FM CASE FILES 3 Flashcards
(151 cards)
1
Q
benefits of breast feeding
A
faster return of uterine tone (reduced bleeding)
quicker return to prepregnant wt
reduced incidence ov ovarian/breast cx
lower cost
2
Q
what hormonal contraception is recommended in breast-feeding women
A
progestin-only “mini-pill”
avoid combined pills b/c it interferes with milk supply
3
Q
how long does uterus take to return to prepregnant size after labor
A
6 weeks
4
Q
white/yellow discharge in weeks following labor
A
this is normal and is called lochia
5
Q
when does ovulation and menstruation return after pregnancy
A
for non breast feeding mothers = 3 months
longer if you are breast feeding
6
Q
common causes of postpartum hemorrhage
A
4Ts
uterine atony
trauma (lacerations)
retained Tissue (placenta)
thrombin (coagulopathies)
7
Q
most common cause of postpartum hemorrhage
A
uterine atony
8
Q
tx for uterine atony
A
oxytocin and bimanual uterine massage
if fails, give methylergonovine
contraindicated in pts
9
Q
sign and sx
endometritis after labor
A
postpartum fever
uterine tenderdness
smelly lochia
10
Q
how do u reduce risk of endometritis
A
abx prophylaxis during delivery
cover vaginal and GI flora
11
Q
duration of maternity blues
A
gone by 10 days after labor
12
Q
tx of depression in breast-feeding mothers
A
SSRIs
13
Q
how soon should women be allowed to breast feed after labor
A
asap
14
Q
what is in colostrum
A
antibodies!
15
Q
what is mastitis?
should she stop breast feeding?
A
obstruction of milk glands then becomes infected
no, keep pumping away
16
Q
how long after labor to start OCPs
A
6 weeks
3 if not breast feeding
17
Q
is depo provera ok in breast feeding women
A
yes
18
Q
how long after labor can she resume IUD or diaphragms
A
6 weeks
get re-fitted
19
Q
what is diastolic vs systolic chf
A
systolic - dilated LV and impaired contractility
diastolic - normal LV but impaired relaxation
20
Q
sensitive and specific marker for CHF
A
BNP
> 500
21
Q
cxr finding in CHF
A
cephalization of pulmonary vasculature
22
Q
initial management of CHF
A
ABCs
then O2
if pulmonary edema, start diuretic
23
Q
first line tx of CHF
A
ACE-I
24
Q
CHF
what benefits do beta blockers offer
A
reduce sympathetic tone
reduce cardiac muscle remodeling
25
3 meds in CHF
ACE-I
beta blockers
diuretics
26
use ccb in systolic CHF?
NO they are contraindicated
27
when would you use ccb in CHF
in DIASTOLIC CHF
promotes increased cardiac output by lowering HR
allows for more ventricular filling time
28
benefits of combination OCPs
protects against ovarian/endometrial cx
protects against iron-def anemia
PID
fibrocystic disease
29
how do combo OCPs work
| 4 things
suppresses ovulation
thickens cervical mucus
retards sperm entry
discourages implanation
30
side effects of OCPs
```
Nausea
HA
breast swelling
fluid retention
weight gain
irregular bleeding
depression
```
31
what to do if OCP pill is missed
take it asap
| take next dose as usual
32
if two pills are missed in OCP
take 2 pills together 2 days in a row
| and use alternative contraception for 7 days
33
how long does depo-provera last
14 weeks
| so inject every 3 months
34
failure rate of spermicides
how about when combined with condoms
20-30%
down to that of OCPs
35
emergency contraception
| works when taken within how many hours
72
36
in adolescents, screen them for sports participation
what are you looking for?
what are signs/sx?
hypertrophic cardiomyopathy
murmur left sternal border
accentuates with activities that decrease cardiac preload and EDV of LV
(i.e standing or straining with valsalva maneuver would increase murmur; while squatting would decrease murmur)
37
nonpharm tx of HTN
DASH
Dietary Approaches to Stop HTN
high K+ and Ca2+
effective as a single agent antihypertensive therapy
38
goal BP for HTN
waht about for DM pts
< 140/90
< 130/80
39
how do you diagnose HTN
two PROPER measurements on two occasions
40
signs and sx
| intussusception
abdominal pain
crying (infants)
periods of pain-free / no crying
SAUSAGE SHAPED MASS
currant jelly stool (red mucousy)
41
x-ray of intussusception
coiled spring
42
diagnostic test for intussusception
barium enema
| its also therapeutic
43
x-ray shows perforation in intussusception
| whats the next step
surgery
44
how does vomiting present in intussusception
vomiting gradually becomes bilious as obstruction sets in
45
where do most intussusception occur
right lower quadrant
| ileocecal jxn
46
signs and sx
| malrotation in a child
bilious vomiting and abdominal pain
47
complication of malrotation
twisted bowel will become necrotic
| causing fluid loss and sepsis
48
imaging findings on malrotation
misplaced duodenum or obstruction
| beaklike appearance caused by volvulus
49
tx for malrotation
surgery
50
which objects require immediate intervention in a foreign body complication
batteries
| if both poles touch the esophageal wall, it will conduct electricity and PERFORATE
51
what is aphasia
cannot understand words
52
what is apraxia
lost of muscle coordination
cannot perform complex tasks involving muscles
53
what is agnosia
cannot recognize common objects
54
what is pseudodementia
depression in the elderly which "appears" as alzheimers
55
tx for alzheimers
cholinesterase inhibitors
donepezil
rivastigmine
tacrine
memantine
56
what is vascular dementia
memory loss from STROKES
57
compare vascular with alzheimers dementia
alzheimers - GRADUAL
vascular - SUDDEN ONSET, STEPWISE FASHION loss as subsequent infracts occur
58
signs and sx
| NPH
urinary incontinence
gait disturbance
dementia
59
contrast lewy body vs alzheimers dementia
lewy body - hallucinations early on
60
tx for obesity
diet AND exercise....one alone is not good enough
61
metabolic syndrome
| 5 things
```
waist > 40 in (men) or 35 in (women)
triglycerides >150
HDL < 40 (men) and 50 (women)
BP > 130/85
fasting glucose > 110
```
62
signs and sx
| migraines
```
pulsating HA
unilateral
photophobia
phonophobia
worsens with activity
multiple attacks lasting hours to days
NV
```
63
diagnosis?
| headache with fundoscopic showing papilledema
increased intracranial pressure
64
when should u image a pt with migraines
if he/she has "red flags":
```
HA with head trauma - hemorrhage
sudden onset HA - hemorrhage
inc severity/freq - mass/hematoma
HA after 50yo - temporal arteritis, mass lesion
HA in AIDS pt - meningitis
HA with neck stiff - meningitis
HA with focal neurol signs - stroke
```
65
tx for migraines
triptans
ergotamine
NSAIDs
66
signs and sx
| tension HA
bilateral bandlike distribution
no aggravation with activity
no NV
no photophobia / phonophobia
67
tx for tension HA's
| avoid what
caffeine and ergotamine drugs
68
signs and sx
| cluster HA
unilateral
orbital / supraorbital / temporal
PACES AROUND - unable to find a comfortable position
69
contrast cluster vs migraines
migraines - wants to stay in one place
cluster - PACES AROUND
70
what are screening recs for lipids?
starting at 20yo
| then ever 5 yrs after that
71
how do u screen for cholesterol?
fasting lipid panel (total, LDL, HDL, trig)
or
nonfasting total and HDL with subsequent fasting lipid panel if total is > 200 or HDL < 40
72
which class of drugs are best to lower LDL
statins
73
which class of drugs are best to lower Triglycerides
which have no effect on triglycerides
```
nicotinic acids (niacin)
fibrates (gemfibrozil)
```
bile acids
74
side effects
| niacin
facial flushing
75
side effects
| statins
muscle pain
76
side effects
| bile acids
constipation
| decreased absorption of other drugs
77
contraindications
| niacin
gout
| DM
78
contraindications
| fibrates
severe kidney or liver disease
79
bucket-handle fracture of long bones in children
abuse
80
circumferential hematoma of anus of child
abuse
81
retinal hemorrhages in child
shaken baby syndrome
abuse
82
describe slipped capital femoral epiphysis
seen in overweight pts
pain with internal rotation of hip
external rotation during passive flexion
83
how pts with septic hip joint position their legs
flex at hip
abducted
externally rotated
84
definitive dx of septic joint
joint aspiration
85
most common cause of septic joint
< 4 mo
GBS
s aureus
< 5yo
s aureus
s pyogenes (GAS)
86
what is toddler's fracture
how do you diagnose it
spiral fracture of tibia when twisting while foot is planted
x-ray
87
congenital dysplasia of hips
| pain or no pain
painless limp
88
joint complication of viral illness
transient synovitis
89
lab findings on transient synovitis
normal WBC
| normal ESR
90
tx for slipped capital femoral epiphysis
surgical pinning of femoral head
91
causes of postop fever
```
5Ws
water - uti
wind - pna
wound - incisional infxn
walk - dvt
wonder drugs
```
92
which drugs cause wonder drugs
beta lactams
sulfas
heparin
amphoterrible
93
causes of immediate postop fever
malignant hyperthermia
(b/c of anesthetics halothane and succinylcholine)
bacteremia
94
cxr findings on postop atelectasis
elevated hemidiaphragm
| discoid infiltrate
95
what kind of pain in DVT pts
what maneuver can u use
calf pain
homan's sign
pain in calf on foot dorsiflexion
96
most common cause of wheezing in children
bronchiolitis
| RSV
97
signs and sx
| bronchiolitis
at first, rhinorrhea/wheezing
then fever
then gets worst
coughing starts
98
define
| croup
inflammation of subglottic region
99
signs and sx
| croup
barking cough
| hoarse voice
100
cause of croup
viral
| parainflu, adeno, RSV, rhino
101
x-ray of croup
steeple sign
| narrowing of subglottic region
102
tx for croup
supportive b/c its viral
cool-mist therapy
corticosteroids
103
hot potato voice
epiglottitis
| h. influ
104
x-ray of epiglottitis
thumb sign
105
signs and sx
| IBS
constipatio
diarrhea
ALTERNATING
with periods of normal bowel habits
106
how to diagnose
| IBS
Rome criteria
cumulative total of 12 weeks of this:
abdominal pain/discomfort, PLUS
relieved with BM
change in freq BMs (more or less)
change in stool appearance
107
IBS
| alarm features
```
fever
anemia
wt loss > 10 lb
hematochezia (BRBPR)
melena
refractory/bloody diarrhea
fam hx of colon cx or Inflamm Bowel Dis
```
108
IBS
| no alarm features, whats the workup then
CBC
stool hemoccult
colo if > 50yo
109
tx for IBS
antaispasmodics - dicyclomine / hyoscyamine
TCA's / SSRIs
tegaserod (5HT serotonin) - constipation
110
CAGE questions
cut drinking
annoyed
guilty
eye opener
111
at-risk drinking
men < 65
more than 4 drinks / day
more than 14 in a week
men > 65 and ALL women
more than 3 drinks per day
more than 7 in a week
112
how effective are antidepressants in alcoholics?
if depression came at same time as alcoholism, then antidepressants have NO EFFECT
113
signs and sx
| alcohol withdrawal
```
shake/jitters
insomnia
anxiety
depressed mood
heart palpitations
```
severe sx:
seizures
hallucinations
DTs (agitation/tremors)
114
tx for alcohol withdrawal
benzodiazpines
115
complications of long QT syndrome
ventricular arrhythmias
sudden cardiac death
(more in females)
116
how long should long QT syndrome be
470 msec
if over 500 msec, major problemos
117
features
| Marfans
```
scoliosis
pectus excavatum
arachnodactyly
high arched palate
arm span greater than height
mitral valve prolapse
aortic aneurysm rupture
```
118
tx for SVTs
carotid sinus massage
valsalva maneuver
cold applications to face
adenosine
119
tx for local reactions of insect stings
supportive
ice
antihistamine for itching
tetanus prophylaxis if not vaccinated
120
tx for delayed reaction to bee sting
oral steroids
| tetanus prophylaxis
121
tx for anaphylaxis of bee sting
sq or IM epi ASAP
antihistamine
bronchodilators
122
tx for animal bites
irrigate and debride it
abx for 3-5 days (amox-clav)
if celllulitis - abx for 7-14 days
hospitalization for more severe
123
thrombolytic therapy should be started within how many hours after onset of stroke
3 hours
124
waht sign tells you a stroke has affected the dominant hemisphere
aphasia
| middle cerebral artery
125
what tests to order in a stroke pt
head CT noncon
EKG (MI may cause stroke)
126
goal BP for stroke
< 185/110
127
how to prevent another stroke
stop smoking
drinks less
treat HLD
antiplatelets (aspirin)
128
signs and sx following initial exposure to HIV
| 6-8 weeks following exposure
low-grade fever
fatigue
myalgias
129
why do you get the symptoms of HIV?
seroconversion
| development of antibodies to virus
130
lab definition of AIDS
CD4 < 200
any AIDS defining illness
131
prophylaxis for what when CD4 dips below 200
pneumocystis
| bactrim
132
prophylaxis for what when CD4 dips below 50
MAI
| azithromycin
133
in hyperbilirubinemia, what urinarlysis results do you get
elevated bilirubin in CONJUGATED because it gets excreted in urine
unconjugated is not excreted
134
what is gilbert syndrome
unconjugated hyperbilirubinemia
135
marker for hepatitis contagiousness
surface antigen
136
markers for acute viral hepatitis
IgM to core antigen
| surface antigen
137
definition of chronic viral hepatitis
surface antigen
| but no IgM to core antigen
138
lab findings in alcohol abuse
AST >>>> ALT
| 200 : 1
139
how do you test for h pylori
urea breath test
stool antigen test
serum antibodies
140
in a patient with new onset dyspepsia, when should you do an upper gi endoscopy
```
wt loss
progressive dysphagia
recurrent vomiting
GI bleed
FAMILY HX OF CANCER
```
141
risk factors for PUD
h pylori
NSAID
smoking
personal/family hx of PUD
142
in a pt over than 50 who has PUD or melena, what else should you do besides upper endoscopy
colonoscopy
| r/o cancer
143
signs and sx
| roseola
fever comes then goes
| then rash: trunk --> arms
144
waht causes roseola
HHV6
145
tx for roseola
nothing
| limited
146
dewdrops on a petal
chickenpox
147
diagnosis for chickenpox
tzanck smear
148
tx for chickenpox
acyclovir
| valacyclovir
149
complication of parvovirus B19 in pregnancy
fetal hydrops
| abortion
150
describe skin findings of neisseria meningitis
erythematous maculopapular
then becomes petechiae
151
describe skin findings on rocky mountain spotted fever
maculopapular rash starts on WRISTS and ANKLES
