Final Exam Flashcards
(169 cards)
1
Q
Examples of neurodevelopmental disorders
A
ADHD, autism, ID, cerebral palsy
2
Q
Environmental causes of neurodevelopmental disorders
A
Prenatal alcohol, hypoxic brain injury, lead toxicity
3
Q
Genetic causes of neurodevelopmental disorders
A
Metabolic PKU, trisomy 21, fragile X
4
Q
Impaired social communication, repetitive and stereotyped behavior, interests and activities
A
Autism
5
Q
Geriatrics
A
<60
6
Q
Goal in geriatric care
A
optimize function
7
Q
What to assess in geriatric
A
Function, gait, cognition, fall risk, polypharmacy, social support, finances, advanced care planning
8
Q
5 I’s of geriatric assessment
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intellectual impairment, iatrogenic disorders, incontinence, immobility, instability
9
Q
Mini cog exam
A
3 item recall + clock
If you get all 3 items correct, you do not need to do the clock drawing
10
Q
2 question screen
A
for depression
11
Q
BEERS criteria
A
Anticholinergics, antihistamines, benzodiazepines, muscle relaxants, antihistamines, nitrofurantoin, alpha 1 blockers, TCAs, 1st gen antipsychotics
12
Q
Most common incontinence
A
Urge
13
Q
BPH type of incontinence
A
Overflow
Treat with alpha blockers
14
Q
Neuro incontinence
A
Urge
Treat with anticholinergics
15
Q
Decreased musculature incontinence
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Stress
treat with kegals
16
Q
Normal sleep cycle for geriatrics
A
3-5 hours
17
Q
Osteoporosis
A
> 2.5 SD below mean on DEXA scan
Due to decreased estrogen, calcium and vitamin D, exercise, and increased alcohol
18
Q
Sarcopenia
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Decreased muscle mass
19
Q
Presbyopia
A
Decreased near vision due to stiffness of lens
Need reading glasses
20
Q
Presbycusis
A
Decreased hearing, especially high pitched sounds
21
Q
Frailness
A
Decreased weight, weakness, slow walking speed, exhaustion, decreased activity
22
Q
Xerostemia
A
Dry mouth
Treat with pilocarpine or cevimeline
23
Q
Dysphagia
A
Difficulty swallowing
24
Q
Pharmacokinetics
A
Absorption, distribution, metabolism, elimination
Zinc, calcium, iron, multivitamins alter absorption
25
Pharmacodynamics
How the body responds to drugs
| Decreased baroreceptor response in elderly and increased sensitivity to anticholinergics
26
Aim of palliative care
Improve quality of life
27
nociceptive pain
Localized, sharp or throbbing or aching
| Use NSAIDs, acetaminophen, opioids
28
Neuropathic pain
Burning
| Use amitriptyline, neurontin, lidocain patch, capsaicin
29
Avoid what opioids in renal failure
Morphine
30
What opioids are safest for renal failure
Fentanyl and methadone
31
Treatment of dyspnea in palliative care
Morphine
32
Metabolic syndrome
High fasting blood sugar, high BP, High triglycerides, truncal obesity, low HDL, xanthomas
33
Diagnostic for insulin resistance
gold standard is euglycemic insulin clamp technique or fasting plasma insulin concentration (increased plasma insulin and normal glucose=insulin resistance)
34
Where is cholesterol synthesized
in the liver
35
Medications that may cause elevated cholesterol and lipids
Amiodarone, steroids, cyclosporine, beta blockers
36
When should you repeat lipid panel
4-12 weeks after initiating lipid lowering therapy
37
Goals/high values for cholesterol
Total: goal <200, 200-239 borderline, >240 high
LDL: Goal <100, 100-129 above normal, 130-160 borderline high, >160 high
HDL: Goal >60 for cardioprotective, <40 major risk
Triglycerides: Goal <150, >500 high, >1000 risk of pancreatitis
38
SE statins
myopathy (check CK levels), hepatic inflammation (check LFT)
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When to take statins
bedtime
40
Target groups for statins
>190 LDL
DM and LDL 70-189 and age 40-75
CVD disease
ASCVD risk >7.5%
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Xanthelasma
Yellow fatty deposits on eyelids
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Xanthomas
Fatty deposits on elbows, knees, joints
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Secondary hypertension due to
Renal stenosis, pheochromocytoma, coarctation of aorta, cushing disease, thyroid disease, alcohol, OCP, steroids
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Consider secondary htn if age
<30 or >65
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Goals of BP
<60 age <140/90
>60 age <150/90
DM regardless of age <140/90
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If BP goal not reached within 1 month
Increase dose or add another med
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Masked HTN
Normal in office but high out of office
48
Symptoms of end organ damage in htn
blindness, loss of visual acuity, headaches, confusion, seizures, impotence, claudication, chest pain, dyspnea, palpitations, syncope, hematuria, dysuria, oliguria
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monitor what after starting ACEI/ARB or diuretic
K+ and renal function
50
Risk factors for PAD
HTN, DM, increased lipids, tobacco use
51
Symptoms of PAD
poor wound healing, claudication, dependent rubor, loss of hair on extremities
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Dx for PAD
ABI <0.9, US, Angiogram
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PE for PAD
Pain, pulseless, paresthesia, pallor
54
Tx PAD
aspirin, statin, BP control, DM control, compression stockings, decrease smoking
55
HF with reduced EF
Systolic HF--LV
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HF with normal EF
Diastolic HF--RV
57
Sx/PE of HF
Dyspnea, fatigue, edema, JVD
| S3 heart sound, crackles, hepatomegaly, displaced PMI, cardiac enlargement
58
Gold standard for diagnosing HF
Echo
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Strongest marker for HF prediction
BNP
60
Chest X ray can show what in HF
Cardiac enlargement
61
Daily weights in HF
Call if >2ib in 1 day or 5ib in 1 week
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Tx of HF
Beta blocker, ACEI/ARB, loop diuretic, spirinolactone
63
What meds should you avoid in HF
NSAIDs, and CCB
64
Beta blockers recommended for HF
Carvedilol, metoprolol, bisoprolol
65
S1 and S2
S1: closure of AV valves
S2: closure of SL valves
66
Systolic murmurs
```
Aortic stenosis
Pulmonary stenosis
Tricuspid regurg
Mitral regurg
MVP
```
67
Diastolic murmurs
Aortic regurg
Pulmonary regurg
Tricuspid stenosis
Mitral stenosis
68
Harsh crescendo-de-crescendo murmur
AS
69
Midsystolic click
MVP
70
MVP tx
beta blockers, ACEI
71
Most important goal in A fib control
Ventricular rate control
72
1st degree AV block
Prolonged PR interval but always has a QRS
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2nd degree AV block type 1
Prolonged PR interval increasing until QRS dropped
74
2nd degree AV block type 2
Prolonged or normal PR interval and random QRS drop
75
3rd degree AV block
No relationship between PR and QRS
76
Adduction
movement towards midline of body
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Abduction
Movement away from midline of body
78
Most common malignant tumor of bone
multiple myeloma
79
Labs in multiple myeloma
Increased alkaline phosphatase, bence jones proteins, M spike, Increased CRP and ESR
80
Pain management in bone tumors
Vertebroplast, radiation, biphosphonates
81
Shoulder injuries hurt more often when
Arm is elevated
82
Radiculopathy feel better when
Arm elevated
83
Tests for shoulder
Apprehension, empty can, drop arm, impingement, Hawkin, NEER
84
Adhesive capsulitis
Shoulder immobilization or gradual onset of shoulder pain
85
Medial epicondylitis
Golfers elbow
86
Lateral epicondylitis
Tennis elbow
87
ROM testing for elbow
Flexion, extension, suppination, pronation
88
Treatment of fibromyalgia
Amitriptyline, SSRI, cyclobenzaprine
89
Dx for fibromyalgia
>7 tender points for >3 months
90
Symmetric wrist/hand pain
Think RA, SLE or malignancy
91
Tests for capal tunnel
Phalen
| Tinnel--push on median nerve
92
Most common cause of secondary osteoporosis
Steroids
93
DEXA scan recommended
Women >65 and men >70
94
Recommendations for Ca and Vit D
Ca 1000-1200mg daily
| Vit D 800-1000 daily
95
Medications for osteoporosis
Biphosphonates, denosumab, calcitonin, taloxifene
96
Education for biphosphanates
Do not lie down for 30 minutes-60 minutes after
| CI in esophageal dysmotility
97
Master controller
Hypothalamus
98
Anterior pituitary hormones
FLAT PEG
| FSH, LH, ACTH, TSH, Prolactin, Endoprhins, growth hormones
99
Posterior pituitary hormones
Oxytocin, ADH
100
Begin DM screening
Age 45
101
Dx for diabertes
Random BG >200
Fasting BG >126
A1C >6.5
102
Dx for pre-diabetes
Random BG 140-199
Fasting BG 100-125
A1C 5.7-6.4
103
Somogyi effect
Rebound hyperglycemic in the morning due to hypoglycemic in the middle of the night--give less night time insulin
104
Dawn phenomenon
High hyperglycemia in the morning due to growth hormones released at night--increase night time insulin dose
105
Rapid acting insulin
Lispro, aspart, glusiline
106
long acting insulin
Detemir, glargine
107
Microvascular complications of DM
Retinopathy, neuropathy, nephropathy
108
Macrovascular complications of DM
CAD, PVD, stroke
109
Secondary causes of DM
Pheochromocystoma, cushing, acromegaly, hypokalemia, hyperaldosterone, diuretic use, pancreatitis, drug induced
110
DKA S/S
Abdominal pain, N/V, Kussmaul respirations, dehydrated, fruity breath, tachycardia, hypotension, decreased LOC
111
C-peptide
<0.5 Type 1 DM
| >0.5 Type 2 DM
112
ADA A1C goal
<7
<8 in elderly
<6 in type 1 and pregnancy
113
Biguanides
Metformin
Site of action: liver--decrease gluconeogenesis
SE: N/V
NO hypoglycemia
CI in Cr >1.4
Can cause fatal lactic acidosis
D/C 24-48 hours before surgical procedure
114
Sulfonylureas
Glipizide
Site of action: pancreas--increase insulin secretion
SE: weight gain, hypoglycemia
115
Thiazolidinediones
Rosiglitazone
Site of action: muscle--increase insulin sensitivity
SE: weight gain and edema
CI in HF + liver disease
116
Hypoglycemia
BG <70
| S/S: shaking, sweating, tachycardia, weak, pallor, decreased LOC
117
Secondary causes of obesity
cushing, PCOS, hypothyroid, insulinoma
118
Medications that can cause obesity
Steroids, TCA, phenothiazines
119
Tx obesity
Phentermine, amphetamines, orlistat
120
Most common cause of hyperthyroidism
Graves disease
121
Tx of hyperthyroidism
PTU, Methimazole, beta blockers
122
hyperthyroidism tx in pregnancy
PTU first trimester, methimazole second and third trimester
123
SE of PTU/methimazole
rash, jaundice, arthralgia
124
Tx of choice of hyperthyroid if >20 years
Radioiodine therapy
125
Norma TSH
0.5-5.5
126
Normal T4 total
4.6-12
127
Normal T4 free
0.7-1.9
128
Normal T3
80-180
129
Medications that can increase T4
Amiodarone, amphetamines, synthroid
130
Most common cause of hypothyroidism
Chronic autoimmune thyroiditis
131
Myxedema
Skin thickening and CV/Renal issues due to hypothyroidism
132
Tx hypothyroidism
Levothyroxine start 50mcg/day
| Do labs in 4-6 weeks and then assess dosage
133
Education for levothyroxine
Take 1 hour before breakfast and 2 hours before/4 hours after antacids, ferrous sulfate, carafate
134
Drugs that can decrease thyroid
lithium, interferon alfa, tyrosine kinase inhibitors
135
Tx of vertigo
Meclizine, diamox, antiemetics
136
Vertigo vs dizzy
Vertigo: room is spinning
Dizzy: you are spinning
137
Hallpike-dix
Dx fo BPPV
138
Paresthesia
Numbness and tingling
139
Paresis
weakness
140
First line tx of seizures
Levetiracetam (Keppra)
| Check serum levels 2-3x in first 6 months and then every 6 months or if dose changes
141
S/S PD
Resting tremor, bradykinesia, shuffling gait, rigidity
142
PD due to
Decreased dopamine
143
Tx of PD
Levodopa-carbidoba first line
| Others: selegiline, bromocriptine, ropinirole, pramipexole, entacapone, trihexyphenidyl, benzotropine, amantadine
144
Aborptive headache meds
Acetaminophen, aspirine, excedrine FIRST LINE
| ergo derivatives, triptans
145
Caution with ____ when using triptans
CV disease
146
Preventive tx of headaches
Beta blockers, anticonvulsants, CCB, TCA
147
First line preventive tx of cluster headache
verapamil or lithium
148
Most common bacteria for meningitis for adults
Strep pneumoniae
149
Brudzinski sign
Patient actively flexes hips when neck is passively flexed
150
Kernig sign
Resists passive knee extension when hip flexed to abdomen
151
Bacterial meningitis LP
Decreased glucose
152
Viral meningitis LP
Increased or normal glucose
153
Tx fo bacterial meningitis
Vancomycin + ceftriaxone
154
Meningitis vaccine
11-18 years old
If vaccinated between 2-6 years old, should be re-vaccinated again after 3 years
If vaccinated <7 years old, should be re-vaccinated after 5 years
155
Pneumococcal vaccine
>65 one time dose
156
HIB vaccine
2,4,6, 12-15 months
157
Sleeping sickness
Encephalitis
| Usually due to virus
158
Tx of encephalitis
Antiviral + seizure control
159
Rash of herpes zoster
Papular lesions with vesicles
160
Dx for herpes zoster
tzank smear
161
Tx of herpes zoster
Acyclovir within 72 hours, capsaicin cream, amitriptyline or neurontin
162
Vaccines for shingles
Zostavax: live
Shingrix: non live
only vaccinate 2-3 weeks after attack
163
Trigeminal neuralgia
CN5
Tic douloureux
Recurrent pain on one side of face--burning, sharp, penetrating, stabbing
164
Tx of trigeminal neuralgia
Anticonvulsants--carbamazepine + oxcarbazepine first line
All are sedating
Must monitor lab values
165
Bell's palsy
CN 7
Acute and progressive onset
PE: flattening of nasolabrial fold; unable to raise eyebrow or wrinkle forehead, asymmetric smile
166
Tx for bell's palsy
Steroids (prednisone high dose then taper) + acyclovir + artificial tears
Eye protection important
167
Basal skull fracture signs
Raccoon sign + battle sign
168
Heat stroke s/s
Red, hot, dry skin
169
Heat exhaustion s/s
Skin pale and flushed
