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Precision > Psych/Infectious disease/Heme > Flashcards

Psych/Infectious disease/Heme Flashcards

1
Q

Alcohol dependence withdrawal (pharm tx)

A
  1. IV benzo
  2. IV fluids + suppleemnts = Thiamine/magnesium
  3. Avoid meds that decrease seizure threshold (bupropion, haloperidol, anticonvulsants, clonidine, BB)
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2
Q

Alcohol use disorder (pharm tx)

A

Disulfiram = First line

Naltrexone = opioid antagonist to reduce cravings and ETOH induced euphoria

Gabapentin = topiramate

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3
Q

ADHD (hx and pe)

A

Difficulty paying attention, controlling behaviors, hyperactivity

Sx onset = before age 12 and present at least 6 months

Sx must occur in at least 2 settings (home + school)

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4
Q

Conduct disorder, breath-holding (clinical intervention)

A

Family counseling w/ parents + child

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5
Q

Persistent depressive disorder (hx and pe)

A

Chronic depressed for at least 2 years in adult; 1 year child

Lasts most of day, more days than not, patient is not sx free for >2 mo at a time

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6
Q

Histrionic personality (FMLD)

A

Hey look at me - attention seeking
Hissy fits - temper tantrums
Hyperinflated - believes they are more important than others

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7
Q

Postparum depression (pharm tx)

A

SSRI

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8
Q

Schizoaffective disorder (FMLD)

A

Schizo + mood disturbance (MDD or manic)

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9
Q

Schizoid personality (FMLD)

A

Voluntary social withdrawl, loner, hermit, reclusive, isolated, anhedonia/introvert

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10
Q

Schizophrenia (Hx and PE)

A

> 6 mo of illness with 1 month of acute dx with functional decline

Decreased CNS gray matter, increased size of ventricles, increased CNS dopamine receptors

Ask about positive vs negative sx

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11
Q

Schizophreniform disorder (FMLD)

A

Meets criteria for schizophrenia but less than 6 mo duration

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12
Q

Tardive dyskinesia (pharm tx)

A
  1. Switch to second generation antipsychotic
  2. Deutetrabenazine
  3. Valbenazine
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13
Q

Ascariasis (FMLD)

A

Small worm load = asx

Large worm load = Vague abd pain,

High load = migrate to pancreatic duct, bile duct, appendix

Patient may c/o of cough, wheezing, hemoptysis, abdominal pain, diarrhea

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14
Q

Bartonellosis (cat-scratch dx) Pharm tx

A

Azitrho = first line

Doxy preferred if optic neuritis or neurologic disease

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15
Q

Chancroid (scientific concept)

A

STI cause by bacteria = Heamophyllis ducreyi

PAINFUL ulcer vs syphillis is painless chancre

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16
Q

Dengue fever (FMLD)

A

Biphasic fever (high then remission, then second fever)

Joint pain, HA, sore throat

Biphasic rash

Hemorrhagic fever in children

Tourniquet test - Purpura from the pressure of the tourqniuet placed on arm

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17
Q

Diptheria (pharm tx)

A

Diptheria antitoxin (horse serum) supplied by CDC + erythromycin or PCN x 2 weeks

Clinda or Rifampin are alternatives

PCR confirms diptheria

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18
Q

Dengue fever prevention (maint + prevention)

A

Pemethrin on clothes, DEET on body

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19
Q

HIV disease (Dx and labs)

A
  1. Antibody testing = ELISA = SCREENING
  2. Western Blot = CONFIRMS

HIV RNA Load = Used to monitor infectivity

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20
Q

HIV/AIDS (Maint + prevention)

A

Avoid IV drug use/sharing needles

Post exposure prophy = High risk people best started within 72hrsof incident, earlier the better

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21
Q

HIV/AIDS, Cytomegalovirus (scientific concepts)

A

MC virus in AIDS patient

CMV Retinitis if CD4 less than 50

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22
Q

Shigella infection (hx and pe)

A

Mild abd pain to severe diffuse colicky abd pain with mucoid diarrhea preceding BLOODY diarrhea, fever, N/V, anorexia

PE = Tachycardic, hypotensive, abd distention, tenderness with HYPERACTIVE bowel sounds

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23
Q

Lumbricoides infestation (scientific concepts)

A

GIANT roundworm ; MC intestinal helminth worldwide

Contaminated soil

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24
Q

Lyme disease (FMLD)

A

Hx of tick bite;

early localized= erythema migrans

Early disseminated = arthritis + HA, CN7/Facial palsy, AV heart block

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25
Q

Malaria (dx and labs)

A

Gemsa stain peripheral smear (thin and thick) parasites in RBC

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26
Q

Malaria (scientific concepts)

A

RBC disease caused by plasmodium calciparaum

Transmitted by female anophele mosquito

Sickle cell trait + thalassemia trait = Protective against malaria

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27
Q

Mumps (clinical intervention)

A

Supportive

Anti-inflammatory; Sx lasts 7-10 days

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28
Q

Neurosyphillis (pharm tx)

A

PCN IV x 10-14days

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29
Q

Primary syphillis (dx and labs)

A
  1. Darkfield microscopy
  2. Screening tests = RPR, VDRL
  3. Confirm = FTA- BS (fluoroscent treponemal antibody absorption)
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30
Q

Ramsey Hunt - (FMLD)

A

Triad

Ipsilateral facial paralysis (bells palsy)
Ear pain
Vesicles of auditory canal

Decreased hearing, tinnitus, hyperacusis, lacrimation in some patients

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31
Q

Rocky mountain spotted fever (FMLD)

A

Fever + HA a few days after rash

Rash = small spots of bleeding starts at ankles/wrist then palms/soles before spreading centrally over 2-3 days

32
Q

Rubella (Maint + Prevention)

A

Generally no complications in children with rubella

Teratogenic in 1st trimester part of TORCH

Blueberry muffin rash

33
Q

Schistosomiasis (FMLD)

A

Tropical = Swimming, wading in fresh or salt water

Pruritic rash due to cercarial dermatitis aka swimmer itch

Fever, lethargy, malaise, myalgia

34
Q

Sepsis, bacterial (hx and pe)

A

Fever + Hypotension + Increased RR

35
Q

Toxic shock syndrome (hx + pe)

A

Sudden onset of high fever, tachycardia, hypotension, rash like sunburn includes palms/soles

36
Q

Toxoplasmosis (FMLD)

A

Primary infection= usually asx

Mono-like illness, cervical LAD, encephalitis and chorioretinitis if immunocompromised

TORCH syndrome

Triad:
Chorioretinitis
Intracranial calcifications
Hydrocephalus

37
Q

Trichinellosis (FMLD)

A

Hx of wild boar, bear, or cougar hunting

Diarrhea, N/V, fever, fatigue, abd discomfort

38
Q

Typhoid fever (FMLD)

A

Caused by salmonella (s.typhi)

Cephalic phase - HA, constipation, pharyngitis, cough

PEA SOUP STOOLS

Fever, bradycardia, hepatosplenomegaly, ROSE SPOTS

39
Q

Alpha thal (Dx and labs)

A
  1. CBC = hypochromic, microcytic anemia
  2. Peripheral smear = TARGET cells, basophillic stipling; HEINZ BODIES in hemoglobin H dz
  3. Hb electro = normal

Some or all of the 4 genes that make hemoglobin (the alpha-globin genes) are missing or damaged

40
Q

Anemia, hemolytic, secondary to renal failure (pharm tx)

A

Iron supplementation and ESA (recombinant EPO and darbepoetin alfa)

41
Q

Aplastic anemia (dx and labs)

A

CBC, peripheral smear, Hbg electrophoresis, serology for hepatitis

Fluorescent labeled inactive toxin testing

Kidney and liver testing

Bone marrow biopsy

42
Q

Autoimmune hemolytic anemia (clinical intervention)

A
  1. Warm (IgG Ab) Steroids = first line then splenectomy then immunosuppressants
  2. Cold (IgM) Avoid cold exposurer, Rituximab if tx is needed

Coombs (+) distinguishes between hereditary spherocytosis

43
Q

Autoimmune hemolytic anemia (health maint and prevention)

A

Cold (IgM) = Stay away from cold temp, wear gloves

Warm (IgG) = periodic blood transfusions, splenectomy

*G6PD = avoid triggers (fava beans, napthalene)

44
Q

Beta thal (FMLD)

A
  1. Beta thal - trait aka MINOR = asx, only 1 defective gene
  2. Beta thal Intermedia = Assoaciated with anemia, hepatosplenomegaly and bony disease
  3. Beta thal major COOLEYS anemia = usually asx at birth but become symptomatic at 6 mo; frontal bossing; maxillary overgrowth; hepatosplenomegaly; SEVERE HEMOLYTIC anemia, osteopenia, iron overload and pigmented gallstones
45
Q

Beta thal (Dx and labs)

A
  1. CBC = hypochromic, microcytic anemia (decreased MCV); normal or increased RBC count and serum iron
  2. Peripheral smear = TARGET cells, teardrop cells, basophillic stipling
  3. Hgb electrophoresis = B thal trait (minor) = low HbA, HbA2, HIGH Hbf
  4. Hgb electrophoresis = B Major (cooleys) = High HgbF, increased HgbA2, little to no HgbA

Skull Xray = BOSSING with hair on end due to extramedullary hematopoeisis

46
Q

Beta thal (scientific concepts)

A

Decreased production of beta chains leds to excess alpha chains

MC in mediterranean (greek/italian) and africans

47
Q

Protein C coagulation Defect (Pharm tx)

A

Heparin = Anticoag for life

48
Q

Protein C coagulation defect (scientific concepts)

A

Protein C is a Vitamin K dependent anticoagulation protein (produced in liver) that stimulates fibrinolysis and clot lysis

Increased risk of recurrent DVT and PE

Autosomal dominant inherited hypercoaguable disorder

49
Q

Factor V leiden mutation (pharm tx)

A

High risk = Indefinitive anticoagulation; may need thromboprophylaxis during pregnancy to prevent miscarriage

Moderate risk (thrombotic event with a prothrombotic stimulus or asx) = Prophylaxis during high risk procedures

50
Q

Goodpastures Syndrome (FMLD)

A

G + P = Glomerular + Pulmonary

Glomerulonephritis + Pulmonary hemorrhage

51
Q

Goodpasture syndrome (clinical intervention)

A
  1. Steroids + Cyclophosphamide
  2. Plasmapheresis
52
Q

Goodpastures syndrome (dx and studies)

A

Biopsy = Linear IgG deposits in glomeruli or alveoli on immunofluoresence, anti-GBM Ab

53
Q

Goodpasture syndrome (scientific concepts)

A

IgG antibodies against type IV collagen of the alveoli and glomerular basement membrane of the kidney

54
Q

Hemochromatosis (hx and pe)

A

Bronzing of the skin;deep tak color associated with insulin insufficiency

55
Q

Hemochromatosis (clinical intervention)

A

Phlebotomy weekly until depletion of iron

56
Q

Hemolytic anemia (pharm tx)

A

Two means of reducing antibody production

Steroids and cytotoxic drugs

57
Q

Hemolytic anemia secondary to renal failure (pharm tx)

A

Intravascular hemolysis can produce ATN = muddy brown casts

Sx = Red/brown urine and plasma; low haptoglobin; high LSL; deteriorated renal function; fraction excretion of sodium less than 1%

Tx = DIALYSIS

58
Q

Hemolytic uremic syndrome (FMLD)

A

Suspect in kid with GI sxs (E.coli, shigella, slamonella)

Anemia + kidney damage + petechiae/bruising

59
Q

Hemophilia A (scientific concepts)

A

Deficiency of Factor VIII (8) Aiiiight

Affects INTRINSIC pathway = failure to form hematomas; occurs almost exclusively in males

59
Q

Hemophilia A (scientific concepts)

A

Deficiency of Factor VIII (8) Aiiiight

Affects INTRINSIC pathway = failure to form hematomas; occurs almost exclusively in males

60
Q

Hereditary hemochromatosis (dx and labs)

A
  1. Increased serium iron, increases serum transferrin; NORMAL/Decreased TIBC
  2. Increased LFTs,genetic testing for HFE gene, increased risk of hepatocellular carcinoma
  3. Liver biopsy = GOLD STANDARD = increased liver parenchymal HEMOSIDERIN
61
Q

Hereditary spherocytosis (dx and labs)

A
  1. Blood smear = hyperchromic microcytic

2.Osmotic fragiltity test = POSITIVE ; Coombs = negative

62
Q

Herediatry spherocytosis (FMLD)

A

Hemolysis leading to anemia, jaundice, hepatosplenomegaly

PIGMENTED black gallstones (calcium bilirubinate)

63
Q

Hodgkin disease (FMLD)

A

Patient 20 or 50 - BIMODAL

Painless lymphadenopathy in upper body

Alcohol may induce lymph node pain

*Reed-sternberg owl-eye appearance

Associated with EBV

64
Q

Idiopathic thrombocytopenic purpura (clinical intervention)

A

Splenectomy

65
Q

Paroxysmal nocturnal hemoglobinuria (clinical intervention)

A

Eculizumab (anit-complement CD5 Ab)

Prednisone decreases hemolysis

Marrow transplant

66
Q

Paroxysmal nocturnal hemoglobinuria (FMLD)

A

Unexplained hemolytic anemia associated sxs including fatigue, jaundice , and red/pink/black urine.

Decreased bone marrow function in some individuals may further exacerbate anemia and cause other cytopenia

67
Q

Pernicious anemia (scientific concepts)

A

Autoimmune destruction loss of gastric parietal cells that secrete intrinsic factor leading to B12 deficiency

68
Q

Polycythemia vera (dx and labs)

A

Screening test = Hbg >16
Hct less than 48%

Diagnostic test = Subnormal EPO and either Jak2 peripheral blood mutation or exon 12 mutation

69
Q

Secondary polycythemia (FMLD)

A

Increased hematocrit as a response to another process

Sxs related to underlying precipitating cause (COPD) cyanosis, clubbing, HTN, hepatosplenomegaly

+/- heart murmur

70
Q

Thalassemia (scientific concepts)

A

Inherited blood disorderr that causes the body to have less hemoglobin than normal leading to anemia and fatigue

Broken down into classifications =
4 subtypes of alpha (silent, carrier, major, Hgb H disease)

3 subtypes of beta (minor, intermedia, major)

71
Q

Thalassemia (FMLD)

A

Microcytic anemia with normal/elevated serum iron or no response to iron treatment

Associated with severe anemia and abnormal peripheral smear for a given Hct count

72
Q

Thrombotic thrombocytopenic purpura (TTP) (FMLD)

A

PENTAD

Thrombocytopenia
Microgangiopathic hemolytic anemia
Kidney failure
Neurlogic sxs
Fever

*Increased incidence with HIV

FAT RN

F is for fever, A is for anemia, and T is for thrombocytopenia.

R in RN is for renal dysfunction, while the N is for neurologic abnormalities.

73
Q

EMTALA

A

Professional practice

If you work at a facility that accepts Medicare/Medicaid you are required to perform a medical screening exam on every person that comes in

No refusal

Civil penalties if you are in violation

ER must treat everyone - Anti-dumping law

74
Q

Legal/ethical informed consent

A

Required documentation by joint commission

Provider educates patient about risks, benefits, alternatives of a given procedure, intervention, or medication

Patient must be competent to make voluntary decision about procedure or intervention and sign form

75
Q

Medical informatics : medical record documentation

A

Accurate for biling and coding purposes

76
Q

Patient care and communication: informed

A

Patients must be informed of risks and benefits and alternatives in all situations

Patients are allowed to ask questions about procedures and interventions before consenting to ensure they are comprehending the information we give them

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