Eent Flashcards
(491 cards)
1
Q
What do you see in the eye with hypertension?
A
That AV nicked my copper wire and burst into flames.
AV nicking.
Copper wire.
Flame hemorrhages
Cotton wool spots
2
Q
What do you see in the eye with diabetes mellitus?
A
Blot had a micro amount of new cotton candy
Cotton wool spots.
Micro aneurysms.
Neuro vascular
Blot hemorrhage
3
Q
In the eye what size are the retinal vessels and veins?
A
Arteries are brighter, red and narrow than veins with artery and vein having a 2 to 3 or 4 to 5 ratio
4
Q
What does the Snellen eye chart mean?
A
2020 means that the patient can see at 20 feet with a normal person can see at 20 feet the larger the denominator of the poor of the patient’s vision.
5
Q
Hyperopia
A
Farsightedness.
We’ll see in an older person
An example would be an older person, reading the newspaper, and having to move back the newspaper to view the words
6
Q
Myopia
A
Nearsightedness, we’ll see in younger people
7
Q
Presbyopia
A
Common after age 40, results and greater difficulty maintaining a clear focus at a near distance due to the lessening of flexibility of the crystalline, lens and weakening of the Solari muscle which controls Lens focus
8
Q
Arcus senilis
A
Cloudy appearance of the cornea with a gray white arc or circle around the limbus due to deposition of lipid material the arcus has no effect on vision could indicate hyper lipidemia
9
Q
Arcus senilis
A
Cloudy appearance of the cornea with a gray white arc or circle around the limbus due to deposition of lipid material the arcus has no effect on vision could indicate hyper lipidemia
10
Q
Pterygium
A
Raised, wed shaped growth of thin, non-cancerous tissue over the conjunctiva normally seen in dry climates or surfers
11
Q
HORDEOLUM or stye
A
Acute inflammation caused by staphylococcus aureus
Signs and symptoms include abrupt onset, accompanied with pain and erythema of the eyelid. Localized tender mass developing an eyelid.
Management, hot compresses for 10 minutes for two times a day. Next line if needed oral antibiotics for preseptal cellulitis, which include clindamycin, Bactrim, augmentin. Or cefdinir
12
Q
CHALAZION
A
Be nodule on the eyelid, infection, or retention cyst of the meibomian gland usually on the upper eyelid.
Symptoms: swelling on the eyelid, eyelid, tenderness, sensitivity, to light, increase tearing, if very large may cause astigmatism due to pressure on the cornea.
Management, warm compresses, and referral for surgical removal
13
Q
Blepharitis
A
Staphylococcus infection of seborrheic dermatitis of the lid edge
Signs and symptoms: red, scaly, greasy flakes. Thickened, crusted lid margins. Burning. Itching. Tearing.
MANAGEMENT, hot compresses. Topical antibiotics such as bacitracin or erythromycin. Vigorously, scrub lashes and lid margins with eyes closed and follow with thorough rinsing .
14
Q
Conjunctivitis
A
Pink eye, resulting from allergies, chemical, irritation, bacterial, viral, or Gyno cockle or chlamydia infections.
15
Q
What does bacterial conjunctivitis look like in symptoms and what is the treatment?
A
Purulent discharge.
Self limiting: antibiotic ointment are drops which include floxicins and mycins
If recurrent refer to ophthalmologist
16
Q
What does gonococcal conjunctivitis look like? Is it an emergency? And what do you do?
A
Yes, it is an emergency.
The discharge is copious and purulent.
Referred to ophthalmologist, ceftriaxone 1 g IM plus azithromycin 1gm single dose
17
Q
What is chlamydia conjunctivitis and what do you do?
A
Doxycycline 100 milligrams twice a day for 10 days or azithromycin 1gm single dose
18
Q
What is allergic conjunctivitis look like and what do you do?
A
Stringy discharge, increase tearing.
Oral antihistamines, refer to allergist or ophthalmologist. Steroids are not ordered in primary care because of the possible increase intraocular pressure and activation of herpes simplex virus.
19
Q
What does viral conjunctivitis look like and what do you do?
A
Watery discharge.
Symptomatic care: preservative, free, artificial tears, cool compresses with washcloth, and NSAIDS
20
Q
What does herpatic conjunctivitis look like? And what do you do?
A
Bright red eyes and irritated.
Referred to ophthalmologist, treatment includes course of oral antivirals, such as aCyclovir and long-term follow up
21
Q
When do you screen for glaucoma?
A
Recommended by age 40 by tonometry
22
Q
What are the symptoms of open angle glaucoma?
A
Asymptomatic
elevated intaocular pressure.
Cupping of the disc,
Construction of visual fields
23
Q
What are the signs and symptoms of closed angle glaucoma?
A
It is acute
Extreme pain.
Blurred vision.
Halos around lights*
Pupils dilated or fixed
24
Q
What is the normal intraocular pressure
A
10-20
25
What is the treatment for closed angle glaucoma?
Diamox
Osmotic diuretics mannitol
Surgery
26
What is the definition of cataracts?
Clouding and opacification of the normally clear lens of the eye.
Highest cause of treatable blindness, most common surgical procedure in patience 65 and older is senile cataracts
27
What are the signs and symptoms of cataracts?
Painless
Clouded, blurred, or dim vision.
Halos around light.
Difficulty with vision at night.
Sensitivity to light and glare.
Fading yellowing of colors.
Double vision in a single eye.
The need for brighter light for reading and other activities.
No red reflex
Opacity of the lens
28
What are the sides and symptoms of retinal detachment?
Flashes of light PHOTOPSIA, especially in peripheral vision.
Floaters in the eye.
Blurred vision.
Shadow or blindness in a part of a visual field of one eye
REFERRAL for surgery
29
Otitis externa
Inflammation and or infection of the external auditory canal and or auricle and tympanic membrane
30
Symptoms of acute local otitis externa or furunculosis
Cause: staphylococcus aureus
Pustules in the outer third of the ear canal.
Severe pain otalgia with area of cellulitis
Itching
Erythema
Scaling
Crusting
Fishering
Possible exudates
31
What is the management for otitis externa?
Cleansing and debridement of the ear.
Topical OTIc drops: hydrocortisone/neomycin/polymyxin or Cortisporin ear drops
NSAIDs
32
What is the treatment for acute otitis media and serous otitis media if suspected bacteria
Augmentin or a cephalosporin such as cefdinir, cefpodoxime, or cefuroxime
33
When doing a Weber test with suspected conductive hearing loss where does the sound lateralizes to the affected ear or the unaffected ear?
Sound lateralizes to the affected ear
34
When doing a RINNE test which ear would be abnormal?
It would be abnormal in the affected ear, which means air conduction would be less than bone conduction
35
When doing a Weber test with suspecting SENSORINEURAL hearing loss where does the sound lateralize?
The sound lies to the unaffected ear
36
Rinne is only abnormal in the conductive hearing loss? True or false
True
37
Pharyngitis/ tonsillitis signs and symptoms
ANTERIOR CERVICAL ADENOPATHY-strep
MACULOPAPULAR RASH-strep
38
Lab test for pharyngitis/tonisillitis
Rapid strep
MONOSPOT
CBC
39
Antibiotics for strep infection
Penicillin V or amoxicillin
40
If allergic to PCN which drug would you chose for strep throat
Cephalexin
Cefadroxil
Clindamycin
Azithromycin
Clarithromycin
41
Mono is caused by which virus
Epstein Barr
42
Signs and symptoms of mono
POSTERIOR CERVICAL ADENOPATHY
WHITE TONISILAR EXUDATES
FEVER CHILLLS ANOREXIA
43
Which test do you do for mono?
Mono spot positive
Increase WBC with relative lymphocytosis and neutropenia
44
Which antibiotic do you use for bacterial sinusitis?
Augmentin or doxycycline if penicillin allergy
45
Impetigo describe and treatment
Honey colored crusts at the edge.
Infection of the skin classically caused by staph aureus
Primary lesion is a thin walled vesicle that breaks easily.
Treatment; mupirocin cream or ointment
If widespread can use oral abts: dicloxacillin, cephalexin, or clindamycin
46
Squamous cell carcinoma
They arise out of actinic keratoses
Firm regular popular or nodule.
Develop over a few months 3 to 7% metastasize.
Prolonged sun, exposed areas and fair skin people.
Keratotic, scaly bleeding
Treatment biopsy
47
Seborrheic keratoses
Benign, not painful lesions
Beige, brown or black plaques.
Stuck on appearance”
3 to 20 mm in diameter.
Treatment: liquid nitrogen
48
Actinic keratosis
Small patches occurring on some exposed parts of the body.
Premalignant lesions progressed to squamous cell carcinoma
Asymptomatic
Rough FLESH colored, pink or hyperpigmented
49
Basal cell carcinoma
Most common skin cancer.
Slow growing lesion, one to 2 cm after years.
Waxy, PEARLY, appearance may be shiny red
Central depression, or rolled edge.
May haveTelangiectatic vessels
50
Malignant melanoma
ABC DEE
Asymmetry.
Border irregularity
Color variation
Diameter, greater than 6 mm
Elevation.
Enlargement
51
Eczema also known as a topic dermatitis what does it look like and what is the treatment?
Chronic skin condition caused by intense itching.
Acute flareups look like red, shiny, or thicken patches.
Inflamed, scabbed lesions with redness and scaling.
Dry, LEATHERY lichenifications
Treatment: topical steroids CLOBESTASOL CREAM
52
Explosive onset of psoriasis, test for what?
HIV
53
Auspitz sign
Droplets of blood when scales are removed.
Seen in psoriasis
54
Treatment for psoriasis
For scalp: tar/salicyclic shampoo
Topical steroids- bethamethasone
UVB LIGHT EXPOSURE
55
Pityriasis Rosea description
Mild and acute inflammatory disorder.
More common and females during spring and fall.
Itchy rash found on trunk and proximal extremities.
HAROLD patch which is the initial lesion measuring 2 to 10 cm
Follows a Christmas tree pattern.
Eruption last 4 to 8 weeks
56
Laboratory and diagnostic test for PITYRIASIS ROSEA
Serology test for syphilis should be performed. If colon lesions are not itching, lesions are present on hands and feet, lesions are few and perfect.
57
Xanthelasma
Yellow plaques under eye from high cholesterol
58
What is the treatment for Lyme disease and Rocky mounted spotted fever
Doxycycline
59
What is the treatment for Lyme disease and Rocky mounted spotted fever
Doxycycline
60
What test do you do for limes disease initial and confirmatory
Initial test is the ELISA.
The confirmatory test is Western blot
61
What test do you do for Rocky mounted spotted fever
PCR
IHC staining
IFA
62
Physical findings in acute bronchitis
Upper airway Rhonchi cleared with coughing
Resonance to percussion normal
No evidence of lung consolidation
63
Physical findings in acute bronchitis
Upper airway Rhonchi cleared with coughing
Resonance to percussion normal
No evidence of lung consolidation
64
How to differentiate bronchitis from pneumonia?
Ask patient to cough into tissue when osculating will be clear with bronchitis, but not pneumonia
65
Hyper resonance to percussion is what diagnosis
COPD or asthma
66
Antibiotics used to treat acute bronchitis only for bacterial infections are?
Macrolides.
Doxycycline.
Bactroban
67
Is asthma broncoconstriction?
Yes
68
Signs and symptoms of asthma
Pulse greater than 110
Pulses, paradox greater than 12 mmHg (intrathoracic pressure)
Hyperresonance
69
Laboratory signs for asthma
Slight WBC elevation with esosinophillia
PFT reveal abnormalities typical of obstructive dysfunction
Initially respiratory alkalosis with mild hypoxemia on ABGs
Chest x-ray is unnecessary and less to rule out other conditions may show hyper inflation
70
Laboratory signs for asthma
Slight WBC elevation with esosinophillia
PFT reveal abnormalities typical of obstructive dysfunction
Initially respiratory alkalosis with mild hypoxemia on ABGs
Chest x-ray is unnecessary and less to rule out other conditions may show hyper inflation
71
Treatment for chronic bronchitis and emphysema or COPD
A: bronchodilator
B: LABA + LAMA
E: LABA + LAMA
— consider adding ICS if blood eosinophils greater than 300
72
Pneumonia, signs and symptoms and most common agent found in community acquired pneumonia
Streptococcus pneumoniae
Fever/chills
Purulent sputum
Lung consolidation in physical exam
Malaise
INCREASED FREMITIS
73
Atypical pneumonia signs and symptoms
(Walking pneumonia)
More ENT involvement
Cough.
Headache.
Sore throat.
Excessive sweating.
Fever
Soreness, of chest
74
Treatment for low severity outpatient CAP( healthy, no use of antimicrobials within the past three months, no core abilities or risk factors for Mersa or pseudomonas aeruginosa
One period amoxicillin 1 g TID or
Doxycycline 100 mg b.i.d. or macrolide such as azithromycin and clarithromycin
75
Treatment for moderate to high severity outpatient CAP includes patient with comorbiditues or risk factors for resistant organisms
1. Augmentin or cephalosporin plus macrolide or doxycycline OR
2. Mono therapy with levaquin 750 or moxifloxicin
76
Medication regimen for TB
Rifampin
Isonaizid
Pyrazinamide
Ethambutol
Person with HIV should be treated for 9 months
Shortest amount of time on drugs is 6 months
77
Patients taking ethambutol should be tested for___________ and ______ ______ ________-
Visual acuity and red green color perception
78
Chvostek sign
Hypothyroidism
Sustained cheek blinking
79
Trousseau
Hypothyroidism
Carpal pedal spasm from BP cuff
80
Trousseau sign
Hypothyroidism
Carpal pedal spasm from BP CUFF
81
Biguanide class
Metformin
Glucophage
Drug of choice for a starter drug for most patients with type two diabetes
Lowers basal and postprandial glucose levels by affecting glucose absorption and hepatic glucogenesis
Weight loss and reduce LDL’s
Discontinue one to two days before receiving contrast
82
GLP-1 agonist
Dulaglutide
Exenatide
Semaglutide (ozempic)
Semaglutide(Rybelsus) tablet
Black box warning- thyroid cancer and pancreatitis
83
Diabetic ketoacidosis
Symptoms
Seen in type 1 DM
state of INTRACELLULAR, dehydration, as a result of elevated blood glucose levels
Signs and symptoms include polyuria, polydipsia, weakness, fatigue, nausea, and vomiting, Kusum, all breathing, which is rapid breathing, altered level of consciousness, fruity breath, blowing off CO2, hypotension, and tachycardia poor skin turgor
84
Labs in DKA
BG- 250-300
Ketoanemia or ketonuria
Metabolic acidosis- less than 7.30
Elevated hct, BUN, cr, potassium and osmolality
85
HHS
Signs and symptoms
State of greatly elevated serum glucose, hyper, osmolality, and severe intracellular dehydration.
Seen in type two diabetes.
PolyuriA
Weakness
ALTERED LOC
HYPOTENSION
Tachycardia.
Poor skin TURGOR.
86
Labs and diagnostic in HHS
Greatly elevated serum glucose 600 to 1000
Hyper osmolality
Elevated Bun and creatinine
Elevated hemoglobin A1c.
Relatively normal pH
Normal anion gap
87
Which drug is used for symptomatic relief of hyperthyroidism
Propanolol 10 mg may go up to 80 mg four times daily
88
Treatment for hyperthyroidism
Tapazole 30 to 60 mg every day in three divided doses.
PROPYLTHIOURACIL – PTU– 300 to 600 mg daily and four divided doses.
Radioactive iodine 131 – I used to destroy goiters.
Thyroid surgery.
LUGOL solution 2 to 3 drops every day for 10 days
89
Hyperthyroidism lab values
TSH mostly low
Serum, T3, T4, thyroid, resin, uptake, and free thyroxine index increased.
Sometimes T4 is normal, but T3 is elevated 80 to 230
90
Hyperthyroidism lab values
TSH mostly low
Serum, T3, T4, thyroid, resin, uptake, and free thyroxine index increased.
Sometimes T4 is normal, but T3 is elevated 80 to 230
91
Hypo thyroidism laboratory values
TSH is elevated.
T4 is low or low normal.
T3 is decreased.
92
Signs and symptoms of hyper parathyroidism
Asymptomatic,
Fatigue,
Depression,
Bone, joint pain.
Muscle weakness
Anorexia vomiting.
Kidney stones
93
Laboratory values, and hyperparathyroidism
Elevated intact plasma parathyroid, hormone with elevated calcium and decreased phosphorus
94
What is the only known cure for hyper parathyroidism
Parathyroid ectomy
95
Signs and symptoms of hypo parathyroidism
Patchy hair loss,
Fatigue
Anxiety or depression.
Painful menstruation.
Horses or dyspnea.
Paresthesia in fingertips, toes, and or perioral
Tetany, and feet legs, arms, and or abdomen which are involuntary contractions or muscle cramps
Chvostek sign or trousseau sign
96
Laboratory value in hypoparathyroidism
Decrease calcium increased phosphorus, and a decrease in parathyroid hormone
97
Laboratory values in Cushing syndrome
High blood sugar, high sodium
low potassium
Leukocytosis.
Elevated plasma cortisol in the morning
98
What is the treatment for Cushing?
Depends on cause discontinue medication’s inducing symptoms, a transphenoidal resection of the pituitary adenoma.
Surgical removal of adrenal tumors.
Management of electrolyte balance
99
What are the laboratory values for Addison’s disease?
Hypoglycemia
Hyponatremia
Hyperkalemia,
Elevated ESR
Lymphocytosis.
Cosyntropin= to rule in or out addisons
100
Treatment for Addison’s
Mineral corticoid = androgen plus aldosterone
Hydrocortisone
fludroCortizone acetate
101
Which kind of ulcer is relieved by eating?
Duodenal
102
Which kind of ulcer is relieved by eating?
Duodenal
103
Which kind of ulcer does the pain worsen with eating?
Gastric
104
Which kind of ulcer happens with a physical finding of coffee ground emesis
Duodenal ulcer
105
Which kind of ulcer happens with a physical finding of coffee ground emesis
Duodenal ulcer
106
Long-term use of PPI is associated with which illnesses and what is the black box warning
B12 deficiency
Dementia
Cdiff
Chronic kidney disease.
Blackbox warning: increase incident of osteoporosis, specifically hip fractures
107
How long do you wait for an endoscopy after treatment of peptic ulcer disease?
8 to 12 weeks of treatment
108
H2 blockers end in
-dine
109
PPI end in
Prazole
110
H. Pylori treatment
TWO ABTS AND A PPI - 7-14 days of antibiotics and additional 6-8 weeks with PPI
MOC
AOC
MOA
111
Education for mucosal, protective agents, such as Pepto-Bismol, cytotec , Maalox, Mylanta, milk of magnesia include?
Give two hours apart from other medication‘s
112
What do you do if gastroenteritis is persistent longer than 72 hours or blood is noted in the stool
Stool for culture, WBC’s and ova and parasites.
Stool may be guiac positive if a bacterial infection is present
113
HBsAg, HBeAg, Anti-HBc, IgM
Active Hepatitis B
114
HBsAg, Anti-HBc, Anti-HBe, IgM, IgG
Chronic Hep B
115
Anti-HBc, Anti-HBs
Recovered Hep B
116
Anti-HAV, IgM
Active hep A
117
Anti-HAV, IgG
Recovered hep A
118
What do you order to differentiate prior exposure from current?
PCR
119
What lab will you have if successfully vaccinated from hepatitis b?
Anti-HBs- hepatitis b surface antibody
120
Anti-HCV, HCV RNA
Acute hep C
121
Anti- HCV, HCV RNA
chronic hepatitis c
Same as acute. Order pcr
122
Which quadrant is diverticulitis?
Left lower quadrant tenderness to palpation
123
Why is a plain abdominal obtained in diverticulitis and what are we looking for?
Looking for evidence of free air, which would indicate a perforation
124
What dietary consideration would indicate diverticulitis
Individuals with low dietary fiber intake
125
What is the Murphy sign and what would it indicate as a diagnosis?
Deep pain and inspiration while fingers are placed under the right rib cage and it would indicate cholecystitis
126
What is the Murphy sign and what would it indicate as a diagnosis?
Deep pain and inspiration while fingers are placed under the right rib cage and it would indicate cholecystitis
127
What is cholecystitis and what is it often associated with?
Inflammation of the gallbladder, associated with gallstones and 90% of the cases
128
What is cholecystitis and what is it often associated with?
Inflammation of the gallbladder, associated with gallstones and 90% of the cases
129
What are the signs and symptoms of cholecystitis?
Often after a large or fatty meal
Sudden appearance of steady, severe pain in the epigastric or right hypoChondrium
Vomiting in many clients afford relief
130
What are the signs and symptoms of cholecystitis?
Often after a large or fatty meal
Sudden appearance of steady, severe pain in the epigastric or right hypoChondrium
Vomiting in many clients afford relief
131
What are the physical findings in cholecystitis?
Murphy sign.
Right upper quadrant tenderness to palpation.
Fever
Muscle guarding and rebound pain
132
What are the physical findings in cholecystitis?
Murphy sign.
Right upper quadrant tenderness to palpation.
Fever
Muscle guarding and rebound pain
133
What are the Lab values in cholecystitis and what is the gold standard in effective image testing?
Elevated white count, Billy Rubin, AST, ALT, LDH, amylase.
Ultrasound is the gold standard
134
What is the management for cholecystitis?
NG tube
IV
G.I. consult
pain management
135
What is the definition of ulcerative colitis?
Idiopathic inflammation characterized by mucosal inflammation of the colon it involves the rectum and may extend upward involving the whole colon
136
What is the definition of ulcerative colitis?
Idiopathic inflammation characterized by mucosal inflammation of the colon it involves the rectum and may extend upward involving the whole colon
137
Signs and symptoms of ulcerative colitis
Bloody diarrhea is a hallmark symptom.
Rectal TENESMUS or the feeling like they have to have a bowel movement
138
Laboratory or diagnostics for ulcerative colitis
Stool studies are negative
Sigmoidoscopy establishes the diagnosis
139
Management for ulcerative colitis
Mesalamine(Canasa) suppositories or enema for 3 to 12 weeks.
Hydrocortisone, suppositories and enemas
140
What is often a sign and symptom of colon cancer
Changes in bad habits, specifically, thin stools, or ribbon stools that originate from the descending colon cancer.
Weight loss
141
Diagnostics for colon cancer
Stool may be guiac positive
Colonoscopy
CBC
CEA elevated
Non-smokers less than 2.5
Smokers less than 5
142
Which quadrant is the appendicitis in?
Right lower quadrant
143
McBurney’s point tenderness
1/3 the distance from the anterior superior iliac spine to the umbilicus
Acute appendicitis
144
McBurney’s point tenderness
1/3 the distance from the anterior superior iliac spine to the umbilicus
145
Psoas sign
Pain with right thigh extension
Only right thigh
Appendicitis
146
Obturator sign
Pain with internal rotation of flexed right knee
147
Positive rovsing sign
Right lower quadrant pain when pressure is applied to the left lower quadrant
148
What is suspected in appendicitis when the fever is very high
Perforation or another diagnosis
149
Tanner stage one for girls
Pre-adolescent breast
150
Tanner stage two for girls
Breast buds with Ariola enlargement
151
Tanner stage three for girls
Breast enlargement without separate nipple contour
152
Tanner stage three for girls
Breast enlargement without separate nipple contour
153
Tanner stage four for girls
Ariola and nipple project as secondary mound
154
Tanner stage five for girls
Adult breast: Ariola recedes, nipple retracts
155
Low grade squamous intraepithelial lesion
Cervical intraepithelial neoplasia (CIN) 1- HPV OR MILD DYSPLASIA
156
High grade squamous intrepithelial lesion
CIN 2: Moderate dysplasia
CIN 3: severe dysplasia
REFER PATIENT
157
High grade squamous intrepithelial lesion
CIN 2: Moderate dysplasia
CIN 3: severe dysplasia
REFER PATIENT
158
CIS
Carcinoma in situ
159
Trichomoniasis
Malodorous, frothy, yellowish green discharge, itchy, vaginal erythema, strawberry patches on cervix (colpitis macularis) and vagina, painful sex, painful urination
160
Bacterial vaginosis
Watery, gray, fishy, smelling discharge, vaginal spotting
161
Candidiasis
Thick, white, curd like discharge Vulvovaginal redness with itching
162
Testing for trichomonas, bacterial vaginosis, candidiasis
Microscopic wet prep may use NAAT or vaginal culture
163
Description of diagnostic testing with trichomonas
Normal saline mixture shows motile trichomonads low sensitivity, compared to culture
164
Description of diagnostic testing with bacterial vaginosis
Normal saline mixture shows irregularly shaped vaginal epithelial cells also known as clues cells: potassium hydroxide KOH added to culture produces characteristic odor also called the whiff test
165
Description of diagnostic testing for candidiasis
KOH mixture shows pseudoHyphae
166
Description of diagnostic testing for candidiasis
KOH mixture shows pseudoHyphae
167
Treatment for trichomonas
Metronidazole
500mg po for 7 days women
2gm orally x1 men
168
Treatment for bacterial vaginosis
Metronidazole 500mg x7 days
Or
Gel intravaginally x 5 days
Or
Clindamycin cream intravaginally at bedtime x 7 days
Or tinidazole orally or Clindamycin orally
169
Treatment for candidiasis
OTC ZOLE INTRAVAGINALLY OR
FLUCONAZOLE ORAL x1
170
Symptoms of pelvic inflammatory disease
Positive cervical motion, tenderness,
Adnexal tenderness- area over ovaries tenderness
Fever
171
Treatment of PID
Ceftriaxone 500mg IM plus doxy and metronidazole x 14 days
Or
Cefoxitin 2g IM with probenecid orally with doxy and metro x 14 days
172
If bleeding is uterine, determine the caused by the PALM – COEIN pneumonic
Polyps
Adenomyosis
Leo myoma
Malignancy and hyperplasia.
Coagulopathy.
Ovulatory dysfunction
Endometrial causes.
Iatrogenic causes next line not yet classified
173
Breast cancer, symptoms, and history
Non-tender painless mass.
Asymptomatic – later symptoms include pain, erythema, dimpling, ulceration, nipple retraction
174
Physical examination for breast cancer
One – nontender with poorly defined borders.
2 fixed and firm
3 may also find dimpling, nipple reactions, bloody discharge, lymphadenopathy
4 may have bloody nipple discharge
175
Intraductal papilloma
Benign and may have serosanguinous discharge from nipple
176
At what age do you start breast cancer screening and how often do you do it?
Screening will start at age 40 and will be annually for the ages of 45 to 54 and then every two years after the age of 55.
You can stop at age 75
177
What non-hormonal treatment is used in the symptoms of menopause?
Paroxetine 7.5 mg per day or SSRI ssnri
178
Why does anorexia lead to osteoporosis?
Because the excess exercise or eating disorder leads to amenorrhea, which leads to decrease amount of estrogen resulting in bone loss
179
What is the other name of osteopenia?
Low bone mass
180
When taking supplement for osteoporosis, which drug should you avoid?
Avoid aluminum containing antacids because the calcium binds with aluminum
181
What is the other name of a butterfly rash?
Malar rash
182
What is the management for lupus?
Sun protection.
Rest
NSaIDS, Hydroxycholoquines, glucocorticoids
183
Sensitivity
Positive shows positive
184
Specificity
Negative shows negative
185
Antibiotic for uncomplicated cystitis of lower UTIs
Macrobid 100mg bid x 5 days
Or
Bactrim bid x 3 days
Or
Fosfomycin 3mg x 1
186
Which drug can you not give a pregnant person after 36 weeks gestation for an uncomplicated UTI
Macrobid
187
During pregnancy which antibiotic should be considered for an uncomplicated UTI (4)
Amoxicillin, Augmentin, Macrobid under 36 weeks, Keflex
188
What is the other name of an upper UTI?
Pyelonephritis
189
Signs and symptoms of an upper UTI
Flank, low back or abdominal pain.
Fever and chills.
Nausea, vomiting.
Mental status changes in the elderly
190
Laboratory values for upper UTI
White blood cell cast seen on urinalysis
ESR elevated with pylon nephritis
191
Treatment for upper UTIs
Cipro 500 mg by mouth twice a day for seven days if uncomplicated
Levofloxacin
Ceftriaxone 1gm IV EVERY 24 hours for 14 days
192
Management for stress incontinence
Timed voids to prevent full bladder
Pessary.
Surgery
193
Management for stress incontinence
Timed voids to prevent full bladder
Pessary.
Surgery
194
Management for urge incontinence
Urge suppression/distraction.
Quick pelvic contractions.
Medication
195
Tanner stage one in boys
Pre-adolescent testes, scrotum, penis
196
Tanner stage one in boys
Pre-adolescent testes, scrotum, penis
197
Tanner stage two in boys
Enlargement of scrotum and testes: scrotum, roughens and reddens
198
Tanner stage two in boys
Enlargement of scrotum and testes: scrotum, roughens and reddens
199
Tanner stage three in boys
Penis elongates
200
Tanner stage three in boys
Penis elongates
201
Tanner stage four in boys
Penis enlarges in breath and development of glands; rugae appears
202
Tanner stage 5 in boys
Adult shape and appearance
203
What is the common cause of epididymitis in men less than 35 years of age?
Chlamydia
204
What are the symptoms of epididymitis?
UTI symptoms plus scrotal edema
205
Cremasteric reflex
Rub the thigh and scrotum goes up
Normal in epididymitis and absent in testicular torsion
206
Cremasteric reflex
Rub the thigh and scrotum goes up
Normal in epididymitis and absent in testicular torsion
207
Physical examination in epididymitis
Enlarged and tender epididymitis.
Urethral discharge may be evident positive PREHN sign
208
Diagnostic test for epididymitis
STD testing
Culture of urine
Scrotal ultrasound to rule out testicular torsion
209
Treatment for epididymitis
For a cute epididymitis, most likely caused by sexually transmitted, chlamydia and gonorrhea.
Ceftriaxone 500 mg Im times one + doxycycline 100 mg b.i.d. for 10 days
Can also use levofloxacin 500 mg oral once a day for 10 days
210
Acute bacterial prostatitis cause
Usually caused by gram-negative bacteria, especially E. coli.
Non-bacterial prostatitis, mostly in young men caused by chlamydia
211
Acute bacterial prostatitis cause
Usually caused by gram-negative bacteria, especially E. coli.
Non-bacterial prostatitis, mostly in young men caused by chlamydia
212
Signs and symptoms of acute bacterial prostatitis
Fever or chills
Low back pain
Dysuria.
Urgency, and frequency.
Nocturia
213
Physical examination of acute bacterial prostatitis
Edema of the prostate may be warm and tender or boggy to palpation and will have pain
214
Diagnostic testing for acute bacterial prostatitis
Urinalysis.
Urine culture as usually positive for causative agent
215
Treatment for acute bacterial prostatitis
Antibiotic.
Single dose ceftriaxone 250 mg I M or single-dose cefixime 400 mg orally or Cipro Floxin 500 mg orally twice a day for 10 to 14 days or level Floxin 500 mg to 750 mg oral daily for 10 to 14 days. Next line sits back three times a day for 30 minutes each treatment.
216
Which herbal agent is effective in BPH
Saw Palmetto
217
What would a physical examination of someone that has BPH look like
Bladder dissension may be present.
Prostate is nontender with either asymmetry or symmetrical enlargement.
Smooth, rubber consistency with possible nodules
218
What are the advanced stages of prostate cancer?
Bone pain
219
What are the physical examination of prostate cancer?
Adenopathy.
Bladder distention
Prostate palpate harder than normal with obscure boundaries and nodules may be present
220
Normal values of PSA
40-49- less than 2.5
50-59 less than 3.5
60-69 less than 4.5
70-79 less than 6.5
221
When does the sero conversion process of converting HIV negative to HIV positive happen to look like and how long does the process take?
Looks like flu like symptoms and an approximately takes three weeks to six months
222
Aids occurs when the CD4 count is what
Less than 200
223
What is the first test for HIV?
HIV 1/2 antigen/antibody combination immunoassay
224
If HIV 1/2 antigen/antibody combination immunoassay is positive, which test do you do?
HIV-1/HIV -2 antibody differentiation immunoassay
225
If HIV 1/2 antigen/antibody combination immunoassay is positive, which test do you do?
HIV-1/HIV -2 antibody differentiation immunoassay
226
What is the normal CD4 count
500-1200
227
What is the normal CD4 count
500-1200
228
Antibiotic for pneumocystis pneumonia and toxoplasmosis
Bactrim
229
Antibiotic for pneumocystis pneumonia and toxoplasmosis
Bactrim
230
Antibiotic for Mycobacterium avium
Azithromycin
231
Chancroid signs and symptoms
Women are usually asymptomatic. Next line men: single or multiple superficial PAINFUL ulcer, surrounded by edematous halo.
Ulcers may be necrotic or severely erosive
232
How to diagnose chancroid
Probable diagnosis is usually matter of exclusion.
Involves genitalia and unilateral bubo or both – swollen inguinal lymph node
Painful, genital ulcers in absence of herpes simplex virus with coexisting, tender, inguinal lymphadenopathy.
233
Treatment for chancroid
Azithromycin 1 g by mouth for one dose. Or
Rocephin 250 mg Im x1
Or
Cipro 500 mg BID for three days
Or
Erythromycin 500 mg three times a day for seven days
234
Signs and symptoms of chlamydia in women
Females often asymptomatic
Dysuria
Spotting
Postcoital bleeding
Dyspareunia
Vaginal discharge
235
Signs and symptoms of chlamydia and men
Dysuria.
Thick, cloudy penile discharge.
Testicular pain.
Rectal Tenesmus
236
Laboratory and diagnostic test for chlamydia
Nucleic acid amplification test NAAT to detect bacteria, DNA or RNA
Women – vaginal or cervical swabs optimal or first void urine
Men first void urine or urethral swab
237
Treatment for chlamydia
Doxycycline 100 mg BID times seven days
Alternatively – azithromycin 1 g PO times one dose or levofloxacin 500 mg daily times seven days
238
Genital warts (condyloma Acuminata) signs and symptoms
Single or multiple soft, fleshy, papillary, painless, keratinized, growth around anus, Vulvovaginal area, penis, urethra, or perennial
Genital warts- HPV 6&11
239
At what age do you give the Gardasil vaccine and how is it administered?
Given at age 15 to 45 years of age and given in three dose schedule at zero, two months, and six months
240
At what age do you give the Gardasil vaccine and how is it administered?
Given at age 15 to 45 years of age and given in three dose schedule at zero, two months, and six months
241
Signs and symptoms of gonorrhea in women
GG
Often asymptomatic
Dysuria.
Urinary frequency.
MUCOPURULENT VAGINAL DISCHARGE(green)
Lower abdominal pain
Fever
Dysmenorrhea
242
Signs and symptoms of gonorrhea in men
Dysuria
Frequency
White/yellow GREEN penile discharge.
Testicular pain
243
Laboratory testing for gonorrhea
NAAT using urine sample.
POC NAAT GeneXpert
Culture using modified THAYER – Martin media, Endo, cervical and females and urethral in male
244
Laboratory testing for gonorrhea
NAAT using urine sample.
POC NAAT GeneXpert
Culture using modified THAYER – Martin media, Endo, cervical and females and urethral in male
245
Treatment for gonorrhea
Ceftriaxone 500 mg IM for one dose less than 150 kg next line if chlamydia infection not ruled out doxycycline hundred milligrams POBID times seven days
246
HSV type one
Found on lips, face, and mucosa
247
HSV type two
Found on the genitalia
248
HSV 2 signs and symptoms
Headache, fever, bodyaches, malaise, joint pain.
First outbreak is usually the worst the first 2 to 3 weeks: reoccur with additional outbreaks, but less severe and shorter distance next line triggers, other viral, or bacterial infections, menstrual periods, stress
249
HSV 2 signs and symptoms
Headache, fever, bodyaches, malaise, joint pain.
First outbreak is usually the worst the first 2 to 3 weeks: reoccur with additional outbreaks, but less severe and shorter distance next line triggers, other viral, or bacterial infections, menstrual periods, stress
250
Laboratory test for HSV type one and type two
NAAT from lesion
Culture from lesion
251
Lymphogranuloma Venereum signs
2-3mm PAINLESS vesicle, bubo(swollen inguinal lymph node) or nonindurated ulcer
Regional ADENOPATHY follows in approximately one month and is the most common finding.
Stiffness and aching, and groin followed by unilateral swelling of the inguinal region
252
Treatment for LGV
Doxycycline 100 mg twice a day for 21 days
Alternatives.
Azithromycin 1 g once per week times three weeks or myosin 500 mg four times a day for 21 days
253
Molluscum Contagiosum signs and symptoms
Lesions1-5 millimeters, smooth, rounded, firm, shiny flash colored to PEARLY, white papules commonly seen on the trunk and anogenital region
254
Treatment for Molluscum Contagiosum
Cryo anesthesia with liquid nitrogen.
255
Symptoms of syphilis in the primary stage
Chancre present at the side of infection common at three weeks after exposure.
chancre indurated and painless
Regional Lymphadenopathy
256
Symptoms of syphilis in the primary stage
Chancre present at the side of infection common at three weeks after exposure.
chancre indurated and painless
Regional Lymphadenopathy
257
Signs and symptoms of syphilis in the secondary stage
Occurred 2 to eight weeks later.
Flu like symptoms.
Generalized lymphadeneopathy next line generalized MACULOPAPULAR RASH, especially on the palms and soles
258
Signs and symptoms of syphilis in Latent stage
Seropositive, but asymptomatic
259
Signs and symptoms of syphilis in the tertiary stage
Leukoplakia
Cardiac insufficiency
Infiltrated, tumors of the skin, bones, liver.
Central nervous system, involvement, such as meningitis, hemiplegia hemiparasis
260
Serology testing for syphilis
VDRL and or rapid plasma REAGIN
Confirmed with TREPONEMAL test, which is
-Treponema pallidum particle agglutination assay( TP-PA)
- Florescent treponemal antibody absorption (FTA-ABS)
- chemiluminescence immunoassay CIA
261
Treatment for primary, secondary, or early late syphilis
Penicillin G 2.4 million units in one dose
262
Treatment for penicillin in late latent or tertiary stage
Penicillin G 2.4 million units weekly times three weeks
263
If allergic to penicillin, what is the treatment for syphilis?
Doxycycline 100 mg b.i.d. for 14 days or tetracycline 500 mg four times a day for 14 days
264
Normal value for TIBC
250-450
265
Normal serum iron
50-150
266
MCH value
26-34
267
MCHC
32-36
268
Iron deficiency anemia description and lab value
Pica
Dyspnea with mild exercise
Weakness
Tachycardia
Labs
Low hemoglobin
Low hct
Low MCV
low MCHC
Low RBC
LIW SERUM IRON, ferritin
HIGH TIBC
HIGH RDW
269
What drug should not be taken with iron and which juice is better to take with iron because it increases absorption?
Antacids and juice that has vitamin C
270
Thalassemia labs and treatment
Decreased hgb
Low MCV
Low MCHC
normal TIBC
NORMAL FERRITIN
No treatment, RBC TRANSFUSION FOR MORE SEVERE CASES
271
Folic acid deficiency signs and symptoms
Fatigue.
Dyspnea on exertion
Glossitis – inflamed tongue/beefy
APHTHOUS ULCERS-stress ulcers on lips
272
Lab values for folic acid deficiency
Hct and hgb decreased
MVC increased
MCHC NORMAL
SERUM FOLATE DECREASED
273
Treatment for folic acid deficiency
Folate 1gm every day
274
Pernicious anemia signs and symptoms
Weakness
Glossitis
Palpitations
PositiveRomberg
Positive Bobinski
Loss of fine motor control.
Loss of vibratory sense
275
Pernicious anemia signs and symptoms
Weakness
Glossitis
Palpitations
PositiveRomberg
Positive Bobinski
Loss of fine motor control.
Loss of vibratory sense
276
Lab values for pernicious anemia
Hemoglobin, hematocrit, and RBCs decreased
MCV increased
Serum B12 decreased or less than 0.1
Anti-– IN anti-parietal cell antibody test firm a deficiency
277
Management of pernicious anemia
B12 100 IM daily times one week then maintenance shots every month
278
Sickle cell crisis symptoms
Sudden onset of severe pain in extremities, back, chest, and abdomen.
Aching joint pain.
Weakness.
Dyspnea
279
Lab values for sickle cell anemia
Hemoglobin decrease.
Peripheral smear show, classic distorted, sickle cell shaped.
Cellulose, acetate, and citrate a guard gel electrophoresis to confirm hemoglobin genotype
280
Polycythemia signs and symptoms and lab values
Fatigue.
Weakness
Visual disturbances.
Headache
Hemoglobin greater than 18.5 in men and greater than 16.5 in women
281
Management for polycythemia
Phlebotomy.
Aspirin.
Referral
282
Hemochromatosis signs and symptoms and treatment
Fatigue, joint pain, pain, and knuckles of pointer and middle fingers.
Get an iron panel test.
Management: iron chelation and do not eat food high in iron
283
Hallmark sign of acute lymphocytic leukemia
Pancytopenia with circulating blast.
All levels are low, including platelets, hemoglobin, and RBCs
284
What is the Hallmark sign of chronic lymphocytic leukemia?
Lymphocytosis or elevated WBCs
285
What is the hallmark sign of chronic myelogenous leukemia?
Philadelphia chromosome seen in leukemic cells
286
What are the signs and symptoms of leukemia?
Maybe asymptomatic
Fatigue
Weakness
Anorexia.
GENERALIZED lymphADENOPATHY
Weight loss
287
Lab values for leukemia
CBC with normal RBCs and neutrophil.
ELEVATED ESR.
A peripheral blood smear, usually distinguishes, acute and chronic leukemia, but a bone marrow aspiration is required to confirm the diagnosis
288
Stage one of lymphoma
Disease localized to a single lymph node or group
289
Stage one of lymphoma
Disease localized to a single lymph node or group
290
Stage two of lymphoma
More than one lymph node group involved, but confined to one side of the diaphragm
291
Stage three of lymphoma
Lymph nodes or the spleen involved, but occurs on both sides of the diaphragm
292
Stage three of lymphoma
Lymph nodes or the spleen involved, but occurs on both sides of the diaphragm
293
Stage four of lymphoma
Liver or bone marrow involvement
294
Non-Hodgkin’s lymphoma
Often presents with lymphadenopathy next line increased incident in elite 50s
295
Hodgkin’s disease
Younger lymphoma average age is 32 years old.
Usually presents with cervical adenopathy and spreads in a predictable fashion along lymph node groups.
Characteristic REED Steinberg cells differentiate from non-Hodgkin’s disease
296
TNM classification
T- 0-4
N-0-3
M-0/1
297
Meniscus tear characteristics
Locking
Giving away
Acute swelling- grapefruit size
Crepitus
Positive MCMURRAY
298
McMurray test
An audible/palpable click when the knee is raised slowly with 1 foot externally rotated (knee is flexed and then quickly straightened): and peas hand rest on the joint line: test is positive for medial meniscus injury
299
Lachman’s test
Drawer test to assess for anterior/posterior cruciate ligament tear
Place knee in 20 to 30° flexion, grasp leg with one hand with anterior force to proximal tibia to stress the ACL/PCL while the opposite hand stabilizes the thigh : grade 1+ to 3+ grade of displacement as an example of a positive positive test
300
Lachman’s test
Drawer test to assess for anterior/posterior cruciate ligament tear
Place knee in 20 to 30° flexion, grasp leg with one hand with anterior force to proximal tibia to stress the ACL/PCL while the opposite hand stabilizes the thigh : grade 1+ to 3+ grade of displacement as an example of a positive positive test
301
Apley’s grind test
Flex knee 90° with the patient PRONE put pressure on heel with one hand while rotating the lower leg internally and externally: pain or click is positive for medial or lateral collateral ligament damage and or meniscus injury
302
Grade one ankle sprain
Mild, localized, tenderness, normal range of motion, no disability
303
Grade one ankle sprain
Mild, localized, tenderness, normal range of motion, no disability
304
Grade 2 ankle sprain
Moderate/severe pain with weight-bearing: difficulty walking, swelling, and ecchymosis. Pain immediately after injury.
305
Grade 3 ankle sprain
Unable to ambulate, resist any emotion of the feet: egg shaped swelling within two hours of injury
306
Grade 3 ankle sprain
Unable to ambulate, resist any emotion of the feet: egg shaped swelling within two hours of injury
307
Diagnostics for bursitis
Aspiration with gram stain and culture and sensitivity.
WBC, if elevated suggested of bacterial infection
Plain x-ray is to rule out other bone/joint conditions
308
X-ray findings in osteoarthritis
Narrowing of the joint space
Osteophytes
Juxta-articular sclerosis
Subchondral bone
309
X-ray findings and rheumatoid arthritis
Joint swelling
Progressive, cortical thinning.
Osteopenia
joint space narrowing
310
Lab values elevated in rheumatoid arthritis
ESR
USUALLY ANA POSITIVE
311
What drug class is used for treatment of
Rheumatoid arthritis?
Disease, modifying anti-rheumatic drugs or DMARDS
312
Positive pelvic rock test
Screens for sacroiliac joint dysfunction: place hands on each of the anterior superior iliac, spines, and attempt to open and close the pelvis. The test is positive if the patient feels pain in either or both sacroiliac joints.
313
L3-L4 disk pathology
Quadriceps, muscles, weak, and or a trophic.
Pain, radiating into medial malleolus, numbness along the same path, especially medial aspect of the knee.
DIMINISHED or absent patella reflex.
Screening exam: have patient squat and rise
314
L4-L5 disk pathology
Weakness of the dorsiflexion mechanism of the great toe and foot.
Pain radiating into lateral calf: numbness of the dorsum of the foot and lateral calf. screening exam: have patient walk on heels of feet.
315
L5-S1 disk pathology
Weakness of the planter flexion of the great toe and foot
Pain along buttocks, lateral leg, and lateral malleolus: numbness to the lateral aspect of the foot and in posterior calf
DIMINISHED or absent Achilles reflex
Screening : have patient walk on toes
316
Osgood Schlatter disease
Painful limp with pain below the kneecap.
Pain is exacerbated with running, jumping, and climbing stairs
317
Medial tibial stress syndrome is also known as what
Shin splints
318
Finkelstein test
The hand is kept in a fist position with the fingers wrapped over the thumb. The wrist is moved up and down mimicking a handshake. If pain is felt, the test is positive for TENOSYNOVITIS.
De Quervain Tenosynovitis
319
Polymyalgia Rheumatica signs and symptoms
May be associated with temporal arthritis.
Stiffness in neck, shoulders, and hips.
Loss of range of motion in affected areas.
Fatigue, anemia, and mild fever
320
Polymyalgia Rheumatica signs and symptoms
May be associated with temporal arthritis.
Stiffness in neck, shoulders, and hips.
Loss of range of motion in affected areas.
Fatigue, anemia, and mild fever
321
Diagnostic labs and test for polymyalgia rheumatica
ESR
X-ray, as needed to rule out other conditions
322
Management for polymyalgia rheumatica
Cortical steroids.
Symptomatic management
323
Stable causality
It will always be this way
324
Stable causality
It will always be this way
325
Global thinking
Everything is ruined
326
Global thinking
Everything is ruined
327
Internal versus external causes
It’s all my fault
328
One of the two symptoms must be present along with five more symptoms in a two week period to represent major depressive disorder
Depressed mood most of the day, nearly every day or markedly diminish, interest, or pleasure in almost all activities, which is also also known as anhedonia
329
What are the five stages of grief?
Denial
Anger,
Bargaining
Depression
Acceptance
330
Tricyclics such as elavil , doxepin, nortriptyline have a black box warning of?
Prolonged QT
331
Which drug class causes a hypertensive crisis, if used with wine and cheese
MAOI
332
What are the three tests used for cellebellar function?
Romberg
Finger to nose test.
Heel to shin test
333
Cranial nerve pneumonic for motor or sensory
Some say Mary money, but my brother says big bras matter most
334
Cranial nerve 1
Olfactory smell
335
Cranial nerve 2
Optic
Vision
336
Cranial nerve 3
Oculomotor
Most EOMs,
Opening eyelids, pupillary construction
337
Cranial nerve 4
Trochlear.
Down and inward I movement
338
Cranial nerve 5
Trigeminal
Muscles of mastication, sensation of face, scalp, cornea, mucus, membranes, and nose
moving jaw
339
Cranial nerve 6
Abducens
Lateral eye movement
340
Cranial nerve 7
Facial
Move face, close mouth and eyes, taste, saliva and tears secretion.
Puff cheeks
341
Cranial nerve 8
Acoustic.
Hearing and equilibrium
342
Cranial nerve 9
Glossopharyngeal
Phonation, gag, reflex, carotid reflex, swallowing, taste. Gag reflex.
343
Cranial nerve 9
Glossopharyngeal
Phonation, gag, reflex, carotid reflex, swallowing, taste. Gag reflex.
344
Cranial nerve 10
Vagus
Talking, swallowing, general sensation from the carotid body, carotid reflex
345
Cranial nerve 11
Spinal accessory
Movement of the trapezius and sternomastoid muscles.
Shrug shoulders
346
Cranial nerve 12
Hypoglossal
Moves the tongue.
347
Tension, headaches, signs, and symptoms
Vice or tight quality
Usually generalized.
Maybe most intense about the neck or back of head next line no associated focal neurological symptoms.
Usually last several hours
Temporal area soreness
348
Migraine headaches are which cranial nerve
Cranial nerve five – trigeminal
349
Migraine signs and symptoms
Unilateral, lateralized throbbing headache that occurs episodically.
Throbbing
Positive neuroscience
Macy, stars, zigzag of light, or sparks, may have photophobia or phonophobia
350
Management of acute attack of migraine
Rest in dark quiet room
Simple analgesics taken right away to provide some relief.
Imitrex 6 mg subQ at onset may repeat in one hour for a total of three times per day next line
Imitrex 25 mg orally at onset of headache
351
Cluster headaches, signs, and symptoms
Unilateral. Around eye. Last about two hours. Pain occurring daily for several weeks.
352
Treatment for cluster headaches
If oral drugs unsatisfactory then inhalation of 100% oxygen may help
Imitrex 6mg SQ or other triptans
353
Amaurosis fugax
Ipsilateral monocular blindness
Altered vision
354
Amaurosis fugax
Ipsilateral monocular blindness
Altered vision
355
Homonymous hemianopia
Half vision
356
Simple partial seizure
No loss of consciousness.
Rarely last greater than a minute.
Motor symptoms often start in a single muscle group and spreads the entire part of the body.
Paresthesia, flashing lights, vocalization, hallucinations common
357
Simple partial seizure
No loss of consciousness.
Rarely last greater than a minute.
Motor symptoms often start in a single muscle group and spreads the entire part of the body.
Paresthesia, flashing lights, vocalization, hallucinations common
358
Complex partial seizure
Any simple, partial seizure, followed by impaired level of consciousness. May have aura, staring, automatisms such as lipsmacking and picking at clothing
359
Complex partial seizure
Any simple, partial seizure, followed by impaired level of consciousness. May have aura, staring, automatisms such as lipsmacking and picking at clothing
360
Absent or petite mal seizure
Sudden arrest of motor activity with blank stare. Commonly discovered in children/adolescence: begin and end suddenly.
361
Absent or petite mal seizure
Sudden arrest of motor activity with blank stare. Commonly discovered in children/adolescence: begin and end suddenly.
362
Tonic clonic or grand MAL seizure
May have aura.
Begins with tonic contractions, which are repetitive involuntary contractions of the muscle, loss of consciousness, then clonic contractions, which are involuntary contractions of the muscle.
Usually last 2 to 5 minutes
Incontinence may occur.
Followed by post ictal period
363
Tonic clonic or grand MAL seizure
May have aura.
Begins with tonic contractions, which are repetitive involuntary contractions of the muscle, loss of consciousness, then clonic contractions, which are involuntary contractions of the muscle.
Usually last 2 to 5 minutes
Incontinence may occur.
Followed by post ictal period
364
Status epilepticus
A seizure that lost longer than five minutes, or having more than one seizure within a five minute period without returning to normal level of consciousness.
Medical emergency
365
Status epilepticus
A seizure that lost longer than five minutes, or having more than one seizure within a five minute period without returning to normal level of consciousness.
Medical emergency
366
What is the most important test and determining seizure classifications
EEG
367
Maintenance drug for seizure
Carbamazepine( Tegretol)
Phenobarbital
Phenytoin( Dilantin)
Valproic acid (Depakene)
368
Myerson sign
Repetitive tapping over the bridge of the nose, produces a sustained blink response.
Glabellar reflex
369
Cullen sign
Periumbilical bruising indicating pancreatitis
370
Which of the following assessment findings is consistent with pheochromocytoma?
Hypertension
371
erysipelas
A tender, warm-to-the-touch, unilateral, raised, erythematous, patchy rash with clearly defined borders involving the pinna
372
uveitis
constricted pupil and haziness with anterior-chamber leukocytes on slit-lamp examination.
Red eye
373
uveitis
constricted pupil and haziness with anterior-chamber leukocytes on slit-lamp examination.
Red eye
374
lichen sclerosus
Genital pruritus and porcelain-white plaques with atrophic vulvar skin
375
A patient presents reporting severe paroxysms of pain that occur along the distribution of cranial nerve V while chewing, talking, or brushing their teeth. What is the first-line treatment for the suspected condition?
Carbamazepine (Carbatrol)
376
The Brudzinski sign
indicative of meningitis, but it consists of flexion of the hips and knees when supine with the neck flexed.
377
The Brudzinski sign
indicative of meningitis, but it consists of flexion of the hips and knees when supine with the neck flexed.
378
Kernig sign
the patient cannot fully extend the left knee while lying on their back with the left hip at 90°. The patient reports low back pain with this maneuver.
Meningitis
379
Age related macular degeneration
reports poor vision in low lighting, a decrease in central vision, and distortion of straight lines.
380
Age related macular degeneration
reports poor vision in low lighting, a decrease in central vision, and distortion of straight lines.
381
A 68-year-old patient presents with a 2-day history of a red right eye with pain, clear discharge, and photosensitivity. The nurse practitioner suspects herpes keratitis. Which of the following physical exam findings would best support this diagnosis?
Dendritic lesion on fluorescein exam
382
A 68-year-old patient presents with a 2-day history of a red right eye with pain, clear discharge, and photosensitivity. The nurse practitioner suspects herpes keratitis. Which of the following physical exam findings would best support this diagnosis?
Dendritic lesion on fluorescein exam
383
Which of the following assessment findings is consistent with lateral epicondylitis?
Pain elicited with wrist extension while the elbow is extended
384
Which of the following assessment findings is consistent with lateral epicondylitis?
Pain elicited with wrist extension while the elbow is extended
385
medial epicondylitis or golfer's elbow.
Tenderness with palpation of the proximal wrist flexor muscles
386
medial epicondylitis or golfer's elbow.
Tenderness with palpation of the proximal wrist flexor muscles
387
Myasthenia gravis definition
Auto immune disorder, resulting in the reduction of the number of acetylcholine receptors at the neuromuscular junction
388
Agnosia
the impaired ability to process sensory information, such as not recognizing things or people who were previously familiar.
389
Apraxia
involves difficulty performing motor tasks.
390
What is the first-line pharmacological treatment for COPD patients with minimal symptoms and no exacerbations leading to hospitalization according to the GOLD guidelines?
Long- or short-acting bronchodilator
391
Cataracts
worsening blurred vision. The patient reports no ocular pain
392
Diagnostic and labs for myasthenia gravis
Antibodies to acetylcholine receptors a ACHR – AB are found in the serum
393
Blumberg sign
Patients will often present with right lower quadrant (RLQ) abdominal tenderness. This pain is often made worse with the removal of pressure during the abdominal examination.
This sign is called rebound tenderness
394
Alzheimer’s is a deficiency in what?
Acetylcholine
395
Treatment for myasthenia gravis
PROSTIGMIN
Immunosuppressive.
Plasmaparesis
396
Definition of multiple sclerosis
Auto immune disease marked by numbness, weakness, loss of muscle, coordination, and problems with vision, speech, and bladder control.
The bodies immune system attacks, Mylin, Keith substance that serves as a nerve insulator and helps in the transmission of the nerve signals
397
Diagnostic testing for multiple sclerosis
MRI
CSF with a lumber puncture.
Blood test to rule out other causes such as infection
398
Treatment for Bell’s palsy
Prednisone 60 mg divided into 4 to 5 doses daily and tapered over 7 to 10 days
Acyclovir when Bell’s palsy is caused by varicella zoster infection
Lubricating eyedrop‘s and patch at night if unable to close
399
Trigeminal neuralgia definition and treatment
Nerve disorder that causes a stabbing or electrical shock like pain in parts of the face
Treatment include anti-seizure drugs, such as carbazepine, muscle relaxants such as soma or Flexeril and tricyclic antidepressants like amitriptyline
400
Trigeminal neuralgia definition and treatment
Nerve disorder that causes a stabbing or electrical shock like pain in parts of the face
Treatment include anti-seizure drugs, such as carbazepine, muscle relaxants such as soma or Flexeril and tricyclic antidepressants like amitriptyline
401
S1
Mitral/tricuspid. AV valves closure: aortic/pulmonic semilunar – valves open
402
S2
Aortic/pulmonic or semilunar valve closure: mitral/tricuspid or AV valves open
403
S2
Aortic/pulmonic or semilunar valve closure: mitral/tricuspid or AV valves open
404
. Between S1 and S2.
Systole
405
. Between S1 and S2.
Systole
406
Period BetweenS2 an S1.
Diastole
407
Period BetweenS2 an S1.
Diastole
408
Grade one murmur
Barely audible
409
Grade 2 murmur
Audible but faint
410
Grade 3 murmur
Moderately loud or easily heard
411
Grade 4 murmur
Loud : associated with a thrill
412
Grade 5 murmur
Very loud: heard with one corner of the stethoscope off the chest wall
413
Grade 5 murmur
Very loud: heard with one corner of the stethoscope off the chest wall
414
Grade 6 murmur
Loudest murmur
415
Mitral stenosis
Diastolic murmur. Loud S1 murmur, low pitched, mid diastolic : apical crescendo rumbling.
416
Mitral stenosis
Diastolic murmur. Loud S1 murmur, low pitched, mid diastolic : apical crescendo rumbling.
417
Mitral regurgitation
Systolic murmur at fifth intercostal midclavicular line (Apex)May radiate to base or left axilla: blowing or high-pitched may follow an S3
418
Aortic stenosis
Systolic, blowing, rough, harsh murmur at second right intercostal space usually radiating to the neck
419
Aortic regurgitation
Diastolic, blowing murmur at second left intercostal space
420
Where are the mitral murmurs usually located?
Fifth intercostal space aka Apex
421
Where are the aortic murmurs located?
Second or third ICS also known as base
422
Signs and symptoms of left heart failure
Acute
Dyspnea at rest
Overall long fields.
Wheezing, frothy cough.
Appears generally healthy, except for a cute event.
Three gallop.
Murmur of mitral regurgitation
423
Signs and symptoms of right heart failure
Chronic
JVD
Hepatomegaly, splenomegaly
Dependent edema, which is a result of increase capillary hydrostatic pressure.
Paroxysmal nocturnal Dyspnea
Appears chronically ill.
Fatigue on exertion.
S3 and or S4
424
Management for congestive heart failure
Sodium restriction.
Activity balance
Weight reduction
Pharmacological
1. Ace inhibitors are the standard of care.
2. Diuretics
3. Beta blocker
4. Entresto to get rid of fluid
5. Digoxin
Ace or arb
Ace better
425
Stage 1 hypertension
130-139 or 80-89
426
Stage 1 hypertension
130-139 or 80-89
427
Stage 2 hypertension
Sbp greater than 140 or DBP greater than 90
428
Management of blood pressure for non-African-American
Thiazide
Ace or arb
CCB
429
Management of hypertension for African-Americans
First line thiazide diuretics
Then calcium channel blockers
430
Management for hypertension in adults older than 18-year-old with chronic kidney disease
Ace
431
Do not use an ACE and ARB together because it could put you at risk for what?
Hyperkalemia
432
Continue to assess blood pressure__________ until goal is reached
Monthly
433
What is the benefit of thiazide type diuretics?
They are usually recommended for the first line treatment, and they may also protect against osteoporosis by reducing the amount of calcium expelled in the urine
434
Levine’s sign
Clenched fist sign describing angina
435
Prinzmetal angina
Variant/vasospastic: occurs at various times, including rest could show ST elevation in all leads with the treatment being calcium channel blockers
436
Prinzmetal angina
Variant/vasospastic: occurs at various times, including rest could show ST elevation in all leads with the treatment being calcium channel blockers
437
What is the treatment for prinzmetal angina?
Calcium channel blockers
438
What is the LDL goal for patients with diabetes or documented coronary artery disease?
Less than 70
439
What are the two high intensity statin therapies?
Atorvastatin 40 to 80 mg or
Rosuvastatin 20 to 40 mg
440
Lateral MI is shown on the EKG by peaked waves, ST elevation, Q wave development in which leads
I and aVL
441
Inferior MI is shown on the EKG by peaked waves, ST elevation, Q wave development in which leads
2,3, and aVF
442
Anterior MI is shown on the EKG by peaked waves, ST elevation, Q wave development in which leads
V leads( precordial) or V3 and V4
443
Anterior MI is shown on the EKG by peaked waves, ST elevation, Q wave development in which leads
V leads( precordial) or V3 and V4
444
Pericarditis signs and symptoms and physical findings are
Pericardial friction rub characteristically present.
Very localized, retro sternal, chest pain, politic nature.
Pain increased, deep, inspiration, coughing, swallowing, recumbent
Pain is relieved by sitting forward
445
Pericarditis signs and symptoms and physical findings are
Pericardial friction rub characteristically present.
Very localized, retro sternal, chest pain, politic nature.
Pain increased, deep, inspiration, coughing, swallowing, recumbent
Pain is relieved by sitting forward
446
What would an EKG look like in pericarditis?
ST elevation in all leads
Depression of PR segment highly indicative of pericarditis
447
What would an EKG look like in pericarditis?
ST elevation in all leads
Depression of PR segment highly indicative of pericarditis
448
What lab value would be increased in pericarditis
ESR
449
What is the treatment for pericarditis?
NSAIDS are the main state of treatment
Examples are indomethacin, Toradol, ibuprofen.
Antibiotics for cases of bacterial infection.
Cortical steroids are only indicated when there is a total failure of high dose and over several weeks with relapsing pericarditis
450
What is the treatment for pericarditis?
NSAIDS are the main state of treatment
Examples are indomethacin, Toradol, ibuprofen.
Antibiotics for cases of bacterial infection.
Cortical steroids are only indicated when there is a total failure of high dose and over several weeks with relapsing pericarditis
451
What are the signs of cardiac tamponade?
Hypotension, JVD, muffled/distant heart sounds, pulses paradoxus
452
What is the most definitive test for peripheral vascular disease?
Arteriography
But would also do ABI
453
What is the treatment for peripheral vascular disease?
Cilostazol(pletal) in combination with aspirin or plavix
Stop smoking
Walk to develop collateral circulation
454
Billings test
Cervical mucus test – record changes and cervical mucus spinnbarkeit over a 3 to 4 month period
455
Billings test
Cervical mucus test – record changes and cervical mucus spinnbarkeit over a 3 to 4 month period
456
Xulane warning
Increases the risk for serious cardio, embolic events, such as MI, CVA, PE
457
Which birth control can you take? If you are previous smoker, history of CVA, history of MI
DEPO- provera DMPA
458
Surgical abortion, vacuum, D and C
Up to 16 weeks after last menstrual period
459
Surgical abortion, D & E
After 14 weeks
460
What are the signs and symptoms of placenta previa?
Painless bleeding.
May occur immediately after vaginal intercourse
461
What are the signs and symptoms of placenta previa?
Painless bleeding.
May occur immediately after vaginal intercourse
462
What are the signs of abruptio placentae?
Severe abdominal pain.
Bright red bleeding is heavy if unconcealed
May be minimal to moderate bleeding if abruption is concealed
Uterus is rigid in concealed abruption
Fetal distress/absent fetal heart tones
463
Which ethnicity believes in hot and cold and wet and dry concepts
Hispanic/Latin X
464
Which ethnicity believes in hot and cold and wet and dry concepts
Hispanic/Latin X
465
Which ethnicity thinks illness may be caused by mal de ojo
Hispanic/Latin X
466
Which ethnicity believes that health is a result of forces that rule the world yin=cold yang=hot
Chinese
467
Which ethnicity believes that health is a result of forces that rule the world yin=cold yang=hot
Chinese and
Filipino
468
The office for civil rights enforces that HIPAA, which protects the
Privacy of individually, identifiable, health record, and HIPAA security rule which sets national standards for the security of electronic protected health information
469
Under title, one of HIPAA it protects health insurance coverage for workers and their family when the change or loss of jobs. What is that called?
COBRA
470
What is incident to billing?
Service bill under physicians provider number to get the full physician fee or 100% given the following rules.
The physician must perform the initial service and subsequent service of a frequency which reflects his or at her active participation in the management of the course of treatment.
Incident billing is not allowed in the hospital setting an NP must bill under his or her provider number
471
6 QSEN Initiative: quality, and safety education for nurses
Patient centered care.
Teamwork, and collaboration.
Evidence, base practice.
Quality improvement.
Safety.
Informatics
472
Veracity
The duty to be truthful
473
Justice
The duty to be fair
474
Fidelity
The duty to be faithful
475
Autonomy
The duty to respect and individuals thoughts, and actions
476
Utilitarianism
The right act is the one that produces the greatest good for the greatest number i.e. mass casualty
477
Utilitarianism
The right act is the one that produces the greatest good for the greatest number i.e. mass casualty
478
Nonmaleficense
The duty to do no harm
479
Beneficence
The duty to prevent harm and promote good
480
The highest level of evidence in research
Meta-analysis of random controlled trials
481
PICOT
Patient or population
Intervention, i.e. treatment
Comparison, i.e. control
Outcome, i.e. results.
Timing duration of the measure/data collected
482
Type one error
False positive: incorrectly rejecting the true null hypothesis
483
Type two error
False negative, failing to reject a no hypothesis, which is false
484
Meta-analysis
Test hypothesis by using a QUANTITATIVE study to systematically assess the result of previous research
485
Meta-analysis
Test hypothesis by using a QUANTITATIVE study to systematically assess the result of previous research
486
Meta synthesis
Analyzes data across QUALITATIVE studies in order to build new theories
487
CLAS
Culturally and linguistically appropriate service
It is established to help with communication with people that don’t speak English
488
Validity
The degree to which a variable measures what it is intended to measure
489
Incidence
The frequency with which a disease or disorder appears in a particular population or area at a given time the rate
490
Prevalence
Percentage. The proportion of a population that is affected by the disease or disorder at a particular time.
491
Prevalence
Percentage. The proportion of a population that is affected by the disease or disorder at a particular time.
