PCM3 Final Flashcards
(108 cards)
1
Q
___ women 2-3x higher UTI incidence (aside from frequent sexual activity, spermicide use with diaphragm)
A
diabetic women
2
Q
MCC of spinal cord or caudal equine compression, associated sx
A
herniation of IV disc
-sx: LBP is 1st, followed by motor (weakness) and sensory findings, bowel/bladder sx are a late finding
3
Q
___ case recognizes mature minors are owed confidentiality to there medical info
A
Gillick
>12 yo
4
Q
which typical pneumonia is not an CAP and is commonly abx resistant
A
pseudomonas
5
Q
any pts with sx of spinal cord or caudal equine compression or progressive and/or sever neuro deficits should have immediate _____ for further eval and ____
A
urgent MRI and urgent specialist referral
*pts at risk of metastatic cancer should also undergo immediate MRI
6
Q
tx for acute bronchitis
A
- usually self-limited
- no viral cultures, sero test, or sputum test needed
- no ABX unless risk pts with heart, lung, kidney dz, IC, CAP, or suspected pertussis, TB, or chlamhydia)
- bronchodilators and antitussives are good for sx
7
Q
most specific sign of acute cholecystitis if associated with gallstones
A
sonographic murphys sign (pain when transducer presses over GB)
-others: GB wall thickening, stone in GB neck, cystic duct not seen bc of obstruction
8
Q
most common presentation of acute bronchitis (URI)
A
- healthy adult with cough of 1-3 weeks
- winter
- unremarkable PE
- purulent sputum
- ***COLOR OF SPUTUM IS NOT DIAGNOSTIC OF THE PRESENCE OF BACTERIAL INFECTION
9
Q
intersitial cystisis (aka ____ ____ ____) can be due to
A
aka painful bladder syndrome (not acute infectious) -chronic infection -inflammation -unusal pain sensitivity -co-morbidiites
10
Q
FFP and Prothrombin complex concentrate for INR___
A
INR >1.6
11
Q
what is CURB -65
A
to aid in dx of pneumonia
- Confusion
- Uremia >7
- Respiratory Rate > 30
- BP <90/60
- age >65
- *admit if greater than 1 (not equal to)
12
Q
recurring UTI in post menopausal women related to
A
- history of UTIs premenopausal
- anatomic factors: cystoceles, urinicary incontinence, residual urine
- estrogen depletion effect on tissues
13
Q
three major subtypes/complications of pyleonephritis
A
- papillary necrosis
(due to obstruction, DM, Sickle Cell, analgesic nephropathy) - emphysematous pyelonephritis
(production of gas in nephritic and perinephric area, OCCURS ONLY IN DM PTS) - xanthogranulomatous pyelonephritis
(chronic obstruction, chronic infection, suppurative destruction of renal tissue, can lead to abscesses)
14
Q
dx testing of pneumonia
A
- leukocytosis with leftward shift (increased neutrophil band cells) or leukopenia
- elevated ESR, CRP, procalcitonin
- CXR is required for dx (+ infiltrates)
- CT for IC pts
15
Q
low esteem causes over confidence attitude and the need to try to be superior. vain, smug, arrogant. no close relationships, no friendly or warm. trys to “one-up” doctor. and seek the best provider (chief) will challenge authority and disregard advice. doctor should respond with respect and concern vs warmth
A
narcissistic
16
Q
seeks unlimited self-interest, attention, care. demand urgent special attention and appear selfish. can become angry when needs aren’t met with satisfaction. problems: frustration trying to meet needs, rejection or distancing resulting in low productivity of interview
A
dependent pt
17
Q
tx rhinosinusitis
A
- amoxicilin and trimethoprim-sulfamethoxazole 10-14 days = first line tx
- oral and nasal decongestants provide sx relief BUT DO NOT EXCEED 3 DAYS to prevent rebound vasodilation and worsening sx
18
Q
dx of rhinosinusitis
A
purulent nasal discharge, maxillar/dental/facial pain, unilateral maxillary sinus tenderness, worsening sx after initial improvement
19
Q
isoniazid affect what nutrients
A
B6 (pyridoxine)
B3 (niacin)
20
Q
when is HCV screen recommended for fatigue cases
A
- IVDA hx
- men who have sex with men
- born between 1945-1965 (55-75 yo )
21
Q
avoid feelings to others. isolated, unsociable. overly sensitive, fragile. poor/need social services. doctor should not permit patient to withdraw, and maintain an interest that is quiet and reassuring
A
schizoid
22
Q
how to screen older adults for nutritional status
A
DETERMINE
- disease (making it hard to cook, shop, or eat)
- eating poorly (too much or little)
- tooth loss of mouth pain
- economic influence (cheap unhealthy food)
- reduced social contact (lonely)
- multiple meds
- involuntary wt loss
- need for assistance
- elderly (>80 yo = elderly)
23
Q
when to our a CT scan of the abdomen and pelvis without contrast? with IV contrast only? with IV and oral Contrast?
A
without: (stones) ureterolithiathisis
IV only: ab trauma (gold standard, > US FAST scan)
IV and oral: bowel pathology, solid organ pathology, vascular pathology, cancer, BEST TEST FOR UNDIFFERIENTIATED AB PAIN (must confirm good kidney fxn before giving IV dye)
24
Q
when to use platelets
A
stop active bleeding or prevent spontaneous bleeding in case of thrombocytopenia
25
male UTI RF
prostate hypertrophy
| non-circumcised (e.coli colonizes foreskin)
26
common causes of of pharyngitis in teens and kids
teens: M. pneumonia, clamhydia pneumoniae, arcanobacterium (MAC)
kids: Group A beta hemolytic strep (GAS) = 30%)
27
what supplements turn the stool black
bismuth (pep-bismol)
| iron supplements
28
define rhinosinusitis and recurrent acute rhinosinusitis
inflammation/infection of the nasal mucosa and of one or more of the paranasal sinuses
-occurs from obstruction of NL sinus drainage
(acute <4weeks, chronic >12 weeks)
*recuurent: 4+ episodes a year with intermittent sx relief
29
uncomplicated and complicated outpatient CAP tx
uncomplicated: macrolide (azithromycin, clarithromycin) or tetracycline (doxycycline)
complicated: macrolide + penciilin/lactamase or fluroquinolone (levofloxacin or moxifloxacin)
30
what part of the GI and renal system is the PNS innervated by the pelvic splanchnic and S2-4 nerves
renal: bladder, lower ureter
GI: colon, rectum
31
a testicle not in the correct place (i.e cryptochorchidism) can affect ___ and ___
affect fertility and increase risk of testicular cancer
32
___ nerves travel cough stimulants to the cough center in the ____
vagus and phrenic nerves travel to cough center in medulla
33
neomycin and kanamycin affect what nutrients
fat soluble vitamins
| b12
34
what must you check before giving IV contrast dye in a CT scan
kidney fxn
| -BUN, Cr, GFR
35
T/F
| IBD is noncyclic pelvic pain but IBS can be cyclic pelvic pain
true
36
expected liver and spleen span
liver : 6-12cm at the mid-clavicular line
| spleen: from ribs 6-10 at mid-axillary line
37
controlling pt. brings lists of references and sx. focuses on small details, places control on questions and explanations. problem: battle for control causes pt to "shut down"
Obsessive-compulsive
38
leading cause of morbidity and mortality worldwide
pneumonia (CAP)
| also second MCC of hospitalization
39
protein need for the day
5 1/2 oz /day
40
needs to emotionally merge with others of opposite gender. communicates through emotions and feelings vs thoughts. over dramatic, impulsive. initially personable but is lacking depth. can become angry or jealous if attention is not on them
histrionic
41
tetracyclines affect what nutrients
```
12-MIC
B12
Mg
iron
Ca
```
42
increased PNS tone via OA AA and C2 in pneumonia pts has wait effect
thinning of secretion and bronchiole constriction
| SNS increased tone thickens secretions and dilates bronchioles
43
incarcerated vs strangulated hernia
incarcerated: can not reduce without surgery
strangulated: vascular compromise; SURGICAL EMRGENCY
44
most sensitive and specific test for GERD dx is ____ and the first line of tx is ____
1. 24 hr pH monitor (not required)
2. 4 week trial of PPI (both dx and tx)
(no EGD unless no improvement with PPI in 4 weeks)
45
labs helpful in evaluating nutritional deficiency
CRP, elevated WBC, albumin (<3.5 mild or <2.4 severe)
* CBC -iron, folate, b12 deficiency
* TSH - iodine deficiency
* total protein, albumin - protein calorie malnutrition
46
MCC of pneumonia (pathogen) ? and MCC of the severe cases?
MCC: S. pneumoniae
severe: S. pneumo and legionella
47
when to transfuse following a CBC
if hemoglobin is below 7 (low risk pt) or below 9 (high risk pt such as elderly or heart disease)
48
how does vertebral oseteomyletitis present
LBP that gradually increases over weeks to months with +/- fever
49
during inguinal hernia check, and impulse felt a tip of finger with head turn and cough = ? impulse at the side of the finger indicates?
```
tip = indirect
side = direct
```
50
pelvic pain that is deep in the pelvis and often effects ability to defecate or void. may be chronic, escalating, related to exercise, strain, or surgery. affects paravaginal and vaginal tissues
pelvic floor neuralgia or pudendal neuralgia
51
most common reason for cyclic pain complaints in women (menstrual health)
ovarian cysts
52
how to tx periodic limb movement DO
dopamine agonist or anti-epileptic agents
53
define rickets
deficient mineralization prior to plate closure of kids. caused by Ca, phosphorus, or vitamin D deficiency.
(when it occurs after plate closure it is called osteomalacia)
54
three primary pillars to prevent CAP
1. smoking cessation
2. flu vaccine (all pts)
3. pneumococcal vaccine (at risk pts)
55
gold standard dx for GAS pharyngitis
throat culture
| other is rapid antigen testing aka rapid strep; or using the modified CENTOR criteria
56
dirurectics (thiazides and furosemide) affect what nutrients
K+
Mg+
Ca+
Zinc
57
reduced vs light sodium foods
reduced- 25% less
| light- 50% less
58
broad ddx for fatigue
DEAD TIRED
1. depression
2. environment/lifestyle
3. anxiety, anemia
4. diabetes/endocrine
5. thyroid, tumor
6. infection
7. rheumoatologic
8. endocarditis, cardiovascular
9. drugs (meds or abuse)
59
what is the MCC of sepsis
pneumonia
60
health care agent vs surrogate vs gaurdian
health care agent: formal signed document called an advance directive that names a person to have legal authority to make health care decisions
guardian: court assigned as medical guardian to authorize you to make health care choices for someone else
surrogate: informal medical decision making for patient based on your relationship and knowledge of pts wishes
61
screen pregnant women for ___ infection at their first prenatal visit
HBV, and HIV, syphilis, GC (if <24),
NOT HSV
62
how to respond to feelings and emotions
NURS
1. name the problem (this makes you angry?)
2. understand (i understand why your feeling this way)
3. respect (dealing with this takes courage)
4. support (we will fix this)
63
define diastasic recti and when it is seen
- seperation of the rectus abdominis muscle causing a midline ridge formed by abdominal contents
- classically benign and common in obesity, chronic lung dz, and after repeated pregnancies
- seen ONLY when patient is supine and raises head above the shoulders
64
HAP vs VAP
* hospital acquired pneumonia is acquired >48 hrs after hospital admission
* ventilator acquired pneumonia is acquired >48 hours after endotracheal intubation
65
in acute bronchitis, conjunctivitis and adenopathy suggest ___ infection
adenovirus
66
main things to do to tx UGIB
1. recognize and resuscitate early
2. intubate early with back ups
3. consult GI, radiology, surgery
4. ABX
67
hypothyroid tx that falls under metabolic model of OMT
hormone treatment
68
indications of PBRC use
1. hemoglobin < 7 (or <9 if high risk)
2. acute anemia (** PBRC + crystalloid fluids)
3. hemorrhagic shock (hemodynamic instability)
69
`calculate calorie need of sedentary hospitalized pt
30-35kcal/kg body weight to maintain weight
70
distrust others. hyper alertness. complain of mistreatment and neglect, blame others. feel criticized. are time consuming and often demanding with threats of legal action. doctor should be friendly and courteous and avoid closeness
paranoid
71
appearance of B12 deficiency
glossitis, hyperpigmentation, canities (loss of hair pigments- turn gray);
-bright red tongue, with sores and atrophic, pigmented nails, megaloblastic anemia (weak, numb, ataxia), neuro findings
72
classic cough pattern? sound is generated where?
deep inspiration, attempted expiration against closed glottis that opens suddenly for forceful exhalation
-sound is made at the larynx and resonated in the nasal cavity and lungs
73
how to dx UTI
- UA-urinalysis (dipstick and microscopic)
- urine culture (does not test for gonorrhea or chlamydia therefore must order urinary antigen for GC if STI is suspected)
* culture is not needed if dipstick and microscopic is negative
74
most common sx and PE findings of URI
SX:
1. cough (+/- sputum)
2. fatigue
3. fever
4. dyspnea
PE: increased work of breathing, crackles/rhonci/wheezing, + tactile fremitus/egophony/dullness/bronchophony, hypoxemia
75
order of male genital exam
1. inguinal/pubic inspection
2. inguinal hernia inspection
3. penis /glans
4. scrotum
5. rectal/prostate
6. breast (if indicated)
76
what shows lung pathology, bowel distention, and air fluid levels and free air but has low yield
AAS (acute ab series)
77
findings of scurvy (Vitamin C deficiency)
* 4 H's
1. hemorrhagic signs
2. hyperkeratosis of hair follicles
3. hypochondriasis (anxiety)
4. hematologic ABNLs
* *hair shafts curled in follicles capped by ketotic plugs leading to "corkscrew hairs", perifollicular petechiae, hemorrhagic gingivitis, friable gingiva, delayed wound healing, depression
78
coughing is initiated by stimulation of irritant receptors. where are major receptors are located ? minor receptors?
major: larynx, trachea, major bronchi
minor: URI (sinuses and pharynx) and chest (pleura, pericardium, diaphragm)
79
what is the modified CENTOR criteria
- aid in the dx of GAS pharyngitis (Strep throat)
* 1 point for (F-CAT)
- no cough
- tonsillar swelling/exudate
- enlarged tender cervical adenopathy
- >100.4 fever
* + 1 if 3-14 yo and -1 if >45 yo
- 0-1 = no abx or testing
- 2-3 = get rapid strep or throat culture and abx if +
- 4+ = empiric abx tx
80
phenobarbital and phenytoin (anticonvulsants) affect what nutrients
calcium, niacin, folate, Vitamin D
81
which atypical pneumonia causes bullies myringitis
mycoplasma
82
define acute bronchitis (type of URI)
inflammation of the tracheobronchial tree leading to increased mucous production and airway hyper responsiveness
-dx of exclusion
83
define sepsis vs septic shock
Sepsis
infection and an acute increase in organ failure
-caused by dysregulated host response to infection
Septic shock
sepsis infection + progressive organ dysfunction/failure leading to marked increase in mortality (serum lactate is >2)
(vasopressor needed)
84
salt recommendation
<2300 mg /day
| according to DASH diet, limiting to sodium to <2300 lowers BP and LDL
85
tx of LBP
usually no meds, try heat and other nonpharm tx 1st. educate pt and no bed rest of activity modification is needed
- if need meds first try 2-4 weeks of NSAIDS
- if refractory try nonbenzodiazepine muscle relaxant
86
lab tests identify as few as ___ % if patients source of fatigue
< 5%
87
3 main goals in OMM tx of pneumonia
1. reduced parenchymal lung congestion
2. reduced sympathetic hyperactivity to lung parenchyma
3. increased mechanical thoracic cage and diaphragmatic motion
88
T/F anemia or B12 deficiency second to vegan or vegetarian diet does not lead to wt loss
true
89
5 steps in patient centered interviewing
1. set the stage (welcome pt, ensure privacy)
2. elicit CC
3. begin interview (non-focused )
4. use focusing skill to identify sx story, personal context, emotional context
5. transition to middle of interview (clinical centered phase)
90
complicated UTIs (i.e pregnant female) is at risk for
prematurity, low birth weight, and SEPSIS
91
OC reduce risk of
ovarian cysts, ovarian cancer, uterine cancer
92
lithium and amiodarone affect what nutrients
lithium
93
tx for GAS pharyngitis
penicillin (10 day)
| -if allergic then cephalosporins or macrolides
94
sense of love and attention is derived from suffering. to repsonds to self-inflicted emotions of guilt or shame. complain about lots of problems and not happy when fixed. reject advice that would improve sx. the doctor should avoid reassurance, and promises and use less hopeful tx but a more plain/austere approach
self-defeating (masochistic)
95
if scrotal mass is seen ___ may be used to assist in dx of hydrocele vs hernia vs solid mass
trans-illumination
96
recommendations of screening for GC, HIV, syphilis, Hep B,
GC- sexually active women (esp < 24yo)
HIV- 15-65 yo
syphilis- asx, adults with high risk
Hep B: kids and adults with high risk
97
keep platelets at _____ if actively bleeding
>50,000
| *cross match 2-4 units of blood in case need of emergent transfusion arises
98
define pellagra
niacin (B3) deficiency
- 3 D's
1. diarrhea,
2. dermatitis (photosensitive)
3. dementia
* also burning parathesia is common
99
cyclic pain associated with ovulation
mittelschmerz
100
3 most common causes of noninfectious chronic cough
1. UACS (MCC of chronic cough in healthy, nonsmokers with NL CXR) (includes allergic rhinitis and bacterial sinusitis)
2. asthma/COPD
3. GERD
101
what two drugs affect folate
methotrexate (cytotoxic) and sulfasalazine (abx)
| and phenopbarbital/phenytoin (anticonvulsants)
102
visceral vs parietal (somatic) pain pf the abdomen
visceral: due to distention, stretching, or contraction of hollow/solid organs or ischemia
- not localized
somatic: due to inflammation in the parietal peritoneum (usually constant and more severe than visceral)
- localized, worsened by movement
103
most common pathogens caused rhinosinusitis (adults and kids)
Adults: S. pneumoniae and H. influenza
Kids: H. influenza and M. catarrhalis
104
findings of GAS related pharyngitis ? what does it resemble?
abrupt onset of sore throat, fever, palatal or tonsillar petechiae, tender cervical adenopathy, ABSECNE of cough
- also can cause erythematous, sandpaper like (scarlatinaform) rash
* *can be hard to differ from infectious mononucleosis caused by EBV
105
when to use FFP
coagulation deficiency (factor 5 and 7)
106
KUB cannot be used for
rule out intraperitoneal gas or detect air fluid levels
107
a fluid wave is ___ but not ___ for ascites
high specificity low sensitivity (there negative fluid wave does not rule out)
*buldging flanks has high sensitivity but low specificity
108
what is significant unintentional weight loss
5% in 6 months or 10% in one year
| %change = (usual wt- current wt) / usual weight x 100
