Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

From Flashcardlet > AANP exam > Flashcards

AANP exam Flashcards

0
Q

Reticulocytes

A

In health, make up 1-2 % of total RBCs, increased in response to anema. Absence of reticulocytosis or presence of reticulocytopenia shows inadequate bone marrow response.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Erythropoetin

A

90 % renal, 10% hepatic, need supplementation when GFR is less than 49

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hemoglobin

A

normal is 12 for females and 15 for males. Ratio to hematocrit is 1:3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MCV

A

determines red blood cell size - normal is 80-96

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MCH

A

reflects hgb content and color, normal is 31-37

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

RDW

A

variation of RBC size - normal is 11.5-15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Normocytic, normochromic , normal RDW

A

acute blood loss, anemia of chronic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Microcytic, hypochromic anemia, elevated RDW

A

Iron deficiency anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Microcytic, hypochromic, normal RDW

A

alpha or beta thalassemia minor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Macrocytic, normochromic, elevated RDW

A

Vitamin B12 deficiency, folate deficiency, pernicious anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Macrocytosis without anemia

A

use of medications like tegretol, AZT, depakote, dilantin, alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Heart murmur seen in b12 deficiency

A

Hemic murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Most common pathogen in CAP, ABRS, AOM

A

S. pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Common pathogen in ABRS, AOM, CAP particularly with recurrent infections and tobacco use

A

H. influenzae, more than 30% now pcn resistant via beta lactamase production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

First line treatment for Acute Bacterial Rhinosinusitis

A

Augmentin 500/125 TID or 875/125 BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Second line treatment for Acute Bacterial Rhinosinusitis

A

Augmentin 2000/125 BID or doxy 100 mg BID or 200 mg QD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment for ABRS if allergic to PCN, Cephalosporins

A

Doxy, Levofloxacin, Moxifloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment for ABRS if antibiotic resistance of failed initial therapy

A

Doxy, levofloxacin, moxifloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Presbycusis

A

slowly progressive hearing loss that is symmetric and high frequency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

1st line controller therapy in allergic rhinitis

A

Intranasal corticosteriods like Flonase, Nasonex, Nasacort, Omnaris. Side effects are that nasal irritation and bleeding may occur. Optimal efficacy may take 1-2 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

1st line rescue treatment in allergic rhinitis

A

Nasal antihistamines, esp if there is nasal congestion. sedation could occur. Drugs like astelin, Astepro, and patanase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

1st generation oral antihistamines

A

significant potential to cause sedation and anticholinergic effects so not a first line therapy. Ex. benadryl, chlor trimeton, dimetapp, vistaril.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

2nd generation oral antihistamines

A

These are preferred over because no anticholinergic effects but not as helpful with nasal congestion. Ex. claritin, clarinex, zyrtec, allergra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Oral decongestants

A

alpha adrenergic agonist so vasoconstrictive. Take caution with the elderly, young children, HTN, bladder neck obstruction, glaucoma, and hyperthyroidism. Ex. sudafed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Nasal decongestants

A

Alpha adrenergic agonist so vasoconstrictive. Can cause rebound congestion/medicamentosa so limit use to 5-7 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Intranasal anticholinergics

A

reduce runny nose because of drying action. No effect on other nasal symptoms. Dryness can occur. Ex.. Atrovent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Found on fundoscopic exam of person with angle-closure glaucoma

A

deeply cupped optic disc because of increase intraocular pressure than pushes the optic disc backwards., acute, painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Amsler grid

A

screening test for macular problems.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Tonometry

A

measurement of intraoccular pressure, screen for glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Presbyopia

A

Hardening of the lens, close vision problems, adults over 45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Senile cataracts

A

lens clouding, progressive vision dimming, distance vision problems, close vision usually retained and often improves. Risk factors are tobacco use, poor nutrition, sun exposure, systemic corticosteriod therapy. Potentially correctable with surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Open-angle glaucoma

A

Painless, gradual onset of increased intraocular pressure leading to optic atrophy. Causes a loss of peripheral vision if not treated. Avoidable with appropriate and ongoing intervention. more than 80% of all glaucoma. Treat with topical miotics, beta blockers, or surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Angle closure glaucoma

A

sudden increases in intraocular pressure. Usually unilateral, painful, red eye, halos around lights, eyeball firm when compare to other. Immediate referral to opthmalogy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Macular degeneration

A

thickening sclerotic changes in retinal basement membrane complex. Causes painless changes in vision including distortion of central vision. On fundo exam will see drusen (soft yellow deposits in macular region). Risk factors are tobacco use, sun exposure. No treatment available for dry form. Laser treatment or intraviteal injection of antivascular growth factor for wet form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Treatment of suppurative (non gonococcal or chlamydial infection (s. aureas, s. pneumo, H. influ)

A

Primary: opthalmic with FQ ocular solution.
Secondary: opthalmic treatment with polymixin B with trimetroprim solution or with azithromycin 1%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Treatment of otitis externa (pseudomonas sp, proteus sp). Acute infection often S. aureus.

A

otic drops with ofloxacin or cipro with hydrocortisone or polymixin B with neomycin and hydrocortisone. Cleaning of ear canal important. Use 1:2 mix of white vinegar and rubbing alcohol after swimming. Do not use neomycin if eardrum punctured.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Exudative pharyngitis

A

Caused by A, C, G streptococcus, viral, HHV-6, M. pneumo. 1st line therapy is PCN PO for 10 days or IM for 1 dose if problems with adherence.
2nd line: erythromycin for 10 days; 2nd generation cephalo for 4-6 days; azithromycin for 5 days, or clarithomycin for 10 days.
If vesicular or ulcerative, usually viral.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Chicken pox

A

2-3 mm vesicles that start on trunk, appear on limbs 2-3 days later. Non clustered and at a variety of stages. Mild to moderately ill.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Small pox

A

2-3 mm vesicles with generalized distribution without a pattern. All lesions at same stage. Severe systemic illness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Actinic keratoses

A

mostly on sunexposed areas. Red or brown, scaly, often tender. Sometimes flesh colored. Can turn into SCC. Can remain unchanged, spontaneously change or progress. Can treat with topical 5-FU, 5% imiquimod cream, photodynamic therapy with topical acid. Can do cryosurgery, laser resurfacing, chemical peel.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Basal Cell carcinoma

A

more common,, sun exposed areas, arise de novo, papule, nodule with or without central erosion, pearly or waxy appearance, telangiectasia, low mets risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Squamous cell carcinoma

A

less common, sun exposed areas, can arise for actinic keratoses or de novo, red, conical hard lesions with or without ulceration, less distince borders, more chance of mets especially if located on lip, oral cavity, or genitalia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

psoriasis tx and location

A

vitamin D derivative cream, anterior surface of knees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

scabies tx and location

A

permetherin lotion, over waist band area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Verucca vulgaris treatment

A

Imiquimod cream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Tinea pedis tx

A

Topical ketoconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Rosacea tx

A

Topical metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Keratosis pilaris tx

A

ammonium lactate lotion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Eczema location

A

antecubital fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Pityriasis rosea location

A

usually proceeded by a herald patch on the trunk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Acanthosis Nigrans

A

hyperpigmented plaques with a velvet like appearance at the nape of the neck, axillary region, and groin. Check fasting BG.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Contact dermitis

A

intensely pruiritic rash on both hands and right cheek. Scattered vesicles, small areas of crusting.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Bactrim

A

best choice in antimicrobial therapy for a skin and soft tissue infection likely caused by MRSA.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Brown Recluse spider bites

A

Central blistering with surrounding gray to purple discoloration at bite site. Surrounded by ring of blanched skin surrounded by large area of redness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

TSH

A

normal level is 0.4-4.0. Reflects anterior pituitary lobe’s ability to detect amount of circulating free thyroxine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Free T4

A

Normal level is 10-27. Unbound metabolically active portion of thyroxine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Total T4

A

Normal level is 4.5-12.0. Reflects the total fo protein bound and free thyroxine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Free T3

A

Normal level is 3.5 to 7.7. unbound metabolically active portion of triiodothyronine (T3). Is about four times more metabolically active.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Total T3

A

Noraml is 95-190. Reflects the total of the protein bound and free triiodothyronine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Untreated hypothyroidism

A

low free T4 and high TSH. Give synthroid by dosing by weight, using ideal body wt in obesity, actual in underweight. 1.6 mcg/kg/day in adults, 4.0 mcg/kg/day in kids, 1.0 mcg/kg/day in elderly. 50% increase during pregnancy so send to high risk OB. Increase dose by 33% or more as soon as pregnancy is confirmed. Check TSH every 6-8 weeks or 8-12 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Untreated hyperthyroidism

A

High free T4 and low TSH. treat with beta adrenergic antagonist with B1,B2 blockage such as propranolol to counteract tachycardia and tremor. Use PTU or tapazole. Radiactive iodine tx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Subclinical hypothyroidism

A

High TSH, normal free T4. Recommend tx of people with TSH more than 5 if the patient has goiter or if thyroid antibodies present. Presence of sxs compatible iwth hypothyroidism, infertility, pregnancy, or imminent pregnancy would favor tx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Evaluation of thyroid nodule

A

Risk of malignancy if 5%. Hx of head or neck irradiation, localized pain, dysphonia, hemoptysis, regional lymphadenopathy, or a hard, fixed mass should raise suspicion. Initial testing with TSH measurement. A hot nodule has low risk of malignancy. Fine needle aspiration advised regardess of TSH results.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Red flag onset of headache

A

Sudden, abrupt, “thunderclap” headache is suggestive of subarachnoid hemorrhage. Headache with exertion, sex, coughing and sneezing is suggestive of increased cranial pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Tension type headache

A

last 30 minutes to 7 days but usually 1-24 hours; pressing, nonpulsatile pain, mild to moderate intensity, bilateral, Can have 1 of the following characteristics: nausea, photophobia, phonophobia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Migraine without aura

A

last 4 to 72 hours, unilateral, moderate to severe with pulsating, aggravated by normal activity, nausea, ,vomiting, photophobia, phonophobia,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Migraine with aura

A

focal dysfunction of cerebral cortex of brain stem causes more than 1 aura symptom; develop over 4 mins. Sxs include feeling of dread or anxiety, unusual fatigue, nervousness, GI upset, visual or olfactory alteration. Should not last more than 1 hour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Migraine specific meds

A

triptans, ergot deriviatives. Caution about pregnancy, CVD, uncontrolled HTN due to vascular effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Prophylactic “controller meds” for HA

A

Beta blockers like propranolol, CCBs, TCAs, antieleptics like gabapentin, depakote, topamax), lithium for cluster. Need these if use any product more than 3 times a week, have more than 2 migraines a month with disabling sxs more than 3 days, poor sx relief from other txs, present of other conditions like HTN, hemiplegic or basilar migraines.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Use MRIs for

A

hemorrhage of days to weeks duration, AV malformation, carcinomatous meningitis, tumor, posterior fossa lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

CT without contrast

A

acute or chronic hemorrhage, edema, atrophy, ventricular size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

CT with contrast

A

tumor, abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

GERD

A

Eliminate offending meds: smooth muscle relaxers like CCBs, theophylline, nitrates, estrogen, progestin.
Treat with H2RAs like pepcid, zantac. These are considered first line acid suppression therapy. Proton pump inhibitors are better than H2RAs at suppressing post-prandial acid surge. Protracted use association with B12, Ca, and Fe malabsorption.
Alarm findings may warrant endoscopy: dysphagia, bleeding, wt loss, odynophagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

GERD presentation

A

dyspepsia, chest pain, postprandial fullness, chronic hoarseness, sore throat, cough, wheezing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Nikolsky’s Sign

A

positive when slight lateral pressure on the skin results in epidermal exfoliation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Markle’s Sign

A

pt stands on tiptoes and falls back on heels. Positive if abdominal pain increases and localized with the maneuver and is suggestive of peritoneal inflammation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Blumberg’s Sign

A

Gently and deeply palpate an area of abdominal tenderness then rapidly release the pressure. Pain is worse with release, indicating abdominal wall or peritoneal inflammation. Rebound tenderness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Murphy’s Sign

A

Painful arrest of inspiration triggered by palpating the edge of inflamed gallbladder.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Erosive gastritis

A

NSAID use, intermittent nausea, burning, and pain limited to upper abdomen, often worse with eating. Tender at epigastrium, LUQ, hyperactive bowel sounds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Acute Pancreatitis

A

drinks alcohol, acute onset of epigastric pain radiating to the back with bloating, nausea, vomiting. Epigastric tenderness, hypoactive bowel sounds, abdomen distended and hypertympanic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Duodenal ulcer

A

history of intermittent upper abdominal pain described as burning, gnawing pain about 2-3 hours . Relief with food, antacids, Awakening at 1-2 am with sxs. Tender at epigastrum, LUQ hyperactive bowel sounds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

IBD

A

Intermittent crampy abdominal pain, diarrhea, wt loss, fatigue. Increasing discomfort, fever, and tenesmus. Pale conjunctiva, tachycardia, hyperactive bowel sounds, diffuse abdominal tenderness without rebound.

82
Q

Diverticulitis

A

Intermittent left lower quadrant pain accompanied by fever, cramping, nausea and 4-5 loose stools a day. Abdomen soft,, tender to LLQ palpation without rebound.

83
Q

CAP by S. pneumo

A

Effective treatments if not resistance: macrolides, standard dose amox, some cephalosporins, tetracyclines.
If possible DRSP: high dose amox, respiratory FQ, Ketek.

84
Q

CAP by H. Influenzae

A

Treatment needs to be stable with beta lactamase production so cephalosporins, augmentin, macrolides, respiratory FQ, Tetracyclines - see more with tobacco related lung disease.

85
Q

CAP by M. pneumo or C pneumo or Legionella

A

macrolides, FQ, tetracyclines.

Cephalosporins and PCN not effective. See more for those in correctional facilities or living in close proximity to others.

86
Q

CYP 450 3A4 inhibitors

A

macrolides

87
Q

CYP450 3A4 substrates

A

Viagra, statins, effexor, xanax

88
Q

CYP450 3A4 inducers

A

St John’s wort. Can diminish effectiveness of oral contraceptives, antiretrovirals, and cyclosporine

89
Q

Pneumonia Consolidation findings

A

Dullness to percussion because of dense tissue
Increased tactile fremitus because of increased tissue density
Bronchial or tubular breath sounds often with late inspiratory crackles that don’t clear with cough.

90
Q

Pleural Inflammation

A

sharp, localized pain, worse with deep breath, movement or cough. Audible pleural friction rub. “fresh snow” sound.

91
Q

Acute bronchitis by virus

A

Anticholinergic bronchodilator, inhaled beta 2 agonist

92
Q

Acute bronchitis by M. pneumo, C. pneumo, pertussis

A

macrolide or tetracycline

93
Q

Asthma

A

recurrent cough, wheeze, SOB, chest tightness. Sxs worse at night, with exercise, viral resp infections, aeroallergans, pulmonary irritants. Airflow obstruction is at least partially reversible.

94
Q

Asthma controller meds

A

ICS are preferred for persistant asthma (flovent, pulmicort, QVAR)
ICS/LABA are preferred for moderate or severe asthma (Symbicort, Advair).
LTRA or LTM: most often used in conjunction with ICS: Singulair

95
Q

Air trapping in asthma or COPD

A

Hyperresonance, decreased tactile fremitus, wheeze (exp first and insp later), low diaphragms, increased AP diameter.

96
Q

Clinical dx of COPD

A

Considered in any pt with persistant dyspnea, chronic cough, history of exposure to smoke, pollution. The presence of bronchdilator FEV1 less than 0.70 confirms persistant airflow obstruction.

97
Q

Treatment of COPD exacerbation

A

Short acting beta 2 agonist and/or anticholinergic as needed.
Consider a LABA.
If baseline FEV1 less than 50% predicted, add systemic corticosteroid for 10 days.
Use noninvasive positive pressure ventilation in more severe exacerbations.
Mild to moderate exacerbation: ABX usually not indicated but if given: Amox, Bactrim, Doxy
Moderate to severe: Augmentin, microlides, FQ

98
Q

Sulfonylurea (glipizide, glyburide)

A

Insulin secretagogue, may be less effective after 5 years

99
Q

Biguanide (Metformin)

A

Reduces hepatic glucose production and intestinal glucose absorption. It is an insulin sensitizer. Monitor kidney function. Avoid in heart failure. Rare risk of lactic acidosis. Omit day of surgery and 48 hours after and reinitiate once baseline renal function obtained. Can be use preventatively.

100
Q

Thiazolidinedione (TZD, glitazones)

A

Insuilin sensitizer via receptors found in muscle, adipose, tissues. Edema risk. TZD can exacerbate heart failure. Proglitazone use for more than 1 year can cause bladder cancer.

101
Q

GLP 1 agonist (Byetta, Victoza)

A

Stimulates insulin production in response to increase in plasma glucose. Slows gastric emptying. Major SE is N/V. Contraindicated in gastroparesis. Exenatide can cause pancreatits.

102
Q

DPP4 Inhibitor (gliptins)

A

Use in combination with metformin or TZD. Watch for pancreatitis.

103
Q

Alpha glucosidase inhibitors (Acarbose)

A

Delays intestinal carb absorption. Taken with first bite of a meal. Does not enhance insulin secretion or sensitivity. Flatulaence is a problem. Avoid in IBD, impaired renal function.

104
Q

When to initiate insulin use

A

At time of dx if gluose betwee 250-300
When acutely ill because glucose should be kept between 140-180
When more than 2 agents at optimized use are inadequate.

105
Q

Short Acting Insulin/ rapid(Lispro - humalog)

A

Onset: 15-30 minutes
Peak: 30 minutes to 2.5 hours
Duration: 3-6.5 hours

106
Q

Short acting, rapid (Aspart - Novolog)

A

Onset: 10-20 minutes
Peak: 1-3 hours
Duration: 3-5 hours

107
Q

Short Acting /Rapid (Apidra)

A

Onset: 10-15 minutes
Peak: 1-1.5 hours
Duration: 3-5 hours

108
Q

Short Acting (regular, Humulin R, Novolin R)

A

Onset: 30 mins to 1 hour
Peak” 2-3 hours
Duration: 4-6 hours
I

109
Q

Intermediate acting (Humulin N or Novolin N)

A

Onset: 1-2 hour
Peak: 6-14
Duration: 16-24 hours

110
Q

DM additional Care

A

Aspirin, ACEI, or ARB
Beta blocker or alpha beta blocker
Statin - check renal function, GFR, CR, microalbuminuria, fasting lipid profile annually
Foot exam with every visit

111
Q

Sodium recommendation in HTN

A

2.4 g sodium or 6 gr sodium chloride

112
Q

Diuretics (HCTZ)

A

lower volume sodium depletion that leads to PVR reduction
Can have negative impact on lipids, glucose control.
Monitor Na, K, Mg. Calcium sparing. Less effective for advanced renal impairment and should be swapped to loop diuretic. Can make gout worse

113
Q

Beta Adrenergic Antagonists( Beta blockers)

A

Use with caution in COPD, asthma, untreated heart block.
In DM, benefit of beta blocker use outweighs the risk of worsening insulin resistance or masking hypoglycemia sxs. Taper dose over 10-14 days.

114
Q

Alpha beta adrenergic antagonist (Carvedil)

A

Use with caution in COPd, asthma, untreated heart block. Less insulin resistance inducing properties when compared to standard beta blockers

115
Q

ACEI

A

Don’t use in presence of bilateral renal stenosis, modest hyperkalemia risk, Can cause cough. No use during pregnancy.

116
Q

Tanner Stage 1

A

Prepuberty for both male and female.

117
Q

Tanner Stage 2

A

Female: Breast buds and papilla elevated, downy pigmented pubic hair along labia majora
Male: Testes enlarge, scrotal skin reddening with change in texture, sparse growth of long pubic hair at base of penis

118
Q

Tanner Stage 3

A

Female: breast mound enlargement, darker coarser pubic hair on mons, labia majora, onset of growth spurt
Male: increase in penile length, but minimal change in width, scrotal enlargement, pubic hair darker, coarser, covering more area

119
Q

Tanner Stage 4:

A

Female: areola and papilla elevated to form second mound above level of rest of breast, adult like pubic hair with no spread to thighs, menarche
Male: increase in penis length and width with development of glans, darkening of scrotal skin, adult pubic hair without spread to thighs

120
Q

Tanner Stage 5

A

Female: recession to areola to mound of breast, extension of hair to thighs
Male: full adult genitalia, hair to thighs

121
Q

Candida Vulvovaginitis

A

pH: less than 4.5, white curdy cottage cheese discharge, sometimes increased, odor absent, microscope reveals mycelia, budding yeast, pseudo-hyphae with KOH prep, pt complains of burning/itching, discharge. Treat with azole antifungal.

122
Q

Bacterial vaginosis

A

pH greater than 4.5, thin, homogeneous white, gray adherent, increased discharge, fishy smell, greater than 20 clue cells, discharge, foul odor, itching sometimes present, treat with metronidazole topical or oral, clindamycin vaginal cream,

123
Q

Atrophic vaginitis

A

pH greater than 5, scant, white-clear discharge, absent odor, see few or absent lactobacilli, complain of itcing, burning discharge but may be without sxs, treat wtih topical estrogen if symptomatic.

124
Q

Genital herpes

A

classic presentation with painful, ulcerated lesions, lymphadenopathy. Tx with antivirals.

125
Q

Nongonococcal urethritis and cervicitis

A

irritative voiding sx, occassional micropurulent sx. cervicitis common in women. Large number of WBCs. Both sexes sometimes without sxs. Treat with Azithromycin

126
Q

Gonococcal urethritis and vagintitis

A

irritative voiding sx, occassional micropurulent sx. cervicitis common in women. Large number of WBCs. Both sexes sometimes without sxs. Tx with Rocephin IM plus azithromycin (1 dose) or doxy x 7 days

127
Q

Trich

A

dysuria, itching, irritation, pain with sex, yellow-green vaginal discharge, cervical petechial hemorrhages (strawberry spots), sometimes no sxs. Alkaline pH. Tx with metronidazole as one time dose.

128
Q

Syphilis

A

Primary stage: chancre (firm, round, painless with clean base and indurated margins accompanied by localized lymphadenopathy, last about 3 weeks and resolves without therapy. Secondary stage: nonpruritic skin rash, palms and soles, as well as mucus membrane lesions. Fever, lymphadenopathy, sore throat, patchy hair loss, HA, wt loss, muscle aches, fatigue. Latent stage: neuro issues. Tx with injectible PCN or doxy if allergic.

129
Q

Genital warts (HPV 6/11)

A

May go unrecognized. Tx with podofilox, liquid nitrogen, cryoprobe, tricholoroacetic, acid, podophyllin resin, surgical remove, imiquiod. Trichloroacetic acid and cryoprobe preferred during pregnancy.

130
Q

Pelvic Inflammatory Disease

A

Irritative voiding, fever, abdominal pain, cervical motion tenderness, vaginal discharge,. Can cause infertility, tubal scarring. Tx: rocephin IM plus doxy for 14 days with or without metronidazole.for 14 days.

131
Q

UTI in nonpregnant women

A

Primary: if resistance to Bactrim is low and no allergy, give bactrim twice a day for 3 days. If resistance high or if there is an allergy, give nitrofurantoin for 5 days or fosfomycin for 1 dose.
Alternative: Can give FQ for 3 days or Aumentin 875/125 for 5-7 days or an oral cephalosporin.

132
Q

Uncomplicated pyelonephritis

A

usually women 18-40 with fever greater than 102 with CVA tenderness.
Primary: Cipro 500 mg bid for 7 days, levaquin for 5 days.

133
Q

G6PD deficiency

A

Treat with a cephalosporin

134
Q

Epididymitis

A

Upper reproductive tract infection, usually younger than 35. Present with irritative voiding, painful swelling or epididymis and scrotum. Possible infertility after. Treat with Rocephin plus doxy, advise scrotal elevation. Plehn’s sign - relief of discomfort with scrotal elevation.

135
Q

Epidymitis or epididymoorchitis

A

Age greater than 35 or insertive partner in anal intercourse. Present with irritative voiding, painful swelling or epididymis and scrotum. Possible infertility after. Tx with Cipro 550 or levo 750 for 10-14 days.

136
Q

Acute bacterial prostatis less than 35 y.o.

A

irritative voiding, suprapubic, perineal pain, fever, tender, boggy prostate, leukocytosis. Treat with rocephin IM plus doxy for 10 days

137
Q

Acute bacterial prostatis older than 35.

A

irritative voiding, suprapubic, perineal pain, fever, tender, boggy prostate, leukocytosis. Treat with cipro or ofloxacin for 14 days.

138
Q

Chronic bacterial prostatis

A

irritative voiding, dull, poorly localized pain, suprapubic, perineal pain. Tx with Cipro BID for 4 weeks or levo qd for 6 weeks. Can treat with Bactrim twice a day for 1-3 months. If doesn’t work, consider prostatic stones.

139
Q

Delirium etiology

A

DRUGS:Anticholingergics like TCAs, 1st gen antihistamines, neuroleptics, atypical psychotics, opioids, benzos, alcohol EMOTIONAL: mood disorders, loss. ELECTROLYTE IMBALANCES: esp hyponatremia, LOW PO2, LACK OF DRUGS: withdrawal from alcohol, INFECTION: UTI, CAP, Retention of urine or feces. Reduced sensory input, seizures, undernutrition, metabolic, myocardial problems, subdural hematoma. Fractures, infections, and medications are most common causes.

140
Q

Lumbar spinal stenosis sx

A

back pain with standing, leg numbness, pain improvement iwth flexed forward position. For sxs lasting longer than 1 month, consider MRI, EMG. Do PT, NSAIDS, epidural steroid injection, maybe surgery.

141
Q

Seizure

A

longer than 5 minutes, aura or prodrome, usually no injury, may have urinary incontinence, elevated CK, postictal state.

142
Q

Syncope

A

less than 5 minutes, no warning, injury, no urinary incontinence, Normal CK, No disorientation after.

143
Q

Dizziness

A

sense of disturbed relationship to space but surroundings are not moving. “feels lightheaded” Treat underlying cause.

144
Q

Vertigo

A

Surroundings are moving, sensation of motion with eyes closed, “room is spinning” Usually an inner ear disturbance, treat cause.

145
Q

Depression in the elder

A

relatively rapid, can usually report correct time, date, location. Notices or worries about memory problem, can report nature of memory difficulty, has trouble with concentration. Usually slow when compared to baseline but normal.

146
Q

Dementia in the elder

A

Slow mental decline, confused and often becomes lost in a familiar location. Difficulty with short term memory but usually does not notice memory problems. Writing, speaking and motor skills impaired.

147
Q

Prescribing in the Elderly

A

Ditropan sustained release form better because it has better tolerance with similar efficacy. Avoid antiarrhythmic drugs as first line treatment for afib.Data suggest that rate control yields better balance of benefits and harms than rhythm control for most older adults. Amiodorone associated with multiple toxicities, including thyroid disease, pulmonary disorders, and QT interval prolongation.Aspirin use is cautioned in adults older than 80. Pradaxa has greater risk of bleeding than with warfarin in adults older than 75. A1c goal is 8%

148
Q

Hypomagesemia with PPI use

A

Can cause muscle cramps, palpitations, dizziness, tremors, seizures. 24 hour mg more accurate. Tx with elemental mg 200-400 mg.

149
Q

PPIs in elderly

A

PPIs inhibit CYP 450 2C19 which can reduce the antiplatelet activity of Plavix 20-40 % .

150
Q

Meds in elderly

A

Decline in CNS function so exaggerated response to CNS active meds like benzos, anesthetics, opioids. Decrease in effect of beta adrenergic agents like beta 2 agonists or beta blockers. Inhaled anticholinergics and CCBs seem to be impacted less by age. Dose adjustments needed for Bactrim, Cipro, Nitrofurantoin. CrCl approximates GFR but might overestimate due to creatinine secreted by proximal tubule. Filtered by glomerulus.

151
Q

Citalopram in elderly

A

causes QT prolongation, no dose above 40 mg. Use not recommended in those with congenital long QT syndrome, bradycardia, hypokalemia, or hypomagesemia, recent acute MI, or uncompensated HF. Do not exceed 20 mg /day in elderly.

152
Q

newborn milestones

A

moves all extremities, reacts to sound by blinking turning, sense of smell, likes high pitched voices, reflexes, tonic neck, palmar grasp, babinski response, rooting awake and asleep, suck, calmed by feeding, cuddling, responds to cries of other neonates,

153
Q

1-2 months

A

lifts head, holds head erect, follows objects through visual field, moro reflex fading, spontaneous smile, recognizes parents

154
Q

3-5 months

A

reaches for objects, brings objects to mouth, respberry sound, sits with support, rolls from back to side, laughs, recognizes food by sight.

155
Q

6-8 months

A

sits briefly without support, scoops small object with rake grip, some thumb use, hand to hand transfer, recognizes no

156
Q

9-11 months

A

stands alone, imitates peek a boo, picks up small object with thumb and index finger, cruises, follow simple command like come here. able to self feed with simple finger foods.

157
Q

12-15 months

A

walks solo, neat pincer grasp, place cube in cup, tower of two bricks, scribbles spontaneously, indicates wants by pointing, hands over objects on request.

158
Q

15-20 months

A

points to several body parts, uses spoon with little spilling, walks up and down steps with help, understands two step commands, feeds self, seats self in chair, carries and hugs doll

159
Q

24 months

A

kicks ball upon request, jumps with both feet, developing handedness, copies vertical and horizontal line. washes and dries hands, parallel play.

160
Q

30 months

A

walks backwards, hops on one foot, copies circle, gives first and last name.

161
Q

36 months

A

holds crayons with fingers, walks down stairs with alternating steps, rides tricycle, copies circles. Dresses with supervision.

162
Q

3-4 years

A

responds to command to place object in, on or under a table, draws circle when one is shown, takes off jacket and shoes, washes and dries face, cooperative play, knows gender.

163
Q

4-5 years

A

runs and turns while maintaining balance, stands on 1 foot for at least 10 seconds, counts to 4, draws a person without a torso, copies cross by imitation, buttons clothes, dresses self except tying shoes, can play without adult input for about 30 minutes, verbalizes activities to do when cold, hungry, tired. 6-8 word sentences, names 4 colors, counts 10 objects correctly.

164
Q

5-6 years

A

catches ball, knows age, knows right hand from left hand, draws person with 6-8 parts including torso, able to complete simple chores, sense of gender, identifies best friend, likes teacher.

165
Q

6-7 years

A

copies triangle, draws person with at least 12 parts, prints name, reads multiple single syllable words, counts to 30 and beyond, ties shoe laces, plays well with peers, no big behavior problems at school, names career

166
Q

7-8 years

A

copies diamond, able to read simple sentences, draws person with at least 16 parts, ties shoes, knows days of the week.

167
Q

8-9 years old

A

able to add, subtract, borrow, carry, teamwork, able to give response to a question such as what to do if an object is accidentally broken.

168
Q

Language 1-6 months

A

coos in response to voice

169
Q

lang 6-9 months

A

babbles

170
Q

lang 10-11 months

A

imitates sounds, nonspecific mama, dada

171
Q

lang 12 months

A

specific mama, papa, 2-3 syllable words imitated

172
Q

lang 13-15 months

A

4-7 words, jargon, less than 20% of speech understood by strangers

173
Q

lang 16-18 months

A

extensive jargon, 20-25% of speech understood by strangers

174
Q

lang 19-21 months

A

20 words, 50% of speech understood by strangers

175
Q

lang 22-24 months

A

more than 50 words, 2 word phrases, less jargon, 60-70% of speech understood

176
Q

lang 2-2.5 yrs

A

more than 400 words, 2-3 word phrases, uses pronouns, 75% of speech understood

177
Q

3-4 years

A

3-6 word sentences, ask questions, tells stories, almost all speech understood

178
Q

4-5 years

A

6-8 word sentences, names 4 colors, counts 10 objects correctly

179
Q

Neonatal Vital signs

A

P - 120-160
BP greater than 60 systolic
40-60 breaths a minute

180
Q

Infant vital signs

A

100-140 pulse
70-95 systolic
25-50 breaths a minute

181
Q

Child up to 8 vitals

A

80-100 beats
80-110 systolic
15-30 breaths a minute

182
Q

Separation anxiety

A

occurs at 7-8 months.

183
Q

Gonococcal conjunctivits

A

eye drops at birth prevent this.

184
Q

Time out

A

can start this at 18-24 months, 1 minute for every year of life

185
Q

Autism screening

A

done at 18 and 24 months of age

186
Q

Developmental red flags

A

By 6 months: no big smalls or joyful expressions
9 months: no back and forth sharing of sounds, smiles or other facial expressions
12 months: lack of response to name, no babbling or baby talk, no back and forth gestures such as pointing, showing, reaching, or waving
16 months: no spoken words
24 months: no meaningful two word phrases that don’t involve imitating or repeating.

187
Q

Car seat use

A

infants to 2 years: rear facing until 2 y.o. or until highest ht or wt allow by manufacturer
Toddler/preschoolers: forward facing seats with harnesses up to highest ht and wt allow by manufacturer
School aged: booster until 4 ft 9 inches and between 8 and 12 y.o.
Older children: seat belts and rear seats until 13 y.o.

188
Q

scarlet fever

A

scarletina form or sandpaper like rash with exudative pharyngitis, fever, HA, tender, localized ant cervical lymphadenopathy. Rash usually erupts on day 2 of pharyngitis and peels a few days later. PCN or macrolide if allergy.

189
Q

Roseola

A

Discrete rosy pink macular or maculopapular rash lasting hours to 3 days that follows a 3-7 day period of fever, often quite high. usually in kids less than 2. supportive tx.

190
Q

Rubella

A

fever, sore throat, malaise, nasal discharge, diffuse maculopapular rash lasting about 3 days, post cervical and postauricular lymphadenopathy 5-10 days prior to onset of rash. arthralgia in 25%. incubation period of 14-21 days with disease transmissable for 1 week prior to onset of rash to weeks after rash appears. generally self limiting. danger to fetus with 1st trimester exposure.

191
Q

Measles - rubeola virus

A

acute with fever, nasal, discharge, cough, general lymphadenopathy, conjunctivits, photophobia, koplik spots (white spots with blue rings held within red spots in oral mucosa), mild pharyngitis without exudate. maculopapular rash 3-4 days after onset of sxs. incubation period of 14-21 days with disease transmissable for 1 week prior to onset of rash to weeks after rash appears. CNS and resp tract complications common. Risk of neruo impairment or death. supportive tx.

192
Q

Mono

A

fever, shaggy purple white exudative pharyngitis, malaise, diffuse lymphadenopathy, hepatic and splenic tenderness, monospot test. If given amox or ampicillin, rash will occur. Avoid contact sports for more than one month because of risk of splenic rupture.

193
Q

Systolic Murmurs

A 
MR=Mitral regurg
P= physiologic
AS=Aortic Stenosis
S=Systolic
MVP=Mitral Valve Prolapse
194
Q

Diastolic Murmurs

A

MS = Mitral Stenosis
AR=Aortic regurg
D=Diastolic

195
Q

Harsh Murmur

A

use bell and diaphragm - aortic stenosis

196
Q

Rumble

A

low so heard best with bell - mitral stenosis

197
Q

Blowing

A

High so heard best with diaphragm - aortic regurg

198
Q

Pregnancy Cat A meds

A

well controlled human study fails to demonstrate fetal risk in first trimester - levothyroxine, insulin

199
Q

Pregnancy Cat B meds

A

animal studies have not demonstrated fetal risk but no controlled study in humans OR animal studies have shown adverse effect but not demonstrated in human study = PCN, Cephalosporins, Macrolides except for clarithromycin, tylenol, ibuprofen, Macrobid or macrodantin except at term b/c of hemolysis, Pulmicort but not fluticasone

200
Q

Pregnancy Cat C

A

No controlled study in humans available. Studies in animals have revealed adverse effects on fetus = clarithromycin, FQs, SSRIs

201
Q

Pregnancy Cat D

A

positive evidence of human fetal risk. May use if benefits outweigh risk like lifethreatening disease = ACEI and ARB in 2nd, 3rd,Tetracyclines, Tegretol, Depakote, Lithium, Paroxetine

202
Q

Pregnancy Cat X

A

Accutane, Talidomide, Statins

From Flashcardlet (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions