Review Flashcards
Discussion of code status with pt admitted to hospital is what type of preventive care
Quaternary prevention
What’s a type of primary prevention
Immunizations
What type of prevention is a Pap smear screening
Secondary prevention- strategies to promote early detection of disease
What type of prevention is mastectomy
Tertiary - aim to limit impact of established disease
What are the components of an intervention for treating tobacco use
Ask,advise,assess,assist,arrange
An immuno-compromised pt would like the pneumonia vaccine what is recommended
pCV 13 now and revaccinate with PPSV23 in 8 weeks
Screening of a hepatitis panel results with negative HBsAg, positive anti-HBs,negative anti-HBc what does this mean
Pt had hep B in the past and has passive immunity
Who should be screened for lung cancer
Adults 55-80 who have 30pk smoking history and currently smoke or quit with in past 15 years
Order Low dose CT chest
Women 50-74 should get screened how often for breast cancer
Biennial mammogram
Elevation in lead II, III and aVF indicate what type of MI
Inferior
Elevation in lead v3&v4 what type of MI
Anterior
Elevation in lead v1 V2and V3indicate MI where
Anteroseptal
Hgb levels
14-18 males
12-16 femals
HCT levels
Males: 40-54
Female 37-47
TIBC what is it and levels
Binding capacity of iron- increased means higher need for iron
Normal 250-450
Serum iron
50-150
MCV
Volume and size of erythrocyte
80-100
MCV
Mean corpuscular volume - average amount/weight of Hgb in a single erythrocyte
Normal 26-34
MCHC
Mean corpuscular hemoglobin concentration-average Hgb concentration of each RBC more accurate then MCH
Normal 32-36%
Low MCV anemias
Iron deficiency
Thalassemia
Microcytoc anemia
High MCV anemia
Macrocytic anemia
B12 or folate deficiency,alcoholism,liver failure and drug effects
Normocytic anemia
Anemia of chronic disease
Sickle cell
Renal failure
Blood loss
Hemolysis
The most common cause of anemia
Iron deficiency anemia
Causes of iron deficiency anemia
Blood loss
Inadequate iron intake
Impaired absorption of iron
What anemia may cause Pica
Iron deficiency anemia
Labs: low h/h, low serum ferritin, high TIBC and low MCV - what type of anemia
Iron deficiency
Labs: low h/h, low MCV, low MCHC, normal TIBC and decreased a Hgb chain
Thalassemia
Genetically inherited disorder in abnormal Hgb and microcytic and hypochromic anemia
Thalassemia
Who gets thalassemia
Mediterranean African middle eastern Indian and Asian
Most common type of thalassemia
Beta thalassemia
An adult with thalassemia has which type most likely
Thalassemia minor
One copy of beta chain
Mild anemia
A child has what type of thalassemia that is progressively severe
Thalassemia major/Cooleys Anemia
2 genes for beta
Can you administer iron in thalassemia
No contraindicated
Tx for thalassemia
No treatment for mild/moderate, RBC transfusion/splenectomy for severe forms
Pt with fatigue, tachycardia and glossitis with out neuro changes has anemia what type do you expect
Folic acid deficiency
Labs: low h/h, elevated MCV, normal MCHC, decreased serum folate
Anemia?
Folic acid deficient
Tx for folic acid deficiency anemia
Folate acid 1mg every day
High folate food/ bananas, peanut butter,fish, green leafy vegetables iron fortified breads and cereals
Anemia caused by deficiency of intrinsic factor
Pernicious anemia (b12)
Labs: low h:h, MCV increased, decreased b12
Anemia?
Pernicious anemia
What type of anemia is pernicious anemia
Macrocyctic normochromic
Tx for pernicious anemia
B12 100mcg IM daily x1 eeek (front load) then lifelong monthly
Most common anemia in elderly and hospitalized patients
Anemia of chronic disease
Labs: low h/h, MCV normal, MCHC normal, serum iron and TIBC low, high serum ferritin
Anemia chronic disease
Pt reports pain in chest and aching joints, upon assessment appears dehydrated you suspect sickle cell what is the treatment
Fluids
Analgesics
Oxygen
Genetic disorder results in deficiency of clotting factor VIII
Von willebrand disease
Tx for von willebrand disease
Desmopreasin
Recombinant von Willebrand factor/factor VIII concentration
Acute leukemia in adults with long term survival of 40%
Acute myelogenous leukemia (AML)
90% remission rate in children hallmark of disease is Pancytopenia with circulation of blasts
Acute Lymphocytic leukemia (ALL)
Most common leukemia in adults
Chronic lymphocytic leukemia (CLL)
Hallmark of this leukemia is lymphocytosis
CLL - chronic lymphocytic leukemia
What leukemia is Philadelphia chromosome seen in
Chronic myelogenous leukemia (CML)
Pt with fatigue weight loss and generalized lymphadenopathy - what do you suspect
Leukemia
Pt presents with low h/h, fatigue, glossitis and parenthesis - what anemia do you suspect
How do you treat
Pernicious anemia
B12 IM daily x 1week then monthly
How is leukemia confirmed
Bone marrow biopsy
Why give allopurinol to a pt undergoing chemotherapy
To reduce tumor lysis syndrome
Management of leukemia
Chemo
Bone marrow transplant
Control symptoms
What stage is lymphoma if you have enlarged lymph in neck and groin
Stage III- lymph involved on both sides of diphragm
Stage II lymphoma involves what
More than one lymph node group- confined to one side of diaphragm
Stage I lymphoma is dx how
Disease localized to one single lymph node
Pt has lymphoma that has spread to neck lymph nodes, the spleen and the liver - what stage is this
Stage III- involves liver or bone marrow
20 year old male presents with advanced stage lymphoma - what type is this most likely
Non-hodgkins
What finding would differentiate Hodgkin’s disease from non-hodgkins
Reed-stern berg cells
Manager of lymphoma
Radiation
Chemo
Bone marrow transplant
Management of ITP( idiopathic thrombocytopenia purpura)
May not need till PLT <20000
High dose corticosteroids
IV gamma globulin (preferred for HIV pt)
PLT transfusion
Mtg if DIC
Treat underlying cause
PLT Tx for thrombocytopenia, FFP to replace clotting factors, cryo for fibrinogen
Use heparin
Labs associated with DIC
Thrombocytopenia PLT <150000
Hypofibrinogenemia /fibrin <170
Decreased RBC
Increased fibrin degradation products. (FDP) >45 mcg/ml
Prolonged PT >19 seconds
Prolonged PTT >42 seconds
DDimer +
Difference in acute vs chronic pain
Acute <6 months
What to consider to treat bone pain with Mets
Biophosphonates
What is neuroleptic malignant syndrome
Toxic on antipsychotic or antidepressant like SSRI
Pt presents to ED with possible overdose he is vomiting with hyperthermia elevated LFTs and tinnitus what substance do you suspect
Aspirin
Pt presents to Ed with possible overdose s/s include nausea excessive salivation blurred vision with kiosks and bradycardia. What substance do you suspect
Organophsphate insecticide
Tx for insecticide (organophosphate) poisoning
Wash skin
Activated charcoal if swallowed
Atropine is drug of choice
Tx for serotonin syndrome
Dantrolene sodium
Clonazepan to treat rigor
Cooling blankets
What condition do you need to worry about developing with antidepressant toxicity
Seizures- treat with benzodiazepines IV
S/s antidepressant toxicity
Confused
Hallucinations
Urinary retention
Hypothermia
Hypotension
Tachycardia
Seizure
Tx for beta blocker overdose
Glucagon
Atropine as needed
Stabilize airway
Tx of ethylene glycol overs OPO se
Fomepizole (antizol)
Ethanol if fomepizole not AV
What indicates compartment syndrome and what is treatment
Pressure >30 mmHG
Delta pressure <=30
Fasciotomy
What is delta pressure
Difference in Diastolic BP and the intra-compartmental pressure - if less then 30 need fasciotomy
Pathogen and drug for endocarditis
Staphylococcus aureus
Vanco + ceftriaxone
Drug choice for peritonitis
Metronidazole plus 3rd gen. Cephalosporin or zosyn
Common pathogen cause acute otitis media sinusitis and bronchitis
S. Pneumoniae
Common pathogen of cellulitis and Tx
Staph. Aureus , group A strep
Cefazolim, Vanco, clindamycin, linezolid and dapto
Tx for transplant Pt that you think is rejecting organ
Immediate biopsy
What is most effective anti-rejection regimen
Triple therapy
Steriod- methyprednisolone or prednisone
Antimetabolite
Calcimeurin inhibitor or mTOR
Who gets shingrix
Shingles vaccine
Adults >=50- 2 doses with 2nd dose given 2-6 months after first
Rough flesh colored pink patches in sun exposed parts of body
Actinic keratoses
Firm irregular pPule or nodule that is keratitis and scaly bleedinh
Squamous cell carcinoma
Benign non painful beige or black plaques that are “stuck on”
Sevorrheic kerToses
No treatment or nitrogen removal
Most common skin cancer
Basal cell carcinoma
Tx of basal cell carcinoma
Shave/punch biopsy and surgical excision
Highest mortality rate of all skin cancers
Malignant melanoma
Most common type of headache
Tension headache
Headache effecting middle age men and often at night and unilateral
Cluster headache
Tx of cluster headache
100% oxygen
Sumatriptan 6mg SQ
Normal urine sodium
10-20 mEq/L
Normal serum osmolality
275/285 (2x Na)
What does high urine sodium usually indicate
Renal salt wasting a problem with kidney
What sodium defect usually occurs with extreme hyperlipidemia or hyperproteinemia
Isotonic hyponatremia
normal CVP
0-6
Normal PAP
15-25/5-15
normal PCWP
6-12
normal CO
4-8
normal CI
2.5-4
normal SVR
800-1200
normal CV02
60-80%
Shock state with low CO, LOW CVP and high SVR
hypovolemic
type of shock with low CO, high CVP and high PCWP
cardiogennic
shock state with high CO, low CVP, low PCWP and low SVR
septic shock
shock with low CO, high CVP, high SVR and high SV02
obstructive shock
shock with low CO, low CVP, low PCWP, low SVR
anaphylatctic
neurogenic
side effect of st johns wort
increase blood clotting
serotonin syndrome wiht SSRI
two herbs that help with premenstrual and menopausal discomfort
black cohosh
evening primrose
what is side effect of kava kava
hypertension long term
alcohol increased toxic effects
first drug to administer for anaphylactic shock
diphenhydramine (Benadryl) 25-75mg IV or IM
elements of aSOFA
SBP <100 - 1 point
RR >=22 - 1 point
GCS <15, AMS - 1 point
2 or more points greater risk of death or prolonged ICU
what is serum osmolality of hypotonic hyponatremia
<280
Causes of hypovolomeic with urine NS <10
dehydration
diarrhea (C-Diff)
Vomiting / NGT suctioning
causes of hypovolemic w/ urine Na > 20
-Low volume and kidneys cannot conserve Na
Diuretics
ACE inhibitors
Mineralocorticoid deficiency
causes of hypervolemic hypotonic hyponatremia
- Need to restrict water-most common
edematous states
CHF
liver disease
advance renal failure
state of body wat´r excess diluting all body fluids , clinical signs arise from water excess
hypotonic hyponatremia
usually due to excess water loss; always indicates hyperosmolality
hypernatremia - serum osmolality >295
Mtg of hypernatremia
hypovolemic- NS IV followed by 1/2 NS
euvolemia- free water (D5W)
hypervolemia- free water and loop diuretic; may need dialysis
pt has muscular weakness, fatigue and muscle cramps as well as prominentU waves and broad T waves - what do you suspect
hypokalemia -
MTG of hypokalemia
oral replacement if >2.5 and EKG normal
IV replacement if <2.5 or severe s/s - 40mEq/hour
Check Mg!!!!
common drug cause of hyperkalemia
NSAID
tx of K >6.5 with muscle paralysis (emergent treatment )
10 units insulin plus one amp D50
what does total calcium vary with
albumin
causes of hypocalcemia
hypoparathyroidism, hypomagnesemia, pancreatitis, renal failure, severe trauma and multiple blood transfusions
ds/s of hypocalcemia
Trousseau’s sign (carpopedal spasm)
Chvostek’s sign (increased irritability of the facial nerve, twitching with percussion of facial nerve)
Prolonged Qt
Mtg of hypocalcemia
if acute IV calcium gluconate
pt presents with fatigue, muscle weakness, constipation and anorexia what electrolyte disturbance do you expect
hypercalcemia
Tx of hypercalcemia
calcitonin if impaired cario/renal function
NS with loop diuretic
dialysis in severe cases
what is the first ABG abnormality when in pt in distress
respiratory alkalosis - hyperventilation
what do you usually see ketones with
Type I DM
glutamic acid decarboxylase is associated with what
80% of Type I DM patients
glutamic acid decarboxylase
GAD -65
what serum fasting blood glucose diagnostic of DM
8 hour blood glucose >=126 mg/Dl on more than one occasion
A1C diagnostic of DM
glycated hemoglobin >= 6.5
somogyi effect
nocturnal hypoglycemia
pt is hypoglycemic at 0300 but rebounds with elevated BS at 0700
tx of somogyi effect
reduce or omit the bedtime dose of insulin
dawn phenomenon
BS becomes progressively elevated throughout night resutling in elevated BS at 0700
tx of dawn phenomenon
add or increase bedtime dose of insulin
criteria of metabolic syndrome
waist circumference >=40” men, >=35”women
BP >= 130/85
Triglycerides >= 150
FBG >=100
HDL < 40 in men <50 in women
Must have 3 to dx
pt has had a frequent recurrent vaginitis as well as pruritus and now complains of blurred vision - what should you work her up for
DM II
started drug for type II DM
biguanide- Metformin
BLACK box : lactic acidosis c/o muscle pain
types of GLP-1 and black box warning
trulicity
byetta
Victoza
Ozemic
Thyroid Ca
REMS program-pancreatitis
pt presents with increased appetite, weight loss, exophthalmos and tachycardia what do you suspect and associated labs
hyperthyroidism (overdrive)
TSH low
Elevated T3 T4 free thyroxine index
pt presents with cold intolerance, puffy eyes, and edema of hands and face
what do you expect and associated labs
hypothyroidism (sluggish)
TSH elevated, low T4
labs associated with hashimotos
elevated TSH
low T4
labs with Graves disease
decreased TSH
elevated t3 & y4
what med do you avoid in thyroid crisis
Acetylsalicylic acid
pt presents with tachycardia and severe anxiety, tremors and has elevated T3
what do you worry about and how do you treat
thyroid crisis
propylthiouracil 150-250 q 6 OR
methimazole 15-25 mg every 6 hours
pt presents hypothermic, unable to maintain airway and bradycardia
TSH is elevated
what do you suspect and how to treat
myxedema coma
intubate if needed
fluid replacment
Synthroid 400mcg IV
slow rewarming
what is most common presentation of hyperthyroidism
Graves’ disease
Medication tx for hyperthyroidism
propranolol for s/s relief
Thioruea drugs for patients with small goiters or fear of isotopes-
- Methimazole every day in 3 doses
- Propylthiourcia daily in 4 doses
TX for thyroid storm
propylthiouracil every 6 hours OR methimaozle every 6 hours plus other tx
avoid ASA
what is the reason most people are non compliant with taking levothyroxine
initial hair loss
management of myxedema coma *hypothyroidism crisis
protect airway
fluid replacement
levothyroxine 400mcg IV then daily
slow rewarming with blankets
Cushing syndroom is caused by what
to much steroid
ACTH hyper secretion
adrenal tumor
chronic admin of glucocorticoids
s/s of Cushing
central obesity
moon face buffalo hump
hypertension (vasoconstriction)
Hyperglycemia
Hypernatremia
Hypokalemia
elevated AM cortisol
test for Cushing disease
dexamethasone suppression test
Addisons disease caused by what
to little steroid , androgen and aldosterone
deficient cortisol
autoimmune
metastatic cancer
bilateral adrenal hemorrhage
pituitary failure
s/s of Addisons
hyperpigmentation of buccal mucosa and skin creases
hypotension
scant axially and pubic hair
hypoglycemia
hyponatremia
hyperkalemia
AM cortisoll <5mcg/dl
test for Addison
cosyntropin stimulation test
mtg of Addison
glucocorticoid and mineralocorticoid replacement
- hydrocortisone
-fludrocortisone acetate
s/s of SIADH
neurologic changes from hyponatremia (mild headache, seizure, coma )
decreased DTRs
hypothermia
labs r/t SIADH
hyponatremia
decreased serum osmolality <280
increased urine osmolality >100
increased urine sodium >20
increased urine specific gravity because urine osmosis is increased
what is DI
diabetes inspires
excessive urination and extreme thirst from to much vasopressin
s/s of DI
thirst/cravings for water
polyuria (2-20 L/day)
hypotension
weight loss, fatigue
elevated temp
labs r/t DI
hypernatremia
increased serum osmolality >290
decreased urine osmolality <100
elevated BUN/creatinine
low urine specific gravity
how do you test for DI
Vasopressin challenge test (Desmopressin) - positive in central DI negative in nephrogenic DI
management of DI
if NA >150 - give D5W to replace 1/2 volume deficit in 12-24 hours
if Na <150 substitute 1/2 NS or 0.9
DDAVP IV or Sq in acute situations
DDAVP maintenance intranasally
management of SIADH
if Na <120 restrict fluids to 1000ml/24hours
if Na <110 or neuro s/s replace with isotonic or hypertonic saline and Lasix at 1-2mEq/h
a pt presents with liable BP, diaphoresis and severe headaches also notice postural hypotension TSH is normal what do you suspect
pheochromocytoma
tumor of adrenal medulla
how do you dx pheochromocytoma
plasma-free metanehines (blood_
Assay of urine catecholamines, metanephrines, vanillylmandelic acid (VMA) and creatine
24 hours urine >2.2 ug metanephrine per mg creatine and >5.5 VMA
how do you CONFRIM pheochromocytoma
CT of adrenals
what do you monitor post operatively in pheochromocytoma
hypotension
adrenal insufficiency
hemorrhage
Younger people have what type of ulcer
Duodenal ulcer
What type of ulcer typically occurs between 55-65
Gastric ulcer
Who are ulcers more common in
Men
This type of stomach pain feels better after eating
Duodenal ulcer
This type of stomach pain gets worse after eating
Gastric ulcer
Pt presents with severe epigastric pain, rigidity and quiet bowel sounds what do you suspect
Acute abdomen- perforation
Treatment for suspected PUD
pPI
-prazole
What is the treatment for H Pylori
Two antibiotics + PPI with or with out bismuth x 10-14 days
What is a precursor for esophageal cancer
Barrett’s esophagus
How do you dx Barrett’s esophagus
EGD
Hepatitis related to IV drug use
Hep C
Pt has anti-HAV and IgM what do you suspect
Active Hep A
iGm-immediate
Pt has HBsAg, anti-HBc, HBeAG and IgM what it’s this
Active hep b
Pt has HBsAg, anti HBc, anti HBe IGM IGH what is this
Chronic Hep B
Pt has anti-HBc, antiHBs what is this
Recovered hep B
Pt presents with LLQ tenders ness and pain along with loose stools and nause what do you suspect
Diverticulitis
Dietary risk for diverticulitis
Low dietary fiber
Pt presents with abdominal pain and has deep pain while breathing in when fingers placed under right rib cage
What do you suspect
Murphy sign
Cholecystitis
How dx cholecystitis
US is gold standard
Most common complication of ERCP
Pancreatitis
Causes of acute pancreatitis
Gallbladder disease -#1 cause cholelythisis
HEAVY alcohol use
Pt presents with upper abdomen tenderness severe epigastric pain that is improved by sitting forward you note flank discoloration what do you suspect
Grey turner sign
Hemorrhagic pancreatitis
Ransom criteria
Greater than 55
W- WBC >16000
G- glucose >200
L- LDH > 350
A- AST >250
George Washington Got Lazy After
Treatment for autonomic dysreflexia
Remove stimulus
- cath cause bladder full
- straighten sheet
- move fan
Parkinson’s is deficient of what
Dopamine
What is Murphys sign
Deep pain on inspiration while fingers are placed under right rib cage - indicates cholecystitis
How do you dx cholecystitis
Ultrasound - gold standard
Major complication associated with ERCP
Pancreatitis
What is ransoms criteria used for
Evaluate prognosis with pancreatitis
Pt presents with cramping periumbilical pain , afebrile, unable to pass stool and high pitched tinkling BS what test do you order
KUB- dilated loops of bowel and air fluid levels with bowel obstruction
Pt had pain with right thigh extension what do you suspect
Appendicitis
-psoas sign
Pt had RLQ pain with pressure applied to LLQ what do you suspect
Appendicitis
Positive rovsings sign
How do you dx appy
CT or US
RIFLE is used for what
Assess AKI
R- risk
I- injury
F-failure
L- loss
E- end stage
Pt has AKI with BUN ratio of 20:1 FENa <1 and urine sodium <20, what type of renal cause do you suspect and how to Tx
Prerenal
Expand intravascular volume
Most common cause of intrarenal AKI that effects renal cortex
Nephrotoxic agents
Initial Tx of nephroliyhiasis
Morphine
Toradol
Metoclopramide
Pt has a “Kentucky” sound upon assessment what is this and what does it indicate
S3
Fluid overload- CHF, pregnant
Pt has developed. New heart sound after an MI what is this
S4 “ten-ne-ssee “
Murmur that is loud with thrill
IV/VI
Murmur heard at 5th ICD and in diastole
Mitral stenosis
Murmur heard at base and in systolic
Aortic stenosis
Where are mitral murmurs
5th ICS, apex
Where are aortic murmurs
2nd or 3rd ICS, base
Stage I HTN
130-139 or 80-89
Stage 2 HTN
> =140 or >=90
Elevated Bp
120–129 and <80
Typical first line Tx for HTN
Thiazide diuretic
Tx for HTN in DM
Acei or Arb
Normal cholesteroL
Normal LDL
Normal HDL
Normal VLDL/triglycerides
<200
<100
>40
<150
Goals for lipids for DM or CAD
LDL <70
hDL >40
triglycerides <150
Elevation in lead I and aVl is MI where
Lateral
Elevation on leads II,III and aVF
Inferior MI
Elevation in V leads
Anterior MI
Pt had PRI that gets longer then drops qrs is what type of heart block
Type I second degree /mobitz type I
Atrial rate is regular PRI is constant but ventricular rhythm is irregular and has dropped QRS
Type 2 Heart block
No relationship between P wave and QRS complex
Type 3 block
Normal INR
0.8-1.2
Normal PT
11-16 seconds
Who enforces HIPAA
Office of civilian rights
What dx must be reported
Gonorrhea
Chlamydia
Syphilis
HIV
TB
Covid
Nonmaleficence
Duty to do no harm
Utilitarianism
Right act is one thag produces the greatest good for the greatest number
Beneficence
Duty to prevent harm and promote good
Justice
Duty to be fair
Fidelity’s
Duty to be faithful
Veracity
Duty to be truthful
Autonomy
Duty to respect individual thoughts and actions
Cross sectional research
Type of observational study, designed to find relationships between variable at specific point in time or “surveys”
Examines population with similar attributes but differ in specific variable such as age
Cohort
Nonexperemtal
Compares particularl outcome in groups that are alike but differ by certain characteristic
Longitudinal study
Nonexperimental
Taking multiple measures of group over attended period of time to find relationship between variables
Useful frame work to answer clinical based question
P-patient
I- intervention
C- comparison
O- outcome
T- timing
What is a type 1 error
False positive
Incorrectly rejecting the true null hypothesis
Type 2 error
False negative
Failing to reject a null hypothesis which if false
What does CN XII do
Move the tongue
What nerve shrugs the shoulders
CN XI spinal accessory
What is function of CN VIII
Acoustic- hearing
What does CN VI do
Abducens - lateral eye movement
CN that does pupillary construction
CN III ovulomotor
Pneumonic for CN
Oh- olfactory
Oh- optic
Oh- oculomotor
To- trochlear
Touch- trigeminal
And- abducens
Feel- facial
A- acoustic
Girls- glossopharyngeal
Vagina - vagus
So - spinal accessory
Heavenly -hypoglossal
heart sounds in S1
aortic/pulmonic open - mitral/tricuspic close
heart sounds in S2
aortic/pulmonic close- mitral/tricuspid open
