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DT4 Exam 1 > Clinical > Flashcards

Clinical Flashcards

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1
Q

cancers effective screening from Pap

A

squamous cell carcinoma

not good at preventing adenocarcinoma

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2
Q

conventional Pap

A

plastic spatula scraping cervix

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3
Q

liquid based

A

same technique but placed in liquid in vial
inflammation, blood can be removed prior to slide prep
additional testing for HPV, chlamydia, gonorrhea

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4
Q

image analysis systems

A

computer analyzes slide and picks out most atypical cells

pathologist reviews slide

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5
Q

specimen adequacy

A

presence or absence of transformation zone

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6
Q

general categorization

A

negative for lesion or malignancy or an abnormality present

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7
Q

epithelial cell abnormality

A

squamous cell

atypical of undetermined significance, low grade intraepithelial, high grade, or carcinoma

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8
Q

glandular cell abnormality

A

atypical of undetermined significance, cervical adenocarcinoma in situ, or adenocarcinoma of endocervical or endometrial origin

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9
Q

near 100% sensitivity

A

liquid based plus testing for high risk HPV

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10
Q

paradox of Pap

A

less efficient in detecting invasive cancer than in finding preinvasive disease

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11
Q

most important reason for failure of Pap

A

women fail to get screened

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12
Q

age of Pap recommendation

A

21

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13
Q

reflex testing

A

21-30 if ASCUS then test for HPV

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14
Q

cotesting

A

over 30 test together (HPV and pap)

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15
Q

cytology interval

A

3 years

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16
Q

cotesting interval

A

5 years

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17
Q

most common drugs consumed during pregnancy

A 
analgesics
antacids
antibiotics
antiemetics
sedatives
antihistamines
diuretics 
ethanol
iron
vitamins
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18
Q

DES use and teratogenicity

A

used for pregnancy wastage

caused clear cell vaginal adenocarcinoma

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19
Q

thalidomide use and teratogenicity

A

insomnia

caused phocomelia, facial palsy

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20
Q

bendectin use and teratogenicity

A

anti-emetic

caused presumed malformations

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21
Q

results of fetal alcohol syndrome

A

decrease in uterine growth, psychomotor dysfunction

craniofacial abnormalities

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22
Q

embryogenesis

A

3-8 weeks

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23
Q

fetogenesis

A

affects gonadal development or nervous system

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24
Q

altered distribution in pregnancy

A

increased plasma volume and TBW late in pregnancy

decrease in albumin leads to increased free fraction

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25
biotransformation in pregnancy
maternal liver fetal liver placenta
26
excretion changes in pregnancy
GFR increase | renal excretion of drugs
27
drugs cannot enter fetus
insulin and heparins
28
FDA category A
fail to demonstrate risk in first trimester
29
FDA category B
not demonstrated fetal risk in animals, not confirmed in humans
30
FDA category C
animals adverse effect on fetus no controls in women | only if beneficial to fetus
31
FDA category D
positive evidence of human fetal risk but benefits for pregnancy acceptable despite risk
32
FDA category X
fetal risk and risk during pregnant women outweighs benefits contraindicated
33
adverse of androgen
virilization
34
adverse of antineoplastics
multiple congenital defects
35
adverse of systemic corticosteroids in high dosage
cleft lip/palate
36
adverse of DES
vaginal adenosis and adenocarcinoma in daughters
37
adverse of tetracyclines
yellow discoloration of teeth, inhibition of bone growth
38
adverse of warfarin
multiple congentital defects, skeletal, and CNS defects
39
adverse of systemic retinoids
CNS, craniofacial, cardiovascular
40
adverse chloroquine
deafness
41
adverse lithium
cardiovascular defects
42
adverse phenytoin
congenital defects
43
other drugs to avoid
co-trimoxazole, rifampicin, sulfonyluras, trimethoprim
44
adverse aspirin
kernicterus, hemorrhage
45
adverse aminoglycoside
eighth nerve damage
46
antithyroid drugs adverse
goiter and hypothyroidism | asplenia with methimazole
47
adverse benzodiazepines
floppy infant syndrome
48
adverse chloramphenicol
periperhal vascualr collapse
49
adverse oral anticoagulants
fetal or retroplacental hemorrhage, microcephaly
50
adverse sulfonylurea
hypoglycemia
51
adverse sulfonamides
kernicterus
52
adverse tetracyclines
teeth
53
adverse thiazide diuretics
thrombocytopenia
54
adverse chloramphenicol
grey baby
55
adverse streptomycin
ototoxicity
56
treatment of UTI in pregnancy
nitrofurantion, penicillins, trimeth/sulfa
57
treatment bacterial vaginosis
metronidazole
58
treatment candidiasis
azoles
59
treatment acute bacterial sinsitis
trimeth/sulfa, penicillins, azithromycin
60
treat nausea
promethazine
61
anemia in pregnancy
iron of folic acid
62
treat maternal hyperthyroidism
carbimazole, methimazole or propylthiouracil (concern of hepatic failure) avoid breast feeding
63
treat pre-existing insulin dependent DM
change from oral hypoglycemics to human insulin
64
likely safe diabetes drugs
metformin and glyburide
65
treat pre-eclampsia
methyldopa hydralazine labetalol
66
drugs to avoid for HTN in pregnancy
diuretics and BB without alpha blocking activity | ACEi and ARB
67
treat anticoagulation
heparin or LMW heparin until 2-3 weeks before delivery
68
teat epilepsy
``` slight teratogenicity with phenytoin monitor plasma (decrease albumin) and supplement with folic acid before conception and until end of 1st trimester ```
69
asthma treatment
beta sympathomimetics for acute exacerbations inhaled corticosteroids systemic corticosteroids for severe leukotriene inhibitors third line
70
nausea and vomiting treatment
only if severe smaller meals, ginger, pridoxine use promethazine or prochlorperazine ondansetron appears safe
71
hyperemesis gravidarium
requiring hospitalization due to dehydration | due to elevated E/P/hCG
72
treat depression
abrupt withdrawal dangerous
73
defects paroxetine
cardiac defects, ASD/VSD
74
tobacco in pregnancy
increase fetal death or loss, increase premature birth and decrease weight
75
signs of withdrawal
irritability and excessive high-pitched crying, tremor, frantic suckling, hyperactive reflexes increased RR, increased stools, sneezing, yawning, vomiting and fever
76
incidence of diabetes mellitus
between 7-8% incidence is expected to increase in the future major public health issue
77
adipose tissue and insulin resistance
visceral adipose has high insulin requirements | lack of exercise leads to decreased skeletal
78
risk factors for diabetes
``` family history high risk ethnic group (black, hispanic, pacific islander) truncal obesity physical inactivity age >45 BMI >25 waist size >34 in ```
79
prediabetes
disorder of adipose tissue atherogenic process begins before sugar reaches diabetic level potential to reverse process before pancreatic damage occurs screening
80
associated findings for diabetes
elevated BP obesity diabetic dyslipidemia (low HDL, high TG) mild fatty infiltration of the liver
81
symptoms of diabetes
at severe glucose-polyuria, polydipsia, weight loss | may present with neuropathy
82
glycosuria
when sugar exceeds 180
83
treatment diabetes
lose weight | exercise >150 min/week
84
monitoring diabetes
glucometers to check sugars daily, before eating | monitor Hgb A1c every 3 months (goal <6.5-7
85
oral medications diabetes
insulin secretagogues, incretin drugs, agents to decrease insulin resistance insulin ideally given in split dose when needed
86
BP goal in diabetics
130/80
87
cholesterol in diabetics
LDL<100 | treat TG and HDL
88
renal involvement diabetics
proteinuria first sign | control BP and treat with ACEi
89
loss of GFR in diabetics
can have loss of 10cc/yr with aggressive renal disease
90
macrovascular disease in DM
risk factor for CAD and CVA | PAD (micro and macrovascular elements)
91
infection and stress in DM
worsen hyperglycemia in diabetics
92
immune suppression in DM
increased risk of death with MI, pneumonia, sepsis, CVA
93
clinical care DM
yearly BS at risk yearly eye exam foot care and foot exams aspirin to prevent macrovascular disease (secondary prevention)
94
diagnosis autoimmune diabetes
autoantibodies
95
hypercalcemia causes
``` malignancy myeloma granulomatous disorders milk alkali syndrome hyperparathyroidism medications-HCTZ ```
96
cardiac and mental changes from hypercalcemia
>14 mg/dL | short QT on EKG
97
IL-6 and hypercalcemia
myeloma
98
lymphoma and hypercalcemia
hypercalcemia through vitamin D prouction
99
treatment of hypercalcemia
treat with IV saline bisphosphonates renal function improves with hydration (hypercalcemia causes renal vasoconstriction)
100
milk alkali syndrome
patients taking milk and sodium bicarb for peptic ulcer disease not in women taking calcium carbonate after vomiting or using diuretics
101
clinical milk alkali syndrome
PO4 high, normal, or low | vitamin D and PTH low
102
hyperparathyroidism
``` 85% have parathyroid adenoma 14% MEN syndrome nephrolithiasis common increased gout and HTN osteoporosis ```
103
parathyroid scan
99m Sestamibi | MRI and US also useful
104
criteria for surgery for hyperparathyroidism
worsening renal function age <50 worsening osteoporosis renal stones
105
vitamin D deficiency
``` x ray shows cortical thinning low vitamin D malabsorption of calcium mostly nutritional, can be worsened by low sunlight replace with calcitriol, PTH high ```
106
hypoparathyroidism
after thyroid or parathyroid surgery | hypocalcemia (can be treated with IV calcium)
107
hungry bone syndrome
transient hypocalcemia following parathyroid or thyroid surgery patient with pre-existing hyperparathyroidism older patients and chronic kidney disease low Mg and PO4 sudden increase in bone uptake of minerals after abrupt withdrawal of PTH
108
causes of hypocalcemia
severe pancreatitis rhabdomyolysis tumor lysis
109
presentation hypocalcemia
muscle weakness-respiratory weakness with severe deficiency long QT on EKG risk for arrhythmia treat with IV calcium
110
mild hypocalcemia
common in hospitalized patients check ionized Ca correct for serum albumin
111
chronic kidney disease
phosphate retention and decrease vitamin D synthesis chronic elevation of PTH mild metabolic acidosis and secondary hyperparathyroidism lead to bone disease
112
treatment chronic kidney disease
phosphate binders and oral vitamin D
113
risk factors T1DM
``` viruses diet high SES obesity vitamin D def season ```
114
presentation T1DM
polyuria, polydipsia, polyphagia weight loss DKA silent
115
associations with T1DM
thyroiditis-anti GAD celiac-tTG Addison's IPEX-immune dysregulation polyendocrinopathy, enteropathy, X-linked
116
complications T1DM
``` hypoglycemia/hyperglycemia DKA growth autoimmune diseases psychiatric-depression and eating disorders vascular nephropathy HTN retinopathy neuropathy cardiovascular gastroparesis ```
117
hypoglycemia
<70
118
indications for pump T1DM
``` recurrent severe hypoglycemia wide fluctuations suboptimal control microvascular complications lifestyle young children/infants adolescents with eating disorders ketosis prone athletes ```
119
check thyroid and celiac T1DM
every 2-3 years
120
check 10yo T1DM
foot exam lipid screen urine albumin/creatinine
121
presentation T2DM
asymptomatic symptomatic DKA hyperglycemic hyperosmolar state
122
pathogenesis T2DM
hyperglycemia insulin resistance not immune mediated risk factors-obesity, family history, ethnic groups, female
123
screening T2DM
``` BMI >85th and -T2DM in relative -high risk ethnic group -signs of insulin resistance -maternal history of diabetes screen at 10yo or puberty every 3 years -A1C -oral glucose tolerance test ```
124
management of T2DM
glycemic control improve insulin insensitivity treat comorbidities prevent vascular complications
125
mechanism of action metformin
decrease hepatic glucose production | improve insulin sensitivity
126
side effects metformin
cardiac GI renal lactic acidosis
127
clinical presentation DKA
``` weight loss symptoms <1 month dehydration Kussmaul acetone abdominal pain vomiting obtunded->coma ```
128
diagnosis DKA
``` hyperglycemia and acidosis and ketosis (ketonemia, ketonuria) glucosuria leukocytosis elevated amylase electrolyte abnormalities ```
129
differential diagnosis DKA
``` gastroenteritis ingestion infections pancreatitis appendicitis ```
130
therapy DKA
correct dehydration correct acidosis correct electrolytes provide insulin
131
choice to treat dehydration in DKA
normal saline | change to 0.45% later
132
add glucose to saline for DKA
BS <300
133
treat acidosis in DKA
bicarb rarely needed | correcting dehydration and providing insulin sufficient
134
electrolyte treatment in DKA
sodium-false hyponatremia potassium-add when <5.5 Kphos with first liter of fluids chloride-can worsen the acidosis
135
insulin in DKA
stop pump give regular insulin IV never stop insulin infusion
136
monitoring of DKA
``` glucose STAT and q1h ABG electrolytes STAT and q2h EKG neuro mannitol ```
137
osmol serum
2Na+glucose/20+BUN/3
138
common age and time of DKA complications
7-11 yo | in first 10 hrs
139
cerebral edema
treat with mannitol, hypertonic saline ventilation
140
risks cerebral edema
younger new onset longer duration of symptoms
141
blood clots in urine
lower tract source
142
dipstick analysis of hematuria
may show false +
143
glomerular bleeding
red cell casts proteinuria dysmorphic cells
144
isolated glomerular bleeding
post infectious glomerulonephritis | exercise induced hematuria
145
persistent glomerular bleeding
IgA nephropathy Alport syndrome thin basement membrane nephropathy
146
transient hematuria pt >50
malignancy
147
primary cancers with hematuria
bladder renal prostate
148
risk factors malignancy with hematuria
``` age >50 smoking analgesic abuse M>F gross hematuria ```
149
urine cytology
90% sensitivity for bladder cancer | use for at risk patients
150
imaging tests
CT urography (high sensitivity but also high radiation) renal US retrograde pyelography
151
cytoscopy
used for all adults with unexplained hematuria | only test that visualizes urethra and prostate
152
risk factors nephrolithiasis
``` urine composition history family history increases in oxalate absorption (gastric bypass) some meds low fluid intake persistent acidic urine upper tract UTI ```
153
symptoms nephrolithiasis
pain gross hematuria N/V dysuria and urgency
154
differential diagnosis nephrolithiasis
``` ectopic pregnancy abdominal aortic aneurysm acute intestinal obstruction appendicitis drug seeking patients ```
155
confirmatory test nephrolithiasis
non-contrast helical CT | almost 100% sensitive
156
US for nephrolithiasis
used in pregnant women | may miss small stones
157
abdominal radiograph miss stones
misses uric acid stones or small stones
158
acute therapy for nephrolithiasis
``` pain control (NSAIDs, opioids) hydration help stone pass-antispasmotic agents, calcium channel blockers, alpha blockers ```
159
immediate expulsive therapy for nephrolithiasis
patients with sepsis, ARF, anuria, relentless pain and nausea treat with shock wave lithotripsy, ureteroscopic lithotripsy with laser probes, percutaneous nephrolithotomy, laproscopic stone removal
160
causes of transient hematuria in children
UTI trauma fever exercise
161
causes of persistent hematuria in children
``` IgA nephropathy thin basement membrane disease Alport syndrome (x linked recessive) postinfectious glomerulonephritis hypercalcuria (high urinary Ca/Cr ratio) ```
162
Alport syndrome
hearing loss, ocular abnormalities, progressive renal failure over time
163
Nutcraker syndrome
L renal vein compression by aorta and superior mesenteric artery can have proteinuria also
164
nitrite in urine
positive for enterobacteriaceae
165
suprapubic aspiration of bladder
needle into bladder (rarely used but best)
166
clean catch urine specimen
spread labia, wipe with antiseptic wipe F2B and place cup in midstream
167
indications for urine culture
suspicion of complicated UTI atypical symptoms treatment failure recurrent symptoms
168
common etiologies for acute dysuria
cystitis urethritis vaginitis
169
UTI risk factors
``` F>M sexual intercourse history diaphragm use spermicidal use pregnancy urethral catheterization post menopausal prostatic hypertrophy ```
170
common pathogens UTI
``` E. coli enterococcus pseudomonas aeruginosa proteus mirabilis klebsiella pneumoniae staph saprophiticus ```
171
pathogenesis UTI
retrograde transmission or hematogenous sticky bacteria and epithelial cells fecal germs close to urethra (short in women) male prostatic secretions are bacteriostatic
172
cystitis
lower tract infection | affects bladder wall
173
pyelonephritis
upper tract infection | affects kidney
174
upper tract symptoms
flank pain fever abdominal pain N/V
175
lower tract symptoms
dysuria frequency urgency suprapubic pain
176
symptomatic treatment dysuria
phenazopyridine | turns urine red and false + dipstick urinalysis
177
hemolytic anemia from phenazopyridine
in patients with G6PD
178
cystitis prevention
``` cranberry juice-tannins void after sex avoid bath soaking wipe F2B drink water cotton underwear, loose fitting clothes, decrease warmth ```
179
uncomplicated UTI
cystitis in healthy non-pregnant adult woman | most E. coli or staph saprophyticus
180
complicated UTI
``` pregnancy DM history of acute pyelonephritis relapsing UTI in past year UTI in childhood 3 or more in past year uropathogen with resistance pattern hospital acquired in-dwelling urinary catheter anatomic or functional abnormality of urinary tract antibiotic treatment in last month ```
181
common antibiotics for UTI treatment
``` flouroquinolones TMP/SMX tetracyclines nitrofurantoin cephalosporins penicillins ```
182
admit for pyelonephritis
``` more severe, toxic appearing complicated UTI (elderly, instrumented, diabetic, urologic abnormality) unable to take oral meds pregnancy compliance issues ```
183
dysuria in male
chlamydia
184
dysuria and discharge in male
gonorrhea
185
urinlysis for chlamydia
pyuria without bacteriuria
186
urethral culture for gonorrhea
calcium alginate tip swab onto pre-warmed Thayer-Martin agar
187
common etiologies vaginitis
candida trichomonas bacterial
188
atrophic vaginitis
post-menopausal, estrogen deficient women may experience dysuria topical estrogen effective
189
irritant dysuria
reaction to local contract with irritant | can be from contraceptive gel, tampon, condom, bubble baths
190
non-infectious causes of dysuria in children
irritants minor trauma labial adhesions with small tears psychogenic
191
indications for long-term catheterization
uncorrectable bladder outlet obstruction intractable skin breakdown due to urinary incontinence some patients with neurogenic bladder palliative care

DT4 Exam 1 (5 decks)

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