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DT4 Exam 1 > Clinical > Flashcards

Clinical Flashcards

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
Q

biotransformation in pregnancy

A

maternal liver
fetal liver
placenta

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26
Q

excretion changes in pregnancy

A

GFR increase

renal excretion of drugs

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27
Q

drugs cannot enter fetus

A

insulin and heparins

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28
Q

FDA category A

A

fail to demonstrate risk in first trimester

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29
Q

FDA category B

A

not demonstrated fetal risk in animals, not confirmed in humans

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30
Q

FDA category C

A

animals adverse effect on fetus no controls in women

only if beneficial to fetus

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31
Q

FDA category D

A

positive evidence of human fetal risk but benefits for pregnancy acceptable despite risk

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32
Q

FDA category X

A

fetal risk and risk during pregnant women outweighs benefits
contraindicated

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33
Q

adverse of androgen

A

virilization

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34
Q

adverse of antineoplastics

A

multiple congenital defects

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35
Q

adverse of systemic corticosteroids in high dosage

A

cleft lip/palate

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36
Q

adverse of DES

A

vaginal adenosis and adenocarcinoma in daughters

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37
Q

adverse of tetracyclines

A

yellow discoloration of teeth, inhibition of bone growth

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38
Q

adverse of warfarin

A

multiple congentital defects, skeletal, and CNS defects

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39
Q

adverse of systemic retinoids

A

CNS, craniofacial, cardiovascular

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40
Q

adverse chloroquine

A

deafness

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41
Q

adverse lithium

A

cardiovascular defects

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42
Q

adverse phenytoin

A

congenital defects

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43
Q

other drugs to avoid

A

co-trimoxazole, rifampicin, sulfonyluras, trimethoprim

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44
Q

adverse aspirin

A

kernicterus, hemorrhage

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45
Q

adverse aminoglycoside

A

eighth nerve damage

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46
Q

antithyroid drugs adverse

A

goiter and hypothyroidism

asplenia with methimazole

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47
Q

adverse benzodiazepines

A

floppy infant syndrome

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48
Q

adverse chloramphenicol

A

periperhal vascualr collapse

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49
Q

adverse oral anticoagulants

A

fetal or retroplacental hemorrhage, microcephaly

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50
Q

adverse sulfonylurea

A

hypoglycemia

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51
Q

adverse sulfonamides

A

kernicterus

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52
Q

adverse tetracyclines

A

teeth

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53
Q

adverse thiazide diuretics

A

thrombocytopenia

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54
Q

adverse chloramphenicol

A

grey baby

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55
Q

adverse streptomycin

A

ototoxicity

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56
Q

treatment of UTI in pregnancy

A

nitrofurantion, penicillins, trimeth/sulfa

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57
Q

treatment bacterial vaginosis

A

metronidazole

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58
Q

treatment candidiasis

A

azoles

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59
Q

treatment acute bacterial sinsitis

A

trimeth/sulfa, penicillins, azithromycin

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60
Q

treat nausea

A

promethazine

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61
Q

anemia in pregnancy

A

iron of folic acid

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62
Q

treat maternal hyperthyroidism

A

carbimazole, methimazole or propylthiouracil (concern of hepatic failure)
avoid breast feeding

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63
Q

treat pre-existing insulin dependent DM

A

change from oral hypoglycemics to human insulin

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64
Q

likely safe diabetes drugs

A

metformin and glyburide

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65
Q

treat pre-eclampsia

A

methyldopa
hydralazine
labetalol

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66
Q

drugs to avoid for HTN in pregnancy

A

diuretics and BB without alpha blocking activity

ACEi and ARB

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67
Q

treat anticoagulation

A

heparin or LMW heparin until 2-3 weeks before delivery

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68
Q

teat epilepsy

A 
slight teratogenicity with phenytoin
monitor plasma (decrease albumin) and supplement with folic acid before conception and until end of 1st trimester
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69
Q

asthma treatment

A

beta sympathomimetics for acute exacerbations
inhaled corticosteroids
systemic corticosteroids for severe
leukotriene inhibitors third line

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70
Q

nausea and vomiting treatment

A

only if severe
smaller meals, ginger, pridoxine
use promethazine or prochlorperazine
ondansetron appears safe

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71
Q

hyperemesis gravidarium

A

requiring hospitalization due to dehydration

due to elevated E/P/hCG

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72
Q

treat depression

A

abrupt withdrawal dangerous

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73
Q

defects paroxetine

A

cardiac defects, ASD/VSD

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74
Q

tobacco in pregnancy

A

increase fetal death or loss, increase premature birth and decrease weight

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75
Q

signs of withdrawal

A

irritability and excessive high-pitched crying, tremor, frantic suckling, hyperactive reflexes
increased RR, increased stools, sneezing, yawning, vomiting and fever

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76
Q

incidence of diabetes mellitus

A

between 7-8%
incidence is expected to increase in the future
major public health issue

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77
Q

adipose tissue and insulin resistance

A

visceral adipose has high insulin requirements

lack of exercise leads to decreased skeletal

78
Q

risk factors for diabetes

A 
family history 
high risk ethnic group (black, hispanic, pacific islander)
truncal obesity 
physical inactivity 
age >45
BMI >25
waist size >34 in
79
Q

prediabetes

A

disorder of adipose tissue
atherogenic process begins before sugar reaches diabetic level
potential to reverse process before pancreatic damage occurs
screening

80
Q

associated findings for diabetes

A

elevated BP
obesity
diabetic dyslipidemia (low HDL, high TG)
mild fatty infiltration of the liver

81
Q

symptoms of diabetes

A

at severe glucose-polyuria, polydipsia, weight loss

may present with neuropathy

82
Q

glycosuria

A

when sugar exceeds 180

83
Q

treatment diabetes

A

lose weight

exercise >150 min/week

84
Q

monitoring diabetes

A

glucometers to check sugars daily, before eating

monitor Hgb A1c every 3 months (goal <6.5-7

85
Q

oral medications diabetes

A

insulin secretagogues, incretin drugs, agents to decrease insulin resistance
insulin ideally given in split dose when needed

86
Q

BP goal in diabetics

A

130/80

87
Q

cholesterol in diabetics

A

LDL<100

treat TG and HDL

88
Q

renal involvement diabetics

A

proteinuria first sign

control BP and treat with ACEi

89
Q

loss of GFR in diabetics

A

can have loss of 10cc/yr with aggressive renal disease

90
Q

macrovascular disease in DM

A

risk factor for CAD and CVA

PAD (micro and macrovascular elements)

91
Q

infection and stress in DM

A

worsen hyperglycemia in diabetics

92
Q

immune suppression in DM

A

increased risk of death with MI, pneumonia, sepsis, CVA

93
Q

clinical care DM

A

yearly BS at risk
yearly eye exam
foot care and foot exams
aspirin to prevent macrovascular disease (secondary prevention)

94
Q

diagnosis autoimmune diabetes

A

autoantibodies

95
Q

hypercalcemia causes

A 
malignancy 
myeloma
granulomatous disorders 
milk alkali syndrome 
hyperparathyroidism
medications-HCTZ
96
Q

cardiac and mental changes from hypercalcemia

A

> 14 mg/dL

short QT on EKG

97
Q

IL-6 and hypercalcemia

A

myeloma

98
Q

lymphoma and hypercalcemia

A

hypercalcemia through vitamin D prouction

99
Q

treatment of hypercalcemia

A

treat with IV saline
bisphosphonates
renal function improves with hydration (hypercalcemia causes renal vasoconstriction)

100
Q

milk alkali syndrome

A

patients taking milk and sodium bicarb for peptic ulcer disease
not in women taking calcium carbonate after vomiting or using diuretics

101
Q

clinical milk alkali syndrome

A

PO4 high, normal, or low

vitamin D and PTH low

102
Q

hyperparathyroidism

A 
85% have parathyroid adenoma 
14% MEN syndrome
nephrolithiasis common
increased gout and HTN
osteoporosis
103
Q

parathyroid scan

A

99m Sestamibi

MRI and US also useful

104
Q

criteria for surgery for hyperparathyroidism

A

worsening renal function
age <50
worsening osteoporosis
renal stones

105
Q

vitamin D deficiency

A 
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
Q

hypoparathyroidism

A

after thyroid or parathyroid surgery

hypocalcemia (can be treated with IV calcium)

107
Q

hungry bone syndrome

A

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
Q

causes of hypocalcemia

A

severe pancreatitis
rhabdomyolysis
tumor lysis

109
Q

presentation hypocalcemia

A

muscle weakness-respiratory weakness with severe deficiency
long QT on EKG risk for arrhythmia
treat with IV calcium

110
Q

mild hypocalcemia

A

common in hospitalized patients
check ionized Ca
correct for serum albumin

111
Q

chronic kidney disease

A

phosphate retention and decrease vitamin D synthesis
chronic elevation of PTH
mild metabolic acidosis and secondary hyperparathyroidism lead to bone disease

112
Q

treatment chronic kidney disease

A

phosphate binders and oral vitamin D

113
Q

risk factors T1DM

A 
viruses
diet
high SES
obesity 
vitamin D def
season
114
Q

presentation T1DM

A

polyuria, polydipsia, polyphagia
weight loss
DKA
silent

115
Q

associations with T1DM

A

thyroiditis-anti GAD
celiac-tTG
Addison’s
IPEX-immune dysregulation polyendocrinopathy, enteropathy, X-linked

116
Q

complications T1DM

A 
hypoglycemia/hyperglycemia
DKA
growth
autoimmune diseases
psychiatric-depression and eating disorders 
vascular
nephropathy
HTN
retinopathy
neuropathy 
cardiovascular 
gastroparesis
117
Q

hypoglycemia

A

<70

118
Q

indications for pump T1DM

A 
recurrent severe hypoglycemia
wide fluctuations 
suboptimal control
microvascular complications
lifestyle
young children/infants 
adolescents with eating disorders 
ketosis prone
athletes
119
Q

check thyroid and celiac T1DM

A

every 2-3 years

120
Q

check 10yo T1DM

A

foot exam
lipid screen
urine albumin/creatinine

121
Q

presentation T2DM

A

asymptomatic
symptomatic
DKA
hyperglycemic hyperosmolar state

122
Q

pathogenesis T2DM

A

hyperglycemia
insulin resistance
not immune mediated
risk factors-obesity, family history, ethnic groups, female

123
Q

screening T2DM

A 
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
Q

management of T2DM

A

glycemic control
improve insulin insensitivity
treat comorbidities
prevent vascular complications

125
Q

mechanism of action metformin

A

decrease hepatic glucose production

improve insulin sensitivity

126
Q

side effects metformin

A

cardiac
GI
renal
lactic acidosis

127
Q

clinical presentation DKA

A 
weight loss
symptoms <1 month
dehydration
Kussmaul
acetone
abdominal pain
vomiting 
obtunded->coma
128
Q

diagnosis DKA

A 
hyperglycemia and acidosis and ketosis (ketonemia, ketonuria)
glucosuria
leukocytosis
elevated amylase
electrolyte abnormalities
129
Q

differential diagnosis DKA

A 
gastroenteritis
ingestion
infections 
pancreatitis 
appendicitis
130
Q

therapy DKA

A

correct dehydration
correct acidosis
correct electrolytes
provide insulin

131
Q

choice to treat dehydration in DKA

A

normal saline

change to 0.45% later

132
Q

add glucose to saline for DKA

A

BS <300

133
Q

treat acidosis in DKA

A

bicarb rarely needed

correcting dehydration and providing insulin sufficient

134
Q

electrolyte treatment in DKA

A

sodium-false hyponatremia
potassium-add when <5.5
Kphos with first liter of fluids
chloride-can worsen the acidosis

135
Q

insulin in DKA

A

stop pump
give regular insulin IV
never stop insulin infusion

136
Q

monitoring of DKA

A 
glucose STAT and q1h
ABG
electrolytes STAT and q2h
EKG
neuro
mannitol
137
Q

osmol serum

A

2Na+glucose/20+BUN/3

138
Q

common age and time of DKA complications

A

7-11 yo

in first 10 hrs

139
Q

cerebral edema

A

treat with mannitol, hypertonic saline ventilation

140
Q

risks cerebral edema

A

younger
new onset
longer duration of symptoms

141
Q

blood clots in urine

A

lower tract source

142
Q

dipstick analysis of hematuria

A

may show false +

143
Q

glomerular bleeding

A

red cell casts
proteinuria
dysmorphic cells

144
Q

isolated glomerular bleeding

A

post infectious glomerulonephritis

exercise induced hematuria

145
Q

persistent glomerular bleeding

A

IgA nephropathy
Alport syndrome
thin basement membrane nephropathy

146
Q

transient hematuria pt >50

A

malignancy

147
Q

primary cancers with hematuria

A

bladder
renal
prostate

148
Q

risk factors malignancy with hematuria

A 
age >50
smoking
analgesic abuse
M>F
gross hematuria
149
Q

urine cytology

A

90% sensitivity for bladder cancer

use for at risk patients

150
Q

imaging tests

A

CT urography (high sensitivity but also high radiation)
renal US
retrograde pyelography

151
Q

cytoscopy

A

used for all adults with unexplained hematuria

only test that visualizes urethra and prostate

152
Q

risk factors nephrolithiasis

A 
urine composition
history
family history 
increases in oxalate absorption (gastric bypass)
some meds
low fluid intake
persistent acidic urine 
upper tract UTI
153
Q

symptoms nephrolithiasis

A

pain
gross hematuria
N/V
dysuria and urgency

154
Q

differential diagnosis nephrolithiasis

A 
ectopic pregnancy
abdominal aortic aneurysm
acute intestinal obstruction
appendicitis 
drug seeking patients
155
Q

confirmatory test nephrolithiasis

A

non-contrast helical CT

almost 100% sensitive

156
Q

US for nephrolithiasis

A

used in pregnant women

may miss small stones

157
Q

abdominal radiograph miss stones

A

misses uric acid stones or small stones

158
Q

acute therapy for nephrolithiasis

A 
pain control (NSAIDs, opioids)
hydration
help stone pass-antispasmotic agents, calcium channel blockers, alpha blockers
159
Q

immediate expulsive therapy for nephrolithiasis

A

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
Q

causes of transient hematuria in children

A

UTI
trauma
fever
exercise

161
Q

causes of persistent hematuria in children

A 
IgA nephropathy
thin basement membrane disease
Alport syndrome (x linked recessive)
postinfectious glomerulonephritis 
hypercalcuria (high urinary Ca/Cr ratio)
162
Q

Alport syndrome

A

hearing loss, ocular abnormalities, progressive renal failure over time

163
Q

Nutcraker syndrome

A

L renal vein compression by aorta and superior mesenteric artery
can have proteinuria also

164
Q

nitrite in urine

A

positive for enterobacteriaceae

165
Q

suprapubic aspiration of bladder

A

needle into bladder (rarely used but best)

166
Q

clean catch urine specimen

A

spread labia, wipe with antiseptic wipe F2B and place cup in midstream

167
Q

indications for urine culture

A

suspicion of complicated UTI
atypical symptoms
treatment failure
recurrent symptoms

168
Q

common etiologies for acute dysuria

A

cystitis
urethritis
vaginitis

169
Q

UTI risk factors

A 
F>M
sexual intercourse 
history
diaphragm use
spermicidal use
pregnancy
urethral catheterization
post menopausal
prostatic hypertrophy
170
Q

common pathogens UTI

A 
E. coli
enterococcus
pseudomonas aeruginosa 
proteus mirabilis
klebsiella pneumoniae 
staph saprophiticus
171
Q

pathogenesis UTI

A

retrograde transmission or hematogenous
sticky bacteria and epithelial cells
fecal germs close to urethra (short in women)
male prostatic secretions are bacteriostatic

172
Q

cystitis

A

lower tract infection

affects bladder wall

173
Q

pyelonephritis

A

upper tract infection

affects kidney

174
Q

upper tract symptoms

A

flank pain
fever
abdominal pain
N/V

175
Q

lower tract symptoms

A

dysuria
frequency
urgency
suprapubic pain

176
Q

symptomatic treatment dysuria

A

phenazopyridine

turns urine red and false + dipstick urinalysis

177
Q

hemolytic anemia from phenazopyridine

A

in patients with G6PD

178
Q

cystitis prevention

A 
cranberry juice-tannins 
void after sex
avoid bath soaking 
wipe F2B
drink water
cotton underwear, loose fitting clothes, decrease warmth
179
Q

uncomplicated UTI

A

cystitis in healthy non-pregnant adult woman

most E. coli or staph saprophyticus

180
Q

complicated UTI

A 
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
Q

common antibiotics for UTI treatment

A 
flouroquinolones
TMP/SMX
tetracyclines
nitrofurantoin
cephalosporins
penicillins
182
Q

admit for pyelonephritis

A 
more severe, toxic appearing
complicated UTI (elderly, instrumented, diabetic, urologic abnormality)
unable to take oral meds
pregnancy
compliance issues
183
Q

dysuria in male

A

chlamydia

184
Q

dysuria and discharge in male

A

gonorrhea

185
Q

urinlysis for chlamydia

A

pyuria without bacteriuria

186
Q

urethral culture for gonorrhea

A

calcium alginate tip swab onto pre-warmed Thayer-Martin agar

187
Q

common etiologies vaginitis

A

candida
trichomonas
bacterial

188
Q

atrophic vaginitis

A

post-menopausal, estrogen deficient women
may experience dysuria
topical estrogen effective

189
Q

irritant dysuria

A

reaction to local contract with irritant

can be from contraceptive gel, tampon, condom, bubble baths

190
Q

non-infectious causes of dysuria in children

A

irritants
minor trauma
labial adhesions with small tears
psychogenic

191
Q

indications for long-term catheterization

A

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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