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From Flashcardlet > ABX (A) from apea FNP (sasmall) > Flashcards

ABX (A) from apea FNP (sasmall) Flashcards

0
Q

Gram Negative Bugs

A

Almost everything else

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1
Q

Gram Positive Bugs

A
  • Staph
  • Strep
  • Enterococcus
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2
Q

Staphylococcus

A

Gram +

  • Staphylococcus aureus (skin)
  • MRSA (skin)
  • Staph saprophyticus (UTI, vagina)
  • Staph epidermis (skin)
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3
Q

Streptococcus

A

Gram +

  • Strep pyogenes (throat)
  • Strep pneumoniae (lungs)
  • Strep viridans (dental abscess, endocarditis)
  • Strep agalactiae (Group B strep)
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4
Q

Enterococcus

A

Gram +

  • Enterococcus faecalis (urinary tract)
  • Enterococcus faecium (urinary tract)
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5
Q

Gram Negative Bugs

A
  • Neisseria gonorrhoeae
  • Neisseria meningitides
  • E. coli
  • Shigella
  • Campylobacter
  • Salmonella
  • Pasturella (cat bites)
  • Mycoplasma
  • H. flu
  • M. catarrhalis
  • Proteus
  • Pseudomonas
  • Legionella, etc……
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6
Q

Penicillins

A

Coverage: Gram + (NOT MRSA or MSSA)

  • ampicillin
  • amoxicillin
  • penicillin G
  • penicillin K
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7
Q

Extended Spectrum PCNs

A

Coverage: Gram +, Gram Neg., B-lactamase (NOT MRSA or MSSA)

-amoxicillin/clavulanic acid

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8
Q

Tetracyclines

A

Coverage: Gram neg, atypicals, MRSA

  • doxycycline
  • minocycline (preferred for tx of MSSA & CA-MRSA)
  • vibramycin
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9
Q

Sulfonamides

A

Coverage: Gram neg, MRSA

-TMP/SMX

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10
Q

Cephalosporins: 1st generation

A

Coverage: Gram +

  • cephalexin
  • cefadroxil
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11
Q

Cephalosporins: 2nd generation

A

Coverage: Gram + and Gram neg

  • cefuroxime
  • cefaclor
  • cefprozil
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12
Q

Cephalosporins: 3rd generation

A

Coverage: Gram neg. (weak Gram +)

  • ceftibuten
  • cefixime
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13
Q

Extended Spectrum 3rd Generation

A

Coverage: Gram +, Gram neg., B-lactamase

  • ceftriaxone
  • cefdinir
  • cefpodoxime
  • cefditoren
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14
Q

Macrolides

A
  • erythromycin: atypical pathogens (NOT Staph, Strep, or Enterococcus)
  • azithromycin and clarithromycin (NOT Strep)
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15
Q

Fluoroquinolones

A
  • Cipro: Gram neg., atypical pathogens (for bugs below the belt)
  • Respiratory Fluoroquinolones: Gram +, Gram neg., atypical pathogens, and DRSP: levofloxacin, moxifloxacin, gemifoloxacin, gatifloxacin
  • Do NOT give to patients <18yo or if pregnant
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16
Q

SSRIs

A

-fewer side effects and less danger of overdose
-Tx: dysthmia, OCD, and anxiety disorders
E.g.: citalopram, escitalopram, fluoxetine, paroxetine, sertraline, fluvoxamine

  • Serotonin syndrome: potentially life threatening, hyperreflexia, clonus, rigidity in the lower extremities, tachycardia, hyperthermia, hypertension, vomiting, disorientation, agitated, delerium, or tremor.
  • -can occur from an interaction between an SSRI and dextromethorphan, triptan, or other SSRIs
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17
Q

Dopa/Norepi RIs

A

-Few side effects: no weight gain, drowsiness, orthostatic hypotension, or sexual dysfunction
E.g.: bupropion

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18
Q

SNRIs

A

-similar side effects as SSRIs

E.g.: venlafaxine, duloxetine, desvenlafaxine

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19
Q

TCAs

A
  • Side effects include: sedation, dry mouth, peripheral vasodilation
  • NOT as safe in overdose or in pts w/ bradyarrhythmias
  • Useful in patients with depression and chronic pain or migraine
  • E.g.: amitriptyline, clomipramine, desipramine, doxepin, nortriptyline, protriptyline
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20
Q

Black cohosh

A

herb for hot flashes

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21
Q

St. John’s Wort

A

herb for depression

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22
Q

Milk thistle

A

herb for liver, GI

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23
Q

Red yeast

A

herb for high cholesterol

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24
Q

Serotonin syndrome

A

sleepy to coma, potentially life threatening, hyperreflexia, clonus, rigidity in the lower extremities, tachycardia, hyperthermia, hypertension, vomiting, disorientation, agitated, delerium, or tremor.
–can occur from an interaction between an SSRI and dextromethorphan, triptan, or other SSRIs

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25
Q

HTN meds

A
  • Triamterene: K+ sparing
  • ACE inhibitors: raises serum K+
  • HCTZ: increases serum Ca2+ (Good for osteopenia, Bad for gout, DM, and hyperlipidemia)
  • Do NOT use CCBs w/ thiazide diuretics
  • CCBs do NOT effect the pulse
  • In pregnancy: do NOT use ACEs or ARBs
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26
Q

GLP-agonists (incretin-mimetics)

A

-enhances insulin secretion
-weight loss, delays gastric emptying
-injected, expensive
E.g. Byetta, Victoza

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27
Q

Thiazolidinedione (TZDs)

A
  • No hypoglycemia, improves insulin sensitivity
  • Expensive, weight gain, edema, high dose associated with bone fractures
  • E.g. **pioglitazone (Actos)—-Do NOT use in HF
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28
Q

Insulin

A
  • reduces BG levels, weight gain
  • hypoglycemia
  • STOP sulfonylureas before when initiating meal time insulin
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29
Q

When to consider insulin?

A
  • HgbA1C >10%
  • fasting glucose >250
  • after maxing out po therapy
  • symptoms of hyperglycemia
  • pregnant patients
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30
Q

Thyroid Values

A
  • TSH: 0.5 - 4.5 (produced by anterior pituitary)
  • Normal Serum Free T4: 0.8 - 1.8
  • Replace adults with 1.6mcg/kg/day of levothyroxine
  • Adults >50yo start at 50mcg daily of levothyroxine
  • **Recheck TSH in 4-6wks
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31
Q

T-score

A
  • Osteopenia between -1.0 and -2.5

- Osteoporosis < -2.5

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32
Q

Breast Cancer Screening Recommendations

A
  • CBE q 1-3yrs from age 20-39
  • Mammogram and CBE annually at age 40
  • CBE q 1yr + mammogram q 2yrs at age 50+
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33
Q

Saw Palmetto

A

Herb for prostate health

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34
Q

BPH

A

-Prostate: firm, smooth, symmetrically enlarged prostate

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35
Q

Prostatitis

A
  • Pain in the perineum, lower abdomen, testicles, or penis; pain with ejaculation; voiding difficulty
  • Prostate: enlarged, boggy, and tender, fever, cloudy urine, frequency, urgency, pain with defecation, hematuria
  • no significant elevation in PSA
  • Cipro for 6 weeks, alpha blocker, NSAIDs, stool softeners, adequate fluids
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36
Q

Prostate Cancer

A
  • Prostate: asymmetry, induration, nodularity, hard
  • Normal PSA < 4.0
  • PSA >10 Needs biopsy
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37
Q

Prostate Cancer Screening

A
  • Start screening at age 50; High risk begin discussions at 40-45
  • If PSA < 2.5; test q 2yrs
  • If PSA > 2.5; annual testing
  • If PSA > 4.0; refer for evaluation
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38
Q

Honey colored crusts

A

impetigo

Tx w/ topical antibiotics

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39
Q

Herald patch

A

pityriasis rosea

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40
Q

Christmas tree pattern rash

A

distribution of pityriasis rosea

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41
Q

Burrows

A

scabies

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42
Q

well circumscribed lesion found on the trunk

A

tinea corporis

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43
Q

sandpaper textured rash

A

strep (trunk)

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44
Q

pearly domed nodule

A

basal cell

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45
Q

bright, beefy, red rash

A

candida (diaper)

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46
Q

silvery scales

A

psoriasis

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47
Q

Bull’s eye lesion

A

Lyme disease

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48
Q

Nits

A

head lice

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49
Q

RBC casts indicate

A

glomerulonephritis, urinary tract injury

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50
Q

WBC casts indicate

A

inflammation (nephritis, post-Strep glomerulonephritis), infection, or pyelonephritis

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51
Q

Epithelial casts

A

acute tubular necrosis, hepatitis, anything that causes epithelial cell death

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52
Q

Chlamydia

A
  • often asymptomatic, vaginal tenderness, cervical motion tenderness, dysuria, salpingitis,proctitis, epididymitis
  • associated with PID, infertility, ectopic pregnancy
  • Tx: doxycycline 100mg bid for 7 days or azithromycin 1G once
  • refer sexual contacts in past 2months
  • rescreen in 3mo after tx
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53
Q

Gonorrhea

A
  • often asymptomatic, endocervical/urethral discharge (gr.), dysuria, Bartholin’s gland abscess, testicular pain
  • Tx: ceftriaxone 250mg +azithromycin 1G, or doxycycline 100mg bid for 7 days
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54
Q

Trichomoniasis

A
  • frothy, diffuse, and yellow-green discharge, cervical petechiae “strawberry cervix”
  • Tx: metronidazole 2G 1x or tinidazole 2G 1x orally
  • Treat sexual partners
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55
Q

Syphilis

A
  • Tx: penicillin G 2.4 million units IM
  • *If Pen allergic can use doxycycline, tetracycline, or erythromycin
  • Primary stage: painless chancre
  • Secondary stage: lymphadenopathy
  • Latent: seropositive, but asymptomatic
  • Tertiary: serious symptoms of cardiac insufficiency or an aortic aneurysm
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56
Q

Folic Acid in Pregnancy

A

0.4 - 0.8mg daily

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57
Q

Naegele’s Rule

A

-subtract 3 months from the LMP then add 7 days and 1 year

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58
Q

Uterine Size

A
  • 12wks: palpable just above the symphysis pubis
  • 16wks: palpable midway between symphysis pubis and umbilicus
  • 20wks: at level of umbilicus

-McDonald’s rule. Between 16 and 34 weeks, the height of the fundus approximately equals the number of weeks gestation. Measurements are taken from the top of the symphysis pubis to the top of the fundus in a straight vertical line. The patient’s bladder should be empty for accurate measurement.

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59
Q

quickening

A

first perceived in a primipara around 17-20wks

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60
Q

Placenta previa

A
  • Improper implantation of the placenta in the lower uterine segment
  • Painless
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61
Q

Maternal Assessment of Fetal Activity

A
  • Kick counts
  • lie on Lt side after eating and count kicks for 30 minutes
  • should move 3-5 times in an hour
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62
Q

Pyloric stenosis

A
  • symptoms begin at 3-5 weeks of age
  • olive like mass palpated after vomiting, hypertrophied pyloric ms
  • ultrasound to dx
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63
Q

Intussusception

A
  • sausage-like mass palpable in the RUQ
  • child 3-11 mo cries and pulls legs up to chest (colick expected at 1-3mo)
  • intermittent colicky abdominal pain, vomiting, bloody mucous stools, currant jelly stools
  • dx with KUB or ultrasound
  • surgery required
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64
Q

Undescended testes

A

-refer if not descended by 6mo

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65
Q

Pediatric UTI

A

-bowel or bladder dysfunction: withholding maneuvers, incontinence, constipation
-vesicoureteral reflux
-tx with 3rd generation cephalosporin: cefixime, cefdinir, ceftibuten for 3-5 days if afebrile and 10 days if febrile
-if febrile refer to urology
renal bladder ultrasound (RBUS) for all infants 2-24 months with first febrile UTI

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66
Q

Kawasaki disease

A
  • acute generalized systemic vasculitis, leading cause of acquired heart disease in children, etiology unknown
  • fever for 5 days + 4 of 5 criteria of coronary vessel involvement
    1. bilateral conjunctival injection without exudate
    2. polymorphous rash urticarial, or pruritic
    3. inflammatory changes of lips and oral activity (strawberry tongue)
    4. changes in extremities (edema, desquamation of hands and feet)
    5. cervical lymphadenopathy (unilateral, anterior cervical)
  • refer for IV immune globulin and aspirin
  • NO need to isolate
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67
Q

Roseola

A

Human Herpesvirus 6

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68
Q

Fifth disease (erythema infectiosum)

A

Parvovirus B19

  • “slapped cheek” rash; lacey macular rash, pruritic, palms and soles may be affected
  • spread via respiratory droplets
  • fever, malaise, sore throat, lethargy,
  • ok to return to school after 24hrs fever-free
  • infection on pregnancy associated with 10% chance of fetal death
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69
Q

Rubella

A

Rubella virus

-Maculopapular rash, looks like measles, remarkable lymphadenopathy, macules on soft palate

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70
Q

Rubeola (measles)

A

Rubeola virus

  • Maculopapular “brick red” rash; starts on head and neck, spreads to trunk and extremities
  • 3 C’s: conjunctivitis, coryza, and cough
  • develop Koplik’s spots: 1-3mm whitish-bluish, grey elevations on the buccal mucosa, hard, and soft palates
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71
Q

Varicella Zoster

A

Herpes virus

-vesicular lesions on erythematous base appearing in crops

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72
Q

Herpangina

A

Coxsackie A virus

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73
Q

Hand Foot and Mouth disease

A

Coxsackie virus A16

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74
Q

Milia

A

white papules on nose and cheeks

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75
Q

Mongolian spots

A

congenital with indefinite borders; buttocks and base of spine; predominately in African American and Asian infants

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76
Q

Nevus simplex

A

“stork bite”, pink red capillary on face or neck

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77
Q

Nevus flammeus

A

port wine stain anywhere on body

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78
Q

Fontanelles

A
  • anterior closes at 9-18 months

- posterior closes 2 months (not always open at birth)

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79
Q

Hypertelorism

A

-eyes far apart; associated with many syndromes

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80
Q

Evoked otoacoustic emission testing

A

-method for universal screening of hearing in newborns

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81
Q

Symptoms of TIA usually last

A

< than 24 hrs

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82
Q

Joints involved in OA

A

fingers, knees, hips

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83
Q

Aphthous ulcer

A

“canker sore”, painful, usually heal in 5-14 days

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84
Q

Leukoplakia

A

white or grey patches on the inside of the mouth that occur d/t long-term irritation (no pain). May be a sign of oral cancer.

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85
Q

Diverticulitis

A
  • tenderness usually on LLQ
  • bloating, gas
  • fever and chills
  • nausea and vomiting
  • low fiber diet (feces trapped in pouches leading to inflammation or infection)
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86
Q

GERD

A
  • hoarseness, cough, chest pain, nocturnal symptoms, heartburn
  • perform endoscopy if pt over 50 yo, have an inadequate response to PPI therapy, or have dysphagia or odynophagia (Barret’s esophagus?–precancerous
  • pyrosis: heartburn
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87
Q

Brain natriuretic peptide (BNP)

A

substance secreted by the ventricles in response to changes in pressure that occur when heart failure develops and worsens.

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88
Q

Erysipelas

A
  • Involves upper dermis, superior lymphatics
  • raised above level of surrounding skin
  • fever and chills with acute onset
  • often affects ear, face, and lower extremities
  • commonly caused by Strept
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89
Q

Tanner Stages Female

A
  • Begin at age 8
    1. Prepubertal: papilla elevated above chest wall
    2. Breast budding (8-13yo)
    3. breast and areola enlarge
    4. secondary mound formed by areola and papilla
    5. adult breast

*growth spurt stage II - III

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90
Q

Sprain Grades

A

I: minimally torn ligament, stable joint
II: more severely torn ligament, stable joint
III: completely torn ligament; severe pain; swelling, tenderness, no weight bearing–refer to Ortho

*Eversion sprain more serious—-refer

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91
Q

Gestational DM Screening

A
  • all pregnant women at 24-28 weeks

- 2 step screen, OGTT

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92
Q

Allergic Rhinitis

A

-inflammation of the mucous membranes of the nasal tract with subsequent mucosal edema, clear discharge, sneezing, itching, and nasal stuffiness.
-intranasal glucocorticoids (single most effective treatment): budesonide, fluticasone, mometasone, ciclesonide
-non-sedating antihistamines: loratadine, fexofenadine, levocetirizine
*cetirizine is NOT non-sedating
Other agents: decongestants, leukotriene blockers, mast cell stabilizers

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93
Q

Osteoarthritis

A
  • pain exacerbated by activity, relieved by rest
  • AM stiffness that resolves within 30 mins
  • tenderness to palpation, crepitus, Bouchard’s nodes
  • osteophytes and joint space narrowing on x-ray
  • Tx: Move!, weight loss, tylenol, NSAIDs, heat/cold application
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94
Q

Rheumatoid Arthritis

A
  • autoimmune disease
  • symmetric, peripheral polyarthritis
  • commonly affects: MCP, PIP, and MTP joints
  • AM stiffness lasts longer than 30 mins, improves as the day progresses
  • rheumatoid nodules
  • erosion of cartilage and bone on x-ray
  • Tx: methotrexate, sulfasalazine, hydroxychloroquine, target cytokines, infliximab
  • refer to rheumatology
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95
Q

RICE Therapy

A

R: rest
I: ice
C: compression
E: elevation

Analgesics: acetaminophen and NSAIDs

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96
Q

Tanner Stages Male

A
  • Begin at age 8
    1. 1cm testes, scrotum and penis as seen in early childhood
    2. scrotum becomes reddened and textured (10-13.5)
    3. Further testicular growth, slight enlargement of penis
    4. penis increases in length and diameter, testes enlarge (4-5cm)
    5. adult genitalia

*growth spurt stage III - IV

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97
Q

Tanner Stages Pubic Hair

A
  • Begin at age 8
    1. No pubic hair present
    2. sparse, lightly pigmented
    3. hair becomes more pigmented, coarse, curled, and more abundant
    4. pubic hair abundant, but covers smaller area than in an adult
    5. adult hair distribution
    6. Hair grows up linea alba
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98
Q

2 Month Milestones

A
  • focuses on face
  • grasps rattle if placed in hand, (shakes it)
  • smiles, coos
  • able to lift head 45 degrees
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99
Q

4 Month Milestones

A
  • able to hold head and control head when held upright
  • reach for objects
  • no head lag when pulled upright
  • raises body on hands
  • rolls prone to supine
  • follows light 180 degrees
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100
Q

6 Month Milestones

A
  • able to place object in opposite hand and in mouth
  • sits with support
  • unilateral reaching
  • rolls supine to prone
  • bears weight
  • recognizes parent
  • says “dada” or “baba”
  • babbles
  • smiles, squeals, laughs, imitates sound
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101
Q

9 Month Milestones

A
  • pulls to stand
  • bangs, shakes, drops, and throws objects
  • able to feed self with finger foods
  • responds to own name and knows a few words
  • stranger anxiety
  • crawls, creeps, and scoots
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102
Q

12 Month Milestones

A
  • pulls to stand, may take a few steps
  • uses pincer grasp and able to point
  • says 2-4 words
  • looks for dropped or hidden objects
  • responds to own name and understands a few words
  • feeds self and drinks from a cup
  • waves and says “bye-bye”
  • imitates vocalizations
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103
Q

15 Month Milestones

A
  • walks well and is able to stoop
  • can point to a body part
  • says 3-6 words
  • stacks 2 blocks
  • follows simple commands
  • points, grunts, pulls to show what they want
  • listens to a story
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104
Q

18 Month Milestones

A
  • able to walk backwards
  • can throw a ball
  • says 15-20 words
  • imitates words, uses two word phrases
  • points to multiple body parts
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105
Q

2 Year Milestones

A
  • able to walk up and down stairs one step at a time
  • can kick a ball
  • says at least 20 words
  • imitates adults
  • follows 2 step commands
  • stacks five blocks
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106
Q

3 Year Milestones

A

-able to jump
-can stand on 1 foot
-able to ride a tricycle
-says name, age, and gender
-knows gender of others
-able to copy a cross, circle
able to recognize colors

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107
Q

4 Year Milestones

A
  • able to sing a song
  • can hop on one foot
  • able to throw a ball overhand
  • able to draw a person with three parts
  • able to cut and paste
  • able to build a tower with 10 blocks
  • counts to five
  • able to copy a square
  • able to dress self with supervision
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108
Q

5 Year Milestones

A
  • able to draw a person with body, head, arms, legs
  • able to recognize most letters and can print some
  • plays make believe
  • learns address and phone number
  • can define at least one word
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109
Q

Immunization: Hep A

A
  • all children at 12mo

- 2nd dose 6mo later

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110
Q

Immunization: Hep B

A 
#1 birth
#2 age 1-2 months
#3 age 6 mo (at least 2mo after 2nd dose)
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111
Q

Immunization: DTaP

A 
#1 at 2mo
#2 at 4mo
#3 at 6mo
#4 12-18mo
#5 4-6 years
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112
Q

Tdap booster

A
  • adolescents 11-12 yo

- Td q 10yrs

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113
Q

Immunization: Hib

A 
#1 age 2mo
#2 age 4mo
#3 age 6mo
#4 age 12-15mo
  • Not needed after 5 years of age
  • If there is any household contact under 4 years-of-age who has not been immunized, rifampin prophylaxis should be given to all household contacts, including the adults.
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114
Q

Immunization: IPV

A 
#1 age 2mo
#2 age 4mo
#3 age 6-18mo
#4 age 4-6 years
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115
Q

Live Vaccines

A
  • MMR, Varicella, Rotavirus, Flu mist, Zostavax
  • rash after live or attenuated immunizations represents a reaction to viral replication, not the vaccine
  • *No live vaccines prior to 1 year of age (except rotavirus)
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116
Q

Immunization: MMR

A 
#1 12-15mo
#2 4-6yrs
  • Do NOT give in pregnancy, and avoid pregnancy for 28 days post immunization
  • Ok if breastfeeding
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117
Q

Immunization: Varicella

A 
#1 12-18mo
-booster at 4-6 years
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118
Q

Immunization: Influenza

A
  • annually for >6mo

- children < 8yo receiving IM for the first time, need 2 doses separated by 1 month

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119
Q

Immunization: MCV4

A
  • at age 11-12yo

- Booster at age 16

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120
Q

Immunization: HPV

A 
-minimum age 9yo
#1 11-12yo
#2 2mo later
#3 6months after first dose

-Administer at 0, 2, and 6months

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121
Q

Immunization: Zostavax

A
  • 1 dose at age 60
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122
Q

Cellulitis

A
  • Involves deeper dermis, subcutaneous fat
  • has poor demarcation
  • often no systemic symptoms; localized symptoms noted with onset over a few days
  • often seen periorbital, lower extremities
  • Streptococcus pyogenes most common cause
  • Other causes: Staph aureus
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123
Q

Medicare Part A

A

-covers inpatient hospital care, skilled nursing facility, hospice, and home health care

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124
Q

Medicare Part B

A

-covers doctor and other health care provider’s services, outpatient care, durable medical equipment, home health care. and some preventative services

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125
Q

Multiple Myeloma

A

-normocytic, normochromic anemia, hypercalcemia, bone pain (back, pelvis, ribs, and skull), renal failure

126
Q

High purine foods

A

organ meats, seafood and fish, beans, meat, asparagus, cauliflower, mushrooms, spinach, beer, lager, vodka, and ale

127
Q

Foods high in Fe

A

red meat, egg yolk, dark green leafy vegetables, dried peas, and beans, dried fruits, mollusks, artichokes

128
Q

PAP Specimen Collection

A
  • 1st: Ectocervical specimen

- 2nd: Endocervical specimen with a brush

129
Q

Safe Water Heater Temp

A

-Less than 120 degrees

130
Q

Pes Planus

A

“flat feet”, change in foot shape in which the foot does not have a normal arch when standing

131
Q

Hirschprung’s Disease

A
  • Blockage of the large intestine due to improper muscle movement in the bowel
  • 5x more common in males than females, associated with congenital disorders such as Down’s
  • s/s: difficulty with bowel movements, failure to pass meconium shortly after birth, failure to have first stool within 48hrs of birth, infrequent, but explosive stools, jaundice, poor weight gain, vomiting, watery diarrhea in newborn
132
Q

Fe Replacement Therapy

A
  • Take 1-2 hrs before meals on empty stomach for greatest absorption; food may reduce absorption by 50%
  • Do NOT take concomitantly with antacids, tetracycline, dairy products
  • BMs will be very dark in color
  • Fe is highly toxic, keep out of children’s reach
  • In infant’s place drops in back of mouth to reduce staining of teeth
  • Administration with vitamin C enhances absorption
133
Q

Physiologic Reflux

A
  • rarely occurs at night
  • occurs after eating
  • is short lived
134
Q

Patrick’s Test

A

Patrick’s test stresses the hip and sacroiliac joints. A positive test produces back, buttocks, or groin pain.

135
Q

Finkelstein’s Test

A

test to detect de Quervain tenosynovitis in which the thumb is flexed into the palm and is covered by the remaining four digits

136
Q

Allen’s Test

A

A test for occlusion of the radial or ulnar artery, in which one of these arteries is compressed after blood has been forced out of the hand by clenching it into a fist; failure of the blood to diffuse into the hand when opened indicates that the artery not compressed is occluded.

137
Q

Talipes Equinovarus (club foot)

A
  • congenital deformity of the foot, involves plantar flexion of the foot at the ankle joint, inversion deformity of the heel, and adduction of the forefoot.
  • AP/Lat standing films
  • Ortho may attempt casting, but surgery (soft tissue release, naviculectomy, or arthrodesis) is usually required for correction.
138
Q

Bipolar Disorder

A

I: at least 1 manic episode plus an episode of major depression
II: at least 1 hypomanic episode plus at least 1 episode of major depression
Bipolar Spectrum Disorder: bipolar features that don’t meet Bipolar I or II disorder. Hypomania results in dysfunctional behavior but doesn’t rise to the level of a manic episode.
-racing thoughts, sustained periods of high energy, no sleep–but no fatigue, excessive sexual interest, spending $, taking unusual risks,
-Mood Disorders Questionnaire

139
Q

Observational Studies

A

-participants live out their normal lives and report these activities to researchers

140
Q

Prospective Cohort Studies

A

-A prospective cohort study follows a large group of people forward in time.

141
Q

Case-Control Study

A

A case-control study takes a different approach. Researchers identify two groups—one with people who already have an outcome (like breast cancer) and one with people who do not. They then compare the two groups to see if any exposure (like alcohol use) was more common in the history of one group compared to the other.

142
Q

Initiate Insulin

A

-0.2u/kg or 10units of peakless insulin

143
Q

Varicocele

A
  • collection of abnormally large dilated veins in the scrotum, usually situated above the testis. Caused by poorly functioning anti-reflux valves of the spermatic veins
  • usually asymptomatic, varicocele increases in size when standing or with valsalva maneuver, infertility
144
Q

PAP Smear

A

-No douching or sex for 48hrs prior to PAP

145
Q

HPV

A

-Cervical dysplasia associated with HPV 16,18,31,33
-Genital warts associated with 6 & 11
-risk factors: sexual activity, multiple sexual partners, exposure without barrier protection
-soft, flesh-colored warts, warts are usually painless, pruritus, irritation
Tx: podophyllin resin 10-25% topically q 1-2 weeks, trichloroacetic acid 80-90%, Imiquimod 5%, Podofilox 0.5%

146
Q

BP in children

A
  • height/percentile, gender, age

- begin initial reading at age 3

147
Q

Osgood Schlatetter’s

A
  • During periods of rapid bone growth increased traction is placed upon the insertion of the patellar tendon at the tibial tubercle
  • common cause of knee pain in children 10-18yo
  • tends to appear during periods of rapid growth or repetitive jumping
  • self-limiting condition resolves with skeletal maturation
148
Q

PNA Treatment Guideline

A
  • Previously healthy and No abx tx in the past 3mo: macrolide (azithromycin or clarithromycin) or doxycycline
  • Suspect DRSP: respiratory quinolone (gemifloxacin, levofloxacin, moxifloxacin) or Beta-lactam (PCN or Ceph) + macrolide or Beta-lactam + doxycycline
  • tx for 5-10 days
  • f/u CXR if >40yo or smoker in order to exclude underlying disease
149
Q

Tinea capitis

A
  • Risk factors: daycare age, poor hygiene
  • Findings:round, patchy scales on scalp, occasionally alopecia will develop
  • Oral griseofulvin, an oral antifungal is the drug of choice. Tinea capitis rarely occurs in adults.
150
Q

Tinea corporis

A
  • Risk factors: close contact with animals, warm climates, obesity, prolonged use of topical steroids, immunocompromised state
  • Findings: rash, pruritus, well-circumscribed, red, plaque, usually found on the trunk, may occur in groups of 3 or more
151
Q

Tinea Cruris

A
  • Risk factors: wearing wet clothing, excessive sweating, obesity, prolonged use of topical steroids, immunocompromised state
  • Findings: pruritus, well-marginated half-moon plaques in the groin and or upper thighs, may take on an eczematous appearance from chronic scratching, does not affect the scrotum or penis, may appear as vesicles
152
Q

Tinea versicolor

A
  • Risk factors: hot, humid climates, wearing wet clothing, prolonged use of topical steroids, immunocompromised states
  • Findings: well-marginated lesions of varying color, rare itching, common in axilla shoulders, chest, back (sebum rich areas)
153
Q

Major Depression

A 
-Screen at EVERY visit
5 or more of the 9 characteristics present most of the day nearly every day for a minimum of 2 consecutive weeks
-depressed mood
-loss of interest or pleasure in doing things
-insomnia, hypersomnia
-change in appetite or weight
-psychomotor retardation or agitation
-low energy
-poor concentration
-thoughts of worthlessness or guilt
-thoughts about suicide or death

**Minor depression 2-4 of these are present

154
Q

Diagnosis of Depression

A

SIG E CAPS

  • Sleep issues
  • Interest
  • Guilt

-Energy

  • Concentration difficulties
  • Appetite
  • Psychomotor agitation or irritation
  • Suicidality
155
Q

Claims Made Policy

A

-a liability policy that pays claims only during the period that the policy is active

156
Q

Lead Screening

A
  • Blood lead level (BLL) should be checked 9-12 mo & 24 mo
  • <10 micrograms/dl ~ok
  • 10-14; repeat BLL in 12 wekks
  • 15 –lead poisoning
  • 45 begin chelation therapy
157
Q

When does an infant regain birth-weight?

A

by 2 weeks

158
Q

Normal Infant Growth Parameters

A
  • 2lbs/mo for the first 5 months
  • 0.5-1oz/ day for the first 3mo
  • 1inch/mo for the first 6 months
  • 1/2cm/mo for the first year for head circumference
159
Q

Blood Flow through the Heart

A

SVC –> Rt atria –> Tricuspid –> Rt ventricle –> Pulmonic valve –> Lungs –> Lt atria –> Mitral valve –> Lt ventricle –> aortic valve –> aorta –> Body

160
Q

Biliary Tract disease

A

Biliary colic and cholecystitis are in the spectrum of biliary tract disease. This spectrum ranges from asymptomatic gallstones to biliary colic, cholecystitis, choledocholithiasis, and cholangitis.

Gallstones can be divided into 2 categories: Cholesterol stones (80%) and pigment stones (20%). Most patients with gallstones are asymptomatic. Stones may temporarily obstruct the cystic duct or pass through into the common bile duct, leading to symptomatic biliary colic, which develops in 1-4% of patients with gallstones annually.

Cholecystitis occurs when obstruction at the cystic duct is prolonged (usually several hours) resulting in inflammation of the gallbladder wall. Acute cholecystitis develops in approximately 20% of patients with biliary colic if they are left untreated.[1] However, the incidence of acute cholecystitis is falling, likely due to increased acceptance by patients of laparoscopic cholecystectomy as a treatment of symptomatic gallstones.[2]

Choledocholithiasis occurs when the stone becomes lodged in the common bile duct, with the potential sequelae of cholangitis and ascending infections.

Biliary sludge is a reversible suspension of precipitated particulate matter in bile in a viscous mucous liquid phase. The most common precipitates are cholesterol monohydrate crystals and various calcium-based crystals, granules, and salts.[3] A portion of biliary sludge contains comparatively large particles (1-3 mm) called microliths, the formation of which is an intermediate step in the formation of gallstones (about 12.5%)

161
Q

Lotion to Ointment

A
  • Lotion: least thick (absorption)
  • Cream: medium thickness
  • Gel: more thick
  • Ointment: most thick (greatest protection and absorption)
162
Q

Cataracts

A
  • an opacification of the lens of the eye and the leading cause of blindness in the U.S.
  • Symptoms: diminished red reflex, leukocoria (white reflex), blurred vision, diminished night vision, diminshed visual acuity (especially at night and sensitivity to glare)
  • A cataract opacity is seen as a dark disruption of the red reflex on ophthalmoscopic exam.
163
Q

DBP and correlation with age

A

DBP decreases with age over 60

164
Q

Screen for oral health at

A

6mo of age

165
Q

BMI

A
  • Normal BMI 18.5 - 24.9
  • Overweight: BMI >25
  • Obese BMI > 29.9
166
Q

Hesselbach’s triangle

A

A triangular area with in the groin. Its base is formed by theinguinal ligament, the lateral border by the inferior epigastric vessels and the medial border by the lateral edge of the rectus sheath.

167
Q

Koilonychia

A

An abnormal shape of the fingernail. The nail has raised ridges and is thin and curved inward. This disorder is associated with iron deficiency anemia.

168
Q

GGT

A

Gamma-glutamyl transpeptidase increased by alcohol, phenytoin, and phenobarbital. It is used to detect diseases of the liver or bile ducts.

169
Q

multiple sclerosis

A
  • Disease of the CNS which is slow and progressive
  • Characterized by demyelination of nerve cells in the brain and spinal cord which produce neurological deficits.
  • age at onset 16-40 yrs old; female > male
  • Onset is insidious, paresthesias in extremities, weakness or clumsiness of a hand or leg, stiffness or unusual fatigability of a limb, transient blindness or pain in an eye, nystagmus, speech slow and hesitant, difficulty with bladder control, mild emotional disturbance
  • Charcot’s triad: scanning speech, nystagmus, tremor—common in later stages of the disease
170
Q

Amyotrophic lateral sclerosis; Lou Gehrig’s Disease

A
  • is a disease of the nerve cells in the brain and spinal cord that control voluntary muscle movement.
  • in ALS, nerve cells (neurons) waste away or die, and can no longer send messages to muscles. This eventually leads to muscle weakening, twitching, and an inability to move the arms, legs, and body. The condition slowly gets worse. When the muscles in the chest area stop working, it becomes hard or impossible to breathe.
  • Symptoms usually do not develop until after age 50, but they can start in younger people. Persons with ALS have a loss of muscle strength and coordination that eventually gets worse and makes it impossible to do routine tasks such as going up steps, getting out of a chair, or swallowing.

Breathing or swallowing muscles may be the first muscles affected. As the disease gets worse, more muscle groups develop problems.

ALS does not affect the senses (sight, smell, taste, hearing, touch). It only rarely affects bladder or bowel function, eye movement, or a person’s ability to think or reason.

Symptoms include:

 Difficulty breathing
 Difficulty swallowing
 Choking easily
 Drooling
 Gagging
 Head drop due to weakness of the neck muscles
 Muscle cramps
171
Q

Glucose-6-phosphate dehydrogenase deficiency (G6PD) should avoid….

A

aspirin and sulfa drugs

172
Q

Increased lymphocytes indicates

A

viral infection

173
Q

Increased leukocytes indicates

A

bacterial infection

174
Q

Sciatica relieved by

A

side lying or standing

175
Q

Sciatica

A

Nerve root irritation that produces burning pain that usually radiates down the posterior aspect of the leg, is associated with numbness and tingling, and increases with coughing, sneezing, or straining. Pain is usually worsened by sitting.

176
Q

Antihypertensive used for systolic dysfunction

A

ACE inhibitors

177
Q

Chancroid ulcer

A
  • STD characterized by painful, necrotizing genital ulcers, with erythematous halo, often accompanied by inguinal lymphadenopathy
  • Increase risk of acquiring HIV d/t break in mucosal barrier
178
Q

molluscum contagiosum

A
  • benign, viral skin disease -smooth, rounded, firm, shiny flesh-colored to pearly white papules
179
Q

Prenatal Visit Schedule

A

0-28 weeks q 4 weeks
28-36 weeks q 2 weeks
36- delivery q week

180
Q

Prinzmetal’s angina

A

Prinzmetal’s angina is the result of coronary vasospasm, rather than atherosclerosis. Therefore, calcium channel blockers are effective for treatment.
-symptoms may occur at rest

181
Q

Calendar Method

A

is a way of determining a woman’s fertility by subtracting 18 days from the shortest cycle and 11 days from the longest cycle.

182
Q

Basal Body Temperature Method

A

a woman’s fertility can be gauged according to her body temperature, which drops 12-24 hours prior to ovulation

183
Q

Cervical mucus test

A

The couple should abstain from time of mucus change until approximately four days after change

184
Q

Symptothermal method

A

is a combination of the BBT and the cervical mucus test

185
Q

Lymphogranuloma venereum

A

LGV is a subtype of genital ulcer diseases that include other STDs, such as HSV-2, syphilis, and chancroid. This condition is characterized by self-limited genital papules or ulcers followed by painful inguinal and/or femoral lymphadenopathy, which may be the only clinical manifestation at presentation. Patients with LGV may also present with rectal ulcerations and symptoms of proctocolitis, especially among patients participating in receptive anal intercourse.

186
Q

Genu Varum

A

bowed legs. should not persist beyond 24 months of age. Variations of > 20 degrees could produce medial tibial problems and require a 1 year follow-up.

187
Q

Pelvic inflammatory disease

A

-fever/chills, nausea, vomiting, vaginal discharge, dysuria, dyspareunia, lower abdominal pain, and infertility. The physical exam would be positive for cervical motion tenderness, adnexal tenderness, abdominal tenderness, and fever > 100.4°F (38°C).

188
Q

Osteogenesis imperfecta type I characteristics

A

bones that fracture easily, predisposing family history, near normal or slightly shorter stature, blue sclera, dental problems, triangular face, tendency toward spinal curvatures, and hearing loss beginning in the early 20s and 30s. Most fractures occur before puberty; occasionally women will have fractures after menopause.

189
Q

Rhett syndrome

A

is characterized by reversals in expressive language and hand movement and the patient would have experienced symptoms very early in childhood.

190
Q

Bilateral femoral retroversion

A
  • Femoral version is defined as the angular difference between axis of femoral neck and transcondylar axis of the knee;
  • excessive femoral anteversion (medial femoral torsion) is most common cause of in-toeing that first presents in early childhood;
  • it is twice as common in girls as in boys, it is nearly always symmetrical, and it is often familial;
  • tripping as a result of crossing the feet may occur, and child may be teased by peers because of pigeon-toed gait and the awkward running pattern;
  • normal values:
  • on average, femoral anteversion ranges from 30-40 degrees at birth and decreases progressively throughout growth to about 15 degrees at skeletal maturation
191
Q

Genu valgum

A

-Deformity in which the legs are curved inward so that the knees are close together, nearly or actually knocking as a person walks with ankles widely apart of each other. “knock-knee”

192
Q

Pre-eclampsia

A

-edema, HA, vision problems
-is a hypertensive pregnancy disorder that involves pregnancy induced hypertension, plus proteinuria and generalized edema after 20 weeks gestation.
Tx: bedrest in Lt lateral recumbent position, diet high in protein, sodium restriction, Mg sulfate (for sz), methyldopa, hydralazine, beta blockers, or calcium channel blockers

193
Q

Eclampsia

A

-Seizures and coma in a patient with pre-ecalmpsia

194
Q

HEELP Syndrome

A

Hemolysis
Elevated Liver Enzymes
Low Platelet count
-HA, edema, jaundice

195
Q

Carpal Tunnel Syndrome

A

a median nerve compression of the wrist beneath the transverse ligament, affects women more than men with about a 5:2 ratio. CTS is idiopathic, associated with repeated wrist flexion (i.e., job-related overuse), and frequently affects the dominant hand.

  • median paresthesias affecting the thumb, index finger, and radial side of the ring finger. nocturnal paresthsias, + phalen’s and + Tinel’s
  • EMG studies
  • Tx: NSAIDs. cortisone injections, or surgery
196
Q

Cholecystitis

A
  • Cholecystitis occurs when obstruction at the cystic duct is prolonged (usually several hours) resulting in inflammation of the gallbladder wall. Acute cholecystitis develops in approximately 20% of patients with biliary colic if they are left untreated.[1] However, the incidence of acute cholecystitis is falling, likely due to increased acceptance by patients of laparoscopic cholecystectomy as a treatment of symptomatic gallstones.
  • obstruction of the common bile duct leads to jaundice, light colored stools, and biliary colic
  • obstruction of the pancreatic duct can produce pancreatitis, pain over the epigastric area, nausea, and vomiting
    • Murphy’s sign (inspiratory arrest with deep palpation of RUQ), may radiate to Rt shoulder, nausea, vomiting, anorexia, attack follows meals, low grade fever, mild leukocytosis, mild bilirubin elevation, mild elevation in LFTs, **usually lie very still b/c of peritoneal inflammation, intense dull pressure over the midabdomen
  • US for diagnosis, HIDA scan if gallbladder disease is suspected and US is negative.
197
Q

p-value

A

-Is the smallest significance level at which the null hypothesis can be rejected

198
Q

Healthy People 2020

A

Four Overarching Goals:

  1. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death;
  2. Achieve health equity, eliminate disparities, and improve the health of all groups;
  3. Create social and physical environments that promote good health for all; and
  4. Promote quality of life, healthy development, and healthy behaviors across all life stages.

-Includes 1,200 objectives organized into 42 topic areas

199
Q

standard deviation

A

the square root of the variance. A measure of the spread of the distribution around its mean.

200
Q

confidence interval

A

-an interval that contains the true value of a population parameter with a pre-specified probability when computed over repeated samples

201
Q

Folic Acid Deficiency

A

macrocytic anemia, caused by inadequate dietary intake (overcooking vegetables), glossitis, no neurological symptoms

202
Q

Alpha-adrenergic antagonists (alpha blockers)

A
  • Tx: HTN, BPH, and Raynaud’s disease
  • Relax certain muscles and help small blood vessels to remain open. They block norepinephrine preventing constriction.
  • E.g. doxazosin, alfuzosin, prazosin, terazosin, tamulosin
203
Q

Immunization: Pneumococcal

A 
PCV 
#1 age 2mo
#2 age 4mo
#3 age 6mo
#4 age 12-15mo

-1 dose of PPSV 2 months after last dose of PCV to children aged 2yrs and older w/ certain underlying medical conditions

204
Q

Rheumatic fever

A

-an inflammatory disease that develops in about 1-3% of children who have untreated infection with Group A, beta-steptoccocal infections. It can affect the heart, joints, skin, and CNS
-(2 major or 1 major and 2 minor criteria for dx):
Major criteria: carditis, polyarthritis, chorea, erythema marginatum, subcuteneous nodules
Minor criteria: fever (101-104), arthralgias, previous rheumatic fever, elevated ESR, CRP, prolonged PR interval on ECG

Tx: PCN (erythromycin or sulfadiazine in those who are PCN allergic), prednisone, and aspirin
-refer to cardiology

205
Q

Sensory CN

A

I, II, VIII

206
Q

EOM CN

A

III, IV, VI

207
Q

Hiradenitis Suppurativa

A
  • Inflammation of the apocrine glands of the skin that produce tender, cyst-like abscesses.
  • common sites: axilla, groin, trunk, and the scalp
  • Symptoms: cyst like abscess, pain, warmth, erythema, discharge, fluctuance
  • Tx: 1st or 2nd generation cephalosporin or sulfa drug if MRSA, topical clindamycin, relapse almost always results
208
Q

Medicare Reimbursement Rate for NPs

A

85% of the MD fee

209
Q

Blepharitis

A
  • inflammation of the lid margins
  • Tx: clean eyelid margins 2-4x/day with baby shampoo, warm, moist compresses several times per day, antibiotic ointment (bacitracin, erythromycin, or quinolone)
210
Q

MRSA Coverage

A
  • Bactrim
  • Clindamycin
  • Co-trimoxazole
  • Doxycycline
  • Minocycline
211
Q

Heart Murmurs (grading system)

A

I: barely audible
II: audible, but faint
III: moderately loud, easily heard
IV: loud associated with a thrill
V: Very loud, audible with corner of stethoscope off of chest
VI: loudest, do not need stethoscope to hear

212
Q

CXR Findings

A
  • Active TB: darkening of parenchyma
  • Pleural effusion: blunting of CPA
  • Asthma: hyperinflation
213
Q

Normal Non-fasting Glucose

A

<125 is NORMAL

214
Q

Atopic Dermatitis (Eczema)

A
  • chronic, pruritic skin eruption with acute exacerbations. Lesions commonly in wrists, ankles, and flexural surfaces
  • Prevention: emollients
  • Tx: topical steroids
  • *areas with greatest absorption: face, groin, and axillae
215
Q

Psoriasis

A
  • chronic, pruritic, inflammatory skin disorder characterized by rapid proliferation of epidermal cells. Expect frequent remissions and exacerbations.
  • Sometimes caused by beta-hemolytic strep infection
  • distribution: elbows, knees, scalp, eyebrows, ears, trunk
  • Prevention: sunburn, sudden withdrawal of steroids, stimulating drugs: ACE inhibitors, NSAIDs, PCNs, salicylates, sulfonamides, and tetracyclines
  • Tx: emollients, topical steroids, salicylic acid gel, systemic treatments (etanercept, cyclosporine, methotrexate)
216
Q

Bell’s Palsy

A
  • Facial nerve (CN VII) weakness or paralysis usually unilateral and idiopathic
  • Etiology: idiopathic, Viral, exposure to cold, inflammation of the facial canal from trauma
  • Symptoms: numbness, sagging of eyebrow, partial or total paralysis of facial ms, excessive/inadequate tearing
  • Tx: eye lubricant, oral corticosteroid and oral antiviral
217
Q

Squamous Cell Carcinoma

A
  • abnormal cells of the epidermis penetrate the basement membrane of the epidermis and move into the dermis, producing squamous cell carcinoma
  • *often begins as actinic keratosis which undergoes malignant change
  • seen in sun exposed areas, lower lip common
  • firm, irregular papules with scaly, bleeding, friable surface like sandpaper, grows rapidly
  • biopsy
218
Q

Basal Cell Carcinoma

A
  • abnormal cells of the basal layer of the epidermis expand, The surrounding stroma support the basal cell growth. UV rays are the major cause. Slow-growing and rarely metastasizes
  • tumor seen on face and neck. nodules greater than 1cm appear shiny, pearly color with telangiectasia, center caves in
  • **most common form of skin cancer
219
Q

Malignant Melanoma

A
  • abnormal cells proliferate from the melanocyte system. malignant tumors develop d/t the inability of damaged cells to protect themselves from long-term exposure to UV rays
  • asymmetrical tumor of the skin, with irregular border, variation in color, greater than 6mm in diameter, and can metastasize to any organ
220
Q

Dacryostenosis

A
  • obstruction of the nasolacrimal duct
  • most common cause of persistent tearing in children (usually resolves by 6mo of age)
  • Tx: maintain patency by applying pressure and massaging duct at least 2x daily; surgery to probe the duct
221
Q

Sideroblastic Anemia

A

-RBCs cannot make enough Hgb
-Often tired and irritable, and suffer from vertigo, cold, clammy skin, leg cramps, headaches, and tachycardia. Often, their liver and spleen are enlarged. Iron also concentrates in the mitochondria of red blood cells in abnormal amounts, and brings its own symptoms. These iron-glutted blood cells have nuclei that have a ring around them, and so are called ring sideroblasts. They’re found in the bone marrow. The hereditary form of the disease is gotten through the X chromosome and so can be inherited from either parent, though males are more likely to suffer from this form of anemia. Most only live 10yrs after dx.
-Transferrin low or normal, ferritin high
Tx: regular blood transfusuions, deferoxamine to remove excess Fe

222
Q

Fetal HR Baseline

A
  • auscultate and count FHR for 60 seconds
  • perform between contractions
  • normal: 110-160 bpm (change occurs when it persists for > 10mins)

-fetal heart tones auscultated between 9-12 weeks

223
Q

De Quervain’s Tenosynovitis

A
  • Inflammation of thumb extensor tendons
  • First dorsal extensor compartment (snuff box) symptoms
  • Crepitation with extensor tendon movement
  • Local thickening of tendon sheath
  • Radiation of pain
    1. Ascending up Forearm
    2. Descending down into thumb
  • Provocative maneuver eliciting pain
    1. Finkelstein Test
    2. Active and passive range of motion of thumb
  • Management:
    1. NSAIDs, immobilization, avoid offending activity, moist heat as needed, De Quervain’s tenosynovitis injection, first dorsal compartment release surgically
224
Q

Medial Epicondylitis

A
  • inflammation of the flexor forearm muscles
  • dull ache, gradual onset of pain, pain radiates into forearm, max tenderness over medial epicondyle, provocative maneuver’s ellicit pain
  • AKA: golfer’s elbow
225
Q

5-alpha-reductase

A
  • Interferes with the conversion of testosterone to 5-apha-dihydrotestosterone
  • side effects: impotence, libido decrease, ejacualte volume decrease, sperm count decrease, PSA decrease
    e. g. dutasteride, finasteride
226
Q

Epididymitis

A

-inflammation of the epididymis usually occurring from movement of pathogens from urethra or prostate
-the most common cause of scrotal pain in prepubertal boys.
-risk factors: recent trauma to the scrotum, multiple sexual partners, previous STI, heavy physical labor
-S/S: gradual development of scrotal pain, urethral discharge, dysuria, hematuria, epididymis tender, enlarged, indurated, discomfort decreases with elevation of testes, cremasteric reflex present (may be painful)
Dx: doppler US of scrotum, UA (pyuria, hematuria) and cx, C&G, HIV, syphillis
Tx: NSAIDs, appropriate abx if indicated

227
Q

Appendicitis

A
  • Inflammation of the vermiform appendix
  • abdominal pain, usually severe and initially throughout the abdomen, or periumbilical area, later becomes localized to the RLQ (McBurney’s point).
  • S/S: anorexia, abdominal pain, nausea and vomiting are most common (in this order), fever, + psoas sign (pain with Rt thigh extension), and +obturator sign (pain with internal rotation of flexed Rt thigh)
  • CT scan exam of choice
228
Q

Candidiasis

A
  • fungal infection
  • see yeast
  • risk factors: immunosuppression, abx use, hyperglycemia, chronic steroid use, frequent douching, wearing dentures
  • Tx: nystatin, clotrimazole, miconazole, terconazole
229
Q

C- diff

A
  • diarrhea, abdominal pain, N/V

- Tx: metronidazole and vancomycin

230
Q

Shingles vaccine

A
  • has an increased viral count than chicken pox vaccine

- 1 dose at age 60

231
Q

Fever

A

101.0 F or 38.3 C

232
Q

Medications to avoid with grapefruits

A

-statins, fexofenadine, Calcium channel blockers, tacrolimus, amiodarone

233
Q

viral conjuctivitis

A

-profuse tearing

234
Q

HIV testing-Occupational exposure

A

-baseline, 6 weeks, 3 months, 6 months, and 1 year

235
Q

Ototoxic drugs

A

-aspirin, aminoglycosides, vancomycin, erythromycin, loop diuretics (like furosemide), the anti-malarial medications, sildenafil (tadalafil, vardenafil) and cisplatin

236
Q

Pancreatitis

A
  • Inflammation of the pancreas
  • swollen or tender abdomen, N/V, fever, tachycardia
  • most common cause in adults is gallstones and alcoholism
237
Q

Croup

A
  • an acute viral illness characterized by stridor, barking cough, and hoarseness. Infection of the nasopharynx, larynx, and trachea produces swelling and subglottic obstruction.
  • S/S: coryza, fever, barking cough, low grade fever
  • CXR: “steeple” shaped narrowing of the trachea
  • Tx: oral or nebulized corticosteroids (dexamethasone or budesonide)
238
Q

Epiglottitis

A
  • inflammation and swelling of the epiglottis and is a medical emergency.
  • usually caused by H. influenzae in children 2-8yo
  • S/S: sudden onset of fever, dysphagia, drooling, and muffled voice
  • Lat x-ray of neck for dx
  • ED for airway management and abx
239
Q

Diverticulitis

A

-infection and inflammation of the diverticula of the large intestine.
-risk factors: low fiber, low residue diet, age > 50 yrs
-S/S: LLQ abdominal pain, rebound tenderness, board like rigidity, anorexia, N/V, diarrhea, constipation, abdominal distension, fever
-abdominal CT or barium enema
Tx: Cipro, Flagyl, or Bactrim

240
Q

Torn meniscus

A
  • common knee injury
  • S/S: pain, swelling, stiffness, popping sensation, or “locked knee” sensation
  • RICE or arthroscopy
241
Q

Kava Kava

A
  • used for anxiety, stress, insomnia

- associated with liver damage

242
Q

fixed split

A

-splitting in both the expiratory and inspiratory phases. Rt heart failure and pulmonary HTN

243
Q

Papule

A
  • A papule is solid, raised spot on the skin that is up to 0.5 centimeter wide.
    e. g. warts, acne, moles
244
Q

Macule

A
  • A macule is a flat, distinct, discolored area of skin that is usually less than 1 centimeter wide. It usually does not include a change in skin texture or thickness.
    e. g. freckle
245
Q

Cotton Wool spots

A
  • these yellow-white spots are called cotton wool spots. They are caused by retinal nerve fiber layer microinfarcts.
  • Any process that occludes small retinal arterioles will do this: hypertension, diabetes, HIV, severe anemia or thrombocytopenia, hypercoagulable states, connective tissue disorders, viruses, lues, Behçet’s and many others.
246
Q

Calcium channel blockers

A

–exacerbate GERD by relaxing the muscles of the esophageal sphincter muscle (calcium is needed for muscle contraction)

247
Q

Most common causes of bacterial diarrhea

A

Salmonella, Campylobacter, and Shigella

Staph” has a very short incubation period of 30 minutes to 6 hours. Fever is uncommon, but nausea, vomiting, and abdominal cramping are usual. Clostridium has an incubation period of 8 to 12 hours and produces the same symptoms, but is usually accompanied by fever. Salmonella has an incubation period of 6 to 72 hours, but usually less than 24 hours and the same abdominal symptoms present with the addition of fever. E. coli requires 10 hours to several days for incubation and produces only abdominal cramping and watery diarrhea.

248
Q

Niacin

A
  • can increase liver enzymes
  • can decrease glucose tolerance; therefore increasing fasting glucose levels
  • used to increase HDL levels (can decrease LDLs and total cholesterol)
  • Take in the evening with an aspirin to minimize side effects
  • Common side effects: flushing, hypotension, and occasionally gout flares
249
Q

Initial dyslipidemia assessment

A

at 2yo
-Children who have cholesterol levels greater than 170 mg/dL (4.42mmol/L) are known to be at increased risk for coronary artery disease. Total dietary intake of fats for children and adults should be < 30% of total caloric intake and < 7% should be from saturated fat. Reduction of dietary fat intake is not recommended for children < 2 year-of-age.

250
Q

Screening for renal nephropathy in Type I diabetic

A
  • 5yrs after dx
  • Diabetic nephropathy is defined as the presence of diabetes and more than 300 mg/d of albuminuria on at least 2 occasions separated by 3-6 months.
251
Q

Bulimia Nervosa

A

-Treat with high dose SSRIs

252
Q

Tetanus Immunization

A
  • have 72hrs post injury to receive tetanus vaccine and be protected
  • In elderly who completed initial tetanus series Tdap recommended
253
Q

Mycoplasma PNA

A
  • is an atypical pathogen and produces atypical pneumonia
  • It can be difficult to diagnose because symptoms can be varied and involve multiple body systems (extrapulmonary manifestations). Infection with Mycoplasma may present with a normal white blood cell count, maculopapular rash, GI symptoms, tender joints and aches, and though rare, cardiac rhythm disturbances
  • On chest x-ray there are some unique findings (peribronchial pattern) with Mycoplasma. These include thickened bronchial shadow, streaks of interstitial infiltration, and atelectasis. These are more likely to occur in the lower lobes
254
Q

Drugs to avoid in patient’s with Sulfa allergy

A
  • sulfas
  • bactrim
  • HCTZ
255
Q

Drugs associated with causing photosensitivity

A
  • Tetracyclines
  • Sulfa drugs
  • Fluoroquinolones
  • HCTZ
  • Diltiazem
  • SSRIs
  • Ibuprofen
  • Naproxen
256
Q

Tachyphylaxis

A

-a gradual and progressively poorer clinical response to a treatment or medication. This is particularly true of topical glucocorticoids, bronchodilators, nitroglycerine, and antihistamines when they are overused.

257
Q

Presbycusis

A

-Presbycusis is influenced by genetics as well as noise exposure, medications, and infections. Loss of ability to hear speech in crowded rooms or noisy area, inability to understand consonants, and loss of high-pitched sounds is typical. Hearing loss is symmetrical.

258
Q

Developmental Dysplasia of the Hip

A
  • Assess in the first 3-4 months with an ultrasound

- After 4 months of age AP x-rays of the hip are valuable

259
Q

HTN Treatment in Children

A

Pharmacologic treatment should be initiated for children who have both hypertension and diabetes, symptomatic hypertension, Stage 2 hypertension, end-organ damage, or Stage 1 hypertension that is resistant to lifestyle modifications.

260
Q

CAP Treatment in Children

A

-should show improvement in symptoms in 24-48 hours if he is on appropriate antibiotic therapy. Azithromycin treats atypical pathogens like Mycoplasma and Chlamydia, but, has poor Strept coverage. The most likely pathogen in this age group that causes pneumonia is an atypical pathogen, but, at this point the most common typical pathogen, Strept pneumo, must be considered. The best choice is to consider Strept as the pathogen and treat with a penicillin. Specifically, this patient should receive high dose amoxicillin because of the increased incidence of resistant Strept pneumo.

261
Q

Intertrigo

A

-This is common in areas between skin folds, under the breasts, between the scrotum and inner thigh, or between the toes. These are moist lesions with maceration and possible skin loss. It is easily treated if the skin can be separated from touching the adjoining skin and the area can be kept dry. A topical powder with an antifungal would likely resolve this if used twice daily for 7-14 days. A diagnosis of diabetes should be considered if this is resistant to treatment or if it recurs.

262
Q

Sarcopenia

A

-gradual loss of muscle mass that can affect people beginning in their 30’s

263
Q

Dyshidrotic dermatitis or eczema

A

-a condition in which small blisters develop on the hands and feet. Blisters are often itchy.
-People are more likely to develop dyshidrotic eczema when:
They are under stress
They have allergies, such as hayfever
Their hands are often in water or moist
They do cement work or other work that exposes their hands to chromium, cobalt, nickel
-Tx: benadryl, claritin, Eucerin or vaseline, oral steroids, coal tar preparations, or phototherapy

264
Q

Mastoiditis

A
  • A bacterial infection of the mastoid antrum and cells that can be asymptomatic or life threatening. Usually is the result of untreated or under treated AOM.
  • S/S: persistent, throbbing otalgia, bulging TM, fever, postauricular swelling and tenderness, auricular protrusion (pinna displaced laterally and inferiorly), possible profuse creamy otorrhea, possible hearing loss
  • *suspect mastoiditis when symptoms of AOM persist beyond 2 weeks (even if TM appears normal). Refer immediately to ENT
  • Tx: IV abx, topical abx, analgesics for pain, antipyretics for fever, water precautions, Myringotomy
265
Q

Angle-closure glaucoma

A

Acute angle-closure glaucoma causes ocular pain, blurred vision, and a fixed mid-dilated pupil.

266
Q

Panic Attacks

A

Panic attacks are characterized by a sudden onset of an intense fear accompanied by feelings of impending doom. Diagnostic criteria include 4 attacks within a 4 week period with at least 4 of the following symptoms: shortness of breath, faintness, palpitaions, dizziness, tachycardia, trembling, sweating, nausea, diarrhea, choking, numbness or tingling sensations, chest pain or discomfort, hot flashes, chills, derealization, immediate fear of death, loss of control, or fear of “going crazy”.

267
Q

Physical examination in chronic emphysema

A

Typical physical examination findings for the patient with chronic emphysema include AP chest diameter equal to transverse chest diameter (“barrel chest”), decreased tactile fremitus, decreased diaphragmatic excursion, hyper-resonance to percussion, and wheezes.

268
Q

Physical examination in chronic bronchitis

A

AP chest diameter equal to transverse chest diameter, increased tactile fremitus, decreased diaphragmatic excursion, hypo-resonance to percussion, wheezes, rhonchi, and productive cough are typical examination findings associated with chronic brohchitis.

269
Q

Dog bite bacteria

A

Staphylococcus and Pasteurella multocida.

270
Q

Urinary incontinence

A

Stress urinary incontinence is not expected as a result of the normal aging process. The primary problem is sphincter incompetence. The ingestion of caffeine or alcohol decreases sphincter control.

  • Anticholinergic and antidepressant medications are causative factors related to overflow incontinence.
  • Detrusor muscle instability is the primary underlying problem causing urge incontinence.
271
Q

Assessment of Infant Cry

A

A hoarse cry is associated with hypothyroidism (cretinism). A high-pitched cry is associated with cri du chat.

272
Q

Stages of HTN (Adult)

A
  • Pre-HTN: SBP 120-139 OR DBP 80-89
  • Stage 1: SBP 140-159 OR DBP 90-99
  • Stage 2: SBP 160 or greater OR DBP 100 or greater
273
Q

PO Treatment of Hypoglycemia

A

Hypoglycemia may be appropriately self-treated with 15 grams of sugar

274
Q

Stages of HTN (Pedi)

A
  • High normal 90th-94th percentile for age
  • Significant 95th-99th percentile for age
  • Severe > 99th percentile for age
275
Q

Legally Blind

A

20/200

can see the “E”

276
Q

Snellen Eye Chart

A

First number represents the test distance. The second number represents the distance at which the average eye can see at said feet

277
Q

Lyme disease treatment

A

Doxycycline, amoxicillin, or cefuroxime have all been shown to have equivalent efficacy for treatment of Lyme disease.

278
Q

Chalazion

A

-these nodules or masses are typically PAINLESS and present without erythema.

279
Q

Hordeolum

A
  • erythema, localized pain, and a small, tender mass on the affected eyelid
  • Hordeolum’s HURT
280
Q

Tuberculosis treatment

A

The combination of isoniazid (INH), rifampin (RIF), pyrazinamide, and ethambutol is a typical course of treatment for tuberculosis. This combination should be administered for two months followed by four more months of INH and RIF daily

281
Q

Conductive Hearing Loss

A

Conductive hearing loss is indicated by sound that lateralizes to the affected ear with bone conduction greater than air conduction.

282
Q

Sensorineural Hearing Loss

A

sound lateralizing to the unaffected ear with air conduction greater than bone conduction.

283
Q

Early HIV infection

A

often asymptomatic but can also be indicated by a constellation of symptoms that include night sweats, fever, and weight loss, among others.

284
Q

Incident-to-billing

A

Incident-to billing refers to basic services, such as weighing and temperature taking, provided by a physician or done within the physician’s office with the physician in close proximity. It is NOT allowed within the hospital setting.

285
Q

Toxic Synovitis

A
  • Unilateral hip or groin pain
  • The most sensitive test for toxic synovitis is the log roll test, which may detect involuntary muscle guarding of one side when compared to the other side
286
Q

Septic Arthritis

A
  • Acute joint inflammation marked by severe pain and swelling is a hallmark of septic arthritis
  • decreased ROM
287
Q

Juvenile Rheumatoid Arthritis

A
  • high fever, transient rash, inflammation, and warm joint

- should have an annual ophthalmology exam

288
Q

Gynecological Cancer

A

1st: Uterine cancer
2nd: Ovarian cancer
3rd: Cervical cancer (detected via PAP smear)
4th: Vaginal cancer

289
Q

AUDIT questionnaire

A

AUDIT is an acronym for Alcohol Use Disorders Identification Test. It is a 10-item questionnaire that organizes the patient history of alcohol use.

290
Q

Hormone Replacement Therapy (HRT)

A

Oral estrogen therapy decreases low density lipoprotein (LDL) and raises high density lipoprotein (HDL). There is conflicting evidence about whether or not this helps prevent heart disease in women.

291
Q

Gout treatment

A

Allopurinol 100 mg qd to qid daily is the treatment of choice for chronic gout prophylaxis. Colchicine and NSAIDs are treatments of choice for acute attacks. Alcohol and purine containing foods (organ meats, preserved seafood, shellfish) trigger attacks because they block uric acid secretion by the renal tubules which results in under excretion.

292
Q

Viral infection

A

It is therefore, characterized by an increased number of lymphocytes and a decreased number of neutrophils.

293
Q

Bacterial Infection

A

characterized by an increased number neutrophils and a decreased number of lymphocytes.

294
Q

Growing Pains

A

typical in 3 to 5 year old children present at night and do not involve joints. They are usually bilateral and intermittent. Acetaminophen along with heat and massage at bedtime may be helpful.

295
Q

Risk Factors for Cervical Disease

A

Risk factors for cervical disease are multiple and include partner with carcinoma in situ of the penis, high parity, multiple sexual partners, smoking, sexual intercourse prior to 18 years-of-age, first pregnancy before age 18 years-of-age, low socioeconomic status, viral exposure, and immunodeficiency.

296
Q

Occurrence-based Policy

A

An “occurrence-based” policy provides coverage for injuries arising out of incidents occurring during the period the policy was in effect, even if the policy subsequently expires or is not renewed by the policy-holder.

297
Q

Claims-made policy

A

A “claims-made” professional liability insurance policy provides coverage only if an injury occurs, and the claim is reported to the insurance company, during the active policy period or during an uninterrupted extension of the policy (“policy tail”).

298
Q

Herniated nucleus pulposus

A

When the nucleus pulposus (located in the center of the intervertebral disc) ruptures and herniates into the spinal canal, it causes pressure on the spinal root, with consequent numbness and paresthesia along the distribution of the involved dermatome. Mobility and motor function may be impaired. There is usually local tenderness to palpation. This injury occurs most often in men between the ages of 20 and 45 and most frequently due to lifting and/or twisting. Lumbar herniation most often affects L4-L5 and L5-S1 and causes sciatic pain producible with straight leg raising (LaSegue’s test). On standing, the patient typically lists away from the affected side toward the unaffected side.

299
Q

Senile lentigines (“liver spots”)

A

flat brown macules, benign variant of aging

300
Q

Cherry angiomas

A

small, round, red spots, benign variant of aging

301
Q

Senile purpura

A

purple patchy areas, benign variant of aging

302
Q

Xerosis

A

dry, rough, scaly, pruritic skin commonly found on the anterior lower legs (the shins), benign variant of aging

303
Q

Dermatophytosis

A

a tinea (fungal), infection of the skin, scalp, and/or nails which causes (depending on the site) pruritis, inflammation, hair loss, thickened discoloration of the nails, and requires treatment with an anti-fungal agent.

304
Q

Treatment of Severe Depression

A

Electroconvulsive therapy (ECT) is generally the most effective, most rapid treatment for severely depressed or acutely suicidal patients. ECT is the treatment of choice for psychotic depression and is also useful for the patient with poor response to medication.

305
Q

Prevention of Cardio Events

A
  • Adult men 45-79 and women 55-79 at risk of CHD d/t age, HTN, hyperlipidemia, family history, or smoking
  • Benefit: prevent MI
  • Risk: possible GI or cerebral bleed
  • Dose: 75-325mg daily
306
Q

AAA Screening

A
  • all men 65-75 who have ever smoked

- abdominal US

307
Q

Leukemia

A
  • ALL: primary type in children
  • CLL: primary type in adults
  • blastocytes identified in a CBC are always abnormal (premature WBC’s that should only be in bone marrow)
  • Treatment: radiation and chemo
308
Q

Lymphoma

A
  • Hodgkin’s: malignant disease of the lymphatic system characterized by Reed-Sternberg cells
  • Treatment: radiation, chemo, splenectomy, autologous bone marrow transplant
309
Q

Contraindications to breastfeeding

A
  • HIV positive mother
  • Active TB
  • Newly diagnosed breast CA
  • Drug abuse by mother
  • Infant galactosemia
  • Herpes lesion on mother’s breast
  • Mother taking medications that are contraindicated for infant
310
Q

Gout

A
  • -Prevention: probenecid, colchicine, allopurinol (monitor liver function at 1wk, 6wks, and q 3months while on allopurinol)
  • Treatment: High dose NSAIDs for 2-5 days, corticosteroids, or intra-articular injection of corticosteroids
311
Q

Controlled Substances Schedule

A

I: no currently accepted medical use (e.g. heroin, LSD, cannabis)
II: high potential for abuse which may lead to severe psychological or physical dependence (e.g. dilaudid, methadone, oxycodone, fentanyl, ritalin)
III: moderate potential for abuse (e.g. Vicodin, Depo, ketamine)
IV: low potential for abuse (e.g. ativan, valium, versed)
V: low potential for abuse with limited quantities of narcotics (e.g. phenergan with codeine, robitussin AC)

312
Q

Cardiac cocktail

A

-ACEI, ASA, B-blocker, statin

313
Q

Phototherapy for jaundice

A

-total serum bilirubin level at or above 15mg/dl

From Flashcardlet (14 decks)

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