LEIK Flashcards
The drugs that most often trigger hemolytic reactions include…
- sulfa drugs (including Bactrim aka TMP-SMX)
- certain diuretics
- fava beans
- drugs for the prevention/ treatment of malaria
(3) contraindications to Metformin use
- alcoholism
- liver disease
- kidney disease
medication class & indication: tamsulosin (Flomax)
alpha blocker
used to treat BPH
medication class & indications: terazosin (Hytrin)
alpha blocker
used to treat BPH and HTN
BBW on thiazolidinediones (TZDs), e.g., pioglitazone (Actos)
Pioglitazone (Actos) is in the drug classification of thiazolidinediones (TZD) used in type 2 diabetes. TZD’s side effects include fluid retention and edema. It has a U.S. black box warning for causing or exacerbating congestive heart failure.
management of ocular shingles for AGPCNP outpatient primary care generalist
If suspected, refer the patient to the emergency department or an ophthalmologist the same day. Sequelae include corneal scarring, corneal blindness (visual loss), and chronic pain.
what are Koplik’s spots?
Koplik’s spots are characterized as clustered, small white lesions located on the buccal mucosa opposite the first and second molars. Koplik’s spots appear in the prodromal stage of MEASLES (RUBEOLA).
what is a pterygium?
A pterygium is a noncancerous growth of clear, thin tissue that lies over the sclera. One or both eyes may be involved. Risk factors are exposure to sunlight and wind. The main symptom is a painless area of white tissue with blood vessels on the inner or outer edge of the cornea. No specific tests are usually needed; physical exam confirms the diagnosis. No treatment is needed unless it begins to block vision or cause symptoms.
- venous engorgement
- loss of venous pulsation
- hemorrhages over and/or adjacent to the optic disc
- blurring of optic margins
- elevation of the optic disc
on fundoscopic eye exam, all of these characteristics are describing…..
papilledema (increased ICP)
normal appearance of the optic disc on fundoscopic exam
The optic disc of a normal examination has sharp margins, a yellowish-orange to a creamy pink color, and round or oval shape.
normal appearance of the arteries and veins on fundoscopic exam of the eye
The veins are darker in color and larger than the arterioles (3:2 ratio).
how to interpret Snellen chart results in testing visual acuity - what do the first and second numbers mean?
In the Snellen fraction 20/20, the first number represents the test distance, WHERE THE PATIENT IS STANDING. The second number represents the distance at which the average eye can see the letters on a certain line of the eye chart.
e.g., So 20/20 means that the eye being tested can read a certain size letter when it is 20 feet away. If a person sees 20/30, at 20 feet from the chart that person can read letters that a person with 20/20 vision could read from 30 feet away.
Q. A test called the visual fields by confrontation is used to evaluate one’s….
peripheral vision
what is the optic disc?
The optic disc is the anatomical location of the eye’s “blind spot,” the area where the optic nerve and blood vessels enter the retina.
most common cause of additional pathological cupping of the optic disc
acute glaucoma
leading cause of blindness in older adults in USA
dry (atrophic) macular degeneration –> occurs slowly
wet macular degeneration occurs suddenly
what is oral leukoplakia?
Leukoplakia mainly affects the mucous membranes of the mouth. It is thought to be caused by irritation. Leukoplakia are patches on the tongue, in the mouth, or on the inside of the cheek that occur in response to long-term irritation, including smoking, holding chewing tobacco or snuff in the mouth for a long period, or other tobacco use, especially pipes (smoker’s keratosis). Leukoplakia on the tongue is also an early sign of HIV.
what is the Weber hearing test and how is it interpreted?
In the Weber test, a vibrating tuning fork is placed in the middle of the forehead, above the upper lip, under the nose, over the teeth, or on top of the head equidistant from the patient’s ears on top of thin skin in contact with the bone. In a normal patient, the Weber tuning fork sound is heard equally loud in both ears, with no one ear hearing the sound louder than the other (lateralization). In a patient with hearing loss (otitis media, cerumenosis), the Weber tuning fork sound is heard louder in one ear (lateralization) versus the other (the “bad” ear).
It can detect unilateral conductive hearing loss (middle ear hearing loss) and unilateral sensorineural hearing loss (inner ear hearing loss).
presentation of scarlet fever
Scarlatina (scarlet fever) is a rash that usually first appears on the neck and chest, then spreads over the body. It is described as “sandpapery” in feel. The texture of the rash is more important than the appearance in confirming the diagnosis. The rash can last for more than a week. As the rash fades, peeling (desquamation) may occur around the fingertips, toes, and groin area. Another sign is a bright red tongue with a “strawberry” appearance.
Q. A 27-year-old kindergarten teacher presents with a severe sore throat accompanied by a pink generalized rash with sandpaper-like texture. She is currently being treated with amoxicillin 500 mg three times a day for 10 days. Which of the following conditions is best described?
A small abscess on a hair follicle of the eyelid is called…
hordeolum
Hordeolum is a common, painful, acute bacterial infection of the hair follicle on the eyelid. It is a focal infection (usually staphylococcal) involving either the glands of Zeis (external hordeola or styes) or, less frequently, the meibomian glands (internal hordeola). Histologically, hordeola represent focal collections of polymorphonuclear leukocytes and necrotic debris (i.e., abscesses).
Pinguecula and pterygium are both commonly caused by….
the UV light of long-term sun exposure.
AV nicking and copper wire/silver wire arterioles are signs of ….
hypertensive retinopathy
rare tumor of the adrenal glands that results in a release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism, and blood pressure.
pheochromocytoma
a narrowing of one or both arteries leading to the kidneys. It can cause severe hypertension and irreversible kidney damage.
renovascular stenosis
congenital heart defect of the aorta; it is a narrowing of the aorta that causes the heart to work harder to get blood to flow through the narrow aortic passageway to other organs, which, in turn, causes an increase in blood pressure.
coarctation of the aorta
most common cause of “walking pneumonia”
Mycoplasma pneumoniae causes a slowly developing infection (vs. streptococcal pneumonia’s abrupt onset with shaking chills/ fever and rust-colored sputum).
(2) OTC cough and cold medications that can increase BP
Pseudoephedrine and diphenhydramine both can increase blood pressure.
medication class: dextromethorphan
antitussive
bronchophony
bronchophony (the ability to hear increased loudness of the spoken sounds), even a whisper can be heard through the stethoscope through an area of consolidation
tactile fremitus
tactile fremitus is a type of vocal fremitus found over the area of secretions. Tactile fremitus is evaluated using the surface of both hands over the back/lungs.
increased over areas of consolidation
MOA of anticholinergics for COPD
Anticholinergic drugs are another group of bronchodilators that are different from the beta-agonists. Although the beta-agonists affect the bronchioles (small airways), anticholinergics affect the muscles around the bronchi (large airways). When the lungs are irritated, these bands of muscle can tighten, making the bronchi narrower. Anticholinergics work by stopping the muscles from tightening.
Easily ruptured blisters (fragile) is a classic finding for _____, an acute bacterial skin infection caused by (2)
bullous impetigo
Staphylococcus or Streptococcus.
what is erysipelas
Erysipelas is a type of cellulitis caused by strep. It resembles a bright-red, warm, raised rash (plaque-like) with discrete borders usually located on the face or the shins. Blistering is not present.
what is the “dawn phenomenon”
The Dawn phenomenon is the end result of a combination of natural hormonal body changes that occur during the sleep cycle. Between 3 a.m. and 8 a.m., the body starts to secrete growth hormone and cortisol. These hormones work against insulin’s action, causing an increase in the fasting blood glucose in the morning.
leading cause of lower limb amputations
diabetes
Data from the National Diabetes Fact Sheet note that more than 60% of nontraumatic lower limb amputations were performed in people with diabetes.
diagnostic definition of a UTI in terms of CFUs and WBCs
A UTI is defined as the presence of 100,000 organisms per milliliter of urine in asymptomatic patients or greater than 100 organisms per milliliter of urine with pyuria (>7 WBCs/mL) in a symptomatic patient.
iliopsoas testing
To perform the iliopsoas muscle test, ask the patient to raise the leg, flexing at the hip, while you push downward against it.
These muscle tests are positive if the patient experiences pain.
obturator testing
The obturator muscle test is performed with the right leg flexed at the hip and the knee at 90 degrees. The examiner rotates the leg laterally and medially.
These muscle tests are positive if the patient experiences pain.
normal change in alk phos during adolescence
Alkaline phosphatase is a group of related enzymes. The bone form of the enzyme creates the alkaline conditions it requires to be most active with a chemical reaction involving the osteoblasts. Because of the rapid bone growth and increased deposition of calcium during the adolescent growth spurt, there is a higher level of enzymes.
fiber is generally useful for preventing diverticular disease. when might be a time that fiber is NOT recommended?
During a flare-up of diverticulitis, a low-fiber diet is recommended and fiber supplementation is not recommended.
common cause of acute gastritis
chronic NSAID use
Signs and symptoms of gastritis are nausea/vomiting, upset stomach, loss of appetite, and burning/aching or gnawing pain located in the epigastric area. Nonselective NSAIDs (aspirin, ibuprofen, naproxen, others) have adverse effects on the gastrointestinal (GI) tract, kidneys, central nervous system, and cardiovascular effects, and decrease platelet aggregation (aspirin). Chronic use of nonselective NSAIDs disrupts the production of prostaglandins, which involves cycloxygenase-1 (COX-1) and COX-2. The GI mucosa uses COX-1 to produce mucosal protective factors. Blocking COX-1 decreases these protective factors and increases risk of gastritis, ulcers, and GI bleeding. Selective NSAIDs, such as celecoxib (Celebrex), do less damage to the GI tract because they block only COX-2, which is responsible for pain and inflammation.
in order to be truly positive, remember to perform Murphy’s sign testing in which way?
on the left side too, should NOT elicit a response
rovsing’s sign
The Rovsing sign is right lower quadrant pain intensified by left lower quadrant abdominal pressure (i.e., pain referred to the opposite side of the abdomen after release of palpation). It is associated with peritoneal irritation and appendicitis.
what is celiac disease?
Celiac disease, known as sprue, is an autoimmune disease that damages the small intestine and interferes with the absorption of nutrients. People with celiac disease cannot tolerate a protein called gluten, which is found in wheat, rye, and barley. If they eat foods or use products containing gluten, their immune system responds by damaging the lining of the small intestine. This damage to the small intestine decreases the absorption of all nutrients—resulting in an overall poor nutritional status. If not treated, a person with celiac disease can develop more severe nutritional deficiencies, such as osteoporosis (because of poor calcium absorption), iron-deficiency anemia, or multiple other vitamin and mineral deficiencies.
Q. The gold standard for the diagnosis of active Helicobacter pylori infection of the stomach or duodenum is:
urea breath test
Cullen’s sign
Periumbilical ecchymosis (bluish periumbilical discoloration), Cullen’s sign, is most often considered a sign of hemorrhagic pancreatitis.
normal liver span for adults
15 to 18 cm in the midclavicular line??????
what is zollinger-ellison syndrome and its primary treatments and complications?
Zollinger–Ellison syndrome is a type of tumor (gastrinoma) that is usually located in the head of the pancreas and/or the upper small intestine. It causes increased production of the hormone gastrin, which stimulates excessive hydrochloric acid production. The result is multiple gastric and/ or duodenal ulcers, intestinal bleeding, or intestinal perforation. Proton-pump inhibitors (PPIs) are the first choice for medical treatment of Zollinger–Ellison syndrome. PPIs reduce acid production by the stomach, and promote healing of ulcers in the stomach and small intestine. About one half to two thirds of single gastrinomas are malignant tumors, which can metastasize and cause death. Surgical removal of the tumor, chemotherapy, and radiation are used, depending on the stage of the cancer.
first line treatment for uncomplicated, non-H. pylori, peptic ulcers
For uncomplicated cases of peptic ulcer disease that are Helicobacter pylori negative, the first-line agents are the H2 receptor blockers such as ranitidine (Zantac), nizatidine (Axid), famotidine (Pepcid), and cimetidine (Tagamet). If these are not effective, the next step would be to try a proton-pump inhibitor.
what is Barrett’s esophagus?
considered a precursor to esophageal cancer
Barrett’s esophagus is most often diagnosed in people who have long-term gastroesophageal reflux disease (GERD)—a chronic regurgitation of acid from the stomach into the lower esophagus. Only a small percentage of people with GERD will develop Barrett’s esophagus.
management of an adult male with UTI
UTIs are unusual in adult males and this patient should be treated for a complicated UTI—empiric treatment with a fluoroquinolone, such as ciprofloxacin, BID for 7 to 14 days. The patient should be referred to a urologist for evaluation of causative factors.
Evidence of blood in the urine can be seen with (3)
kidney stones, bladder cancer, and acute pyelonephritis.
most common causes of orchitis
Mumps is the most common virus that causes orchitis. Other causes of orchitis are sexually transmitted infections such as gonorrhea or chlamydia.
Orchitis is inflammation of one or both of the testicles.
Amsel criteria for diagnosing BV
Diagnosis of bacterial vaginosis includes three of four Amsel criteria: (1) white, thick adherent discharge; (2) pH greater than 4.5; (3) positive whiff test (amine odor mixed with 10% potassium hydroxide [KOH]); (4) clue cells greater than 20% on a wet mount (epithelial cells dotted with large numbers of bacteria that obscure cell borders).
Discuss the treatment of UTIs in patients with diabetes
Prompt diagnosis and early therapy are warranted when a urinary tract infection (UTI) occurs in a diabetic patient. A urine C&S before starting treatment and repeated 1 week posttreatment is recommended to evaluate for eradication of the infection. Do not use the 3-day treatment regimen in this population. Treatment of asymptomatic bacteriuria in diabetic patients is not indicated except in pregnant women.
cremasteric reflex
The cremasteric reflex is elicited by stroking the inner thigh (proximal to distal) with a blunt instrument such as a handle of the reflex hammer. The testicle and scrotum should rise on the stroked side.
two conditions you can use the physical exam technique of transillumination for
Transillumination is used for evaluation of the frontal and maxillary sinusitis as well as for a hydrocele. Because light is able to pass through the delicate skin covering the hollow sinus cavities, a light source held against the upper cheek will produce a red dot on the palate if the sinuses are normal (filled with air rather than obstructed). The transillumination test is used to differentiate a hydrocele from hernia—an illuminated scrotum will show the testicle in the center surrounded by water in the hydrocele.
management of suspected acute testicular torsion
Immediate referral to the emergency department is required to prevent irreversible ischemia. Success of treatment is usually 100% if treated within the first 6 hours and 0% if treated after 24 hours. The diagnosis of testicular torsion is often made clinically, but if it is in doubt, an ultra-sound is helpful in evaluating the condition. Emergency diagnosis and treatment are usually required within 4 to 6 hours to prevent necrosis.
causes of balanitis
Balanitis is swelling (inflammation) of the foreskin and head of the penis. Balanitis is usually caused by poor hygiene in uncircumcised men. Other possible causes include Candida (fungal infection) and bacterial infection, harsh soaps, and uncontrolled diabetes. Symptoms include redness of the foreskin or penis, other rashes on the head of the penis, foul-smelling discharge, and pain.
A boggy and warm prostate with tenderness is suggestive of ….
acute prostatitis.
common migraine triggers
foods high in tyramine content (blue cheese, smoked meats, salami, beer, soy, fava beans), change in sleep patterns, and fermented foods—are all possible migraine triggers. Other triggers include skipping meals/fasting, hormonal fluctuation, environmental factors, stress, overexertion, visual triggers such as eyestrain/bright glaring lights, and others.
what is cauda equina
Cauda equina is a serious condition caused by compression of the lumbar, sacral, or coccygeal nerve roots in the lower portion of the spinal cord. It is considered a surgical emergency. If left untreated, acute pressure causes ischemia and can lead to permanent nerve damage, including loss of bowel and bladder control and paralysis of the legs. Signs and symptoms include a change in bowel and bladder control (incontinence), saddle-pattern anesthesia (perineum), sciatica, low-back pain, and loss of sensation or movement below level of the lesion. Causes include disk herniation, abscess, tumor, inflammation, and others.
treatment for Raynaud’s disease
The preferred drug is a calcium channel blocker such as nifedipine (Norvasc) or amlodipine (Procardia).
(6) medications first-line for migraine prevention
Sufficient evidence and consensus exist to recommend propranolol, timolol, amitriptyline, divalproex (Depakote), sodium valproate (Depakote), and topiramate (Topamax) as first-line agents for migraine prevention.
discuss diabetic eye disease
Patients with diabetes often develop ophthalmic complications, such as corneal abnormalities, glaucoma, neovascularization (and microaneurysms), and cataracts. The most common and potentially most blinding of these is diabetic retinopathy. In the initial stages of diabetic retinopathy, patients are generally asymptomatic, but in more advanced stages of the disease patients may experience floaters, as well as distorting and/or blurred vision. Microaneurysms are the earliest clinical sign of diabetic retinopathy.
normal ESR
. The normal ESR for males is 0 to 15 mm/hr, and for females is 0 to 20 mm/hr. The ESR can be slightly more elevated in the elderly
treatment for Bell’s palsy
Early treatment with oral glucocorticoids (prednisone) is recommended. If herpes simplex 1 infection is suspected, use combined therapy with valacyclovir (Valtrex) and prednisone for 1 week.
folks with Downs syndrome are at increased risk for… (3)
- congenital heart defects
- atlantoaxial instability (10-30%)
- early onset Alzheimer’s disease
Down’s syndrome and atlantoaxial instability implications
The American Academy of Pediatrics issued a position statement in 1984 on AAI and Down syndrome (DS): All children with DS who wish to participate in sports should have cervical spine x-rays. Repeated x-rays are not indicated for children with DS who have had a previously normal neck x-ray. Persons with DS who have no evidence of AAI may participate in all sports.
how to test cranial nerve II
CN II (optic)—distance vision, near vision;
extraocular movements (EOMs), visual fields of gaze; these test cranial nerves….. (3)
III, IV, VI (oculomotor, trochlear, abducens)
Q. During a physical examination, a 40-year-old patient who has hypertension is noted to have a few beats of horizontal nystagmus on extreme lateral gaze that disappeared when the patient’s eyes returned toward midline. Which of the following statements best describes this clinical finding?
normal finding
A few horizontal nystagmic beats are within normal limits (WNL).
diagnostic evaluation of infectious mono
In most cases of infectious mono, the clinical diagnosis can be made from the triad of fever, pharyngitis, and lymphadenopathy lasting 1 to 4 weeks. Serology tests show normal to moderately elevated white blood cells and increased numbers of lymphocytes, greater than 10% atypical lymphocytes, and a positive reaction to a mono spot test. The antibody response in primary EBV infection appears to be quite rapid.
koilonychia
spoon-shaped nails (seen in iron-deficiency anemia)
Vitamin B12 deficiency adversely affects myelin, leading to what characteristic symptom. …
neuropathy
The most common cause of B12 deficiency anemia is ….
pernicious anemia.
The differential diagnosis of a microcytic anemia includes (4)
- iron-deficiency anemia (IDA)
- thalassemias
- anemia of chronic disease (ACD)
- sideroblastic anemias, including lead poisoning
Q. The most sensitive and specific diagnostic test for both sickle cell anemia and thalassemia is:…
hemoglobin electrophoresis
positive Finkelstein’s test is specific for….
De Quervain’s tenosynovitis or tendinosis is a painful inflammation of the tendons on the thumb side of the wrist (radial side). The affected tendons are the abductor policis longus and extensor pollicis brevis. Patient complains of radial wrist pain that is exacerbated by movement of the wrist and/or thumb such as grasping, opening a jar, or making a fist. The pain may radiate down to the thumb or up the forearm. The Finkelstein test helps to diagnose the condition. Instruct the patient to fold the thumb toward the palm, then cover the thumb with the remaining four fingers. Bend the wrist with hand downward, it will cause pain on the tendons on the thumb side. This is a positive Finkelstein test.
positive Lachman’s test is specific for….
The Lachman maneuver is a test performed to assess for knee instability (i.e., damage to the motion of anterior translation [laxity] of the anterior cruciate ligament [ACL]). The maneuver should be tested on both knees, comparing the injured and the opposite knee, the uninjured knee is used as the “control.” The test is positive if the injured knee slips back further (laxity). Perform the test by bending the knee 30 degrees. Stabilize the femur with one hand. Place the other hand under the proximal tibia at the level of the joint line and then pull forward. The laxity is graded on a 0 (normal)-to-3 scale (1.0–1.5 cm of translation).
Bouchards node
enlargement of the PIP joint
Heberdens node
enlargement of the DIP joint
positive Phalen’s test is specific to….
The Phalen maneuver is a diagnostic test for carpal tunnel syndrome (Median Nerve Irritation). The test is performed by pushing the back of the hands together for 1 minute. This compresses the median nerve within the carpal tunnel. Characteristic symptoms (burning; tingling; numbness over the thumb, index, middle, and ring fingers) convey a positive test result.
what is ankylosing spondylitis
Ankylosing spondylitis (AS) is a lifelong autoimmune disease and form of arthritis that causes inflammation, pain, and stiffness mainly in the spinal joints. In the early stages of AS, the pain and stiffness often start in the lower back, but over time it may move up the spine and into the neck. Most people with AS experience episodes of acute pain—known as flares—followed by periods when symptoms temporarily subside. There are no specific lab tests to identify ankylosing spondylitis. The erythrocyte sedimentation rate (ESR) is increased by the inflammation.
Rheumatoid Arthritis typically spares which joint in the hand
DIPs (Heberden’s nodes NOT present)
(2) priority complications of untreated gout
- loss of joint mobility
- kidney impairment
Left untreated, gout can develop into a painful and disabling chronic disorder. Persistent gout can destroy cartilage and bone, causing irreversible joint deformities and loss of motion. High urate levels can deposit in the kidney and also lead to kidney stones.
typical clinical presentation of rheumatoid arthritis
When rheumatoid arthritis is active, symptoms can include fatigue, loss of energy, depression, low-grade fever, muscle and joint aches, and stiffness. Muscle and joint stiffness are usually most notable in the morning and after periods of inactivity. During flares, joints frequently become red, swollen, painful, and tender. This occurs because the lining of the tissue of the joint (synovium) becomes inflamed, resulting in the production of excessive joint fluid (synovitis).
positive McMurrays test is specific for….
meniscal injury
The McMurray test is used to detect a torn meniscus. With the patient supine, flex one knee completely with the foot flat on the table near the buttocks. Maintain that flexion with your thumb and index finger stabilizing the knee on either side of the joint space. Hold the heel with your other hand, and rotate the foot and lower the leg to a lateral position. Extend the patient’s knee to a 90-degree angle; notice any palpable or audible click or limited extension of the knee. Return the knee to full flexion and repeat the procedure, rotating the foot and lower leg to the medial position. A palpable or audible click in the knee or lack of extension is a positive sign.
“podagra” is associated with….
gout
Gout is characterized by recurrent attacks of acute inflammatory arthritis— a red, tender, hot, swollen joint. The metatarsal–phalangeal joint at the base of the big toe (podagra) is the most common location, but it can also affect other joints, such as the ankle or the knee. Pain occurs due to the accumulation of uric acid and salts in the joint.
management of scoliosis by degree
A mild curvature (up to 20 degrees) generally warrants only periodic observation to evaluate for signs of further progression. Bracing is the usual treatment for children and adolescents with curves of 25 to 40 degrees, and in other special circumstances.
testicular “blue dot sign” is specific to….
torsion of the testicular appendage
The “blue dot sign” is caused by torsion of the appendix testis (or appendix epididymis). It is a small vestigial structure with a pedunculated shape (0.3 cm size) and is located on the superior aspect (or inferior pole) of the testes. It becomes gangrenous when it becomes twisted, resulting in the “blue dot sign.” Symptoms include acute onset of localized pain, which lasts from 5 to 10 days. The blood flow of the testicle is not affected. Treatment is supportive (analgesics, scrotal support, and bed rest). All prepubertal and young adult males with acute scrotal pain should be considered to have testicular torsion until proven otherwise.
(2) most common causative agents of epididymitis in young adult males
- chlamydia
- gonorrhea
Epididymitis is usually caused by the spread of bacteria from the urethra or bladder. The most common infections include chlamydia and gonorrhea. Physical examination shows a red, tender, and sometimes swollen lump on the affected side of the scrotum. Tenderness usually occurs in a small area of the testicle where the epididymis (connects the testicle with the vas deferens) is attached.
what is apraxia
Apraxia is characterized by loss of the ability to execute or carry out learned purposeful movements despite the desire and the physical ability to perform the movements. Apraxia is not a sign or symptom of depression; it is a disorder of motor planning caused by damage to specific areas of the cerebrum.
first line medication for OCD treatment
The first medication usually considered is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI).
Wernicke-Korsakoff syndrome
Thiamine is administered to prevent Wernicke–Korsakoff syndrome, usually found in chronic alcoholics. Wernicke–Korsakoff syndrome (alcoholic encephalopathy) can cause a seizure, vision changes, ataxia, and impaired memory.
how long to avoid alcohol when taking metronidazole
The patient should avoid alcoholic drinks during and for at least 3 days after therapy with metronidazole (Flagyl). Flagyl and alcohol together cause severe nausea and vomiting, flushing, fast heartbeat (tachycardia), and shortness of breath. The reaction has been described as being similar to the effects of Antabuse.
what is delirium tremens
Delirium tremens is a severe form of alcohol withdrawal that involves sudden and severe mental or nervous system changes. Symptoms most often occur within 72 hours after the last drink. However, they may occur up to 7 to 10 days after the last drink. It is especially common in those who drink 4 to 5 pints of wine or 7 to 8 pints of beer (or 1 pint of “hard” alcohol) every day for several months. Delirium tremens also commonly affects people who have had alcoholism for more than 10 years.
causative agent for Rocky Mountain Spotted Fever
Rocky Mountain spotted fever is caused by Rickettsia rickettsii (bacteria; atyipcal) which is carried by infected ticks. Risk factors include recent hiking or exposure to ticks in areas known to be infested. Bacteria can also infect people who crush ticks they have removed from pets. Symptoms develop around 2 to 14 days after tick bite: chills, fever, headache, muscle pain, and rash.
what is Fitz-Hugh-Curtis syndrome
Fitz-Hugh–Curtis syndrome (or perihepatitis) is a complication of pelvic inflammatory disease (PID). It is more common with chlamydial PID, but it can also occur with gonorrheal PID infection. It is caused by inflammation of the liver capsule, which leads to scarring. Signs and symptoms include sharp pain on the right upper quadrant (pleuritic-like) with PID symptoms. Like PID, it is treated with antibiotics.
causative agent of Toxic Shock Syndrome
staph aureus
causative agent for erysipelas
- group A beta haemolytic streptococcus (strep pyogenes)
Erysipelas is cellulitis caused by group A Streptococcus bacteria in the upper dermis and superficial lymphatics. Diagnosis is general, based on assessment; a skin biopsy is usually not indicated. Symptoms include vesicles, blisters, petechiae, pain, fever, chills, and headache. The erythematous skin lesion enlarges rapidly and has a sharply demarcated raised edge. It is also known as St. Anthony’s fire. The rash is due to an exotoxin.
characteristic rash of lyme disease is called…..
erythema migrans
treatment for lyme disease presenting with erythema migrans
doxycycline 100mg BID x 14-21 days
Erythema migrans is the rash characteristic of Lyme disease and it usually appears 7 to 10 days after a tick bite. Lyme disease is caused by Borrelia burgdorferi, a spirochete. The rash appears either as a single expanding red patch or a central spot surrounded by clear skin that is in turn ringed by an expanded red rash (bull’s eye). The choice of antibiotic depends on bacterial sensitivity. Doxycycline 100 mg BID for 14 to 21 days is the recommended treatment of adults
A tetanus vaccine booster is recommended for recent injuries if it has been more than_______ since the last dose.
5 years
what is a Jarisch-Herxheimer reaction
An immune-mediated reaction precipitated by the destruction of a large number of spirochetes due to an antibiotic injection
The dying bacteria release antigens that cause a host reaction. Herxheimer reaction, or Jarisch–Herxheimer reaction, may occur with infections caused by spirochete bacteria such as syphilis and Lyme disease. It is more commonly seen after treatment of early-stage syphilis. It usually occurs in the first 24 hours after therapy. Signs and symptoms are headache, myalgias, rigors, sweating, hypotension, and worsening of rash (if present). No treatment is needed, as it usually resolves within 12 to 24 hours.
what is cheilosis
Cheilosis or angular cheilosis (perleche) is an acute or chronic inflammation of the labial mucosa and adjacent skin due to excessive moisture and/or salivation. The corners of the mouth are macerated with fissures and painful reddened skin. Risk factors are dentures, poor oral hygiene, drooling, dry mouth (sicca symptoms), oral fungal infection, immunodeficiency, and vitamin deficiency.
(3) causes of acute pancreatitis
- gallstones
- alcohol excess
- severely elevated triglycerides
The most common cause of acute pancreatitis is gallstones and excessive ETOH (ethanol) consumption. Significantly elevated triglyceride levels also can precipitate episodes. Treatment of hypertriglyceridemia-induced acute pancreatitis consists of immediate reduction of serum triglyceride levels and long-term modifications to medications and lifestyle.
elevated GGT most often signifies damage to which organ
liver
elevated alk phos in adolescents
The rapid bone growth during growth spurts and adolescence elevates the alkaline phosphatase level. Alkaline phosphatase levels are higher in children and adolescents due to physiologic osteoblastic activity. Most of the serum alkaline phosphatase in the body comes mainly from the liver and bones.
claims-made malpractice insurance vs. occurrence-based malpractice insurance
An occurrence-based policy will cover any claim that occurred during the active policy period (paid premium or fee), even if the policy has since been canceled.
In contrast, claims-based malpractice insurance will only cover a claim if both the incident and the claim happen when the policy is active. When the nurse practitioner stops paying the premiums for this type of policy, it is no longer active.
triple therapy for H. pylori duodenal ulcer
Clarithromycin (Biaxin) BID, amoxicillin BID, and omeprazole (Prilosec) daily
(2) medication options for ACUTE gout
- NSAIDs
- colchicine
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin (Indocin), have been used for the treatment of acute gout. Colchicine may be added to the NSAIDs if relief is not obtained
(2) medication options for PREVENTING gout
- allopurinol
- probenecid
Maintenance therapy consists of allopurinol and/or probenecid. Allopurinol is used to prevent gout attacks, not to treat them once they occur. It may take several months or longer before the full benefit of allopurinol is felt. Allopurinol may increase the number of gout attacks during the first few months that it is taken, although it will eventually prevent attacks.
mid-systolic click on cardiac exam is specific to….
mitral valve prolapse
Mitral valve prolapse (MVP) occurs when the mitral valve does not close all the way, causing a late systolic murmur heard best in the apical area during auscultation of the chest. Following a normal S1 and briefly quiet systole, the valve suddenly prolapses, resulting in a mid-systolic click. The click is so characteristic of MVP that even without a subsequent murmur, its presence alone is enough for the diagnosis. Immediately after the click, a brief crescendo–decrescendo murmur is heard, usually best at the apex. Symptoms patients may experience at times include palpitations and dizziness.
contraindications to beta blocker eye drops (e.g., timolol) for glaucoma
Contraindications include bronchial asthma, asthma history, severe COPD, uncompensated heart failure, second- or third-degree AV block, sinus bradycardia, and cardiogenic shock. Caution should be used if the following conditions are present: closed-angle glaucoma, peripheral vascular disease, bronchospastic disease, diabetes, hyperthyroidism, and myasthenia gravis.
This is the first antipneumonia antibiotic approved for single-dose delivery (consider as a good option for folks with difficulty following-up or medication aquisition such as homelessness)
azithromycin ER (Zmax)
Q. Which class of antihypertensive agents should be weaned off when discontinuing the drug in patients who have taken it for many years?
beta blockers
Beta-blockers require a gradual reduction in dose. Suddenly stopping a beta-blocker can sometimes cause problems such as palpitations, a rise in blood pressure, or a recurrence of angina pains.
medication class and (2) indications for terazosin (Hytrin)
- alpha blocker
- BPH and HTN
Terazosin is in a class of medications called alpha-blockers. It relieves the symptoms of BPH by relaxing the muscles of the bladder and prostate. It lowers blood pressure by relaxing the blood vessels so that blood can flow more easily through the body.
(3) classes of drugs that can affect metabolism and efficacy of OCPs
Drugs affecting contraceptive efficacy include anti-convulsants (carbamazepine, phenytoin), antibiotics (tetracycline, rifampin), and antifungals (griseofulvin, ketoconazole).
medication class of finasteride (Proscar) and how it works for its primary indication
5 alpha reductase inhibitor
finasteride (Proscar) prevents the conversion of testosterone to dihydrotestosterone (DHT) in the body. DHT is involved in the development of benign prostatic hyperplasia (BPH). Thus, shrinks the size of the prostate
can you still take sulfonylurea drugs (e.g., glipizide) if you have a sulfa allergy?
yes
The sulfonamide component in the typical sulfa antibiotics is of a slightly different molecular structure than that in sulfonylureas. Although cross-reactivity is technically possible, current literature does not consider this likely, and sulfonylureas are typically well tolerated in patients with a sulfa allergy.
Q. A cauliflower-like growth with foul-smelling discharge is seen during an otoscopic examination inside the middle ear of a new patient with a history of chronic otitis media infection. The tympanic membrane is not visible, and the patient reports hearing loss in the affected ear. What condition is most likely?
cholesteatoma
An abnormal skin growth in the middle ear behind the eardrum is called cholesteatoma. Repeated infections and/or a tear or pulling inward of the eardrum can allow skin into the middle ear. Cholesteatomas often develop as cysts or pouches that shed layers of old skin, which build up inside the middle ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear, leading to hearing loss that surgery can often improve. Permanent hearing loss, dizziness, and facial muscle paralysis are rare, but can result from continued cholesteatoma growth.
normal Rinne test
A normal result in the Rinne is air conduction (AC) greater than bone conduction (BC). When there is a conductive hearing loss (ceruminosis, otitis media), the result will be BC greater than AC. The reason is that the sound waves are blocked (e.g., cerumen, fluid in middle ear). Therefore, the patient can hear the sound louder through bone conduction.
Sensorineural hearing loss (i.e., presbycusis) involves damage to both (2)….
- inner ear: the hair cells in the cochlea (sensory portion)
- cranial nerve VIII (acoustic)
first line treatment for otitis externa
The most common bacteria is Pseudomonas. The second most common bacteria is Staphylococcus aureus. Combination topical antibiotic ear drops containing a topical steroid (hydrocortisone) are the first-line treatment for otitis externa. The topical steroid decreases inflammation and ear pain. An example is hydrocortisone-neomycin-polymyxin B (Cortisporin). Quinolone ear drops (e.g., ofloxacin, ciprofloxacin topical drops) are also effective.
what is the Isihara Chart used to evaluate
color vision
The Ishihara chart (or Ishihara Color Test) is used to evaluate color blindness and can be used in patients ranging from school-aged children to adults. It displays colored numbers with different colored dots in the background. A pediatric color vision test for preschool children (3–6 years of age) uses shapes instead of numbers.
positive Auspitz test is most commonly associated with….
psoriasis
The Auspitz sign is simply bleeding that occurs after psoriasis scales have been removed. It occurs because the capillaries run very close to the surface of the skin under a psoriasis lesion, and removing the scale essentially pulls the tops off the capillaries, causing bleeding. Auspitz sign is also found in other scaling disorders such as actinic keratoses.
overview of treatment options for psoriasis
Treatment of psoriasis is based on disease severity and patient preferences. Topical treatment can range from petroleum jelly, steroids, retinoids, tar, or vitamin D analogs to ultraviolet B (UVB) phototherapy with tar (Goekerman’s regimen). Systemic treatment ranges from oral steroids and retinoids to biologic agents, methotrexate, and cyclosporine. Topical tar is in the psoralen drug class.
When the ______ nerve is involved in a herpes zoster outbreak, there is an increased risk of corneal blindness.
trigeminal (CN V - ophthalmic branch)
appropriate initial management for a second-degree burn
irrigate with normal saline and apply silvadene cream BID
Silvadene (silver sulfadiazine) is the initial cream used for suspected partial and full-thickness burns (second and third degree). It contains silver sulfadiazine in micronized form, which has broad microbial activity. It is bactericidal against many gram-negative and gram-positive bacteria as well as being effective against yeasts. Silvadene is a sulfa drug and should not be used on someone who has a sulfa allergy. It should be used on external areas only.
most common type of skin cancer in the USA
- basal cell carcinoma
Basal cell carcinoma (BCC) is the most common type of skin cancer diagnosed in the United States each year. More than one out of every three new cancers are skin cancers, and the vast majority are BCCs. BCCs are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis. Initially appearing as a dome-shaped waxy lesion with telangiectasia, it enlarges with raised “pearly” edges and telangiectasia and the center may ulcerate. BCCs can also look like open sores, red patches, pink growths, or scars. Usually caused by a combination of cumulative UV exposure and intense, occasional UV exposure, BCC can be highly disfiguring if allowed to grow, but almost never metastasize beyond the original tumor site.
how do you determine a pulse deficit
The pulse deficit is the difference between the apical pulse and the radial pulse. These should be taken at the same time, which will require that two people take the pulse: one with a stethoscope and one at the wrist. Count for 1 full minute. Then subtract the radial from the apical.
cardiac side effects of calcium channel blockers
Common side effects of calcium channel blockers include headaches, edema of the lower extremities, and heart block or bradycardia. Contraindications for calcium channel blockers include second- or third-degree atrioventricular (AV) block, bradycardia, and congestive heart failure.
JNC8 BP goals for someone 60yo or older
For the general population (no diabetes or chronic kidney disease) the recommended systolic blood pressure (SBP) goal at age 60 years or older goes up by 10 mmHg to blood pressure less than 150/90. But if the patient is a diabetic and/or has chronic kidney disease, then the blood pressure goal does not change and continues at blood pressure less than 140/90.
eye exam findings in diabetic retinopathy
Neovascularization and microaneurysms
how long before exercise should you pre-medicate to avoid exercise-induced bronchospasm in folks with asthma?
Exercise-induced asthma is best controlled by using the Proventil inhaler (bronchodilator) approximately 10 to 15 minutes before exercise, to prevent vasospasm of the bronchioles and shortness of breath with exercise. The effects of these bronchodilators usually last approximately 4 hours. They also work quickly to open up the bronchioles if an acute attack/shortness of breath occurs.
pulsus paradoxus and asthma
Normally, the pulsus paradoxus (i.e., the difference in systolic blood pressure between inspiration and expiration) does not exceed 15 mmHg. In patients with severe asthma, a pulsus paradoxus of greater than 25 mmHg usually indicates severe airway obstruction.
what is Addison’s disease
Addison’s disease is also known as primary adrenal insufficiency. The most common cause of damage to the adrenal cortex (the outer layer of the gland) is autoimmune destruction. The adrenal cortex produces glucocorticoids (cortisol) and mineralocorticoids (aldosterone). Aldosterone regulates sodium retention and potassium excretion through the kidneys (affects blood pressure). Electrolyte abnormalities are high potassium and low sodium. In primary disease (Addison’s), the serum cortisol level is low, adrenocorticotropic hormone (ACTH) is high, and serum aldosterone is low. If the patient is not treated, severe stress (illness, accident) may cause an adrenal crisis (“Addisonian” crisis), which can be fatal.
eye exams and hydrochloroquine
A comprehensive eye exam by an ophthalmologist is recommended because hydroxychloroquine can adversely affect the retina (scotomas or visual field defects, loss of central vision, loss of color vision). Higher doses and long-term use increase the risk of retinal toxicity.
routine labs needed for someone on atypical antipsychotic medication (2nd gen antipsychotics)
Fasting blood glucose, fasting lipid profile, and weight
Patients on atypical anti-psychotics commonly gain weight and are at risk for obesity, hyperglycemia, and type 2 diabetes. Zyprexa will increase lipids (cholesterol, low-density lipoprotein [LDL], and triglycerides). Atypical antipsychotics also increase the risk of death among frail elderly and elderly living in nursing homes.
most specific lab test for SLE lupus
ANA
The ANA test is usually positive in lupus patients. Other types of autoantibody testing recommended for these patients, in addition to ANA tests, are antiphospholipid antibodies, antibodies to double-stranded DNA, and anti-Smith (Sm) antibodies. Patients with suspected lupus should be referred to a rheumatologist. The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) are nonspecific findings of inflammation and are elevated in patients with autoimmune diseases, infections, and others.
priority risks of a carotid bruit found on physical exam
- coronary artery disease
- ischemic stroke
Carotid stenosis puts the patient at risk for stroke and coronary artery disease. A bruit is a murmur heard over the carotid artery in the neck, suggesting arterial narrowing and atherosclerosis. It may increase risk of cerebrovascular disease.
location of Virchow’s Node (lymph node)
- left supraclavicular lymphadenopathy
Virchow’s node (or signal node) is a lymph node in the left supraclavicular fossa (the area above the left clavicle). It takes its supply from lymph vessels in the abdominal cavity. The finding of an enlarged, hard node (also referred to as Troisier’s sign) has long been regarded as strongly indicative of the presence of cancer in the abdomen, specifically gastric cancer, that has spread through the lymph vessels.
classic triad of symptoms in Meniere’s disease
- episodic vertigo
- tinnitus
- sensorineural hearing loss
The classic triad of symptoms of Ménière’s disease is episodic vertigo, tinnitus, and sensorineural hearing loss (low frequency). Tinnitus is usually low pitch (like listening to a conch shell). One may have a strong sensation of ear fullness. The condition can resolve spontaneously or may be chronic.
what are the (3) MAJOR criteria for PID
- cervical motion tenderness
- uterine tenderness
- adnexal tenderness
Pelvic inflammatory disease (PID) is a clinical diagnosis. The presence of at least one of the major criteria (cervical motion tenderness, adnexal tenderness, uterine tenderness) when combined with the history is highly suggestive of PID. Minor criteria are not necessary, but they help to support the diagnosis of PID (oral temperature >101°F [>38°C], mucopurulent cervical or vaginal discharge, elevated sedimentation rate, elevated C-reactive protein, large amount of white blood cells on saline microscopy of the vaginal fluid, or laboratory documentation of cervical infection with Neisseria gonorrhoeae or Chlamydia trachomatis).
most sensitive screening test for HIV
- combination HIV-1 and HIV-2 with p24 antigen immunoassay
The Centers for Disease Control and Prevention (CDC) recommends the fourth generation combination HIV-1 and HIV-2 with p24 antigen immunoassay for screening asymptomatic individuals or those with chronic HIV infection. The p24 antigen is produced even before antibodies develop. If suspect acute HIV infection (mono-like symptoms), add HIV RNA test. Previously, the ELISA (enzyme-linked immunosorbent assay) was used as the screening test and the Western blot was the confirmatory test. The ELISA and Western blot only tested for the HIV antibody. The CDC recommends that everyone between the ages of 13 and 64 years be tested for HIV at least once as part of routine health care. If risk factors present, test for HIV annually. For sexually active gay and bisexual men, the CDC recommends more frequent testing, perhaps every 3 to 6 months (CDC, 2017).
the type of condyloma associated with syphilis
condyloma LATA
the type of condyloma associated with HPV
condyloma ACCUMINATA
Condyloma acuminata (genital warts) are caused by the human papillomavirus (HPV) and spread to others by skin-to-skin contact.
Flexion of the hips and knees when flexing the neck is a positive ______ sign for meningeal irritation.
Brudzinski’s
(2) preferred antibiotics for anthrax exposure
- ciprofloxacin
- levofloxacin
Ciprofloxacin is the preferred drug for anthrax (Bacillus anthracis) prophylaxis. The other option is levofloxacin (Levaquin). The CDC-recommended prophylaxis for persons known or suspected to have been exposed to a substantial inoculum of spores from a deliberate-release scenario is antibiotic therapy for 60 days and administration of anthrax vaccine adsorbed (BioThrax).
recommended order of pneumonia vaccines after 65yo
The Centers for Disease Control and Prevention (CDC) recommends administering Prevnar 13 first, then waiting at least 1 year (12 months) and giving the Pneumovax 23. The immunogenic response is better using this method.
most common cause of death in folks with HIV/AIDs+
- PCP pneumonia
Pneumocystis jirovecii pneumonia (previously known as Pneumocystis carinii pneumonia, or PCP) can be life threatening in patients with AIDS with a low CD4 count. It is the most common cause of death of these patients in the United States. Once a patient’s CD4 count declines significantly, prophylaxis for opportunistic infections is initiated and continues indefinitely. The first-choice preventive regimen is trimethoprim-sulfamethoxazole one double-strength tablet PO daily.
latent TB treatment
isoniazid PO daily for 9 months (preferred) or for 6 months.
recommended screening test for TB in someone who previously received the BCG vaccine
- serum interferon-gamma release assay (QuantiFERON-TB-Gold)
The preferred method of testing for tuberculosis (TB) infection in persons who previously received the bacillus Calmette-Guérin (BCG) vaccine is a TB blood test—the interferon-gamma release assay—such as the QuantiFERON-TB Gold (Centers for Disease Control and Prevention, 2016). Unlike the TB skin tests (purified protein derivative [PPD], Mantoux), the blood tests are not affected by prior BCG vaccination.
if there is no secondary sex characteristics development in a male adolescent by age ____, refer to pediatric endocrinologist
14yo
If there is no testicular development by 14 years of age, an endocrinology consult is warranted.
Thayer-Martin culture is a test specific for….
- gonorrhea of the pharynx or rectum
Thayer–Martin Selective Agar is an enriched medium for the selective isolation of Neisseria species. N. gonorrhoeae is a gram-negative bacteria that can infect the genitourinary and reproductive tracts, throat, eyes (infants), and rectum. Thayer–Martin culture is recommended for screening to diagnose gonorrheal pharyngitis or proctitis.
(3) drugs used for the prevention of PCP pnuemonia
- TMP-SMX (Bactrim)
- dapsone
- aerosolized pentamidine
Menarche typically occurs within_____ years after thelarche (breast budding; Tanner stage II)
2-3 years
folks with PCOS are at higher risk for…. (5)
- endometrial cancer
- uterine cancer
- infertility
- heart disease
- diabetes
top 1 and 2 causes of infertility in US
#1 = ovulatory disorder (25%) #2 = endometriosis (15%)
By the age of 70 years, about ____ of males have erectile dysfunction.
80%
management of patient for primary care AGPCNP with mild acute diverticulitis
The patient has a mild case of acute diverticulitis and can be treated as an outpatient with antibiotics and a clear fluid diet for 2 to 3 days. It is very important to use care in patient selection and close follow-up (within 48 hours) are very important. Instruct patients to go to the hospital if symptoms get worse, if fever increases, if unable to tolerate PO treatment, and if pain worsens. Order a complete blood count (to check for leukocytosis, neutrophilia, and possible shift to the left), chemistry profile, and urinalysis (to rule out renal causes).
first line treatment for C. diff outpatient
metronidazole
First-line treatment for a mild case of Clostridium difficile colitis is metronidazole (Flagyl) 500 mg PO TID for 10 days. Discontinuation of the offending antibiotic (if possible) or switching to another anti-biotic class is recommended. The role of probiotic supplementation is controversial. Complications are pseudomembranous colitis, toxic megacolon, and fulminant colitis.
lab finding specific to celiac disease
Antigliadin IgA and IgG are elevated in almost all patients (90%).
common pathogen to colonize the lungs of folks with cystic fibrosis
pseudomonas aeruginosa
P. aeruginosa is the major pathogen in the lung with cystic fibrosis (CF). Prevalence is high and, once acquired, chronic infection will almost always ensue. P. aeruginosa settles into the thick mucus trapped in the airways. Once it sets up house in the respiratory tract, P. aeruginosa is hard to get rid of. Respiratory failure caused by the infection is often the ultimate cause of death in many people with CF.
COPD on spirometry (4)
- reduction in the FEV1 and FVC
- increases in the RV (residual volume) and TLC (total lung capacity)
