LEIK Flashcards
The drugs that most often trigger hemolytic reactions include…
- sulfa drugs (including Bactrim aka TMP-SMX)
- certain diuretics
- fava beans
- drugs for the prevention/ treatment of malaria
(3) contraindications to Metformin use
- alcoholism
- liver disease
- kidney disease
medication class & indication: tamsulosin (Flomax)
alpha blocker
used to treat BPH
medication class & indications: terazosin (Hytrin)
alpha blocker
used to treat BPH and HTN
BBW on thiazolidinediones (TZDs), e.g., pioglitazone (Actos)
Pioglitazone (Actos) is in the drug classification of thiazolidinediones (TZD) used in type 2 diabetes. TZD’s side effects include fluid retention and edema. It has a U.S. black box warning for causing or exacerbating congestive heart failure.
management of ocular shingles for AGPCNP outpatient primary care generalist
If suspected, refer the patient to the emergency department or an ophthalmologist the same day. Sequelae include corneal scarring, corneal blindness (visual loss), and chronic pain.
what are Koplik’s spots?
Koplik’s spots are characterized as clustered, small white lesions located on the buccal mucosa opposite the first and second molars. Koplik’s spots appear in the prodromal stage of MEASLES (RUBEOLA).
what is a pterygium?
A pterygium is a noncancerous growth of clear, thin tissue that lies over the sclera. One or both eyes may be involved. Risk factors are exposure to sunlight and wind. The main symptom is a painless area of white tissue with blood vessels on the inner or outer edge of the cornea. No specific tests are usually needed; physical exam confirms the diagnosis. No treatment is needed unless it begins to block vision or cause symptoms.
- venous engorgement
- loss of venous pulsation
- hemorrhages over and/or adjacent to the optic disc
- blurring of optic margins
- elevation of the optic disc
on fundoscopic eye exam, all of these characteristics are describing…..
papilledema (increased ICP)
normal appearance of the optic disc on fundoscopic exam
The optic disc of a normal examination has sharp margins, a yellowish-orange to a creamy pink color, and round or oval shape.
normal appearance of the arteries and veins on fundoscopic exam of the eye
The veins are darker in color and larger than the arterioles (3:2 ratio).
how to interpret Snellen chart results in testing visual acuity - what do the first and second numbers mean?
In the Snellen fraction 20/20, the first number represents the test distance, WHERE THE PATIENT IS STANDING. The second number represents the distance at which the average eye can see the letters on a certain line of the eye chart.
e.g., So 20/20 means that the eye being tested can read a certain size letter when it is 20 feet away. If a person sees 20/30, at 20 feet from the chart that person can read letters that a person with 20/20 vision could read from 30 feet away.
Q. A test called the visual fields by confrontation is used to evaluate one’s….
peripheral vision
what is the optic disc?
The optic disc is the anatomical location of the eye’s “blind spot,” the area where the optic nerve and blood vessels enter the retina.
most common cause of additional pathological cupping of the optic disc
acute glaucoma
leading cause of blindness in older adults in USA
dry (atrophic) macular degeneration –> occurs slowly
wet macular degeneration occurs suddenly
what is oral leukoplakia?
Leukoplakia mainly affects the mucous membranes of the mouth. It is thought to be caused by irritation. Leukoplakia are patches on the tongue, in the mouth, or on the inside of the cheek that occur in response to long-term irritation, including smoking, holding chewing tobacco or snuff in the mouth for a long period, or other tobacco use, especially pipes (smoker’s keratosis). Leukoplakia on the tongue is also an early sign of HIV.
what is the Weber hearing test and how is it interpreted?
In the Weber test, a vibrating tuning fork is placed in the middle of the forehead, above the upper lip, under the nose, over the teeth, or on top of the head equidistant from the patient’s ears on top of thin skin in contact with the bone. In a normal patient, the Weber tuning fork sound is heard equally loud in both ears, with no one ear hearing the sound louder than the other (lateralization). In a patient with hearing loss (otitis media, cerumenosis), the Weber tuning fork sound is heard louder in one ear (lateralization) versus the other (the “bad” ear).
It can detect unilateral conductive hearing loss (middle ear hearing loss) and unilateral sensorineural hearing loss (inner ear hearing loss).
presentation of scarlet fever
Scarlatina (scarlet fever) is a rash that usually first appears on the neck and chest, then spreads over the body. It is described as “sandpapery” in feel. The texture of the rash is more important than the appearance in confirming the diagnosis. The rash can last for more than a week. As the rash fades, peeling (desquamation) may occur around the fingertips, toes, and groin area. Another sign is a bright red tongue with a “strawberry” appearance.
Q. A 27-year-old kindergarten teacher presents with a severe sore throat accompanied by a pink generalized rash with sandpaper-like texture. She is currently being treated with amoxicillin 500 mg three times a day for 10 days. Which of the following conditions is best described?
A small abscess on a hair follicle of the eyelid is called…
hordeolum
Hordeolum is a common, painful, acute bacterial infection of the hair follicle on the eyelid. It is a focal infection (usually staphylococcal) involving either the glands of Zeis (external hordeola or styes) or, less frequently, the meibomian glands (internal hordeola). Histologically, hordeola represent focal collections of polymorphonuclear leukocytes and necrotic debris (i.e., abscesses).
Pinguecula and pterygium are both commonly caused by….
the UV light of long-term sun exposure.
AV nicking and copper wire/silver wire arterioles are signs of ….
hypertensive retinopathy
rare tumor of the adrenal glands that results in a release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism, and blood pressure.
pheochromocytoma
a narrowing of one or both arteries leading to the kidneys. It can cause severe hypertension and irreversible kidney damage.
renovascular stenosis
congenital heart defect of the aorta; it is a narrowing of the aorta that causes the heart to work harder to get blood to flow through the narrow aortic passageway to other organs, which, in turn, causes an increase in blood pressure.
coarctation of the aorta
most common cause of “walking pneumonia”
Mycoplasma pneumoniae causes a slowly developing infection (vs. streptococcal pneumonia’s abrupt onset with shaking chills/ fever and rust-colored sputum).
(2) OTC cough and cold medications that can increase BP
Pseudoephedrine and diphenhydramine both can increase blood pressure.
medication class: dextromethorphan
antitussive
bronchophony
bronchophony (the ability to hear increased loudness of the spoken sounds), even a whisper can be heard through the stethoscope through an area of consolidation
tactile fremitus
tactile fremitus is a type of vocal fremitus found over the area of secretions. Tactile fremitus is evaluated using the surface of both hands over the back/lungs.
increased over areas of consolidation
MOA of anticholinergics for COPD
Anticholinergic drugs are another group of bronchodilators that are different from the beta-agonists. Although the beta-agonists affect the bronchioles (small airways), anticholinergics affect the muscles around the bronchi (large airways). When the lungs are irritated, these bands of muscle can tighten, making the bronchi narrower. Anticholinergics work by stopping the muscles from tightening.
Easily ruptured blisters (fragile) is a classic finding for _____, an acute bacterial skin infection caused by (2)
bullous impetigo
Staphylococcus or Streptococcus.
what is erysipelas
Erysipelas is a type of cellulitis caused by strep. It resembles a bright-red, warm, raised rash (plaque-like) with discrete borders usually located on the face or the shins. Blistering is not present.
what is the “dawn phenomenon”
The Dawn phenomenon is the end result of a combination of natural hormonal body changes that occur during the sleep cycle. Between 3 a.m. and 8 a.m., the body starts to secrete growth hormone and cortisol. These hormones work against insulin’s action, causing an increase in the fasting blood glucose in the morning.
leading cause of lower limb amputations
diabetes
Data from the National Diabetes Fact Sheet note that more than 60% of nontraumatic lower limb amputations were performed in people with diabetes.
diagnostic definition of a UTI in terms of CFUs and WBCs
A UTI is defined as the presence of 100,000 organisms per milliliter of urine in asymptomatic patients or greater than 100 organisms per milliliter of urine with pyuria (>7 WBCs/mL) in a symptomatic patient.
iliopsoas testing
To perform the iliopsoas muscle test, ask the patient to raise the leg, flexing at the hip, while you push downward against it.
These muscle tests are positive if the patient experiences pain.
obturator testing
The obturator muscle test is performed with the right leg flexed at the hip and the knee at 90 degrees. The examiner rotates the leg laterally and medially.
These muscle tests are positive if the patient experiences pain.
normal change in alk phos during adolescence
Alkaline phosphatase is a group of related enzymes. The bone form of the enzyme creates the alkaline conditions it requires to be most active with a chemical reaction involving the osteoblasts. Because of the rapid bone growth and increased deposition of calcium during the adolescent growth spurt, there is a higher level of enzymes.
fiber is generally useful for preventing diverticular disease. when might be a time that fiber is NOT recommended?
During a flare-up of diverticulitis, a low-fiber diet is recommended and fiber supplementation is not recommended.
common cause of acute gastritis
chronic NSAID use
Signs and symptoms of gastritis are nausea/vomiting, upset stomach, loss of appetite, and burning/aching or gnawing pain located in the epigastric area. Nonselective NSAIDs (aspirin, ibuprofen, naproxen, others) have adverse effects on the gastrointestinal (GI) tract, kidneys, central nervous system, and cardiovascular effects, and decrease platelet aggregation (aspirin). Chronic use of nonselective NSAIDs disrupts the production of prostaglandins, which involves cycloxygenase-1 (COX-1) and COX-2. The GI mucosa uses COX-1 to produce mucosal protective factors. Blocking COX-1 decreases these protective factors and increases risk of gastritis, ulcers, and GI bleeding. Selective NSAIDs, such as celecoxib (Celebrex), do less damage to the GI tract because they block only COX-2, which is responsible for pain and inflammation.
in order to be truly positive, remember to perform Murphy’s sign testing in which way?
on the left side too, should NOT elicit a response
rovsing’s sign
The Rovsing sign is right lower quadrant pain intensified by left lower quadrant abdominal pressure (i.e., pain referred to the opposite side of the abdomen after release of palpation). It is associated with peritoneal irritation and appendicitis.
what is celiac disease?
Celiac disease, known as sprue, is an autoimmune disease that damages the small intestine and interferes with the absorption of nutrients. People with celiac disease cannot tolerate a protein called gluten, which is found in wheat, rye, and barley. If they eat foods or use products containing gluten, their immune system responds by damaging the lining of the small intestine. This damage to the small intestine decreases the absorption of all nutrients—resulting in an overall poor nutritional status. If not treated, a person with celiac disease can develop more severe nutritional deficiencies, such as osteoporosis (because of poor calcium absorption), iron-deficiency anemia, or multiple other vitamin and mineral deficiencies.
Q. The gold standard for the diagnosis of active Helicobacter pylori infection of the stomach or duodenum is:
urea breath test
Cullen’s sign
Periumbilical ecchymosis (bluish periumbilical discoloration), Cullen’s sign, is most often considered a sign of hemorrhagic pancreatitis.
normal liver span for adults
15 to 18 cm in the midclavicular line??????
what is zollinger-ellison syndrome and its primary treatments and complications?
Zollinger–Ellison syndrome is a type of tumor (gastrinoma) that is usually located in the head of the pancreas and/or the upper small intestine. It causes increased production of the hormone gastrin, which stimulates excessive hydrochloric acid production. The result is multiple gastric and/ or duodenal ulcers, intestinal bleeding, or intestinal perforation. Proton-pump inhibitors (PPIs) are the first choice for medical treatment of Zollinger–Ellison syndrome. PPIs reduce acid production by the stomach, and promote healing of ulcers in the stomach and small intestine. About one half to two thirds of single gastrinomas are malignant tumors, which can metastasize and cause death. Surgical removal of the tumor, chemotherapy, and radiation are used, depending on the stage of the cancer.
first line treatment for uncomplicated, non-H. pylori, peptic ulcers
For uncomplicated cases of peptic ulcer disease that are Helicobacter pylori negative, the first-line agents are the H2 receptor blockers such as ranitidine (Zantac), nizatidine (Axid), famotidine (Pepcid), and cimetidine (Tagamet). If these are not effective, the next step would be to try a proton-pump inhibitor.
what is Barrett’s esophagus?
considered a precursor to esophageal cancer
Barrett’s esophagus is most often diagnosed in people who have long-term gastroesophageal reflux disease (GERD)—a chronic regurgitation of acid from the stomach into the lower esophagus. Only a small percentage of people with GERD will develop Barrett’s esophagus.
management of an adult male with UTI
UTIs are unusual in adult males and this patient should be treated for a complicated UTI—empiric treatment with a fluoroquinolone, such as ciprofloxacin, BID for 7 to 14 days. The patient should be referred to a urologist for evaluation of causative factors.
Evidence of blood in the urine can be seen with (3)
kidney stones, bladder cancer, and acute pyelonephritis.
most common causes of orchitis
Mumps is the most common virus that causes orchitis. Other causes of orchitis are sexually transmitted infections such as gonorrhea or chlamydia.
Orchitis is inflammation of one or both of the testicles.
Amsel criteria for diagnosing BV
Diagnosis of bacterial vaginosis includes three of four Amsel criteria: (1) white, thick adherent discharge; (2) pH greater than 4.5; (3) positive whiff test (amine odor mixed with 10% potassium hydroxide [KOH]); (4) clue cells greater than 20% on a wet mount (epithelial cells dotted with large numbers of bacteria that obscure cell borders).
Discuss the treatment of UTIs in patients with diabetes
Prompt diagnosis and early therapy are warranted when a urinary tract infection (UTI) occurs in a diabetic patient. A urine C&S before starting treatment and repeated 1 week posttreatment is recommended to evaluate for eradication of the infection. Do not use the 3-day treatment regimen in this population. Treatment of asymptomatic bacteriuria in diabetic patients is not indicated except in pregnant women.
cremasteric reflex
The cremasteric reflex is elicited by stroking the inner thigh (proximal to distal) with a blunt instrument such as a handle of the reflex hammer. The testicle and scrotum should rise on the stroked side.
two conditions you can use the physical exam technique of transillumination for
Transillumination is used for evaluation of the frontal and maxillary sinusitis as well as for a hydrocele. Because light is able to pass through the delicate skin covering the hollow sinus cavities, a light source held against the upper cheek will produce a red dot on the palate if the sinuses are normal (filled with air rather than obstructed). The transillumination test is used to differentiate a hydrocele from hernia—an illuminated scrotum will show the testicle in the center surrounded by water in the hydrocele.
management of suspected acute testicular torsion
Immediate referral to the emergency department is required to prevent irreversible ischemia. Success of treatment is usually 100% if treated within the first 6 hours and 0% if treated after 24 hours. The diagnosis of testicular torsion is often made clinically, but if it is in doubt, an ultra-sound is helpful in evaluating the condition. Emergency diagnosis and treatment are usually required within 4 to 6 hours to prevent necrosis.
causes of balanitis
Balanitis is swelling (inflammation) of the foreskin and head of the penis. Balanitis is usually caused by poor hygiene in uncircumcised men. Other possible causes include Candida (fungal infection) and bacterial infection, harsh soaps, and uncontrolled diabetes. Symptoms include redness of the foreskin or penis, other rashes on the head of the penis, foul-smelling discharge, and pain.
A boggy and warm prostate with tenderness is suggestive of ….
acute prostatitis.
common migraine triggers
foods high in tyramine content (blue cheese, smoked meats, salami, beer, soy, fava beans), change in sleep patterns, and fermented foods—are all possible migraine triggers. Other triggers include skipping meals/fasting, hormonal fluctuation, environmental factors, stress, overexertion, visual triggers such as eyestrain/bright glaring lights, and others.
what is cauda equina
Cauda equina is a serious condition caused by compression of the lumbar, sacral, or coccygeal nerve roots in the lower portion of the spinal cord. It is considered a surgical emergency. If left untreated, acute pressure causes ischemia and can lead to permanent nerve damage, including loss of bowel and bladder control and paralysis of the legs. Signs and symptoms include a change in bowel and bladder control (incontinence), saddle-pattern anesthesia (perineum), sciatica, low-back pain, and loss of sensation or movement below level of the lesion. Causes include disk herniation, abscess, tumor, inflammation, and others.
treatment for Raynaud’s disease
The preferred drug is a calcium channel blocker such as nifedipine (Norvasc) or amlodipine (Procardia).
(6) medications first-line for migraine prevention
Sufficient evidence and consensus exist to recommend propranolol, timolol, amitriptyline, divalproex (Depakote), sodium valproate (Depakote), and topiramate (Topamax) as first-line agents for migraine prevention.
discuss diabetic eye disease
Patients with diabetes often develop ophthalmic complications, such as corneal abnormalities, glaucoma, neovascularization (and microaneurysms), and cataracts. The most common and potentially most blinding of these is diabetic retinopathy. In the initial stages of diabetic retinopathy, patients are generally asymptomatic, but in more advanced stages of the disease patients may experience floaters, as well as distorting and/or blurred vision. Microaneurysms are the earliest clinical sign of diabetic retinopathy.
normal ESR
. The normal ESR for males is 0 to 15 mm/hr, and for females is 0 to 20 mm/hr. The ESR can be slightly more elevated in the elderly
