Study guide Questions Flashcards
What is not used in the tx of migraine headaches?
Verapamil — used to tx cluster headaches!
verapamil causes vasodilation which would exacerbate a migraine headache but since cluster headaches are due to vasoconstriction it fixes these
Can you prescribe triptan medications for migraine tx to patients with HTN?
NO!. Triptans cause VASOCONSTRICTION.
what is the treatment for positional vertigo
antihistamines: Meclizine (Antivert) or promethrazine, dimenhydrinate
Anticholinergic (scopolamine)
What is the most common characteristic found in patients with migraine headache
Family hx (80% have a positive family hx)
what finding would not warrant further investigation into a headache
Relief with common analgesics
What causes headaches in meningitis
inflammation of the meninges
flat affect no facial movement
parkinsons
What is the term used to describe the active resistance to passive motions associated with Parkinson’s?
Lead pipe rigidity
Which CN are responsible for ocular movement
CN3,4,6
T/F?? Nausea & Vomiting are associated with tension headaches
FALSE.
NO N/V in tension. Only in migraine and tumors, Increased ICP
What is Munchausen by proxy?
Munchausen syndrome by proxy (MSBP) is a mental health problem in which a caregiver makes up or causes an illness or injury in a person under his or her care, such as a child, an elderly adult, or a person who has a disability. Because vulnerable people are the victims, MSBP is a form of child abuse or elder abuse.
Pt who are bulimia, what is their typical weight status?
average or NORMAL weight.
Common side effects of SSRI?
Sexual dysfunction
Which medication is not used in treating depression?
a. Buspar
b. Fluoxetine
c. Amitriptyline
D. Bupropion
A. Buspar – anxiety medication
b= SSRI, C = TCA, D
Which of the following is an abnormal finding for aging skin?
a. Cherry angiomas
b. Sebheroeric keratosis )
c. Dermatophytes??
d. other skin thing.
C. Dermatophytes = NEVER NORMAL
Risk factors for Tinea Capitis?
Daycare attendance
Contact with infected items (combs, brushes, hats)
Poor hygiene
Diabetes
Tinea capitis = fungal of head
Why is benzoyl peroxide used in combination with erythromycin to treat acne?
Decreases the risk of resistance to erytromycin
What is a Dermatophyte
Dermatophyte a pathogenic fungus that grows on skin, mucous membranes, hair, nails, feathers and other body surfaces, causing ringworm and related diseases
what is a keloid?
hypertrophic scars that extend beyond the original wound margin
The finding of a dome-shaped in the dermis that forms a benign closed, firm sac attached to the epidermis is:
a. Keloid
b. A tophi
c. A cutaneous cyst
d. Chondrodermatitis
C. Cutaneous cyst
Which of the following skin assessment finding is NOT normal in aging process?
a. Xerosis
b. Cherry angiomas and senile purpura
c. Senile keratoses and senile lentigines
d. Dermatophytoses
Dermatophytoses!
Treatment for atopic dermatitis? (Pharm)
topical corticosteroids (cream preferred) *lowest potency that controls symptoms
Low dose:
- alclometasone dipropionate
- flucinolone acetonide
- hydrocortisone butyrate
inflammatory disorder of the dermis that develops silvery, scales and pruritus?
Psoriasis
where is psoriasis typically found?
extensor surfaces (outer elbows, knees, scalp, gluteal cleft, fingernails)
Palms & Soles of hands/feet!
what is a positive auspitz sign and what does it indicate?
Pinpoint bleeding when lesions are scraped = psoriasis
what is the apparance of basil cell carinoma?
pearly domed nodule!
we use the mneumonic ABCDE & HARMM to assess what type of skin cancer?
malignant melanoma - most deadly
how does psoriasis present?
positive auspitz sign
pruritus
pitted nails
Where are janeway lesions primarily located?
palmer hands and feet
indicated endocarditis
where are osler nodes located?
Tips of fingers and toes
sign of endocarditis
What is the reversal for pradexa (dabigatran)?
Praxbind (idarucizumab)
what body system do we need to make sure to assess in down syndrome patients?
Caridac… more at risk for congenital heart defects
A patient comes in with digoxin levels at a normal level, two weeks later the patients levels have dropped, what medication could be responsible for the drop?
antacids (aluminum hydroxide, calcium carbonate, magnesium hydroxide)
Patient missed yesterday’s dose and todays dose of 5mg Coumadin, what should you instruct him to do?
Take next dose when due, notify MD
<12 hours = take dose and continue on. INR in 1 week
>12 hours = take next dose at time due. Notify MD. INR in 3-7 days
In transposition of the great arteries, what is the purpose of prostaglandin?
to produce vasodilation and provide adequate oxygenation
slows down the closing of the ductus arteriosus and PFO allowing O2 blood to cross from pulm circulation to systemic through congenital pathway
Which cardiac problem is associated with chest pain and JVD?
CHF?
How is a diagnosis of varicose veins made?
Clinical presentation
Trendelenburg maneuver
How do you perform the trendelenburg maneuver and what does this assess?
Assess valves of peripheral veins that cause varicose veins
supine legs 90 degrees, occlude greater saphenous then have pt stand to map veins
clinical manifestations of endocarditis
Pain relieved by leaning forward
Janeway lesions
Osler nodes
What is important education to give to a patient on Advair (Fluticasone propionate / Salmeterol)
do NOT use during an acute asthma attack –> steroid/LABA
NEED albuterol/levalbuterol
What would indicate atypical PNA in an 18 year old college student
Temp with clear lungs sounds
what is the most common pathogen that causes PNA?
Streptococcus pneumoniae
what would croup present with?
barking cough
pt comes in with an acute asthma episode, what is appropriate treatment
SABA (albuterol/levalbuterol)
What does NOT cause hemoptysis?
a. PE
b. Viral PNA
c. Chronic bronchitis
d. Lung CA
e. TB
Viral PNA —> typically associated with bacterial pna
A condition in which pus gathers in the area between the lungs and the inner surface of the chest wall is called?
Empyema
Which patient is most at risk for TB?
a. Patient works in a nursing home
b. Patient smokes daily
c. Patient is low income immigrant
d. Patient who had recent contact with someone infected with TB
RECENT CONTACT
what would indicate a SBO
vomiting and pain
norovirus is the most common cause of what?
gastroenteritis
heartburn and regurgitation are associated with what condition?
GERD
other symptoms, frequent throat clearing, post nasal drip, chest pain
what is the therapy for gerd?
8 week course of PPI (step down approach)
if persistent then transition to low dose PPI or H2 blocker for maintenance
Which vaccine is for blood or body fluids that affect the liver?
Hep B?
pt with giardiasis is treated with metronidazole, what should you screen for?
alochol use - severe interaction
Most common tx for H. Pylori is
triple therapy
2 ABX & PPI for 7-10 days
(amoxicillin + Clarithromycin or Flagyl + Clarithromycin)
A 34 year old man presents with complaints of ABD pain. NP suspects hemorrhagic pancreatitis due to findings of superficial edema, bruising around the umbilicus and what other assessment finding?
positive Cullen’s sign
what is enterobiasis and how should it be treated?
Albendazole 400mg x1
repeat dose in 2 weeks!!!
what disease is characterized by chronic bloody diarrhea
chrons
What is a slow progressive transmural inflammation of the GI tract that causes chronic diarrhea with or without bleeding
crohn’s disease
Does UC or Crohns have skip lesions?
Crohns!!! (affects mouth to anus)
what is the condition that causes chronic inflammation of the colonic mucosa and submucosa that remains in the colon
Ulcerative colitis
what clinical conditions is treated with anticholinergics?
Urge incontinence
what doe alpha blockers do?
relax smooth muscles - used in overflow incontinence
-sin) Tamsulosin (its a sin to not tx symptoms
5 alpha reductase inhibitors do what?
reduce side of prostate, used in BPH
(-ride) Finasteride
Takes 6-12 months for MAX effect!
how do anticholinergics causes urinary retention?
decrease bladder detrusor muscle contractions seen in urge incontinence (overactive bladder)
which diagnostic tests are ordered to measure renal fx in a pt with suspected insufficiency
BUN/ Cr
A pt with a UTI. what findings on the dipstick would BEST correlate with this?
Positive leukocytes!
nitrates can be present but typically indicate gram neg rods (e.coli)
What is the BEST way to test for renal insufficiency?
GFR
Which of the following is formed in the liver as a byproduct of protein metabolism and eliminated entirely by the kidneys?
Urea
What attaches a bone to bone?
Ligament
what is considered a synovial joint
shoulder
found between two bones that moves against each other (shoulder, elbow, hip, knee)
Which is most concerning for a child with scoliosis?
a. 13 yr old girl with 10 degree curvature
b. 17 year old with 10 degree curvature
c. 17 year old boy with 10 degree curvature
d. 13 year old boy with 5 degree curvature
13 yr old girl with 10 degree
Still growing and has to be a degree curve or greater = scoliosis
A man has pain with ambulation and relief with lumbar flexion. What is the most likely condition
spinal stenosis
What test would you perform to evaluate for a meniscal tear?
McMurray test
how do you identify osteosarcoma in a child
pain in the affected bone
Assessment finding of a swan neck deformity due to weakness or tearing of the cartilage on the palm side of middle joints in fingers and boutonniere deformity are typically associated with which diagnosis?
RA
which is a characteristic of RA that is not a characteristic of OA?
RA = symmetrical joint involvment OA= NOT symmetrical
what medication is used to tx acute gout
colchicine (best within first 36 hours of flare up )
what medication is best used to tx chronic gout?
allopurinol
ALL pts get allopurinol to prevent flare ups since they are ALL better
first line therapy for arthritis
tylenol up to 4g/day
first line therapy for osteoporosis?
exercise and weight loss
patient with torn rotator cuff, which muscle is affected?
supraspinatus
In non therapeutic interventions failed with dysmenorrhea what is next best intervention?
NSAIDs (ibuprofen/naproxen)
first line therapy (non pharm) tx for PMS
heat pack
first line therapy for prementrual dysphoric disorder
SSRI (fluoxetine, sertraline, paroxetine)
for breast cancer screening, where is the Tail of SPence?
axilla armpit
what is the most common type of breast cancer?
Ductal and Lobular carcinoma
When is estrogen replacement therapy contraindicated
Prior hx of breast cancer!!!!
also<21 days postpartum
older 35 smoker >15 cigs/day
pts with polycystic ovarian syndrome probably have elevated levels of
a. estrogen
b. insulin
c. progesterone
d. renin
INSULIN
which is not a risk factor of breast cancer
A. Family History
B. Hormone replacement
C. Post-menopausal
D. Low social economical
low social economical
42 year old obese woman who smokes lives a sedentary lifestyle, what would be the most concerning for prescribing a contraceptive?
SMOKING!!!!
what is most likely to be present if there is bloody discharge from nipples
malignant – pagets disease of the breast
intraductal/lobular carcinoma
paopilloma (non malignant)
what would you NOT suspect as breast cancer?
Mastoplasia
what is a rope like cyst in the breast tissues
Mastoplasia (fibrocystic breast disease)
what would an enlarged, warm, boggy prostate indicate?
Acute prostatits
causes of acute prostatitis?
<35 = STI >35 = e. COli
