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OME Flashcards

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1
Q

Dx insomnia w/what criteria?

A

Difficulty falling asleep or waking up too early w/out ability to fall back asleep

3 nights/wk for 3 months

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2
Q

What is the basic treatment for HF?

A

Restrict fluids to < 2 L/day

Restrict salt < 2 g/day

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3
Q

What is the BEST test to Dx heart failure?

What else can you use?

A

Left Heart CATH

BNP, 2D echo (looking at EF)

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4
Q

What defines stage II HTN?

A

> 160 / 100

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5
Q

Acne pt w/severe pustular or nodulocystic disease treat how?

If SEVERE inflammatory or resistant?

A

PO Abx (Doxy, Eryth)

Isoretinoin —> do a UPT

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6
Q

COPD exacerbation w/out signs of infection treat with what?

Can check what level?
How will it look?

A

Doxycycline

Procalcitonin level
Decreased if viral

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7
Q

What diseases automatically are indications for statin therapy?

A

Vascular diseases:

Stroke
CAD
PVD
Carotid stenosis

StarCraft on your PC

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8
Q

Define bronchitis

A

Productive cough for > 3 months in 2 consecutive years

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9
Q

When do you give tPA for ACS?

Door to balloon should be no longer than how long?

A

Facility is more than 60 minutes away

90 minutes

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10
Q

UC flares are treated how?

A

steroids

Abx - Cipro and metronidazole

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11
Q

Quetiapine is useful to treat what?

SEs?

A

2nd line for Bipolar

QTC prolongation, weight gain

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12
Q

Salicylate toxicity causes what sx early in the disease? What acid base status?

Late in the disease?

A

Tinnitus, vertigo, hyperventilation —> respiratory alkalosis

Hyperpyrexia —> AG metabolic acidosis

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13
Q

What signs and symptoms will a chronic bronchitis pt have?

A

JVD, edema, HSM —> Right Heart Failure

INC pulm vascular resistance
Clubbing and edema

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14
Q

If a stress test is positive on a pt, what is the next step?

What kind of pharm stress testing can pts go through?

A

Elective CATH

Adenosine and dobutamine

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15
Q

What are TCAs indicated for?

A

Enuresis

1st line for neuropathic pain

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16
Q

What are the somatic complaints in GAD?

A 
Restlessness
Irritability
Fatigue 
Muscle tension
Trouble [ ]
Sleep changes
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17
Q

What are the stages of sleep and their wave types?

A 
BATS Drink Blood
Beta - awake
Alpha - Drowsy
Theta - N1
Spindles - N2
Delta - N3
Beta - REM
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18
Q

Acute anxiety is treated how?

Chronic?

A

CBT, BENZOs

SSRI

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19
Q

What are the Kubler-Ross states of death and dying?

A 
DABAD
Denial 
Bargaining 
Anger
Acceptance
Depression
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20
Q

Mild persistent asthma:

Daytime sx?

Nocturnal sx?

FEV1?

Tx?

A

< 1 /day

> 2 /month

> 80%

SABA + Low dose ICS

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21
Q

Workup of a pt w/fever and cough w/suspected PNA?

A

CXR and SpO2

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22
Q

Pt experiencing yawning, lacrimation, N/V, and hurts everywhere with sweating is experiencing what?

A

Opiate withdrawal

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23
Q

What is acute dystonia?

Treated how?

A

Involuntary m. Contraction - torticollis, oculogyric crisis, etc

Benzotropine or diphenhydramine

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24
Q

A PCWP < 12 means what in the heart?

How do you find out this info?

A

Noncardiogenic origin

Right Heart CATH

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25
How is grief defined? Duration is how long?
Normal rxn that does NOT impair normal functioning and improves SPONTANEOUSLY < 12 months
26
Intermittent asthma: Daytime sx? Nocturnal sx? FEV1? Tx?
= 2 / wk = 2 /month > 80% Rescue inhaler aka SABA
27
Defensive injury against downward blow called what? What breaks? What dislocates?
Galeazzi Fracture Radius breaks, ulna dislocates
28
CKD pts get what BP medication to start?
ACEI or ARB
29
What is emphysema?
Destruction of alveolar walls at the terminal bronchiole that cause air trapping
30
When does baby blues occur? With which baby? Treatment?
Within 2 weeks #1 None
31
Presents pt w/COPD that wants to stop smoking, what do they need to know? What is the best prognostic indicator?
Start 8 weeks before surgery bc congestion initially worsens FEV1/FVC ratio
32
If pt has methanol or ethylene glycol poisoning, what can be given to inhibit conversion of toxic metabolites?
Fomepizole
33
What toxic substances do not cause an anion gap but do cause an osmolar gap? Treatment?
Ethanol, isopropyl alcohol Supportive
34
When does a COPD pt need at home O2?
pO2 < 55 on ABG Or SpO2 < 88%
35
What does COPD produce pathologically?
Airway inflammation and irreversible bronchoconstriction
36
When evaluating the heart with an Echo, what are you looking for during stress?
Dyskinesia (will be absent on rest)
37
What is HTN urgency? Emergency?
BP > 180 or > 110 w/out evidence of end organ damage > 180 or > 110 WITH end organ damage
38
What is rumination disorder? Occurs in whom?
Regurgitation of food for at least 1 month Infants or those w/developmental disorder
39
Pt w/HTN, tachy, dilated pupils is on what drug?
Cocaine
40
Refeeding syndrome causes what electrolyte abnormalities?
Low PO4 Low K+ Low Mg2+
41
Prior to starting Lithium for bipolar, what labs do you need?
Cr and TSH
42
Secretory diarrhea has what kind of Osmotic gap? Blood or mucous in stool? Nocturnal sx? Change w/NPO? Fecal fat?
Normal No YES NO Normal
43
What are the 2 methods of treating for specific phobias?
Systemic desensitization - takes longer, BEST to Flooding - time-sensitive need
44
What contradicts non-cardiac surgery?
EF < 35% (75% chance of MI while IN surgery) MI w/in 6 months (40% mortality at 3 months)
45
What are the 1st gen antipsychotics in order of strongest to weakest?
Haloperidol Fluphenazine Thioridazine Chlorpromazine
46
What are the most prominent signs of heart failure?
S3 | Laterally displaced PMI
47
MC cause of PNA in a COPD/Smoker? Post viral? Immunosuppressed?
H influ Staph aureus Legionella
48
How do you treat Impetigo? If bullous or NO response? Can lead to what if untreated?
Topical mupirocin Clindamycin PSGN
49
Defensive injury against upward black called what? What breaks and what dislocates?
Monteggia fracture - MU Ulna breaks, radius dislocates
50
COPD pt w/purulent sputum and/or increased production needs what? Use what?
Abx Amoxicillin, Bactrim, Azithro, Doxy
51
Osmolar gap < 50 in pt w/diarrhea means what? > 100? Formula is what?
Secretory Osmotic 290 - 2(Na + K)
52
what is acute stress disorder?
Traumatic even LESS than 4 weeks from event | Pt will have anhedonia, hyper-vigilance, avoidance, flashbacks
53
What labs should you get baselines of when starting a statin?
Lipids, A1c, CK, LFTs
54
What causes erysipelas? Describe it: Treat how? Symptoms?
Strep pyogenes Dark red, well-demarcated, indurated lesion in ADULTS!!! Beta-Lactams (Amoxicillin) Acute onset fever and chills
55
How long do cardiac enzymes take to peak? When can they be considered negative?
18 hours 2 sets separated by 6 hours NEG or 18 hours passes
56
1st Gen antipsychotics antagonize which receptor? Treat what symptoms? Cause what symptoms?
D2C + sx - hallucinations, delusions, disorganized thought EPS - akathisia, acute dystonia, dyskinesia
57
GAD diagnosis criteria? Treatment?
Anxiety most days > 6 months AND have > 3 somatic sx Psychotherapy - adjunct w/SSRI, buspirone
58
What is mild substance abuse disorder? Mod? Severe?
2-3 4-5 6+
59
What are atypical GERD sx?
Hoarseness, cough, NOCTURNAL ASTHMA
60
What is the 1st step in treating a heart attack w/ST changes in leads II, III, and aVF? Why?
IVF Bc right-sided infarcts are preload dependent
61
What is the 4th gen cephalosporin? Used to cover what?
Cefepime Pseudomonas
62
When does post-partum depression occur? Which baby? Feels how about the baby? Treatment?
With 1 month > #1 Doesn’t care about it, may hurt it SSRI
63
Acetaminophen OD causes what? Treatment?
Liver injury NAC
64
Pt w/LDL 70-189 and what else are indications for statins?
Age 40-75 and DM Age 40-75 and Calculated RFs
65
Hospital Acquired PNA MC bugs? Treatment?
Pseduomonas, MRSA Vanc + Pip/Tazo
66
Nitrates should be avoided with what kind of chest pain presentation?
Right-sided infarcts —> Leads II, III, aVF
67
HTN is defined how? Dx how?
Greater than 140 or 90 2 separate BP taken at 2 separate office visits
68
Treatment for Barrett’s? Dysplasia? Adenocarcinoma?
High dose PPI Ablation Surgical resection
69
What causes central sleep apnea? Path? Treatment?
Opiates, COPD, idiopathic Lost intrinsic drive to breath BiPAP
70
SE’s of TCAs?
Widen QRS Cause seizures Coma or AMS
71
What are the 4 major categories of substance abuse disorder?
Controlling use Social impairment Risk taking Physical/pharm changes
72
Tender prostate in the setting of a UTI is what? Treat how?
Acute prostatitis Bactrim or FQ
73
Ant dislocation of the shoulder, what is the position of the arm? What can be damaged? Dx how?
ABducted and ER “Shaking hands” Axillary nerve Xray
74
What defines Pre HTN?
Syst < 140 | Dia < 90
75
Sx of CO poisoning? Hg Saturation is what? Treatment?
HA, N/V, delirium Normal, get a carboxyHg level 100% FiO2 and hyperbaric
76
Major complaint of pt w/OSA is what? Diagnose how? Long term consequences lead to what?
Daytime somnolence 15 OSA/hour or 5 apneas/hour AND Snoring/breathing pauses w/daytime somnolence Pulm HTN -> RHF
77
What are the components of the Child-Pugh score for surgery? Any single marker + means what?
``` Ascites Albumin Bilirubin Encephalopathy INR/PT ``` Mortality of 30-40%
78
Pt with suspected fracture of ankle and is ambulatory? Nonambulatory?
Do Not Image Xray
79
What is the 1st FQ? Treats what kind of bacteria? What condition?
Cipro Gram (-)’s UTI
80
Pt in a manic episode gets what med? Made of what?
B52 Benadryl Ativan Haloperidol
81
What are the typical (intestinal) sx of GERD?
Retrosternal burning chest pain worse w/spicy foods and recumbency, better w/sitting up, antacids and cold water
82
1st step in ACS no matter what?
ASA PO | Then troponin levels
83
What are the 3 components of typical chest pain?
Substernal Worse w/exertion Better with nitroglycerin
84
Bulimia Nervosa severity categorized by what? What is mild? Mod? Severe? Extreme?
The PURGE 1-3 per week 4-7 8-13 > 13
85
Elderly pt FOOSH injury is what?
Colles’ fracture
86
What are the severe signs of anorexia nervosa? Defined how? Tx?
Bradycardia, leukopenia, HoTN Fear of getting fat despite being underweight AND lack of recognition CBT
87
What does SIGECAPS stand for?
``` Sleep - insomnia Interest - anhedonia Guilt - feeling worthless Energy - DEC Concentration - loss of it Appetite - loss of weight Psychomotor - slow thoughts, movements Suicidal Ideations ```
88
Pt that is pregnant and has major depression what is the best treatment?
ECT
89
Anti-endomysial ABs means what? What answer never to pick in chronic diarrhea question?
Celiac disease Stool Cx
90
Pt that is having flashbacks and hallucinations is experiencing what?
LSD
91
Biopsy of UC colon shows what? When does colonoscopy screening begin? Continues when?
Crypt abscesses and superficial inflammation 8 yrs from diagnosis and continues annually
92
What is amnesic-confabulatory syndrome?
Retro and anterograde amnesia, confabulation after lots of drinking
93
How do you treat type A dissections? Type B?
Surgery - replace aortic valve Medically w/IV Labetalol or BBlocker
94
What defines stage 1 HTN?
> 140 / 90
95
What are the 5 stages in order of substance abuse?
``` Pre-contemplative Contemplative Preparation Action Maintenance ```
96
What is the Dx workup for dissection?
1 - R/O CAD w/EKG and Troponin 2 - XRay shows widened mediastinum 3 - CT Angio shows false lumen 4 - if renal dz do MRI/TEE
97
When on a statin, when should you assess lipids? CK and LFTs?
Annually Only when symptomatic
98
Acute asthma exacerbation what is the treatment? Examine what?
O2 Duonebs Corticosteroids PEak flow, PE, ABG
99
To be considered HCA PNA must be what exposure?
Healthcare facility w/90 days Acquire PNA w/in 48 hours of admission Be on a ventilator
100
What are the 2 main theories behind anti-depressant therapy and what do they say?
Monoamine hypothesis - not enough nt’s so you sad (No serotonin or NE) Plasticity concept - happy neurons tend to become easier to stimulate
101
Pt with LDL above what gets a statin?
190
102
Cyanide poisoning symptoms? 1st line tx? 2nd? Caution why?
Coma, seizure, HoTN, Heart Block, cherry red skin/blood Thiosulfate Amyl nitrate —> worsens CO poisoning
103
What are the types of demand ischemia in the heart?
Stable and unstable angina | NSTEMI
104
Pts w/CAD should be on what meds?
``` MONA BASH Morphine Oxygen Nitrates ASA ``` BBlocker ACEI Statin Heparin
105
When do you go to surgery for AAA? When do you screen q6mo? Q1yr? When do you do surgery regardless of size?
> 5.5 cm OR growin .5 cm/6mo > 4.5cm, > 3.5cm Pain or tenderness of the aneurysm or BACK PAIN
106
Treatment for mild UC is what?
5-ASA or Mesalamine
107
When is AICD placed in HF patient? What class must they be?
EF < 35% III
108
ABG of COPD pt will show what? CBC shows what?
Hypoxic hypercapnic respiratory acidosis Erythrocytosis
109
How can the EKG look of a COPD pt?
RVH - for pulmonale or Right Axis Deviation
110
If no improvement in Peak Flow of asthma pt after 3 hours of continuous nebs, what happens next?
ICU
111
Pt has fever, cough w/Negative CXR, Dx? Tx?
Bronchitis Azithromycin, then Doxycycline
112
If no alarm sx with GERD, what is next step? Best Dx test? Pt that has GERD sx w/alarm symptoms needs what?
Treat w/PPI for 6 weeks 24-hour pH monitoring EGD w/biopsy
113
What is the treatment for a CHF exacerbation?
``` LMNOP Lasix Morphine Nitrates Oxygen Position (elevate HOB) ```
114
Trazadone is used as what? Mirtazapine?
Sleep aid Appetite stimulant
115
MDD diagnosed how? Treatment? Must treat for how long?
5 SIGECAPS for at least 2 weeks SSRI/SNRI 4-8 weeks at max dosing
116
Valgus stress means what kind of stress? What is injured? Dx how?
Lateral stress MCL MRI
117
HIV pt w/PCP also has what elevated lab value? Dx how? If pt has low PaO2 add what?
LDH Silver stain steroids
118
How do EtOH and BENZOs work? Symptoms of withdrawal? Treatment?
Stimulate GABA Over-excitation —> HTN, tachy, tremors, anxiety, dt’s, coma Long acting BENZO - chlordiazepoxide or diazepam
119
What is Disruptive Mood dysregulation disorder?
Kids having at least 3x /wk behavioral outbursts Evident before age 10
120
What are the pathologies of diastolic HF?
MAIN Cause: HTN Restrictive/Hypertrophic cardiomyopathy Pericardial tamponade or constrictive pericarditis
121
How long is avg REM latency? Shorter or longer in narcolepsy? Depression?
40 minutes Shorter Shorter
122
What is the 3rd FQ? Treats what kind of bacteria? What condition?
Moxifloxacin G(+) and G(-)’s PNA
123
Bipolar diagnosed how?
3 symptoms + Elevated mood (mania) for at least 1 week
124
What are the symptoms of Right HF?
HSM, JVD Peripheral edema DOE, Inc JVP
125
How do you screen for AAA?
US in men who smoke, over 65 y/o
126
Femoral head fracture requires what? Intertrochanteric? Shaft? Open fracture requires what?
Femoral prosthesis Plates ORIF Rods Emergency washout
127
When do nightmares occur? Memory? Tone?
REM Yes No tone
128
How is dysthymia diagnosed? Treatment?
Depressed mood for > 2 years w/out sx for > 2 months at a time R/o hypothyroid and suicide Then give SSRI
129
What is the goal BP for someone over age 60? Everyone else?
Below 150/90 Below 140/90
130
How do you treat HTN emergency?
IV nitrates or CCBs to get MAP down 25% w/in first 2- 6 hours
131
CURB-65 stands for what?
Confusion of new onset Urea > 7 or BUN > 19 Respirations > 30 BP < 90/60 65 or older
132
Symptoms of opiate withdrawal? Treatment?
Lacrimation, Rhinorrhea, D/N, pain, dysphoria Clonidine
133
Pt with asthma has FEV1/FVC ratio? Can be affected how? If no active disease do what to induce asthma?
Decreased Reversed w/bronchodilators Methacholine
134
Pt w/toxic ingestion of pills of unknown origin do what?
Activated charcoal | NG tube and gastric lavage if it has been less than 1 hour
135
What are the nt’s of sleep?
``` SAND Serotonin - Inc Sleep ACh - Inc Dream NE - Inc Dream, Dec Wake Dopamine - Inc Wakes ```
136
When does post-partum psychosis occur? Which baby? Feels how about it? Treatment?
W/in 1 month > #1 Fears baby, will kill it Mood stabilizers and antipsychotics
137
What are the signs of Left HF?
Orthopnea, crackles, rales DOE, S3 PND
138
What is the progression for COPD treatment?
SABA —> LAMA —> LABAL —> ICS —> PDE4- + steroids
139
Severe Persistent asthma: Daytime sx? Nocturnal sx? FEV1? Tx?
>/= 1 /day Frequent < 60% SABA, High dose ICS + LABA
140
What is the 2nd FQ? Treats what kind of bacteria? What condition?
Levofloxacin Gram (-)’s Soft tissue infection
141
Post dislocation of the shoulder, what is the position of the arm? What etiology? Dx how?
ADDucted and IR “Protected wrist” Seizure or electricity Xray
142
When do night terrors occur? Memory? Tone? Treat how?
N3 No Yes Reassurance or BENZOs (don’t use them)
143
Chronic hypoxia of COPD in alveoli leads to what?
INC pulm vascular resistance and Pulm HTN
144
3/3 classic sx for chest pain called what? 2/3? 0-1/3?
Typical Atypical Non-anginal
145
What meds to use for CAP?
Moxi or Ceftraix + Azithro (IV) or Azithro (PO) If ambulatory
146
Urethritis etiology? Big symptom? Treat with what?
STD - discharge Ceftriaxone + Doxy OR Azithro 250 x 1 PO
147
Osmotic diarrhea has what kind of Osmotic gap? Blood or mucous in stool? Nocturnal sx? Change w/NPO? Fecal fat?
Increased NO NO YES Increased
148
Acne Pt with comedones treat with what? If inflamed? If they do NOT respond?
Topical retinoids ADD benzoyl peroxide ADD topical Abx
149
What consists of a complicated UTI? Treat for how long? Treat with what?
Penis - male Plastic - foley Procedure Pyelo 7 days treatment Cipro or IV Ceftriaxone
150
What does bupropion treat?
Smoking cessation Depression Prevents weight gain
151
Narcolepsy definition? Diagnose how? Treat how?
Rapidly plunge to REM sleep at least 3 times per week for 3 months CSF hypocretin-1 Schedule naps, stimulants
152
Best way to treat grief?
Psychotherapy
153
Pt with edema, erythema, brown discoloration, and scaling has what? What MAJOR sign involved? Treatment?
Stasis dermatitis Venous stasis ulcer at Medial Malleolus Diuretics if volume overload, Compression stockings and leg elevation
154
What is tinea unguium? Treat with what? Diagnose how?
Onychomycosis (Nail infxn) Terbinafine is BEST Itraconazole is ok KOH prep
155
Bipolar II is what? Cyclothymia is what?
Hypomania and Major depression At least 2 years of hypomanic and major depressive episode
156
Valproate treats what? SEs?
1st line Bipolar if cannot use Li Teratogen Thrombocytopenia Agranulocytosis Pancreatitis
157
What is the best treatment for Acute Panic Disorder attacks?
BENZOs > psychotherapy
158
What SE can Beta blockers cause?
Bradycardia and syncope
159
Moderate persistent asthma: Daytime sx? Nocturnal sx? FEV1? Tx?
>/= 1/day > 1 /week 60-80% SABA, Low dose ICS + LABA
160
What are the pathologies of Systolic HF?
Leaky valve Dead heart - ischemia/infarction Floppy muscle - EtOH, HTN, Drugs

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