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COM: PCM IV > Midterm Lectures > Flashcards

Midterm Lectures Flashcards

1
Q

When performing an internal bimanual exam on a female, it is important to move the cervix gently side to side and observe the pt for any expression of pain or discomfort. What can cervical motion tenderness suggest?

A

PID

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2
Q

What is Tinea Cruris?

A
  • fungal infection that affects the skin of your genitals, inner thighs, and buttocks
  • Causes an itchy, red, often-ring shaped rash in warm, moist areas of your body
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3
Q

At 65yo, cervical cytology can typically be discontinued, when is this not the case?

A

if the pt has a history of CIN2 or CIN3, then they need to continue pap for 20yrs after even it it extends >65yo

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4
Q

What allergens are mandatory to be listed on a food label?

A

milk
eggs
peanuts

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5
Q

What is the classic presentation of genital herpes?

A
  • single or clusters of vesicles on the genitalia

- may have burning, tingling and pain prior to vesicle appearance

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6
Q

What is the treatment for HSV-2?

A

Acyclovir

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7
Q

What immunizations should be given to women 19-39yo?

A
  • Tdap booster every 10yr
  • HPV -> one series for those who are not previously immunized between ages of 9-45
  • influenza annually
  • MMR and varicella if not previously immunized
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8
Q

What is Vernix?

A
  • white cheesy stuff that babies have all over (esp inguinal/axillary), appears about 35wks and may be gone at 41 weeks

**Long nails, lack of vernix, peeling/dry skin = signs of post-maturity

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9
Q

What are Epstein pearls?

A

epithelial cysts made of collagen that are found in the mouth

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10
Q

____________ is a potential peripheral complication of IV therapy that presents with pain, increased skin temp and redness

A

Phlebitis

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11
Q

What routine lab tests should you run on women age 65yo and older?

A
  • bone mineral density screening no more than every 2 yrs unless they have new risk factors
  • lipid profile assessment every 5yrs starting at 45yo
  • mammography annually
  • TSH every 5yrs beginning at 50yo
  • diabetes testing every 3 yrs after 45yo
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12
Q

What are the sources of niacin?

A

meats, poultry, fish
legumes
wheat
synthesized in body from tryptophan

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13
Q

What nutrients are affected by tetracyclines?

A

Ca
Mg
Fe
Vitamin B12

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14
Q

What gynecological labs should be done periodically for women 13-18yo?

A
  • chlamydia and gonorrhea if sexually active -> urine based screening is an efficient method without a speculum exam
  • HIV if sexually active
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15
Q

What is the classic presentation of Gonorrhea in men vs women?

A
  • men = penile discharge and dysuria or can be asymptomatic
  • female = pelvic pain or mucopurulent vaginal discharge

**Can cause in fiction of urogenital, anorectal or pharyngeal infections

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16
Q

What nutrients are affected by neomycin and kanamycin?

A

fat-soluble vitamins

Vitamin B12

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17
Q

Albumin <3.5 is considered to indicate a ___________________ response

A

Mild systemic inflammatory response

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18
Q

The ACOG recommends the initial visit to the OB/GYN for screening and the provision of preventative health care services and guidance to take place between the ages of ___-___

A

13-15 -> just gathering a hx, only do pelvic exam if indicated by hx (vaginal d/c, menstrual do, pelvic pain, STIs can be tested by urine)

**the major things you want to get from this appt are FH, tobacco, alcohol and other drug use, sexual abuse

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19
Q

What is Naegeles rule?

A

It establishes the estimated date of confinement (EDC) AKA the due date -> subtract 3mo and add 7 days to LMP or add 9mo and 7days

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20
Q

What is the treatment for syphilis?

A

Penicillin

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21
Q

What are the components of 0.9% NaCl and is considered isotonic, hypotonic or hypertonic?

A
  • Na and Cl -> 154 mEq/L

- isotonic (osmolality 250-375) -> 308

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22
Q

Why vitamin K is injected and topical erythromycin ophthalmologic ointment is applied immediately after birth

A

a. Vitamin K = to prevent hemorrhagic disease of the newborn bc newborns are born with low levels of vitamin K
b. Topical erythromycin ophthalmologic ointment = prevention of gonococcal conjunctivitis; less against chlamydia

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23
Q

How long does it take for a vitamin B12 deficiency to develop?

A

may take 3-6yrs after GI abnormalities develop

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24
Q

____________ is a potential peripheral complication of IV therapy that is defined as leakage of IV solution or medication into the extravascular tissue

A

Infiltration

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25
Q

What is the most common solid tumor among males 15-34yo?

A

testicular cance r

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26
Q

What are the 2 specific questions you should ask to every pt in every office visit to assess for depression?

A
  • During the past month, have you been bothered by feeling down, depressed or hopeless?
  • during the past month, have you been bothered by little interest or pleasure in doing things?

**Yes to these questions prompts a more detailed questionnaire -> Patient Health Questionnaire-9 (PHQ-9)

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27
Q

What nutrients are affected by hypolipidemics such as cholestyramine or colestipol?

A

fat and fat-soluble vitamins

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28
Q

Differentiate between the presentations assoc with the various stages of syphilis

A
  • primary = chancre
  • secondary = joint pains, fatigue, LAD, maculopapular rash
  • latent phase = may be asymptomatic
  • tertiary = neurosyphilis (confusion, HA, stiff neck, vision loss)
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29
Q

What nutrients are affected by sulfa drugs?

A

Folate

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30
Q

What is urge incontinence?

A
  • detrusor muscle overactivity, leading to uninhibited (involuntary) detrusor muscle contractions during bladder filling
  • detrusor muscle under activity or bladder outlet obstruction
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31
Q

5 clinical components of the APGAR score (all get a score of 0-2, w/7-10 being normal)

A

a. HR
b. Respiratory Effort
c. Muscle Tone
d. Reflex Irritability
e. Color

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32
Q

What is Central Cyanosis?

A
  • bluish discoloration of tongue/mucus membranes

- Persisting after the first 10 mins of life is always abnormal -> think cardiac dz/pulmonary dz

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33
Q

What are the risk factors for osteoporosis?

A
  • white females
  • older white males
  • postmenopausal females
  • certain chronic medical conditions
  • certain medications
  • vitamin D deficiency
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34
Q

What is a Omphalocele?

A

abdominal wall defect where the gut comes through the umbilical cord and is covered with amnion and peritoneum

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35
Q

_______ is the term used for a woman who is or has been pregnant

A

Gravid

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36
Q

What are the 2 maneuvers used to examine the hips in a newborn baby?

A

Ortolani and Barlow

**Assess for dysplasia of the hip which is more common in females, if there are CNS abnormalities, or with breech presentation

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37
Q

Name the one common hypotonic solution

A

0.45% normal saline

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38
Q

What is the treatment for epididymitis?

A
  • single intramuscular dose of ceftriaxone with 10 days of oral doxycycline is the tx of choice for sexually active males 14-35
  • ceftriaxone with 10 days of oral levofloxacin or ofloxacin is recommended for men who practice insertive anal intercourse
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39
Q

What is the Hegar’s sign?

A

in pregnancy the uterine consistency becomes softer and you may be able to palpate between the cervix and fundus -> this is the Hegar’s sign

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40
Q

What are the high risk factors for osteoporosis that would require a woman to get diabetes testing prior to 45yo?

A
  • BMI >25
  • First degree relative with DM
  • High risk race (native american, Latuba)
  • prior birth > 9lbs
  • history of gestational DM, PCOS
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41
Q

What nutrient deficiencies cause pallor?

A

Fe
Vitamin B12
Folate

**these also cause conjunctiva pallor

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42
Q

What are the sx of protein deficiency?

A
  • dry and scaly, cellophane appearance of skin
  • interosseous muscle atrophy, squaring off of shoulders, poor hand grip and leg strength
  • parotid enlargement
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43
Q

Small, shallow, painless, genital or rectal papule or ulcer with no induration and unilateral tender inguinal or femoral LAD is indicative of what STI?

A

LGV

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44
Q

What are the sx of Vitamin A deficiency?

A
  • follicular hyperkeratosis of the skin
  • night blindness
  • Xerosis, keratomalacia, bitot spots -> all of the eyes
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45
Q

Explain Milia

A

1-2mm white, firm papules on the face and bridge of the nose that appear at 36 wks gestation and resolve spontaneously by a few months

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46
Q

How do you calculate the percent weight change of someone?

A

Their usual weight - current weight then divided by their usual weight x 100

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47
Q

Explain the sizing and usage of IV needles

A
  • *The smaller the number, the bigger the needle/tubing**
  • 22 gauge = children and older adults; slow infusions
  • 20 gauge = crystalloid infusion for maintenance
  • 18 gauge = fluid resuscitation or blood transfusion
  • 16 gauge = fluid resuscitation or blood transfusion
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48
Q

St. Johns wart should not be combined with what type of antipsychotic?

A

SSRI’s -> serotonin syndrome

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49
Q

T/F: the acute phase reactants transferring and prealbumin are reliable tools in the assessment of nutritional status

A

FALSE! Transferring and prealbumin have not been found to be reliable tools int he assessment of nutritional status!

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50
Q

What are the components of a discharge summary?

A
  • onsultants
  • procedures w/dates
  • pertinent H&P details
  • Course -> brief summary of hospital course, tax and progress during stay
  • discharge condition
  • disposition -> home, skilled nursin, rehab center, etc
  • meds
  • follow-up -> who, when and why
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51
Q

How often should women 40-64 get clinical breast exams?

A

Yearly

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52
Q

Who needs a geriatric assessment?

A

> 65yo along with..

  • chronic comorbid conditions
  • cognitive changes
  • high health care utilization
  • change in living situation, risk of fall or functional status change
  • polypharmacy
  • change in health like weight loss, etc
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53
Q

Normal number of arteries and veins in an umbilical cord

A

2 arteries and 1 vein

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54
Q

When does the ACOG and ACS recommend clinical breast exams for women?

A
  • every 1-3yrs for women 20-39yo

- every year with annual mammograms for women >/= 40yo

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55
Q

When can chemoprophylaxis for breast cancer be done?

A

For high risk women aged 35yo or older

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56
Q

____________ is a potential peripheral complication of IV therapy that is defined as inflammation of a vein

A

Phlebitis

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57
Q

What nutrient deficiencies cause glossitis?

A 
riboflavin
niacin 
B vitamins 
Fe
Folate
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58
Q

Low-fat means ___g of fat or less per serving

A

3g

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59
Q

___________ is a painless cystic mass separate from the testis located superior and posterior to the testis

A

spermatocele

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60
Q

What immunizations should be given to women age 65yo and older?

A
  • herpes zoster if not already
  • Tdap booster every 10yrs
  • influenza annually
  • pneumococcal vaccine once at 65yo or older
  • varicella vaccine if no immunity
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61
Q

What nutrients are affected by laxatives such as mineral oil?

A

water
electrolytes
fat
fat-soluble vitamines

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62
Q

Isotonic solutions are the best choice with normal saline preferred. However, during high volume resuscitation with NaCl, its possible to overload the Cl and induce a _____________________ metabolic state

A

Hyperchloremic metabolic acidosis (NAGMA)

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63
Q

What is overflow incontinence?

A

continuous urine leakage due to incomplete bladder emptying

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64
Q

Is the cremaster reflex present or absent with testicular torsion?

A

typically absent

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65
Q

How do you calculate BMI?

A

weight (kg)/height (meters)

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66
Q

What are the components of D10W and is considered isotonic, hypotonic or hypertonic?

A
  • glucose (double the amount of D5W) -> 100g/L

- hypertonic (osmolality >375) -> 505

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67
Q

What are the sx of Zn deficiency?

A
  • Flaking dermatitis
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68
Q

what is the classic presentation of acute orchitis?

A
  • sudden onset of testicular pain and high fever

- nausea and vomiting are common

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69
Q

What nutrients are affected by diuretics such as thiazides and furosemide?

A

K
Mg
Ca
Zn

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70
Q

How does the treatment differ between phlebitis, infiltration and extravasation?

A
  • D/C IV line for all
  • use moist warm compress for phlebitis and infiltration but a cool compress for extravasation
  • elevate extremity for filtration
  • administer antidote if one exists for extravasation
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71
Q

Expected daily weight gain after the first week of birth

A

15-30g/day**

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72
Q

Age at which the majority of newborns regain their birth weight

A

10-14 days

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73
Q

What are the high risk factors for osteoporosis that would require a woman to get mammograms prior to 40yo?

A
  • hx of breast cancer or FH of relatives who have hx of premenopausal breast or breast and ovarian cancers
  • positive for BRCA 1 or 2 mutations
  • hx of high-risk breast biopsy results (atypical hyperplasia and lobular carcinoma in situ)
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74
Q

What immunizations should be given to women 13-18yo?

A
  • Tdap vaccine booster once between ages of 11-18
  • HPV -> one series for those who are not previously immunized between ages of 9-45 (Gardasil 9 is the newest most broad coverage one)
  • MMR and varicella if not previously immunized
  • Influenza annually
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75
Q

What nutrients are affected by lithium and amiodarone?

A

Iodine

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76
Q

List sources for vitamin A

A 
milk 
fish oil
liver
eggs
carrots
squash 
greens
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77
Q

What are the sources of vitamin B12?

A

eggs
dairy products
meats, liver

NONE in plants

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78
Q

What is the cause of presbycusis?

A
  • loss of cochlear hair cells and ganglion cells in the vestibulocochlear nerve.

**Consider reviewing med list for ototoxicity

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79
Q

What labs should be routinely done on women 40-64yo?

A
  • HIV
  • Lipid profile assessment every 5 yrs starting at 45yo
  • mammography yearly after 40yo
  • TSH every 5yrs starting at 50yo
  • diabetes testing every 3yrs starting at 45yo
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80
Q

What are the components of 3% NaCl and is considered isotonic, hypotonic or hypertonic?

A
  • Na and Cl -> 513 mEq/L

- hypertonic (osmolality >375) -> 1026

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81
Q

Name the 4 common hypertonic solutions

A

3% saline
D5NS
D5LR
D10W

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82
Q

What immunizations should be given to women 40-64yo?

A
  • Tdap booster every 10yrs
  • influenza annually
  • HPV between 9-45 if not already
  • MMR and varicella alone if not already
  • varicella zoster if 60yo or older**
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83
Q

What are the complications of untreated gonorrhea?

A
  • PID

- fertility issues due to scarring of the fallopian tubes

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84
Q

It is Important to examine the lumbosacral spine in every infant. What can a dimple indicate?

A

a. possible “spinal dysraphism” (tethered cord); should US by 3 mos

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85
Q

What 2 STI’s most commonly cause painless genital ulcers and how can you tell them apart?

A

Syphilis and LGV -> LGV is assoc with inguinal or femoral LAD (groove sign)

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86
Q

What is the treatment for urge incontinence?

A
  • fluid restriction
  • kegels
  • pessary
  • beta-agonist
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87
Q

What are the only vitamins required by law to be listed on a food label?

A

Vitamin A
Vitamin C
Calcium
Fe

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88
Q

What are the sources of saturated fats and trans fats?

A
  • animal fats: meat, butter, whole milk, etc
  • solid fats: margarine
  • coconut & palm kernel oils
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89
Q

Trans fat free means the food has less than ____g trans fat per serving.

A

0.5

**This can still add up!

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90
Q

What should you be concerned for with post-coital versus post-menopausal bleeding?

A
  • postcoital = cervical cancer

- postmenopausal = endometrial/uterine cancer

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91
Q

When can cervical cytology be discontinued in women?

A

In women age 65yo or older who have no history of CIN 2 or higher, 3 consecutive negative prior cytology results, or 2 consecutive negative co-tests pithing the previous 10yrs

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92
Q

____________ is a potential peripheral complication of IV therapy that occurs when the IV catheter becomes dislodged and medication infuses into the tissues

A

Extravasation

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93
Q

What nutrient deficiencies cause tetany?

A

Ca

Mg

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94
Q

Vitamin A is worse with what types of conditions?

A

those that have fat malabsorption

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95
Q

Explain a Caput Succedaneum

A
  • blood that gets between the scalp and the periosteum so it can flow ACROSS suture lines
  • Looks like a boggy area of edema and/or bruising
  • present at birth and gone in days
  • generally DOESN’t enlarge
How well did you know this?
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2
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4
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96
Q

What does G4P2113 mean?

A

She has been pregnant 4 times, has had 2 term births, 1 preterm birth, 1 abortion, 3 living kids

97
Q

A single, painless, well-demarcated ulcer (chancre) is indicative of what STI?

A

Syphilis (primary)

98
Q

T/F: the cremasteric reflex is present with scrotal abscesses

A

True

99
Q

What is considered “significant” weight loss?

A

Unintentional weight loss of 5% over 6mo or 10% over one year

100
Q

Who should be screened for osteoporosis and how should this be done?

A
  • DEXA scan for women 65yo or older

- screening women <65yo whose 10yr fracture risk is high -> use FRAX fracture risk assessment tool

101
Q

What are the components of D5W and is considered isotonic, hypotonic or hypertonic?

A
  • glucose

- isotonic (osmolality of 250-375) -> D5W is 278

102
Q

List the classes of medications to be cautious of in geriatric pts

A
  • opioids
  • benzos
  • antidepressants
  • hypnotics
  • antipsychotics
  • antihistamines
  • glaucoma agents
  • NSAIDS
  • Muscle Relaxants
103
Q

What are the components of 0.45% NaCl and is considered isotonic, hypotonic or hypertonic?

A
  • Na and Cl -> 77mEq/L

- hypotonic (osmolality <275) -> 154

104
Q

What are the components of Lactated ringers and is considered isotonic, hypotonic or hypertonic?

A
  • Na, Cl, K, Ca

- isotonic (osmolality 250-375) -> 274

105
Q

What is a chloasma?

A

pigmentation over the bridge of the nose and under the eyes that may be a sign of pregnancy

106
Q

What is Acrocyanosis?

A
  • blue discoloration of the perioral area, feet and hands

- Normal for the first 24hrs, closely assoc w/cold surroundings, perioral changes seen w/sucking/feedings

107
Q

Explain Erythema toxicum

A
  • AKA flea-bite syndrome
  • Benign rash of the newborn that usually appears on day 2-3
  • Erythematous base with 1-2mm pustules or papules; spares palms & soles
  • Pustule/vesicles contain debris and eosinophils
108
Q

Fat free means the food has less than ____g of fat per serving

A

0.5g

109
Q

How do you calculate caloric need?

A
  • 3 components of total energy expenditure = basal energy expenditure, thermal effect of feeding, and activity energy expenditure
  • in a sedentary hospitalized pt, 30-35 kcal/kg of body weight will maintain weight
  • acutely or severely ill pts (trauma, burn pt, etc) may require 35-40Kcal/kg
110
Q

If a solid intra-testicular mass is discovered, __________ is both diagnostic and therapeutic

A

orchiectomy

111
Q

What does the vaginal discharge from a yeast infection look like?

A

white adherent discharge

112
Q

What does the vaginal discharge from a Bacterial vaginosis infection look like?

A

foul smelling thin grey homogenous discharge

Most common type of vaginal infection

113
Q

________ disease is the development of fibrous scar tissue inside the penis that causes curved, painful erections

A

Peyronies disease

**sx may appear suddenly or develop gradually typically due to trauma

114
Q

Explain when cervical cytology should be done on women and when co-testing of HPV should be done

A
  • 21-29yo = screen every 3yrs w/cytology alone

- >/= 30yo = screen every 3yrs w/cytology alone & co-test with cytology and HPV every 5yrs

115
Q

What are the STOPP and START criteria for elderly medications?

A
  • STOPP = Screening Tool of Older Person’s Prescriptions -> similar to Beers criteria but also includes drug-drug interaction and duplication of drugs within class
  • START = screening tool to alert doctors to the right treatment -> consists of 22 evidence based prescribing indicators in older persons
116
Q

What is the classic presentation of chlamydia in men vs. women?

A
  • men = penile discharge, pruritus, dysuria
  • female = vaginal discharge, vaginal bleeding or pain during intercourse (dyspareunia), dysuria

**Can cause infection of urogenital, anorectal, conjunctival (neonatal), or pharyngeal infections

117
Q

Fluid resuscitation includes dehydration, hypovolemia or shock (any type). During fluid resuscitation, the goal is to keep fluids within the intravascular space. ____________ solutions are the best choice, with ____________ being the preferred one

A

Isotonic solutions are the best choice with normal saline preferred

118
Q

Albumin <2.4 represents a _________________ response

A

severe systemic inflammatory response, reflecting systemic inflammation that produces anorexia and increases protein catabolism and thus accelerates the development of protein-calorie malnutrition

119
Q

____________ is a potential peripheral complication of IV therapy that presents with pain, stinging, burning, swelling, and redness at the injection site

A

Extravasation

120
Q

What are the components of a hospital progress note?

A
  • Date and time
  • Subjective -> update all info that has occurred since last evaluation including overnight events, new or different concerns
  • Objective -> VS, focused PE, new labs or imaging results
  • Assessment -> update of current problems, new problems
  • Plan -> to changes, radiographic or labs needed, discharge plan
121
Q

What does testosterone supplementation cause and increased risk for in men?

A

prostate adenocarcinoma -> testosterone supplementation in men with hypogonadism improves ED and libido but requires interval monitoring of hemoglobin, serum transaminases and PSA levels

122
Q

What is the tx for tinea cruris?

A

topical anti fungal for up to 4 weeks

123
Q

What is the classic presentation of prostatitis?

A
  • painful ejaculation, hematospermia, and painful defecation
  • acute onset of irritative or obstructive voiding sx
  • pt may report suprpubic, rectal or perineal pain
124
Q

What are sx of niacin deficiency?

A
  • pigmentation changes of the skin
  • glossitis
  • angular stomatitis
  • Cheilosis
125
Q

Routine delivery room care of a healthy, term infant

A

Warming, Drying, Clearing of airways

126
Q

Explain a Cephalohematoma

A
  • blood under the periosteum between the periosteum and bone; DOESN’T cross suture lines
  • May be b/l
  • inc in size after delivery; may be tense or fluctuant; can mimic fracture on X-ray
  • resolves in wks to mos
127
Q

what is the classic presentation of epididymitis?

A

gradual onset of scrotal pain with fever, urethral discharge, and urinary sx

128
Q

At what age is it appropriate to start asking women about a history of pelvic prolapse?

A

65yo

129
Q

What nutritional deficiencies can be determined from a CBC?

A

Fe
B12
Folate

130
Q

What does Ginkgo Biloba supplementation increase the risk of?

A

bleeding

131
Q

What are the high risk factors for osteoporosis that would require a woman to get bone mineral density scans younger than 65yo?

A
  • hx of fractures
  • body weight less than 127lbs
  • medical causes of bone loss such as meds or diseases (RA)
  • current smoker or alcoholic
132
Q

Multiple vesicular lesions that rupture and become painful, shallow genital ulcers are indicative of what STI?

A

HSV

133
Q

What is the tx for stress incontinence?

A
  • fluid restriction
  • pelvic floor exercise (kugels)
  • anticholinergic meds
134
Q

_______ is the term used for a woman who is in or who has experienced her first pregnancy

A

Primagravida

**Multigravida is used for women who have been pregnant more than once

135
Q

What tests should be run for dx of genital ulcers?

A
  • serologic tests (VDRL or RPR) for syphilis and darkfield microscopy or direct fluorescent Ab testing for Treponema pallidum
  • culture or PCR test for HSV
  • culture for H. Ducreyi in settings with a high prevalence of chancroid
136
Q

Define free water

A

Water not bound by macromolecules. When applied to IV fluids, will cause a shift of fluids into the cells (ICF) from the vascular space (ECF)

137
Q

What is the average age of menarche and what is considered primary amenorrhea?

A
  • 12-13yo

- primary amenorrhea = if pt hasn’t cycled at 16yo

138
Q

What is the daily salt recommendation?

A

less than 2,300mg/day

**A diet that sticks to this recommendation = dash diet

139
Q

What is the management for osteoporosis?

A
  • lifestyle change: fall prevention, smoking cessation, moderation of alcohol intake
  • bisphosphonate therapy
  • hormone therapy
140
Q

What are the 2 tools for assessment of balance problems in geriatric pts to be able to intervene to prevent falls and fall related injuries?

A
  • Tinetti Balance and Gait Evaluation

- Get Up and Go Test

141
Q

What certain screenings can be stopped in a geriatric pt unless the pt has 10 or more yrs life expectancy left?

A
  • colonoscopy stopped after 75yo
  • pap smear after 65yo
  • mammogram after 65yo
142
Q

How do you calculate body water deficit?

A

(0.6 x weight (kg) x (pt Na - 140))/ 140 -> answer will be in L

143
Q

What type of paresthesias are common with niacin deficiency?

A

burning paresthesias

144
Q

Choanal atresia is associated with __________________

A

CHARGE syndrome

145
Q

What nutrient deficiencies cause spooning of the nails?

A

Fe

146
Q

What factors put you at risk for HPV infection?

A
  • under 30yo
  • smokers
  • weakened immune system
  • hx of child abuse
  • children of a mother who had the virus during childbirth
147
Q

Who should be screened for prostate cancer?

A

men 55-69 who know the benefits and harms of measuring PSA levels -> individualized decision

148
Q

____________ is a potential peripheral complication of IV therapy that has the common PE findings of skin blanched, tight/leaking, bruised, swollen, edema, pitting and pain

A

Infiltration and extravasation both have these PE findings

149
Q

Older adults should be screened for nutritional status using the acronym __________

A

DETERMINE:

  • Disease
  • Eating poorly
  • Tooth loss/mouth pain
  • Economic hardship
  • Reduced social contact
  • Multiple medications
  • Involuntary weight loss
  • Need for assistance with self-care
  • Elderly years = >80yo
150
Q

____________ fluids such as ___________ increase mortality and are not recommended for volume resuscitation

A

Colloids such as HydroxylEthyl Starches (HES)

151
Q

What are sx of vitamin C deficiency?

A
  • petechiae and purpura
  • bleeding gums
  • corkscrew hairs
152
Q

Reduced sodium diet is considered at least _____% sodium than in the original product

A

25% sodium

153
Q

What strain of HSV causes genital warts?

A

HSV-2

154
Q

What are isotonic solutions used for?

A
  • maintenance fluids or resuscitation
155
Q

Explain the T-score assoc with osteoporosis

A
  • normal = spinal or hip BMD with 1SD below the young adult female -> T-score >/= 1
  • low bone mass (osteopenia) = spinal or hip BMD between 1-2.5SD below the young adult female reference mean -> T-score -2.5
  • osteoporosis = spinal or hip BMD >/= 2.5 SD’s below the young adult female reference mean -> T-score = -2.5
  • severe/established osteoporosis = BMD >/= 2.5SD’s below the young adult female reference mean and the presence of one or more fragility fractures
156
Q

T/F: A sudden collection of fluid in the scrotum can be a sign of cancer

A

True

157
Q

When does the ACOG recommend beginning pelvic exams for women?

A

at 21yo

158
Q

What populations are most at risk for malnutrition?

A
  • older persons who live alone
  • chronically ill pts (renal failure, CHF, COPD, celiacs)
  • adolescents who eat and diet erratically
  • cancer pts undergoing chemo or radiation
  • drug interactions
  • alcoholics
  • homelessness, low socioeconomic status
159
Q

What are the 2 useful scales for assessing the functional ability (ADL’s) of geriatric pts?

A
  • Katz Index if Independence in Activities of Daily Living

- Lawton Instrumental Activities of Daily Living Scale

160
Q

What are the three major categories of the beers criteria?

A
  • medications to always avoid for older pts
  • medications that are potentially inappropriate for older pts with certain medical conditions
  • medications used with caution
161
Q

What vaccinations should you make sure pts over 65 are up to date on?

A
  • tetanus or tetanus w/pertussis vaccine
  • influenza vaccine
  • pneumococcal vaccine
  • herpes zoster vaccine
162
Q

How do you test cervical discharge for gonorrhea/chlamydia?

A

with a gee-probe which is a swab that is inserted into the cervical os for 45 sec (keep in for the full 45 sec)

163
Q

What is a Gastroschisis?

A

abdominal wall defect where the gut comes out just to the right of the belly button usually and its just bare gut and bowel with nothing covering it

164
Q

What complications are assoc with genital warts from HPV?

A
  • most lesions are self-limited

- high risk strains can lead to cancer of the oropharyngeal region or lower genital tract

165
Q

What is the treatment for overflow incontinence?

A

Indwelling urethral catheter

alpha-adrenergic antagonist

166
Q

What complications are assoc with HSV-2?

A

meningitis
PID
hepatitis
inc risk of HIV infections (possible due to open sores)

167
Q

When should women begin getting colorectal cancer screenings?

A
  • beginning at age 50
  • african americans begin screening at 45yo bc of inc incidence and earlier onset of colorectal cancer

**colonoscopy every 10yrs is the preferred method

168
Q

_________ is a testicular mass most commonly on the left side that lays posterior to and above the testis. The classic description is a “bag of worms”

A

varicocele

169
Q

Who should be screened for testicular cancer?

A

only symptomatic men

170
Q

What are the sources of poly & mono-unsaturated fats?

A
  • seafood: omega-3 fats
  • sunflower, corn, olive, soybean and cottonseed oils
  • Walnuts, pine nuts
  • sesame, sunflower, pumpkin and flax seeds
171
Q

________ is the term used for a woman who has given birth to one child

A

Primapara

**Multipara is used for a woman who has given birth multiple times

172
Q

Define Molding

A

the shaping of the fetal head to allow it to pass through the birth canal during childbirth

173
Q

What do the numbers after parity mean?

A

number of term births (37-42wks), preterm births (20-36+6 wks), abortions (before 20wks), living kids

174
Q

____________ is a potential peripheral complication of IV therapy that presents with edema, pallor, decreased skin temperature and pain

A

Infiltration

175
Q

What ethnicities are at particular risk for obesity?

A

Minority populations with African Americans and Mexican Americans being most at risk

176
Q

________ and __________ are the primary pathogens identified in men with urethritis

A

C. trachomatis and N. gonorrhoeae

177
Q

Explain the mediterranean diet

A
  • plant based: fruits, veggies, nuts, grains, seeds, beans, and olive oil
  • eggs, dairy, poultry, and fish are eaten several times/weeks but portions are small
  • minimal intake of red meat, refined sugar, flour, butter and fats (except for olive oil)
  • 1-2 glasses of red wine/day
178
Q

salt/sodium free diet means less than ____mg of sodium per serving

A

5mg

179
Q

Who falls under the level A recommendation for STI screening?

A
  • persons at risk

- pregnant women

180
Q

When should routine chlamydia and Gonorrhea testing be done?

A
  • if aged 25yo or younger and sexually active
  • 26yo and older who are at high risk should be screened routinely

**always screen for HIV

181
Q

What should men presenting with urethral sx be examined for?

A
  • inguinal LAD, ulcers or urethral discharge
  • palpation of the scrotum for evidence of epididymitis or orchitis is advised
  • DRE of the prostate may be considered esp in older pts or if rectal pain is reported
182
Q

Where is vitamin B12 absorbed?

A

In the distal ileum after binding to gastric intrinsic factor

**Deficiency is more common with GI abnormalities like celiac disease, pancreatic disorder, atrophic gastritis

183
Q

Currently, how is urethritis reported?

A

by at least one of the following

  • presence of urethral discharge
  • positive leukocyte esterase test result in first-void urine
  • at least 10 WBC’s per high-power field in first void urine sediment
184
Q

What is the classic presentation of HPV warts?

A

genital warts -> papules, cauliflower-like lesions or flat

185
Q

What are crystalloids and what are the 3 common crystalloid solutions?

A
  • solutions of salts and electrolytes used for volume expansion
  • includes NS, LR, D5W
186
Q

What is the BMI difference between obesity versus overweight?

A
  • obesity = BMI >/= 30 or waist circumference >40 in men and >35 in women
  • overweight = BMI 25-29
187
Q

_________ is a birth defect in which the opening of the urethra is on the underside/ventral surface of the penis instead of at the tip

A

Hypospadias

188
Q

What lab test is used to diagnose gonorrhea?

A

Nucleic acid amplification tests (NAAT)

189
Q

What nutrient deficiencies cause bleeding gums?

A

vitamin C

riboflavin

190
Q

Reduced fat or less fat means the food has at least ____5 less fat than the regular product

A

25%

191
Q

What is the function of a spatula versus cytobrush used in a pap smear?

A
  • spatula is used to gently scrape the ectocervix
  • cytobrush is then used to obtain endocervical cells

**wipe spatula on half the microscope slide and the cytobrush on the other half then send to the lab for testing

192
Q

What are the uses for a conventional slide versus liquid based prep for pap smear testing?

A
  • conventional slide is used for specimen for cytology
  • liquid based prep allows a single specimen to be used for cytology, HPV testing, evaluate ASCUS cytology and to test for gonorrhea and chlamydia
193
Q

What STI’s are required to be reported?

A

syphilis
gonorrhea
chlamydia
HIV

**HPV is the most common STI overall but not required to be reported

194
Q

If a male presents with scrotal pain, what condition is most likely?

A

Epididymitis

195
Q

What are hypertonic solutions used for?

A

Used with caution in extreme cases of hyponatremia (Na ~115). Must be done slowly with frequent sodium monitoring. May induce osmotic demyelination syndrome (locked-in syndrome), iatrogenic hypernatremia, fluid overload

196
Q

To what compartment do hypotonic solutions go?

A

They have an abundance of free water and do not stay in the vascular space. They will move into ICF causing them to reach a lower osmolality (cellular swelling)

197
Q

Dermal Melanosis AKA Slate Grey Spots

A
  • slate blue/grey or black macular to patch size benign spots formerly called “Mongolian Spots”
  • More common in darker skinned races but can affect all races
  • Those on the lower back/butt tend to resolve over several years
  • May resemble bruises and should always be documented -> Recommend to parents that they show them to new daycares, baby sitters, etc
198
Q

What is Fournier’s gangrene?

A
  • genital, groin or perineal involvement
  • polymicrobial cellulitis -> signs or sx of infection followed by suppuration and necrosis of overlying skin
  • non-sexually transmitted but assoc with/secondary to epididymitis
199
Q

What vitamin deficiency can cause impaired wound healing?

A

Vitamin C

200
Q

What does G3P0121 mean?

A

she has been pregnant 3 times, has had 0 term births, 1 preterm birth, 2 abortions, 1 living kid

201
Q

What are colloids and what solutions are common examples of this?

A
  • solutions that contain large molecules and provide oncotic pressure in addition to volume expansion
  • ex. Protein solutions such as albumin and non-protein solutions such as dextran and hydroxyethyl starch (HES)
202
Q

Where is the epididymis in relation to the testis?

A

posterior

203
Q

What is the classic presentation of testicular torsion?

A

young male with acute onset of unilateral scrotal pain

**Cremaster reflex is typically absent

204
Q

Bifid uvula can be indicative of a ____________________

A

SOFT PALATE CLEFT

205
Q

What on the abdomen during PE may be a sign of pregnancy?

A

Darkening of the linea nigra in the midline of the abdomen

206
Q

__________ and ___________ are the most common pathogens in sexually active males 14-35yo

A

Neisseria gonorrhea and chlamydia trachomatis

207
Q

What is the most common hearing condition in older pts?

A

presbycusis or age related sensorineural hearing loss

**Progressive symmetric loss of high frequency hearing

208
Q

Who are considered high risk individuals for contracting meningococcal and should therefore be sure to get vaccinated?

A
  • adults with anatomic or functional asplenia
  • first year college students living in dorms, military recruits
  • pts that are traveling to hyper endemic or epidemic areas
209
Q

Maximum acceptable weight loss in the week following birth

A

up to 10% is acceptable in most situations but 7% loss or greater demands close follow-up

210
Q

__________ is a collection of fluid in the testicle that presents as painless scrotal swelling that can be transilluminated. May worsen through the day

A

Hydrocele

**A new hydrocele or one that hemorrhages after minor trauma may signal cancer r

211
Q

__________ is a condition in which one or both of the testes fail to descend from the abdomen into the scrotum and is the MOST common male birth defect

A

Cryptorchidism

**“5 day old infant with absence of 1 testicle”

212
Q

What fungi cause tinea cruris?

A

Trichophyton rubrum or T. mentagrophytes

213
Q

_________ is a “3 yr warning for heart problems” in men

A

erectile dysfunction

214
Q

What does G3P1021 mean?

A

she has been pregnant 3 times, had 1 term birth, 0 preterm births, 2 abortions, 1 living kid

215
Q

What does the vaginal discharge from a Trichomonas vaginalis infection look like?

A
  • yellowish green discharge and punctate hemorrhages on ectocervix “strawberry cervix” are often noted
216
Q

What are the complications assoc with untreated chlamydia?

A
  • PID

- Fertility issues due to scarring of the fallopian tubes

217
Q

What is Mittelschmerz syndrome?

A

midcycle ovulatory pain

218
Q

light in sodium or lightly salted means at least _____% less sodium than the regular product

A

50% sodium

219
Q

What does a tight vs lax vs absent anal sphincter palpated on rectovaginal exam tell you?

A
  • tight sphincter = scarring, fissures, inflammation
  • lax sphincter = neuro deficit
  • absent sphincter = secondary to improper repair of 3rd/4th degree laceration from childbirth
220
Q

What nutrients are affected by cytotoxic agents such as methotrexate?

A

Folate

221
Q

How do you calculate the maintenance fluid?

A

80+ 1ml for each >30kg

Ex. 70kg person = 120ml/hr

222
Q

What vitamin deficiencies cause angular stomatitis and cheilosis?

A

riboflavin
pyridoxine
niacin

223
Q

Name the 3 common isotonic solutions

A

0.9% NS
D5W
Lactated ringers

224
Q

What nutritional deficiencies can be determined from a TSH level?

A

Iodine

225
Q

What should all men with erectile dysfunction be tested for?

A

cardiovascular risk factors -> ED sx present on average 3yr before CAD sx -> initial workup should be limited to glucose, lipids, TSH, and testosterone

**men with ED are at inc risk of coronary, cerebrovascular and peripheral vascular diseases

226
Q

What is the clinical presentation of presbycusis?

A
  • hearing loss along with tinnitus

- vertigo and feeling off balance

227
Q

If a male presents with urethral discharge and no scrotal pain, what is most likely?

A

urethritis

228
Q

What are the risk factors assoc with testicular cancer?

A 
cryptorchidism
personal or family hx of testicular cancer
age
ethnicity
infertility
229
Q

Differentiate between gravidity vs. parity

A
  • gravidity = number of times a women has been pregnant

- parity = number of pregnancies that led to a birth at or beyond 20 weeks or of an infant weighing more than 500g

230
Q

What lab test is used to diagnose chlamydia?

A

Nucleic acid amplification tests (NAAT’s)

231
Q

____________ is a potential peripheral complication of IV therapy that has the common PE findings of erythema, pain, red streak along vein, palpable venouse cord, and purulent drainage

A

Phlebitis

232
Q

Very low sodium diet means less than _____mg of sodium or less per serving

A

35mg

233
Q

Explain Supernumery nipples

A
  • inferior to true nipples and are more common in African Americans
  • In white pts they are assoc with renal anomalies such as hydronephrosis, hypoplasia, etc
  • Can occur anywhere along the mammary line
234
Q

A nonindurated painful genital ulcer with serpiginous border and friable base and unilateral inguinal LAD is indicative of what STI?

A

Chancroid (H. Ducreyi)

235
Q

What nutrients are affected by anticonvulsants such as phenobarbital or phenytoin?

A

Ca
Vitamin D
Folate
Niacin

236
Q

Pierre-Robin Sequence is associated with ___________**

A

MICROGNATHIA**

237
Q

Low sodium diet means _____mg of sodium or less per serving

A

140mg

238
Q

Where can reliable nutrition information be found for pt education?

A
  • academy of nutrition and dietetics
  • office of disease prevention and health promotion
  • health and human services
  • american academy of pediatrics
  • american heart association
  • american diabetes association
239
Q

What 3 things is vitamin C necessary for the biosynthesis of?

A

bile acids
collagen
norepinephrine

COM: PCM IV (3 decks)

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