Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NP > Fitzgerald Review FNP COPY > Flashcards

Fitzgerald Review FNP COPY Flashcards

1
Q

Assessment of optic disc - what cranial nerve?

A

CN II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Symptoms of low CO

A

Dyspnea w/ exertion

Chest pain

ORTHOPNEA

Syncope or near syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What murmur: Holosystolic, blowing quality, Grade II-III/VI w/ predictable pattern of radiation (axilla)

A

Mitral regurgitation

Blood regurgitates back to left atrium = Low CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is holosystolic murmur

A

Murmur is heard ALL of systole at same intensity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe incompetent valve

A

valve cannot CLOSE properly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pattern of radiation - aortic regurgitation

A

Radiation to neck/carotid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Most common target organ damage in HTN

A

LVH, MR is common in LVH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Asthma flare - assess what first?

A

FEV1

Oxygen Sat drops LATE in an asthma flare

Asthma is a disease of AIR TRAPPING, difficulty getting air OUT

Oxygen Sat drops when difficult to get air in, which is LATE in asthma flare

At 90% O2 sat, 60 PaO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe asthma pathophysiology

A

Disease of AIR TRAPPING

Disease of airway inflammation w/ superimposed bronchospasm

Inflammation begets bronchospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where to auscultate renal arterires

A

MCL at level of elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bruit what is occuring

A

Turbulent blood flow through at atherosclerotic vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Grade 1 and 2 hypertensive retinopathy

Visual changes

Findings

A

Common in poorly-controlled HTN No visual changes w/ low-grade findings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Renal bruit

A

Bruit occassionally noted with renal artery stenosis

Cause of secondary HTN

Usually w/ markedly elevated BP at presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Evidence Hierarchy

A

Systematic review (meta-analysis)

RCT

Cohort Study

Case-control

Case series

Case report

Editorial

Expert opinion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Primary prevention

A

Prevent health problem, most cost-effective

Immunizations

Counseling

Disease prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Secondary prevention

A

Detecting disease early, asymptomatic/pre-clinical

BP checks, mammography, colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Tertiary prevention

A

Minimize negative disease-induced outcomes

Avoid target organ damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Burn prevention - hot water

A

Set to no hotter than 120F

At 130F 3rd degree burn at 30 seconds exposure

At 140F 3rd degree burn at 6 seconds exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Diphtheria

A

Pseudomembrane

Upper airway obstruction (cause of death)

Stridor (sound of upper airway obstruction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Herd immunity

A

95% need to be immunized for herd immunity

Measles - droplet - very contagious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Immunization principles

A

Remove artificial barriers - need only focused history prior to receiving vaccines

Re-immunize when in doubt; risk is minimal

Only defer in the presence of moderate to severe illness (with or without fever)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which immunizations cannot be given?

Neomycin Allergy

A

IPV

MMR

Varicella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which immunizations cannot be given?

Streptomycin, Polymyxin B allergy

A

IPV

Vaccinia (smallpox)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which immunizations cannot be given?

Bakers Yeast Allergy

A

Hepatitis B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which immunizations cannot be given?

Gelatin allergy

A

MMR

Varicella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which immunizations cannot be given?

Egg Allergy

A

None

Egg allergy NOT a contraindication to flu vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Anaphylaxis Treatment

Patent Airway

A
  1. Epinephrine (IM preferred d/t more dependable absorption)
    1. No contraindication to epinephrine use in anaphylaxis
    2. Repeat epinephrine every 5 minutes if symptoms persist or increase
  2. Antihistamine (only use WITH epinephrine)
    1. Benadryl
    2. Ranitidine
  3. Biphasic response: observe for 2 hours in an ER or urgent care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Tetanus

A

C. Tetani

Obligate anaerobe

Grow in the absence of ambient O2

Deep wounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Hep B

Why age 19-59 recommendation for previously unvaccinated adults

A

Not as robust immune response to Hep B vaccine after age 59

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

HPV Type

Genital Warts

A

6, 11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

LAIV Vaccine

A

Give age 2-49 years

Do not give in pregnant women, immunosupression, history of egg allergy, airway disease, people who have received flu antiviral in the last 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

LTBI lifetime risk of developing active TB

A

5-10%

The majority within the first 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Hep B Vaccine

A

Birth

1-2 months

6-18 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

RSV vaccine

frequency

Max age final dose

A

2, 4, 6 months

Max age for final dose 8 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Dtap vaccine

Tdap vaccine

A

Dtap

2, 4, 6 months

15-18 months

4-6 years

(Tdap at 11-12 years)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Hib vaccine

A

ActHIB: 3 doses

2, 4, 6 months

PedvaxHIB: 2 doses

2, 4, months

Booster at 12-15 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Pneumococcal Vaccine

A

Prevnar PCV 13

4 doses

2, 4, 6

and

12-15 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

IPV vaccine

A

2 months

4 months

6-18 months

4-6 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

MMR

Varicella

A

2 doses

12-15 months

4-6 years

doses minimum 4 weeks apart

May give 2nd dose of MMR before age 4 if 3 months since first dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Hepatitis A

A

1st dose at 12-23 months

2nd dose 6-18 months later

-

6 months minimum time between doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Zoster vaccine

A

Recommended starting age 60 years per ACIP

FDA licensed for adults 50 years and older

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Adults

Pneumonia vaccine

A

Previously unimmunized 65 years and older - PCV13 then PPSV23 6-12 months later

If have received PPSV23 at age 65 or older, PCV13 1 year after PPSV23 dose

If PPSV23 received before age 65, give PCV13 1 year after most recent dose of PPSV23, then PPSV23 6-12 months later (and at least 5 years has passed since most recent dose of PPSV23)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Pack year history for tobacco

A

PPD x years smoked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Highest rate of suicide in which population

A

Males > 65 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Precontemplation stage

A

Pt not interested in change

Unaware of problem

Minimizes impact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Contemplation stage

A

Considering change

Feels stuck

HCP to examine barriers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Preparation stage

A

Some change behaviors

Does not have tools to proceed

HCP to assist in finding tools, removing barriers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Action stage

A

Ready to go through w/ change

Inconsistent in carrying through

HCP to work w/ patient encourage healthy behavior, praise positive, acknowledge regression is common but not unsurmountable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Maintenance/relaps stage

A

Has adopted and embraced healthy habit

Relapse can occur

HCP to continue positive reinforcement

Backsliding is common but not insurmountable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

USA leading cause of death

A

Heart Disease

Cancer a close second d/t rising gero population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Leading Cancer Cases and Deaths

A

Cases

Male: Prostate, Lung, Colon

Female: Breast, Lung, Colon

Deaths

Male: Lung, prostate, colon

Female: Lung, breast, colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Next step: unexplained bleeding in postmenopausal woman

A

EMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Breast Ca Screening

A

Mammography annually starting age 40

High risk (> 20% lifetime risk): MRI + mammography annually

Yearly MRI not recommended if lifetime risk < 15%

CBE every 3 years for women 20-40 years

CBE every year 40 years and older

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Colon cancer screening

General population

A

FOBT/FIT annually starting at 50 years

Colonoscopy if FOBT/FIT positive

Preferred FOBT/FIT method: two samples from 3 consecutive specimens collected by pt at home

OR

Flexible sigmoidoscopy every 5 years starting at 50

Colonoscopy if positive

OR

Double-contrast barium enema every 5 years starting at 50

Colonoscopy if positive

OR

Colonoscopy every 10 years starting at age 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Colon cancer screening

High risk

A

History of colon cancer, adenomatous polyps, Crohn disease, or Ulcerative Colitis, strong family history (colon cancer of first degree relative before age 60, or 2 or more first-degree relatives at any age).

Ulcerative Colitis: start colonoscopy 12 years after onset, then every thereafter

Crohns: start colonoscopy 8 years after onset, then every year thereafter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Prostate cancer screening

A

Start discussion at 50 years for men at average risk w/ 10 year life expectancy

Prostate cancer grows slowly, if < 10 year life expectancy, not likely to benefit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Endometrial cancer screening

A

Women at menopause

Report unexpected bleeding

Abnormal vaginal bleeding is presenting sign in 90% of women with endometrial carcinoma

For women with hereditary non-polyposis colon cancer (HNPCC), annual screening with EMB beginning at 35 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Lung cancer screening

A

Age 55-74 years with 30 pack year smoking history, current smokers, or 15 years or less since quitting:

Annual low dose CT until age 74 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Cervical cancer screening

A

PAP smear starting age 21 every 3 years

Cytology + HPV every 5 years starting 30 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Erythropoietin source

A

90% renal, 10% hepatic

Diminished in advancing renal failure, usually beginning when GFR < 49 mL/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

First thing to respond after anemia correction (e.g. in iron deficiency)

A

Reticulocyte count responds in 1 week

Hgb in 1 month 1gm/dL per month

Ferritin in 4-6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Drugs then can cause B12/iron malabsorption causing anemia

A

Chronic PPI use
Long-term Metforming use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

B12 stores

A

7+ years of B12 stored in liver

will take 7+ years to be depleted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Most common cause of spit-up and vomiting in young infant

A

GI immaturity allowing reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Peak risk for hypoglycemia for short-acting rapid insulin (insulin aspart)

A

1-3 hours after injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Most important measure in Hep C prevention

A

Use of single-use injection drug paraphernalia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Exenatide contraindication

A

Gastroparesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Belimumab

A

B-lymphocyte stimulater-specific inhibitor

first biologic agent approved for adults with SLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Cluster Headache

A

AKA: Migrainous neuralgia, Suicide headaches

Only primary headache M > F

Most common in middle-aged men, likely underdiagnosed in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Triptans in pregnancy

A

Contraindicated in pregnant women d/t potential vasoconstrictor effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Raynaud disease epidemiology

A

Most often found in women

Condition usually appears between age 15 and 45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Addison’s

A

Primary adrenal insufficiency

Key risk factor: autoimmune conditions

E.g. chronic thyroiditis, dermatitis herpetiformis, Graves, hypoparathyroidism, myasthania gravis, Type I DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Next step, microcytic anemia

A

Ferritin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Fatigue, spoon-shaped nails

A

Iron deficiency anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Most common for of IDA 4 years and older

A

Chronic low volume blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Most common type of anemia in the elderly

A
  1. Chronic disease
  2. IDA
  3. Pernicious anemia (distant)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Haptoglobin is ordered when considering

A

Hemolytic anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Most important source of body’s iron supply

A

Recycled iron content from aged RBCs

85% typically comes from old RBCs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

B12 Deficiency typical MCV

A

MCV > 125

(most macrocytic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

When does RDW normalize after tx

A

RDW starts to normalize as soon as tx started

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Iron supplementation

How to take

enteric coating

A

On an empty stomach

GI upset common

Try w/o food, if GI upset, take w/ breakfast and dinner in divided doses

BID best frequency

Duodenum is where iron is absorbed, after a big dose of iron, intestines cannot absorb more for another 6 hours

Enteric coated iron = very little is absorbed as a lot of is released beyond the duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Cooley Anemia

A

Beta thalassemia major

Life threatening w/o intervention

dx shortly after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Acute rhinosinusitis

A

Inflammation of paranasal sinuses/nasal mucosa lasting up to 4 weeks

Caused by allergens, environmental irritants, and/or infections

Infectious causes: virus (majority), bacteria, fungi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

ABRS

How common

A

Secondary bacterial infection usually following a viral URI

Less than 2% of viral URIs are complicated by ABRS

Vast majority will clear w/o abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Acute ABRS

Risk for DRSP Factors

A

Age < 2 or > 65

Prior abx in the past month

Prior hospitalization within past 5 days

Comorbidities

Immunocompromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Transillumination for ABRS

A

Disproven as diagnostic for sinusitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

ABRS First line tx

A

First Line:

Amoxicillin-Clav 500/125 PO TID or 875/125 BID

Second Line: Doxy 100 mg BID - (note: DRSP tx failure risk)

In beta-lactam allergy:

Doxy 100 mg BID

Levo 500 mg daily

Moxi 400 mg daily

If DRSP risk: Respiratory fluroquinolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

CYP450 inhibitors

A

Erythromycin

Clarithromycin

Increases toxicity

e.g.

Clarithro + Statin = 15x statin dose = rhabdo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Manifestation of IgE mediated allergy

A

Hive-form/urticaria

Angioedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

CYP450 inducers

A

Pushes substrate OUT the exit pathway
= decreased substrate levels

E.g.

St. John’s Wort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Presbycusis changes

A

slowly progressive, symmetric, predominantly high frequency hearing loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Conductive hearing loss

A

Reversible

Something in between sound and auditory apparatus

OME: can persist for up to 3 months; treatment is TIME

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Presbycusis describe

A

Inability to discriminate human voice in a noisy environment

During exam, HCP to:

face-to-face

Eye-level

quiet environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Allergic Rhinitis

A

allergen-induced

upper airway inflammation and hypersensitivity d/t genetic-environmental interactions

s/sx

nasal discharge, sneezing, nasal congestion, anosmia, and

nasal/pharyngeal/ocular itch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Allergic Rhinitis Tx

First Line

A

First line

Intranasal corticosteroids

e.g. Flonase 1 spray BID or 2 sprays daily

Onset of action within 12-24 hours

Optimal efficacy can take 1-2 weeks

Very low-dose

Low systemic absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

First generation antihistamines

A

Diphenhydramine, Chlorpheniramine, Brompheniramine, Hydroxyzine

Blocks histamine-1 receptor sites

Significant SE: sedation, impairs performance, ANTICHOLINERGIC effects

Problematic in older adult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Ophthalmic antihistamines

A

Olopatadine (Patanol, Pataday)

For ocular allergy symptoms

Drop might sting for a few seconds

Will not sting once inflammation goes down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Oral decongestants

A

Alpha-adrenargic AGONIST

Relieves congestion via vasoconstriction

Caution w/ elderly, young children, HTN, bladder neck obstruction, glaucoma, and hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Nasal decongestants

A

Afrin

Effective in ABRS

Rebound congestion/rhinitis may occur

LIMIT USE TO 5-7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Anticholinergic effects

A

Dry as a bone (dry mouth)

Red as a beet (flushing)

Mad as a hatter (confusion)

Hot as a hare (hyperthermia)

Can’t see (vision changes)

Can’t pee (urinary retention)

Can’t spit (dry mouth)

Can’t shit (constipation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Lymph node concerning for malignancy

A

Painless

Firm

Immobile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Oral cancer

A

90% squamous cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

CN I

A

Olfactory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

CN II

A

Optic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

CN III

A

Oculomotor

Eyelid and eyeball movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

CN IV

A

Trochlear

Turns eye downward and laterally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

CN V

A

Trigeminal

Chewing

Face, mouth sensation and pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

CN VI

A

Abducens

Turns eye laterally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

CN VII

A

Facial

Facial expressions, secretion of tears, saliva, taste

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

CN VIII

A

Acoustic

Hearing, equilibrium, sensation

111
Q

CN IX

A

Glossopharyngeal

Taste, senses carotid BP

112
Q

CN X

A

Vagus

Senses aortic BP

Slows HR

Stimulates digestive organs, taste

113
Q

CN XI

A

Spinal accessory

Controls trapezius and sternocleinomastoid

Controls swallowing movements

114
Q

CN XII

A

Hypoglossal

Controls tongue movements

115
Q

Describe ophthalmic emergency

A

Red Eye

Painful

Acute vision change

116
Q

Macular degeneration

A

Most common cause of new onset vision loss in elderly

F > M

Female retina likes estrogen, post-menopause, eye ages rapidly

Central vision loss

Test: Amsler grid test

117
Q

Open-angle glaucoma

Describe

A

Thief of the night d/t progressive and aymptomatic presentation

Enlarged optic disc cupping

Loss of visual fields

>90% of glaucoma cases

Gradual blockaage of aqueous flow despite apparently open system

118
Q

Open-angle glaucoma

Risk Fx

A

African ancestry

DM

Family Hx

History of eye trauma/uveitis

Advacing age

119
Q

Closed-angle Glaucoma

s/sx

A

Narrow angle glaucoma

< 10% of glaucoma

Most serious form

s/sx

Injected conjunctiva

Very painful

N&V

If drainage is only partially blocked: only warning signs may be blurry vision and colored halos around lights

120
Q

Drugs that increase IOP

A

Anticholinergics

Steroids

Sympathomimetic pupil dilating drops

TCAs

MAOIs

Antihistamines

Antipsychotic meds

Sulfonamides

Antispasmolytic agents

121
Q

Open-angle glaucoma Tx

A

First line: topical prostaglandins

Latonoprost (Xalatan) - 1 drop in affected eye daily in the evening

Bimatoprost (Lumigan) - 1 drop affected eye daily in the evening

-

Beta-blockers: Timolol 1 drop BID

Alpha-adrenergic agonists: Alphagan 1 drop TID

122
Q

Angle-closure glaucoma Tx

A

Acute primary attack:

Prompt IOP lowering eye drops (Timolol, Iodipine, pilocarpine)

Oral or IV acetazolamide or oral glycerold isosorbide: Give two 250 mg Acetazolamide tablets in the office, recheck eye-pressure 30-60 minutes later

Systemic medication other than acetazolamide should be given under guidance of an ophthalmologist

Once attack is broken, treatment of choice: laser peripheral iridotomy

If laser peripheral iridotomy fails to remain patent or if cornea too cloudy, surgical peripheral iridectomy may be necessary

123
Q

Ruptured TM otitis media tx

A

Ofloxacin otic 10 drops BID x 14 days

(Ofloxacin also used for otitis externa 10 drops daily x 7 days)

124
Q

Fungal otitis externa tx

A

Clotrimazole 1% BID x 14 days
then re-assess

If fungal elements persist, clean meticulously then treat for another 10-14 days

Refer to ENT if persisting

125
Q

Anosmia

A

Diminished sense of smell, age-related, accelerated by tobacco use

126
Q

Senile cataracts

A

Lens clouding

Progressive vision dimming

Risk Fx: tobacco, poor nutrition, sun exposure, systemic steroids

Potentially correctable w/ surgery, lens implant

127
Q

Presbyopia

A

Hardening of lens

Near all 45 years and older need reading glasses

128
Q

Suppurative Conjunctivitis common pathogens (nongonococcal/chlamydial)

A

S. aureus

S. pneumo

H. influenzae

Outbreaks d/t atypical S. pneumo

129
Q

Suppurative conjunctivitis (nongonococcal/chlamydial)

Tx

A

Primary tx:

Fluroquinolone ophthalmic solution

(preferred in contact lens wearers d/t pseudomonas coverage)

Alternative:

Polymyxin B w/ trimethoprim or azithromycin 1% opththalmic solution

DOSE:

0.5 inch of ointment inside lower lid

OR

1-2 drops

QID x 5-7 days

Ointment preferred in kids, those w/ poor compliance as ointment stays on lids

Drops preferred in adults who need to read/drive as ointment clouds vision for 20 minutes after admin.

130
Q

Otitis media w/ puctured TM

A

Do NOT use neomycin containing ointment if ruptured TM

USE:

Ofloxacin otic drops

5 drops BID x 3-5 days

AND

Amox 500 mg TID x 5-7 days

If PCN allergy

  • Cefdinir 300 mg BID
  • Cefpodoxime 200 mg BID
  • Cefuroxime 500 mg BID
  • Ceftriaxone 2 g IM

If beta-lactam allergy:

  • Erythromycin combine with sulfisoxazole
  • Azithromycin
  • Clarithromycin

If tx failure:

Cefuroxime 250 mg BID x 10 days

Augmentin 875/125 BID x 5-7 days (10 days if severe)

–

Avoid acidic/antiseptic agents

TM should heal within days

Prevent water entry into ear canal while healing

Follow up in 4 weeks to reassess and for audiometry

ENT referral if persistent perforation or hearing loss > 4 weeks of injury

131
Q

Exudative pharyngitis

Causes

A

Group A, C, G strep

Viral

HHV-6

M. Pneumo

132
Q

Strep pharyngitis tx

A

First line: Penicillin V 500 mg 3-4x/day x 10 days

Alternative:

Erythromycin x 10 days

Second generation cephalosporin x 4-6 days

Azithromycin x 5 days

Clarithromycin x 10 days

Note: Up to 35% of S. pyogenes are resistant to macrolides

133
Q

First generation cephalosporins

A

Cefazolin, cephalexine, cephapirin, cefadroxil, cephadrine, cephalotin

Active against most gram+ cocci except for enterococci, oxacillin-resistant staph, and PCN-resistant pneumococci

Active again most E-coli strains, proteus mirabillis, and klebsiella

134
Q

Second generation cephalosporins

A

cefuroxime, cefoxitin, cefotetan, cefprozil, cefactor, cefonicid, cefamandole, cefmetazole

-

somewhat less active against gram positive cocci than first gen

more active against certain gram negative bacilli

Cefuroxime - active against Haemophilus influenzae

Cefoxitin and cefotetan - active against most E. coli, P. mirabillis, and Klebsiella, active against Bacteroides

135
Q

Third generation cephalosporins

A

Ceftriaxone, Cefdinir, Cefixime, Cefotaxime, Ceftazidime, Cefpodoxime, Cefditoren, Cefoperazone, Ceftibuten

Marked by stability to the common beta-lactamases of gram-negative bacilli

Useful alternatives to aminoglycosides in treating gram-negative infections resistant to other beta-lactams, esp. in patients with renal dysfunction

136
Q

Fourth generation cephalosporin

A

Cefepime

Only one

137
Q

Fifth generation cephalosporin

A

Ceftaroline

138
Q

Malignant otitis externa

(HIV, DM, chemo)

A

Oral cipro 750 mg BID for early disease suitable for outpatient

Inpatient IV tx in severe disease

  • Tx typically started IV then orally

Riskf or osteomyelitis of skull/TMJ

MRI or CT indicated to r/o osteomyelitis often indicated

ENT consult w/ surgical debridement should be considered

Obtain cultures of ear drainage or results of surgical debridement

139
Q

Otitis externa tx

general population/immunocompetent

A

Fungi rare

Pseudomonas, Proteus, Enterobacteriaceae

Acute infection often S. aureus

Tx:

MILD: Acetic acid w/ propylene glycol and hydrocortisone (VoSol) drops

MODERATE-SEVERE: Otic drops with ciprofloxacin with hydrocortisone

DO NOT USE NEOMYCIN IF TM RUPTURE SUSPECTED

140
Q

Otitis Externa Prevention

A

Systemic abx seldom needed

Ear canal cleansing: decrease risk of infection by use of eardrops 1:2 mixture of white vinegar and rubbing alcohol after swimming

141
Q

Allergic Rhinitis and antihistamines

A

Will help with itchy/watery eyes, sneezing and rhinorrhea

Antihistamines will not help with nasal congestion

142
Q

Derm assessment questions

A

Is the patient otherwise well? = localized skin infection (acne, rosacea, kp, seborrheic derm)

Is patient miserable but not systemically ill? = uncomfortable with itch, burning, pain (severe psoriasis, Norwegian scabies, herpes zoster)

Is patient systemically ill? = Systemic disease (varicella, transepidermal necrosis, SJS/erythema multiforme, Lyme disease)

Are there primary/secondary lesions? = Where is the oldest lesion and when did it occur? Where is the newest lesion and when did it occur?

143
Q

Primary Lesions vs Secondary

A

PRIMARY

Result from disease process. No alteration from outside manipulation/tx/natural course of disease. Eg. vesicle

SECONDARY

Lesions altered by outside manipulation/tx/course of disease. Eg. crust

144
Q

Auspitz sign

A

Psoriasis

Pinpoint bleeding when scale is scraped off.

145
Q

Vitiligo

A

Autoimmune against melanocytes

Common w/ other autoimmune diseases (thyroid)

146
Q

Palpable Purpura

A

NEVER BENIGN

“blueberry muffin” appearance

e.g. Meninigitis rash

147
Q

Macule

A

flat, nonpalpable discoloration

e.g.

Freckle

148
Q

Papule

A

Solid elevation

e.g.

raised nevus

149
Q

Umbilicated

A

Papule with indented center

e.g.

Molluscum contagiosum

150
Q

Pustule

A

Vesicle-like lesion with purulent content

e.g.

Impetigo

151
Q

Patch

A

> 1 cm

flat, nonpalpable discoloration

e.g.

Vitiligo

152
Q

Plaque

A

> 1 cm

Raised lesion, same or different color of surrounding skin, can result from coalescence of papules

e.g.

Psoriasis

153
Q

Bulla

A

> 1 cm

Fluid filled (bigger than vesicle)

e.g.

Necrotizing fasciitis

154
Q

Cyst

A

Any size

Raised, enxapsulated, fluid-filled lesion

Always benign

e.g.

Intradermal cyst

155
Q

Wheal

A

Any sized

Circumscribed area of skin edema

e.g.

Hives

156
Q

Purpura

A

Purpura > 1 cm

Petechiae

Flat red-purple discoloration caused by RBCs lodged in the skin

Do NOT blanch

(vascular lesion = blanches)

157
Q

Excoriation

A

Linear, raised, often covered with crust.

e.g.

scratch marks over pruritic areas

158
Q

Crust

A

Raised lesions produced by dried serum and blood remnants

e.g.

scab

159
Q

Lichenification

A

Skin thickening usually found over pruritic or friction areas

e.g.

Callus

160
Q

Scales

A

Raised superficial lesiosn that flake with ease

e.g.

Dandruff

161
Q

Erosion

A

Loss of epidermis

e.g.

area under vesicle

162
Q

Ulcer

A

Loss of epidermis AND dermis

e.g

arterial ulcer

Chancre

163
Q

Fissure

A

Narrow linear crack into epidermis, exposing dermis

e.g.

athletes foot

164
Q

Annular lesion

A

In a RING

e.g.

Erythema migrans (“bull’s eye”) in Lyme disease

165
Q

Scattered lesion

A

Generalized over body w/o specific pattern or distribution

e.g.

maculopapular rash in rubella

166
Q

Confluent/coalescent lesions

A

Multiple lesions bleding together

167
Q

Clustered lesions

A

Occurring ina group with pattern

e.g.

Acne-form drug induced rash

seen with lithium, phenytoin, and iodine use = anticipated adverse effect

168
Q

Linear lesions

A

In streaks

e.g.

Contact dermatitis poison ivy

169
Q

Reticular lesions

A

Appearing in a net-like cluster

e.g.

Erythema infectiosum (Fifth Disease/slapped cheek)

170
Q

Dermatomal or zosteriform lesion

A

Limited to boundaries of a single or multiple dermatomes

e.g.

Shingles

NOTE:

If suspected, start on high-dose acyclovir and come back in 24 hours to confirm dx

Pain occurs 1-2 days before lesions erupt

Suspect in acute shoulder/back pain, skin is “sore”

Skin could also itch severely

171
Q

Varicella

A

Infants vulnerable - vaccine is given at year

2-3 mm vesicles that start on trunk, appear on limbs 2-3 days later

Nonclustered lesions at a variety of stages

Mild to moderately ill

Miserably itchy, risk for bacterial suprainfection of lesions

Tx:

Acyclovir within 24-48 hours of eruption

Prevention:

Varicella vaccine = 80% lifetime immunity first dose, 99% lifetime immunity second dose

172
Q

Zoster (shingles)

A

Typically 50 years or older

Possible in anyone with history of varicella

Vesicles in a unilateral dermatomal pattern, slowly resolving with crusting

Usually not systemically ill but quite miserable with pain and itch. Complications include postherpetic neuralgia, ophthalmologic involvement, and superimposed bacterial infection.

Tx:

High-dose acyclovir within 72 hours of eruption helps minimize duration and severity of illness

Prevention:

Zoster vaccine

173
Q

Actinic Keratoses (AK)

A

Predominantly on sun-exposed skin

Size ranges

On skin surface - red, brown, scaly, often tender but usually minimally symptomatic

Occassional flesh-colored - more easily felt than seen

Most common precancerous lesion though possibly represent early-stage SCC

1 in 100 will progress to SCC

Tx:

Topical 5-FU, 5% imiquimod cream, topical diclofenac gel or photodynamic therapy with topical delta-aminolevulinic acid

Cryosurgery w/ liquid nitrogen, laser resurfacing, chemical peel

174
Q

Basal cell carcinoma

A

More common than SCC
Sun-exposed area

Arises de novo (of new)

Papule, nodule w/ or w/o central erosion

Pearly or waxy appearance, usually relatively distinct borders w/ or w/o telengiectasia

Metastatic risk low

175
Q

Squamous cell carcinoma

A

Less common than BCC

Sun-exposed areas

Can arise from AK or de novo

Red, conical hard lesions w/ or w/o ulceration

Less distinct borders

Metastatic risk greater (3-7%)

Greatest metastatic risk = lesion on lip, oral cavity, genitalia

176
Q

ABCDE

Malignant Melanoma

A

A - Asymmetric

B - Irregular borders

C - Color not uniform

D - Diameter usually 6mm or >

E - Evolving (new) lesion or change in a longstanding lesion, particularly in a nevus or other pigmented lesion

E - Elevated (not consistently present)

* Majority of melanoma are de novo

177
Q

Psoriasis vulgaris tx

A

medium-potency topical corticosteroid

178
Q

Rosacea tx

A

Topical metronidazole

179
Q

Pityriasis rosea

A

Acute, self-limited, erythematous skin disease

Most likely viral

Herald patch

X-mas tree pattern

Prodrome might occur but typically asymptomatic aside from itching

Most cases do not require tx, may use medium-potency topical corticosteroid for itching

Acyclovir may be useful in severe disease in shortening length of disease

180
Q

Acanthosis nigricans

A

cutaneous manifestation of hyperinsulinemia

puberty = worsenign insulin resistance

can regress w/ control of disease

e.g. after gastric bypass

181
Q

Erysipelas

A

Infection of upper dermis, superficial lymphatics

Streptococcus pyogenes (aka GABHS)

182
Q

Cellulitis

A

Infection of dermis and subcutaneous fat

Streptococcus pyogenes, less commonly MSSA beta-lactamase producing, MRSA (resistance via altered protein-binding sites)

183
Q

Cutaneous abscess, furuncle

A

Skin infection involving hair follicle and surrounding tissue

Carbuncles = cluster of furuncles connected subcutaneously, causing deeper suppuration and scarring

Staph aureus (MSSA, MRSA)

184
Q

Nonpurulent skin infection

A

Necrotizing infection/Cellulitis/Erysipelas

Moderate = inpatient for IV PCN or Ceftriaxone, Cefazolin, or Clindamycin

Mild = Oral Rx of PCN VK or Cephalosporin or Dicloxacillin or Clindamycin

Dicloxacillin = PCN stable in beta-lactamase

Clindamycin = most common abx assoc. w/ c-diff; take with probiotic

185
Q

Purulent skin infection

A

Furuncle/Carbuncle/Abscess

Mild = I & D

Moderate = I & D and C & S

Empiric therapy with Bactrim, Doxy

Defined Rx

MRSA = Bactrim

MSSA = Dicloxacillin or Cephalexin

*Keflex = First gen $4

186
Q

Brown Recluse Spider Bite

A

“Red, white, and blue”

Central blistering with surrounding gray to purple discoloration at bite site

Surrounded by ring of blanched skin surrounded by large area of redness

187
Q

Most common cause of new onset ulcerating skin lesion across North America

A

MRSA

188
Q

Nafcillin

A

Narrow spectrum

Beta-lactamase resistant PCN

Use of not risk factors for MRSA

189
Q

Rocky mountain spotted fever

s/sx and dx

A

Tick-borne

Most cases occur in spring or early summer

Early in disease: fever, malaise, arthralgias, headache, nausea w/ or w/o vomiting; children might present w/ abd pain

Rash between day 3 and 5 of illness

Early disease = empiric tx based on clinical judgment and epidemiological likelihood

Later disease = dx via skin bx or serological testing

190
Q

Rocky mountain spotted fever

Tx

A

Start within 5 days of symptom onset

Doxycycline 200 mg/day in two divided doses

Tx should continue until 3 days of patient being afebrile

Doxy: risk of dental staining in children

Doxy typically tolerated well except for N&V, give antiemetics/antimotility agents as needed

Doxy assoc. w/ photosensitivity = counsel about skin protection

Pregnancy: use chloramphenicol if available

191
Q

Lyme disease

A

Erythema migrans (central erythema, ring remains flat, blanches, does not desquamate)

Tx:

Doxy 100 mg BID x 10-21 days

Amox 500 mg every 6-8 hours for 21 to 30 days

Cefuroxime 500 mg BID x 20 days

Use Amox/Ceftin for children

Prophylaxis:

Within 72 hours of tick removal: Doxy 200 mg x 1 dose

192
Q

CA-MRSA tx

A

Bactrim DS = 2 tablets x 5-10 days

Rifampin can be added - use w/ caution CYP450 inducer

If can’t have sulfa (bactrim), use:

Doxy

Minocycline

To cover staph and strep use Bactrim with a beta-lactam (cephalosporin)

193
Q

Babies

A

Avoid sun exposure

Lightweight long pants, long-sleeved shirts, brimmed hats

May apply sunscreen 15 spf or > minimal amt

If sunburned - apply cold compresses to affected area

194
Q

Sun safety

Children > 6 months and adults

A

Hat w/ 3 inch brim or bill facing forward

Sunglasses that block 99 to 100% of UV, cotton clothing w/ tight weave

Stay in shade

limit sun exposure during peak intensity hours 10 and 4

Use SPF 15 or > on both sunny and cloudy days

Protect against UVB and UVA rays

Apply enough sunscreen 1 oz (30 mL) per sitting for older child and adult

Reapply every 2 hours or after swimming/sweating

Extra caution near water, sand, snow (reflects UV rays)

195
Q

Hypothyroidism

s/sx

A

Skin = decreased cell turnover, decreased subum = thick and dry

Hung-up patellar reflex, slow arc out, slower arc back

Overall hyporeflexia

Mentation = slow thoughts

Weight change (5-10 lbs gain largely fluid)

Stool = constipation

Mentrual = menorrhagia

Heat/cold tolerance = easily chilled

196
Q

Hypothyroidism etiology

A

Hashimoto thyroiditis (most common) = autoimmune

Post-radioactive iodine (RAI) = s/p Graves disease tx or thyroid ca tx

Select medication use = lithium, amiodarone, interferon

197
Q

Hyperthyroidism

s/sx

A

Excessive cellular energy release

Skin = increased cell turnover = smooth, silky

Hyperreflexia

Mentation = mind racing

Weight change = loss 10 lbs on average

Stool pattern = frequent, low volum, loose

Mentrual = oligomenorrhea

Heat intolerance

198
Q

Hyperthyroidism

Etiology

A

Graves disease (most common) = autoimmune, multisystem presentation (exophthalmos, tachycardia, proximal muscle weakness, goiter)

Toxic adenoma (benign metabolically active nodule)

Thyroiditis (viral or autoimmune, post-partum, drug-induced, often transient, usually accompanied by thyroid tenderness)

Select medication use (Amiodorane, interferon)

199
Q

TSH

Normal values

A

0.4 to 4.0 mIU/mL

200
Q

TSH test evaluates what

A

Reflects anterior pituitary lobe’s ability to detect amount of circulating free thyroxine (T4)

TSH receptors found in thyroid follicular cells

Receptor stimulation = increases T3 and T4 production/secretion

Single most reliable test to dx all common forms of hypo/hyperthyroidism in the ambulatory setting

201
Q

Free T4

A

NL = 10-27 pmo/L

Unbound, metabolically active portion of thyroxine

About 0.025% of all T4

202
Q

Total T4

A

Rarely indicated

Total of protein-bound and free thyroxine

Often altered in the absence of thyroid disease

203
Q

Free T3

A

Rarely indicated

unbound, metabolically active portion of triidothyronine (T3)

T3 4x more active than T4

About 20% of circulating T3 is from thyroid, 80% is from conversion of T4 to T3

204
Q

Total T3

A

Rarely indicated

Reflects total protein-bound and free triidothyronine (T3)

Often altered in the absence of thyroid disease

205
Q

Antiperoxidase antibody

(antimicrosomal, antithyroid, thyroperoxidase)

A

Test to help detect autoimmune thyroid disease

Measures an antibody against peroxidase, an enzyme held within the thyroid

206
Q

Levothyroxine replacement

A

Need increases when metabolic need needs increases

50% or > increased need in pregnancy

Increase dose by 33% as soon as pregnancy confirmed

Use ideal body weight in obesity, actual body weight in healthy weight/underweight

Check TSH after 6-8 weeks

Levothyroxine = long half-life, takes 3-5 half-lives to reach steady state + few more weeks for body to acclimate

T3 = short half life (Armour Thyroid T3/T4 preparation)

Levothyroxine:

Take with water on an empty stomach same time every day

Should not be taken within 2 hours of cation such as calcium, iron, aluminum, magnesium

207
Q

Hyperthyroidism

Test results and Tx

A

Low TSH, high free T4

Tx:

Beta-adrenergic antagonist with B1, B2 blockade (propranolol, nadolol) if not contraindicated to counteract tachycardia, tremor

Antithyroid medication:

Propylthiouracil (PTU)

Methimazole (Tapazole)

*Consult with endo: black box warning for acute liver failure

–

Radioactive iodine (RAI) with end-result thyroid ablation and hypothyroidism

208
Q

Subclinical hypothyroidism

A

Elevated TSH w/ normal free T4

AACE recommends tx of patients with TSH > 5 if patient has goiter or if thyroid antibodies are present

Presence of sx = tx

209
Q

Goal TSH

A

0.5 to 2.0

Symptom resolution

Measure TSH at 6 months then annually or when symptomatic

–

If TSH > 4

Increase dose by 12.5 to 25 mcg/day

If TSH

Decrease dose by 12.5 to 25 mcg/day

210
Q

Thyrotoxicosis arrhythmia

A

atrial fibrillation

211
Q

Risk of malignancy thyroid nodule

A

5%

(similar to breast bx rates)

212
Q

Malignant thyroid nodule characteristics

A

history of head or neck irradiation

Size > 4 cm

Firmness, nontender

Immobile

Persistent, nontender cervical

213
Q

Thyroid nodule

A

If palpable nodule (clinically evident)

Order TSH and U/S

TSH suppressed = metabolically active nodule = thyroid scan

HOT nodule = always benign = tx with RAI

COLD nodule = fine-needle aspiration bx

TSH not suppressed = fine-needle aspiration bx

214
Q

Headache Red Flags

A

SNOOP

S - systemic sx (fever, weight loss), secondary risk fx (HIV, ca, pregnancy, anticoagulation, HTN)

N - neurologic signs (confusion, impaired alertness, nuchal rigidity, HTN, papilledema, cranial nerve dysfunction, abnormal motor)

O - onset abrupt or w/ exertion, “thunderclap” h/a = subarachnoid hemorrhage; onset of h/a with exertion = increased ICP

O - onset age > 50 or

P - previous onset history = new onset; first h/a > 30 years

215
Q

Tension h/a

A

Pressing, non-pulsatile pain

Lasts 30 minutes to 7 days

Mild to moderate intensity

Usually bialteral

F:M ration 5:4

More than one of the following suggests migraine and not tension:

Nausea, photophobia, phonophobia

216
Q

Migraine w/o aura

A

Lasts 4-72 hours

Usually unilateral, occassionally bilateral

Pulsating

Moderate to severe

Aggravation by normal activity such as walking

During headache 1 or more of the following:

Nausea and/or vomiting, photophobia, phonophobia

F:M ration 3:1

Positive family hx in 70-90%

217
Q

Migraine w/ aura

A

Migraine type h/a w/ or after aura

Focal dysfunction of cerebral cortex or brain stemp causes 1 or > aura sx developing over 4 minutes, or 2 or more sx occurs in succession

Sx can include: feeling of dread/anxiety, unusual fatigue, nervousness, excitement, GI upset, visual or olfactory alteration

No aura sx should last > 1 h - if this occurs, consider alternate dx

Positive family hx in 70-90%

218
Q

Cluster h/a

A

H/a tends to occur daily in groups or clusters

Lasts several weeks to months then disappears for months to years

Usually occurs at characteristic times of year, at the same time of day

Common time: 1 hour into sleep, “alarm clock” headache

Pain awakens the person

h/a often located behind 1 eye with a steady, intense (“hot poke in the eye”) sensation

Severe pain in a crescendo pattern lasting 15 min to 3 hours

Suicide headache

Most often with ipsilateral autonomic signs such as lacrimation, conjunctival injection, ptosis, and nasal stuffiness

F:M ration 1:3 to 1:8

Family hx of cluster h/a 20%

219
Q

Pressing non-pulsatile pain h/a

A

Tension

220
Q

Usually bilateral h/a

A

Tension

221
Q

Pulsating pain

A

Migraine

222
Q

Hot poker feeling in one eye h/a

A

Cluster

223
Q

Nausea and photophobia w/ h/a

A

Migraine

224
Q

Usually unilateral h/a

A

Migraine (90% favor one side)

Cluster

225
Q

Nasal stuffiness w/ conjunctival injection h/a

A

Cluster

226
Q

Lifestyle modifications for primary h/a

A

Highly effective, infrequently used

Recognize and avoid triggers (chocolate, ETOH, certain cheeses, MSG, stress, perfume, too much or too little sleep, hunger, altered routine)

Encourage regular exercise

Attend to posture at workstation

Use tinted lens to minimize glare and bright lights

227
Q

Analgesic use in primary h/a

A

NSAIDs, APAP, others

Limit use to 2 tx days/week to avoid analgesic rebound h/a

228
Q

Triptans

Ergot derivatives

A

Selective serotonin receptor agnosists

Select ergot derivatives

Migrainef specific

Caution use in pregnancy, CVD, uncontrolled HTN d/t potential vascular effect

Helpful in tension-type h/a that does not respond to analgesic tx

Also used in tx of cluster h/a (as is high flow O2)

229
Q

Primar h/a prophylactic (controller) medications

A

Beta-blockers (propranolol)

TCAs (nortriptyline, amitriptyline)

Antiepileptic (gabapentin, valproate, topiramate)

Lithium (specific to cluster h/a)

Nutritional supplements (butterbur, feverfew, coenzyme 10, Mg, riboflavin) = effective and recommended

CCBs = relatively ineffective

230
Q

Indiations for primary h/a prophylaxis

A

Any or all of the following:

Use of any product > 3x/week

2 or > migraines per month that produce disabling sx for 3> days

Poor sx relief from various abortive tx

Presence of select concomitant medical condition including HTN, hemiplegic, or basilar migraine

Goal: reduce h/a frequency and severity, allow h/a medications to be more effective in controlling h/a sx

231
Q

NP when to refer

A

Beyond scope

Likely has dx that need to be supported/clarified by specialist (e.g. RA, SLE)

Compex health condition for which input into ongoing care from a specialist is warranted (e.g. HF or angina pectoris to cardiologist)

Failure to respond to standard, evidence-based care (e.g. pt w/ low back pain who has failed to respond to standard therapies and pain mgmt)

232
Q

CT w/o contrast of head

A

Reveals:

Acute hemorrhage

Chronic hemorrhage

Edema, shift

Atrophy

Ventricular size

Emergent image to r/o bleed: CT w/o contrast

233
Q

CT w/ contrast of head

A

Reveals: tumor, abscess

234
Q

MRI of head

A

Soft tissue imaging

typically needs abnormal CT before MRI is considered for head

Reveals:

Tumor, hemorrhage of days-weeks duration, carcinomatous meningitis, AV malformation, posterior fossa lesions

Sometimes done first to look for brain mets

235
Q

Migraine and OCPs

A

Migraines w/ aura = HIGH risk of STROKE on OCPs w/ estrogen

236
Q

Giant Cell Arteritis

A

Autoimmune vasculitis that affects medium-large vessels as well as temporal artery

Inflammation and swelling of arteries leads to decreased blood flow and assoc. sx

Disease most commonly occurs 50-85 years of age

F > M

Clinical sx:

Tender/nodular pulseless vessel (usually temporal artery) accompanied by severe unilateral h/a

50% will have visual impairment (transient visual blurring, diplopia, eye pain, sudden loss of vision)

CRP and ESR usually markedly elevated - order first

Definitive dx: temporal artery bx

Color duplex U/S can be used as an aleternative/complement bx

Tx:

High-dose systemic corticosteroids 1-2mg/kg/day until disese stabilized followed by careful reduction in dose and continued for 6 months to 2 years

ASA can be used to reduce risk of stroke

GI cytoprotection (PPI or misoprostol) should be provided to minimize adverse effects of long-term corticosteroid tx

237
Q

Typical BP pain response

A

SBP elevated but DBP is at/close to baseline

238
Q

Riboflavin and Magnesium for migraine prevention

A

Riboflavin 500 mg

Magnesium 250-350 mg

for 6-8 weeks

–

Mg - might loosen stools

Riboflavin - glow urine

239
Q

GCA mgmt

A

NSADs & Steroids

risk for gastritis = PPI

minimize bone resorption = add low-dose biphosphonate

Use opioid analgesics as needed

Refer to neurosurgery for bx and neuro for mgmt

240
Q

Pain on chewing

A

Jaw claudification in GCA

241
Q

Potential dietary triggers primary h/a

A

sour cream, ripened cheeses, sausage, salami, pizza, MSG, Herring, any pickled/fermented, marinated food, yeast products

chocolate, nuts, nut butters

Broad beans, lima beans, fava beans, snow peas, onions

Citrus fruits, Bananas, caffeinated beverages, ETOH, aspartame/phenylalanine

242
Q

Lifestyle triggers, primary h/a

A

Menses, ovulation, pregnancy

Illness of any kind

Intense/strenuous activity or exercise

Altered sleep

Altered eating patterns

Bright/flickering lights

Odors, fragrances, tobacco smoke

weather, seasonal allergies

Excessive/repetitive noises

High altitudes

Medications (SSRI, SNRI, other psych meds, analgesic overuse, hormonal contraception, hormonal tx post menopause)

Stress or stress letdown

243
Q

GERD Dx

A

Typical sx of heartburn/regurg

H. pylori screening not recommended in typical GERD

Upper endoscopy not required in typical GERD sx

244
Q

When to order upper endoscopy in GERD

A

Alarm findings:

dysphagia, odynophagia, unintended weight loss, hematemesis, black or blood stools, chest pain, choking

Repeat endoscopy not indicated in patients w/o Barrett’s esophagus in the absence of new sx

245
Q

GERD mgmt

A

Empiric tx with PPI

Protracted PPI use assoc w/ B12, Ca, Mg, Fe malabsorption, possible increased fracture and C-diff associated diarrhea risk

If no response to PPI - refer for evaluatiion

Weight loss if overweight

Elevate head of bed 3-4” blocks 2-3 hours

Avoid meals within 2-3 hours of bedtime

Lowest effective dose if long-term including on-demand and intermittent tx

H2RAs can be used as maintenance in pts w/o erosive disease

8-week PPI course = tx of choice in healing erosive esophagitis

PPI tx should be once-a-day, before first meal of day (traditional release PPIs such as omeprazole = 30-60 minutes before meal)

May use twice-daily doising/adjust dose timeing if sx are nocturnal or variable schedule

No major differences between different PPIs

Maintenance PPI tx for pts w/ sx after PPI is dicontinued or in pts with complications such as erosive esophagitis and Barrett’s

246
Q

H. pylori and which ulcers?

A

95% of all duodenal ulcers =

H. pylori

247
Q

Neutrophilia

A

Elevated in Bacterial infection

NL :

248
Q

Lymphocytosis

A

Elevated in Viral infection

NL:

249
Q

Monocytosis

A

Elevated in Debris removal

Good sign during recovery after illness

NL :

250
Q

Eosinophilia

A

Elevated in Allergens, parasites

(“worms, wheezes, and weird diseases”)

NL:

251
Q

Basophilia

A

elevated in Anaphylaxis, not fully understood

NL:

252
Q

Blumberg’s sign

A

LATE peritoneal sign

Deep palpate area of abd tenderness

Pain upon release = peritoneal inflammation

AKA: rebound tenderness

253
Q

Markle’s Sign

A

Stand on tiptoes, then let bodyweight fall quickly onto heels

Positive = abd pain increases and localizes

Indicative of peritoneal inflammation

In kids: “show me how you hop”

254
Q

Murphy’s sign

A

Painful arrest of inspiration triggered by palpating edge of inflamed gallbladder

255
Q

45 y/o male

Drinks 8-10 beers/day

12 hour history of acute onset epigastric pain radiating to back w/ bloating, N&V

Epigastric tenderness, hypoactive bowel sounds, abdomen distended and hypertympanic

Elevated lipase, amylase

Dx?

A

Acute Pancreatitis

“Boring epigastric pain to the back”

ETOH use

256
Q

64 y/o F

3-day hx of intermittent LLQ abd pain w/ feer, cramping, nausea, 4-5 loose stools/day

Soft abdomen, +BS, LLQ tenderness w/o rebound

Leukocytosis, neutrophillia

Dx?

A

Acute Diverticulitis

-

Cover for anaerobes and gram negative bacteria:

Cipro + Flagyl

257
Q

34 y/o M

3 month hx of intermitten upper abdominal pain described as epigastric burning, gnawing pain 2-3 h PC, relief w/ foods, anatacids.

Awakens 1-2 AM w/ sx

Tender epigastrum, LUQ

Slightly hyperactive BS

Dx?

A

Duodenal ulcer

-

Check for H. Pylori

RELIEF w/ FOOD

258
Q

52 y/o F

Recently laid off, 3-4 Ibuprofen/day for 2-3 months to help w/ headaches

1 month hx of intermittent nausea, burning, and pain, limited to upper abdomen, worse w/ eating

Tender epigastrum, LUEQ, hyperactive BS

Dx?

A

Erosive gastritis

-

D/C NSAIDs

May check H. Pylori

WORSE w/ FOOD

259
Q

21 y/o F

2 month hx of intermittent crampy abd pain, diarrhea, weight loss, fatigue

3 day hx of increasing discomfort, fever, tenesmus (sensation of incomplete bowel emptying)

Pale conjunctiva, tachycardia, slightly hyperactive BS, diffus abd tenderness w/o rebound

Normocytic, normochromic anemia, leukocytosis w/ neutrophilia

A

Inflammatory Bowel Disease

-

TOXIC MEGACOLON - anemia, leukocytosis w/ neutrophilia

Need hospital admission

260
Q

Pancreatic ca risk fx

A

Hx of chronic pancreatitis

Tobacco use

DM

261
Q

Most efficient route of transmission for hep C

A

Blood transfusion

Vertical transmission (mom to nursing infant) = uncommon

262
Q

Vertical transmission

A

Mom to nursing infant

263
Q

Horizontal transmission

A

Person to person

e.g. sexual contact

264
Q

Hep A transmission

A

Fecal-oral

265
Q

HBsAg positive

A

Hep B surface antigen +

=

HBV is present

266
Q

Anti-HBc positive

A

Anti-Hep B core

=

ongoing Hep B infection

267
Q

Infectious hepatitis liver enzymes

A

ALT > AST

Acute hep B infection = markedly elevated LFTs

268
Q

Hep A transmission

A

ingestion of fecal matter via

close person to person contact w/ infected person

Sexual contact w/ infected person

Ingestion of contaminated food/drinks

269
Q

Hep A risk fx

A

travelers to regions w/ intermediate/high rates of hep A

Sex contacts of infected persons

household members or caregivers of infected persons

Household members or caregivers of infected persons

Men who have sex w/ men

user of certain illegal drugs

persons w/ clotting factor disorders

270
Q

Hep A incubation period

A

15 to 50 days

Avg: 28 days

271
Q

Viral hepatitis clinical sx

A

fever, fatigue, loss of appetite, N&V, abdominal pain, gray-colored BMs, Joint pain, jaundice

272
Q

Hep A risk for chronic infection

A

None

Most recover w/ no lasting liver damage

Rarely fatal

No chronic disease

273
Q

Hep A test for acute infection

A

IgM anti-HAV

NP (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions