FM CASE FILES 2 Flashcards
(147 cards)
1
Q
tx for GBS during pregnancy
A
penicillin
others: ampicillin, cephalothin, erythromycin, clinda
2
Q
how to confirm rupture of membranes
A
see amniotic fluid leaking from cervix
polling of amniotic fluid in vaginal fornix
Nitrazine paper - pH >6.5 in vaginal fluid
ferning on dried slide
3
Q
prolonged rupture of membranes predisposes to what
A
infection
4
Q
define first stage of labor
A
contractions until complete cervical dilation
latent phase
active phase - starts at 4cm
5
Q
rate of dilatation
epidural vs nonepidural
A
NO EPIDURAL
- 2cm / hr (nulliparous)
- 5cm / hr (parous)
6
Q
define second stage of labor
A
delivery of fetus
7
Q
normal duration of 2nd stage of labor
A
2 hours (nulliparous) 1 hour (parous)
epidural can prolong these times by 1 hour
8
Q
normal duration of 3rd stage of labor
A
30 min
9
Q
labor depends on 3Ps
A
power (strength of contractions)
passenger (size, lie, position)
pelvis (shape and size)
10
Q
what can cause of false-positive nitrazine test
A
semen
blood
bacterial vaginosis
all can elevate pH
11
Q
how do you assess fetal well being when mother is admitted to L&D
A
fetal heart rate monitoring
with a doppler ultrasound
or fetal scalp electrode
(requires membranes to be ruptured)
12
Q
what 3 things do you look at in fetal heart rate tracings
A
baseline heart rate
variability
heart rate changes
13
Q
normal baseline heart rate of fetus
A
110-160
14
Q
normal variability of fetus
A
3-5 cycles per minute
15
Q
comomn causes of decreased fetal heart rate variability
A
fetus sleeping
cns depressants (narcotic analgesics)
prematurity
fetal acidemia 2nd to hypoxemia
16
Q
define fetal heart rate accel
A
15 beats/min
15 sec
17
Q
what causes early decels
A
compression of fetal head
18
Q
what causes late decel
A
uteroplacental insufficiency
causes:
maternal hypotension (given epidural or oxytocin)
maternal HTN, DM, placental abruptio
19
Q
what causes variable decel
A
umbilical cord compression during contractions
20
Q
what do you use to monitor uterine contractions and its strength
A
external toco
strength: IUPC (need ruptured membranres)
21
Q
giving too much oxytocin during labor can result in what consequence
A
uterine hyperstimulation
late decels
22
Q
cardinal movements during labor
A
refers to movement of fetal head
flexion
internal rotation (occiput to move anteriorly - symphysis)
extension
external rotation
23
Q
maneuvers for shoulder dystocia
A
McRoberts Maneuver (hyperflexion)
suprapublic pressure
episiotomy
24
Q
most calcium is found where in the body?
A
bones - 98% of total
bound to albumin - 1%
watch out for low albumin, causing low calcium (correct for this)
free - 1% (active)
25
formula for corrected serum calcium
corrected calcium =
[normal albumin - serum albumin] X 0.8(serum calcium)
26
what hormone decreases serum calcium and how?
calcitonin
causes increased renal excretion
27
what hormone increases serum calcium and how?
PTH
increases bone resorption by activating osteoclast
promotes kidney resorption
promotes GI absorption through calcitriol
28
most common cause of hypercalcemia
hyperparathyroidism
29
signs and sx
| hypercalcemia
kidney stones
bone pain (arthritis, etc)
psychic (poor concentration, weakness, fatigue)
abdominal (pain, constipation, NV, pancreatitis)
30
first thing you look at when a pt has hypercalcemia
look at meds they're taking
stop the suspected med
31
if a pt has hypercalcemia, what is the next step
order PTH
if PTH is low, feedback loop is working fine
if PTH is high or normal, feedback is not fine
(primary hyperparathyroidism)
32
how do you distinguish between primary hyperparathyroidism vs familial hypocalciuric hypercalcemia (FHH)
FHH is a genetic disorder
measure 24-hour urinary calcium
FHH: low calcium level
hyperparathyroidism: normal or elevated urinary calcium
33
if hypercalcemia, if PTH is low and Ca2+ is high, what lab test do you order next?
PTH-rP
parathyroid hormone related peptide
this is produced by cancers
lung, SCC of head and neck, kidney cx
34
how does PTH-rP work
osteoclast bone resorption
increases calcitriol (uptake in gut)
inc kidney resorption
35
tx for primary hyperparathyroidism
surgical removal of the adenoma
36
activities of daily living
```
bath
dress
eat
toilet
continence
transfer from bed to chair
```
37
instrumental activities of daily living
```
transportation
shop
cook
telephone
manage money
take meds
housecleaning
laundry
```
38
leading cause of blindness in elderly
age-related macular degeneration
39
what is macular degeneration
atrophy of cells in central macular region
leading to central vision loss
40
what is glaucoma
what is responsible for the disease
increased intraocular pressure
optic neuropathy
41
most common cause of blindness worldwide
cataracts
42
leading cause of blindness in working age adults in US
diabetic retinopathy
43
what is presbycusis
how does it present
age-related hearing loss
sensorineural hearing loss results in:
high-frequency loss
difficulty with speech discrimination
44
what is otosclerosis
autosomal dominant disorder of inner ear bones
loss of conduction
presents in 20-40s
speech discrimination is preserved
45
what is CAPD and contrast it with presbycusis
central auditory processing disorder
(CNS dysfxn)
has difficulty understanding spoken language
but hears sound well
46
quick cognitive screening test for dementia
clock draw
| three-item recall
47
immunizations for ppl over 65
annual influenza
pneumococcal once
DPT booster
48
acute bronchitis
| which antibiotic
none
| antibiotics has not been shown to benefit
49
orgs in bacterial sinusitis (adults)
pneumococcus
| h influenzae
50
orgs in bacterial sinusitis (children)
pneumococcus
h influenzae
moraxella catarrhalis
51
tx for acute sinusitis
first line
amoxicillin and bactrim
```
if fail, then 2nd line
amoxicillin-clavulanic acid
2nd/3rd gen cephalo
quinolones
macrolides (azithro)
```
52
common causes of pharyngitis in teens/young adults
group A strep
mycoplasma pneumoniae
chlamydia pneumonia
arcanobacterium haemolyticus
53
group A strep findings
```
ABRUPT onset of sore throat/fever
tonsillar/palatal petchiae
tender cevical adenopathy
NO COUGH
sandpaperlike rash (scarlatiniform)
```
54
signs of
| infectious mono
cervical and generalized adenopathy
HSM
atypical lymphocytes on smear
55
complication of infectious mono
splenic rupture to trauma
restrict sports
56
signs and sx
epiglottitis
cause?
stridor
drooling
toxic appearance
leaning forward (tripod position)
H influ
57
differential dx of tonsillar exudates
```
GAS
EBV
mycoplasma
chlamydia
adenoviruses
```
note: having tonsillar exudates does not automatically mean its bacteria vs virus
58
signs and sx
| peritonsillar abscess
tonsil is pushed toward midline
uvula deviation
59
tx of peritonsillar abscess
surgical drainage
60
causes of peritonsillar abscess
strep
| GAS
61
complications of GAS
```
rheumatic fever
glomerulonephritis
toxic shock syndrome
peritonsillar abscess
meningitis
```
62
does tx prevent poststreptococcal glomeruloneprhitis
NO
you can get it either way
63
tx for GAS
10-day course of oral penicillin
64
what is swimmer's ear and what causes it
otitis externa
pseudomonas aeruginosa
65
common causes of otitis media
s pneumo
h influe
m catarrhalis
66
tx for otitis media
aomxicillin
alternative
amox/clavu
bactrim
2nd/3rd gen cephalosporins
67
immediate tx for chest pain
MONA
morphine
oxygen
nitro
aspirin
beta blocker
68
how does cocaine induce angina?
coronary artery spasm
69
patient is on clopidogrel needs bypass surgery, what do you do next?
withhold clopidogrel for 5-7 days before surgery
70
what is unstable angina
what is the immediate treatment
angina at rest
give platelet inhibitors gIIb/IIIa
71
how are beta blockers helpful in MIs
reduces infarct size
decreases mortality
reduces risk of another one
72
how are ace-i helpful in MIs
reduces shor-tterm mortality if started within 24 hours of MI
prevents LV remodeling
73
hypomagnesemia increases risk of what
torsades de pointes
74
what is benefit of CCB in MIs
which CCB is contraindicated in MIs
none
nifedipine - increases mortality
75
diet for MI patients
low saturated fat and cholesterol
76
risk factors for CAD
```
DM
HLD
age
HTN
smoking
family hx of CAD
Male
postmenopausal
LVH
homocystinemia
```
77
why give statins right after having ACS
decreases incidence of major adverse cardiovascular events
78
what is goal LDL if using statins after MI
< 70
79
minimum duration of exercise
30 min
80
minimum weight reduction to get benefits
5% minimum
81
what is the Levine Sign
holding fist to chest
sign of MI
82
unequal upper extremity pulses is a sign of what
aortic dissection
83
tx for elevated potassium
kayexalate
insulin
retention enemas
84
causes of chronic renal failure
DM
HTN
glomerulonephritis
85
drugs that affect kidney fxn
nsaids
aminoglycosides
contrast
86
in chronic renal failure, what is the first step in management
```
remove anything that reduces renal perfusion:
hypovolemia (give IV fluids)
hypotension
infection --> sepsis
drugs that lower GFR like nsaids
```
87
goal of BP tx in chronic renal failure
< 130/80
88
what med do u treat BP with in chronic renal failure
ace-i
add diuretic if BP still not controlled
89
microscopic exam of trichomonas vaginalis
motile
flagellated
many wbcs
90
tx for trichomonas vaginalis
flagyl 2g one dose
and for partner as well
91
signs and sx
| trichomonas vaginalis
green frothy discharge
| strawberry cervix
92
vaginitis with recent abx use
| what org is it
candida
93
vaginitis in a DM pt
| what org is it
candida
94
describe candidal vaginitis
white discharge
no odor
VERY itchy
involves vulvar and vaginal areas (outside and inside)
95
tx for candidal vaginitis
single dose fluconazole
or
creams/vaginal suppositories
96
should you treat sexual partners of women with candidal vaginitis?
no, unless symptomatic
97
signs / sx
| gardnerella vaginalis
pH > 4.5
positive KOH "whiff" test (fishy odor after adding KOH
clue cells on wet mount
98
tx for gardnerella vaginalis
metronidazole or clindamycin
| oral or vaginal preparations
99
should sexual partners of gardnerella vaginosis be treated?
not necessary
| as it does not reduce risk of recurrent infection
100
tx for gonorrhea
CTX
| or Cipro
101
tx for chlamydia
doxycycline x 7 days
or azithromycin ONCE
and treat partners
102
what is PID
pelvic inflammatory disease
103
signs and sx
| PID
```
inflammation of any of the reproductive organs
ovaries
fallopian tubes
uterus
cervix
vagina
```
all you need for dx:
cervical motion tenderness
adnexal tenderness
104
tx for PID in prego woman or HIV
admit
| parenteral abx
105
complications of PID
```
recurrence
tuboovarian abscess
chronic abdominal pain
infertility
ectopic pregnancy
```
106
diagnostic test for lower GIB
colonoscopy
107
what are hemorrhoids
dilated veins in the hemorrhoidal plexus of the anus
108
risk factors for hemorrhoids
chronic constipation
straining for BMs
pregnancy
prolonged sitting (truck drivers)
109
where do diverticula mostly occur
where blood vessels penetrate thru muscles of the colon
110
signs and sx
| diverticulosis
painless bleeding
111
management of asymptomatic diverticulosis
dietary modification
| high-fiber diet
112
management of hemorrhoids
high-fiver diet
| stool softeners
113
contrast diverticulitis and diverticulosis
itis - painful inflammation
osis - not painful
114
usual location of diverticulitis
lower left quadrant
115
complication of diveritculitis
perforation resulting in:
peritonitis
intraabdominal abscess
116
tx for diverticulitis
bowel rest
abx (quinolone and metro)
if perforated --> surgery
117
major risk factor for IBD
family hx
118
IBD
| besides GI, what are other common manifestations
arthritis
119
tx for IBD
symptomatic therapy
antidiarrheal
aminosalicylates
corticosteroids
120
precancerous polyps
| name the 3
in order of increasing risk
tubular adenomas
tubulovillous adenomas
VILLOUS ADENOMAS
121
most common causes of CAP
pneumococcus
others
h influ
moraxella catarrhalis
common in very young and old
122
cause of pneumonia in COPD patients
h influ
123
atypical pneumonia
mycoplasma pneumonia
chlamydia pneumoniae
legionalla pneumphila
common in adolescent or young adults
124
risk factors for hospital acquired pna
intubation
NG tube
preexisting lung disease
multisystem failure
125
orgs in hospital acquired pna
aerobic GM-
pseudomonas
klebsiella
acinetobacter
GM+ cocci
staph aureus
126
ways to reduce intubation associated pna
use oropharyngeal vs naso
elevate head during feeds
infection control (wash hands, alcohol based disinfectants)
127
pneumonia with diarrhea
| what bug
legionella
128
pneumonia after influenza
staph aureus
129
abrupt onset of pna
pneumococcus
130
sign of focal lung consolidation
egophony (E to A change)
131
sign of pleural effusion
dullness to percussion
132
cxr
| ground glass infiltrates
pneumocystis carinii
| AIDS patients
133
GI aspiration usually affects what lobe
right lower lobe
| due to branching of bronchial tree
134
how to diagnose legionella
urine antigen testing
135
tx for pneumococcus pneumonia
beta lactam (ctx) or macrolide (azithromycin)
136
complications of pna
bacteremia
| pleural effusion
137
tx for pleural effusion
if lots of fluid, do a thoracentesis with gram stain/cx
if empyema fluid, place chest tube for drainage
138
differential dx
| depression
hypothyroidism
anemia
substance abuse
139
tx duration for depression
at least 6-9 months
if recurrent depression, treat for longer
140
side effects
| SSRI
```
sexual dysfxn
weight gain
GI disturbance
fatigue
agitation
```
141
side effects
| TCA
```
sedation
dry mouth and eyes
urinary retention
wt gain
sexual dysfxn
HIGHLY TOXIC / FATAL IN OD
```
142
side effects
| MAO-I
drug-drug interactions
| SSRI and meperidine (Demerol)
143
side effect
| buproprion
seizure
contraindicated in pts with seizure disorders
144
side effect
| trazodone
priapism (persistent erection)
| sedation (used for insomnia)
145
comorbidity of panic disorders
depression
146
bereavement vs depression
bereavement < 2 months
| no suicidal ideations or psychosis
147
rule out what in depressed patients
bipolar
| ask about mania
