Main points Flashcards
temporal arteritis s/s
L temporal headache, scalp tenderness, indurated temporal artery. Pt with elevated WBC (>12,000), shift to the left, neurtrophilia (>70%) likely is bacterial infection
sensitivity
rule out, do Not have the disease
specificity
rule in, have the disease
cuada equina syndrome
a rare disorder that usually is a surgical emergency. In patients with cauda equina syndrome, something compresses on the spinal nerve roots. You may need fast treatment to prevent lasting damage leading to incontinence and possibly permanent paralysis of the legs.
meningococcoal meningitis
caused by Neisseria meningitides.
affects the the lining of the brain and spinal cord (meningitis) and bloodstream infections (bacteremia or septicemia).
Kiesselbach’s plexus
Over 90% of nose bleeds occur in the anteroinferior (front bottom) nasal septum and is formed by anastomoses (coming together) of 5 arteries
test for sickle cell anemia, g6pd anemia, alpha/beta thalassemia
hemoglobin electrophoresis
otitis media 1st and 2nd line rx
1st line: amoxicillin
2nd line: amoxicillin-claculanate (augmentin) bid x 10-14 dAYS if no improvement
alternative for PCN allergy
macrolides (azithro/z pack, eryrho, clarithro) or clindamycin (lincosamide)
s/e erythromycin
n/v. switch patient to azithro (z pack)
If COPD patient on ipratronium bromide (Atrovent) for sob, add what rx if s/s still there?
add albeterol inhaler (Ventolin)
Triad for mono
sore throat, prolonged fatigue, enlarged cervical nodes ( if present in older patient, reactivated mono)
lupus or SLE (systemic lupus) s/s
butterfly rash (malar rash). advise spf
polymyalgic rheumatica (PMR) s/s
An inflammatory disorder causing muscle pain and stiffness around the shoulders and hips. long term low dose steroids. PMR >risk for temporal arteritis
gold standard for temporal arteritis
biopsy of the temporal artery. refer pt to ophthalmologist for management
finkelstein test
thumb in fist, pain to radial wrist is positive for de quervains tenosynovitis
diabetic retinopathy
neovascularization, microaneurysyms, cotton wool spots, hard exudates
hypertensive retinopathy
av nicking, silver/copper wire arterioles
scoring for reflex
0 absent 1 hypoactive 2normal 3 hyperative 4 clonus
benign variants
s4 in elderly, torus palatinus, fishtail uvula
1st line for htn
arb/ace, esp with diabetic pts and mild renal disease
ipratropium (atrovent) is an anticholingeric
true
Penicillin drugs
amoxicillin (broad spectrum), penicillin VK
macrolide
erythromycin, azithromycin (zpack), clarithromycin (biaxin)
cephalopsorin 1st generation
Keflex
cephalosporin2nd generation
cefaclor, ceftin, cefzil
cephalosporin 3rd generation
rocephin, suprax, omnicef
quinolones
levofloaxacin (levaquin), moxiflozacin (avelox), gatifloxacin (tequin)
sulfa
bactrim/septra (trimethroprim/sulfamethazole), nitrofurantoic (macrobid)
tetracyclines
tetracycline, doxy, mino (minocin)
antitussives
dextromorphan (robitussin), benzonate (tessalon perles)
avoid nitrofurantoin and sulfa drugs (bactrim/septra/macrovid)during pregnancy,
true
tx for cutaneous anthrax
cipro 500mg bid for 2 months
prochaska theory
change theory ( decision theory)
age 11 most children can understand abstract thinking
ie NP asks child about proverbs
hemoglobin males
14-17.4 g/dl
hemoglobin females
12-16 g/dl
hematocrit males
42%-52%
mcv
80-100
rdw
> 15%
platelet
> 140,000 increased risk for bleeding
reticulocytes
.5-1.5% of red blood cells (increased in acute bleed). starting tx for vitamin def (iron, b12, folate)
neutrophils
> 50%= increased risk for bacterial infection
band forms (immature abc)
> 6%,increased risk for bacterial infection. aka “shift to the left)
eosinophils
> 3% (increased in allergies)
TSH
> 5.0 (hypo)
psa
> 4 (BPH, prostate cancer)
ferritin
ESR (sed rate)
elevated in RA, lupus, temporal arteritis
potassium
3-5
primary prevention
anything “that will prevent the disease or social condition”
ex: youth violence, safety promotion, immunizations, spf, lifestyle, osha laws
secondary prevention
“screening” for disease;
cbc for anemia, tsh for thyroid, uspstf, suicide risk assessment, depression assessment, cancer tests (bse, gse)
tertiary prevention
limiting harm
ie:exercise for obese patient supports groups (AAA), rehab (PT, OT, speech therapy)
microscopy for candidiases
large number of WBC, psuedohyphae, spores ( spaghetti and meatballs)
1st line for CAP
macrolides
s/e ca channel blocker
swollen ankles/headache
s/e of diuretics
hyperuricemia, hyperglycemia
s/e bb
depression and fatigue
highest prevalence of cancer
skin cancer (basal cell)
highest mortality of cancer (both sexes)
lung
disease causing most deaths overall
heart disease
most common gyn cancer
uterine
tarus palatinus
benign bony growth midline of hard palate
leukoplakia
slow growing white plaque on the tongue or inside the mouth. considered precancerous legion dt poorly fitted dentures, tobacco. refer for biopsy
oral hairy leukoplakia
“PAINLESS” white corrugate patch associated with HIV and AIDS of the EBV
initial workup for ovarian cancer
intravaginal US and CA 125
risk factors for ovarian cancer
early menarche, late menopause, nulliparity, endometriosis, pcps, family hx, vrca1 and via 2 higher risk for BOTH breast and ovarian
breast cancer screen
50-74, every 2 years
cervical cancer
21-65, every 3 years
colon
50-75. fecal occult every year, sigmoidoscopy every 5 years, colonscopy q 10yrs
skin cancer counseling
spf 10a-3p
smoking cessation
ask all adolescents and adults
fall prevention
age 65+. recommend mod-int aerobic activity 150 min or 2/5 hours/week
high risk ovarian cancer
ashkenazi jew, brca gene, family history of 2 or more first or 2nd degree relative
AAA
one time screen for men 65-75 who are cigarette smokers. test is US of the abdomen
barretts esophagus
precancerous lesion of the esophageal. managed by gastroenterologists. tx is lifetime of PPI.
high risk for esophagus cancer
> 50yo, chronic GERD, smoker
s/s of gynecomastia
disc like breast tissue that is mobile, tender, and asymmetric
food interactions with tetracycline
dairy
high potassium content food (avoid in warfarin)
potatoes, apricots, brussel sprouts, banana, oranges, raisins, green veges
avoid what foods with warfarin
Vit K (kale, collard greens, broccoli)
migraine headaches and maoi avoid which foods
high tyramine ( cheese, lava beans, beer, wine, fermented foods)
maoi rx
marplan nardil, parnate
plant sterols that reduce LDL
benecol spread, wheat germ, sesame/corn oil, peanuts
magnesium
nuts, whole west, laxatives, antacids
iron
beef, liver, black eye peas
pityriasis rosea
maculopapular rash oval shaped with a herald patch ( xmas tree formation)
maculopapular rash in a lace like pattern
fifth disease, Fifth disease (also called erythema infectiosum) is caused by parvovirus B19. “slapped cheek”
classic location of scabies
finger webs, waist, penis. “excoriated pruiritic rash”. high risk group is health care worker, prison. Treat all family members, clean used clothes with hot water
scarlatina
sandpaper like texture, “strawberry tongue”, skin desquamination ( peeling) of the palms and soles. Not itchy .
Impetigo
initially appear as papules that develop into bullae. “weeping” rash with honey exdate. Very itchy
cutaneus larva migranes
red wavy lines, red, itchy. common locations are body exposed to contaminated soil, sand (soles of feet). Cutaneous larva migrans is a parasitic skin infection caused by hookworm larvae that usually infest cats, dogs and other animals. Humans can be infected with the larvae by walking barefoot on sandy beaches or contacting moist soft soil that have been contaminated with animal faeces
tx for cutaneus larva migrans
ivermectin once a day for 2 days or albendazole for 3 days
1st line for AOM and acute sinusitis in children and adults
amoxicillin. If recent antibiotics 3 mos or tx failture, 2nd line is augmenten bid or cefdinir (Omnicef) bid.
if PCN allergy, alternative is azithromycin (z pack) or clarithromiycin (niacin)
Best place to listen for s3
pulmonic area. s3 is pathognomic for heart failure
PPD
must have induration, not just “red” . Gold standard is sputum culture, Tx is with 3 anti tubercular drugs, base lie LFT level and follow up are recommended for pts on INH.
senile arcus or
arcus senilis
AOM or
purulent otitis media
Group a beta strep or
strep pyogenes
enterobiasis or
pinworms
b12 or
cobalamin or cyanocobalamin
scarlet fever or
or scarlatina
condyloma acuminata or general warts
or genetical warts
tic douloureux or
or trigeminal neuralgia
tinea cruris or
jock itch
giant cell arteritis
temporal arteritis
light reflex or
hirschberg test (test for strabismus)
sentinel nodes or
virchows nodes. Virchow’s node (or signal node) is a lymph node in the left supraclavicular fossa (the area above the left clavicle). 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.
erythema migraines or
lyme disease.
lyme disease
erythema migraines. Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. The two most-used antibody tests are the enzyme-linked immunosorbent assay (ELISA) and the Western blot
1st line for depression, OCD, generalized anxiety disorder, panic and social disorder, premenstrual mood
SSRI. ie fluoxetine or Prozac (pms), citalopram (celexa), escitalopram ( lexapro), fluoxetine (prozac), sertraline (Zoloft), paroxetine (Paxil)
TCA used for
depression, ocd ( 2nd line), migraine headache prophylactic, neuropathic pain. amitriptyline (Elavil), nortriptiline (Pamelor). Do not give to suicidal patients as they can hoard and OD (cardiac and CNS toxicity)
carbamazepine ( Tegretol)
anticonvulsants used for chronic pain and trigeminal neuralgia
1st line drug for HTN uncomplicated
Thiazide diuretic. TZD mech of action on the bone is decreases calcium excretion by the kidneys and stimulates osteoclast. Helps with bone formation
1st line drug for HTN in diabetic or renal disease
ace/arb
HTN pts with migraines or DM with no chronic lung disease best rx
BB (contraind in chronic long; asthma, COPD etc)
