Final NP Exam Review Flashcards
(470 cards)
1
Q
G6PD deficiency anemia’s Sx
Trigger?
A
African American
Jaundice, hemolysis anemia
Could be asymptomatic
Can be triggered by having sulfa drug or eating fava beans
2
Q
What are sulfa drugs (8)
A
3S+ b+ c+ 2d+ n
S: sulfonylurea (glyburide, glipizide).
S: sulfazalazine
S: sumatriptan
B: bismuth subsalicylate
C: COX-2 inhibitor: celecoxib
Diuretic: laxis, thiazide diuretic,
Nitrofurantoin
3
Q
Sulfonamide
Coverage
Drugs
Interaction
ADR
Contrandication
A
Gram negative and some +
Bactrium/septra
Interaction: Wa
—warfarin
—astemizole
ADR:
–fever, no blistering rash
—Steven-Johnson syndrome
Contrandication:
—hypersentive to sulfa drugs
—G6PD anemia (genetic hemolytic anemia)
—< 2 months
—pregnancy >=32 weeks (increase bilirubin, hemolytic anemia)
4
Q
Sx of digoxin toxicity (5)
A
Hag VC
GI (N/V),
High K
Arrhythmia (HR could be high or low)
Visual change
Confusion
5
Q
ACEI, ARB and pregnancy, lactation
A
Don’t give it
6
Q
PDE5 and when don’t give it
Don’t mix with what
A
If MI or stroke within 6 months
Nitrate: isosorbide, nitroglycerin, alpha blocker
7
Q
What’s reverse agent for plavix
A
No reversible agent; can give plasma
8
Q
Ketorolac
Drug class
What to watch
A
NSAID
Don’t use it more than 5 days
9
Q
Thiazide diuretic and DM?
A
Thiazide diuretic increase A1C
10
Q
If patient has sulfa allergy, what diuretic can they use
A
K- sparing diuretics
11
Q
Spirinolactone ADR
A
Gynecomastia and high K
12
Q
How loop diuretic affect Na, K, Mg, Cl
A
Decrease all of them
13
Q
What does angiotensin 2 do
A
Potent vasoconstrictor
Promote release aldosterone
14
Q
ANRI
If switching ACE or ARB to this, how long do u have to wait?
A
Sacubitril/ valsartan
Don’t use it within 36 hours switching from to ACEi
Don’t use it if hx of angioedema
15
Q
For DM patients, what BP meds is preferred
A
ACEi, ARB,
But
If eGFR< 60, don’t use it, will cause AKI
16
Q
1st line treatment for reduced HF and left ventricular dysfunction
A
ACEi
17
Q
Captopril is associated with
A
Agranulocytosis: reduce neutrophil (< 100)
So monitor CBC
18
Q
After starting ACEi, ARB, when do you check kidney functions
A
3 days after
19
Q
Verapamil cannot mix with
Contradication
A
Erythromycin, clarithromycin
Contradication:
– AV block
–bradycardia,
—reduced HF
ADR:
Reflex tachycardia
20
Q
In patient with reduced HF, avoid use
A
Non-DHP CCB
21
Q
What drug is preferred to treat angina and post MI
A
BBB
22
Q
Don’t combine PDE5 inhibitors with what
A
Alpha blocker
Using nitrate
Recent, post MI
Post stroke, TIA
Major surgery
Any condition that exertion
23
Q
Can DM patient with micro vascular disease take oral combined contraceptive?
A
No; higher risk of thrombosis; take progestin- only OC
24
Q
What cause hand, foot, and mouth disease
A
Coxsackie virus
25
What is dacryostenosis
Obstruction of lacrimal duct
26
What cause oral hairy leukoplakia
EBV
27
Meclizine
First generation antihistamine to help motion sickness
28
What is pulsus paradoxus
SBP drops with inspiration;
Commonly occur with people with asthma
29
bronchiolitis
Cause
Sx
Caused by RSV
During winter/ spring
Infants and young children
Fever
Inspiratory/ expiration wheezing with clear drainage
30
Tracheobronchitis
Start with dry cough, then become productive cough
31
Croup
Is it viral or bacterial
Sx?
Fever?
Viral infection: parainfluenza most common
Barking cough
Runny nose
Usually no fever
32
What's second line treatment for CAP
1at line is amoxicillin
2nd line: doxycycline, or macrolide
If patient has comorbiditries>=65 yr: 1st line is clavulin
33
Chronic bronchitis is defined as
Coughing with excessive mucus production for >=3 months, for minimum >=2 more consecutive years
Light coloured sputum
Dry to productive cough
34
If I see consolidation in CXR, could it be what PNE
Bacterial PNE
Atypical PNE doesn't show consolidation (malaise, headache, muscle pain, hemolysis in blood work)
35
PCOS have higher risk of
They have excessive estrogen
Higher risk for:
- CHD
- breast and endometrial CA, endometrial hypersplasia
- nonalcoholic fatty liver disease
-depression
- OSA
36
In atrophic vagina, FSH and LH level
Higher
37
Is BV STI?
No. But risk factor include sexual activity, new or multiple sex partner, and douching
38
Normal vaginal PH
4-4.5
39
If women find out having BV, do we treat partner
No. It's not STI
40
BV's education
No sex until treatment is done
41
Drugs that interact with oral contraceptive
cart has AD
Anticonvulsant
Antifungal
HIV/ HCV protease inhibtor: Indinavir, boceprevir
ampicillin,
tetracycline,
rifampin,
clarithromycin
St. John worst: might lead to breakthrough bleeding.
Dilatin
42
Risk factors of breast cancer (10)
- BRCA1 & 2 mutation
- late menopause: > 55yr
- mom took DES
- not physical active
- fat
- take hormone pills last> 5 years
- pregnancy at >=30 yr
- not breastfeeding
- never give birth to kid
- mod- high alcohol intake
43
Pharmacokinetic
Drug movement in body: absorption, bioavailability. Distribution, metabolism, excretion
44
Pharmacodynamic
What drug does to our body: physiologic & bio-checmical
45
Drugs that high risk of drug interaction
MACC+ PA
Macrolide
Antifungal
Cimetidine
Citalopram
Protease inhibtor: Navir
Antipsychotic: cloaxapine, Olanzapine, Quetiapine
46
MRSA treatment
Septra
Clindamycin
47
Mastitis treatment
48
Patient feels nausea after taking erythromycin
Normal reaction for erythromycin. Not allergic reaction
49
Streptococcal pharyngitis
Treatment
Peter cough mucus
Adult:
1st line: oral penicillin V x 10 days
Kids:
1st line: oral penicillin V or amoxicillin
2nd line: clindamycin
Macrolide
Make sure to repeat culture after treatment
If Centro score>=2: get culture
50
Lithium toxicity (4)
SISI
Seizure
Slurred speech
Increased urination
Increased thirst
51
Dilatin toxicity
Nystagmus
Ataxia
Confusion
52
Carbamazepine toxicity
Skin rash
Jaundice
53
What drug should be cautious to use with erythromycin ?
Erythromycin is a potent 3A4 inhibtor;
Use cautious with warfarin
54
Does chronic use NSAIDs affect respiratory system?
Yes
55
Treatment for gonorrhea, chlamydia infection
Gonorrhea: ceftriaxone( add doxycycline if you can’t rule out chlamydia
Chlamydia: Doxycycline: 100mg BID x 7 days, or Azithromycin single dose ( if pregnant)
56
Treatment for syphilis
Benzathine penicilllin G
57
Treatment for genital herpes
Acyclovir x 7-10 days
58
Hydrochlorothiazide ADR
Suppress bone marrow--> neutropenia
59
Nifedipine watch
Suppress cytokine-induced activation of neutrophils
60
Antihistamine affect on elders
Does it cause bradycardia or arrhythmia?
Confusion
Urinary retention
Incontinence
Sedation
No affect on heart: bradycardia, arrhythmia, etc..
61
Patient is on tetracycline while taking oral contraceptive
Tetracycline reduce oral contraceptive effectiveness; so use condom, and additional contraceptive method while on tetracycline
62
What antibiotic should not be give to kids < 9 yr
Tetracycline
63
Ramelteon is
Melatonin receptor agonist
64
Pregnancy drug category
A: human & animal show no risk
B: animal show no risk; no human data
C: bad animal result
D: evidence of fetal risk: but you consider; can use if benefit> risk
X: evidence of fetal risk: risk> benefit
65
Antibiotic that is safe to use during pregnancy
Macrolide (except for clarithromycin)
Penicillin
66
Drugs to avoid during 3rd trimester
NAS S
NSAID
Aspirin
Salicylate: bismuth (pepto)
Sulfa drugs: Septra
67
Why can't use sulfa drugs during 3rd trimester (5)
High bilirubin
Jaundice
Kernicterus (brain damage)
Oligohydramnios
Premature closure ductus arteriosus
68
Signs of pregnancy
Positive: confirmed pregnancy: can see, can feel, can hear
Probable: mod evidence: beg cuh
---ballotement
---enlarged uterus
---Goodell's sign: soft cervix
---Chadwick: vagina and cervical becomes blue
--uterine or blood pregnancy test positive
-- Hegar: soft uterus isthmus
Presumptive: lowest: things that aren't here
69
When can we hear fetal heart sound
10-12 weeks
70
Fundal height marking date
12 week: above symphysis pubis
16 week: between symphysis pubis and umbilicus
20 week: umbilicus
Starting at 20 - 35 weeks: fundal height should= gestation week+- 2cm
71
BP. Meds that can be used during pregnnacy
Methylopa
Labetalol
72
Who can't have methylopa
Alpha 2 agonist:
Active liver problem, so after starting this, check LFT periodically
73
What are the signs to discontinue methyldopa
Fever
Jaundice
Abnormal LFT
74
When should we consider phototherapy when 2 day old baby has jaundice
Bilirubin level> 5 mg/dL
75
What is diagnostic for diverticulitis
What is the Sx
Treatment
LLQ pain+ leukocytosis
Some patient don't have Sx
Might have bloody stool, but mucus, pus is not common
Uncomplicated diverticulitis: bed rest, clear fluid x 2-3 days
Complicated: (signs of sepsis): fs, fc, c
-----flagyl+ septra
------flagyl+ ciprofloxacin
-----clavulin
76
Kawasaki disease
Phases
Diagnostic
Common 1-2 yr
Infectious disease, but we don't what infectious agent is
Primarily affect mucocutaneoous & lymphatic system: affect cardiac system, increase risk of coronary aneurysm, pericarditis, MI, myocarditis
Not contagious
3 phases:
1. Acute arteritis: marked neutrophil infiltration and necrosis of all vessels layers
2. Subacute, or chronic vasculitis: start weeks, months, or years after the fever
3. Liminal myofibroblastic proliferation: cause coronary artery stenosis
Diagnostic: out of exclusion; lab isn't diagnotic
Persistent fever>=5 days+ >= 4 of the following:
-- bilateral conjunctival injection
--change of lip and oral cavity
--unit lateral cervical lymphadenopathy
--polymorphous exanthema (疹子)
--swelling of hands, feet, or perineal area
--labs:
----------low albumin: <=3
Urine>= 10 WBC
Platelet: >=450,000 7 days after fever
Anemia
Total WBC>=15000
High ALT
Stages:
---acute phase: eye, rash, extremeties edema, lymphadenopathy
----subacute phase: above subsides, joint pain, heart disease+ finger skin becomes flaky+ thrombocytosis.
Treatment: hospital
77
Appendicitis Sx
Pain staring from periumbilical to RLQ
nausea, vomiting, cramping, anorexia
Could have peritonitis
78
When a patient with PUD say their abdomen is no longer painful
Perforated ulcer
79
Pyloric stenosis
Sx
Diagnosis
Treatment
Prognosis
Abdominal distension
Dehydration
Projectile vomiting: immediately after feeding; emesis can contain blood
Failure to thrive
Unable to satisfied: weight loss, insatiable
Diagnosis: Sx + olives mass felt on epigastrium+ abdominal US
Management: surgery (pyloromyotomy)+ correct lyte & fluid
Vomiting can still happen a few days after surgery, but as not as bad as before. Feeding should be started slowly
Prognosis: excellent
80
IBS treatment
Diarrhea: tel: TCA, eluxadoline ( anyimotility): loperamide, CBT, hypnotherapy, low FODMAP diet
Mixed: TCA, probiotic, low FODMAP diet, CBT, hypnotherapy
Constiaption (SLL): linaclotide ( increase intestinal secretion); SSRI, Lubiprostone (no low FODMAP diet, no hypnotherapy)
81
Traveler diarrhea
What cause it
Treatment
E.coli most causative pathogen
Occur up to 10 days after travel
Self-limited:
Oral hydration+ PRN Imodium up to 16mg/ day; PRN bismuth subsalicylate
If abx: ciprofloxacin, azithromycin
82
Parkinson disease
Diagnosis
Management
Bradykinesia+ >=2 Sx: rrar
- resting tremor
-rigidity
-asymmetric
-responsive to levodopa
Management: if mild, don't need treatment
See picture
83
Duodenal ulcer vs gastric ulcer
Peptic ulcer includes duodenal and gastric ulcer
Duodenal ulcer: pain gets better after eating, then 2-5 hours later, it get worse
Gastric ulcer: pain becomes worse when eat
84
Where in abdomen hurt when pancreatitis
Epigastric
85
If mom has hx of GDM
how often do we check DM
Check DM 1-3 month postpartum+ lifelong DM checking q 3 years
86
Screening for GDM and diagnosis of GDM
Check it at first visit & if no risk, check @ 24-28 week gestation
Diagnostic:
1. 1 step method
2. 2 step method
87
DM high in 1st trimester is
DM2. GDM has to be diagnosed in 2-3 trimester
88
Treatment of breastfeeding mastitis (lactational mastitis )
Dicloxacillin x 10-14 days
If high risk of MRSA: septra , or clindamycin
89
Preeclampsia.
Sx
Risk factor
Think about HELLP
Headache
RUQ pain
Acute kidney failure
Blurred vision
DIC
PE
Stroke
Liver rupture
Risk factor:
HTN
Hx of preeclampsia
1st time or many babies already
Old >35
Fat
Kidney problem
90
Diagnostic criteria of preeclampsia
1. BP >140/90
2.edema: fast edema and weight gain > 2lb per week. Edema mostly on face, eyes hands
3. Proteinuria: > 0.3G protein in 24 hr urine specimen.
91
Treat preeclampsia
Refer to OB
Only cure is deliver the baby
92
Preeclampsia vs chronic HTN
What week
Abp>140/90 before 20 week is chronic HTN
93
How to prevent placenta abrupt
Don’t smoking
Control BP
No cocaccine
Seatbelt
94
Sx of placenta abrupt
Sudden vaginal bleeding with abd or back pain
Rigid uterus: hypertonic
Uterus ve try tender
Painful uterine contraction
95
Sx of placenta previa
Placenta implant too close to cervix
Sudden vaginal bleeding
Mild contraction
Uterus no tender and very soft
96
When suspect placenta previa, what do u do?
Nothing goes into vagina or rectum
Don’t do digit exam.
Only abdominal US, not even transvaginal US
97
If oligohydramnios
Normal AFI
Refer to OB
Normal AFI 5-25cm
98
Polyhydramnios
AFI > 25cm
Very rare
Often due to genetic problem: fetal anomalies is the most common cause
99
RhoGAM
What is it for
Doses? When do we give it
It’s a IgG antibody against Rh factor
It kills the Rh factor across placenta from baby
So it prevent mom develop antibody ( because during this process it will cause baby hemolysis &anemia)
We give 2 doses to all mom who is Rh negative. Regardless if they successful deliver the baby or not.
1st dose: 28 week: 300mcg IM
2nd dose: within 72 hours after delivery.
100
Spontaneous abortion
Loss the fetus before it’s livable < 20 weeks.
101
Stillbirth
Loss baby after 20 weeks. Or weight loss>= 350g
102
Threatened abortion
Vaginal bleeding. But cervical os is closed.
103
We don't need parental consent if
STD testing or treatment
Birth control
104
Treat genital wart during pregnancy
What causes wart
Wart is safe during pregnnacy
Only treat it if problematic
Trichloroacetic acid (topical), or CO2 laser, or surgical
Wart is caused by HPV (6, 11).
105
Diagnose HPV infection
No test available. We can only check for cervical cancer via Pap smear
106
HPV vaccine for pregnancy
Gardasil: can't get it until 6 week postpartum; against 16,18,6,11 (all). 100% protection. Give before sex. Both male and female can get it
Ceravix: against 16,18; both male and female can get it; give it before sex
107
Do we need to swab wart for HPV
No
108
When we do rectal STI swab, watch for what
Goal is what
Make sure no poop on it; goal is to get epithelial cells
109
Treatment of syphilis
What if pregnnacy women who can't have penicillin
2nd line: doxycycline x 2 weeks;
If they can't have penicillin: desensitization penicillin
110
Treatment for Chlamydia
What do we do after completing abx?
Often no Sx
Deao:
Doxycycline (x 7 days: preferred for non-pregnant)
Azithromycin (x1 dose): 1g x 1 dose: preferred for pregnant
Erythromycin
Oxofloxacin (all quinolone is fined 7 days).
Make sure to
1. Test 1 month after completing abx to see if it's cured
2. Then retest after 3 months after finishing treatment for re-infection
111
Treatment for HSV-1 & 2
If severe?
Need to give treatment within 72 hours after Sx onset
Acyclovir
Fam
Valvyvlocir
If severe, IV
112
Treatment for recurrent HSV
Start treatment asap see lesion
Famciclovir
Valvacyclovir
Acyclovcir
113
Chancreoid Sx & treatment
Lesion that start after exposure can grow more pustular lesions; lesion can be painful
CC
Ceftriaxone IM
Ciprofloxacin
114
Can pregnnant get acyclovir?
Yes. Safe
115
Screen all pregnant women what at their first visit
HIV
Syphilis
Hep B& C
ABO
1hr OGTT
116
Do we give prophylactic treatmetn for gonorrhea if we find out the patient has chlamydia?
Usually no; unless the situation indicated
117
What is reactive arthritis
caused by what
Rare complication of STI infection
Often caused by Chlamydia
Occur in young people
Self limited within 6 month - 1 year: supportive treatment
118
Is herpes simplex STI?
How does it transmit
Yes. Transmitted by direct contact
HSV-1: often oral
HSV-2: often genital
But both can be oral and genital
119
Sx of herpe simplex
Primary infection
General Sx: acute onset of small vesicles on red base; that rupture easily then becomes a painful ulcers;
HSV-1: lip/ mouth (gingivostomatitis), eye, throat:
HSV-2: genital
Primary infection: when has vesicular fluid and crust: most contagious.
Each reoccurrence usually become less severe
120
If suspect acute or early HIV infection, what diagnostic test do we order
1. 4th generation: aka combination antibody/ antigen assay
2. Viral load test
121
Pneumocystis PNE
Complication from HIV infection
Treatment: 1st line: Septra
If severe allergic to sulfa: Dapson (sulfones is the drug class; abx)+ trimethoprim
Before starting dapson: make sure the patient doens't have G6PD anemia due to potential hemolysis
122
What is the most common CNS infection in AIDs patients
How to treat it?
How to prevent it from happening
Toxoplasma gondii infections (protozoa)
Can lead to brain infection, problem
1st line: septra
2nd line: dapsone+ pyrimthamine+ leucovirin
Prevention: avoid clean cat litter & eat uncooked meat
123
For HIV infection patient, what are the treatment
ART: to promote CD4+ count (means better immunity) & reduce HIV viral load
After starting treatment: follow up with viral load (aka HIV RNA)
1st viral load: 2-8 weeks after starting treatment
2nd viral load: q 1-2 months until viral load becomes undetectable
3rd vital: then watch CD4+ & CBC q 3-4 months for the first 2 years of ART
For prevention HIV:
-- get all the not active vaccine: HPV (after 21yr), pneumococcal, Tdap, hep A & B
--pap smear every year: if 3 negatives, then do it q 3 years
--avoid cat litter & eat uncooked meat: toxoplasma
--no amphibian 两席动物: turtle, snake...: salmonella
--no bird stool: histoplasmosis
--take ART as instructed
124
pre exposure prophylaxis treatment for HIV
Who is it for
What do we do before we order it
For the people with high risk of HIV infection
Must check HIV infection before starting med: and recheck HIVB q 3 month after
Take the drug everyday
125
HIV screening test
1. EIA test (enzyme immune assay)--> not- reactive--> no HIV
2. If reactive--> repeat EIA x2 times--> >=2/3 tests are reactive---> confirmatory test----->
3. If confirmatory test is non-reactive--> no HIV
4. If confirmatory test is reactive---> positive HIV
126
Common Sx of HIV
General lymphadenopathy
Rash
Thrush
Mucosal ulceration
127
If give post exposure prophylaxis HIV treatment, when do we give it
Don't wait for the result to be back
Must give it within 72 hours after exposure, otherwise, it's useless
Duration could be 4 weeks
128
Pregnant women with HIV infection
What specific treatment recommended for pregnant women? Can we give it to infant?
Name of the drug
What do we watch for the treatment
Start ART anytime during pregnnacy, but best start right after known pregnant status: signicaint reduce viral load given to the baby
Preferred treatment for both mom and baby: (best give it within 8 hours after birth): Zidocudine (Retrovir)
Before start the drug: check CBC with differential (get baseline because this drug suppress bone marrow)
Then watch CBC with differentials
129
What is Gardasil 9
Get pregnant women get Gardasil?
A HPV vaccine
Pregnancy women can't get it until 6 week postpartum
130
Treatment of genital wart
Some methods that patient can self-administered at home. These are:
1. Podophyllotoxin: pregnancy contrandicated
2. Imiquimod: pregnnacy contrandicated: leave it on for 6 hours then wash it off: stimulate local interferon and cytokines production: can cause hypopigmentation, irritation, ulcer.
3. Sinecatechins: pregnnacy can use it; also make sure to wash it off before sex. Only external use: not for vagina or anus; can weaken condom & diaphragms
Provider- method: TCA & cryotherapy are common for small wart (< 1cm); if bigger, surgical
131
Pelvic inflammatory disease Sx (6)
What's pelvic inflammatory disease?
Common cause
Diagnosis
Sx
Complication:
Tests to order:
PID means when infection spread up to the upper genital tract;
Common cause by gonohhea, or chlamydia
Diagnosis is clinical: even NAAT comes back negative for both, we still treat it. This disease, it's better over treat it than leave it.
Sx:
--adnexal tenderness: most sensitive for PID
- acute onset of lower abdominal or pelvic pain (could be one side or both)
- new vaginal discharge+- bleeding
- painful sex
- cervical motion tenderness
- fallopian, ovaries might be painful on palpation
Complication: perihepatitis: RUQ tenderness
Tests: (5).
--pregnancy test
--NAAT
--syphilis
--HIV
--inflammatory markers
132
Treatment for PID
When should you expect improvement
Outpatient (FCD): ceftriaxone 500mg IM x 1 dose+ doxycycline x 14 days + flagyl x 14 days
Within 72 hours
133
Who is more likely to get PID;
Young patients
134
What is most characteristics of syphilis
Primary: painless chancre: heal in 9 weeks if not treated
Secondary: have systemic Sx (because syphilis can actually affect heart, nerve, and gum)
Latent: no Sx. But positive tire
Tertiary: affect cardiovascular. Gum, and nerve: this happen at least 1 year after primary infection
Other characteristics Sx in *secondary syphilis*: rash
-- condyloma lata: white papules that look like wart grow on moisturd areas: mouth, perineum
--Maculopapular rash: this rash happen the whole trunk., extremeties and hands. NOT itchy
135
Syphilis diagnosis
NAAT culture of chancre, oral and lesions
Syphilis serology testing: RPR
Patient with hx of syphilis: positive nontreponemal test means new infection, evolving respond to treatment, or treatmetn failure
Patient with no hx of syphilis: both nontreponemal and treponemal tests are reactive to diagnose.
Make sure to use RPR to monitor treatment responds.
136
If the pregnancy women have high risk of syphilis, when do we screen them
1st visit, then 28-32 week, then at delivery
137
Do we follow up after starting syphilis treatmetn? Do we treat partner if their RPR is negative
Yes. We treat partner regardless the result
We follow 6 month and 12 months after treatment; we should expect at least fourfold decrease in pretreatement and post treatment. Most patients their titre will go down after treatmetn, but some people will have high titre for the rest of their life.
For chancre: follow up in 3-7 days after penicillin. : should expect start healing.
138
What do you do patient starting to be diaphoretic, hypotensive, headache,e Malawi, fever, chill after starting syphilis treatment?
What’s is it called.
This is called Jarisch-Herxheimer reaction; it's normal after syphilis treatmetn. Self limited. Management is supportive
We can't prevent this from happening.
139
After the patient receive gonorrhea and chlamydia treatmetn, NAAT remains positive, what do you do
It's normal to remain positive 2-3 weeks after treatmetn due to dead organism.
140
What can cause false positive syphilis
Plac
Pregnancy
Autoimmune
Lyme
Chronic acute problem
141
Chlamydia vs gonorrhea
Chlamydia Sx usually at GU system
Gonorrhea Sx can be systemic
142
What STD can cause liver problem
PID
Can lead to perihepatitis/ Fitz-Hugh-Curtis Syndrome
143
When should we refer when teenager don't have testicular development (by what age)
14 yr old
144
What's oxybutynin for?
Anticholinergic: treat urinary incontinence
145
Chlamydial ophthalmia neonatorum
Diagnostic test
Baby eyelid becomes red, swelling, discharge (purulent, bloody at the end);
Diagnostic: swab conjunctiva (for epithelial cells)
Must: rule out chlamydia pneumonia
146
How does Down syndrome look (7)
ear?
Small AP head diameter
Up-tilted parental fissures
Big tonge
Short neck
Small ear
Simple transverse palm crease
Short finger and small palm
147
When does retina mature
6 year
148
Infant vision
1. Neonate/ 1 month: basically blind: 20/200- 20/400: no tear, prefer human face, blue-gray eye is normal: can briefly fix on human face
---if one eye always turns inward or outward: refer
2. 3 months:
--hold hands out to see your face
---see bright, follow and fixate for seconds
3. 6 month:
---eye contact
----turn head
4. 12 months:
---prolonged eye contact, observe surround and people for long time
---recognize self and favourite people in long distance
149
Down syndrome baby has higher risk of
Heart problem
TSH problem
Hearing
Others: AD, atlantoaxial, IQ
150
Hypospadias vs epispadias
Hypospadias: urethral meatus is ventral (lower) aspect of penis： 龟头后侧
Epispadias: .... dorsal aspect (upper): 龟头前侧
151
Who can't have flu vaccine (4)
--hx of anaphylaxis of egg ( less severe egg allergy can still have influenza)
--hx of Giuliani garre (immune damage CNS nerve, cause if unknown, people usually recover from it)
-- if moderate- severe illness with fever: wait until recovery to get vaccine
--<= 6 months (can't get it before that; immune is not mature enough).
152
If the patient get DTaP before 7 year
Doesn't count;
153
Tdap vaccine before 7yr
Before 7 yr: DT
154
Can lactation get Tdap
Yes
155
Who can't have Tdap
-- hx of Brian problem within 7 days after getting previous DT vacccine that is not caused by other brain problem
-- severe allergic to Tdap
156
Family hx of seizure
Family hx of SID
Fever that is < 40.5 C or 105 F
Can they get Tdap?
Yes they can
157
What's abnormal and you should watch about Tdap?
1. Fever> 40.5 C/ 105 F within 2 days after getting Tdap
2. Seizure within 3 days
3. Collapse or shock like within 2 days
158
What can baby 9 months do
1. Pincher grasp
2. Clap
3. Wave bye bye
--------
1. Pull themselves up: bear weight well
2. Crawl
3. Cruises
----------
1. Play peek-a boo
159
When is marked stranger anxiety noted? (Age)
9 month
160
What can kid 1 yr do
sir ssek f (sir sick as F)
1. Can stand independently
2. Cruise: Start to cruise: move from one piece of furniture to next for support
3. Use sip cup
4. 1-2 word+ repetitive sounds+ 感叹号 (exclamations) (Uh-Oh!)
5. Know first name
6. Follow simple directions: such as pick up the toy
--------------------
161
When growth rate slows down
1 yr
162
Can parents heat the formula in the microwave?
No
163
How to prevent choking
Remove object smaller than 2 inch: grapes, raw carrots, hot dogs, latex balloons, coins, buttons.
164
When can we give kid hard candy
After 6 years
165
How long the kid should have rear- facing seat?
Until 2 yr
166
Can we put kid in frontseat?
Why?
Not until 13 yrs
Air bags can cause serious brain or neck injury
167
Car safety seats
2yr
8yr
12yr
Back—harness—booster seatbelt
168
At what age the kid can say single syllable?
6 months
169
At what age the kid can play pat-a-cake
9 months
170
What cause acute dacryocystitis
Sx
Diagnosis:
Treatment?
Chronic dacryostenosis+ bacterial growth in lacrimal sac
Sx: purulent eye discharge without other signs of infection
Dx: culture the discharge+ systemic abx x 7-10 days: prevent orbital cellulitis
171
When do we use Barlow and Ortolani test to check congenital hip displasia
Until chid is weight-bearing /walking
172
If you suspect hip dysplasia
Order hip US+ refer to ortho
173
What temp is considered fever in newborn & infant
>=38 C (100.4 F)
174
When infant colic, make sure to rule out
Formula allergy
175
Bilirubin pathway
Unconjugated bilirubin: RBC breakdown: toxic : fat soluable
Conjugated bilirubin: new bilirubin processed by liver: water soluble
176
What's pathological jaundice
1. Bilirubin increase too fast: > 5mg/dL per day
2. Total bilirubin > 17mg/dL
3. Jaundice of full term infant after 2 weeks of age;
4. Jaundice before 24 hr : alway pathologic
177
What can cause fetal jaundice
TORCH
Toxoplasmosis
Others: syphilis, hepatitis B
Rubella
Cytomegalovirus
Herpes simplex
Bleeding
178
Full term baby that has been jaundice > 3 week with exclusive breastfeeding
Consider breastfeeding jaundice; which is no pathological
179
Physiologic jaundice
When is the physiologic jaundice usually resolve?
Jaundice occurs after 24 hour,
Self limited and resolve without intervention by 2-3 weeks
Usually total bilirubin can peak 7-9 for white & black
Asian can peak up to 14mg/dL
180
Breast milk jaundice
Show 4-5 days, peak 1-2 weeks, can take more than 1 month to resolve
Temporary stop breastfeeding: like 12 hours
Total bilirubin can > 20 mg/dL
Some need phototherapy
181
What do you do if pathological jaundice
1. Use transcutaneous bilirubin testing first: finger poke
2. Serum fractionated bilirubin level
3. Coombs test
4. CBC
5. Reticulocyte count
6. Peripheral smear
7. Breastfeed q 2-3 hours
First line treatment: phototherapy & follow up in 5 days
182
What's physiologic anemia in infancy
Hgb drop to 90-110 at 2-3 months; due to high O2 in body, so lower Hgb production
183
When can the baby turn from front to back
4 month
184
When should we expect the strawberry hemangioma will resolve
2 yrs;
Watch and wait
Benign lesion
185
If the baby has fever of 37.8, can you give vaccine?
As long as it's not> 38, you can give it
186
What does Coomb test do
Test if you have antibodies against your own RBC
187
When can the baby hold head unsupported
4 month
188
Miosis is
Excessive constriction of pupils
189
What's common Sign of child abuse; and what NP do?
1. Postiomedial rib fractures (back and mid of body)
2. Spinal fracture
3. Metaphysical avulsion (force) fractures
4. Bruises that are different stages of healing
190
What's the common pathogen causing epiglottis is
Before vaccine, is Hib
After vaccine: staphyl aureus, or strep pyrogen, fungi
191
Common pathogen cause septic joint
S. Aureus
192
Umbilical hernia resolve by
2 yr old
193
Inguinal hernia noted at infancy
Need surgery
194
Sacral dimple
Need spinal US
195
Bowl leg until
18 months
196
Anterior vs posterior frontanelle
Posterior close by 2 month
Anterior close 1-2 yr old
197
Uncoordinated eye movement will resolve
By 6 month
198
Heart murmur in infant
Common in newborn, but should disappear in a few hours; signicant murmur is not normal
199
First stool must be passed
Within 2 days after birth
200
Hydrocele should resolve by
1 yr; longer than that is not normal
201
Cutis marmorata
202
Signs of bilirubin toxicity to brain
Kernicterus
Loss Moro reflex
Poor feeding
Lethargy
Hypotonia
203
To prevent SIDS, how long the infant should be supine until
6 month
204
When the chest and head circumference becomes the same
6 month
205
Age
Neonate
Infant
Toddler
Preschool
Preterm
Low birth weight
Neonate: < 28 day
Infant: 1 month to 1 yr
Toddler: 1-3 yr
Preschool 3-5 yr
Preterm: < 37 week
Low birth weight: < 2.5kg
206
Mom's IgE will protect the baby for how long
3 month
207
When is the growth spurt that baby wants to eat a lot
6-8 week
208
Weak cry
Myasthenia gravis
209
Hoarseness cry
Hypothyrodism
210
Edinburgh postpartum depression, what score should be referred
>=13
211
When does kid pee incontinence at night is abnormal
> = 5 yr
212
When do we screen for autism
18 month:
We watch for 5 signs:
1. No point/ show/ reach, or babbling by 12 month
2. Don't say 1 word by 16 month
3. Don't say 2 word phases on their own by 1 year
4. Loss language or social skills at any age
213
What stuttering is not normal
Last>=6 months
>=5 yr
214
Kawasaki disease
Treatment
Commonly patient is < 5 yr
Sx usually resolve within 3 weeks
Fever (> 40C) x >=5 days+ >=4 of the folllowing:
1. Swollen hands and feet
2. Neck lymadenopathy
3. Bright red rash
4. Strawberry tongue: or oral mucosa change
5. Bilateral conjunctivitis without discharge
Treatment: high dose aspirin + IV gamma globulin+ refer to pediatric cardiologist because those consequences will happen once kid is older.
Watch: close follow up because can have serious consequences: aortic dissection, aneurysms/ dilation of coronary artery, or hearing loss.
215
Signs of child leukemia
1. Signs of bleeding
2. Fatigue
3. Weak
4. Pale
216
What;s most common leukemia in kid and what cause it
Sx
Cure?
ALL: acute lymphocytic leukemia: fast growing cancer of lymphoblast (immature lymphocytes)
Sx: (WBC, Hgb, platelet) neurtropenia+ anemia+ thrombocytopenia
Girl has higher chance of cure than boys
217
Acute myelogenous leukemia (AML)
Pathology
Cure?
Fasting growing cancer of bone marrow that affect immature or precursor blood cells, such as myeloblast (WBC), monoblast (macrophages ), erythroblast (RBC), and megakaryoblast (platelet)
Better chance of cure:
1. Down syndrome
2. < 4 yr old
218
Thing that may disqualify youth from sports participation
1 ham meaf pib
1. 1 kidney (solitary kidney)
2. Hypertrophic cardiomyopathy
3. Mitral valve prolapse
4. Marfan syndrome : eye displacement, aortic aneurysms, cardiac death, joint hyper mobility
5. Ehlers-Danlos syndrome: vascular form: joint hypermobility. Spondylolisthesis, cerebral, cervical artery aneurysm
6. Atlantoaxial instability
7. Fever: dehydration, hypotension, increased heart lung input
8. Pink eye
9. Infectious diarrhea
10. Bleeding disorder
219
Fragile X syndrome
Features
1. Long face
2. Prominent forehead & Jaw
3. Large/ protrude ears
4. Large body with flexible flat feet
220
Hand foot mouth disease
How does it spread
Acute flu like Sx+ blister turning into ulcer
Small blister on hand, feet, mouth, around rectum; mouth, tonsil, throat, tongue can have small ulcers,
221
Measles Sx
How the rash spread
-Koplik spots. Inside cheek
-Maculopapular rash start on face and spread from head to feet without getting to palms and soles.
-
Spread: top down without affecting palm and sole
222
Varicella skin Sx
Generalized rash with different stages. New lesion appear daily for 5days.
Papule
Vesicles
Pustules
Crust
Pruretic.
Very contagious.
223
Molluscum contagiosum
Sx
Cause
Smooth
Wax like
Round: doom shaped
Cause by poxvirus
224
Maculopapular rags that at webs of hand feet axilla… super itchy. But more at night
Scabies.
225
Scarlet fever
Sandpaper rash with sore throat.
226
Pediculosis capitis
Aka. Head lice
Red papules initially located a hairline behind neck and ears.
227
Piaget stages.
228
HPV vaccine at youngest age can get is
9
229
Most common cancer in children
Most common cancer in teens
In children is ALL
In teens 15-19yr is : Hodgkin’s lymphoma, germ cell tumour ( such as testicular and ovarian cancer)
230
Hodgkin’s lymphoma
—Large lymph node with fever
—-Those big lymph nodes might become painful after drinking alcohol
— night sweat & other signs of cancer
231
Testicular cancer
Age
Sx
15-35yr
Heavy feeling scrotum with a firm mass that is painless
232
So to testicular torsion. It will loose function by what time
24 hours. If no surgery is done.
233
With torsion of appendix testis. What’s the UA
How to manage it
UA is normal
Self limited. Elevate acronym, bed rest, ice, NSAID
234
Tanner stage
Don't memorize the pubic hair changes; only know the breast change for girl and genital changes for boys
Only memorize 2-4
Precocious puberty:
For girl: before 8
For boys: before 9
Delayed puberty:
For girls: no breast development by 12y.
For boys: no testicular enlargement by 14 yr
235
Mittelschemerz
Ovulation pain
Unilateral; caused by big follicle
236
Menarche
First onset
Sx after
Breast bud vs menarche
Average starts at 12 yr
Then 1-2 yr after, period becomes irregular due to irregular ovulation
After breast bud, first period starts within 2 years.
237
Normal period
Every 28+- 7 days
Last: 2-7 days
1st day spotting, then 2-3 days of heavy bleeding, then becomes light bleeding
238
Dysmenorrhea associated with prostaglandin level
High prostaglandin level
239
Most fertile day
3 days before and during ovulation (11-14day).
240
Adolescent top cause of death
AAS:
1. Accident
2. Assault/ homocide
3. Suicide
241
When the teenage doesn;'t need parental consent
1. They don;t need for contraceptive, STI to begin with
2. Legally married
3. Active duty in armed force
4. Live separately from parents or self- supporting
242
When can you break the confidentially
1. Gunshot wound, stab wound: report police
2. Suicidal idea or attempt: tell parents or hospital
3. Homocide idea
243
Anorexia nervous binge-purging type vs bulimia
Bulimia can't control; eat a lot within short amount of time, then they use stuff to get it out
244
What weight loss you should start consider anorexia?
Weight loss> 10% of body weight
245
Idiopathic adolecent scoliosis
Who likely to get it
What have worse outcome
Screening
Diagnosis
Treatment
Girls like to get it
Kid starts to have curvy spine during bone spurt
Physical exam:
---Adam' forward bend test: patient bend forward with both arms handling free: watch assymmetry of spine, scapula, thorax, and lumbar curvature
---order X-ray to get Cobb angle (curve degree)
Treatment:
--< 20 degrees wait and watch
--20-40: brace: Milwaukee brace
> 40 degree: surgery
246
Tanner stage 1
Aka?
Prepubertal
247
When gynecomastia is normal
Before 14 yr
248
Tylenol toxicity
First 24 hr: could be no Sx.
24-72hr: high liver test, high renaltest, high Prothrombin
3-4 days: low sugar
249
What drug myasthenia gravis patients can’t have?
Macrolide
250
At what year the patient can’t have tetracycline
<9 yr old
251
What drugs that is not ototoxic that can be used on perforated TM
Ofloxacin
All the mycins are ototoxic
252
What’s meningococcmia
Treatment
Prophylaxis treatment
Blood infection caused by Neisseria Meningitis
1st line Ceftriaxone
Prevention treatment: Rifampin
253
Rocky Mountain spotted fever
Flu like first ( include joint and muscle pain)
2-5 days later have small red dot petechiae at wrist ankle.
Treatment: doxycycline.
254
What nerve does shingle affect
Trigrminal
255
Is tinea versicolour itchy?
No
256
Signs of pityriasis rosea
Herald patch—-> collarette scaling patch—> Christina’s tree ( rash on cleavage)
257
What Rocky Mountain spotter fever caused
Rickettsia tick bite.
Sudden high fever, severe headache, joint muscle pain rashes at ankle wrist
258
Spider bite treatment
If kid has systemic Sx?
Abx on wound
Cold pack
NSAID
If kids with systemic Sx: hospital due to hemolysis risk
259
Pseudofolliculitis barbae
Barber’s itch.
Caused inflammation from curly hair grow back into the skin
Treatment. Let the beard grow 3-4 weeks.
260
What’s this
Melasma
261
Skin tags
Acrochordon
262
Steroid potency
263
Acne treatment.
264
What bacteria causes acne
Cutibacterium acnes
265
Anthrax
Caused by
266
Smallpox
Treatment
267
For mild onychomycosis
Start with topical antifungal: ciclopirox, efinaconazole
268
Moderate to severe onychomycosis
Finger vs toes
Oral terbinafine
Finger: 6weeks
Toe: 12 weeks.
269
Lyme disease tick pathogen
Borrelia burgdorferi
270
Diagnostic tests and treating Lyme disease.
271
Once you remove the tick and find tick is engorged
Give 1 dose of doxycycline. 200mg
272
What's this
What do you do
Necrotizing fasciitis
Send to ED
273
What's this
What do u do about it?
Pityriasis rosea
Cleavage 卵裂lines
Christmas tree pattern
Herald patch
Maybe itchy
Self limited within 1 month
May caused by viral infection
274
Korbner phenomenon
In psoriasis paitent;
Psoriasis formed after a skin trauma
275
Auspitz sign
Bleeding if you peel psoriasis skin scale
276
Treatment of psoriasis
1st line: topical steroid+ emollient
Others:
1. Topical retinoids : tazarotene
2. Tar preparation: psoralen drug
3. Topical vitamin D
4. Anthralin: natural product from tree
If severe: MTX, TNF, phototherapy...
277
What's about topical tacrolimus
Can cancer, but rare
Don't use it in immune bad paitents
Make sure use sunscreen when on it
278
What's this
Guttate psoriasis:
Drop-shaped lesion
Caused by beta-hemolytic streptococcus infection:
Usually due to strep throat
279
What's this
Pustular psoriasis
Can associated with life-threatening situation, such as other body organ dysfunction, or infection
280
Rocky Mountain spotted fever
Cause
Dx
Tests
Tx
Sx
Complication
Caused by Rickettsia rickettsii infection caused by dog tick/ wood tick bite
Risk: woody area, high grass, expose to dogs, southeastern or south central state
Diagnosis: clinical+ hx (risk factors).
-----definitive Dx: indirect fluorescent IgG antibodies IFA assay: check in 2, and 4 week you see values x 4 increase ; result will stay elevated for months after Sx resolved.
Tx: doxycycline start best within 5 days since Sx onset
Report the disease
* red spot starts on hand/palm/ feet+ fever, headache, muscle pain
Complication: death, neuro problem: hearing loss, neuropathy
281
If the patient has Sx of Rocky Mountain sported fever + risk factor but result is negative, do you treat it?
Yes; antibody often negative in early infection
282
How to properly remove tick
283
What’s this.
That’s the treatment
284
Scabies treatment
Can you apply on kids? Face? Scalp
285
What pathogen causes tinea versicolour
286
Treatment of tinea versicolour
287
Shingle vs chickenpox
Shingle is the reactivation of chickenpox
288
What’s this
Shingle
289
Complication of herpe zoster
290
Phases of wound healing
291
Wound care for superficial and partial thickness (burn)
292
When do you think about tetanus shot when wound occurs
If last dose > 5 yrs, get one
293
Don’t suture what wound
294
Can immune compromised patient get shingrix?
Yes. When they r getting treatment. Must be >50 years
295
If many skin lesions of impetigo, what’s your treatment
If limited number: topical mupirocin
If many: oral cephalexin, or dicloxacillin
296
What’s virus causes herpetic whitlow
Heroes simplex
297
Degree of burn and where it damage
Superficial: epidermis
Superficial partial thickness: blister between epidermis and dermis
Deep partial thickness: dermis & hair follicles and granular tissue
Full-thickness : all dermis and often fat tissue
298
Carbuncle vs furuncle
Involves what
Carbuncle: combined several inflamed follicles into a single inflammatory mass with orient drainage
Furuncle: well circumscribed, painful, supportive inflammatory nodule that involves hair follicles and often for preexisting folliculitis
299
First line treatment for psoriasis
Mild: topical corticosteroids and emollient
300
Paronychia treatment
If have access: incision and drainage
No abcess: topical abx and warm water or antiseptic soaks
301
Skin changes associated with bacterial/ infectious endocarditis
Subungual hemorrhage
Petechiae on palate
Painful violet nodes on finger or toes ( Osler nodes)
No tender red spots on palm or soles( janeway lesions)
Eye exam shows Roth Spots ( retinal bleeding)
302
Typical Sx of infectious endocarditis
Common pathogen
1st line diagnostic test
Fever chill
New murmur
Anorexia
Weight loss
Pathogen: Staphyl aureus
1st test: ECHO
303
Aortic stenosis is systolic or diastolic murmur
Systolic.
304
For the exam, what murmur that radiates.
Systolic.
305
Murmur quality
What radiate to axilla
What rumbles
Mr: radiate to axilla or base
Ms: rumble
306
What murmur is very bad, what it sounds like
Aortic stenosis
Harsh and noisy
Refer to cardiologist
Avoid physical exertion—> sudden cardiac death
307
What murmur you can listen when patient is at a special position
308
What murmur you use bell to hear?
Ms
Use bell
Best heard at mitral
Also called opening snap
309
Risk factors of endocarditis
Oral problem or procedure
Fake valve
Congenital valve problem
310
What abx do you give as prophylaxis endocarditis going to an oral procedure.
Give amoxicillin 2g one time dose 1 hour before procedure.
If allergic to penicillin: cephalexin or clarithromycin.
311
What’s this
A-fib
No P wave
Irregularly irregular
312
What’s this
Anterior wall MI
Elevated ST at V2 to V 4
Looks like tombstone
313
What’s this
Ventricular tachycardia
Jagged irregular QRS
314
Lentigines
Aka liver spots. Brown coloured macules located at hands and forearms
Benign
315
Neurofibromatosis is associated with what
316
Should the patient see breast specialist first or get biopsy first
See specialist first.
317
What’s Russell’s sign and Telogen effluvium
318
Drugs that increases warfarin
319
DOAC associated bleeding is treated by what
320
Anticoagulation and INR
321
High Vitamin K food
322
What’s this
Paroxysmal supraventricular tachycardia
ECG: peaked QRS with P wave
One type is called Wolff-Parkinson-White ( WPW)—- short PR interval+ wide QRS+ paroxysmal tachycardia —->high risk of death: refer
Comes and go
Refer to cardiologist for catheter ablation.
323
Can pregnant women have warfarin?
No
324
Chest x ray shows Kerley B lines
Right heart failure.
325
Normal jugular vein distension
<= 4 cm
326
Classification of HF
327
Does low carb diet help HTN?
Yes
328
Lifestyle change for dyslipidemia (5)
Reduce sugar & simple carb
Avoid alcohol
Eat finish with omega 3 ( salmon, sardines)
Weight loss
Increase Aerobic exercise
329
What intensity of statin to use
330
Statin intensity reduction
331
Atorvaststin and rosuvastatin dose and intensity
332
Risk factor of ASCVD
333
Which statin has higher drug interaction, and what do u watch
334
If patient has Sx of rhabdomyolysis
Stop drug and go to ER ( risk of acute kidney injury)
335
Avoid order statin for what patient
Alcoholic
336
When pregnant women tends to have S3 and it’s normal
3rd trimester
337
Eyes changes associated with HTN
Clinical significance of these changes
1. AV nicking: vein ( the thicker one) stop abruptly at the side of artery
2. Copper
3. Bleeding: flame or dot shape, cotton wool spots, hard exudate
4. Microaneurysm
5. Arteriolar narrowing and wall thickening
If you see these: need to get their BP down now!
338
Renal artery stenosis
Age
Sx
Common in young adults
Sx: HTN+ bruit @ epigastric, abdomen, or flank
339
Polycystic kidney Sx
Large kidney with cystic renal mass+ HTN
340
HTN+ increased creatinine + decreased GFR
Renal insufficiency or acute kidney failure.
341
Secondary HTN cause and age
Young adult : renal stenosis
Middle age: endocrine
Old: CKD
342
Hypertensive emergency vs hypertensive urgency
Urgency doesn’t have target organ damage: often caused by not taking meds. If no damage: make sure they take their meds and close follow up
Emergency has target organ damage ( systemic Sx): ER
343
DM eye change
1. Neovascularization
2. Cotton-wool spots
3. Microaneurysm
344
Why does AV nicking happens
When a retinal vein is compressed by arteriole and cause the vein to collapse
345
When assess orthostatic hypotension. What’s the time range
See the reduction within 2-5 min
346
With stage 1 HTN. What do u do
Depends on their FRS
If < 10%: lifestyle and reassess in 3-6 month
If >10%: lifestyle and drug.
347
For stage 1 and 2 HTN, what’s your goal BP
<130/80
For stage 2HTN, If not at goal BP 1 months after current intervention, switch a different BP med
348
About DASH diet
349
Where do u get Ca, Ma, K, Omega3
Omega: kaf : krill, anchovy, flaxseed
350
What’s contraindication of thiazide diuretic
Lithium treatment
351
What loop diuretic potential drug interaction
This diuretic might change excretion of lithium and salicylates.
352
What do you think before prescribing diuretic
Sulfa allergy
Anuria ( kidney failure) can’t have loop diuretic.
353
What’s bumetanide
Loop diuretic.
354
k sparing diuretic
Side effects
Contraindication
355
How thiazide helps osteopenia
Slow down Ca loss& stimulate osteoclasts
356
What’s BBB role in migraine?
Use a prophylactic only.
357
How to treat essential tremor
No selective BBB: propranolol
358
What’s non-selective BBB
Propranolol
Timolol
Pindolol
359
BBB that’s has both alpha and beta blocking action
Labetalol
Carvedilol
360
Non-DHP CCB vs DHP CCB
361
Contraindication of CCB
362
Can you give ACEI or ARB to patient with renal artery stenosis
No. Will cause acute renal failure
363
Cotton wool look eye means
Retinal nerve micro infarction
364
What Microaneurysm looks like in fundal exam
365
What alpha -1 blocker is
Potential vasodilator
Relax bladder neck and prostate gland smooth muscle.
366
SE of alpha blocker
Orthostatic hypotension
367
Can tamulosin help with BP?
No. Only BPH. But other alpha blocker reduce BP and help BPH
368
What MVP sounds like
Click+ holosystolic murmur
369
Marfan’s syndrome
Hypermovable joint
Long arm
Pectus excavatum
Might have MVP
370
What do you do if you find the patient has MVP
Lifestyle change
If they don’t have Sx, don’t need treatment
MVP often benign.
Lifestyle change:
Avoid caffeine, stimulants, alcohol, cigarette
Aerobic exercise training
Reduce stress
371
ARNI meds side effect
Same as ACEI
372
Does loop diuretic affect uric acid?
Yes. It increases it
373
MVP with palpitation. What do u do?
Treat it with BBB
374
If you suspect MVP, do you order any test? Why?
Yes. ECHO. Even if they have family he of MVP.
MVP associated with higher risk of severe MR, arrhythmia, bacterial endocarditis
375
What is is:
Leg pain when walk and instantly relieved by rest
PAD
376
What’s diagnostic for PAD
ABI<= 0.9
377
How to measure ABI
378
What drugs can increase serum concentration of anti platelet
God T
Grapefruit
Diltiazem
Omeprazole if taken together
379
PAD increases risk of
Carotid plaque
So check carotid bruits
380
Pulses paradoxus
How much does it drop
Pericarditis
Cardiac tamponade
Asthma
Emphysema
381
What Raynaud syndrome
Sx
Treatment
Drug therapy
Complication
Caused by reversible vasospasm of peripheral arterioles response to cold or emotional stress
Primary: no autoimmune diseases
Secondary: has autoimmune disease
Treatment: keep warm, avoid any stimulants ( caffeine), stop smoking, manage stress is very important
Initial drug: CCB + avoid vasoconstriction drugs ( triptan, ergot, decongestant, amphetamine
Complication: ulcers
382
What’s this
What’s your management
Order US to rule out DVT
Treatment: warm compression+ NSAID+_ anticoagulant depends on patient’s risk for VTE
383
When do we need to give infectious endocarditis prophylactic antibiotic?
384
Supraventricular tachycardia
Definition
Diagnostic
Treatment
385
What’s the definitive diagnostic test for right heart failure
Cardiac catheterization
386
What’s this
What’s your management
Atrial flutter
Rapid, regular atrial depolarization
Super fast HR
Sawtooth
No P wave
Treatment: rate control: non-DHP CCB, or BBB
387
Can a patient with second degree AV block use CCB?
No. Contraindicated. 1st degree is fine.
388
What’s the risk enhancing factors for ASCVD
1. CRP >= 2
2. CKD
3. Persistent high LDL>= 160mg/dL
4. Hx of preeclampsia
5. Premature menopause
6. Metabolic syndrome
7. Family hx of early ASCVD
8. PAD
389
Breath sounds
Bronchial: over manibrium
390
COPD treatment
391
Insulin time
392
What’s this
Soft exudate : infarct
Neovascularizatoon
Microaneurysm: red dots: bleeding
Hard exudate: protein leaking.
393
What’s this
Hypertension:
Silver/ copper wiring
Arterovenous nicking
394
What’s this
Pretibial myxedema
Rare Sx seen in Graves’ disease
Thickening skin usually at shin and give an orange peel appearance.
395
What’s this
Addison disease
Tanning
Freckles
Pigmented crease
Scant axillary and pubic hairs
396
Problematic drugs that tends to have drug drug interactions
397
Drugs interact with grapefruit
398
Quinolone SE
399
Quinolone contraindication
400
What drugs that need eye exam
401
What's this
Orbital cellulitis
402
What's this
Candida rash
403
What’s this?
Smallpox: flu like Sx + this papules.
404
What define supraventricular tachycardia
405
Asthma stages and treatment (NEPPA)
406
Pneumonia treatment
Atypical
CAP
Atypical: azithromyvin, doxycycline, levodloxacin
407
TB reading
408
Adrenal problem: primary secondary tertiary
409
Hepatitis A reading
IgM anti-HAV: IgM antibody hepatitis A virus
410
Hepatitis B reading
HBsAg: surface antigen
Anti-HBs: antibody
HBeAg: “e” antigen
HBcAg: core antigen
411
Hepatitis C reading
Anti-HCV: antibody
412
Hepatitis D reading
413
Liver enzyme interpretation
AST: in liver, ST ( heart), spread ( muscle)
ALT: liver ( liver 特别）
GGT: many places: alcoholic, drug, biliary, pancreas
ALP: a bone (*), liver, placenta
414
GGT elevated alone
Alcoholic
415
GGT elevated with other liver enzymes
Liver disease or biliary obstruction
416
Anti-HBc
Core antibody: start to have this at onset of Sx and will persist for life
417
Atypical squamous cell
Women under 24 yr has strong cervical immunity. So if we find abnormal cells, we give them time to recover: repeat PAP at 12 month ( if not positive)
But after 24 yr our cervical immunity declines, so if positive: colposcopy.
418
Buds andpseudohyphae
Clue cells
What are they?
419
US va mammogram when screening for breast cancer
<30yr or pregnant: do US
>30yr: mammogram
420
Scheduled pregnancy visit
421
Second trimester time
14-28 week
422
What do we do in second trimester screening
423
What STI do we screening during pregnancy
Hepatitis B (HBsAG)
HIV
Gonorrhea and chlamydia
Syphilis
HSV1-2
424
Syphilis stage and treatment
425
vaccines schedules
426
Hip dysplasia assessment
427
What drug can’t mixed with nitrate
PDE5
428
nephrology consultation (6)
pregnancy
eGFR < 30
persistent protein to creatinine ratio >500
ACR > 300mg/ g
abnormal urine microscopy
hx of SLE or mutiple myeloma
429
Gonorrhea treatment
430
Odynophagia
Pain when swallowing
431
Asthma treatment (Gina)
432
DM diagnosis
433
Metabolic syndrome diagnosis
434
Diagnostic test of Cushing syndrome
435
Pre DM
436
Prostate cancer screening
437
HTN treatment goal
438
Immediate HtN diagnosis
439
Target glucose in pregnancy
440
Epidydimitis treatment
441
Malignant neuroleptic syndrome
442
Serotonin syndrome
443
Drug for stress incontinence
Duloxetine.
444
Treatment of acute pyelonephritis
445
Piriformis syndrome
446
Hemophilia A
447
Hodgkin’s lymphoma
448
MoCA
449
MMSE
450
High oxalate food
451
Iron rich food
452
Sensitivity vs positive predictive value
453
Folate rich food
454
UTI treatment if risk for resistance
455
Pneumococcal vaccine
456
Meningococcal vaccine
457
2 yr
458
4 yr
459
5 yr
460
AV block
461
ECG
462
Septra contraindication
<2 month
g6PD
>= 32 gestation week
463
Tetracycline contraindication
<9yr
Renal failure
464
Triptan is
Sulfa drug
465
Phenylenephrine is
Nasal decongestants
466
Another nasal decongestants
Pseudoephedrine
467
Shingle vaccine schedule & contraindication
2nd by 2-6 months
Who can’t have it:
Pregnancy or lactation
Active shingle
Negative varicella titer
468
Black dot sign seen in
Tinea capitus
469
Lung cancer can present as
Recurrent PNE
470
Bronchiolitis, croup, tracheobronchitis
