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Hannah- PCM > PCM3 Final > Flashcards

PCM3 Final Flashcards

1
Q

___ women 2-3x higher UTI incidence (aside from frequent sexual activity, spermicide use with diaphragm)

A

diabetic women

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2
Q

MCC of spinal cord or caudal equine compression, associated sx

A

herniation of IV disc

-sx: LBP is 1st, followed by motor (weakness) and sensory findings, bowel/bladder sx are a late finding

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3
Q

___ case recognizes mature minors are owed confidentiality to there medical info

A

Gillick

>12 yo

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4
Q

which typical pneumonia is not an CAP and is commonly abx resistant

A

pseudomonas

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5
Q

any pts with sx of spinal cord or caudal equine compression or progressive and/or sever neuro deficits should have immediate _____ for further eval and ____

A

urgent MRI and urgent specialist referral

*pts at risk of metastatic cancer should also undergo immediate MRI

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6
Q

tx for acute bronchitis

A
  • usually self-limited
  • no viral cultures, sero test, or sputum test needed
  • no ABX unless risk pts with heart, lung, kidney dz, IC, CAP, or suspected pertussis, TB, or chlamhydia)
  • bronchodilators and antitussives are good for sx
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7
Q

most specific sign of acute cholecystitis if associated with gallstones

A

sonographic murphys sign (pain when transducer presses over GB)
-others: GB wall thickening, stone in GB neck, cystic duct not seen bc of obstruction

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8
Q

most common presentation of acute bronchitis (URI)

A
  • healthy adult with cough of 1-3 weeks
  • winter
  • unremarkable PE
  • purulent sputum
  • ***COLOR OF SPUTUM IS NOT DIAGNOSTIC OF THE PRESENCE OF BACTERIAL INFECTION
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9
Q

intersitial cystisis (aka ____ ____ ____) can be due to

A 
aka painful bladder syndrome 
(not acute infectious) 
-chronic infection 
-inflammation 
-unusal pain sensitivity 
-co-morbidiites
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10
Q

FFP and Prothrombin complex concentrate for INR___

A

INR >1.6

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11
Q

what is CURB -65

A

to aid in dx of pneumonia

  • Confusion
  • Uremia >7
  • Respiratory Rate > 30
  • BP <90/60
  • age >65
  • *admit if greater than 1 (not equal to)
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12
Q

recurring UTI in post menopausal women related to

A
  1. history of UTIs premenopausal
  2. anatomic factors: cystoceles, urinicary incontinence, residual urine
  3. estrogen depletion effect on tissues
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13
Q

three major subtypes/complications of pyleonephritis

A
  1. papillary necrosis
    (due to obstruction, DM, Sickle Cell, analgesic nephropathy)
  2. emphysematous pyelonephritis
    (production of gas in nephritic and perinephric area, OCCURS ONLY IN DM PTS)
  3. xanthogranulomatous pyelonephritis
    (chronic obstruction, chronic infection, suppurative destruction of renal tissue, can lead to abscesses)
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14
Q

dx testing of pneumonia

A
  • leukocytosis with leftward shift (increased neutrophil band cells) or leukopenia
  • elevated ESR, CRP, procalcitonin
  • CXR is required for dx (+ infiltrates)
  • CT for IC pts
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15
Q

low esteem causes over confidence attitude and the need to try to be superior. vain, smug, arrogant. no close relationships, no friendly or warm. trys to “one-up” doctor. and seek the best provider (chief) will challenge authority and disregard advice. doctor should respond with respect and concern vs warmth

A

narcissistic

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16
Q

seeks unlimited self-interest, attention, care. demand urgent special attention and appear selfish. can become angry when needs aren’t met with satisfaction. problems: frustration trying to meet needs, rejection or distancing resulting in low productivity of interview

A

dependent pt

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17
Q

tx rhinosinusitis

A
  • amoxicilin and trimethoprim-sulfamethoxazole 10-14 days = first line tx
  • oral and nasal decongestants provide sx relief BUT DO NOT EXCEED 3 DAYS to prevent rebound vasodilation and worsening sx
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18
Q

dx of rhinosinusitis

A

purulent nasal discharge, maxillar/dental/facial pain, unilateral maxillary sinus tenderness, worsening sx after initial improvement

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19
Q

isoniazid affect what nutrients

A

B6 (pyridoxine)

B3 (niacin)

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20
Q

when is HCV screen recommended for fatigue cases

A
  1. IVDA hx
  2. men who have sex with men
  3. born between 1945-1965 (55-75 yo )
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21
Q

avoid feelings to others. isolated, unsociable. overly sensitive, fragile. poor/need social services. doctor should not permit patient to withdraw, and maintain an interest that is quiet and reassuring

A

schizoid

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22
Q

how to screen older adults for nutritional status

A

DETERMINE

  • disease (making it hard to cook, shop, or eat)
  • eating poorly (too much or little)
  • tooth loss of mouth pain
  • economic influence (cheap unhealthy food)
  • reduced social contact (lonely)
  • multiple meds
  • involuntary wt loss
  • need for assistance
  • elderly (>80 yo = elderly)
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23
Q

when to our a CT scan of the abdomen and pelvis without contrast? with IV contrast only? with IV and oral Contrast?

A

without: (stones) ureterolithiathisis
IV only: ab trauma (gold standard, > US FAST scan)
IV and oral: bowel pathology, solid organ pathology, vascular pathology, cancer, BEST TEST FOR UNDIFFERIENTIATED AB PAIN (must confirm good kidney fxn before giving IV dye)

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24
Q

when to use platelets

A

stop active bleeding or prevent spontaneous bleeding in case of thrombocytopenia

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25
Q

male UTI RF

A

prostate hypertrophy

non-circumcised (e.coli colonizes foreskin)

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26
Q

common causes of of pharyngitis in teens and kids

A

teens: M. pneumonia, clamhydia pneumoniae, arcanobacterium (MAC)
kids: Group A beta hemolytic strep (GAS) = 30%)

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27
Q

what supplements turn the stool black

A

bismuth (pep-bismol)

iron supplements

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28
Q

define rhinosinusitis and recurrent acute rhinosinusitis

A

inflammation/infection of the nasal mucosa and of one or more of the paranasal sinuses
-occurs from obstruction of NL sinus drainage
(acute <4weeks, chronic >12 weeks)

*recuurent: 4+ episodes a year with intermittent sx relief

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29
Q

uncomplicated and complicated outpatient CAP tx

A

uncomplicated: macrolide (azithromycin, clarithromycin) or tetracycline (doxycycline)
complicated: macrolide + penciilin/lactamase or fluroquinolone (levofloxacin or moxifloxacin)

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30
Q

what part of the GI and renal system is the PNS innervated by the pelvic splanchnic and S2-4 nerves

A

renal: bladder, lower ureter
GI: colon, rectum

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31
Q

a testicle not in the correct place (i.e cryptochorchidism) can affect ___ and ___

A

affect fertility and increase risk of testicular cancer

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32
Q

___ nerves travel cough stimulants to the cough center in the ____

A

vagus and phrenic nerves travel to cough center in medulla

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33
Q

neomycin and kanamycin affect what nutrients

A

fat soluble vitamins

b12

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34
Q

what must you check before giving IV contrast dye in a CT scan

A

kidney fxn

-BUN, Cr, GFR

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35
Q

T/F

IBD is noncyclic pelvic pain but IBS can be cyclic pelvic pain

A

true

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36
Q

expected liver and spleen span

A

liver : 6-12cm at the mid-clavicular line

spleen: from ribs 6-10 at mid-axillary line

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37
Q

controlling pt. brings lists of references and sx. focuses on small details, places control on questions and explanations. problem: battle for control causes pt to “shut down”

A

Obsessive-compulsive

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38
Q

leading cause of morbidity and mortality worldwide

A

pneumonia (CAP)

also second MCC of hospitalization

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39
Q

protein need for the day

A

5 1/2 oz /day

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40
Q

needs to emotionally merge with others of opposite gender. communicates through emotions and feelings vs thoughts. over dramatic, impulsive. initially personable but is lacking depth. can become angry or jealous if attention is not on them

A

histrionic

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41
Q

tetracyclines affect what nutrients

A 
12-MIC
B12
Mg
iron 
Ca
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42
Q

increased PNS tone via OA AA and C2 in pneumonia pts has wait effect

A

thinning of secretion and bronchiole constriction

SNS increased tone thickens secretions and dilates bronchioles

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43
Q

incarcerated vs strangulated hernia

A

incarcerated: can not reduce without surgery
strangulated: vascular compromise; SURGICAL EMRGENCY

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44
Q

most sensitive and specific test for GERD dx is ____ and the first line of tx is ____

A
  1. 24 hr pH monitor (not required)
  2. 4 week trial of PPI (both dx and tx)
    (no EGD unless no improvement with PPI in 4 weeks)
45
Q

labs helpful in evaluating nutritional deficiency

A

CRP, elevated WBC, albumin (<3.5 mild or <2.4 severe)

  • CBC -iron, folate, b12 deficiency
  • TSH - iodine deficiency
  • total protein, albumin - protein calorie malnutrition
46
Q

MCC of pneumonia (pathogen) ? and MCC of the severe cases?

A

MCC: S. pneumoniae
severe: S. pneumo and legionella

47
Q

when to transfuse following a CBC

A

if hemoglobin is below 7 (low risk pt) or below 9 (high risk pt such as elderly or heart disease)

48
Q

how does vertebral oseteomyletitis present

A

LBP that gradually increases over weeks to months with +/- fever

49
Q

during inguinal hernia check, and impulse felt a tip of finger with head turn and cough = ? impulse at the side of the finger indicates?

A 
tip = indirect 
side = direct
50
Q

pelvic pain that is deep in the pelvis and often effects ability to defecate or void. may be chronic, escalating, related to exercise, strain, or surgery. affects paravaginal and vaginal tissues

A

pelvic floor neuralgia or pudendal neuralgia

51
Q

most common reason for cyclic pain complaints in women (menstrual health)

A

ovarian cysts

52
Q

how to tx periodic limb movement DO

A

dopamine agonist or anti-epileptic agents

53
Q

define rickets

A

deficient mineralization prior to plate closure of kids. caused by Ca, phosphorus, or vitamin D deficiency.
(when it occurs after plate closure it is called osteomalacia)

54
Q

three primary pillars to prevent CAP

A
  1. smoking cessation
  2. flu vaccine (all pts)
  3. pneumococcal vaccine (at risk pts)
55
Q

gold standard dx for GAS pharyngitis

A

throat culture

other is rapid antigen testing aka rapid strep; or using the modified CENTOR criteria

56
Q

dirurectics (thiazides and furosemide) affect what nutrients

A

K+
Mg+
Ca+
Zinc

57
Q

reduced vs light sodium foods

A

reduced- 25% less

light- 50% less

58
Q

broad ddx for fatigue

A

DEAD TIRED

  1. depression
  2. environment/lifestyle
  3. anxiety, anemia
  4. diabetes/endocrine
  5. thyroid, tumor
  6. infection
  7. rheumoatologic
  8. endocarditis, cardiovascular
  9. drugs (meds or abuse)
59
Q

what is the MCC of sepsis

A

pneumonia

60
Q

health care agent vs surrogate vs gaurdian

A

health care agent: formal signed document called an advance directive that names a person to have legal authority to make health care decisions

guardian: court assigned as medical guardian to authorize you to make health care choices for someone else
surrogate: informal medical decision making for patient based on your relationship and knowledge of pts wishes

61
Q

screen pregnant women for ___ infection at their first prenatal visit

A

HBV, and HIV, syphilis, GC (if <24),

NOT HSV

62
Q

how to respond to feelings and emotions

A

NURS

  1. name the problem (this makes you angry?)
  2. understand (i understand why your feeling this way)
  3. respect (dealing with this takes courage)
  4. support (we will fix this)
63
Q

define diastasic recti and when it is seen

A
  • seperation of the rectus abdominis muscle causing a midline ridge formed by abdominal contents
  • classically benign and common in obesity, chronic lung dz, and after repeated pregnancies
  • seen ONLY when patient is supine and raises head above the shoulders
64
Q

HAP vs VAP

A
  • hospital acquired pneumonia is acquired >48 hrs after hospital admission
  • ventilator acquired pneumonia is acquired >48 hours after endotracheal intubation
65
Q

in acute bronchitis, conjunctivitis and adenopathy suggest ___ infection

A

adenovirus

66
Q

main things to do to tx UGIB

A
  1. recognize and resuscitate early
  2. intubate early with back ups
  3. consult GI, radiology, surgery
  4. ABX
67
Q

hypothyroid tx that falls under metabolic model of OMT

A

hormone treatment

68
Q

indications of PBRC use

A
  1. hemoglobin < 7 (or <9 if high risk)
  2. acute anemia (** PBRC + crystalloid fluids)
  3. hemorrhagic shock (hemodynamic instability)
69
Q

`calculate calorie need of sedentary hospitalized pt

A

30-35kcal/kg body weight to maintain weight

70
Q

distrust others. hyper alertness. complain of mistreatment and neglect, blame others. feel criticized. are time consuming and often demanding with threats of legal action. doctor should be friendly and courteous and avoid closeness

A

paranoid

71
Q

appearance of B12 deficiency

A

glossitis, hyperpigmentation, canities (loss of hair pigments- turn gray);
-bright red tongue, with sores and atrophic, pigmented nails, megaloblastic anemia (weak, numb, ataxia), neuro findings

72
Q

classic cough pattern? sound is generated where?

A

deep inspiration, attempted expiration against closed glottis that opens suddenly for forceful exhalation

-sound is made at the larynx and resonated in the nasal cavity and lungs

73
Q

how to dx UTI

A
  • UA-urinalysis (dipstick and microscopic)
  • urine culture (does not test for gonorrhea or chlamydia therefore must order urinary antigen for GC if STI is suspected)
  • culture is not needed if dipstick and microscopic is negative
74
Q

most common sx and PE findings of URI

A

SX:

  1. cough (+/- sputum)
  2. fatigue
  3. fever
  4. dyspnea

PE: increased work of breathing, crackles/rhonci/wheezing, + tactile fremitus/egophony/dullness/bronchophony, hypoxemia

75
Q

order of male genital exam

A
  1. inguinal/pubic inspection
  2. inguinal hernia inspection
  3. penis /glans
  4. scrotum
  5. rectal/prostate
  6. breast (if indicated)
76
Q

what shows lung pathology, bowel distention, and air fluid levels and free air but has low yield

A

AAS (acute ab series)

77
Q

findings of scurvy (Vitamin C deficiency)

A
  • 4 H’s
    1. hemorrhagic signs
    2. hyperkeratosis of hair follicles
    3. hypochondriasis (anxiety)
    4. hematologic ABNLs
  • *hair shafts curled in follicles capped by ketotic plugs leading to “corkscrew hairs”, perifollicular petechiae, hemorrhagic gingivitis, friable gingiva, delayed wound healing, depression
78
Q

coughing is initiated by stimulation of irritant receptors. where are major receptors are located ? minor receptors?

A

major: larynx, trachea, major bronchi
minor: URI (sinuses and pharynx) and chest (pleura, pericardium, diaphragm)

79
Q

what is the modified CENTOR criteria

A
  • aid in the dx of GAS pharyngitis (Strep throat)
  • 1 point for (F-CAT)
  • no cough
  • tonsillar swelling/exudate
  • enlarged tender cervical adenopathy
  • > 100.4 fever
    • 1 if 3-14 yo and -1 if >45 yo
  • 0-1 = no abx or testing
  • 2-3 = get rapid strep or throat culture and abx if +
  • 4+ = empiric abx tx
80
Q

phenobarbital and phenytoin (anticonvulsants) affect what nutrients

A

calcium, niacin, folate, Vitamin D

81
Q

which atypical pneumonia causes bullies myringitis

A

mycoplasma

82
Q

define acute bronchitis (type of URI)

A

inflammation of the tracheobronchial tree leading to increased mucous production and airway hyper responsiveness
-dx of exclusion

83
Q

define sepsis vs septic shock

A

Sepsis
infection and an acute increase in organ failure
-caused by dysregulated host response to infection

Septic shock
sepsis infection + progressive organ dysfunction/failure leading to marked increase in mortality (serum lactate is >2)
(vasopressor needed)

84
Q

salt recommendation

A

<2300 mg /day

according to DASH diet, limiting to sodium to <2300 lowers BP and LDL

85
Q

tx of LBP

A

usually no meds, try heat and other nonpharm tx 1st. educate pt and no bed rest of activity modification is needed

  • if need meds first try 2-4 weeks of NSAIDS
  • if refractory try nonbenzodiazepine muscle relaxant
86
Q

lab tests identify as few as ___ % if patients source of fatigue

A

< 5%

87
Q

3 main goals in OMM tx of pneumonia

A
  1. reduced parenchymal lung congestion
  2. reduced sympathetic hyperactivity to lung parenchyma
  3. increased mechanical thoracic cage and diaphragmatic motion
88
Q

T/F anemia or B12 deficiency second to vegan or vegetarian diet does not lead to wt loss

A

true

89
Q

5 steps in patient centered interviewing

A
  1. set the stage (welcome pt, ensure privacy)
  2. elicit CC
  3. begin interview (non-focused )
  4. use focusing skill to identify sx story, personal context, emotional context
  5. transition to middle of interview (clinical centered phase)
90
Q

complicated UTIs (i.e pregnant female) is at risk for

A

prematurity, low birth weight, and SEPSIS

91
Q

OC reduce risk of

A

ovarian cysts, ovarian cancer, uterine cancer

92
Q

lithium and amiodarone affect what nutrients

A

lithium

93
Q

tx for GAS pharyngitis

A

penicillin (10 day)

-if allergic then cephalosporins or macrolides

94
Q

sense of love and attention is derived from suffering. to repsonds to self-inflicted emotions of guilt or shame. complain about lots of problems and not happy when fixed. reject advice that would improve sx. the doctor should avoid reassurance, and promises and use less hopeful tx but a more plain/austere approach

A

self-defeating (masochistic)

95
Q

if scrotal mass is seen ___ may be used to assist in dx of hydrocele vs hernia vs solid mass

A

trans-illumination

96
Q

recommendations of screening for GC, HIV, syphilis, Hep B,

A

GC- sexually active women (esp < 24yo)
HIV- 15-65 yo
syphilis- asx, adults with high risk
Hep B: kids and adults with high risk

97
Q

keep platelets at _____ if actively bleeding

A

> 50,000

*cross match 2-4 units of blood in case need of emergent transfusion arises

98
Q

define pellagra

A

niacin (B3) deficiency

  • 3 D’s
    1. diarrhea,
    2. dermatitis (photosensitive)
    3. dementia
  • also burning parathesia is common
99
Q

cyclic pain associated with ovulation

A

mittelschmerz

100
Q

3 most common causes of noninfectious chronic cough

A
  1. UACS (MCC of chronic cough in healthy, nonsmokers with NL CXR) (includes allergic rhinitis and bacterial sinusitis)
  2. asthma/COPD
  3. GERD
101
Q

what two drugs affect folate

A

methotrexate (cytotoxic) and sulfasalazine (abx)

and phenopbarbital/phenytoin (anticonvulsants)

102
Q

visceral vs parietal (somatic) pain pf the abdomen

A

visceral: due to distention, stretching, or contraction of hollow/solid organs or ischemia
- not localized

somatic: due to inflammation in the parietal peritoneum (usually constant and more severe than visceral)
- localized, worsened by movement

103
Q

most common pathogens caused rhinosinusitis (adults and kids)

A

Adults: S. pneumoniae and H. influenza
Kids: H. influenza and M. catarrhalis

104
Q

findings of GAS related pharyngitis ? what does it resemble?

A

abrupt onset of sore throat, fever, palatal or tonsillar petechiae, tender cervical adenopathy, ABSECNE of cough

  • also can cause erythematous, sandpaper like (scarlatinaform) rash
  • *can be hard to differ from infectious mononucleosis caused by EBV
105
Q

when to use FFP

A

coagulation deficiency (factor 5 and 7)

106
Q

KUB cannot be used for

A

rule out intraperitoneal gas or detect air fluid levels

107
Q

a fluid wave is ___ but not ___ for ascites

A

high specificity low sensitivity (there negative fluid wave does not rule out)
*buldging flanks has high sensitivity but low specificity

108
Q

what is significant unintentional weight loss

A

5% in 6 months or 10% in one year

%change = (usual wt- current wt) / usual weight x 100

Hannah- PCM (3 decks)

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