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PcmIV Flashcards

1
Q

Saline lock

A

An IV cannula placed that allows for immediate administration of medications intravenously. Flushed with saline each shift, to maintain patency

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2
Q

Maintenance IV

A

solution that is given at a constant rate, round-the-clock. Examples include patients that are unable to maintain their fluid needs by mouth (after surgery, intractable vomiting, comatose, etc.)

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3
Q

Piggy back

A

Additional medication given IV by utilizing a port included in the maintenance IV tubing; runs concurrently with the maintenance IV

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4
Q

Bolus

A

A specific volume given over a short period of time (i.e. 250ml wide open—as fast as the fluid can be administered within the vein

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5
Q

Colloid

A

Does not readily pass through a membrane; i.e. intravascular and extravascular (interstitial) fluid compartments

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6
Q

Crystalloid

A

Pass readily through a membrane; i.e. intravascular and extravascular (interstitial) fluid compartments

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7
Q

Isotonic solution

A

Osmolality near that of plasma (>250mOsm/L but <375mOsm/L)

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8
Q

Hypotonic

A

Osmolality that is less than that of plasma (<250mOsm

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9
Q

Hypertonic

A

Osmolality greater than that of plasma (>375mOsm

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10
Q

Free water

A

Water not bound by macromolecules

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11
Q

Calculate maintenance fluid

A

Hourly rate 4 ml for 1 – 10kg +
2 ml for 11 – 30kg + 1 ml for each >30kg
70 kg person = 120 ml/hr

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12
Q

Body water deficit calculate

A

{0.6 x weight (kg) X (patient Na – 140 [nl Na])}/ 140 [nl Na] Ex: 0.6 X 70 X (144 – 140)/ 140 = 1.2 L deficit

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13
Q

Crystalloid

A

solutions of salts and electrolytes used for volume expansion. Examples includes NS, LR, D5W

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14
Q

Colloids

A

solutions that contain large molecules and provide oncotic pressure in addition to volume expansion. Examples include protein solutions such as albumin and non-protein solutions such as Dextran and Hydroxyethyl starch (HES

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15
Q

D5W dextrose 5%

A

Osmolality-278

Glucose-50

Na-0

Cl-0

Hco3 equilivent-0

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16
Q

D10W dextrose 10%

A

Osmolarity 505

Glucose 100

Na0 cl0 hco30

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17
Q

.45 nacl

A

Osmolality 154

Glucose 0

Na 77mEq/L

Cl 77 mEq/L

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18
Q

.9% nacl

A

Osmolality 308

Glucose 0

Na 154
Cl154

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19
Q

3% nacl

A

1026

Na 513
Cl513

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20
Q

Lactated ringers

A

Osmolality 274

Na 130
Cl109
Hco3 equilivents 28

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21
Q

Hypotonic solutions

A

.45 ns

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22
Q

Isotonic solutions

A

.9% ns
D5w
Lactated ringers

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23
Q

Hypertonic solutions

A

3% saline
D5NS
D5LR
D10W

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24
Q

When use isotonic

A

solutions can be used for maintenance fluids or resuscitation. Maintenance fluids applies to situations when a patient is unable to drink or take in enough fluids to maintain physiologic needs. Examples include post-operative period, inability to swallow or protect airway from aspiration (facial trauma, acute CVA), burns, or intubation

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25
Q

AE isotonic

A

Fluid resuscitation includes dehydration, hypovolemia or shock (any type). During fluid resuscitation, the goal is to keep fluids within the intravascular space. Isotonic solutions are the best choice, with NS preferred. However, during high volume resuscitation with NaCl, it is possible to overload the Cl- and induce a hyperchloremic metabolic acidosis (NAGMA).

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26
Q

Use LR

A

LR is also be used for vascular expansion and electrolyte replacement

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27
Q

Hypertonic solution use

A

solutions: 3%NS may be used with caution in extreme cases of hyponatremia (Na ~115). Must be done slowly with frequent sodium monitoring. It may induce Osmotic Demyelination Syndrome (Locked-in Syndrome), iatrogenic hypernatremia, fluid overload

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28
Q

Hypotonic

A

HYPOTONIC solutions have an abundance of free water, such as 0.45% NS. Hypotonic solutions do not stay in the vascular space. They will move into ICF causing them to reach a lower osmolality (cellular swelling

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29
Q

When use D5w and d10w

A

D5W and D10W are generally used to treat hypoglycemia. While D5W is isotonic, the uptake of the glucose leaves behind no solute, thus is often considered hypotonic and NOT used for resuscitation as it may cause fluid overload. Generally does not change the glucose concentration of the patient as it is assimilated into the cells. However, in a diabetic patient it may not be assimilated and can cause hyperglycemia

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30
Q

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).

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31
Q

Smaller number IV

A

Bigger needle/tubing

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32
Q

Bigger number IV needs

A

Smaller needle/tubing

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33
Q

22 gauge

A

22 gauge: 0.8 mm—childeren & older adults; slow infusions

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34
Q

20 guage

A

20 gauge: 1.0 mm—crystalloid infusion for maintenance

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35
Q

18 guage

A

18 gauge: 1.2 mm—fluid resuscitation or blood transfusion

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36
Q

16 guage

A

16 gauge: 1.7 mm—fluid resuscitation or blood transfusion

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37
Q

Phlebitis

A

Vein inflammation

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38
Q

Symptoms phlebitis

A

Pain, increased skin temp, redness

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39
Q

Treat phlebitis

A

D/C IV line, moist warm compresses, monitor

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40
Q

Signs PE findings phlebitis

A

Erythema, pain, red streak along vein, palpable venous cord, pure lent drainage

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41
Q

Infiltration definition

A

Leakage of IV solution or medication into the extravascular tissue

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42
Q

Symptoms infiltration

A

Edema, pallor, decreased skin temp and pain

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43
Q

Treatment infiltration

A

D/C IV line, elevate extremity, warm compresses may facilitate absorption of fluid

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44
Q

Signs PE findings infiltration

A

Skin blanched, tight/leaking, bruised, swollen, edema, pitting, pain

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45
Q

Extravasation definition

A

IV catheter become dislodged and medication infuses into the tissue

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46
Q

Symptoms extravasation

A

Pain, stinging, burning swelling, redness at site

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47
Q

Treatment extravasation

A

D/C IV line, apply cool compresses, administer antidote if one exists

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48
Q

Signs PE findings extravasation

A

Skin blanched, tight/leaking, bruised, swollen edema, pitting , pain

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49
Q

H and P

A

is a comprehensive health document. It is required for any hospital or long-term care facility. It must be performed no more than 30 days prior to or 24 hours after admission. The purpose is to capture the current state of health and any comorbidities that may require monitoring or effect the care of an individual. It must include all of the following components:
Time & date
CC/History of Present Illness PMH
PSH
Meds (prescription and non-prescription) Allergies (including reactions)
FH
SH
ROS: 2 symptoms in at least 10 (of 14) systems unrelated to the CC

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50
Q

COMPLETE PHYSICAL , assessment, plan

A

Complete physical: General, VS, HEENT, Lymph, CV, Lungs, Abd, Skin, MSK, OSE, neuro/psychiatric; current laboratory or radiographic data.
Assessment: start with reason for admission (or surgery) and include all comorbidities
Plan: start with care of current/most urgent problem and include maintenance of comorbidities. Signature of author/cosignature if required

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51
Q

Progress note

A

D aily update of a hospitalized patient Date & time
Subjective: (CC/HPI) update all of the information that has ocured since the last time evaluated (rounded on) by your service; include overnight events, new or different concerns of the patient or staff.
Objective: VS (HR, RR, BP, temp, O2sat, weight, I/O) focused physical exam, new labs and/or imaging results
Assessment: update of current problems (reso

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52
Q

Discharge summary

A

: a succinct document summarizing the major events of the hospital stay. Vital to provide outpatient provider with the most important information so that treatment plans can be identified and maintained. Common components:
Consultants: include physician names and specialties
Procedures: dates
Pertinent H & P details: brief summary of reason for admission. Includes pertinent lab and
imaging findings.
Course: brief summary of hospital course, treatments and progress during stay.
Discharge Condition: (good, fair, guarded, critical)
Disposition: home, skilled nursing, nursing home, rehab center
MEDICATIONS: reconcile medications to be continued upon discharge from the facility. Must
include dose, route and frequency (duration if a short-term medication such as antibiotic). List previous home medication and indicate whether they are continued or discontinued.
Instructions: activities, restrictions, diet, wound care FOLLOW-UP: Who, when and why

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53
Q

Why give IV

A 
Unable to maintain hydration orally
• Surgery
• Acute illness, vomiting and/or diarrhea
• Altered mental status
• Inability to swallow: CVA
• Trauma: jaw or facial trauma
• Volume depletion • Dehydration
• Acute blood loss/acute anemia
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54
Q

Crystalloid

A
  • Solutions of salts and electrolytes used for volume expansion
  • Normal saline, solutions vary
  • Lactated Ringers
  • D5W
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55
Q

Colloids

A
  • Solutions that contain large molecules and provide oncotic pressure in addition to volume expansion
  • Protein
  • Albumin
  • Non-Protein • Dextrans
  • HES
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56
Q

Volume resuscitation

A

Isotonic preferred

First line-normal saline

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57
Q

Colloids such as hydroxyethyl starches for volume resuscitation

A

Increase mortality and are not recommended

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58
Q

Hypotonic and volume resuscitation

A

• Fluids that are hypotonic (0.45% NaCl) will loose the free water to the extracellular space and are not recommended

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59
Q

Lactated ringers

A

Yes
Isotonic
Na,cl, hco3

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60
Q

38 yo male vomiting blood. Drinks heavily and has been drinking for at least three days. 3 meiosis episodes bright red and dark blood

Bp 80/50, HR 140, RR 18, temp 97

What treat with

Hypotensive, tachycardia and mental status need volume resuscitation

A

.9% nacl normal saline

Lactated ringers-has k, cl and this patient needs blood products bc reverse anticoagulatns packed with rbc and cause clotting

Hes-colloid contraindicated
D5w-taken up by cells leaves only free water even thoug isotonic once in vascular space becomes hypotonic
Packed red cells-probably used later..not first choice. When need blood products must be types and cross matched can take 30 min to hours…if volume depleted give normal saline

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61
Q

Signs hypovolemia or ineffective circulating volume

A

Dry mucous membranes, flat jugular veins, loss of turf or, tachycardia, delayed capillary refill, hypotension, oliguria, tachypnea, postural hypotension-one position to another get dizzy lightheaded (if change position bp drops systolically 20 mmHg or HR increase ten bpm then orthostatic hypotension)

Symptoms-icnreased thirst , fatigue, muscle cramps, dizziness, syncope, agitation, confusion

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62
Q

Packed rbc

A

Replace volume in blood loss

Takes time-type, cross match

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63
Q

Fresh frozen plasma

A

Contains plasma proteins and coagulation factors

Used to reverse some anticoagulatns and in bleeding disorders

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64
Q

Cryoprecipitate

A

Fibrinogen
VWF
Factor VIII
XIII

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65
Q

Platelets

A

Asprin platelet dysfunction

Treat thrombocytopenia

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66
Q

Back to 38 yo male what size needle should be used

A

Bigger number smaller lumen
Bigger number smaller lumen
22 20 guage-small, elderly ppl or small kids

16 18-ok for high volume fluid resuscitation and transfusion

16 and 18 ok!

Fluid resuscitation-high volume fluid

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67
Q

What initial labs are appropriate for this patient

A

AbG, CBC with diff, CMP, PT/PTT, INR

CMP-liver and kidney function, electrolytes, glucose,
Pt/PTT-monitor warfarin and heparin
INR-clotting
Blood cultures-no, febrile septic infectious

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68
Q

Hb 6.5 and hcg 19 with macrocytosis

A

Takes 45-72 hours where CBC willl reflect volume in vascular space

Rn maybe chronic anemia or gastritis, could have hb lower

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69
Q

Alt 90 ast 54

A

2:1 alcohol use

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70
Q

Na 145 k 5 bl 105 glucose 92 BUN 25 cr .9

A

Prerenal azotemia

Why so high? Upper gi bleed blood through gut and reabsorbed so also have elevated BUN and how we tell apart from lower GI bleed

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71
Q

AbG 7.32, pco2 30, po2 78

A

Hypoxia

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72
Q

Prolonged

A

CBCliver function
Kidney function na, k, cl, bun
Glucose

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73
Q

Monitor IV fluid patient

A

Weight daily

In and out

Daily BMP
BUN/Cr
Glucose
Electrolytes

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74
Q

Increase in weight on IV

A

3 rd spacing

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75
Q

Med student walks in notice cool pale indurated area around IV site in left cubical fossa

A

Phlebitis-vein inflammation, would be red
and follow up a rem
Infection skin cellulitis-around area warm red and tender
Niduration-hardening sign of extravation

Probably infiltration of IV diet .

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76
Q

Treatment for IV infiltration

A

Warm compress elevate

Move IV site dif location or more proximally from where it was

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77
Q

Where does this go in hospital documentation

A

Progress note for day 2
And Discharge summary

Admission H and P-admission, dont go back and change

An amendment to h and p NO something left out or mistake on it

Discharge summary-show complications as well

Nursing documentation-theirs

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78
Q

30 yo female pre op awaiting cholecystectomy, which IV fluid is most appropriate. Hasn’t eaten or drank since night. What IV peripoerative period (before to end of surgery)

A

LR*-

Need intravascular support and maintenance hydration-want crystalloids
Isotonic best , when hypo and hyper probably treating something else not just maintenance and vascular support

D5W-no need can go a few days without glucose (becomes quickly hypotonic too)
Saline lock-start IV site but dont hook up to solution, in perioperative period wnt solution running
HES-.45%-hypotonic

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79
Q

22 yo male ED for altered level of consciousness and abdominal pain. He is wearing a bracelet indicating he is diabetic. In route he was found to have a blood sugar of 429
BO 85/50, p140, rr20, temp 100.1

Best initial

A

Fever is 100.4 so no fever

Albumin-no its a colloid dont need for resuscitation

D5W-blood sugar is up and diabetic so dont give more glucose
If blood sugar 40 then yes d5w

.45-hypotonic-fluid wont stay in vascular supply and we need bp and HR

.9%-best choice

LR-option

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80
Q

Labs after large volume of fluid

Bp110/80
Na little high
K littl elow
Cl high
Glucose 225
Co2 ok
BUN high
Cr ok

What best choice for fluid and what compartment will the fluid move to

A

Intravascular to intracellularrly

LR -ok but K is low and we need large volume

Need IV piggy back with K in it

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81
Q

A 78 yo female found lying on floor fell three days ago . Trouble speaking, flattened neck veins, forehead tenting, left leg shortened and externally rotated

Bp 100/60 rr 18 t 97.2

What guage

A

22 guage, reality put in large bore needle dehydrated

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82
Q

While in route to hospital put in two large iv bore needle what fluid choose

A

Normal saline

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83
Q

Isotonic

A

Stay where put it in vascular supply

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84
Q

Hypotonic

A

Into cells

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85
Q

Hypertonic

A

Pulls things into the vascular supply

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86
Q

Sepsis

A

Ineffective circulating volume

-fever, difficulty breathing, low bp, fast HR, mental confusion

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87
Q

Geriatrics with

A

Akhtar

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88
Q

73 yo DM, CAD< sleep apnea here for wellness check. Her niece accompanies her to the visit today and noticed she is more withdrawn and foregetful . What ask niece and patient and assessment tools. Does age matter

A

Ok

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89
Q

Who is assessing the geriatric patient

A

Team
PA, PT, OT, nurses, you

Everyone gather information and discuss as a team

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90
Q

Medication effect polypharmacy

A

Increased herbal and diet supplement can interact with prescription
Ginnkgo Bilbao-incrase memory but cause risk of bleeding if on blood thinner, St. John warts for depression and on SSRI serotonin effects

Mental impairment, hypoglycemia and change in vision can be seen

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91
Q

Meds

A

Think interactions and know you may not be the only person prescribing medications or different pharmacies

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92
Q

Age and meds

A

Increase harmful effects

40% reduction in hepatic blood flow in older

Renal blood flow down by half by 80

Some degree of CKD

-decreased first pass liver, body fat, serum protein levels

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93
Q

Serum protein levels

A

Dentures, poor appetites, loss of partner who prepared food, comorbid conditions

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94
Q

Substance abuse and medication

A

Alcohol and interaction with prescription meds

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95
Q

Beers criteria

A

List of meds they wnt you to avoid

Can prescribe if necessary, but try not to

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96
Q

Categories of beer most common

A

Medications to always avoid, potentially inappropriate for older, medications for caution

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97
Q

Stop and start criteria’s

A

Stopp-screening tool of older persons prescriptions

Start-screening tool to alert doctors to the right treatment-indicators to prescribe

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98
Q

What do when come in

A

Brown bag check-get good history and know every single med, vitamins, herbals, review during every visit

Use beer

Start low, go slow-start low old people

Close follow up after starting new med

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99
Q

Functional ability

A

ADL
Self care-consider effort needle to button or unbutton shirt, wear shoes, climb up on bed
Living independently

FUTURE PLANNING-if you cant do ADL should u live with someone, get help, of go to long term care facility

Useful scales-katz and Lawton

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100
Q

Vision

A

Increase prob age

Maybe meds

Maybe comorbids

Neglect from CVA
DM retinopathy
Poor night vision
Glaucoma, cataracts,

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101
Q

USPSTF

A

Guideline for health maintenance

No guideline for vision assessment
-snellen eye chart every year, can refer to ophthalmologist if DM is HTN uncontrolled bc comorbid big eye , or family history.

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102
Q

Who more prone to falls

A

History, opioid, benzo, bp med, gait , weak, neurologic impairment, shoes, how do they live

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103
Q

Get up and go test or tenet time balance and gait test

A

Reduce falls try to alleviate things that may cause fall, exercise if weak, PT, bedside commodes, walker, shower, assess home hazard, review meds, assessing vision, performing neurologic exam

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104
Q

Age and cognitive health

A

High risk of cognitive decline and risk of depression

Comorbid conditions-meds may contribute

Early diagnosis of dementia

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105
Q

Conditions of old

A

Cognitive, dementia, AD, CVA, hemispatial attention or neglect, seizure disorders, history of syncope, many many more

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106
Q

Test for cognition

A

Mental status exam, CN test, vision, cerebellar status, strength, sensation, reflex’s, babinski

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107
Q

Mini mental state exam

A

Questionnare for testing cognition

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108
Q

Depression assessment

A

May mimic cognitive decline

UNDERDIAGNOSED in old

-“during past month have you been bothered by feeling down, depresses, or hopeless? During the past month have you been bothered by little interest or pleasure in doing things”?/ ASK THESE

Yes promotes more detailed questionnaire PHQ-9** dense grade how depressed patient is

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109
Q

Mild depression

A

Psychologist

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110
Q

Severe depression

A

SSRI or other meds

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111
Q

MOCA and minimental status

A

How impaired or demented test

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112
Q

Hearing

A

Presbycusis age related sensorineural hearing loss

Loss of cochlear hair cells
May get tinnitus, note cerumen

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113
Q

Work up hearing loss

A

Otoscopic exam (note cerumen, effusions), audioscpoe exam and whispered voice test

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114
Q

USPSTF hearing

A

Ask patient about hearing but no guideline for asymptomatic patient

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115
Q

Treat hearing

A

Presbyscusos-hearing aids

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116
Q

Urinary incontinence

A

Associated with decubitus ulcers, uti, sepsis

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117
Q

Diagnose incontinence

A

Good history

PE

Postvoid residual volume, cough stress test

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118
Q

“Is your incontinence caused by coughing, sneezing, lifting, walking or running?

A

This along with incontinence questionnaires

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119
Q

Stress

A

Involuntary leakage of urine that occurs with increases in intra abdominal pressure

Treat wit fluid retention, pelvic floor exercise

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120
Q

Urge

A

Bladder muscles contracting too often

Alpha agonist, fluid restriction, keels, pessary

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121
Q

Overflow

A

Obstruction or neuro issue

Indwelling urethral cath, alpha adrenergic antagonist BPH

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122
Q

Anticholinergic?

A

On beer list so consider if appropriate

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123
Q

Osteoporosis

A

White females, old white males, postmenopausal

DEXA on 65 and older
<65 with 10 year fracture history use FRAX fracture risk assessment tool

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124
Q

Manage osteoporosis

A

Lifestyle fall prevention, smoking cessation, moderation of alcohol intake, bisphosphonate therapy, hormone therapy

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125
Q

DEXA scan

A

T value compares with 30 yo female patient

Low bone mass 1-2.5 sad below T-1 and >-2.5

Osteopenia

Osteoporosis->2.5 sx below
T score

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126
Q

Vaccination assessment

A

Tetanus with pertussis, influenza, pneumococcal vaccine, herpes zoster

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127
Q

Social support

A

Do they have someone to help if get sick

ADL

Advance directive

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128
Q

Male genital exam

A

Ok

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129
Q

Penicillin exam

A

Lesions, palpated for plaques or induration

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130
Q

Testes

A

Palpated for mass, equal volume, tenderness, cryptoorchidism, t

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131
Q

Testes mass

A

Transilluminated-light will not transmit through solid mass. Hydrocele will glow soft red

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132
Q

Chronic testes lesion

A

Can cause testicular atrophy

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133
Q

If testicular not palpated

A

Examine inguinal canal and lower abdomen

Turn head cough and check for hernia

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134
Q

Check cremaster

A

Ok

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135
Q

Digital rectal exam

A

Prostate normal size symmetric nodularity

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136
Q

Most common male GU complaints

A

Infection-(fever chills)foreskin, epididymitis, urethra
, scrotum abscess

Structural-testicular torsion, hypospadias, undescended, hydrocele, spermatocele peyronies

Other-herpes, warts, tinea cruris, ED, cancer

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137
Q

Testicular torsion

A

Bell clapper deformity allows spermatic cord to twist, resulting in occlusion of testicular blood flow.
-trauma, exercise, but also may occur in sleeo
=usually say previous minor pain

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138
Q

Epidemiology testicular torsion

A

Young male 14 year old acute onset unilateral scrotal pain

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139
Q

Diagnose testicular torsion

A

Clincia, US, referral to urologist

Scrotal edema and erythema , tender firm testis that are retracted upward as a result of the twisted spermatic cord

Cremaster absent

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140
Q

Treat testicular torsion

A

Bilateral orchiplexy as bell clapper deformity often occurs bilaterally. If blood flow is restored within 6 hours of torsion, 80-100% of testes can be saved

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141
Q

How long to save testes

A

6 horus

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142
Q

Cremaster with testicular torsion

A

Absent

Lightly touch inside thigh and testicular on that ide raise up

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143
Q

Balatitis

A

Inflammation of head glans penis with chronic skin condition

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144
Q

Epididymitis

A

Gradual onset of scrotal pains ith fever, urethral discharge, and urinary symptoms

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145
Q

Acute orchitis

A

Sudden onset of testicular pain and high decker and palpate and tender testicle and nausea and vomiting

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146
Q

Scrotal abscesses

A

Testis, epididymitis, urethra

Do not have acute onset

Prominent edema, induration, erythem,a no fever, no n/v

Cremasteric is present

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147
Q

Epididymitis

A

Gradual onset posterior scrotal pain, urinary symptoms burn hard to pee. Inflammation of epididymitis

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148
Q

Young kid epididymitis

A

Enteric bacteria like E. coli reflex of urine just

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149
Q

14-35

A

Gc and chlamydia

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150
Q

Treat Gc chlamydia

A

IM ceftriaxone and 10 days doxycycline

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151
Q

Men anal intercourse

A

E. coli and give ceftriaxone with 10 days oral levofloxacin or ofloxacin

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152
Q

Who needs the additional treatment for men with insertive anal intercourse

A

Msm
Msw who have anal intercourse

Ask ‘it looks like infection in order to determine antibiotic i need to ask if you participate in anal sex:

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153
Q

Urethritis

A

Urethral discharge , itching tingling, dysuria

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154
Q

What causes urethritis

A

C trach, n gonorrhea

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155
Q

Look for chlamydia first

A

But Hpv most common sti

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156
Q

Hpv most common across board

A

Chlamydia most common reported

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157
Q

Exam urethral symptoms

A

Examined for inguinal lad, ulcers, or urethral discharge. Palpation of scrotum for evidence of epididymitis or orchitis is advised. Digital rectal Adam if in right age group

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158
Q

How diagnose urethritis

A

Discharge, positive leukocyte esterase test from first void urine or at least 10 wbc per high power field

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159
Q

Syphilis screening

A

At increased risk and all pregnant women

Asymptomatic not at risk po

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160
Q

Gc chlamydia

A

Sexually active women and men

Men-I current evidence insufficient

Women-B , active women age 24 years and younger and older women increased risk *

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161
Q

Fournier gangrene

A

Genital groin, or perineal involvement; polymicrobial cellulitis-infection followed by suppurations Nd necrosis of overlying skin

Be aggressive

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162
Q

Prostatis is

A

Urinary issues and scrotum and epididymitis fine no drainage. Move to DRE prostate tender and swollen

-painful ejactulaiton or blood in sperm, pain poop, systemic fever chills nausea

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163
Q

Cystitis

A

Bladder infection. Young healthy men dont get it

-cloudy or strong smelling urine, hematuria, feeling orf pressure in lower abdomen, pelvic discomfort

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164
Q

Most common genital ulcer

A

HSV1 and 2

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165
Q

Differential STI genital ulcers

A

Sti
Genital herpes simplex virus-hsv1 and 2
Syphilis-trepnmena pallidus

Chancrois-ducreyi
Granuloma inguinal-donovanosis
Lymphgranuloma venerum-chlamydia

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166
Q

Diagnosis ulcer

A

Chancre-serological and conformation fluorescent antibody

H. Ducreyi-culture

Herpes-skin scraping

Syphilis-VDRL RPR and darkfield

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167
Q

HSV

A

Multiple vesicular lesions and become painful shallow ulcers

LAD

PCR of scraping

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168
Q

Syphilis

A

Singl, painless chancre with a clean base and indurated border

Mild or minimally tender inguinal LAD

Dark field microscopy or direct fluorescent antibody testing of a chancre or lymph node aspirate1

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169
Q

Chancroid

A

Nonindurated paiful with serpingious border and friable base; covered with a necrotic, often pursuant exudate

Tender, suppurative, unilateral inguinal LAD or adenosis

H ducreyi on culture

Gram stain suggestive of h ducrey

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170
Q

Luv

A

Small shallow painless genital or rectal papile or ulcer no induration

Unilateral, tender inguinal or femoral LAD grooves sign

Chlamydia trachomatis l1-3 culture, identified from clincial specimen and others

RARE MSM mainly

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171
Q

Painless

A

Syphilis LGV

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172
Q

Syphilis LGV

A

Groove sign inguinal LAD with LGV swelling in inguinal region

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173
Q

Syphilis

A

Indurated border syphilis painless

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174
Q

High risk group

A 
Msm
Low socioeconomic and urban settings 
Prison
Military
Mental illness
Iv users
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175
Q

Complication untreated sexually transmitted infections

A 
PID
Upper genital infections
Infertility (GC CHLAMYDIA)
Chronic pelvic pain
Cervical cancer
Chronic infection
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176
Q

Treat

A

Antibiotics and virals
Treat partner
Counseling safe sex
Stress condone

Reduce high risk behavior

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177
Q

Who test behavior counseling and sti screening

A

B sexually active adolescents and adults

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178
Q

Syphilis A

A

Person at risk

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179
Q

HIV type A

A

Everyone

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180
Q

Gonorrhea

A

Spirochete, Treg pallidus

Primary chancre
Secondary0joint pain, fatigue, lad maculopapular rash

Latent-asymptomatic

Tertiary-neurosyphilis

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181
Q

17 yo sex active male itchy red painless rash of the genitals and inner thigh. On exam there is no tender inguinal or female lad. What is it

A

Jock itch

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182
Q

Tinea

A

Jock itch common

Fungal infection young’s thletes inner thigh and buttocks.

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183
Q

Hpv genital warts

A

Cauliflower

Finger like projections

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184
Q

Peyroies disease

A

Fibrous scar tissue causes penis to change direction when erect can go anyway

5-10% OF MNE

SUDDEN OR DEVELOP GRADUALLY

-

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185
Q

Cryptoorchidism

A

I descended

Most common male birth defect

3% infants

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186
Q

Most common male birth defect

A

Cryptorchidism

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187
Q

Inguinal hernia

A

Abdominal fat or a loop of small intestine enter the inguinal canal, a tubular passage through the lower layers of the abdominal wall and may enter the scrotum

Two testicular but other stuff in there

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188
Q

Pre participation sports physical

A

Insufficient evidence o do genital exam

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189
Q

Hydrocele

A

Collection of fluid presents as painless scrotal swelling that can be transilluminated. Ma be worse thru the day. New hydrocele or one that hemorrhage after monitor trauma may signal cancer

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190
Q

Varicocele

A

Most common on the left side. Mass lying posterior to and above the testis. Classic bag of worms

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191
Q

Spermatocele

A

Painless cystic mass separate from testis located superior and posterior to the testis

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192
Q

Testicular cancer

A

Sudden collection of fluid in scrotum?? Varicocele
-can be indicator of cancer…check consider cancer

Lump or enlargement, tender breast, back pain

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193
Q

Risk factor

A

Undescended testis, personal of family history, age, ethnicity

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194
Q

Orchiecctomy

A

Diagnostic and therapeutic

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195
Q

If scrotal mass

A

Not inside testicular 90% not cancer

If in testicular 90% cancer

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196
Q

Germ cell tumors 95% of testicular cancer

A

Ok

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197
Q

When screen for testicular cancer

A

Most common 15-34 solid tumor males

97% survival

Level D no better cure rate

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198
Q

Ed

A

Most common sexual problem in men

-male ed know ed presents 3 years before cardiac issues come up screen for cardiac disease.

Ed-screen for cardiac disease

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199
Q

25 yo sexually active male presents with burning sensation when urinarting . What is source

A

Urethritis

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200
Q

How meet patient

A

Fully dressed, respect them, ask questions for abuse and stuff have a chaperone

Thorough history and cc

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201
Q

Cc and HPU

A

Cc and explain

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202
Q

PMH

A

All medical conditions recorded…some common disorders like DM and HTN and renal disease affect pregnancy outcomes

Need to know

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203
Q

HTN DM

A

Pre eclampsia, IUGR

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204
Q

Medications

A

Alllll including otc and herbal for teratogens

Ask if considering getting pregnant ….start prenatal and folic acid

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205
Q

Family history

A

Breast, ovarian, uterine endometrial cancer, colorectal cancer

Diabetes, thyroid disease, familial hyperlipidemia

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206
Q

Surgical history

A

Myomectomy-fibroid out want to know cause want to know where if on top of uterus on top can get uterine rupture. Want to be thorough

Pelvic surgery and needed 4 units of rbc

-no vaginal birth

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2
3
4
5
Perfectly
207
Q

Obstetric history

A

What kind of deliveries and pregnant, natural epidural, complications

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208
Q

Gravidity

A

times pregnant

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209
Q

Parity

A

pregnancies led to birth or beyond 20 weeks or infant more than 500 g

Term, preterm, abortion, living

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210
Q

Termterm

A

37-42

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211
Q

Preterm

A

20-26 weeks and 6 days

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212
Q

Abortion

A

Less than 20 weeks

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213
Q

Living

A

Ok

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214
Q

23 year old 39 week 2 spontaneous abortions at 10 and 12 weeks and 1 living child

A

G3 p1, 0, 2, 1

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215
Q

27 year old 1 living child, had twins and 2 abortions

A

G3 p p0121

216
Q

3 deliveries at 27, 29 and 32 weeks and had a ruptured ectopic w subsequent salpingectomy at 13 weeks.

A

G4p2113

217
Q

Gravid

A

Women pregnant

218
Q

Primagravid

A

First preg

219
Q

Multigravid

A

Multiple pregnancies

220
Q

Nullgracida

A

Never pres

221
Q

Primagrava

A

Birth to one child

222
Q

Primary amenorrhea

A

No start by 16

223
Q

Most common cause amenorrhea

A

Pregnancy or menopause

First lab serum preg

224
Q

Post cordial bleeding

A

Cervical cancer

225
Q

Post menopausal bleeding

A

Endometrial cancer

226
Q

Heavy bleeding clots

A

Structural abnormalities-fibroid and polyps

227
Q

Naegels ruls to determine due date

A

If last menstrual period substract 3 months and add seven days

228
Q

Who cant do naegels rule

A

Irregular cycle or not know last menstrual period

229
Q

Folic acid

A

Neural tube defects -if trying not trying

230
Q

Cats

A

Toxoplasmosis

231
Q

ROS breast

A

Pain, discharge, masses,inverted nipple

232
Q

GU ROS

A

Discharge, dyspareunia-, menses regulatory, incontinence

233
Q

PE

A

Breast exam 1-3 years 20-29

40 yearly mammography

234
Q

Pelvic exam when state

A

21 annual

235
Q

13-18

A

Initial OBGY service

Menstrual, family medical history, tobacco, alcohol ad other drugs, sexual abuse, drugs
NO PELVIC EXAM unless problems , tanner staging

Test chlamydia and gonorrhea or HIV if sexually active

236
Q

13 counseling

A

Encourage condom, psychosocial and sexual abuse , drugs tobacco alcohol

237
Q

Immunization 13-18

A 
Tdap
Hep b
Hpv vaccine
Mmr
Varicella
238
Q

Hv vaccine

A

Ceramic-16, 18
Gardasil 11,16,18
Gardasil 9-lots

9-45 can have, boys girls -want prevent recurrence

239
Q

16 and 18

A

Cervical cancer

240
Q

19-39

A

Talk about sexual practive and alcohol and drugs

241
Q

19-39 breast exam

A

1-3 years at age 20 clinical

Mammography starts at 40

242
Q

19-39 pap

A

21-29 pap every 3 years with cytology alone

After 30 continue every 3 years cytology alone or co test with HPV and negative extend to 5 years

243
Q

19-39 chlamydia and gonorrhea

A

If age 25 or younger and sexually active

26 and older just high risk

244
Q

HIV 19-39

A

Ok

245
Q

Counseling 19-39

A

Sex, reproduction planning, genetic counseling, std prevention, intimate partner violence, rape prevention, breast self awareness, tobacco

Pelvic pain and treat over and over-think abuse

246
Q

Immunization 19-39

A 
Tdap
HPC
Influenza
MMR
Varicella vaccina
247
Q

40-64 screening

A

Pelvic prolapse, menopausal symptoms (51), tobacco, alcohol and other drugs , family medical history

248
Q

PE 40-64

A

Mammograms years

Cervical test 3 years or co test every 5 years

Colorectal 50 if African American
——everyone 45 yo q 10 years preferred

249
Q

Labs 40-64

A

Lipid profile every 5 year at 45

Mammography every year at 40

TSH every 5 years at 50

Diabetes every 3 years at 45

250
Q

Counseling 40-64

A

STD, violence, same same, breast self awareness, chemoprophylazis if high risk tamoxifen

251
Q

Immunization 40-64

A

Varicella zoster at 60 new one Mae sure caught up

252
Q

65 over

A

Pelvic prolapse menopausal

Yearly breast

Pelvic exam when appropriate

253
Q

When stop pap

A

65 if no history of CIN 2 or higher and 3 consecutive negative or two consecutive negative co test

In CIN 2 or 3 have to make sure normal pap for 20 years even if beyond 65

254
Q

Lab 65 older

A

Bone mineral start 65 every 3 years

Rest same

255
Q

Counseling 65

A

Advance directive

Sexual function, std

Breast awareness

Tobacco, alcohol other drugs

256
Q

Immunization

A

Pneumococcal after 65 get once

Same rest

257
Q

High risk for bone mineral density early

A

<65 history fractures less than 127, bone loss disease RA< smoker, alcohol, history suspicious

258
Q

Early mammography

A

40 younger if high risk, BRCA1 or 2 or history of high risk breast biopsy

259
Q

High risk for lipid before 45

A

CAD history, aaa, family history, obese, hyperlipidemia, premature cvd

260
Q

Colorectal

A

Family history, polyps first degree relative younger 60 or 2 of any age

Familial, UC, crohns , polys

261
Q

Diabetes less 45

A

BMI>25
First degree relative, prior birth over 9 lbs
History PCOS

262
Q

Thyroid before 50

A

Strong family history thyroid disease

263
Q

Genetic testing

A

If history of genetic disorder or birth defect

264
Q

Std early

A

Multiple partners, partners with known sti, iv drug users

265
Q

Meningococcal vaccine

A

Function asplenia or reserved, military recruit college dorms

266
Q

Start of PE

A

Inform patient what will take place , meet when dressed , knock on door and wait for answer

WASH hands

Bring chaperone

267
Q

Melanoma

A

May not know pregnant malar rash under eyes

268
Q

Breast

A

Dark aerola sign of pregnant

269
Q

If see melasa or dark aerola

A

Get preg test

270
Q

2nd leading cause of death in america women

A

Breast

Lung, breast colorectal

271
Q

How do breast exam

A

Uprigh patient palpate quadrants (mobile, quadrant, feel), compare breast

Supine, raise arm behind head allow to spread more evenly and deeper palpation

272
Q

When do breast exam

A

Week after menstruate put hands on hips lean forward look lean back ok

See if stuck to muscle

273
Q

Palpate nipple

A

Compress between thumb and index, discharge galactorrhea, bloody, blah
Tell them why doing it

1/8 ladies get it inform patients why doing it

274
Q

Most breast cancer

A

Upper outer or under nipple

275
Q

Breast exam

A

Stand palpate tail of spence, breast cancer feel hard
Pain-not pain
If limbs come and go away with menstruation-fibroadenoma

Get different positions come in contact with all breast tissue

276
Q

Nipple inversion

A

New problem cancer old fine

277
Q

First pelvic exam

A

How and why we are doing it. Explain!

Show her instruments before inform importance of testing

278
Q

Pelvic exam bed

A

30 degrees can see face can see if hurting her, if flat abdominal muscles tense

Readjust pillow

Inform

Warm speculumput gloves on

Scoot till bottom hangs a bit off end of table

279
Q

Dorsal lithotomy position

A

30 degrees

280
Q

Examine external genetalia thoroughly

A

Abnormal HPV condyloma 6 11

HSV-satellite lesion

281
Q

Pediatric speculum

A

Very narrow blades,

282
Q

Grave speculum

A

Wide multiparous, or very heavy

283
Q

How long is vagina

A

10 cm

284
Q

Peterson speculum

A

Thinner blades half as wide

285
Q

Pediatric

A

Very narrow

286
Q

Plastic speculum

A

Can use light but problem with heavier ladies can snap off and pinch

287
Q

Where butt

A

Barely off end of table

288
Q

How hold speculum and put in

A

Dominant hand

Take other hand and separate the labia minora and majora

Once tip of the speculum is inserted at 45 degrees
-may adjust on prolapse

Insert as far as will go

  • then open
  • if dont see if close then go more then open then tilt up or down
289
Q

Put speculum in and wait for

A

Secondary relaxation then insert

290
Q

Nulliparous

A

Small conical spherical

291
Q

Multiparous cervix

A

Bass mouth

292
Q

Cervical polyp

A

Fleshy mass interlude spotting

-intercourses and post comical spotting cervical cancer

293
Q

Pregnant cervix

A

Chadwicks sign-blueish hue to vagina and cervix

294
Q

Most common vaginal infection

A

Bacterial vaginalis

295
Q

Trichmonas

A

Frothy yellow green strawberry cervix

296
Q

Bacterial vaginosis

A

Most common foul amine fishy odor

297
Q

Year vaginitis

A

White adherent discharge

298
Q

Gonorrhea/chlamydia

A

Swab that is inserted into vertical

-negative, but repeat positive bc need to put swab in 45 seconds

299
Q

Pap

A

Spatula scrape ectocervix

Cytobrush is then used to obtain endocervical cells
Slide or thin prep

300
Q

Slide

A

Wipe of spatula then wipe cytobrush on other half

301
Q

Thin prep

A

May swish or actually remove the tip of swab and send in

302
Q

Thin prep benefit

A

Cytology, HPV, test for chlamydia and conorrhea, ASCUS cytology

303
Q

Have specimen and speculum in

A

Don’t pinch cervix when close……

Place in hazardous red bag

304
Q

If put speculum in and have cystocele

A

Won’t see

So breaks speculum in half and put one in to see bladder

305
Q

Internal bimanual exam

A

Feel cervix, uterus, palpate ovaries, feel for structural abnormalities

Use lube press down waiting for relaxation and other hand on suprapubic region

This is uncomfortable

306
Q

Vaginalis wall palpate

A

Cyst, nodules, mass, growths

307
Q

Terms

A

Not good

Use normala or healthy

308
Q

How did cervix

A

Palpate hand move side to side and see for discomfort

309
Q

Cervical movement discomfort

A

Chandeliers sign PID

310
Q

Non pregnant

A

Firm cervix

Soft preg

311
Q

Uterus

A

Lift up vaginal hand down with other hand

312
Q

Anteverted

A

Toward stomach

313
Q

Retroverted

A

Toward back

314
Q

Anteflexed

A

Top fundus toward stomach

315
Q

Ovaries

A

Fingers lower quadrant sweep down and other hand lateral fornix

316
Q

Normal ovary

A

Form, ovoid, slightly tender and 3x2x1 cm

317
Q

Rectovaginal exam

A

Tone anal sphincter , lax , absent-improper repair 3rd 4th degree

318
Q

Anal walls

A

Can feel endometriosis

Advance and ask to bear down

Rectocele

319
Q

Conclusion of exam

A

Cover
Push back ad normal
Help sit up
Dress while step out

320
Q

What percent of patients see physician 5 times before diagnosis of endometriosis confirmed by surgery

A

47%

321
Q

Signs that may get endometriosis with pelvic pain

A

Dysmenorrhea before 15 and symptoms before 20

322
Q

Genetic endometriosis for severe rather than mild

A

More common if sister or mother

323
Q

Allergies and endometriosis

A

Associated

324
Q

Segmental dysfunction endometriosis

A

Lumbar type II dysfunction

325
Q

Abrupt increase in severity and radiation fo endometriosis

A

Rupture indication

326
Q

Hemorrhage due to rupture endometriosis

A

And peritoneal inflammation lead to reactive exudates

327
Q

Ca 125

A

Ruptured ovarian endometriosis cysts mimic ovarian malignancy bc high ca125

328
Q

Ct scan and pelvic sonogram or mri endometriosis

A

If patient has hemoperitoneum, active bleeding seen on CT by active arterial extravasation of IV contract with a measured attenuation value higher than of free or clotted blood is indicative of the need for prompt surgical intervention

329
Q

Symptoms endometriosis

A

Dysmenorrhea, pelvic pain, menorrhagia, hormone dependent, dyspareunia, lumbago, rectal pain, dyschezia, infertility, increased allergic reactions, positive family history

Or asymptomatic

330
Q

When do endometriosis exam

A

Early menses

331
Q

PE endometriosis

A

Pelvic tenderness

Nodules on bimanual exam on uterosacral ligament or posterior curl de sac
Decreased uterine mobility/retro version

Tender fixed nodular adnexal masses
Osteopathic findings

332
Q

Diagnose endometriosis labs

A 
Ca125 up or ovarian malignancy 
Get hcg
Ua0for UTI
CBC
CMP
STD-chlam and gon gram stain cervical
333
Q

When do mri/ct

A

Usual use MRI and US for gynecology

CT0pain of unknown etiology

CT-see hemoperitoneum by active arterial extravasation of IV contrast with measured attenuation value higher than that of free or clotted blood is indicateive of need for prompt surgical intervention

334
Q

Transvaginal US

A

Endometriomas-look for homogenous cysts

335
Q

Har to diagnose endometriosis without what

A

Surgical confirmation

336
Q

Histology endometriosis of biopsy

A

Endometrial glands and stroma

337
Q

Visual lesions of endometriosis from laparoscope

A

Black powder burns-classic

Red white lesions

338
Q

Complications endometriosis

A

Progressively worse-implants spread

339
Q

Etiologies endometriosis

A

Retrograde menstruation

Vascular lymphatic dissemination

Coelomic metaplasia of multipotential cells in peritoneal cavity

340
Q

Coelom

A

Cavity between splenic and somatic mesoderm in embryo forms the lining of general body cels

341
Q

Mesonephric remnants

A

Undergo endometrial differentiations nd give rise to ectopic endometrial tissue

342
Q

Müllerian ducts

A

Females-upper uterine tubes
Lower parts form uterus and upper vagina

Male vestigial as vagina masculine
Appendix testes

343
Q

Extrauterine stem cell progenitor

A

Stem cells from bone marrow differentiated into endometrial tissue

344
Q

Metastases to

A

Bone lung brain via vascular lymphatic

345
Q

Associated of endometriosisand what cancer

A

Endometrioid cancer

Clear cell ovarian cancer

346
Q

Shared gene mutations endometriosis

A

PTEN

AR1D1A

347
Q

Trans problems

A

Homeless, poverty, psych distress, SA, negative HC experiences, fear mistreatment do dont get treatment , could not afford health care

348
Q

Waiting room

A

Set stage
Important
Be welcoming

349
Q

Intake form

A

Gender

Female to male that sort of thing

350
Q

Rainbow pin on jacked

A

Helpful

351
Q

Introduction

A

Pronouns

352
Q

Opening door to coming out

A

Assess where patient is first

Need to form alliance

Ways to set stage

Consequences of premature outing

353
Q

Opening for to suicide prevention

A

Suicide attempt history
Assessing patient
Normalize. Conversation
Risk highest to lowest in LGBTQ

354
Q

How do you calculate caloric need: what are the 3 components

A

Basal energy expenditure (55-65% of total calories)

Thermal effect of feeding (1-% of calories)

Activity energy expenditure )25-33

355
Q

In sedentary hospitalized patient ____kcal/kg of body weight will maintain weight

A

30-35

356
Q

Acutely ill patient may need what

A

35-50 kcal.kg

357
Q

Risk factors that contribute obesity

A

Minority -AA mexican

Lifestyle
-only 1% is neuroendocrine
LIFESTLYE

358
Q

What is considered obesity how do you measure

A

> 40 and >35 inch waist circumference

BMI>30

359
Q

Risk factors for malnutrition

A 
Older who live alone
Chronically ill
Adolescents who eat and diet erratically
Cancer patients 
Drug interactions
Alcoholics
Homelessness, low socioeconomic status
360
Q

Nutritional deficits without weight loss

A

Uncommon

Vegetarian or vegan with B12 defiency

361
Q

DETERMINE for nutritional status screen

A 
Diseases
Eating poorly
Tooth loss mouth pain
Economic hardship
Reduced social contact
Multiple meds
Involuntary weight loss
Need for assistance with self care
Elderly>80
362
Q

Tetracyclines

A

Affect calcium, mg, iron, b12

363
Q

Neomycin, kanamycin

A

Effect fat soluble, b12

364
Q

Sulfasalazine

A

Folate

365
Q

Phenobarbital phenytoin

A

Calcium vitamin d, folate, niacin

366
Q

Cholestyramine ,colestopol

A

Fat fat soluble

367
Q

Methotrexate

A

Folate

368
Q

Mineral oil

A

Water electrolytes, fat and. Fat soluble vitamins

369
Q

Isoniazid

A

B6 B3

370
Q

Warfarin

A

Vit k

371
Q

Thiazide furosemide

A

K mg ca zinc

372
Q

Lithium amiodarone

A

Iodine

373
Q

What is significant weight loss

A

Unintentional 5% over.6 months or 10% over year

% weight change =usual weight-current weight/usual weightx100

374
Q

Decreased caloric intake

A

Anorexia, old, early satiety, difficulty chewing or swelling, cant self feed, depression, social isolation

375
Q

Malabsorption and maldigestion

A

Diarrhea, fatty malodorous stools, change in bowel habits

376
Q

Impaired metabolism or increase requirements

A

Fever pregnancy, chronic disease

377
Q

Increased lossses or excretion

A

Draining fistula or open wounds diarrhea excessive vomiting

378
Q

Vitals

A

Heigh weight BMI is weight/height

379
Q

Tricep skinfold thickness

A

Assess subQ fat, 50% of body is fat is subcutaneous

380
Q

Rapid weight gain

A

Fluid retention

381
Q

Weight loss

A

Tissue related

382
Q

Protein defiency

A

Dry scaly cellophane appearance of skin

383
Q

Zinc defiency

A

Flaking dermatitis

384
Q

Vitamin a

A

Follicular hyperkeratosis, night blindness, xerosis, keratomalacia, I tot spot

385
Q

Niacin

A

Pigmentations hanges

386
Q

Vitamin c

A

Petechiae , purpura

387
Q

Iron b12 folate

A

Parlor

Conjunctiva pallor

388
Q

Riboflavin, B6 B3

A

Angular steomatitis, cheilosis, glossitis

389
Q

Vitamin c and riboflavin

A

Bleeding gums

390
Q

Protein calories vitamin d

A

Interosseous msucle atrophy, squaring off of shoulders, poor hand drip and lef strength (temporal and supraspinatus)

391
Q

Calcium mg

A

Tetany

392
Q

Iron

A

Spooning

393
Q

Iodine

A

Goiter

394
Q

Protein

A

Parotid enlargement

395
Q

Vitamin c

A

Corkscrew hairs

396
Q

Appearance and nutritional def

A

Muscle mass, hair texture, nail health, skin texture

397
Q

Muscle strength and nutrition

A

Grip strength squeeze indies finger en seconds
Ambulatory-walk
Extremity strength against resistance

398
Q

Labs indicate pathology or illness

A

CRP, elevated WBC and albumi.

399
Q

Albumin less than 2.4

A

Severe systemic inflammatory response reflecting systemic inflammation that produced anorexia and increases protein catabolism and accelerates development of protein calorie malnutrition.

400
Q

Iron b12 folate effects

A

Cbc

401
Q

Iodine effects

A

Tsh

402
Q

Protein calories malnutrition

A

Total protein albumin

403
Q

Labels are based on serving. Why prob

A

More than one serving in package usually will need to multiple

404
Q

Calories

A

How much energy you get from a serving of a food

405
Q

Nutrition facts label is based on a __ calorie a day diet

A

2000

406
Q

If food calories is 200 and 100 from fats what percent of calories from fat

A

50%

407
Q

Fat

A

3 times calories of other
Gives energy
Absorbed things

408
Q

Healthy fat

A

Monosaturated and polyunsaturated

409
Q

How much fat eat

A

Less tan 1/3 of your daily calories

410
Q

Eat less than how many cholesterols

A

300 mg

411
Q

Sodium

A

Eat less than 2300

412
Q

How much fiber eat

A

20-35 g

413
Q

Daily value %DV

A

Percentage of daily recommended amount get from 1 serving

414
Q

How are saturated fat and vit and min labeled

A

%DV

415
Q

Fat free

A

Less than .5 g

416
Q

Low fat

A

3 g or less per serving

417
Q

Reduced gat

A

At least 25% less than regular

418
Q

Trans fat free

A

.5 g trans fat or less per serving

Eating a lot can add up

419
Q

Cholesterol free

A

Less than 2 mg

2 g or lesss of saturated fat per serving

420
Q

Low cholesterol

A

20 mg of cholesterol or less per serving .

2 g of saturated fat or less per serving

421
Q

Sodium free

A

Less than 5 mg per serving

422
Q

Very low sodium

A

Less than 35 mg

423
Q

Low sodium

A

140 mg or less

424
Q

Reduced sodium

A

25% less

425
Q

Light in sodium

A

50% less than regulat

426
Q

No salt added

A

May still be salt just not added in processing

427
Q

Low alorie

A

40 cal or less per serving

428
Q

Sugar free

A

Less than .5 g of sugar per serving

429
Q

Fortified

A

At least 10% of daily requirement for nutrient the food is fortified with

430
Q

High or rich

A

20% at lest the daily value

431
Q

Gluten free

A

Less than 20 ppm

432
Q

What is term

A

36-40

433
Q

Routine care full term >35 weeks

A

Dry, clear airways , warm , go right to mom

434
Q

History and mom

A

Get it all!!!!! Know what happened before during and after and history since born

435
Q

Erythromycin in eyes newborn

A

Bacterial gonorrhea

Opthalmia neonatorium

436
Q

APGAR

A

1 min, 5 min and 10 sometimes

HR, RR< muscle tone, reflex irritability, color

Helps know what to do

437
Q

7-10 APGAR

A

905 fine dont do anything

438
Q

Transition period

A

4-6 hours after born
RR 40-60
HR 120-160
T97-99

439
Q

Pink color baby

A

Heart rate good tone

440
Q

When first PE

A

18-24 hours

441
Q

Why baby hep b vaccine

A

Breast milk

442
Q

Why give K1 to baby

A

Supplement bc need in clotting cascade and baby dont have enough

Can’t get circumcision without it

443
Q

Erythromycin give

A

To prevent gonococcal infection eye

444
Q

Mom diabetes

A

How well controlled during pregnancy

Sporadic control and high blood sugar when deliver-pancreas is trying and baby’s is doing it and baby doesnt have sugar supply and blood sugar can drop fast

CONTROL

445
Q

If baby lose more than 10% of birth weight

A

Close follow up

Lose in first week

446
Q

2 weeks

A

Should be at or over 15-30g a day gain in 2 weeks

447
Q

25%mg hyperbilirubinemia

A

PAY ATTENTION
Can BIND-bilirubin induced neurologic dysfunction.kernicterus

ABO incompatibility, excessive bruising, prematurity sepsis, heart disease
Risk from hemolysis
Bruising-bruises

448
Q

Why naked baby

A

Watch it. With eyes and ears unaided

WATCH observe

449
Q

Sleeping baby

A

Watch breathing

Count for full minute bc irregular

450
Q

See saw paradoxical movement

A

Fine in baby bc Lacoste of chest walll and skeletal structure

451
Q

Retractions breathing

A

Not normal
Espicially if grunting

Singing-may be present high pitched grunting

452
Q

Pleural space problems

A

Effusions

Pneumothorax-much more common
-usually from spontaneous pneumo or from PPV during resuscitation

453
Q

Pink is ___

A

Good

454
Q

What color further evaluation

A

Blue, purple, yellow, green, mottling

455
Q

Mottling of skin

A

Poor perfusion

456
Q

Purple

A

Cyanosis

457
Q

How check perfusion

A

Bruise-dont blanch , cyanosis blanches

Face bruise concern

458
Q

Green meconium baby

A

When rupture membranes see chunky green fluid indication for pediatrician

459
Q

Pale baby

A

Anemia

460
Q

Gray baby

A

Acidosis in newborn

Severe infections, cardiac disease with poor perfusion of tissue
GRAY BAD

461
Q

Position baby

A

Flexed

Flaccid-attention work up

462
Q

What look for in baby eye

A

Red reflex

White-red
Dark baby-pale

463
Q

White red reflex

A

Urgent referral -retinoblastoma look for intraocular mass

464
Q

Glaucoma pupil

A

Cloudy

465
Q

Eye movement baby

A

Google eyes couple months

Tasted down not move-ophthalmologist right away

466
Q

Subscleral hemorrhage

A

Will clear away fine

467
Q

Posterior rotated ears with simian crease

A

Downs turner low ears

468
Q

If see ear abnormalities what other organ think about

A

Kidney

469
Q

Ear drum baby

A

Looking for patency

470
Q

Preauricelar pit

A

Can get infected

471
Q

Nose

A

Look and see if can breathe

Septal dev-ENT for eval and treat

Obligate nose breathers until 6 moths breathe while eat
Dramatic suction it mroe reactive inflammation you get

472
Q

Choanal atresia nasal obstruction

A

Charge

May be cyanosis when not

473
Q

Micrognathia

A

Pierre robin sequence

474
Q

Epstein pearls

A

Inclusion cyst in back of mouth normal

475
Q

Skin in back neck

A

Turner

476
Q

Clavicles

A

Can be fractures

477
Q

Moro reflex

A

Hold hands up let go and they’ll

478
Q

Cardiac

A

Hear murmur take seriously

479
Q

Transition period murmur and go away

A

Ductus arteriosus

480
Q

Femoral and brachial pulses

A

Check

481
Q

No murmur hear but cardiac signs and symptoms

A

Does not ensure no pathological structural problems

482
Q

Most babies have murmurs

A

Transient

483
Q

When refer murmur

A

Grade 2 or more with harsh qualities , to and fro murmur, or pansystolic that persist past first few hours of life

484
Q

How keep ductus open

A

Prostagladins

485
Q

Breast

A

Come out

486
Q

Heat tenderness breast

A

Look into it

487
Q

Bowel inc best cavity

A

Diaphragmatic hernia

488
Q

Abdomen

A

Kidneys often palpable bl

489
Q

Umbilical cord

A

2 arteries 1 vein

A single artery is msot often a normal variant
A single artery accompanied by any other

490
Q

Capture seccedaneum

A

Blood between scalp and periosteum can flow across suture lines

491
Q

Cephalohematoma

A

Between periosteum and bone doesnt cross suture lines takes a long time to resolve

492
Q

Subjaleal hemorrhage

A

Can trick you

Above periosteum can lose a lot of blood

493
Q

Lumbosacral spine dimple hair, lipoma

A

Evaluate for spinal things

494
Q

Lumbosacral pit

A

Imaging study US

495
Q

Barlow ortolani

A

Developmental hip dislocation

496
Q

Development of vascularity of femur depends on what

A

Fit of it in hip-risk leg calves

497
Q

Ambiguous genitalia

A

Congenital adrenal hyperplasia

498
Q

Hypospadias

A

Ventral shaft of penis

499
Q

Feel for testicles

A

If cant find do US

500
Q

Bronchi, esophagus

A

Lateral to T2 spinous process

501
Q

Intertransverse space between t2-3 and intertransverse space between t2-4

A

Upper lung

502
Q

Lower lung

A

Intertransverse pace between t405

503
Q

Heart bronchi esophagus

A

2nd intercostal space along sternal

504
Q

Upper lung

A

3rd ICS

505
Q

Lower lung

A

4th ICS

506
Q

Lymphatic pump

A

Increase circulating leukocytes to enhance immune response in pneumonia

507
Q

C30c5

A

Phrenic nerve motor ,

508
Q

T1-t7

A

Sympathetic

509
Q

Most common cause outpatient acquired pneumonia

A

Mycoplasma pneumona

510
Q

Most common pneumonia inpatients not in ICU

A

S pneumonia

511
Q

Most common pneumonia inpatients admitted to ICU

A

S pneumonia

512
Q

Who doesnt get varicella, zoster, and MMR

A

<200, immune comp, pregnant

513
Q

Who gets pneumonia shot

A

13 valent -over 2 not MSM heart disease lung disease, chronic liver disease, diabetes, health care personnel if other risk and everyone else

23-pregnant get if need, MSM healt care personal , if other risk and everyone else

514
Q

Pneumococcal 13 and 23

A

1 dose for adults

If both indicated, PCV13 first, not at same time

515
Q

Over 65 or 6

A

12 followed by 23 in 6 -12 months

If have 12 but no 23 at age 65 give 12 at least 1 year after 23

516
Q

19-54 who smoke

A

23

517
Q

Curb-65

A 
Confusion 
BUN>20
RR>30
BP<90 <60
Over65
518
Q

0-1 CURB65

A

Outpatient

519
Q

2 points

A

Inpatient

520
Q

> 3 points

A

15-40

521
Q

CLL diagnosis

A

Absolute B lymphocyte count in the peripheral blood >5000/microL with preponderant population of morphology mature appearing small lymphocytes

Demonstration of clonatlity of circulating B cells by flow cytometry of the peripheral blood. A majority o population should express the following pattern of monoclonal B cell markers: expression of B cell association antigens 19,20,23 and T cell antigen CD5

522
Q

Demonstration of colonialists of the circulationmorphology CLL

A

Prolymphocytes

Smudge cells

523
Q

Pathological features CLL

A

CBC with diff
Examination of peripheral smear
Immunophenotype analysis of circulating lymphocytes

524
Q

Immunoglobulin abnormalities

A

Significant decrease of hpogammaglobulinemia and neutropenia, when present result in increased vulnerability of CLL patients to major bacterial infections

525
Q

Cytopenias

A

Neutropenia, anemia, thrombocytopenia

526
Q

CLL

A

Autoimmune hemolytic anemia

Direct coombs test

527
Q

Pure red cell aplasia

A

Rare

528
Q

Autoimmune thrombocytopenia

A

Bone marrow biopsy shows adequate numbers of megakaryocytic but the peripheral blood has low platelet count . 2-3% of CLL and may be initiating attention

529
Q

Lymphocytosis

A

CLL

>5000 B cells and can be 100,000

530
Q

Other organs CLL

A

All lymphoid tissue enlarged at diagnosis, wanderers ring in pharynx. In contrast to lymphomas, GI mucosal involvement is rare and meningeal leukemia is unusual

531
Q

Skin CLL

A

Lesions face and can manifest as msucles, papules, plaques, nodules, ulcers, blisters

532
Q

Liver CLL

A

Enlargement

533
Q

Splendid CLL

A

Enlarged

534
Q

Most common abnormal finding on PE with CLL

A

Lymphadenopathy

Cervical, supraclavicular, axillary
Firm rounded discrete nontender and freely mobile

535
Q

Symptoms CLL

A

Painless swelling nodes
Cervical area, which spontaneously wax and wane but dont disappear

Mot no symptoms

Routine blood count

536
Q

B symptoms in 5-10%

A

Unintentional weight low>10%
Fever>100.4 for >2 weeks with no infection
Night sweats
Extreme fatigue cant work

► Med Notes (62 decks)

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