Review set 3 Flashcards
Alcoholism: CAGE screening tool for alcohol abuse: Score > \_\_\_ suggestive of alcoholism. C A G E *** On exam, anyone who meets any ONE of the criteria is the answer
Cut down (feel the need)
Annoyed (about comments)
Guilty
Eye-opener (in the morning)
Alcoholism:
Elevated _____ alone or with elevated ___/____
GGT; ALT/AST
Acoholism: Treatment is with _______ such as ___ or ______, and _______
Vitamins include ________
Refer to AA
Family members’ support group is called Al Anon.
benzos; Librium
Valium; clonidine
thiamine 100 mg IV, then 400 mg PO
Abnormal lab results with chronic alcohol abuse:
MCV > ____ (macrocytosis) due to deficiency in ______ from poor diet and effect on bone marrow
Hypertriglyceridemia
Thrombocytopenia
100; folate
_______-______ dementia or “alcoholic dementia” is permanent damage to the brain and spinal cord due to chronic alcohol abuse and chronic vitamin deficiency, esp of thiamine or Vit B1
Wernicke-Korsakoffs
The physical effects of marijuana include tachycardia, MI, orthostatic hypotension, tachypnea, conjunctival injection, increased appetite, dry mouth, ataxia, slurred speech, and ______ ______ ______.
The mental and emotional effects include impaired memory and worsens ________.
Lower sperm counts
schizophrenia
The physical effects of cocaine include tachycardia, HTN, ventricular dysrhythmias, seizures, coma, stroke, and ______ ______ (_____)
dilated pupils (mydriasis)
Physical effects of heroin include _____ pupils, slurred speech, drowsy, endocarditis.
pinpoint
Rohypnol is AKA the \_\_\_\_ \_\_\_\_\_ \_\_\_\_\_. Mental/physical effects include: A B S
Date rape drug
amnesia
blackout
sedation
Complications of anorexia/bulimia include osteoporosis, stress fractures due to amenorrhea, low calcium intake, underweight,
____ _____ and _____ are the usual cause of death
CHF, arrhythmia (K+ depletion), seizures
Gastroparesis, brain atrophy, aspiration pneumonia (purgers)
cardiac arrest; cardiomyopathy
***Anorexia/bulimia often presents as the FEMALE ATHLETE TRIAD, which is
1
2
3
1 Underweight (BMI < 18)
2 Amenorrhea
3 Osteopenia/osteoporosis
ADHD meds include _____ and ______. The non-stimulant drug for ADHD is ______, but it has increased risk of suicidal ideation and severe liver injury. Check LFTs.
Ritalin; Adderall
Strattera
Higher risk of suicide: Past hx of attempted suicide Family hx of suicide White race Males (adolescent and elderly) Alcohol/substance abuse Plan to use a gun or lethal weapon \_\_\_\_\_ make more attempts, \_\_\_\_\_\_\_ have a higher success rate Successful suicide \_\_\_\_\_ >\_\_\_\_\_ (_:_)
Females; males
male > female (3:1)
***____ ____ with multiple health co-morbidities have the highest risk for death by suicide compared with other age groups.
Suicide at age 75 or more years: ___ men and ___ women per 100,000 elderly people
Older men
39 men
4 women
The immediate goal in treating depression is to assess ______ _____ ____.
Current suicidal risk
Newly diagnosed depression: Rule out organic causes such as H A S
hypothyroid
autoimmune
severe anemia
***_______ are first-line treatment for depression, GAD, panic disorder, OCD, social anxiety disorder, and PTSD
SSRIs
***The list of SSRIs are:
L
C
Z
P
P
("Lou Can Zip Past Paul")Lexapro Celexa Zoloft Paxil Prozac
***Which SSRI has the highest risk for ED?
Paxil
*** After initiating SSRIs with a patient, follow-up should occur in __ _____.
2 weeks
SSRI contraindications: Do not prescribe within ___ days of MAOI, triptans, TCAs, Eldepryl, due to higher risk of serotonin syndrome.
14
BLACK BOX WARNING for SSRIs:
Children, adolescents, and young adults up to age ____ are at higher risk of ______.
23
suicide
Which depression drugs have the best safety profile in the elderly?
____, specifically _______, _______, & _____
SSRIs
CeLEXa
LEXapro
Zoloft
“LEX, LEX, Z”
Name the condition:
Acute onset with rapid progression with high fever, muscle rigidity, change in mental status, hyperreflexia/clonus, and uncontrolled shivering
serotonin syndrome
Treatment for serotonin syndrome includes:
B
I
C
S
Wait for at least ___ weeks before starting another drug that also affects serotonin.
Benzos
IV fluids
cyproheptadine
stop offending drugs
2
MAOIs include:
_______, ______, ______.
They are not used often due to food interactions (aged cheese, red wine, beer, fermented foods, etc.)
Marplan
Nardil
Parnate
MAOI-B - the drug in this category is _________ and is usually used for dementia.
Eldepryl
The TCAs include ____ and _____
doxepin; amitriptyline
Think TAD - TCAs Amitriptyline, Doxepin
TCAs are NOT first-line treatment due to risk of ________ _______ from an _____.
successful suicide; overdose
causes a fatal arrhythmia
***Bupropion is AKA Wellbutrin and is an ______ ______. When used for smoking cessation, it’s called ________, but it’s the exact same drug.
atypical antidepressant
Zyban
***bupropion is used for depression, ______ _______, and ______ ______ _____.
smoking cesation
seasonal affective disorder
***Wellbutrin:
Avoid w/hx of seizures or head injuries.
DO NOT PRESCRIBE within or during ____ days of ____ (____, ______, _____)
14; MAOI
Nardil, Parnate, Eldepryl
Smoking cessation drugs:
Zyban and Chantix have side effects of seizures, sleep problems, sleepwalking, behavior/mood changes.
Can a person still smoke or use nicotine gum, patch, vape while on Zyban or Chantix?
yes.
Follow-up after initiation of Zyban or Chantix should be in ____ ______
2 weeks
Smoking cessation:
Nicotine gum, patch, vape
For smoking cessation, you can combine __ _____ of using nicotine.
2 methods
SNRIs are contraindicated with ___-
HTN
SNRIs include the drug ________.
Cymbalta
A contraindication to Cymbalta, a SNRI, is ____ _____ ____.
narrow angle glaucoma
With Effexor, a SNRI, do not _______ _____.
discontinue abruptly
Benzos:
Careful with mixing with opioids.
DO NOT MIX WITH ________ - can cause resp depression and death.
alcohol
Intermediate-acting benzos (11-20 hours) are ____ and _______.
Xanax; Ativan
The long-acting benzo (1 to 3 days) is _______.
Klonopin
Benzos:
_______ is used as a muscle relaxant, and for alcohol withdrawal and a sedative.
Valium
Benzos:
_______ is used for alcohol withdrawal
Librium
Non-benzo anti-anxiety med taken daily for anxiety (NOT PRN) is ______.
buspirone
Benzos for inducing sleep (hypnotics) are ____ and _____.
Halcion
Restoril
***Benzos:
Avoid ________ ________ due to risk for addiction
chronic usage
Benzos:
Hypnotics - Need to be free for at least 8 hours to sleep. Women usually need ______ doses than males. Do not mix with alcohol and other ____ ______.
lower
CNS depressants
Non-benzo hypnotics (sleep inducers) include ______ and ______,
Lunesta
Ambien
***The 1st-line treatment for insomnia is:
sleep hygiene
Insomnia:
_____ insomnia is not caused by medication or a disease. It can be chronic and last for years or short-term. Caused by stress, shift work, travel to another time zone, etc.
Primary
Insomnia:
_______ insomnia: A side effect of meds or diseases (depression, chronic pain, GERD, dementia, delirium, menopausal symptoms, stimulants, etc)
Secondary
***Transient insomnia (short-term insomnia) has symptoms present for ___ ____ ___ _____.
It is expected to resolve when the stressor resolves or the patient adapts to the stressor.
less than 3 months
Transient insomnia (short-term insomnia) is caused by \_\_\_\_\_\_ and is \_\_\_\_\_\_-related or caused by acute \_\_\_\_\_, \_\_\_\_\_\_, divorce, etc
adjustment; stress
grief; pain
Chronic insomnia:
Symptoms occur at least ___ times per ____ for ___ ____ or longer
3; week; 3
months
Sleep hygiene involves:
Avoid caffeine & heavy meals __ hours before bed.
Sleep at the same time each night and wake up at the same time each day.
If you are in bed and cannot fall asleep within 20 minutes, get out of bed.
Should you nap in the daytime?
4
NO
Meds for insomnia:
OTCs such as _______ (antihistamine)
Alternative meds include: _______, ______, ______
Kava-kava drug interactions - do not mix with ____-_____ meds
Benadryl
melatonin; kava; valerian
CNS sedating (Xanax, Ambien, Lunesta, Ativan)
*** Abuse:
Interview:
Take history in ______ _____ and ______ victim from potential abuser.
private room; separate
*** Abuse physical exam:
______ fractures (______ fracture)
Multiple healing fractures esp. in ____ area,
____ ____ with a ______
Spiral (Greenstick)
rib
Burn marks; pattern
Bipolar disorder has a higher risk of ________, substance abuse, anxiety disorders.
suicide
Type ___ Bipolar disorder:
Full blown manic episodes
1
Type __ bipolar disorder:
Hypomania
2
Lithium salts can be used to treat bipolar. Be aware that it can cause ________, so a ___ would need to be checked annually.
hypothyroidism; TSH
Pharma treatment for bipolar includes:
_____ ____, ______, and _____
lithium salts; Depakote; Lamictal
A war vet that experiences the events over and over with avoidance and hyperarousal is exerpiencing ____, and 1st-line treatment for this is ______ _____ _____.
PTSD
cognitive behavioral therapy
Treatment for PTSD includes:
______ _______ ______,
Medications including _____ or _____,
and _______.
cognitive behavioral therapy
Zoloft; Paxil
EMDR
BPH statistics:
Males > 50 years: ___% with BPH
Males > 80 years: ___% with BPH
50%
80%
Name the condition:
An older male with hx of gradual onset of obstructive voiding symptoms such as weaker stream, dribbling, incomplete emptying, frequency, urgency, nocturia:
BPH
BPH:
On PE the prostate feels ____/_____. The entire prostate is diffusely _______.
Should/should not be tender?
firm/rubbery
enlarged
Should not
For suspected BPH, order ______ and ________ ______.
PSA
transrectal ultrasound
Normal PSA is < ____.
4.0
1st-line meds for BPH are ____ ______
alpha blockers
BPH meds (alpha blockers) include _____ and ______
terazosin; tamsulosin
When treating BPH, do not initiate _____ before cataract surgery or glaucoma surgery due to risk for intraoperative floppy iris syndrome
tamsulosin
The 5-alpha-reductase inhibitor for treating BPH is ________.
Finasteride
Finasteride black box warning: ________/__________ age women and ____ should not handle broken or crushed tablets
Pregnant/reproductive
children
_________ can reduce prostate size by 50%.
Finasteride
***Which prostate medication directly affects the prostate gland?
finasteride
When initiating treatment for BPH with finasteride, check a ______ PSA and then check again in ___ _____.
baseline; 6 months
BPH treatment with finasteride:
Example: Baseline PSA is 10 ng/ml
PSA in 6 months is 4 ng/ml
Conclusion:
PSA has decreased and the med is working
The USPTF screening for prostate cancer is a Grade ___ recommendation.
D - recommends against PSA-based screening
Those at highest risk for prostate ca are
_____ (race) males with a ______ family hx and age
____ or older
Black; positive
50
On prostate exam in a male with prostate cancer, the prostate will feel _______ /_____ areas or ______.
PSA will be ___ or higher.
indurated / hard; nodules
4.0
Name the condition:
Acute onset of fever, chills with suprapubic and/or perineal pain/discomfort with dysuria, frequency, urgency, nocturia. Perineal pain that may radiate to back/rectum/penis. Patient may have purulent urethral discharge, cloudy urine, or hematuria
Acute bacterial prostatitis
In acute bacterial prostatitis, DO NOT ____ _____ prostate as it may cause urosepsis
vigorously massage
The PE of a prostate in acute bacterial prostatitis will be exquisitely ______, _____, ______ prostate.
tender, warm, boggy
Labs for acute bacterial prostatitis include CBC, UA, urine C&S, and a ______ urine x ___ samples.
fractional; 3
STDs responsible for acute bacterial prostatitis include ____ & ______.
Gonorrhea; chlamydia
Treatment for acute bacterial prostatitis includes
_______ & ______ for UNcomplicated case, < 35 years old, and HIGHER risk of STD, and
_______ or ______ for UNcomplicated, LOWER risk of STD.
Rocephin; doxycycline
Cipro; Levaquin
With chronic bacterial prostatitis, classic presentation is a typically ________, _______ male patient.
The prostate may feel ________ on exam.
asymptomatic, older
NORMAL
***With chronic bacterial prostatitis, classic presentation is a typically ________, _______ male patient.
The prostate may feel ________ on exam.
asymptomatic, older
NORMAL
***Chronic bacterial prostatitis:
Lab:
Best to collect urine after _______ ______.
Urine C&S
prostatic massage
***80% of chronic bacterial prostatitis is caused by ________ followed by ____ at 15%.
enterobacteriaceae
E. coli
***1st-line tx for chronic bacterial prostatitis is ____, followed by alternative tx with _____.
Refer to urologist.
Cipro
Bactrim
***Name the condition:
A twisted spermatic cord leading to cessation of blood flow to the testicle and ischemia:
testicular torsion
***What is the peak age for testicular torsion?
___ to ___ years
12; 18
***Classic presentation of testicular torsion:
Adolescent to young male ___ ___ with acute onset of scrotal pain, ____ and ___ scrotum, accompanied by ____/____. Pain may radiate to groin. Afebrile.
PE reveals very ____, swollen, ____ testicle that is “____-_____”.
wakes up swollen; red N/V tender; warm high-riding
*** Testicular torsion: Cremasteric reflex is \_\_\_\_\_\_\_. UA is negative. Refer to \_\_\_\_ \_\_\_. If > 24 hours, 100% of cases are not salvageable.
missing
ER stat
The leading cause of acute scrotum in children is:
torsion of a testicular appendage
What is the “Blue Dot Sign”?
Blue-colored nodule on superior aspect of testicle in a non-tender testicle
A ______ is a painless enlarged scrotum due to serous fluid trapped in the tunica vaginalis. More common in newborns.
hydrocele
The test for hydrocele of scrotum is transillumination, in which the affected scrotum will have a ______ and ___ sized glow.
brighter; larger
Name the condition for this classic presentation: Young adult (usually white) male discovers incidentally, while taker a shower/bathing, either a painless nodule or painless swelling on one testicle. The nodule on physical exam is painless and found on the lower pole (half) of the testicle.
Testicular cancer
When suspicion for testicular cancer is high, order a _______ _____ and refer to specialist.
scrotal ultrasound
Risk factors for testicular cancer are ________, and positive family hx in a 1st-degree relative.
cryptorchidism (undescended testicle)
***Name the condition:
Peak ages are SEXUALLY ACTIVE males < 40 (higher risk of gonorrhea & chlamydia), but it can occur at any age.
Classic presentation is an adult SEXUALLY ACTIVE male with acute onset of fever with red, swollen scrotum that is tender. May be accompanied by dysuria, frequency, cloudy urine.
Acute bacterial epididymitis
THINK - SEXy P-DIDY
*** Physical exam of a patient with acute bacterial epididymitis reveals an _________ and very tender epididymitis with swollen red scrotum. Obtains relief from _____ _______. Some have urethral discharge, escpecially GC - green colored.
scrotal elevation
***What is Prehn’s sign (positive)?
Relief of pain with scrotal elevation
***Treatment for acute bacterial epididymitis:
When STD is suspected, give ______ plus ______.
For older males at lower risk for STD, give ________ or _____.
Rocephin; doxycycline
levofloxacin
ofloxacin
Pain relief for acute bacterial epididymitis includes scrotal ____ and ______ _____.
elevation; ice packs
***Erectile dysfunction:
Has no ______-_____ erections - an organic cause is the best indicator.
night-time
***Erectile dysfunction:
Rule out ________ causation - inability to have erection under any circumstances (no erections at nighttime - at sleep)
organic
***Erectile dysfunction:
Organic etiologies: _______ insufficiency
_______ (________)
smoking
vascular
neuropathy (diabetics)
***Erectile dysfunction:
Males with risk for ED include those on ____ ____,
______, or ______
beta blokers
SSRIs; alcohol
***Erectile dysfunction: Psychic causes (_ \_\_\_\_\_\_) - early AM, night time, or masturbation
+ erections
Treatment for ***Erectile dysfunction:
______: Take one dose about __ hour before sex once daily PRN
Viagra; 1
Name the disease:
Painful, crooked erections, has palpable hard plaques beneath skin
Peyronie’s disease
Name the condition:
Foreskin cannot be pushed back from the glans penis
Phimosis
Pripism: Abnomal, painful, prolonged erection > ___ hours
4
Most common type of hernias are _______.
Obese male who heavy lifts, coughs. Soft _______ mass.
inguinal
reducible
Hasselbach’s triangle - direct or indirect hernia?
Direct.
Hernia physical exam on a male (inguinal) - inspect with patient ________.
Gently slip finger through scrotum into _____ _______ ring, tell patient to cough.
standing
external inguinal
Indirect inguinal hernia (males): Intestines slip through the _____ ____ ring, can drop down into the scrotum
internal inguinal
Direct inguinal hernia (males): Intestines protrude through a weak area in the ______ of the _____ _____ wall (middleaged and older males) (Hasselbach’s triangle)
fascia; anterior abdominal
inguinal hernia on a male: order ________ ultrasound and refer to general surgeon
inguinal
Femoral hernia: More common in ___ over _____ years old. Intestines slip through the femoral canal.
women; 50
Femoral hernia: Higher risk of _______.
strangulation
Name the condition:
Gradual onset of abdominal pain that worsens into severe colicky pain. Vomits bile fluid or feculent fluid. Unable to reduce hernia. Incarcerated hernia feels warm and tender to touch.
strangulated hernia (surgical emergency)
strangulated hernia (surgical emergency):
On PE, initially hyperactive/high-pitched bowel sounds that eventually become ________ or _______. Distended abdomen.
Percussion is ________.
Complication is ______.
hypoactive; absent
tympanic
ileus (small bowel obstruction)
Absolute contraindications of COCs: My C U P L E T S
My: Migraines age > 35 years C: CAD or CVA U: Undiagnosed genital bleeding P: Pregnant/suspected pregnancy L: Liver tumor or active dz E: Estrogen-dependent tumir T: Thrombus or emboli S: Smoker age 35 years or older
An absolute contraindication to COCs in relation to bleeding disorders is the most common bleeding disorder __________ __ _____ / _______ __.
Factor 8 deficiency / Hemophilia A
Relative contraindications to COCs are
D
O
C
F
A
M
Diabetics w/no vascular complications
Obesity
Cigarette smoking < 35 years old
Fibroids
Amenorrhea with undiagnosed cause
Migraines below age 35
Monophasic, Biphasic, and Triphasic OCs all have ____ days of active pills and ___ days placebo pills
21
7
Which birth control type is this:
Low dose ethinyl estradiol (10 - 20 mcg) with progesterone that does not change
monophasic
Monophasic OCs:
____ amount of estrogen and progesterone daily x 21 days
Same
Biphasic OCs:
____ amount of estrogen daily for 21 days, but progesterone increased ____ through the cycle
Same
halfway
Triphasic OCs:
______ different doses of _______ (changes every 7 days) for 21 days
Three; progesterone
***91-day combination Seasonale birth control is one in which one pill is taken daily for 12 weeks followed by 7 days of placebo pills. An “advantage” of this is that it causes:
4 periods per year
Mini-pill or POP (progestin-only pills)
Slightly less effective than regular OCs. Safe for ______ women who can’t take estrogen.
breastfeeding
Mini-pill or POP (progestin-only pills):
Dose late by 3 hours or more:
Take it when you remember, and use back up method for next ____ hours.
48
Mini-pill or POP (progestin-only pills):
Missed one day:
Take __ tablets for that day and use back up method for ____ hours.
2
48
Mini-pill or POP (progestin-only pills):
Missed 2 consecutive days:
Take ___ pills a day for ___ days and use back up method. If no menses in __ - __ weeks, do pregnancy test.
2; 2
4 - 6
Contraceptive transdermal patch (Ortho Evra):
Patch is effective for ___ ___ only. Replace patch on the same day weekly for __ weeks.
Patch-free for one week.
BLACK BOX WARNING: Patch has ____% more exposure to estrogen.
1 week
3
60%
