Primary Flashcards

1
Q

Overweight BMI is __-___

A

25-29.9 BMI (kg/m2)

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2
Q

Underweight BMI is >

A

<18.5 BMI (kg/m2)

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3
Q

Normal BMI is __-___

A

18.5-24.9 BMI (kg/m2)

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4
Q

Obese BMI is __-__

A

30-39.9 BMI (kg/m2)

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5
Q

Extreme obesity is > BMI

A

> 40 BMI (kg/m2)

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6
Q

Weight circumference of > __inches is associated with an increase risk in DM & CVD who are classified as overweight or obese

A

> 35 inches (88cm) in females with a BMI 24.9-39.9

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7
Q

Difference between primary and secondary lesion

A

Primary: result of initial insult (exterior or internal) (e.g., bug bite, papules, vesicles)
Secondary: result from trauma or evolution of primary lesion (e.g., excoriations, fissures, scars, ulcers, crusts, impetigo, lichen simplex chronicus)

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8
Q

ABCDE of skin lesions

A

Asymetry, Border irregular, Color changes (blue/black), Diameter >6mm, Evolution

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9
Q

Describe the difference between macules and patches

A

Both are flat, circumcised areas, change in color of skin; macules are <1cm; patches are >1cm (e.g. Pityriasis Versicolor)

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10
Q

Describe the difference between papules, pustules, and vesicles.

A

Papules: elevated, <1cm, circumscribed, firm
Pustules: same but filled with mucopurulent discharge.
(e.g. acne)
Vesicles are elevated, <1cm, circumscribed, filled w/clear fluid >1cm=bulla (e.g., Herpes Zoster)

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11
Q

Describe plaques

A

Firm, rough, flat top surface, elevated, >1cm (e.g., psoriasis)

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12
Q

Describe wheals

A

Wheals are elevated, irregular cutaneous diameter, varying in size; often red and itchy. (e.g., allergic reaction)

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13
Q

Basal cell carcinoma

A

Raised border, ulcer

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14
Q

Most common type of skin cancer

A

basal cell carcinoma

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15
Q

How deep is an ulcer?

A

Dermis and epidermis

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16
Q

Impetigo: s/sx and tx

A

yellow, honey-crusted lesions usually around mouth. Highly contagious.
Tx: Mupirocin, pens, erythromycin.

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17
Q

Types of psoriasis

A
plaque.
guttate.
inverse
pustular.
erythrodermic
psoriatic arthritis
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18
Q

Number one cause of goiter (enlarged, contender thyroid)

A

Grave’s dz (autoimmune hyperthyroidism)

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19
Q

Single thyroid nodule

A

usually cyst, benign, but need to consider malignancy

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20
Q

PERRLA stands for…

A

Pupils Equal, Round and Reactive to Light and Accommodation

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21
Q

Visual fields full by confrontation test

A

fingers wiggling laterally

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22
Q

Extraocular movements EOM test

A

6 cardinal directions of gaze
No nystagmus (few beats, but not sustained)
No lid lag

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23
Q

Define Presbyopia

A

Far-sighted (cannot see things close up–light focuses behind retina)

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24
Q

Define Myopia (20/100)

A

Near-sighted (cannot see far things far away, light focuses in front of retina)

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25
Q

What might you see with cataracts?

A

opacity of lens

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26
Q

What might dysconjugate gaze mean? (when eyes don’t follow one another in the same direction–aka lazy eye)

A

Diseases, injuries, or lesions affecting CNIII, IV, or VI

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27
Q

What might cause nystagmus?

A

Cerebellar system disorders
Drug toxicity
Vestibular disorders (ears)

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28
Q

What might cause lid lag?

A

exophthalmos/ hyperthyroidism

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29
Q

What might you see during the eye exam w/HTN?

A

AV nicking, when the vein appears to stop on either side of artery, or retinal hemorrhages.

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30
Q

What might you see during subarachnoid hemorrhage, trauma or brain mass causing increased ICP–papilledema?

A

Optic disc margin blurred, bulging physiologic cup.

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31
Q

Conductive hearing loss test results

A

Rinne test: bone conduction greater than air (air usually greater)
Weber: sound materializes to affected ear

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32
Q

Conductive hearing loss is usually impaired through….

A

the external or middle ear

e.g., exudate/swelling, perforated eardrum

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33
Q

Sensorineural hearing test results

A

Rinne test: air conduction greater than bone (normal)

Weber: sound materializes to NORMAL ear

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34
Q

Sensorineural hearing loss results in defect in…

A

the inner ear due to loud noise, aging or acoustic neuroma

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35
Q

S/sx of squamous cell carcinoma

A

white patch on side or undersurface of tongue=leukoplakia

+lymph enlargement

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36
Q

S/sx of streptococcal pharyngitis

A

Tonsils 3+ w/white exudate
Enlarged, tender anterior cervical nodes
Erythematous pharynx

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37
Q

S/sx of allergic rhinitis

A
pale blue nasal mucosa
watery nasal d/c
Posterior pharynx
Mucoid secretions
Cobblestone appearance
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38
Q

Normal lung percussion

A

Resonant: loud, low pitch, hollow

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39
Q

Normal lung sounds

A

Vesicular, soft, low pitch, inspiration last longer than expiration. No adventitious sounds

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40
Q

Emphysema exam findings

A

Percussion: hyperresonance (very loud, low pitch, booming)

Decreased fremitus

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41
Q

Pneumothorax exam findings

A

Percussion: Tympany (loud, high pitched, drum-like), decreased fremitus

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42
Q

Lobar pneumonia exam findings

A

Dull: soft-moderate, mod-pitch, thud. Increased fremitus and ego phony (E–> A)

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43
Q

Exam findings in large pleural effusion

A

Percussion is flat: soft, high-pitch, very dull; decreased fremitus

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44
Q

Normal percussion sound over liver

A

dull

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45
Q

Normal percussion sound over bone

A

flat

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46
Q

Crackles, heard during inspiration, may be fine or coarse and heard during…

A

bronchitis, pneumonia, early heart failure

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47
Q

Rhonchi, low-pitch, loud sound heard on inspiration and expiration due to air passing by thick secretions. May be seen in…

A

Pneumonia and bronchitis

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48
Q

Wheezes, heard during inspiration and/or expiration during…
Louder during expiration in asthma

A

Heard during asthma, COPD, or bronchitis.

Louder during expiration in asthma

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49
Q

Pleural Friction rub is dry, grating sound heard during inspiration OR expiration during…

A

Pneumonia, inflammation, pleurites, tumor.

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50
Q

Exam findings in COPD:

A

Increased AP diameter, decreased tactile fremitus

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51
Q

exam findings w/tumor in lung

A

Increased tactile fremitus and egophony

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52
Q

Where is the point of maximal impulse (PMI) best heard/felt?

A

5th intercostal space (ICS), 7-9 cm lateral to midsternal line

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53
Q

What extra cardiacsound is a normal variation in pregnancy?

A

S3

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54
Q

S1 is best heard at the…

A

apex

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55
Q

S2 is best heard at the…

A

base

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56
Q

S1 indicates the closure of…

A

closure of tricuspid and mitral valves, the start of systole

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57
Q

S2 indicates the closure of…

A

pulmonic and aortic valves, the start of diastole

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58
Q

S3 & S4 are best heard over the____ with the ____ of the stethoscope when the patient is supine or _________.

A

S3 is best heard over the APEX with the BELL of the stethoscope when the patient is supine or left lateral. (low pitch)

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59
Q

S4 may be seen in older adults or….

A

well trained athletes (due to forceful atrial ejection int distended ventricle)

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60
Q

S3 may be seen in 1______, 2.________, and 3._______-

A

children, young adults, and pregnant people. (due to rapid ventricular filling)

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61
Q

In pregnancy, one may have a D or S murmur?

A

Systolic murmur

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62
Q

What kind of murmur might you hear during valvular disease?

A

Diastolic murmur +/- clicks and snaps

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63
Q

Glandular breast tissue may feel…

A

bumpy

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64
Q

Only press nipple for d/c if patient reports…

A

nipple d/c

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65
Q

Liver span is _-__cm in R. midclavicular line.

A

6-12cm, edge smooth and palpable no more than 2cm below R. coastal margin.

66
Q

Spleen is between _-__th rib and percusses ______

A

Spleen is between 6th and 10th rib in mid-axillary line and percusses dull. May not be palpable

67
Q

Aorta is no more than _cm and palpated in the ____

A

3 cm

Anterior, left of midline.

68
Q

Kidneys +/-palpable?

A

Nontender and non-palpable-R. kidney may be more palpable.

69
Q

Murphy’s sign is sharp increase in tenderness with upward pressure under R. costal margin while inhaling and may indicate…

A

Cholecystitis

70
Q

Possible signs of peritonitis

A

guarding, rigidity, rebound tenderness.

71
Q

+ signs for possible appendicitis:

A

McBurney’s point: tender in RLQ
Rovsing’s sign: referred rebound tenderness when L. side is pressed
Psoas and obturator signs: irritation of R. psoas or obturator muscle.

72
Q

S/sx of chronic arterial insufficiency

A

Shiny, cool, dusky red; decreased dorsals pedal and posterior tibial pulses bilaterally;
+/- ulcers on toes on points of trauma on feet.

73
Q

S/sx of chronic venous insufficiency

A

Thick skin, warm, non pitting edema; brown hyper pigmentation around ankles; 2+ dorsals pulses, +/-ulcers on medial aspect of ankles

74
Q

Motor strength is measured 0-_

A

0-5+

75
Q

Normal blood pressure is

A

120/80

76
Q

elevated BP:

A

120-129/80

77
Q

Stage I HTN:

A

130-139/80-90

78
Q

Stage II HTN:

A

> /= 140/90

79
Q

Start lipid screening at __y/o and repeat q _ years

A

Lipid screening starts at 20+ if at increased risk for CHD and repeated q5years (more often if indicated)

80
Q

Lipid testing should be done _________

A

fasting (or non-fasting, if just cholesterol & HDL)

81
Q

Normal cholesterol, HDL, LDL and triglycerides:

A
Cholesterol<200
HDL: 40-60
LDL: <130
Tri: 35-135
MAY BE ELEVATED DURING PREGNANCY
82
Q

When should you screen for DM?

A

+GDM q3 years
Age 45+ q3years
earlier and more often if BMI>25 & one other risk factor

83
Q

How to test for DM?

A
Hgb A1c >6.5%
  5.7-6.4% = pre=diabetes
  <5 =normal 
75g 2hr glucose test
--> repeat test to confirm test
84
Q

+ Diagnosis for DM

A

A1C >6.5%
5.7-6.4% = pre=diabetes
2hr >200 mg/dL
Fasting>126 mg/dL
s/sx of hyperglycemia + random glucose of >200mg/dL
Repeat test on subsequent day to confirm dx unless symptomatic

85
Q

When should A1C be checked in diabetics? And what’s good control?

A

q3 months

A1C<7%

86
Q

Clinical breast exam is recommended starting at age __ Q __year(s)

A

40 annually
1-3years between 25-39

ACS: CBE not needed if having annual mammograms & no risk factors

87
Q

Mammograms

  • ACOG (2017)
  • ACS (2015)
  • USPSTF (2016)
A
  • ACOG: 40 q 1-2 years
  • ACS: 40-45 annually until 55, then q 2yrs
  • USPSTF: 50-74 q 2yrs
88
Q

Screening for +BRCA gene

A

Annual mammogram and MRI

89
Q

Cervical cancer risk factors

A

Smoking, multiple sex partners, lack of screening, high risk HPV

90
Q

HPV testing

A

21-29: q 3 years pap only
30-65: q5 years pap + HPV or q3yrs pap only
66+/hysterectomy: stop screening, unless past +HPV 20years.

91
Q

Colon cancer risk factors

A

Red meat, obesity, smoking EtOH, inflammatory bowel disease, colon polyps, family hx

92
Q

Colon cancer screening

A
Colonoscopy q10 years @ 50yrs
FIT: fecal immunochemical test annually
-Flexible sigmoidoscopy q5yrs
-CT colonography 
-FIT-fecal DNA test q3yrs
93
Q

_____cancer is the leading cause of cancer-related death in women

A

Lung

1/20 women

94
Q

_____cancer is the the most prevalent type of cancer in women

A

breast

95
Q

Lung cancer screening guidelines according to USPSTF, ACS

A

Annual low-dose CT scan ages 55-80 with a 30+ pack-year smoking history & still smoking or quit w/in 15 yrs.

96
Q

How to calculate pack-year history?

A

Multiply packs per day and years smoked (1pk/d for 30 years=30py)

97
Q

Bone mineral density screening recommendations

A

65+ or younger w/risk factors q2-15 years using DEXA

98
Q

T-score interpretation

A

-1 to +1: normal
-1 to -2.5: low bone mass (osteopenia)
>/= -2.5: osteoporosis

99
Q

HIV screening

A

EVERYONE ANNUALLY unless declined (opt-out screening)

-Pregnant: 1st/3rd trimester

100
Q

Screening test for HIV (rapid test using blood or oral mucosa)

A

EIA (enzyme immunoassay) for HIV 1 and 2 antibodies (detectable by 4wks-6 months)

101
Q

Confirmation testing for HIV

A

Western blot or ISA

102
Q

Early screening for HIV

A

P24 antigen: detectable 2-6 weeks after infection and declines when p24 antibodies develop (best if combined with EIA)

103
Q

Who to risk HepC for? and how?

A

born 1945-1965 or with risk factors

With ELISA test (+2wks to 12 mons) =indicates past or present infection

104
Q

What is a hep C virus RNA (PCR) test used for?

A

Determine active vs. chronic infection of HepC

105
Q

When should influenza be administered

A

Everyone, including children and pregnant, annually.

106
Q

Tdap vaccine recommendations

A

Tdap +Td booster q10yrs

Tdap EACH pregnancy between 27-36 weeks

107
Q

Zoster vaccine recommendations

A

60y/o + regardless of history of shingles

108
Q

Pneumococcal Vaccine recommendations

A

65y/o+ or immunocompromised

Give both PCV13 and PPSV23, starting with PCV13, at least one year apart.

109
Q

HPV vaccine–Gardasil 9 (9-valent)

A

covers 9 types of HPV
2-dose <15y/o (0, 6-12mons)
3-dose >/=15y/o or immunocompromised (0, 1-2mons, 6 mons)

110
Q

Age limit for HPV

A

until 45 now!

111
Q

What vaccine should be given to all 1st year college students living in dorms?

A

Menningococcal

112
Q

T or F: Live attenuated vaccines, including varicella, MMR and LIAV-flu, are contraindicated in pregnancy and lactation

A

T-preg

F-lactation, however LIAV-flu shot not recommended.

113
Q

Daily recommendations for Calcium

A

1000-1300mg/day (higher if younger than 19, older than 51)

114
Q

Daily recommendations vitamin D

Normal serum levels

A

400-800 if <51y/o
800-100 if >50
Normal serum level: >30ng or greater

115
Q

Food sources of calcium

A

dairy, soybeans, sardines, salmon, OJ, cereals

  • calcium citrate <500mg
  • calcium carbonate (take w/food) <500mg
116
Q

Food sources of vitamin D

A

sun, egg yok, fortified milk, saltwater fish, liver

117
Q

Daily recommendations for folate (for DNA synthesis)

A

0.4mg/d or 4mg/d one month prior to pregnancy if at NTD risk

118
Q

Daily recommendations for iron

A

14-50y/o: 15-18mg/dL per day

51+y/o: 8mg/dL per day

119
Q

Sources of folate:

A

Dried beans, leafy vegetables, citrus fruits, fortified cereal

120
Q

iron sources

A

meat, fish, cereal

121
Q

Sodium recommendations

A

<2300mg/day

<1500mg/day if 51yrs+, African American, HTN, CKD, DM

122
Q

Fat recommendations

A

<20-35% total fat/day
<10% saturated fats
<300mg/d cholesterol
no trans fat

123
Q

Max heart rate is 220-____

A

your age

124
Q

Muscle strengthening > __days/week and __ days for bone strengthening

A

2 days/week for muscle

3 days for bone strengthening

125
Q

___ minutes of moderate intensity or __ minutes of vigorous intensity aerobic activity

A

150 minutes

75 minutes

126
Q
  1. Mild asthma has symptoms
A

Mild asthma has symptoms =2d/wk, =2 nights/wk

127
Q
  1. Mild persistent asthma has symptoms >__days per week and more than __ days per week
A
  1. Mild persistent asthma has symptoms >2days per week and more than 2 days per week
128
Q
  1. Moderate persistent asthma symptoms occur every day and occur more than __ day(s) per week
A
  1. Moderate persistent symptoms occur every day and occur more than 1 day(s) per week
129
Q
  1. Severe persistent asthma symptoms occur…
A
  1. Severe persistent asthma symptoms occur…continually during the day and frequently during the night
130
Q

Thyroid levels should be checked q___

A

q4wks

131
Q

Most common precursor to skin cancer is…

A

actinic keratosis, often found in areas exposed to sun. Can be removed via cryotherapy or topical meds.

132
Q

Medications that can adversely affect thyroid function are…

A

GAP:
Glucocorticoids
Amiodarone
Phenytoin

133
Q

S/sx of Zika

A

fever, rash, headache, joint pain

134
Q

Congenital Zika Syndrome s/sx

A
  1. Microcephaly, r/I partially collapsed soul
  2. Decreased brain tissue w/brain damage
  3. Damage to back of eye
  4. Limited range of motion, clubfoot
  5. Too much muscle tone restricting body movement
135
Q

Zika last longer in sperm or vaginal d/c?

A

sperm (men should avoid pregnancy for 6 mons; women 8wks)

136
Q

Testing for Zika

A

PCR (not recommended if no risk fxrs)

IgG (prior to pregnancy is reasonable if risk factors)

137
Q

Normal Hgb for pregnant, non-pregnant and NBs

A

Nonpregnant: 12-16
Pregnant: 10.5-14
NBs: 13-20gm/Dl

138
Q

Normal hematocrit for non pregnant, pregnant and NBs

A

Nonpregnant: 37-47%
Pregnant:
NBs: 42-65%

139
Q

Normal platelet count

A

150-400k/mm3

140
Q

Normal WBC

A

5-10k

up to 20k in pregnancy

141
Q

WBCs elevated in viral infections

A

lymphocytes and monocytes

142
Q

WBCs elevated in allergic reactions

A

basophils

143
Q

WBCs active acute bacterial infections

A

neutrophils

144
Q

Free T4 not affected by…

A

increased TBG

145
Q

Renal function tests

A

BUN 5-20mg/dL

Creatinine 0.5-1.1mg/dL

146
Q

Causes of high BUN levels

A

Pre-renal causes: dehydration, burns, reduced cardiac fun, GI bleed, high protein, excessive catabolism (starvation)
Renal causes: renal dz, failure and nephrotoxic drugs
Post-renal causes: obstruction to urine, cancer, prostate enlargement.

147
Q

Causes of decreased BUN levels

A

Pregnancy, over hydration, liver failure, malnutrition, malabsorption, nephrotic syndrome (protein loss in urine)

148
Q

What med class could cause rhabdomyolysis (destruction of skeletal muscle)?

A

Statins

149
Q

Causes of increased creatinine clearance

A

increased blood flow (pregnancy, exercise, high cardiac output)

150
Q

Causes of decreased creatinine clearance

A

decreased blood flow to kidneys: renal dz, cardiac dysfunction, cirrhosis w/ascites, shock, dehydration
(calculated from urine)

151
Q

Liver function tests

A

Bilirubin
Albumin 3.5-5
Liver enzymes: ALP, AST, GGT, LDH

152
Q

T or F: There are no chronic HepA carriers

A

True, not chronic, but IgG can be + for 2 years

153
Q

A HAI titer of 1:10 or greater for rubella indicates…

A

immunity

154
Q

A HAI titer of 1:64 or greater for rubella indicates…

A

possible infection –> test for IgM!

155
Q

> 5mm PPD test is positive for folks who are…

A
  • HIV +
  • Immunocompromised
  • Recent contact of TB case
  • Fibrotic changes on Chest x-ray consistent w/old TB
156
Q

> 15mm PPD test is positive for folks who are…

A

healthy with no risk factors for TB

157
Q

> 10mm PPD is positive for folks who are…

A
  • Immigrants from high-prevalence countries (<5years)
  • Injection drug users
  • Residents/employees of high-risk settings
158
Q

T or F: TB blood test (interferon-gamma release assay–IRGA) is definitive.

A

True

159
Q

ANA is used for…

A
systemic lupus (95%)
Sjogren's syndrome
Rheumatoid arthritis
Scleroderma
Some medications will cause false +
160
Q

Diagnostic criteria for SLE

A

4/11 s/sx: malar/butterfly rash, photosensitivity, oral ulcers, arthritis, kidney disorder, neurologic disorder, heme abnormalities, immunologic disorders, discoid rash
+ ANA >1:40
(persistent negative ANA titer <1:40 rules out SLE)