vocab Flashcards
sensitivity
likelihood of true positive results w/ the disease. __ of test in proportion of ppl known to have dz who test positive for it. ___= positive in disease. TruePos/total # of ppl w/ dz in pop
specificity
likelihood of a true negative result in those who are healthy (dz free). relates to tests ability to identify negative results ___ test, when positive, helps to rule in disease. __ of a test defined as the proportion of pt’s that are known not to have the dz who will test negative for it. TrueNeg/total # w/o dz (healthy individuals).
Tanner Stage 1 Male
Pre-puberty; asexual
Tanner Stage 2 Male
Testes enlg; scrotal skin reddening w/ change in texture; sparse growth of long, slightly pigmented pubic hair at base of penis.
Tanner Stage 3 Male
inc in penile length but min change in width, sometimes called ‘pencil penis’ stage; further scrotal enlgmnt; pubic hair darker, coarser, covers greater area; onset of growth spurt
Tanner Stage 4 Male
inc in penile length & width w/ development of glans; further darkening of scrotal skin; adult-type pubic hair w/ no spread to medial surface of thighs.
Tanner Stage 5 Male
full adult genitalia; adult type pubic hair w/ spread to medial surface of thighs.
Tanner Stage 1 Female
pre-puberty/ asexual.
Tanner Stage 2 Female
breast buds & papilla elev’d; downy pigmented pubic hair along labia majora.
Tanner Stage 3 Female
breast mound enlgmnt; darker, coarser, curling pubic hair on mons, labia majora; onset of growth spurt.
Tanner Stage 4 Female
Areola & papilla elev’d to form a 2nd mound above level of breast; adult-type pubic hair w/ no spread to medial surface of thighs; menarche.
Tanner Stage 5 Female
Recession of areola to mound of breast, extension of pubic hair to medial thigh.
normal/healthy women of reproductive age
vag pH 3.8-4.2. white, clear, flocculent discharge. absent odor. lactobacilli under microscope. no complaints. no intervention.
Candida vulvovaginitis. candida albicans 80-90%
vag pH usually d. amine odor: usually absent. microscopic: mycelia, budding yeast, pseudo-hyphae w/ KOH prep. complaints: itching/burning, discharge. intervention: -azole antifungal, po (fluconazole/diflucan) or vag clotrimazole/monistat, terconazole.
BV; etiology- unclear, likely polymicrobial assoc’d w/ G. vaginalis, M. hominis.
vag pH >4.5. discharge: thin, homogeneous, white, gray, adherent, often inc’d. amine odor (KOH ‘whiff’ test): present (fishy). microscopic: >20 clue cells/HPF few or no WBCs. complaints: discharge, foul odor, itching occasional. Rx: metronidazole (topical metrogel) or po flagyl, clinda vag cream or ovules (cleocin), po tinidazole.
atrophic vaginitis, etiology- estrogen deficiency
vag pH >5. discharge: scant, white-clear. amine odor: absent. microscopic few or absent lactobacilli. complaints: itching/burning, discharge, but often w/o sx’s. Rx: topical &/or vag estrogen if sx.
genital herpes
common asymp or atypical sx’s. classic presentation: painful ulcerated lesions, lymphadenopathy w/ initial lesions. women- thin vag d/c if lesion located at vagina or introitus. tx- acyclovir, famciclovir, valacyclovir.
nongonococcal urethritis & cervicitis. (chlamydia)
irritative voiding sx’s, occasional mucopurulent dc. women- cervicitis common. often w/o sx’s in either gender. micro exam of dc- lg # of wbc’s. tx: azithro 1 time dose 1st line. alt: doxy, erythro, ofloxacin, levofloxacin (multi days of tx needed). most common bacterial sti
gonococcal urethritis & vaginitis (gonorrhea)
irritative voiding sx’s, occasional purulent dc. often w/o sx’s in either gender. micro exam of dc- lg # of wbc’s. tx: ceftriaxone IM 1 time dose + azithro x1 dose or doxy x7d.
trichomoniasis (t. vaginalis)
dysuria, itching, vulvovaginal irritation, dyspareunia, yellow-green vag dc, occasionally frothy, cervical petechial hemorrhages (strawberry spots). often w/o sx’s in either gender. on micro exam: motile organisms & lg # wbc’s. alkaline pH. tx: po metronidazole or tinidazole 1x dose. avoid alcohol during tx of po metronidazole or tinidazole. abstinence from alcohol cont x24 hr after metro or 72hr after tinidazole.
syphilis (t. pallidum)
primary stage: chancre (firm round, painless genital &/or anal ulcer w/ clean base & indurated margins) accompanied by lymphadenopathy, ~3wks duration, resolve w/o tx. Secondary stage: nonpruritic skin rash, often involving palms & soles, as well as mucous membrane lesions. Fever, lymphadenopathy, sore throat, patchy hair loss, HA’s, wt loss, muscle aches, & fatigue common. resolution w/o tx possible. latent stage: presentation variable occurs when primary & 2ndary sx’s resolve. tx: antimicrobial tx w/ dose & length dictated by stage. options: ink PCN (1st line), tetracycline, or doxy.
Genital warts (condyloma acuminata) HPV 6&11 genital warts. HPV 16, 18, 31, 33 assoc’d w/ GU malignancies.
most common STI. verruca-form lesions can be subclinical or unrecognized. location of lesion can guide choice of tx. podofilox, liquid nitrogen, cryoprobe, trichloracetic acid, podophyllin resin, surgical removal, or imiquimod (only indicated for external warts). trichloroacetic acid & cryoprobe preferred tx during preg.
pelvic infalmm dz- gonorrhea, chlamydia, bacteroides, eneterobacteriaceae, streptococci.
infectious, inflamm d/o of upper female reproductive tract, incl uterus, fallopian tubes, adjacent pelvic structures. ascension of sti. irritative voiding sx’s, fever, abd pain, cervical motion tenderness, vag dc. possible sequela incl tubal scarring w/ subsequent inc’d risk for ectopic preg &/or infertility. tx: ceftriaxone IM 1x dose + doxy x 14d w/ or w/o metronidazole x14d.
epididymitis/ epididymoorchitis. </=35 yrs
upper reproductive tract infection w/ inflamm of epididymis/testis). etiology: N. gonorrhoeae, C. trachomatis. irritative voiding sx’s, fever, & painful swelling of epididymis, & scrotum. infertility potential post infection. pain. tx: ceftriaxone IM 1xdose + doxy x10d (same as women PID). advise scrotal elev to help w/ sx relief. Plehn’s sign= relief of discomfort w/ scrotal elev.
epididymitis/ epididymoorchtis. >/=35 yrs or insertive partner in anal intercourse
enterobacteriaceae (coliforms). irritative voiding sx’s, fever, & painful swelling of epididymis & scrotum. infertility potential post infection. voiding pain. primary tx: cipro qd or levofloxacin qd x 10-14d. plehn’s sign doesn’t apply.
acute bacterial prostatitis, </= 35 yrs
etiology: gon & chlamydia. irritative voiding sx’s, suprapubic, perineal pain, fever, tender, boggy prostate, leukocytosis. tx: ceftriaxone IM x1dose, then doxy bid x10d.
acute bacterial prostatitis >35 yrs
etiology: enterobacteriaceae (coliforms). irritative voiding sx’s, suprapubic, perineal pain, fever, a tender, boggy prostate, leukocytosis. tx: cipro or ofloxacin x14d.
paraphimosis
retracted foreskin that cannot be brought forward to cover the glans
varicocele
a palpable, ‘nest of worms’ scrotal mass that is only evident in standing position
hydrocele
collection of serous fluid that causes painless scrotal swelling, easily recognized by transillumination
phimosis
w/ this, the foreskin cannot be pulled back to expose the glans
testicular torsion
characterized by scrotal pain & loss of the cremasteric reflex
cryptorchidism
testicle located in inguinal canal or abdomen
cholinesterase inhibitors= donepezil (aricept), rivastigmine (exelon), galatamine (razadyne)
mild-mod stage dz, considered to be mainstay of tx. clear tho minor & time-ltd benefits by inching availability of acetylcholine. AE: GI effects. more acetylcholine in body- cholinergic SEs: salivation, ^GI motility, lacrimation, urination, defecation, bradycardic.
N-methyl-D-aspartate receptor antagonist= memantine (Namenda).
protects neurons that make acetylcholine. tx of mod-severe AD. thru its effect on glutamate, helps create an environment that allows for storage & retrieval of info.
lumbar spinal stenosis
older age >/=50; standing discomfort w/ improvement in sx’s w/ bending forward; pseudoclaudication; bilateral lower extremity numbness, weakness in majority. dx: initially none indicated. for sx’s >1mo, consider MRI, EMG/NCV. intervention: physical tx, NSAIDs, epidural corticosteroid inj, perhaps surgery.
stress incontinence
assoc’d w/ lifting
transient incontinence
occurs during an acute illness
urge incontinence
reports of strong sensation of needing to void
functional incontinence
often occurs in presence of mobility problems
McMurray test
meniscal tear
talar tilt
ankle instability
tinel’s sign
carpal tunnel syndrome
lachman test
anterior cruciate ligament tear
straight leg raising test
lumbar nerve root compression
spurling test
cervical nerve root compression
drop arm test
rotator cuff evaluation
finkelstein test
De Quervain tenosynovitis
lumbar sacral strain
etiology: spasm, irritation of LS spine supporting muscles, most common reason for low back pain. characteristics: spasm, ache, stiffness. position, activity, rest typically impacts pain. PE: paraspinal muscle tenderness & spasm. LS curve straightening. dec’d LS flexion. neuro exam wnl. dx: usually not required. dx imaging & testing for pt’s w/ low back pain indicated when severe or progressive neuro deficits present or serious underlying conditions. tx: analgesia, physical conditioning/tx, heat or ice as indicated by pain response, muscle relaxer can be helpful but all sedating, some w/ abuse potential. limiting physical activity potentially harmful.
lumbar radiculopathy
etiology: irritation or damage of neural structures such as disks L4-L5, L5-S1 most common sites of disk bulge. characteristics: sharp, burn, electric-shock sensation; worse when inc’d spinal fluid pressure, thus pressure on nerve root; sneeze, cough, straining evoke sharp pain. PE: signs of lumbar-sacral strain; altered neuro exam incl: abnl straight leg raising, sensory loss, altered DTR’s. dx: no required unless severe or progressive neuro deficits. tx: conservative. specialty veal indicated for rapidly evolving defect, persistent neuro defect w/o resolution after 4-6 wks conservative tx.
L4
neuro testing in lumbar vertebral problems. motor: foot dorsiflexion, reflex: knee jerk, sensory area: medial calf.
L5
neuro testing in lumbar problems. motor: great toe dorsiflexion, reflex: none, sensory area: medial foot.
S1
neuro testing in lumbar problems. motor: foot eversion, reflex: ankle jerk, sensory area: lateral foot
NL BMD
BMD w/in 1 SD of a ‘young nl’ adult (T-score at -1.0 and above
low bone mass/osteopenia
BMD btwn 1.0-2.5 SD below that of a ‘young nl’ adult (T-score btwn -1.0 and -2.5)
osteoporosis
BMD is 2.5 SD or more below that of a ‘young nl’ adult (T-score at or below -2.5). pt’s in this group who have already experienced one or more fractures are deemed to have severe or ‘established’ ____.
7-8 mos
can sit & begins to have stranger anxiety
4-5 mos
able to roll over from tummy to back, brings hands to mouth, smiles spontaneously, & babbles.
6-8 mos
responds to own name & sits w/o support
4-6 mos
reaches for toy w/ 1 hand & recognizes familier ppl & objects at a distance
~ 9 mos
babbles mamama, bababa, & transfers objects hand-to-hand w/o difficulty
6-8 wks
vocalizes ‘ah’ & ‘oh’ sounds, & able to life head briefly when positioned on tummy & can turn it from side to side.
communicating hydrocele
incomplete sealing of peritoneal cavity at inguinal area during gest leaving communication btwn abd cavity & scrotum. CP: fluid-filled scrotal sac; transillum, contender; testes nl; however amt of fluid in scrotum (size) varies w/ position of neonate; inc’s w/ dependent upright position (day) & smaller after supine (night). tx: due to communication, infant at risk for herniation of abd contents; refer to pedi urologist or surgeon
non-communicating hydrocele
sealing of abd cavity during gest w/ residual trapped peritoneal fluid in scrotal sac. CP: fluid filled scrotal sac; transillum, nontender; testes nl; no change in scrotal size w/ position change, same at bedtime & when awakens. tx: reassurance, no risk of herniation; no special skin care needed. usually resolves by 2 yrs w/o intervention; refer only if size interferes w/ activity, comfort.
9-12 mos
able to self-feed w/ simple finger foods
15-20 mos
able to point to a body part when asked
30-36 mos
walks backwards
12-15 mos
recently learned to put a sm cube in a cup
10-11 mos
can pull to standing position w/ ease, not walking solo, enjoys playing peek-a-boo, & recently began to respond to request ‘pick up the spoon’
12-14 mos
average age of starting to walk
18-24 mos
appropriate age to start time outs
16-18 mos
~ 25% of speech should be intelligible by ppl not in daily contact w/ child
19-21 mos
~50% of speech should be intelligible by ppl not in daily contact w/ child
2-2.5 yrs
~ 75% of speech should be intelligible by ppl not in daily contact w/ child
3-4 yrs
almost 100% of speech should be intelligible by ppl not in daily contact w/ child. can use plurals
~ 4/5 y/o
able to verbalize what to do when cold, hungry, or tired, can draw a person w/ no torso, & able to count to 4.
5-6 y/o
can name a best friend
6-7 y/o
can draw a person w/ >/= 12 parts & voice an intended career
pneumococcal conjugate 13-valent vaccine (PCV 13)
tell 6 month old infant parents that mild fever of 1-2d is most likely to occur after baby receives ___ vaccine b/c its live.
6 mos red flag
no big smiles or other warm, joyful expressions
9 mos red flag
no back & forth sharing of sounds, smiles, or other facial expressions
12 mos red flags
lack of response to name, no babbling or ‘baby talk,’ no back & forth gestures such as pointing, showing, reaching, or waving
16 mos red flag
no spoken words
24 mos red flag
no meaningful 2 word phrases that don’t involve imitating or repeating.
Fragile X syndrome
mostly males affected. lg testicles (macroorchidism) after beginning of puberty, lg body habitus, learning & behavioral differences (hyperactivity, developmental disability common), lg forehead, ears, prominent jaw, tendency to avoid eye contact.
Klinefelter syndrome XXY male
only males affected w/ developmental issues, most commonly language impairment. low testicular vol, hip & breast enlgment.
scarlet fever
agent- S. pyogenes (group A beta hemolytic streptococci). sandpaper-like rash w/ exudative pharyngitis, fever, HA, tender, localized anterior cervical lymphadenopathy. rash usually erupts on day 2 of pharyngitis & often peels a few days later. tx: pcn 1st line, macrolide in pcn all.
roseola
agent- human herpes virus-6 (hhv-6). discrete rosy-pink macular or papular rash lasting hrs to 3 days that follows a 3-7 d period of fever, often quite high. 90% of cases in kids <2y/o. febrile seizures in 10% of kids affected. supportive tx.
rubella; agent- rubella virus
mild sx’s; fever, s/t, malaise, nasal dc, diffuse maculopapular rash lasting ~3d. posterior cervical & postauricular lymphadenopathy 5-10d prior to onset of rash. arthralgia in ~25% (most common in women). mild, self-limiting dz. greatest risk is effect of virus on unborn child, esp w/ 1st try exposure (~80% rate congenital rubella syndrome). prevent by immunization.
Measles
agent- rubeola virus. usually acute presentation w/ fever, nasal dc, cough, generalized lymphandenopathy, conjunctivitis (copious clear dc), photophobia, koplik spots (appear ~2d prior to onset of rash as white spots w/ blue rings held w/in red spots in oral mucosa in ~1/3). pharyngitis usually mild w/o exudate. maculopapular rash onset 3-4d after onset of sx’s, may coalesce to generalized erythema. CNS & resp tract complications common. permanent neuro impairment or death possible. supportive tx as well as intervention for complications. prevent by immunization.
infectious mononucleosis; agent- epstein-barr virus (human herpes virus 4); dx- monospot test.
maculopapular rash in ~20%, rare petechial rash. fever, ‘shaggy’ purple-white exudative pharyngitis, malaise, marked diffuse lymphadenopathy, hepatic & splenic tenderness, occasionally enlarged. dx- heterophil antibody test. leukopenia w/ lymphocytosis w/ atypical lymphocytes. >90% will develop a rash if given amoxicillin or ampicillin during illness. potential for resp distress when enlarged tonsils & lymphoid tissue impinges on upper airway; corticosteroids may be helpful. splenomegaly most often occurs btwn day 6-21 after onset of illness. avoid contact sports for >/= 1 month due to risk of splenic rupture.
hand, foot, & mouth dz; agent- coxsackie virus A16
fever, malaise, sore mouth, anorexia; 1-2d later, lesions; also can cause conjunctivitis, pharyngitis. duration: 2-7d. transmitted: oral-fecal or droplet route. highly contagious w/ incubation period 2-6wks supportive tx, analgesia important.
5th’s dz. agent- human parvovirus B19
3-4d mild flu-like illness followed by 7-10d of red rash that begins on face w/ slapped cheek appearance, spreads to trunk & extremities. rash onset corresponds w/ dz immunity w/ pt. viremic & contagious prior but not after onset of rash. droplet transmission. leukopenia common. risk of hydrops fetalis w/ resulting preg loss when contracted by woman during preg. supportive tx
kawasaki dz
agent-unknown. for acute phase illness (usually lasts ~11d), fever >104 lasting >/=5d, polymorphous exanthem or trunk, flexor regions, & perineum, erythema of oral cavity (strawberry tongue) w/ very chapped lips, bilateral conjunctivitis usually w/o eye dc, cervical lymphadenopathy, edema & erythema of hands & feet w/ peeling skin (late finding, usually 1-2wks after onset of fever). no other illness accountable for findings. usually kids 1-8y/o. tx: iv immunoglobulin & po asa during acute phase assoc’d w/ reduced rate of coronary abnl such as coronary artery dilation & coronary aneurysm. expert consult & tx advice about asa use & ongoing monitoring warranted.
croup/laryngotracheobronchitis
difficult getting air in. viral, all. supportive tx, perhaps systemic corticosteroid tx. upper airway obstruction, stridor.
peritonsillar abscess
getting air in a problem. stridor. usually bacterial, most often older kid, often presents w/ ‘hot potato’ voice, difficulty swallowing, trismus. attn to airway maintenance, prompt ENT consult, sent to hospital, antimicrobial tx, perhaps surgery.
acute epiglottitis
getting air in a problem. stridor. bacterial origin (most often H. influenza type B), kids 2-7y/o. abrupt onset, high-grade fever, s/t, dysphage, drooling. attn airway maintenance, prompt ENT, antimicrobial tx, inpatient, get out of mouth, call 911. profound throat pain beyond what PE shows. very bad throat pain but throat doesn’t look that bad.
acute bronchiolitis
‘happy wheezer’ 3 mo-3yrs (most <1yr), most often from RSV, less so from influenza or adenovirus, short-term acute illness w/ wheezing often persists ~3wks. usually btwn nov & april. lower airway obstruction. harder getting air out. tx: supportive, little evidence that inhaled bronchodilators or steroids helpful. Palivizumab often used to prevent RSV in premature or immunosuppressed infants.
acute bronchitis
lower airway obstruction. harder getting air out. viral, usually caused by pertussis. short-term, self-limiting. tx: supportive, perhaps inhaled beta 2 agonist, po anti-inflamm tx.
asthma
lower airway obstruction- getting air out a problem. cause- all, inflamm etiology, sx’s recurrent, persist w/o tx. tx: per NIH guidelines, can’t do spirometry in <7 y/o.
hemangioma
benign tumor of endothelium; local proliferative process that affects endothelial cells; perhaps genetic mutation of epithelial regulation. often NOT present at birth, rapid growth from 1st days of life to 6 mos, slow proliferation 6-12mos. then involution phase from 12mos to 3-6yrs; 1/3 present at birth as light port wine stain. tx: dependent on location, risk of complication, scarring, ulceration; options to slow growth= po propranolol, systemic steroids. watchful waiting; will involute slowly thru early childhood.
port wine lesion
d/o of dermal capillaries & post capillary venules. occasionally assoc’d w/ other congenital or genetic syndromes (sturge-weber or AV malformation syndrome). present from birth! blanch able from red to dark pink, grows proportionally w/ child. will darken & often becomes nodular as child grows & will not regress. lesions on face tend to follow branches of trigeminal nerve. tx: pulse dye laser std, lightens lesion but doesn’t remove. refer to opthamology if on eyelids- assoc’d w/ glaucoma. refer to neuro if facial lesions & seizures. important to consider genetic & congenital syndrome.
mongolian spots
diffuse melanocytes w/in dermis. thought to be d/t interrupted movement of melanocytes during fetal development from neural crest to epidermis. blue-black-gray macular lesions usually on lower back & buttocks, single or multiple. rarely on trunk. lighten over time & often disappear during childhood, no tx required. no malignancy potential.
milia
retention of keratin & sebaceous material in pilo-sebaceous glands. raised white bumps mainly on nose & cheeks. no tx. resolve in few weeks. reassure. picking could cause scarring.
erythema neonatorum toxicum (ETN)
etiology unkn. thought to be immaturity of pilosebaceous glands (hair follicles). occasionally present at birth, usually appears w/in 1st 48 hrs & resolves by day 5-7. erythematous papules that progress to pustular lesion. observe, no tx indicated. resolve spontaneously. reassure parents.
atopic dermatitis
impaired epidermal layer- impaired barrier allowing irritants into dermis; dec’d water content d/t poor barrier; itch-scratch cycle worsens condition. believed genetic component. birth to 2 yrs= red, crusty, extensor, face, scalp. child (2-12) lichenification of flexor surf. adult >12 similar to child but common on hands & feet. tx 3 prongs: eliminate triggers, hydrate (thick creams or ointments, avoid lotions), control itch (sedating antihistamines).
acne neonatorum
results from stim of sebaceous glands by maternal or infant androgens. face, esp forehead, nose, cheeks, acneform lesions, starting in 1st month of life, usually lasts 1-2 mos. self resolve. don’t squeeze or pick. benzoyl peroxide 2.5% applied to region q day option.
seborrhea dermatitis; infants= cradle cap
usually in areas of dense sebaceous glands (scalp, face, groin, underarms). thought to be overstim of sebum production; possible lipid-dependent yeast. erythematous plaque; appears greasy w/ yellow, scales. common in infants but can be present thru-out life. infant scalp tx: apply emollient (petrolatum, vegetable or mineral oil) overnight then remove plaque w/ soft brush. other parts of body: ketoconazole 2% cream once dailyx1wk or low dose hydrocortisone 1% dailyx1wk. common from 3wks-12mos.
