given prior to the organ it affects or during the gestational weeks when that organ is developing (ie soft palate develops 7-8 weeks of gestation, medication must be given prior or during that time)

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4
Q

What is important to know about Naegele’s rule? (pregnancy EDD)

A

provides a reasonable estimation, but can be INACCURATE for women with irregular menses or with unclear LMP date

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5
Q

What is the MOST ACCURATE source of expected due date in pregnancy?

A

1st trimester ultrasound (up to 13.6/7 weeks - this is the first week of the 2nd trimester [1st = 0-12, 2nd = 13-26])

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6
Q

What is most accurate source in the 2nd trimester to determine expected due date? (up to 27.6/7 weeks)

A

sizing of the uterus/uterine size, fetal movement felt by mother (quickening - 17-20 weeks usually)

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7
Q

What occurs at 10 weeks of gestation?

A

fetal heart tones via abdominal Doppler

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8
Q

Where is the uterus at 16 weeks of gestation? **

A

fundal height is half-way between symphysis pubis and umbilicus (VERY HELPFUL MARKER)

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9
Q

Where is the uterus at 12 weeks of gestation?

A

rising above the symphysis pubis

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10
Q

Where is the uterus at 20 weeks of gestation?

A

fundus is at the umbilicus

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11
Q

What is important to know about the fundal height in pregnancy during 20 - 36 weeks?

A

the fundal height will increase about 1 cm per week, which is concurrent with gestational age

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12
Q

What is the folic acid requirement of a women WITHOUT a history or family history of neural tube defect?

A

0.4 - 1 mg/day

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13
Q

What is the folic acid requirement of a women WITH a history or family history of neural tube defect?

A

4 mg/day for 1 month BEFORE pregnancy and DURING

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14
Q

What are the elemental iron requirements of a pregnant women?

A

30 mg/day - best from an iron-rich diet

only add on elemental iron if hgb < 11 in 2nd trimester or <10.5 in 3rd trimester

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15
Q

What is the recommended weight gain for a woman with a normal prepregnancy BMI? (18.5-24.9)

A

total weight gain 25-35 lbs

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16
Q

What is the recommended weight gain for a woman with an overweight prepregnancy BMI? (25-29.9) Obese? (>30)

A

total weight gain 15-25 lbs

obese = 11-20 lbs

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17
Q

Pre-pregnancy genetic at-risk group: Ashkenazi Jews, French Canadian, Cajun ancestry are at risk for what genetic condition?

A

Tay-Sachs disease

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18
Q

Pre-pregnancy genetic at-risk group: Northern European or Ashkenazi Jews are at risk for what genetic condition?

A

Cystic Fibrosis - prior to or in early pregnancy need genetic screening

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19
Q

Pre-pregnancy genetic at-risk group: African, Latino, Arabic, Greek, Maltese, Italian, Sardinian, Turkish, and Indian ancestry are at risk for what genetic condition?

A

Sickle cell trait

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20
Q

What vaccines may be given as early as 6-8 weeks in pregnancy or anytime during pregnancy

A

Influenza - during summer

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21
Q

When is Tdap ideally given to the pregnant mother? What about spouse or household members - when should they get a Tdap?

A

27 - 36 weeks gestation with EACH pregnancy.

Anyone in the house/care of infant should have a Tdap within the past 10 years.

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22
Q

What are postpartum vaccines that should be given to a mother?

A

if NOT rubella or varicella immune - give MMR and varicella. NEVER give live vaccines during pregnancy, may be given preconception

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23
Q

What diagnostic testing should be offered to pregnant women that are at an increased risk of fetal aneuploidy with first or second trimester screening?

A

genetic counseling and the option of CVS or mid-trimester amniocentesis

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24
Q

Who is at highest risk of gestational diabetes or the development of type 2 DM during pregnancy? (6 findings)

A

overweight/obese, gestational DM with previous pregnancy, prior delivery of LGA infant, presence of glycosuria, PCOS history, strong family hx of type 2 DM

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25
Q

At what gestation should all pregnant women (non DM hx) be screened for GDM?

A

At 24 - 32 weeks gestation, including those with negative results in first trimester

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26
Q

What is the FIRST intervention for GDM mothers?

A

nutritional therapy - by a trained professional with formal dietary assessment

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27
Q

What are the pharmacological options offered during GDM, if not controlled with diet and exercise alone?

A

Insulin, Sulfonylureas, Metformin

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28
Q

How many weeks postpartum should testing for GDM be conducted? What should NOT be included in this testing?

A

6 - 12 weeks postpartum, NO A1C

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29
Q

What are the treatment options for heartburn in pregnancy?

A

diet (no spicy or high-acidic foods, decrease food/liquid at meals and before bed)
Sleep in semi-Fowlers
Antacids post meal (PPI decrease B12 and iron)

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30
Q

When does hCG peak in pregnancy?

A

10 weeks - n/v is caused by this. May begin by week 6-8

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31
Q

What 5 pharmacologic options are available for moderate to severe nausea and vomiting in pregnancy?

A

*Pyridoxine OTC (Vit B6 analog) 25 mg PO TID,
*Antihistamines (dimenhydrinate, diphenhydramine),
Phenothiazines (promethazine, prochlorperazine),
Prokinetic agen (metoclopramide),
Ondansetron (zofran)

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32
Q

How is Chlamydia trachomatis treated in pregnancy?

A

Azithromycin single dose. Tetracycline eye drops or 2 weeks of erythromycin.

Fitz: Ceftriazone 250 mg IM and Azithromycin 1 gm PO
(Allergy to PCN = Azithromycin 2 gm and CT alone: Azithromycin 1 gm PO)

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33
Q

When should you follow up diagnostic testing for chlamydia trachomatis in the pregnant patient?

A

test of cure in 3 - 4 weeks, rescreen in 3 months for new infection (test of cure is ONLY in pregnancy)

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34
Q

What is the treatment for syphilis during pregnancy? Allergy?

A

Benzathine PCN G IM

allergy to PCN = desensitized therapy

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35
Q

What can be used in a primary episode of HSV in pregnancy? Recurrent episode? Suppression? (do NOT memorize amount drug, know names)

A

PRIMARY: Acyclovir 400 mg TID 7-10 days or Valacyclovir 1 gm BID,
RECURRENT: either med for 5 days,
SUPPRESS: Acyclovir 400 mg TID or Valacyclovir 500 mg BID from 36 weeks until delivery

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36
Q

What should be done with an abnormal PAP during pregnancy?

A

referral for colposcopy (nonpregnant and pregnant)

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37
Q

When does Pap screening begin? HPV with pap?

A

Pap age 21,

HPV = >30 years

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38
Q

What 2 pharmacological treatments are available for anogenital warts during pregnancy?

A

TCA topical or Cryotherapy (may need C-section)

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39
Q

What are symptoms of placenta previa? How is this diagnosed?

A

PAINLESS vaginal bleeding in late 2nd or any part of 3rd trimester
Diagnosed by transvaginal ultrasound

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40
Q

What are symptoms of placental abruption?

A

PAINFUL vaginal bleeding. Tender with a contracting uterus

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41
Q

What are symptoms of postpartum depression? When does this occur?

A

depressed mood >2 weeks with change in appetite, sleep disturbance, guilt, worthlessness
Occurs within the 1st year of child’s life (2-4 months postpartum)

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42
Q

Is levothyroixine safe for pregnancy?

A

yes - may need to increase by 30 percent

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43
Q

What beta-lactam antibiotics are safe during pregnancy and lactation?

A

penicillins and cephalosporins

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44
Q

What macrolides are safe during pregnancy and lactation? What should be avoided?

A

Azithromycin and Erythromycin

AVOID clarithromycin

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45
Q

What antibiotic should be avoided in 3rd trimester due to a risk of the infant developing hemolytic anemia?

A

NItrofuratonin (Macrobid) d/t risk of hemolytic effects/anemia

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46
Q

What asthma medications are safe with pregnancy and lactation?

A

inhaled corticosteroids, short and long acting beta 2

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47
Q

What maybe used during an asthma flare in pregnancy and lactation?

A

short term systemic corticosteroids

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48
Q

What drug class of antibiotics should NOT be used during the third trimester of pregnancy due to a risk of the infant developing kernicterus?

A

Sulfonamides, such as sulfamethoxazole

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49
Q

What two medications maybe used during pregnancy and lactation for allergic rhinitis care?

A

intranasal corticosteroids and 2nd generation antihistamines (loratadine)

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50
Q

What analgesic is approved during pregnancy?

A 
acetaminophen ONLY. 
no NSAIDS (1st trimester = loss, >20 weeks = renal dysfunction)
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51
Q

What SSRI should be AVOIDED during pregnancy? What can this cause?

A

Paroxetine - causes risk for fetal atrial septal defect

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52
Q

What antimicrobials (4) should be AVOIDED during pregnancy and lactation?

A

Fluoroquinolones (-floxacin suffix),
Trimethoprim-sulfamethoxazole (Bactrim),
Clarithromycin,
Tetracyclines (doxy, mino = teeth staining)

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53
Q

What are 8 known teratogens during pregnancy?

A

ACE inhibitors (pril), ARB (sartan), Carbamazepine (tegretol), Valproic Acid (depakote), Lithium, Isotretinoin (accutane), Thalidomide, Statins

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54
Q

How will teratogens affect the body?

A

select target organs in a predictable manner

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55
Q

What is an alternative medication safe for pregnancy that can treat an uncomplicated UTI?

A

Cephalexin

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56
Q

When is pump and dump of breastmilk helpful or advised?

A

When a mother takes a drug that is not safe (ie cocaine, PCP). Needs to pump 3-5 half lives of medication/drug

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57
Q

What birth control may be given to the lactating mother?

A

Medroxyprogesterone (depo-provera)

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58
Q

Infant: What is the treatment of hemangioma?

A

propranolol (benign tumor), can watch and wait

Rapid growth in first days of life to 6 months

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59
Q

Infant: What will a port wine lesion present as? What syndrome may present with this lesion?

A

a blanchable red to dark pink lesion, grows proportionally with child (DOES NOT REGRESS), consider genetic/congenital syndromes (Sturge-Weber)

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60
Q

Infant: What are blue-black-gray macular lesions on lower back and buttocks?

A

Mongolian Spot(s), common on Asian, African, Native American. Lights over time and requires NO TREATMENT.

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61
Q

Infant: What are raised white bumps, mainly on the nose and cheeks?

A

Milia - no treatment, resolves spontaneously, DO NOT PICK

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62
Q

Infant: What may present in the first 48 hours of life and resolves by 5-7 days of age?

A

Erythema Toxicum Neonatorum - no treatment, very common

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63
Q

Infant: What may present as red and crusty on extensor surfaces? What management is best?

A

Atopic Dermatitis - face <2 years, hands and feet 2-12

Eliminate triggers, hydrate skin (no lotion), control itch

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64
Q

Infant: What presents on the scalp of an infant as erythematous plaques that are greasy and yellow scales?

A

Seborrheic dermatitis - cradle cap

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65
Q

Infant: What is the management of seborrheic dermatitis, cradle cap

A

Emollient (petrolatum, vegetable or mineral oil) overnight then remove with soft brush.
Other areas - ketoconazole 2% cream once daily or hydrocortisone 1%

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66
Q

Infant: A rough skin texture (gooseflesh or chicken skin) usually on the outer aspect of the upper arm

A

Keratosis Pilaris - worst with cold/dry weather

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67
Q

Elder: What are 6 normal age-related changes?

A 
Decreased body weight as water, 
Lean muscle mass, 
Increased body weight as fat, 
Decreased serum albumin, 
Decreased kidney weight, 
Decreased hepatic blood flow
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68
Q

Elder: What drug is highly bound to albumin?

A

Coumadin (Warfarin) - 99% albumin-bound,

Others: phenytoin, valproic acid, diazepam

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69
Q

T/F When compared with a healthy 40-year-old adult, CYP450 isoenzyme levels can drop by up to 30% in elders after age 70.

A

TRUE

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70
Q

T/F CYP450 1A2’s activity is influenced by the presence or absence of estrogen in women.

A

TRUE - counsel about caffeine intake to be decreased

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71
Q

Elders: systemic anticholinergic effects present with symptoms of?

A

confusion, urinary retention, constipation, visual disturbance, and hypotension = polypharmacy and risk of delirium.
DRY MOUTH*, sedation, agitation, mydriasis

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72
Q

Elder: What medications that are used to treat overactive bladder cause systemic anticholinergic effects?

A

Oxybutynin (Ditropan) - Sustained release may have better tolerance in older adult

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73
Q

Elder: What SSRI is preferred in the elderly?

A

Sertraline (Zoloft)

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74
Q

Elder: What is a major risk with tricyclic antidepressants?

A

hypotension - amitriptyline, nortriptyline, trazodone, mitrazapine

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75
Q

T/F The risk of torsades de points with erythromycin or clarithromycin is greater in females than males

A

TRUE - any drug that prolongs the QT interval = greater risk of ventricular tachycardia

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76
Q

Elderly: Citalopram should NEVER exceed what mg/day? What if the patient is over the age of 60, what is the maximum dose?

A

40 ! - causes >QT interval prolongation

>60 = 20 mg/day

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77
Q

Elderly: What should NEVER be given with citalopram in an adult over the age of 60 years?

A

Any CYP2C19 inhibitors - PPIs or Cimetidine (Tagamet). Consider escitalopram instead (zero drug-drug interaction)

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78
Q

Elder: What SSRI has the shortest half life but the greatest systemic anticholinergic effects?

A

Paroxetine (21 hours)

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79
Q

Elder: aspirin for PRIMARY prevention of cardiac events

A

NO! especially if >80 years old, lack of evidence of benefit

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80
Q

Elder: When should daily aspirin be considered?

A

As a secondary prevention for CAD. Unsure about >80 year old population

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81
Q

Elder: An older adult women with recurrent UTI, what should be considered?

A

Alternative therapy other than chronic antimicrobial therapy. Estrogen with or without progestins

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82
Q

Elder: Management of dyspareunia, lower urinary tract infections, and other vaginal symptoms for women postmenopausal

A

Topical vaginal cream - low-dose estrogen. (acceptable for atrophic vaginitis)

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83
Q

T/F Vaginal estrogens for treatment of vaginal dryness is safe and effective in women with breast cancer, especially at low doses

A

TRUE

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84
Q

Elder: What is the A1C goal for older adults who are frail or with limited life expectancy

A

<8%

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85
Q

Elder: What medications work well since beta2-agonists (albuterol, salmeterol) work less effectively. What is the alternative?

A

Inhaled muscarinic antagonist/anticholinergic (Tiotropium, Ipratropium bromide; work well as broncho dilators)

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86
Q

Elder: What alternative class of medication works well once beta blockers have decreased effectiveness in older adults?

A

Calcium channel blockers (Dihydropyridine: Amlodipine)

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87
Q

Elder: Should statins be started or continued in older adults?

A

Avoid high-intensity in >80 years, impaired renal function, frailty, multiple comorbidities, with fibrate.
Moderate-intensity is 1st line and preferred.
USPSTF: >76 years and no hx CVD = no evidence

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88
Q

What percent of LDL-C is reduced by high intensity statins?

A

> 50%

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89
Q

What percent of LDL-C is reduced by moderate intensity statins?

A

30-49%

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90
Q

Elder: What are the consequences of long-term (>2 months) PPI use?

A

Rebound hypersecretion = increased GI symptoms.
Decreased absorption of Iron and B12.
Increased fracture risk (lower calcium absorption, BUT not calcium citrate!).
Decreased magnesium absorption

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91
Q

Elder: What medication will become toxic in a person with low magnesium? What are 2 medications that deplete magnesium?

A

Digoxin,

Thiazide and Loop diuretics

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92
Q

Elder: How long should a PPI be prescribed according to Beers Criteria? Who are (6) high-risk patients?

A

Avoid PPI use >8 weeks, unless high-risk.
High risk = oral corticosteroids, chronic NSAID use, erosive esophagitis, Barrett’s esophagitis, pathological hypersecretory condtion, or other need for maintenance treatment (failure to discontinue PPI trial)

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93
Q

Elder: What medication causes induced hyperkalemia? What happens on EKG?

A

TMP-SMX (bactrim), especially when on spironolactone, ACEIs or ARBs

EKG - tall tented T waves

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94
Q

T/F If the prescribing information about a given medication includes a warning about the need for dose adjustment in the presence of renal impairment, then that product is likely nephrotoxic

A

FALSE

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95
Q

Elder: What are adverse effects of cholinesterase inhibitors?

A

Increased rates of syncope, bradycardia, pacemaker insertion, and hip fracture in older adults with dementia.

Donepezil/Aricept, Galantamine/Razadyne ER, Rivastigmine/Exelon

nausea, diarrhea, vomiting, decreased appetite, dyspepsia, anorexia, muscle cramps, fatigue, insomnia, dizziness, bradycardia (falls) headache, and asthenia.

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96
Q

Elder: What DOAC medication has a greater risk of bleeding in comparison to warfarin in adults >75 years?

A

Dabigatran (Pradaxa) - caution use/Beers Criteria

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97
Q

FP: What birth control methods are safe for women that smoke? <35 years vs >35 years

A

<35 = POP, DMPA, implants, IUDs. COC/P/R - MEC 2

> 35 = POP, DMPA, implants, IUDs (NO COC for >15 cigarettes/day and >35 years)

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98
Q

FP: What is the pharmacologic action of progestin?

A

Ovarian and pituitary inhibition
Thickening of cervical mucus
Endometrial atrophy/transformation
Cycle Control

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99
Q

FP: What are the pharmacologic actions of estrogen?

A

Ovarian and pituitary inhibition
THINS or increases cervical mucus
Endometrial proliferation
Cycle control

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100
Q

FP: What exam/test is necessary before starting combined oral contraceptives?

A

blood pressure

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101
Q

FP: What exam/tests are necessary before starting IUD or diaphragm/cervical cap?

A

Bimanual examination and cervical inspection, STD screening (not a criteria)

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102
Q

FP: Should a pregnancy test be conducted prior to initiating birth control?

A

No, not necessarily. If NO symptoms of pregnancy AND <7 days after start of normal menses, no intercourse since last menses start, correct/consistent reliable method of contraception, or <7 days after spontaneous or induced abortion. Within 4 weeks postpartum, fully/near breastfeeding (>85%), amenorrheic, and <6 months postpartum.
Dependent upon health history findings

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103
Q

FP: What are 2 standard methods for starting oral birth control? Which one requires no backup method?

A 
Sunday start (COC, patch, ring) after menses begin, backup for 7 days.
First day of menses start, NO BACKUP. 
Others: quick start, jump start (if had unprotected intercourse since LMP)
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104
Q

FP: Who can take combined oral contraceptives?

A

<35 year old that smokes, 29 year old with PID, <45 with recurrent tension-type headache
NO - HTN with adequate control or with poor control

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105
Q

FP: What antibiotic is most likely to reduce oral contraceptive effectiveness?

A

Rifampin only - any other antibiotics tell pt to continue birth control, do not be surprised if you spot, and use a backup method for duration of time plus an additional 7 days

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106
Q

FP: The reduction in free androgens in a woman taking combined oral contraceptives can improve what condition?

A

Acne vulgaris

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107
Q

FP: What is considered a category 3 (exercise caution) for combined oral contraceptives?

A

History of gastric bypass surgery - medications are absorbed in the duodenum

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108
Q

FP: A breastfeeding mother may have what type of birth controls? (4)

A

progestin-only, Depo-provera, Nexplanon, or cooper IUD (ParaGard). Absolutely NO COCs

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109
Q

FP: Who can have an IUD?

A

45 and nulliparous, smoker, seizure disorder, HIV

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110
Q

FP: What are the effects of nexplanon or implanon? What is a common adverse effect and what are 2 ways to manage this?

A

low dose progestin, replace q3 yr, best for teens

AE: irregular bleeding, can be managed with COC use x3 months or timed NSAIDs use x2 weeks

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111
Q

FP: What are 3 emergency contraception options?

A

IUD - cooper

Pills - UPA single dose (Ella) or Levonorgestrel (Plan B)

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112
Q

FP: How many days after unprotected intercourse can an emergency contraceptive be given?

A

3 days

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113
Q

FP: What emergency contraceptive is available over the counter?

A

Levonorgestrel or Plan B - inhibits transport of egg or sperm, inhibits/delays ovulation; interferes with fertilization

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114
Q

FP: What are the most common adverse effects of progestin-only emergency contraception? What are facts about this medication?

A

nausea and/or vomiting. Repeat dose if vomiting occurs within 2 hours of taking medication. Effective if taken within 72-120 hours post intercourse. OTC by anyone, any age

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115
Q

FP: What is the mechanism of action of Ella, emergency contraception?

A

progesterone agonist/antagonist = inhibits effect on follicular development of ovum release. Changes endometrium that alters implantation.
RX ONLY. Within 120 hours/5 days after unprotected intercourse.

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116
Q

FP: What is the advantage of cooper IUD?

A

it can be left in place for 10 years. Contraindicated in PID.

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117
Q

MS: Redness at the first metatarsophalangeal joint, what diagnosis is suspected

A

Gout

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118
Q

MS: What 3 medications are most effective for acute treatment of gout?

A

Intraarticular corticosteroid injection, NSAIDs, Colchicine (used to prevent and relieve pain of gout attacks)

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119
Q

MS: What are 2 control drugs, not used for an acute attack, in gout?

A

Febuxostat (Uloric) and Allopurinol

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120
Q

MS: What are potential triggers of acute gouty arthritis?

A

Thiazide diuretic, consumption of organ meats/purines, or alcohol consumption

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121
Q

MS: What is the McMurray test?

A

Meniscal tear

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122
Q

MS: What is the Talar tilt?

A

Ankle instability

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123
Q

MS: What is the Spurling test?

A

cervical nerve root compression

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124
Q

MS: What is the Tinel’s sign?

A

Carpal tunnel syndrome

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125
Q

MS: What is Lachman test?

A

Anterior cruciate ligament tear

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126
Q

MS: What is straight-leg raise test?

A

lumbar nerve root compression

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127
Q

MS: What is drop arm test?

A

rotator cuff evaluation - abduct arm (lift arm manually above patient’s head), ask patient to bring arm down slowly. Any loss of control = positive test

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128
Q

MS: What is finkelstein test?

A

De Quervain’s tenosynovitis - caused by chronic overuse of the wrist/repetitive movements. People with wrist pain, use this test: thumb bent into palm of hand with fingers wrapped around thumb, bend wrist to little finger.

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129
Q

MS: A 2 month history of fatigue, aching sensation with morning stiffness in hips and shoulders. Weight loss without trying and struggling to get dressed, especially shirt and pants. Anemia of chronic disease and elevated ESR

A

Polymyalgia rheumatica

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130
Q

MS: Lumbar spinal stenosis will present with what symptoms?

A

Older (>50),
Standing discomfort improved with BENDING forward,
Pseudoclaudication (leg pain worsening with activity, improves with rest),
Bilateral lower-extremity numbness/weakness

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131
Q

MS: What diagnosis is associated with intermittent anterior knee pain that is worse with squatting and walking up or down stairs? Pain improves with rest.

A

Osgood-Schlatter disease, typically found in growing teenagers/after a growth spurt

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132
Q

MS: What are symptoms of reactive arthritis

A

An inflammatory arthritis seen days or weeks after an episode of acute bacterial diarrhea or STD.
Pain/swelling of knees, ankles, heels, toes/fingers with persistent low back pain. Conjunctivitis. Urinary problems.
Can’t see, can’t pee, can’t climb a tree

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133
Q

MS: What are causes of reactive arthritis

A

Infection, STD (Chlamydia - NAAT), Genetic HLA-B27 gene

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134
Q

MS: What are common symptoms of lumbar radiculopathy?

A

sharp, burning, ELECTRIC-shock sensation. WORSE when increased spinal fluid pressure.
Sneeze, cough, straining = SHARP PAIN
(present just like LS strain but abnormal neuro exam)

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135
Q

MS: What abnormal neuro exam findings present with lumbar radiculopathy? How will this be treated?

A

abnormal straight-leg raise, sensory loss, or altered DTRs.
Conservatively, further evaluation if no resolution after 4-6 weeks of conservative therapy

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136
Q

MS: What diagnostic tests should be included for a patient with low back pain?

A 
NO imaging (XRAY, MRI, CT) during 1-2 month trial of standard conservative therapy. Particularly if normal neurological exam, absence of acute trauma, and low risk for vertebral compression fracture.
*MRI is reserved for persistent s/s, candidates for surgery or epidural injection*
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137
Q

MS: What diagnostic tests should be included for a patient with low back pain?

A 
NO imaging (XRAY, MRI, CT) during 1-2 month trial of standard conservative therapy. Particularly if normal neurological exam, absence of acute trauma, and low risk for vertebral compression fracture.
*MRI is reserved for persistent s/s (>4-6 weeks of therapy)*
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138
Q

MS: What is osteopenia BMD?

A

1.0-2.5

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139
Q

MS: What is osteoporosis BMD?

A

2.5

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140
Q

MS: What are non-dairy sources of calcium?

A

Spinach, sardines, tofu, nuts like almonds

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141
Q

MS: What age is appropriate for BMD testing in a woman? Man?

A

Women: 65 years
Men: 70 years regardless of risk factors

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142
Q

MS: What are risk factors associated with osteoporosis?

A

Women: younger postmenopausal
Both: >50 years who has broken a bone, Diseases (RA, SLE, DM, CF, CHF), on medications (long-term glucocorticoids, corticosteroids, thyroid hormones). Risk factors of physical inactivity, low calcium intake or alcohol abuse.

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143
Q

MS: What age is appropriate for BMD testing in a woman? Man?

A

Women: 65 years
Men: 70 years, regardless of risk factors

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144
Q

MS: Anemia of chronic disease (RA, SLE, OA)

A

RA and SLE

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145
Q

MS: Elevated C-reactive protein (RA, SLE, OA)

A

RA and SLE

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146
Q

MS: Joint space narrowing on XRAY (RA, SLE, OA)

A

OA

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147
Q

MS: Positive antinuclear antibody titer (RA, SLE, OA)

A

RA (less commonly) and SLE

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148
Q

MS: Where are Heberden’s nodes located?

A

Distal interphalangeal joints

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149
Q

MS: Where are Heberden’s nodes located?

A

Distal interphalangeal joints (DIP)

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150
Q

MS: Where are Bouchard’s nodes located?

A

Proximal interphalangeal joints (PIP)

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151
Q

MS: Symptoms of progressive aches of hands and fingers, particularly after strenuous work. Heberden’s and Bouchard’s nodes present.

A

Osteoarthritis

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152
Q

MS: What are expected symptoms of a scaphoid fracture? What diagnostic testing is standard?

A

pain radial of wrist and proximal to thumb (snuff box), decreased grip and strength.
XRAYS (PA, lateral, oblique) with a repeat within 7-10 days. CT, MRI, bone scan - xray may miss findings.
TX: thumb spica splint, analgesia, ortho referral

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153
Q

MS: What are expected symptoms of a scaphoid fracture? What diagnostic testing is standard? Interventions?

A

pain radial of wrist and proximal to thumb (snuff box), decreased grip and strength.
XRAYS (PA, lateral, oblique) with a repeat within 7-10 days. CT, MRI, bone scan - xray may miss findings.
TX: thumb spica splint, analgesia, ortho referral

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154
Q

MS: A grade I ankle sprain is best described as? What should be included in recovery?

A

Microscopic tears, no joint instability on exam and can bear weight with mild pain
TX: RICE, crutches, PT, analgesia. Does not require immobilization

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155
Q

MS: A grade II ankle sprain is best described as? What should be included in recovery?

A

An incomplete tear of a ligament, mild to moderate joint instability, decreased ROM, weight bearing and ambulation are painful. Mild to moderate pain, swelling, tenderness and ecchymosis.
TX: immobilize with aircast or splints. Recovery 4-6 weeks. Analgesia. PT, Ortho referral

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156
Q

MS: A grade III ankle sprain is best described as? What interventions may be necessary?

A

A complete tear, pain, swelling, tenderness, ecchymosis and loss of function/motion. Unable to bear weight and ambulate
TX: cast, splint, boot, ortho referral

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157
Q

Cardiac: What symptoms will WOMEN most likely report with suspected acute coronary syndrome?

A

Unusual fatigue** (before an event)

sleep disturbances, SOB, weakness

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158
Q

Cardiac: What is expected in clinical presentation of an elder (>75 years) with acute coronary syndrome

A

Dyspnea
neurological symptoms (syncope, weakness, acute confusion)
chest pain or pressure

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159
Q

Cardiac: What does a displaced PMI indicate? Causes?

A

Usually laterally displaced.
Indicates increased left ventricular volume.
May be caused by pressure overload or HTN

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160
Q

Cardiac: What is a maneuver that enhances PMI that is not palpable?

A

Place them in left lateral decubitus position.

Caused by obesity, thick chest wall, and COPD

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161
Q

Cardiac: What marks the beginning of systole, produced by events surround closure of mitral and tricuspid valve, and heard with carotid upstroke.

A

S1

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162
Q

Cardiac: What marks the end of systole, produced by events surrounding the closure of aortic and pulmonic valves, and heard best at the base of the diaphragm.

A

S2

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163
Q

Cardiac: Physiologic versus pathologic meaning

A

Physiologic - no underlying cause, no symptoms

Pathologic - typically presents with symptoms

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164
Q

Cardiac: Define a physiologic split S2

A

Benign finding. Increases on inspiration. Majority of adults <30 years and best heard in pulmonic region.

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165
Q

Cardiac: Define a pathologic split S2

A

fixed split vs paradoxical split. NO change with inspiration. Uncorrected septal defect in fixed. Delay aortic closure in paradoxical.

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166
Q

Cardiac: Define a pathologic S3 heart sound

A

Marker of ventricular overload and/or systolic dysfunction.
Causes: HF with symtpoms, pregnancy
1-2-3: lub dub-dub

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167
Q

Cardiac: Define S4 heart sound. What may cause this?

A

Poor diastolic function that can be resolved with treatment of underlying cause.
Cause: poorly controlled HTN or recurrent Myocardial ischemia
4-1-2 - dub-lub dub

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168
Q

Cardiac: Define a pathologic S3 heart sound

A

Marker of ventricular overload and/or systolic dysfunction.
Causes: HF with symptoms, pregnancy
1-2-3: lub dub-dub

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169
Q

Cardiac: Define S4 heart sound. What may cause this (2)?

A

Poor DIASTOLIC function that can be resolved with treatment of underlying cause.
Cause: poorly controlled HTN or recurrent Myocardial ischemia
4-1-2 - dub-lub dub

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170
Q

Cardiac: A mid systolic click murmur is heard

A

MVP = mitral valve prolapse, systolic murmur, pectus excavatum or connective tissue disease, >supine than standing

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171
Q

Cardiac: Murmur that is HOLOSYSTOLIC with same intensity and radiates to axilla

A

MR - mitral regurgitation

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172
Q

Cardiac: Murmur most commonly described as a rumble

A

Mitral stenosis

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173
Q

Cardiac: Murmur most commonly described as HARSH

A

Aortic stenosis

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174
Q

Cardiac: Murmur most commonly described as a RUMBLE

A

Mitral stenosis

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175
Q

Cardiac: Murmur most commonly described as a BLOWING sound

A

Aortic Regurgitation

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176
Q

Cardiac: Murmur that radiates to the neck

A

AS - aortic stenosis

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177
Q

Cardiac: Murmur that is crescendo-decresendo

A

AS - aortic stenosis

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178
Q

Cardiac: What are common findings of systolic murmurs

A

benign
negative hx, lower grade, no radiation beyond precordium, no heave/thrill, PMI WNL, softens or disappears with supine to stand position change

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179
Q

Cardiac: When should a murmur be considered pathologic? What is the next step?

A

abnormal hx, higher grade, radiation beyond precordium to neck, axilla, etc. Thrill/heave, displaced PMI, increased intensity with supine to stand
ECHO!

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180
Q

Cardiac: Diastolic murmurs (mnemonic)

A

MS. ARD
Mitral Stenosis
Aortic Regurgitation
Diastolic = bad

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181
Q

Cardiac: What is the difference between a carotid bruit and a radiating murmur?

A

Carotid bruit - softer, unilateral

Radiating murmur - louder, bilateral, same sound and timing as found in chest

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182
Q

Cardiac: What risk factors are associated with abdominal aortic aneurysm? When should a provider screen?

A

Advanced age,
male sex,
white,
positive family history,
smoking,
other large vessel aneurysms and atherosclerosis
Screening: men 65-75 who have ever smoked by US once

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183
Q

Cardiac: What are symptoms of aortic dissection?

A

Sudden tearing or ripping sensation (may spread to neck or down the back),
BP differences between R & L upper,
LE pulses < UE
**Genetic Turner or Marfan. RF: HTN uncontrolled, AAA, cocaine, >60 years, men*

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184
Q

What is the average age for menopause in the US?

A

51 years

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185
Q

What are classic signs/symptoms of HTN target organ damage?

A

visual changes, chest pain, SOB, and dizziness

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186
Q

Establishing the diagnosis of hypertension requires what in the absence of target organ damage?

A

> 2 abnormal readings on 2 different occasions

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187
Q

PCV13 is given today, when should PPSV23 be given?

A

in 1 year given PPSV23

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188
Q

What are findings of a normal retinal exam? (disc shape/color, vessel size, fundus)

A

Sharp disc margins that is yellowish orange to creamy pink and is round or oval
Vessels: AV ratio is 2:3 (width of arterioles to venules)
Fundus: no exudates or hemorrhages with red to purplish colors
No papilledema, no narrowing of arterioles

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189
Q

What findings may present on a retinal exam of a patient with poorly controlled hypertension?

A

Narrowing of arterioles, flame-shaped hemorrhages, papilledema, holes/tears, AV nicking, COTTON WOOL spots, HARD exudates

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190
Q

What is CN III

A

Oculomotor - eyelid and eyeball movement

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191
Q

What is CN IV

A

trochlear - turns eyes downward and laterally

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192
Q

What is CN V

A

Trigeminal - chewing, pain & touch of face/mouth

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193
Q

What is CN VI

A

Abducens - turns eye laterally

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194
Q

What is CN VII

A

Facial - expression, tears, saliva

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195
Q

What is CN VIII

A

Acoustic - hearing, equilibrium

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196
Q

What is CN IX

A

Glossopharyngeal - taste, BP

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197
Q

What is CN X

A

Vagus - BP, HR, taste

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198
Q

What is CN VII

A

Facial - expressions, tears, saliva

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199
Q

What is CN XII

A

hypoglossal - tongue

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200
Q

A patient with unilateral facial paralysis and benign neurological exam otherwise, inability to raise eye brow or smile on the affected side. Flat nasolabial fold. What CN is affected? DX? First line treatment?

A

CN VII, facial.
Bell’s Palsy.
Initiate course of oral corticosteroids

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201
Q

Presents with primary and secondary lesions including vesicles and crusts

A

zoster and varicella

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202
Q

A unilateral dermatomal pattern (Z vs V)

A

zoster

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203
Q

Mild to moderate systemically ill with fever (Z vs V)

A

varicella (vaccine 12 mo, 4 yr)

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204
Q

miserable with pain, itch, and usually without fever (Z vs V)

A

zoster (shingrex vaccine)

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205
Q

A condition limited to the scalp, eyelids, and nasoflods that may have mild symptoms of itch and irritability

A

Seborrhea

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206
Q

A condition limited to the scalp, eyelids, and nasofolds that may have mild symptoms of itch and irritability

A

Seborrhea

1st line tx = antifungal

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207
Q

A condition that presents with Auspitz sign, scaly silver plaque lesions mostly on knees and elbows

A

Psoriasis

TX = corticosteroids

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208
Q

What is the international normalized ratio (INR) goal of a 65-year old with atrial fibrillation on Warfarin therapy?

A

2.0 - 3.0

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209
Q

Does amoxicillin potentially increase bleeding risk during Warfarin therapy?

A

YES! - all antibiotics due to altered gut flora

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210
Q

Does st. john’s wort potentially increase bleeding risk during warfarin therapy?

A

NO! - may lower INR due to CYP450 enzymatic induction/inducer

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211
Q

Does gingko biloba potentially increase bleeding risk during warfarin therapy?

A

YES! - antiplatelet effect

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212
Q

What is the treatment for pelvic inflammatory disease?

A

IM ceftriaxone and PO doxycycline

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213
Q

What is the treatment for syphilis? Pregnant with allergy? Allergy and not pregnant?

A

Penicillin
admit to hospital for desensitization
PO doxycycline if allergic to pcn and not pregnant

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214
Q

What is the treatment for external genital warts? What if it is a pregnant woman?

A

Imiquimod cream

TCA - trichloroacetic acid - if pregnant this is the best option

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215
Q

What is the treatment for pelvic inflammatory disease? What sequelae may present r/t PID?

A

IM ceftriaxone and PO doxycycline with/out metronidazole 2 weeks
complications: tubal scarring, INCREASED risk for ectopic pregnancy or infertility

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216
Q

What are the most common strands of HPV that causes genital warts

A

HPV 6 and 11
in the US - HPV 16 and 18 are the most common cause of cancer
HPV vaccine protects against 6, 11, 16, 18, 31, 33, 45, 52, 58. Approved 9-45 years

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217
Q

A palpable ovary on bimanual examination on a 62-year old woman

A

highest link to ovarian cancer. Ovaries should not be palpable, especially postmenopausal
Vaginal pH should increase with age

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218
Q

What overactive bladder medication may worsen dry mouth and constipation, especially in the older adult

A

Oxybutynin (Ditropan)

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219
Q

A teenager with sudden onset of left-sided scrotal pain for the past 4 hours. C/o mild intermittent unilateral testicular pain in the past, but not like this. He has vomited once. No fever or history of scrotal trauma. What are expected findings of testicular torsion?

A

Unilateral loss of cremasteric reflex on the affected side.
Affected testicle is held higher in the scrotum.
Testicular swelling.

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220
Q

A teenager with sudden onset of left-sided scrotal pain for the past 4 hours. C/o mild intermittent unilateral testicular pain in the past, but not like this. He has vomited once. No fever or history of scrotal trauma. What are expected findings of testicular torsion?

A

Unilateral loss of cremasteric reflex on the affected side.
Affected testicle is held higher in the scrotum.
Testicular swelling.
NO RELIEF of pain with elevation.

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221
Q

PED: 4 year old with intermittent fever as high as 104.5F (40.3C) for the past 8 days and complaining of sore throat. Increased throat pain with swallowing, but no difficulty taking fluids. Little appetite, no N/V, diarrhea/constipation. You find extensive cervical lymphadenopathy, injected conjunctiva, oral erythema and a peeling rash on hands. What disease do you suspect?

A

Kawasaki disease

Systemic vasculitis of medium vessels (heart, kidneys, eyes)
HIGH FEVER (5 days) & 5 criteria: Conjunctival without exudate, Macular rash, Inflammation of lips/oral cavity, Cervical lymphadenopathy, and Changes in extremeties with edema and desquamation  of hands and feet
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222
Q

PED: A mild 3-4 day flu-like illness followed by 7-10 days of a red rash that begins on the face with a “slapped cheek” appearance that spreads to the trunk and extremities. What disease do you suspect?

A

Fifth’s Disease

“Slapped Cheek” rash or LACEY, macular rash that BLANCHES

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223
Q

PED: A mild 3-4 day flu-like illness followed by 7-10 days of a red rash that begins on the face with a “slapped cheek” appearance that spreads to the trunk and extremities. What disease do you suspect? What is a confirmation test? (the virus you test for)

A

Fifth’s Disease

“Slapped Cheek” rash or LACEY, macular rash that BLANCHES
Contagious before rash. Supportive care
Confirmation = Parvo virus B19 IgM

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224
Q

PED: A child under the age of 5 years with fever, malaise, sore mouth with oral vesicles on mucous membranes that ulcerate and crust, and decreased appetite. What disease do you suspect? When can this child return to daycare?

A

Hand, foot, mouth disease

Lesions show 1-2 days after. May cause conjunctivitis or pharyngitis.
May return to daycare once the fever free for 24 hours or until blisters are dry

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225
Q

PED: What age should iron supplementation begin in the child only consuming breast milk?

A

age 4 - 6 months

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226
Q

PED: In the child >12 months, what is the most potent risk factor for iron deficiency anemia? What about the <9 month old child?

A

> 12 months = Cow’s milk intake >16 oz per day

<9 months = maternal iron depletion or prematurity

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227
Q

PED: What children would be at greatest risk for iron deficiency anemia?

A

> 12 months old, drinking > 16 oz of cow’s milk, premature infant that is exclusively breastfed without additional supplements

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228
Q

PED: When should 400 IU vitamin D supplementation begin?

A

All exclusively and partially breastfed infants shortly after birth until weaned then consume >1000 mL/day of vitamin D fortified formula or whole milk
Any infants that ingest <1000 mL/day of vitamin D fortified formula or milk = supplementation

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229
Q

PED: What are 3 key facts about diagnosing ADHD in children? (onset age, setting, evidence of)

A

Symptoms must be present before age 12
Impairment must be present in at least 2 settings
Evidence of functional interference

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230
Q

PED: A airway condition that is caused by upper airway obstruction, air is more difficult to get in and a characteristic sound heard on inspiration

A

Stridor

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231
Q

PED: What are 5 airway diagnoses that may cause stridor in children?

A 
Croup, 
Foreign body, 
Congenital obstruction, 
Peritonsillar abscess, 
Acute epiglottitis
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232
Q

PED: What are key features of croup? Treatment?

A

Viral/allergic in orgin
ages 6 months - 5 years
TX: supportive treatment, maybe systemic corticosteroids (PO dexamethasone)

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233
Q

PED: What are key features of foreign body?

A

sudden onset from mechanical obstruction

TODDLERS

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234
Q

PED: What are key features of peritonsillar abscess?

A

bacterial
older child or adult
“hot potato” voice, difficulty swallowing, trismus (pain opening jaw), CONTRALATERAL uvula deviation
TX: airway, referral to ED, antimicrobial therapy, needle aspiration of abscess

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235
Q

PED: What are key features of acute epiglottitis?

A

organism = H. Influenza (Hib vaccine)
age 2 - 7 years
abrupt onset of high-grade fever, sore throat, dysphagia, and drooling
leaning forward, drooling AIRWAY EMERGENCY

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236
Q

PED: What are 3 potential differential diagnoses of wheeze in children?

A

Acute bronchiolitis,
Acute bronchitis,
Asthma

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237
Q

PED: What has a viral etiology, commonly caused by RSV, that results in a short-term illness with wheezing that may persist for 3 weeks

A

Acute bronchiolitis

TX: supportive

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238
Q

PED: What condition is often allergic with an inflammatory etiology that presents with wheeze and recurrent symptoms or persist without treatment.

A

Asthma

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239
Q

PED: What are the symptoms of moderate persistent asthma? At what age will FEV1 start to be a component of severity?

A

daily symptoms, 3-4x/month of nighttime awakenings, daily SABA use, and some limitation in normal activity

Age 5 and up, start measuring lung function. Moderate is 60-80%

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240
Q

PED: What are 3 organisms that cause acute bacterial otitis media?

A

S. Pneumoniae* - most common, makes kids the sickest
H. Influenza
M. Catarrhalis

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241
Q

PED: To make the diagnosis of AOM in children, what findings must be present?

A
  1. Moderate or severe BULGING of TM OR new onset of otorrhea not related to otitis externa with otaligia
  2. Mild bulging of TM AND recent (<48hrs) onset of ear pain OR intense TM erythema with otalgia
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242
Q

PED: What qualifies for watchful waiting in children that have AOM?

A

> 6 months old with nonsevere illness and UNILATERAL AOM

Age must be >6 months, must be nonsevere illness, and/or must be unilateral

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243
Q

PED: What is the first line treatment for AOM? What if antibiotic treatment fails after 48-72h?

A

Amoxicillin 80-90 mg/kg/d PO BID
or
*Amoxicillin-clavulanate 90 mg/kg/d PO or Ceftirazone for failure with amoxicillin

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244
Q

PED: What is the first line treatment for AOM with penicillin allergy?

A 
3rd generation Cephalosporins 
Cefdinir 
Cefuroxime 
Cefpodoxime 
Ceftriaxone
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245
Q

PED: What is otitis media with effusion in children? What is first line treatment? What type of hearing loss is expected (S or C)?

A

fluid in the middle ear WITHOUT s/s of ear infection.
First line = watchful waiting, should resolve in 3 months
Consider conductive hearing loss if persistent >3 months

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246
Q

PED: What is the most appropriate treatment that can prevent further dehydration for a child with acute gastroenteritis (vomiting) and mild dehydration?

A

A 5HT antagonist (Ondansetron/Zofran)

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247
Q

PED: What are expected findings of mild dehydration?

A

slightly dry lips and thick saliva and slightly decreased urine output.
Exam is normal otherwise - turgor, fontanels, eyes, capillary refill, mental status, thirst (might be increased)

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248
Q

PED: What are the expected findings of moderate dehydration?

A

<2 second recoil of skin turgor, slightly depressed fontanels, dry lips and oral mucosa, slightly sunken eyes, delayed capillary refill, deceased UO, moderately increased thirst

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249
Q

PED: For mild to moderate dehydration, what is the in office treatment?

A

oral rehydration therapy, 50-100 mL/kg over 3-4 hours. Small, frequent volumes in office or urgent care setting

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250
Q

PED: In a febrile child, the degree of temperature reduction in response to antipyretic therapy is NOT predictive of presence or absence of bacteremia.

A

TRUE

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251
Q

PED: The absence of tachypnea is the most useful clinical finding for ruling out pneumonia in children.

A

TRUE

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252
Q

PED: What is the treatment for community acquired pneumonia of children <5 years? >5 years old? What is an alternative treatment?

A

Amoxicillin 90 mg/kg/day BID (<5 years or >5 years)
alternative = amoxicillin-clavulanate
Atypical = macrolide = Azithromycin

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253
Q

PED: What are 3 treatment options for UTI in febrile children age 2 to 24 months old?

A

Amoxicillin
Trimethoprim/sulfamethoxazole
Cephalosporin - cefixime, cefpodoxime, cefprozile, cephalexin

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254
Q

PED: When does concrete thinking with early moral concept struggles, progression of sexual identity development and reassessment of body image. Emotional separation from parents.

A

Early adolescence 10-13

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255
Q

PED: When does increased abstract thinking begin. Views themselves as “bullet proof” and identifies . Strong peer identification. Increased health risk behavior.

A

Mid adolescence 14-17

256
Q

PED: When does complex abstract thinking begin? Increased impulse control. Development of personal identity. Social autonomy.

A

Late adolescence 18-21

257
Q

PED: What tanner stage will breast buds develop?

A

Tanner 2, age 8-13

258
Q

PED: What tanner stage will testes enlarge with scrotal skin reddening and change in texture occur?

A

Tanner 2

259
Q

PED: What tanner stage will the growth spurt start?

A

Tanner stage 3, peaks in Tanner 4

260
Q

PED: What tanner stage will menarche commonly occur?

A

Tanner 4

261
Q

PED: What tanner stage will the breast mound enlarge?

A

Tanner 3

262
Q

PED: What tanner stage may physiologic gynecomastia present?

A

Tanner 3 - 50% of males 13-14 tanner stage 3-4 will develop gynecomastia for about 6-24 months.

263
Q

PED: What tanner stage will the penis length, but minimal change with width occur? “pencil penis”

A

Tanner 3 - also the onset of growth spurt

264
Q

PED: What are two medications that can be offered PO for females ONLY for the treatment of acne vulgaris?

A

Combined estrogen-progestin hormonal contraceptive
Spironolactone (aldactone)
both reduce androgen levels to decrease sebum production

265
Q

PED: What is the most common cause of adolescent death?

A

Accidental injury

266
Q

PED: What is the CRAFT questionnaire tool?

A

a brief screening test for adolescent substance abuse

267
Q

PED: What age does the USPSTF recommend screening for depression?

A

12 - 18 years

268
Q

PED: What are 5 medically emancipating conditions? (legal rights of the adolescent patient)

A 
Contraception 
Pregnancy 
Sexually transmitted infection 
Substance abuse 
Mental Health
269
Q

PED: Screening for type 2 diabetes mellitus is what type of prevention?

A

Secondary

270
Q

PED: What are risk factors associated with adolescent development of type 2 diabetes mellitus?

A

obesity, pacific Islander ancestry, personal family history of PCOS or DM2 (first or second degree), race/ethnicity (everyone EXCEPT European)

271
Q

PED: When should testing for type 2 be considered by the provider?

A

any child that is overweight or obese (>85th percentile for age and sex, weight for height, or weight >120% of ideal height)
PLUS 1 other risk factor
family hx of T2DM, race/ethnicity, signs/conditions indication insulin resistance, SGA at birth, maternal hx of DM or gestational DM

272
Q

PED: What a signs of insulin resistance and risk factors to assess for in children?

A 
Acanthosis Nigricans 
HTN
Dyslipidemia 
PCOS 
SGA at birth (child's history) 
Maternal history of DM or gestational DM
273
Q

PED: At what age or at onset of _____, whichever occurs first, should testing for type 2 diabetes mellitus occur? What will this testing consist of and how often should these values be checked?

A

at age 10 years
onset of puberty (tanner stage 2 if before age 10)
check A1C, FBS, 2h oral GTT - EVERY 3 YEARS

274
Q

PED: What is the recommended treatment option for a child with low HDL, elevated triglycerides, and an acceptable A1c, that is also obese.

A

weight loss

this will be a first line therapy especially with dyslipidemia

275
Q

PED: A 15 year old with a one day history of “sore throat and swollen glands” as well as a low-grade fever and rash. The rash is diffuse maculopapular that is mildly tender, posterior cervical and postauricular lymphadenopathy, and pharyngeal erythema without exudate. She has not received any immunizations since age 6 months. What diagnosis do you suspect?

A

Rubella (3-day German Measles)
most teratogenic virus
MMR given at 1 year
NOTIFIABLE DISEASE to state/public health. IgM serum laboratory confirmation.

276
Q

PED: A child with exudative pharyngitis, fever, headache and tender, localized anterior cervical lymphadenopathy presents today. Rash is a sandpaper texture. What do you suspect? What virus causes this?

A

Scarlet Fever
Group A strep
(rash usually erupts on day 2 of pharyngitis and often peels. Treat with amoxicillin, just like strep throat)

277
Q

PED: A child with a rosy-pink maculopapular rash lasting hours to 3 days that follows a HIGH fever. Rash will not present on the face. What do you suspect? What virus causes this rash?

A

Roseola

Human herpesvirus-6
young child 6 - 24 months

278
Q

PED: A child with fever, generalized lymphadenopathy, conjunctivitis, nasal discharge (coryza) or congestion, and cough. What do you suspect? What type of lesions may be present on the hard and soft palate?

A

Rubeola (Measles)
fever, malaise & 3 C’s
Koplik spots - whitish, bluish, gray on buccal mucosa that blanches and resembles grains of sand

279
Q

PED: A 16 year old with 3 day history of pharyngitis, minimally tender anterior and posterior cervical lymphadenopathy, and right and left upper quadrant abdominal tenderness. What do you suspect?

A

Infectious mononucleosis

280
Q

PED: How long should contact sports be avoided with infectious mononucleosis? What medication should be AVOIDED with this condition?

A

> 1 month, risk of splenic rupture

Amoxicillin = rash

281
Q

PED: What diagnostic test detects mononucleosis? What virus causes this?

A

Heterophil antibody test (Monospot)

Epstein-Barr virus (human herpes 4)

282
Q

PED: Define neonate versus infancy

A

neonate is the first 28 days of life

Infancy is the first year of life

283
Q

PED: What are expected findings of a healthy full term infant? (vision range, scleral, eyes, reflex)

A

Hold baby 8-12 inches, best visual range
Bluish scleral tint regardless of ethnicity for first months
Newborn eyes light and glare sensitive
Defensive blink reflex

284
Q

PED: What are expected findings in a 2 week old

A

visual preference for the human face
hears high-pitched voices best
will react to the cry of other neonates
highly developed sense of smell

285
Q

PED: What are education points about sleep safety

A

back to sleep
firm sleep surface
no bed-sharing

286
Q

PED: What are some facts about neonatal jaundice

A

Jaundice starts on the face then progresses to the trunk/extremities
Physiologic jaundice onset is >24 hours of life
Encourage breastfeeding every 2-3 hours and avoid dextrose/water feedings reduces risk of jaundice

287
Q

PED: What are expected findings of physiologic galactorrhea (cause, finding, onset, resolves)

A

Maternal hormonal influences are likely the cause
Breast engorgement is common/universal
Onset is day 3-4 of life
Resolves spontaneously without intervention within the first 2 months of life

288
Q

PED: An infant with bilateral lid swelling, chemosis, and mucoid eye discharge. The infant received standard care including ocular chemoprophylaxis. What do you suspect?

A

Chlamydial conjunctivitis

presents 5-14 days post exposure. Ocular chemoprophylaxis prevents gonococcal conjunctivitis (blindness). Confirm with culture. Treat with oral erythromycin to prevent pneumonia (Staccato cough)

289
Q

PED: A mother is HBsAG-positive, what should be done for the infant?

A

given hepatitis B immunization AND hepatitis B immune globulin to infant

290
Q

PED: What reflex presents as walking motion made with legs and feet when held upright and feet touching the ground? How long will this present?

A

Stepping reflex

first 3-4 months, then reappears 12-24 months

291
Q

PED: What reflex presents as turning of the head and sucking when cheek is stroked? When does this go away?

A

Rooting reflex

stops 6-12 months

292
Q

PED: What reflex presents as throwing out arms and legs followed by pulling them back to the body following a sudden movement or loud noise? When does this stop?

A

Moro reflex

16 weeks of age (4 months)

293
Q

PED: What reflex presents as grasping of an object when placed in the palm? When will this reflex disappear?

A

Palmar grasp

2-3 months

294
Q

PED: What reflex presents when an infant’s foot is stroked and elicits a fanning of the toes? When is this no longer seen?

A

Babinski reflex

by 6 months of age

295
Q

PED: At what age should the anterior fontanel close?

A

by age 9 to 18 months

296
Q

PED: At what age should the posterior fontanel close?

A

by age 1 to 2 months

297
Q

PED: When does an infant smile?

A

by 2 months

298
Q

PED: When does an infant roll from stomach to back? Reach for a toy with one hand and recognizes familiar people at a distance.

A

by 4 months

299
Q

PED: When does an infant roll from back to stomach and to back again?

A

by 6 months

300
Q

PED: When will an infant be able to sit up, but still needs support

A

6 months

301
Q

PED: Can lift self up on both arms

A

2 months

302
Q

PED: Can transfer an object from hand to hand

A

6 to 8 months

303
Q

PED: Able to walk on 2 legs

A

12 months

304
Q

PED: Says “no”, copies work an adult would do

A

18 months

305
Q

PED: builds a 2 block tower

A

24 months

306
Q

PED: Can follow a 2-step command

A

24 months

307
Q

PED: Can draw a circle, can speak in 3 word sentences

A

3 years

308
Q

PED: What age should the family introduce the concept of “time out.” How long should the child remain in time out?

A

18-24 months

1 minute for each year of life

309
Q

PED: What percentage of speech should be intelligible by people who are not in the daily contact with a 3 1/2 year old healthy child

A

nearly 100%
3-4 years, speech should be intelligible
75% 2-2 1/2
50% 19-21 months
more than one language may be slightly behind

310
Q

PED: When does separation anxiety begin?

A

7-8 months

311
Q

PED: When will the lower central incisors erupt? Upper?

A

6-10 months - lower is first
8-12 months
time of first tooth eruption or age 1 = first dental visit

312
Q

PED: How long should an adjusted age calculation be utilized for assessing developmental milestones in the premature infant?

A

until 24 months of age

if healthy. A condition may never allow the infant to catch up developmentally

313
Q

PED: A 2-month old healthy newborn that the foreskin cannot be retracted. What should you consider?

A

the foreskin is not easily retractable until the child is about 3 years old

314
Q

PED: An enlarged scrotal sac on an infant that transilluminates, nontender, and testes are descended. What do you suspect? When will this resolve?

A

Noncommunicating Hydrocele

should resolve by age 2 years, no intervention needed

315
Q

PED: Pyloric stenosis.

Presentation? Most common age? Abdominal mass? First line diagnostic tool?

A 
most common in males. 
Nonbilious vomiting. Post-fed projectile vomiting and baby is eager to eat again post emesis. 
Age: 3 weeks (first few months)
Mass: olive-shaped in RUQ 
Ultrasound = 1st line
316
Q

PED: Intussusception.

Presentation findings? Age? Abdominal mass? First line diagnostic tool?

A 
most common in males. 
s/s: sudden-onset, colicky, severe and intermittent abdominal pain, knees drawn to chest. Loose stools of "currant jelly" (blood and mucous). 
Age: 6-12 months
Mass: Sausage-shaped 
Ultrasound is 1st line
317
Q

PED: When should immunizations be delayed?

A

Moderate to severe illness with or without fever.

318
Q

PED: T/F preterm infant should be immunized at the scheduled with their extrauterine age or birth age

A

TRUE

319
Q

PED: When can children start to be immunized for flu?

A

6 months old, should get 2 doses

320
Q

PED: Describe metatarsus adductus. What is the intervention?

A

Pigeon toed
forefoot that turns inward, high arch and wide gap between big toe and second toe
TX: depends on severity. Observation, stretching/exercises, casting, shoes, surgery

321
Q

PED: Define club foot. What intervention method should be included? (name the method)

A

talipes equinovarus
foot is turned inward and bottom of foot facing sideways.
TX: ponseti method, manipulation/casting, surgery

322
Q

PED: What is the presence of an extra digit? What is the fusion of 2 or more digits or webbing of the skin?

A

Polydactyly

Syndactyly

323
Q

PED: When does the American Academy of Pediatrics recommend screening for autism?

A

at 18 and 24 months of age

324
Q

PED: What is suspected with behaviors of restricted, repetitive patterns of behavior, interests, or activities that shows persistent deficits in social communication and social interaction across multiple contexts?

A

DSM-5 criteria for Autism Spectrum Disorder

325
Q

PED: What type of bone fracture should be suspecting of abuse?

A

spiral

326
Q

GU/GYN: Women that presents with white, clear, flocculent (physiologic leukorrhea). pH is 3.8 - 4.2

A

Normal/healthy women of reproductive age

pH 3.8-4.2 = normal

327
Q

GU/GYN: A women with white, curdy, “cottage cheese” like with c/o itching and burning. Vaginal pH is _____

A

Candida vulvovaginitis

pH is usually normal, <4.5

328
Q

GU/GYN: Microscopic exam of vaginal discharge via saline wet mount shows mycelia and pseudohyphae with KOH prep. What do you suspect?

A

Candida vulvovaginitis

329
Q

GU/GYN: A women presents with thin, homogeneous white, gray, adherent that has increased. There is a foul odor and itch present. What is this? What is the pH? What test would be positive?

A

Bacterial vaginosis
pH 5 - 7
KOH = fishy odor

330
Q

GU/GYN: Microscopic exam of vaginal discharge via saline wet mount shows clue cells. What do you suspect?

A

Bacterial vaginosis - overgrowth of organisms

331
Q

GU/GYN: What medication is best to treat bacterial vaginosis?

A 
PO Metronidazole (Flagyl)
clindamycin or flagyl cream
332
Q

GU/GYN: What condition occurs related to aging and postmenopausal? What is the best treatment for recurrent UTIs?

A

Atrophic Vaginitis - estrogen deficiency
Vaginal pH >5
Symptomatic or recurrent UTI = Topical and/or vaginal estrogen

333
Q

GU/GYN: A woman with a personal history of breast cancer, can she use vaginal estrogen?

A

YES! - ACOG approves of low dose vaginal estrogen if c/o atrophic vaginitis or recurrent UTIs postmenopausal

334
Q

GU/GYN: What is the first line therapy for genital herpes?

A

PO Acyclovir, famciclovir, valacyclovir

length of therapy, dose is dependent on infection type (first, recurrent, suppression - this is look up information)

335
Q

GU/GYN: A woman presents with irritative voiding symptoms, and occasional mucopurulent discharge. Women cervititis, men clear discharge. Under microscope, large number of WBCs. What do you suspect and what is the treatment?

A

Nongonococcal urethritis and cervicitis = CHLAMYDIA

Doxycycline or Azithromycin 1 g PO

336
Q

GU/GYN: A woman presents with irritative voiding symptoms, sometimes asymptomatic. Microscopic exam of discharge shows a large number of WBCs. What do you suspect? What is the first line treatment?

A

Gonococcal urethritis and vaginitis (gram negative)

1st line = ceftriaxone IM and doxycycline if chlaymdia has not been ruled out

337
Q

GU/GYN: A woman presents with dysuria, vulvovaginal irritation with yellow-green discharge, occasional frothy and strawberry spots on cervix. What do you suspect?

A

Trichomonas vaginalis
alkaline pH
(men are always asymptomatic)

338
Q

GU/GYN: On microscopic exam, motile organisms are present and a large number of WBCs. What is suspect? What is the first line therapy?

A

Trichomonas

Metronidazole (Flagyl) or Tinidazole

339
Q

GU/GYN: What should be included in the patient teaching of a patient on metronidazole (flagyl) therapy?

A

avoid alcohol during treatment. Continue for 24 hours after completion of flagyl = abdominal pain

340
Q

GU/GYN: What are expected findings in men with genital candida albicans infection? What test may be helpful to determine cause?

A

groin-fold involvement, balanitis (inflammation of penile glands, raw/irritated), scrotal excoriation

Blood glucose (especially if high BMI)

341
Q

GU/GYN: What is the best treatment for an acute, uncomplicated UTI in nonpregnant women?
What if there is local E. coli resistance?
Sulfa allergy (this is ___ line)?

A

TMP/SMX (Bactrim)

E. Coli resistance = Nitrofurantoin (Macrobid) or Fosfomycin (Monurol)

Sulfa allergy = Ciprofloxacin or Cefdinir = 4th line!
add phenazopyridine for symptom control

342
Q

GU/GYN: What is a potential complication of epididymo-orchitis?

A

infertility potential post infection

343
Q

GU/GYN: What is the Prehn’s sign?

A

a relief of discomfort with scrotal elevation - epididymo-orchitis

344
Q

GU/GYN: What are expected findings of benign prostatic hyperplasia?

A

obliterated median sulcus
size is >2.5 cm
symptoms improve with alpha-1 receptor blockade (Tamulosin)
dribbling after urination, excessive urination at night, frequency, incomplete emptying, urge and leaking, slow/weak stream

345
Q

GU/GYN: A nodular, firm, nontender prostate on digital rectum exam indicates

A

prostate cancer

normal is firm, smooth and nontender

346
Q

GU/GYN: Describe urge incontinence. What is the most appropriate management?

A

Caused by detrusor overactivity causing uninhibited bladder contractions; reports strong sensation of needing to void. Most common cause in older adults.
Behavioral therapy. Oral anticholinergic - fesoterodine (toviaz)

347
Q

GU/GYN: Describe stress incontinence. What is the most appropriate management?

A

caused by weakness of pelvic floor and urethral muscles; associated with lifting, coughing, sneezing. Most common in women.
Pelvic floor rehabilitation.

348
Q

GU/GYN: Describe transient incontinence. What is the most appropriate management?

A

Occurs during an acute illness, such as delirium, UTI, or medication use.
Treat the underlying illness

349
Q

GU/GYN: Describe functional incontinence. What is the best treatment?

A

Occurs in the presence of mobility problems, inability to get to toilet, or lack of awareness of need to void.
An assistant that recognizes voiding cues

350
Q

GU/GYN: A pap screening test reveals atypical squamous cells of unknown significance (ASCUS) and high-risk HPV positive on a 32-year old patient. No history of abnormal cytology, last screening 2 years ago. What is the most appropriate next step?

A

Referral for colposcopy

351
Q

GU/GYN: What type of cancer is this (ovarian, cervical, endometrial): minimal, nonspecific symptoms such as bloating, bladder pressure, constipation, vaginal bleeding, indigestion, lethargy, weight loss.

A

Ovarian

352
Q

GU/GYN: What 2 types of cancer is this (ovarian, cervical, endometrial): abnormal vaginal bleeding. Are there any discrepancies?

A

Cervical (post intercourse bleeding) and Endometrial (postmenopausal bleeding)

353
Q

GU/GYN: What are the risk factors of ovarian cancer?

A

older age (post-menopause)
obesity
nulliparity or first pregnancy >35 years
estrogen use post-menopause
family history and genetic factors (BRCA1/2)

354
Q

GU/GYN: Risk factors of this cancer include obesity and personal history of PCOS

A

Endometrial cancer

355
Q

GU/GYN: Risk factors of this cancer include long-term infection with HPV-16 and/or -18

A

Cervical Cancer

356
Q

GU/GYN: What medication provides the most symptom relief in treating vasomotor symptoms?

A

conjugated estrogen

357
Q

What is PEP therapy? When is PEP considered? What individuals should be treated with PEP?

A

PEP is postexposure prophylaxis
It is the use of ART AFTER a single high-risk event to minimize possibility of HIV seroconversion. This is for individuals that DO NOT have HIV but may have been exposed within the past 72 hours to body fluids (healthcare workers, sexual assault victim)

358
Q

What is PrEP? When is PrEP considered? What individuals should be treated with PrEP?

A

PrEP is pre-exposure prophylaxis
It is the use of ART for individuals who DO NOT have HIV but at at a SUBSTANTIAL RISK of being infected (based on high-risk activity). Individuals that ARE NOT HIV infected who are at high risk due to sex or injection drug use.

359
Q

Mental: To diagnose major depressive episode ____ symptoms must be present in the same ___-week period. What mnemonic helps recall symptoms of MD?

A

> 5 symptoms present in the same 2-week period
SIGECAPS
Sleep (staying), Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide

360
Q

Mental: To diagnose generalized anxiety disorder ___ symptoms occurs on most days for ____ months. What mnemonic helps recall symptoms of GAD?

A

> 3 symptoms occurring on most days for >6 months.
WATCHERS
Worry, Anxiety, Tension in body, Concentration difficulty, Hyperarousal, Energy loss, Restlessness, Sleep disturbance (falling)

361
Q

Mental: Choosing the best therapeutic agent. What drug class of medications is best for lifting and smoothing mood?

A

SSRIs

362
Q

Mental: What SSRI is the most energizing, best effect on lifting and smoothing mood?

A

**Fluoxetine (Prozac) **
CAUTION/DO NOT USE in older adults, already highly energized.

Setraline (Zoloft) 
Citalopram (Celexa) 
Escitalopram (Lexapro) 
Paroxetine (Paxil) - most sedating
*in order from most to least energizing*
363
Q

Mental: What SNRI has the best effect on lifting and smoothing mood plus an increasing focus effect?

A 
SNRIs
**Venlafaxine (Effexor)**
Duloxetine (Cymbalta) 
Desvenlafazine (Pristiq) 
**helpful in anxious and/or resistant depression, potentially energizing**
364
Q

Mental: What SDRI (selective dopamine reuptake inhibitor) is best on improving mood when there is an insufficient response with SSRI or as a solo agent?

A

Bupropion (Wellbutrin)

*potentially energizing, helpful as add-on therapy with SSRI with incomplete treatment response**

365
Q

Mental: What are the most common adverse effects with psychotropic medications?

A

Sexual effects

Anorgasmia, erectile dysfunction, altered libido

366
Q

Mental: What FDA-mandated warning is advised on medications for anxiety and depression?

A

increased risk of suicidal thinking and behavior in children, adolescents and young adults age <24 years

367
Q

Mental: What SSRI has the longest half life?

A

Fluoxetine (Prozac) - 84h ! (7-15 days)

368
Q

Mental: What SSRI may increase the risk of abnormal heart rhythms in higher doses? What is the maximum dose? What is the maximum dose for adults >60 years and/or hepatic impairment?

A

Citalopram (Celexa)
max = 40
>60 years = 20 mg/d
box warning = QT prolongation

369
Q

Mental: What SSRI is the most sedating?

A

Paroxetine (Paxil)

caution/do not use in older adults

370
Q

Mental: What SSRI has the least potential for drug-drug interaction?

A

Escitalopram

371
Q

Mental: What symptom is a common short-term problem with early SSRI use?

A

Frontal headache

pt teaching is important, drink more fluids, try tylenol, etc

372
Q

Mental: What symptoms present with serotonin withdrawal syndrome or antidepressant discontinuation syndrome? (mnemonic)

A 
FINISH mnemonic 
Flu-like symptoms
Insomnia 
Nausea
Imbalance (dizziness)
Sensory disturbances (nightmares)
Hyperarousal 
**restart medication at same dose, taper for 6 weeks or more, also not necessary since symptoms only last for 7 or less days**
373
Q

Mental: What tests should be checked periodically while on Olanzapine (Zyprexa)?

A

Second Generation Antipsychotics - all

Blood sugar (insulin resistance)
Lipid profile
weight gain is also present

374
Q

Mental: What medication should be considered to start along with any second generation antipsychotics?

A

Metformin

375
Q

OA: What is the most common electrolyte that will cause delirium in older adults?

A

Low sodium - hyponatremia

376
Q

OA: What is the most common reason for delirium in older adults? Name two specific examples

A

Infection

UTI and CAP - usually presents as a change in mental status

377
Q

OA: What diagnostic tests are ordered to rule in/rule out in evaluation of new-onset altered mental status?

A 
UA, urine c&s 
CBC with diff 
serum electrolytes 
glucose 
BUN/creatinine 
vitamin B12 
Thyroid function 
Liver Function 
Depression screening
378
Q

OA: What are two interventions to slow decline Alzheimer-type dementia according to American Academy of Neurology Standards?

A

Vitamin E 1,000 international units BID or
Selegiline 5 mg BID
(no added benefit to using both)

379
Q

OA: What class of medications is best for mild to moderate stage Alzheimer’s disease and considered the mainstay of treatment?

A

Cholinesterase inhibitors

Donepezil, Rivastigmine, Galantamine - increase the availability of acetylcholine

380
Q

OA: What class of medications is best for moderate to severe Alzheimer’s disease?

A

NMDA receptor antagonist

Memantine/Namenda - can be used with Cholinesterase inhibitor

381
Q

OA: What is the most common adverse effects of cholinesterase inhibitor use?

A

nausea and diarrhea

382
Q

OA: What screening tools are best evaluators of frailty syndrome?

A

meets 3 or more of the following:
Unintentional weight loss (at least 10 lbs or greater than 5% of body weight in prior year)
Muscle weakness, measured by grip strength
Physical slowness based on a measured time to walk a distance
Poor endurance - self reported
Low physical activity

383
Q

OA: What are first line interventions in Frailty Syndrome?

A 
treat underlying cause to AVOID frailty - an irreversible condition 
regular physical exercise/activity 
caloric/protein support 
vitamin D supplementation 
reduce polypharmacy
384
Q

OA: Beers criteria states Zolpidem (ambien) should be avoided because of what risk?

A

Increased risk in falls and fracture risk

385
Q

OA: Beers criteria states Amitriptyline (Elavil) (all TCAs) should be avoided because of what risk?

A

significant risk of orthostatic hypotension

386
Q

OA: Beers criteria states Naproxen sodium or NSAIDs should be avoided because of what risk?

A

potential to promote fluid retention and minimize effect of many anti-HTN medications

387
Q

OA: Beers criteria states Sertraline (Zoloft) should be avoided because of what risk?

A

Increased risk for hyponatremia, especially when used with a diuretic

388
Q

OA: Beers criteria states Oxybutynin (Ditropan) should be avoided because of what risk?

A

significant systemic anticholinergic effects when compared to other medications in its class

389
Q

OA: What is a reason for dizziness in the older adult?

“I feel lightheaded”

A

reduced circulating volume including overdiuresis, orthostatic hypotension, neurologic conditions (parkinson’s), medications, anxiety, hypoglycemia, hyperthermia, dehydration

390
Q

OA: What are causes for vertigo in the older adult?

“The room is spinning”

A

sensation of motion with eyes closed/surroundings are moving.
Usually an inner ear disturbance (small crystals).
Inflammation of inner ear, Meniere’s disease, head trauma, stroke, multiple sclerosis, tumors, migraines

391
Q

OA: A patient complaining of “cramping” in lower posterior legs bilaterally when walking for an extended period of time, but is relieved by rest. What do you suspect? Common findings?

A

Intermittent claudication - Peripheral Artery Disease
s/s - pain with walking, relieved by rest. Diminished bilateral pedal pulses with thinning of the skin. Persistent infections/sores of leg and feet. Hx of HTN, dyslipidemia, stable angina, smoke/ing

392
Q

OA: What diagnostic test is best to evaluate peripheral artery disease?

A

ankle-brachial index (ABI)

Doppler ultrasound or MRI, treadmill test, arteriogram

393
Q

OA: What are common symptoms of venous insufficiency?

A

burning, swelling, throbbing, cramping, aching, and HEAVINESS in the legs
Restless legs and leg fatigue
Telangiectasis

394
Q

OA: What are common complaints of peripheral neuropathy?

A 
a gradual onset of numbness and tingling in the hands and feet 
Burning pain 
Sharp electric-like pain 
Muscle weakness 
Extreme sensitivity to touch
395
Q

CV: What is the blood pressure equation?

A

BP = HR X SV X PVR (peripheral vascular resistance)

396
Q

CV: What is the most common form of high blood pressure in the older adult?

A

systolic HTN - systolic is elevated, diastolic is normal

397
Q

CV: What hypertension medications are considered first line agents? (4)

A

Thiazide diuretics
Calcium Channel Blocker
ACE inhibitor or ARB

398
Q

CV: What hypertension medications are considered first line agents for black adults?

A

Thiazide diuretic or CCB

399
Q

CV: What hypertension medications are considered first line agents for non-black adults?

A

Thiazide diuretic, CCB, ACE inhibitor, or ARB

400
Q

CV: What hypertension medications are considered first line agents for individuals with Chronic Kidney Disease?

A

must include ACE inhibitor or ARB

401
Q

CV: HTN guidelines recommendations - JNC-8 recommends BP < __/__ for all individuals whereas AHA/ACC recommends BP

A 
JNC-8 = < 140/90 
AHA/ACC = < 130/80
402
Q

CV: Why is a urinalysis ordered at initial diagnosis of primary hypertension?

A

to assess for protein in the urine (kidneys are not functioning properly = protein leak into urine [RAAS])

403
Q

CV: Aspirin use is reserved for what type of patients? Is this a primary prevention consideration?

A

High-risk patients ONLY, risk > benefit = GI bleeds.

NO! secondary for patients with a hx of CVD, stroke, etc

404
Q

CV: Why is chlorthalidone a preferred diuretic in comparison to HCTZ?

A

Longer half life!

405
Q

CV: What has been observed in women who take long-term thiazide diuretics for hypertension?

A

good for Osteoporosis. Less rates of fractures in comparison to loop diuretics. However, LOOPs remain effective with lower GFR

406
Q

CV: What is the most adverse effect of aldosterone antagonist, Spironolactone?

A

Gynecomastia with prolonged use in men, libido is negatively effected as well

407
Q

CV: What is the most important hypertension medication class to start a patient on that has diabetes mellitus?

A

ACE inhibitor or ARB, per ADA

408
Q

CV: What class of hypertension medications should be AVOIDED during pregnancy?

A

ACE inhibitors or ARBs

409
Q

CV: What are 3 risk factors associated with the adverse effect of ACE inhibitor induced angioedema?

A

African
Latino
history of NSAID allergy

410
Q

CV: What is an adverse effect of ACE inhibitors or ARBs, especially in an adult with inadequate fluid intake?

A

Hyperkalemia - CAUTION in older adults!

411
Q

CV: What is the most common adverse effect of calcium channel blockers?

A

ankle edema

412
Q

CV: Who should NOT be given beta blockers for hypertension? What medication drug name is okay to use with this condition?

A

anyone with LOWER AIRWAY DISEASE

lower CV-selective effects with Metoprolol = ok with COPD or asthma

413
Q

CV: What 3 medications are SAFE for treatment of hypertension in pregnancy?

A

Methyldopa
Hydralazine
Beta Blockers

414
Q

CV: What class of HTN medication will cause constipation in the Older adult?

A

CCB

415
Q

CV: What class of HTN medication will mask hypoglycemia?

A

Beta blockers

416
Q

CV: What is a normal eGFR?

A

90 - 120

417
Q

CV: What medication should be AVOIDED in a poorly-hypertension patient that is requesting medication for the common cold?

A

Pseudoephedrine! - will elevated blood pressure.

Consider treatment with guaifenesin, dextromethorphan, or chlorpheniramine (all are safe for HTN)

418
Q

CV: A patient presents today with 210/122 blood pressure today and states they have been out of their medication for the past 3 months. Denies visual changes, chest pain, SOB, and feels well. What is this condition and what is your best intervention at this time?

A

HTN urgency!
TX: restart medications! f/u within week with labs.

DO NOT send to ED, DO NOT treat with in-office clonidine, hydralazine, nitroglycerin.

419
Q

CV: What lab value is the best indicator to have a patient fast for lipid panel labs?

A

if the triglycerides are >400, then repeat lipid panel in a FASTING state. Otherwise, nonfasting lipid panel is acceptable even in CVD, DM, obesity, etc

420
Q

CV: What are two statin medications reserved for high-intensity treatment?

A

Atorvastatin 40-80
Rosuvastatin 20-40
reduces LDL-C by >50%

421
Q

CV: When and how often should hepatic enzymes be checked when a person is on a statin medication?

A

When: prior to initiation to establish baseline.
Frequency: NEVER - routine hepatic enzyme monitor is NOT NECESSARY.

422
Q

CV: What 2 medications have been shown to reduce triglyceride levels?

A

Omega 3 fatty acid (Vascepa = rx)

Fibrates (Fenofibrate and fenofibric acid) may also increase HDL

423
Q

CV: What medication is used as an add-on to statin therapy for familial hypercholesterolemia?

A

PCSK9
Evolocumab, Alirocumab
$$$, LDL-C >60%, SC injection only

424
Q

CV: Who needs to be started on a high-intensity statin?

A

LDL-C >190 mg/dL - no risk assessment needed

Those with >20% ‘high risk’

425
Q

CV: Who needs to be started on a moderate-intensity statin?

A

All DM patients age 40-75 years
Anyone 40-75 with LDL-C >70-190, without DM
Anyone with ‘intermediate risk’ >7.5%

426
Q

CV: What is stage A heart failure? What are some examples of conditions that apply to this stage?

A

Individuals at high risk for Heart Failure BUT without structural heart disease or symptoms of HF.
Examples = HTN, ASCVD, DM, Obesity, Metabolic syndrome

427
Q

CV: What is stage B heart failure? What are some examples of conditions that apply to this stage?

A

Individuals WITH structural heart disease BUT without signs/symptoms of HF.
Examples = previous MI, LV remodeling (LVH, low EF), or asymptomatic valvular disease

428
Q

DM: What type is insulin resistance with eventual insulin deficiency?

A

Type 2 DM

Type 1 is autoimmune process involving beta cell destruction resulting in insulin deficiency

429
Q

DM: If a patient has NO risk factors of diabetes, when should screening for diabetes begin? How often should testing be repeated?

A

Age 45, if normal then repeat every 3 years

430
Q

DM: What are common risk factors of diabetes?

A

Overweight (BMI >25)
Physical inactivity, first degree relative with T2DM, high risk ethnicity, Women of baby >9lbs or GDM, HTN >140/90, <35 HDL level, >250 Triglyceride level, PCOS, A1c >5.7%, Insulin resistance, history of CVD

431
Q

DM: A fasting glucose >___ qualifies as a diagnosis of Diabetes Mellitus

A

> 126

432
Q

DM: A random glucose >___ qualifies as a diagnosis of Diabetes Mellitus

A

> 200

100-125 is pre-DM

433
Q

DM: An A1c >___ qualifies as a diagnosis of Diabetes Mellitus

A

> 6.5%

5.7 -6.4 is pre-DM

434
Q

DM: What is the goal A1C for a frail older adult?

A

<8%

435
Q

DM: When the eGFR is

A

<30, especially in frail older adults or Advanced age (INCREASED LACTIC ACIDOSIS RISK)

436
Q

DM: What is a first line medication, if no contraindications, for type 2 Diabetes Mellitus?

A

Metformin

437
Q

DM: What is the greatest adverse effect of sulfonylureas? (-zide, -mide, -ride)

A

hypoglycemia

NO OLDER ADULTS

438
Q

DM: What drug class is best for older adults due to minimal risk of hypoglycemia?

A

DPP-4 inhibitor

-GLIPTIN

439
Q

DM: What drug class should be AVOIDED in gastroparesis or pancreatitis?

A

GLP-1 agonist

-TIDE (peptide = TIDE, ie Exenatide)

440
Q

DM: What drug classes will cause weight gain?

A

TZD (zones)
SU - sulfonylureas
Insulin

441
Q

DM: What drug classes will cause weight loss?

A

GLP-1 agonist (TIDE)
SGLLT-2 inhibitors (-gliflozin)
possibly Metformin

442
Q

DM: What drug class should be AVOIDED with heart failure?

A

TZD - zones

Piaglitazone

443
Q

DM: What drug class should be monitored for adverse effects of UTI or GU infection?

A

SGLT-2 inhibitors (-gliflozin)

444
Q

DM: What 2 drug classes have proven to show benefits with use in ASCVD, HF, and CKD?

A

GLP-1 agonist (-tides)

SGLT-2 inhibitors (-glifozin)

445
Q

DM: What 4 types of patients will qualify for insulin usage?

A

Type 1 diabetes
T2DM with A1C >9% at time of diagnosis with symptoms
T2DM using >2 agents at optimized doses are inadequate
When acutely ill

446
Q

DM: What are 5 key findings to diagnosis of Metabolic Syndrome?

A 
Increased waistline circumference >35 cm, >40 cm
Hypercholesterolemia 
Low HDL cholesterol 
High blood pressure 
High glucose
447
Q

HA: What mnemonic is helpful for assessment of “red flags” of primary headaches?

A

SNOOP
s - systemic symptoms (fever, weight loss, infection)
n - neurologic (newly acquired neuro, confusion, papilledema)
o - onset (sudden, abrupt, THUNDERCLAP, with exertion/sex/cough/sneeze)
o - onset age (>50 years, <5 years)
p - positional (changes in freq/quality, positions)

448
Q

HA: Type of headache - constant pressure or pressing and nonpulsatile pain, bilateral characteristics

A

Tension-type

449
Q

HA: Type of headache - a pulsating quality that is aggravated by normal activity with c/o nausea, photophobia, or phonophobia

A

Migraine

450
Q

HA: Type of headache - often is located behind one eye, mostly in males and occurs at the same time everyday

A

Cluster

451
Q

HA: Abortive or Prophylactic therapy? NSAIDs and acetaminophen

A

abortive or acute therapy

452
Q

HA: Abortive or Prophylactic therapy? Beta blocker

A

prophylactic or preventative

453
Q

HA: Abortive or Prophylactic therapy? Triptans

A

abortive or acute therapy

454
Q

HA: Abortive or Prophylactic therapy? injectable CGRP antagonists

A

prophylactic or preventative

455
Q

HA: Abortive or Prophylactic therapy? Ergot derivatives

A

abortive or acute therapy

456
Q

HA: Abortive or Prophylactic therapy? oral CGRP antagonists

A

abortive or acute therapy

457
Q

HA: Abortive or Prophylactic therapy? Topiramate/Topamax

A

prophylactic or preventative therapy

458
Q

HA: What are 3 contraindications to taking triptan medications?

A

abortive therapy:

NO pregnancy, CVD, poorly controlled HTN

459
Q

HA: When should prophylactic therapy be considered?

A

when using any product >3 times per week
>2 migraines per month with disabling symptoms >3 days
poor symptom relief with abortive therapy

460
Q

HA: What type of birth control should be AVOIDED in migraines?

A

combined oral contraceptives

461
Q

HA: What types of birth control are best for the migraine individual?

A

progestin - IUD or Implant (nexplanon)

or hormone-free = cooper IUD

462
Q

HA: Abortive or prophylactic therapy? Oral gepant (Ubrogepant/Ubrelvy) Who benefits the most from this medication?

A

Abortive therapy

A patient with a history of acute coronary syndrome (cannot take triptan)

463
Q

HA: Prophylactic medication that is best for tension type headaches and is limited by insurance cost.

A

Oral TCA - nortriptyline

464
Q

HA: Describe expected findings of giant cell arteritis.

A

Severe unilateral headache with accompanying jaw pain
Hard to wash/brush hair - SCALP IS PAINFUL
normal neurological exam
Tender/nodular PULSELESS vessel at temple
Vision blurring, diplopia, eye pain, sudden loss of vision
Age 50-85 years, Females

465
Q

HA: What is the best initial test of giant cell arteritis? What test will confirm diagnosis?

A

Erythrocyte sedimentation rate

gold standard confirmation test is Arterial Biopsy

466
Q

HA: What is the treatment of giant cell arteritis?

A

this is an autoimmune vasculitis =
**High-dose systemic corticosteroid therapy until stable then 6 months to 2 years.
Aspirin to reduce stroke. GI - PPI. Bone - bisphosphonate to reduce long-term effects of corticosteroid therapy.

467
Q

DERM: Skin lesion - a single, uniformly brown-colored, slightly raised, irregularly-shaped with defined borders, 6 mm in diameter. Has not changed in years.

A

Papule

468
Q

DERM: skin lesion - single, flat, non-palpable area of discoloration, irregularly-shaped and 0.5 cm at the widest diameter. Present for years.

A

Macule

469
Q

DERM: skin lesion - single, firm, smooth, raised, dome-shaped, fluid-filled, flesh-colored encapsulated lesion of 1.5 cm in diameter on back of neck

A

Cyst

470
Q

DERM: skin lesion - linear-like cleavage with sharp walls through the epidermis

A

Fissure

471
Q

DERM: skin lesion - flat, non-blanchable, confluent, purple-colored irregularly-shaped lesions on skin ranging 2-20 mm in size

A

Purpura

472
Q

DERM: skin lesion - clustered, smooth, slightly-raised, circumscribed, pruritic skin-colored lesions of various sizes up to 2cm, surrounded by area of erythema

A

Wheal

473
Q

DERM: Scaling flesh-colored lesions in a cluster, ranging in size from 3-10 mm on dorsal aspect of the HAND, present for a number of months, without patient complaint. Sometimes tender. Usually presents on sun-exposed areas

A

Actinic Keratosis

most common on light-colored skin, >40 years, a lot of time outdoors without sun protection
diagnosed by CLINICAL DIAGNOSIS
TX: topical 5-fluorouracil, imiquimod cream, diclofenac gel, cryosurgery

474
Q

DERM: What is a possible complication of actinic keratosis?

A

development of squamous cell carcinoma if UNTREATED (second most common skin cancer)

475
Q

DERM: A well-demarcated round to oval erythematous coin-shaped plaques approximately 10 mm in diameter on the anterior aspects of the lower legs described as intermittently itchy, present for a number of months.

A

Nummular eczema

476
Q

DERM: A painless ulcerated lesion approximately 1.5 cm in diameter over the sternum that has been present for a number of weeks. Dome-shaped nodule.

A

Squamous Cell Carcinoma

477
Q

DERM: Pearly or waxy papules or plaques with rolled distinct borders, with or without telangiectasis, and ulceration. Nonhealing scab.

A

Basal Cell Carcinoma

478
Q

DERM: Has a “stuck on” waxy or scaly appearance with varying degrees of pigmentation

A

Seborrheic Keratosis

479
Q

DERM: A loss of pigment (depigmentation) in patches of skin, present for weeks to months

A

Vetiligo - this is autoimmune Type I

480
Q

DERM: What condition is treated with permethrin lotion?

A

Scabies, treat the entire body

481
Q

DERM: What is the treatment for psoriasis vulgaris? Where does this most commonly occur?

A

medium potency topical corticosteroid

Elbows and Knees

482
Q

DERM: What condition is treated with imiquidmod cream?

A

Verruca Vulgaris - WARTS - CANNOT be pregnant for this treatment.

483
Q

DERM: What is a treatment of tinea pedis?

A

topical ketoconazole - antifungals

484
Q

DERM: What is a treatment of rosacea?

A

Topical Metronidazole

485
Q

DERM: Where is eczema commonly seen on the body?

A

antecubital fossa - bends of elbow

486
Q

DERM: Where is rosacea commonly seen on the body?

A

over the cheeks and nose

487
Q

DERM: Where is scabies commonly seen on the body?

A

waistband! also web folds of fingers, under breasts, upper arm, thighs

488
Q

DERM: What condition is usually preceded by a herald patch on the trunk of the body?

A

Pityriasis Rosea

always ask where is the oldest lesion? Where did the first lesion occur?

489
Q

DERM: A hyperpigmented plaque with a velvet-like appearance at the nape of the neck and axillary region. May have skin tags within the lesion as well. No itch or pain.

A

Acanthosis Nigricans

will probably have a high BMI, insulin resistance, presents at onset of puberty follow up with A1C

490
Q

DERM: Where will acanthosis nigricans present on the body?

A

groin folds, over the knuckles, neck, axillary folds, and elbows

491
Q

DERM: What is the preferred treatment for phytodermatitis (poison ivy/oak) when it covers >20% of the total surface area, as a severe rash, or if the rash impacts the face/genitals/hands

A

Systemic Corticosteroid - PO Prednisone

492
Q

DERM: What is preferred for topical treatment of phytodermatitis (poison oak/ivy)?

A

OINTMENT! never cream. Ointment allows medication to contact skin longer
Mid or high-potency topical corticosteroids (Triamcinolone or Clobestasol)
RISK of skin atrophy with 2-3 weeks or > with high-potency use.

493
Q

DERM: An erythematous macule that rapidly evolves into vesicle or pustule. This ruptures then dries and leaves a crusted, honey-colored exudate. What is this condition? What is a likely organism? Treatment?

A

Impetigo - nonbullous
Staphylococcus Aureus or Streptococcus Pyogenes
TX: Mupirocin, consider systemic antimicrobial if extensive/topical fails.

494
Q

DERM: An infection of dermis and subcutaneous fat that feels warm to touch, is red, and painful. What condition is this? What is the likely organism? Treatment?

A

Cellulitis
Streptococcus Pyogenes (possible MSSA or MRSA)
TX: systemic antimicrobial

495
Q

DERM: A skin infection involving a hair follicle and surrounding tissue that is warm to touch, red, and painful. What condition is this? What is the likely organism?

A 
Cutaneous abscess 
Staphylococcus Aureus (MRSA, MSSA) 
TX: varies based on organism. Likely systemic
496
Q

What antibiotic commonly causes C. Diff diarrhea?

A

Clindamycin

497
Q

LRT: What are the most likely causative pathogens of community acquired pneumonia (CAP) in individuals WITHOUT significant comorbidities (no COPD, DM, HF, CRD, asplenia, or alcohol use disorder)?

A

S. Pneumoniae (gram positive) #1 for ARB & otitis media.
M. Pneumoniae (atypical)
C. Pneumoniae (atypical)
Viruses: influenza, RSV, etc

498
Q

LRT: What are the most likely causative pathogens of community acquired pneumonia CAP in individuals WITH comorbidities? (HF, CLD, liver disease, renal disease, DM, alcohol use, malignancy, or asplenia)

A 
S. Pneumoniae (gram positive) 
H. Influenzae (gram negative) 
M. Pneumoniae (atypical) 
C. Pneumoniae
Legionella spp
Viruses: influenza, RSV, etc
499
Q

LRT: What are two gram negative pathogens that cause CAP. Symptoms of dry cough or “walking pneumonia”

A

Atypical pathogens!
M. Pneumoniae & C. Pneumoniae
People: correctional facilities, college dorms, long-term care facilities, small offices, etc

500
Q

LRT: How is legionella, an atypical pathogen, spread? What are major risk factors?

A

Through inhaling mist or aspirating liquid that comes from a water source contaminated. NOT person to person.
RF: older, male, smoking, diabetes mellitus

501
Q

LRT: What is the minimum diagnostic evaluation to be completed outpatient for suspected community acquired pneumonia?

A

CBC with diff
BUN/Creatinine
Chest X-ray
(other tests are based on presentation/symptoms and comorbidity)

502
Q

LRT: What is the minimum length of treatment for the afebrile patient with community acquired pneumonia?

A

5 days, average is 5-7 days

must be afebrile for 48-72 hours prior to antimicrobial discontinuation

503
Q

LRT: What 3 medication drug classes are recommended to treat community acquired pneumonia in the outpatient setting WITHOUT significant comorbidities? (mnemonic for drug name)

A

AABCDE - not listed in priority, these are your options
1. Tetracycline: Doxycycline**
2. Macrolide: Azithromycin, Clarithromycin, Erythromycin
3. Penicillin: Amoxicillin**
(DO NOT use macrolide if resistance rate is >20%)

504
Q

LRT: What medication drug classes are recommended to treat community acquired pneumonia in the outpatient setting WITH significant comorbidities? (COPD, DM, Renal or Heart failure, asplenia, or alcohol use disorder)

A
  1. Fluoroquinolone: Moxifloxacin, Levofloxacin (-ACIN)
    or
    2a. Tetracycline: Doxycycline AND Beta-lactam: Amoxicillin-clavulanate (T & B)
    2b. Macrolide: Azithromycin or Clarithromycin AND Beta-lactam: Amoxicillin-clavulanate (M & B)
    2c. Tetra or Macrolide AND Cefpodoxime or Cefuroxime
505
Q

LRT: What symptom is the MOST sensitive and specific finding of pneumonia?

A

Tachypnea/elevated respiratory rate

especially with children or elderly

506
Q

LRT: What are other symptoms/findings of pneumonia?

A

beside tachypnea…
Crackles/rales (diff from HF - fever, no JVD, no S3)
Consolidation (dull to percussion with increased tactile fremitus)
Pleuritic friction rub (sharp, localized pain, worse with deep breath/cough)

507
Q

LRT: What are the 5 components of CURB-65?

A 
Confusion of new onset, 
Blood UREA nitrogen >19, 
Respiratory rate >30 b/min
Blood pressure <90 mm hg systolic or diastolic <60 
Age - 65
508
Q

LRT: What CURB-65 score allows a patient to be treated in the outpatient setting? Hospital?

A

0-1 = oral antibiotics

2 - consider close outpatient treatment if adequate home support. Otherwise hospital. 3-5 = hospital

509
Q

LRT: What medication drug class increases the QT interval?

A

Macrolide (-MYCIN)

510
Q

LRT: A patient with a cough for more than 5 days (with/without sputum production), absence of fever or tachypnea, and no history of asthma/COPD, or other airway diseases. What do you suspect? What 3 medications would you consider for a protracted, problematic cough?

A

Acute Bronchitis - usually follows an URI
cough = inhaled bronchodilator via MDI such as SAMA (Ipratropium) or SABA (Albuterol) or short course oral corticosteroid (prednisone).

511
Q

LRT: What are common symptoms of asthma? When are symptoms worse?

A

recurrent cough
wheeze
SOB and/or chest tightness
WORSE AT NIGHT, or with exercise, Viral RTI, aeroallergens, and pulmonary irritants (smoke)

512
Q

LRT: What is the best tool to diagnose asthma? What monitors asthma?

A

Spirometry = diagnosis

Peak flow meter = monitor

513
Q

LRT: Asthma is an airflow obstruction that is at least partially reversible. An increase in the FEV by ___% from baseline post ______ use should confirm this.

A

An increase in FEV >12% from baseline post short acting beta agonist use (SABA)

514
Q

LRT: With all asthma diagnosis, what medication is necessary? If the patient uses this >___ days a week (except exercise) suggests a need for better airway inflammation control.

A

an acute reliever/rescue - SABA

>2 days/week = reevaluate medication plan

515
Q

LRT: Classifying asthma severity: >12 years of age at initial diagnosis with moderate persistent symptoms

A 
Symptoms = daily 
Nighttime = >1x/week (NOT nightly) 
SABA use = daily 
Activity = some limitation 
Lung function = FEV >60% but <80% or FEV/FVC reduced by 5% 
Exacerbations needing OSC = >2/year
516
Q

LRT: Classifying asthma severity: >12 years of age with Moderate Persistent Asthma symptoms, what is the first step? Reevaluate in?

A

Step 3 = Medium dose ICS or Low ICS AND LABA

Reevaluate in 2-6 weeks

517
Q

LRT: Assessing asthma control (reevaluating the patient) in >12 years of age patients. What is considered well-controlled symptoms? How long must the patient be well-controlled before step down?

A 
Symptoms: <2 days/week
Nighttime: <2 x/month
NO interference with normal activity 
SABA us: <2 days/week
FEV: >80% of personal best 
Exacerbations: 0-1 /year
***Maintain current step, consider step down after 3 months of controlled.
518
Q

LRT: Assessing asthma control (reevaluating the patient) in >12 years of age patients. What is considered very poorly controlled symptoms?

A 
Symptoms: throughout day 
Nighttime: >4x/week
Activity: Extreme limitation 
SABA: several times per day
FEV: <60% 
Exacerbations: >2/year
**oral systemic corticosteroids, step up 1-2 steps, reevaluate in 2 weeks**
519
Q

LRT: What is the diagnostic tool utilized for COPD? What is the classical finding?

A

Spirometry is required for diagnosis
FEV:FVC <0.70 post bronchodilator = CONFIRMS
Classified by FEV1 (GOLD 1,2,3,4)

520
Q

LRT: Patients with COPD, should not be given inhaled corticosteroids because?

A

there is an increased risk of pneumonia

521
Q

LRT: What is the first line therapy for each stage of COPD? Group A, B, C, D

A

A: SABA or SAMA PRN
B: LABA or LAMA on schedule
C: LAMA on schedule
D: 3 options: 1. LAMA and LABA or 2. ICS and LABA or 3. ICS/LABA/LAMA on schedule

522
Q

What antimicrobial drug should be AVOIDED with use of ACEI or ARB, especially with CKD and/or dehydration, due to hyperkalemia risk?

A

TMP/SMX - Bactrim

523
Q

What antimicrobial drug class increases the risk of QT prolongation, especially in individuals with higher CVD risk?

A

Macrolides -MYCIN

524
Q

What antimicrobial drug class is associated with tendon rupture risk, especially when given with a systemic corticosteroid?

A

Fluoroquinolones -ACIN

525
Q

What antimicrobial drug class has less than 1% cross-risk with penicillin allergy?

A

2nd generation cephalosporins: Cefpodoxime

526
Q

LRT: What is a major indication to initiate long-term oxygen therapy in the COPD patient?

A

hypoxia for >15 hours/day!

PaO2 <55 or SaO2 <88% with/out hypercapnia

527
Q

LRT: What are common risk factors of developing COVID19?

A

older age, chronic kidney disease, COPD, immune-compromised state, BMI >30, serious heart condition, type 2 diabetes, sickle cell anemia, African/Latino/Native American ethnicity

528
Q

LRT: What are common symptoms of COVID19 in mild to moderate disease?

A

up to 50% are asymptomatic
s/s: mild fever, cough, sore throat, nasal congestion, malaise, headache, new loss of taste or smell, muscle pain, pneumonia

529
Q

LRT: What is best for outpatient treatment of COVID19?

A

supportive: acetaminophen/NSAID, guaifenesin, hyrdate

SABA/SAMA ONLY IF PRE-EXISTING AIRWAY DISEASE
F/u at 5 day of symptoms

530
Q

ENT: What diseases are commonly caused by S. Pneumoniae? (mnemonic)

A 
COMPS
conjunctivitis 
otitis media 
meningitis 
pneumonia 
sinusitis 
(second cause organism of same disease = H. influenza)
531
Q

ENT: What are the findings of acute bacterial rhinosinusitis? (VERY IMPORTANT to know each component of ARB)

A

URI like symptoms AND

  1. persistent/not improving (>10 days)
  2. severe with fever >102/39, purulent nasal discharge, facial pain, >3-4 days
  3. Worsening/double-sickening = improvement in URI symptoms, then worsens with fever, headache, nasal discharge
532
Q

ENT: What are risks of antibiotic resistance (reason for 2nd line antimicrobial therapy) related to acute bacterial rhinosinusitis?

A

Age <2 or >65, attends daycare

Prior systemic antibiotics within past month

533
Q

ENT: What is the first line therapy versus controller treatment of allergic rhinitis?

A 
#1 = avoid allergen. 
#1 controller =intranasal corticosteroids
534
Q

ENT: What is the initial empiric therapy of acute bacterial rhinosinusitis in adults?

A

Amoxicillin-Clavulanate 500/125 TID or 875/125 BID 5-7 days

Improvement should occur in 3-5 days, complete full 5-7 day course.

535
Q

ENT: What are 2 choices of therapy for patients with an allergy to beta-lactams in treatment of acute bacterial rhinosinusitis in adults?

A
  1. Tetracycline: Doxcycline - PREGNANACY RISK D!

2. Fluoroquinolones: Levofloxacin, Moxifloxacin - consider for allergy and/or drug resistant S.P. use

536
Q

ENT: What is the FDA-mandated warning with leukotriene modifier therapies for allergic rhinitis?

A 
this is an additional therapy - NEUROPSYCHIATRIC warning. 
Leukotriene modifiers (Montelukast/Singulair) is best as add-on therapy. Consider 2nd generation oral antihistamines before this.
537
Q

A woman taking combined oral contraceptives is requesting more information on St. John’s wort for mild depression treatment. Should you be concerned?

A

YES! - St. John’s wort will decrease effectiveness of COC. Potential contraceptive failure.

538
Q

ENT: What is conductive hearing loss? Sound is being _____. Common causes include? Weber test results? Rinne? Treatment?

A

an outer or middle ear hearing loss. The sound is being BLOCKED
Causes = earwax, foreign object, damaged eardrum, otitis media, bone abnormality
Weber = buzzing sound heard louder in affected ear. LATERALIZED.
Rinne = negative.
Tx = self-resolves usually

539
Q

ENT: What is sensorineural hearing loss? Sound loss is due to what? Common causes include? Weber test results? Rinne? Treatment?

A

an inner ear hearing loss (CN VIII - Vestibulocochlear)
Due to: inner ear or nerve DAMAGE.
Causes: Age, ototoxic medications, immune disorders, trauma.
Weber = LATERALIZED sound to UNAFFECTED ear. Buzzing sound heard lower or not at all in affected ear.
Rinne = positive or normal
TX = this is PERMANENT loss - hearing aids, cochlear implants

540
Q

ENT: Rope-like pale yellow discharge of the eyes is most commonly seen with what condition?

A

allergic conjunctivitis - offer ocular antihistamine

541
Q

ENT: A patient complaining of sudden vision changes such as halos around lights and blurred vision with red, painful eye(s). What would you suspect?

A

Angle-closure Glaucoma

peripheral vision loss is suggestive of open-angle glaucoma

542
Q

ENT: What is the most common form of oral cancer?

A

Squamous cell carcinoma

543
Q

ENT: What is the most common form of oral cancer?

A

Squamous cell carcinoma - expect to find a painless ulcerated lesion with indurated margin and accompanied by a firm, nontender submandibular node.

544
Q

ENT: What is presbycusis? What are expected findings?

A

An age-related hearing loss/alteration. Sensorineural loss (CN VIII)
Background noise makes hearing worse, may have tinnitus, vertigo, disequilibrium. Person can hear but CANNOT understand what is said.

545
Q

ENT: What condition presents in the older adult with a long history of diabetes that is experiencing a gradual peripheral vision loss/tunnel vision? This is often painless and gradual.

A

Open-angle glaucoma

546
Q

ENT: What condition presents as a gradual onset of blurring of near vision in a person over the age of 45 years complaining of never needing glasses, but needs them now?

A

Presbyopia - normal eye changes, stiffening/hardening of lens

547
Q

ENT: What condition presents commonly as a central vision loss that is noted in the older adult that was a former smoker with blue eyes? What is found on fundoscopic exam?

A

Macular degeneration

Soft, yellow deposits in macular region.

548
Q

ENT: What are expected findings of viral pharyngitis?

A

clear nasal discharge,
hoarseness,
scattered small vesicles on soft palate and tonsils,
GENERALIZED BODY ACHES,
“sore throat started AFTER my nose started to run”

549
Q

ENT: What are expected findings of a bacterial (GABHS) pharyngitis?

A 
Significant anterior cervical lymphadenopathy, 
frontal headache without body aches, 
patchy exudates in posterior pharynx, 
"sore throat started all of a sudden" 
(commonly seen ages 5-15)
550
Q

ENT: What is first line therapy to treat confirmed group A beta hemolytic strep? Severe allergy?

A

Penicillin or amoxicillin with supportive therapy. Wait for confirmed results by swab or culture to treat with abx.

Allergy = Macrolide, Cephalosporin, or Clindamycin

551
Q

ENT: What condition is often found in high environmental humidity areas or the diabetic patient that is complaining of ear pain with tenderness over the tragus and/or pinna with ear canal swelling and erythema? Treatment?

A 
Otitis externa (Swimmer's ear) 
Treat with acetic acid/propylen glycol and hydrocortisone drops or ciprofloxacin/hydrocortisone drops IF TM IS NOT PUNCTURED. DO NOT USE NEOMYCIN on punctured TM.
552
Q

GI: What are common risk factors of GERD?

A

Overweight/obesity,
tobacco smoking,
fatty food,
alcohol and/or caffeine or carbonated beverages,
drugs that relax LES - estrogen, calcium channel blockers, etc

553
Q

GI: What are findings that will indicate a upper endoscopy? (mneumonic) What will NEVER indicate a upper endoscopy?

A

NEVER = GERD. You diagnose this based on clinical findings alone, unless pt fails to improve/worsens.
ALARM.
Anemia, Loss of weight (involuntary), Anorexia, Recent onset of progressive symptoms without risk or with therapy, Melena (tarry/bloody) or hematemesis, Swallowing difficulties (dysphagia, odynophagia)

554
Q

GI: What is the first line therapy for GERD? Patient education?

A

Proton Pump Inhibitors

Take PRIOR to first meal of day for maximum effect.

555
Q

GI: What are protracted PPI use adverse effects?

A 
protracted = >8 weeks. 
Micronutrient malabsorption (B12, calcium, magnesium, iron), increased fracture, pneumonia, C. difficile risk
556
Q

GI: What are common symptoms of GERD?

A

Hoarseness, recurrent cough, chronic pharyngitis, reflux with acid taste into mouth, sour/bitter taste after meals, burning sensation in chest especially after meals or once lying down/bending over

557
Q

What do you suspect of a microcytic hypochromic anemia with an elevated RDW? <80 MCV,

A

Iron deficiency

  • *An elevation in RDW can be an early finding of IDA**
  • *Thalassemia, Sideroblastic, and Lead are also common microcytic anemias** Order ferritin, serum iron, TIBC, and transferrin for further evaluation.
558
Q

What findings do you suspect on a CBC in a patient with anemia of chronic disease?

A 
low RBC/Hct with: 
normocytic (MCV 80-100), 
normochromic (MCH 24-32), 
normal limit RDW
WITH UNDERLYING DISEASE PROCESS.
559
Q

What diagnostic test is indicated for thalassemia?

A

Hgb electrophoresis

560
Q

What diagnostic test is indicated for sickle cell anemia?

A

Hgb electrophoresis

561
Q

What diagnostic test is indicated for hemolytic G6PD?

A

peripheral smear

562
Q

GI: What is obturator and psoas signs?

A

Obturator = Internal rotation of flexed right thigh causes pain in RLQ.

Psoas = extending right thigh in left lateral position elicits pain in RLQ.
Rovsing is present with appendicitis as well, L side pressure with palpitation causes pain in RLQ.

563
Q

GI: What are expected findings in primary care of acute appendicitis?

A

12-hour history of epigastric discomfort and anorexia
Nausea
RLQ abdominal pain
Positive obturator and psoas signs

564
Q

GI: What is the most helpful imaging tool to evaluate acute appendicitis, especially in the overweight/obese individuals? Slender body type or child with healthy BMI?

A

CT with contrast

Ultrasound to protect sexual organs

565
Q

GI: What are expected findings of acute pancreatitis? What signs can you assess for, although not always found/common?

A

Alcohol use is significant
12-hour sudden onset epigastric pain RADIATING to back with bloating, nausea, vomiting.
Epigastric tenderness, hypoactive bowel sounds, distention, hypertympanic. Confirm with lipase** (elevated longer) and amylase

SIGNS: Cullen - periumbilical blue discoloration, Grey-Turner - blue flanks, Chvostek - facial muscle spasm

566
Q

GI: What are risk factors and expected findings of diverticulitis? Diagnostic tool of choice? Treatment?

A

RF: >50 years, low dietary fiber.
A couple of days of intermittent LLQ abdominal pain accompanied by fever, cramping, nausea, and 4-5 loose stools/day.
Dx: colonoscopy
TX: diet, gut rest, oral antimicrobial

567
Q

GI: What are risk factors and expected findings of duodenal ulcer? (describe pain, relief, meds) Diagnostic testing? Treatment?

A

RF: H. pylori infection, NSAID use, smoking.
A 3-month history of intermittent upper abdominal pain described as “burning” or “gnawing.” Relief 2-3h POST meals and relief with food or antacids. Awakening at 1-2 am with symptoms.
Tender at epigastrium with hyperactive bowel sounds at LUQ.
DX: H. pylori or urea breath test, stool h. pylori, endoscopy
TX: PPI therapy with antibiotics (Clarithromycin/Amoxicillin or Metronidazole) if H.pylori positive. Negative = PPI and underlying cause.

568
Q

GI: What are the risk factors and expected findings of cholecystitis? Objective assessment findings? Diagnostic? Treatment?

A

RF: diabetes, gallstones.
24-hour/acute history of significant epigastric and RUQ constant abdominal pain with 2-3 minutes of increased pain, accompanied by nausea, episodes of vomiting, and intermittent fever.
Positive Murphy’s sign, Elevated AST, ALT, ALP.
DX: RUQ abdominal US
TX: dependent on gallbladder inflammation. NPO, IV, antibiotics, surgery.

569
Q

GI: HBsAg positive inidicates what? Discuss acute versus chronic.

A 
s = stays in people hepatitis B virus 
Ag = ALWAYS GROWING. Hepatitis B infection.

This can be in an acute or chronic hepatitis B patient.
Look for symptoms of Acute: hepatic enzymes >5x ULN, fatigue, RUQ discomfort, etc. VS Chronic: modest elevation in hepatic enzymes, asymptomatic

570
Q

GI: Anti-HAV positive indicates what? Anti-HAV negative?

A

Anti-HAV positive indicates an IgG (GONE) that is gone, either by vaccine or disease itself. (Hepatitis A in this case)

Anti-HAV negative = NO past/present infection or immunity.

571
Q

GI: Should a HBsAg positive patient get a vaccine against hepatitis B?

A

NO! - stays Always growing = this person has acute or chronic hepatitis B and the vaccine would not do anything/change existing disease.
HBsAg, Anti-HBc, or HBsAb (b=bye) negative would indicate no immunity and the need for vaccine.

572
Q

GI: Should a anti-HAV positive patient get a hepatitis A vaccine?

A

NO! - antibodies are present, either from a prior infection or vaccine. Another Hepatitis A vaccine would not change this finding. Other positive findings of PAST disease are: HAV IgM (miserable), HAV IgG (gone). Chronic Hepatitis A disease does not exist, only findings of acute or past disease.
Anti-HAV negative = vaccine

573
Q

GI: T/F - The USPSTF recommends hepatitis C screening all adults between ages 18 and 79 without regard to HCV risk factors.

A

TRUE!

574
Q

GI: What is the post-exposure prophylaxis available for hepatitis B exposure?

A

give both hepatitis B vaccine AND HBIG, hepatitis B immune globulin

575
Q

GI: How is irritable bowel syndrome (IBS) different from inflammatory bowel disease (IBD)?

A

IBS - no rectal bleeding, fever, weight loss, no CRP/ESR elevation. Presence of altered GI motility.

IBD - yes to rectal bleeding, diarrhea, fever, weight loss, elevation of CRP or ESR, leukocytosi (flares). Biologics need to be considered in treatment.

576
Q

A patient admits to taking Omeprazole (PPI) daily for GERD for the past year or so, what should you anticipate?

A

-prazole = PPI
Chronic PPI use can cause micronutrient malabsorption, particularly B12 and Iron
SUSPECT RBC PRODUCTION REDUCUTION/ANEMIA.

577
Q

A patient is taking Metformin for prediabetes and has been on this medication for years now, what should you anticipate?

A

Vitamin B12 malabsorption, check levels. A nutritional deficit of B12 can cause a reduction in RBC production as well.

578
Q

HEM: What are common primary care conditions that are characterized by chronic low-volume blood loss?

A

Erosive gastritis,
Menorrhageia,
GI malignancy

579
Q

HEM: What lab value indicates the red blood cell size?

A

MCV - mean corpuscle volume, normally 80-100
microcytic = <80 (IDA, thalassemia, lead, sideroblastic)
macrocytic = >100 (Vitamin B12, Folate, Substance abuse)

580
Q

HEM: What lab value indicates the red blood cells’ hemoglobin content or color?

A

MCH - mean cell hemoglobin
Hypochromic = pale (IDA, thalassemia)
Normochromic = normal (Chronic disease anemia, aplastic, blood loss)

581
Q

HEM: In an evolving microcytic anemia, as MCV ______, RDW ________.

A

MCV decreases (size), RDW increases (variation in RBC size) >15%

IDA and Lead - elevate ferritin levels next.

*Thalassemia WILL NOT have elevated RDW!

582
Q

HEM: In an evolving macrocytic anemia, as MCV ______, RDW ________.

A

MCV increases (size), RDW increases (Variation in RBC size) >15%

Vitamin B12, Folate, Substance abuse/alcoholism

583
Q

HEM: What is commonly seen with hemoglobin and hematocrit in a severely dehydrated patient?

A

hgb: normal and hct: HIGH

584
Q

HEM: What are the most common reasons for normocytic (MCV 80-100), normochromic (MCH, color) anemia with a normal RDW lab finding? (mnemonic)

A 
MR B CALM 
Marrow failure 
Renal failure
Blood loss (acute) 
Chronic disease***
Aplastic anemia 
Leukemia 
Metastasis (cancer)
585
Q

HEM: What do you anticipate the MCV, MCH, and RDW to present with suspected thalassemia? What is the next step to confirm/further evaluation?

A

Thalassemia = microcytic (size/MCV low), hypochromic (color/MCV pale) and normal RDW (<15%).
Hemoglobin electrophoresis is the next step

586
Q

HEM: What are the most common reasons for macrocytic (MCV >100), normochromic (MCH, color) anemia with a elevated RDW lab finding? (mnemonic)

A 
FAT RBC 
Fetus (pregnancy, rare) 
Alcohol excess 
Thyroid (hypo) 
Reticulocytosis 
B12 and Folate deficiency ***most common. 
Cirrhosis and chronic liver disease
587
Q

HEM: What is the most common type of anemia in childhood?

A

Iron deficiency anemia

588
Q

HEM: A vegan should supplement with what to prevent anemia?

A

vitamin b12

589
Q

HEM: What is the most common type of anemia in pregnancy?

A

iron deficiency anemia

590
Q

HEM: What is the most common type of anemia in a woman during her reproductive years?

A

Iron deficiency anemia

591
Q

HEM: What is the most common type of anemia in the elderly?

A

Anemia of chronic disease then IDA then pernicious anemia

592
Q

HEM: To maximize the effectiveness of oral iron therapy, what should be advised to the patient?

A

TAKE ON AN EMPTY STOMACH!
may take with OJ to help with absorption.

NEVER: take with antacid, never take with large meals, never take with glass of milk.
look for key words: optimize, maximize

593
Q

HEM: What type of murmur may occur when a patient has profound anemia, severely dehydrated, or has a high fever?

A

hemic murmur - especially in slender/thin individuals or strep throat. This will resolve with underlying cause treatment.

594
Q

HEM: What nutritional supplements are potentially associated with increased bleeding risk and should be discontinued at least 7-10 days prior to elective surgery?

A

Ginseng, Gingko, Garlic, Fish oil, Feverfew (possibly St. John’s Wort)

increased bleeding of aspirin, DOAC, Apixaban/eliquis, warfarin.

595
Q

HEM: Discuss the most likely WBC response to a significant viral infection such as mononucleosis or viral meningitis? (Neutrophils, lymphocytes, bands)

A

Total WBC will be normal to low
Neutrophils (polys, segs): 40% decreased
Lymphoctes: 55% increased with reactive forms
Overall, Neutrophils and Lymphocytes are closer in numerical range
Bands 3% elevation to normal typically

lymphocytosis = virus

596
Q

HEM: Discuss the most likely WBC response in a serious bacterial infection such as appendicitis or bacterial pneumonia? (Neutrophils, Lymphocytes, Bands)

A

Total WBC is elevated
Neutrophils: 71% increased with toxic granulation
Lymphocytes: 20% decreased
Bands: 6% increased (bands are BAD).

Neutrophilia with leukocytosis = left shift
Neutrophilia = bacterial
Wide values between neutrophils and lymphoctes.

597
Q

What is primary prevention health care? Examples?

A

preventing health problem(s). The most cost-effective form of healthcare
Examples: immunizations, counseling or teaching about safety/injury/disease prevention.

598
Q

What is secondary prevention health care? Examples?

A

the detecting of disease in early, asymptomatic, or preclinical state to minimize its impact.
Examples: Screening tests - BP check, mammography, colonoscopy, skin survey, lipid panel, etc

599
Q

What is tertiary prevention health care? Examples?

A

the minimizing of negative disease-induced outcomes.

Examples: established disease - adjust therapy to avoid further target organ damage.

600
Q

What 3 vaccines should NOT be given if a person has an anaphylactic reaction to neomycin?

A

IPV, MMR, Varicella

601
Q

What 2 vaccines should NOT be given if a person has an anaphylactic reaction to streptomycin, polymyxin B, neomycin?

A

IPV, Vaccinina (smallpox)

602
Q

What vaccine should NOT be given if a person has an anaphylactic reaction to baker’s yeast?

A

Hepatitis B

603
Q

What vaccine should NOT be given if a person has an anaphylactic reaction to gelatin and neomycin?

A 
Varicella Zoster (Zostavax) 
***Shingrix is the newer shingles vaccine given in two doses***
604
Q

What vaccine should NOT be given if a person has an anaphylactic reaction to gelatin?

A

MMR

605
Q

What are the immediate interventions for anaphylaxis in the primary care setting?

A 
Assess ABC 
Place in supine position 
Activate EMS, transfer to ED 
Administer IM epinephrine and give H1/H2 blocker (diphenhydramine or ranitidine)
 Initiate IV access, oxygen, monitor
606
Q

Previously unvaccinated adults with diabetes mellitus type 1 or 2 should be vaccinated against ___________ as soon as possible after diabetes diagnosis.

A

Hepatitis B

607
Q

What are 3 live attenuated virus vaccine examples? Who should NOT be given these vaccines?

A

MMR, Varicella, intranasal influenza

NO pregnancy, severely immunocompromised

608
Q

Who is a contraindication for the rotavirus vaccine?

A

infants with severe combined immunodeficiency (SCID) or history of intussusception

609
Q

Should a patient that had shingles 3 months ago and no longer presents with symptoms be vaccinated with Shingrex?

A

YES! - wait 6 weeks post outbreak

give shingrex to all individuals that got the older vaccine, anyone on biologics, anyone over the age of 50

610
Q

What are 3 expected and common side effects of vaccines?

A

discomfort, erythema and swelling

611
Q

What age is recommended for routine mammography in women?

A

At age 50, may begin at 45 annually to 54 then biennially if expected to live of at least 10 years.
Choice as early as 40-44 years

612
Q

What is precontemplation? What should you do as the provider?

A

a person that is NOT INTERESTED in change and may not be aware that the problem exists or minimizes the problem’s impact.
Help them move toward thinking about changing the unhealthy behavior

613
Q

What is contemplatation? What should you do as the provider?

A

A patient considering change and looking at positive and negative aspects. Reports of feeling “stuck” with problem.
Help them examine benefits and barriers to change.

614
Q

What is preparation? What should you do as the provider?

A

Patient exhibiting some change behaviors or thoughts. Often reports they do not have the tools to proceed.
Assist them with finding and using tools to help change and continue to work on lowering barriers to change.

615
Q

What is the action stage? What should the provider do?

A

Patient is ready to make change, takes concrete steps to change. Often inconsistent.
Help them use tools, encourage change, praise positives, acknowledge reverting back to former behavior as common.

616
Q

What is maintenance/relapse stage? What should the provider do?

A

Patient learns to continue the change and has adopted/embraced healthy habit. Person learns to deal with backsliding/relapse.
Continue positive reinforcement for behavior change, put backsliding into perspective but not an insurmountable problem.

617
Q

What is the number one leading cause of death in the US in children/adolescents?

A 
Unintentional injury 
#2 suicide
618
Q

What is the leading cause of death in the US in all ages?

A 
Heart disease 
#2 neoplasms (cancer), #3 unintentional injury
619
Q

What is the number one cancer diagnosis in males?

A 
Prostate
#2 lung #3 colon/rectum
620
Q

What is the number one cancer diagnosis in females?

A 
Breast
#2 lung #3 colon/rectum
621
Q

What is the leading cause of cancer related death in both men and women?

A

lung cancer

622
Q

What age will cervical cancer screenings begin? HPV?

A 
21 years old, pap q3 years, HPV 30-65 years 
Total hysterectomy (no cervix) = no screening unless surgery was done as a treatment of cervical cancer/pre-cancer. Partial hysterectomy (still has cervix) = screening
623
Q

How long must a person must have quit smoking in order to not be screened for lung cancer via low-dose CT?

A

> 15 years quit smoking regardless of pack-year history

624
Q

What does the USPSTF recommend for PSA-based screenings for prostate cancer?

A

stop after age 70 years!
for men 55 to 69 years, PSA screening is an individual choice (Grade C). Make this decision based on family history, race/ethnicity, medical conditions, benefits/harms, etc. Clinicians should not screen men who do not express a preference for screening.

625
Q

When is screening indicated for colorectal cancer?

A

ACS - age 45 (FIT, stool DNA, colonoscopy, sigmoidoscopy, CT, DCBE) UNTIL age 75 years.
USPSTF - age 50 until 75
Individual choice after 75

626
Q

When is screening for lung cancer indicated?

A

ACS - age 55-74 years LDCT in >30 pack-year history AND currently smoke or <15 years since quitting.
USPSTF - 55-80 years in >30 pack-year history AND currently smoke or quit within past 15 years

627
Q

THYROID: What is the most common thyroid disorder encountered in primary care? What mnemonic helps remember the signs/symptoms of this disorder?

A 
hypothyroidism 
MOMS SO TIRED 
Memory loss 
Obesity (modest weight gain <10 lbs) 
Menorrhagia - new onset
Slowness (mental/physical) 
Skin and hair dryness
Onset gradual
Tiredness 
Intolerance to cold
Raised BP - modest, reversible
Energy levels fall 
Depression/Delayed relaxation of all reflexes
628
Q

THYROID: What are 3 etiologies of hypothyroidism?

A

Hashimoto (autoimmune), Post-radioactive iodine tx for Graves or cancer, medication use (lithium, amiodarone, interferon)

629
Q

THYROID: What is the expected clinical presentation of hyperthyroidism? (mnemonic)

A 
SWEATING 
Sweating
Weight loss (muscle and fat)
Emotional lability -racing mind or Exophthalmos
Appetite increased but losing weight 
Tremor/tachycardia 
Intolerance of heat, irregular menstruation, irritable 
Nervousness 
Goiter, GI problems
630
Q

THYROID: What are 4 common etiologies of hyperthyroidism?

A

Graves (autoimmune), toxic adenoma, thyroiditis (transient - pregnancy), medication use (amiodarone, interferon)

631
Q

THYROID: What is the single MOST reliable test to diagnose all common forms of hypothyroidism and hyperthyroidism?

A

TSH ! - high sensitivity and specificity, WNL = thyroid disease is ruled out.

632
Q

THYROID: What lab value should be ordered to follow up confirmation of an abnormal TSH value?

A

free T4 - supports the diagnosis

633
Q

THYROID: What lab value is best to detect an autoimmune thyroid disease after an abnormal TSH value?

A

Thyroid peroxidase antibody TPO Ab

634
Q

THYROID: What is prescribed for hypothyroidism? How should the dose be initiated?

A

Levothyroxine (Synthroid) - dose based on IDEAL body weight if overweight or obese. Elderly 1.0 mcg/kg/day

635
Q

THYROID: What patient teaching is specific to levothyroxine? When should TSH levels be rechecked?

A

-empty stomach with water, same time everyday
-never within 2 hours of calcium, iron, aluminum, magnesium
check 8 weeks with therapeutic therapy.
Dose is increased by 12.5 to 25 mcg/day if TSH >4, decreased if TSH <0.5

636
Q

THYROID: What is the treatment for hyperthyroidism? What is safe for pregnancy?

A

beta-adrenergic antagoinist - beta blocker (Propranolol)
Methimazole or PTU (safe for pregnancy)
Once normal = RAI use, ablation

637
Q

THYROID: What is subclinical hypothyroidism? How should this patient be treated?

A

an elevated TSH with a normal free T4 level.
Usually asymptomatic/feels well, incidental finding.
Treat with levothyroxine if TSH >5, assess for goiter or TPO antibodies, assess for infertility, imminent pregnancy for reason to treat, and f/u as hypothyroid patient

FNP practice 2021-2022 (19 decks)

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