Primary Flashcards
(160 cards)
1
Q
Overweight BMI is __-___
A
25-29.9 BMI (kg/m2)
2
Q
Underweight BMI is >
A
<18.5 BMI (kg/m2)
3
Q
Normal BMI is __-___
A
18.5-24.9 BMI (kg/m2)
4
Q
Obese BMI is __-__
A
30-39.9 BMI (kg/m2)
5
Q
Extreme obesity is > BMI
A
> 40 BMI (kg/m2)
6
Q
Weight circumference of > __inches is associated with an increase risk in DM & CVD who are classified as overweight or obese
A
> 35 inches (88cm) in females with a BMI 24.9-39.9
7
Q
Difference between primary and secondary lesion
A
Primary: result of initial insult (exterior or internal) (e.g., bug bite, papules, vesicles)
Secondary: result from trauma or evolution of primary lesion (e.g., excoriations, fissures, scars, ulcers, crusts, impetigo, lichen simplex chronicus)
8
Q
ABCDE of skin lesions
A
Asymetry, Border irregular, Color changes (blue/black), Diameter >6mm, Evolution
9
Q
Describe the difference between macules and patches
A
Both are flat, circumcised areas, change in color of skin; macules are <1cm; patches are >1cm (e.g. Pityriasis Versicolor)
10
Q
Describe the difference between papules, pustules, and vesicles.
A
Papules: elevated, <1cm, circumscribed, firm
Pustules: same but filled with mucopurulent discharge.
(e.g. acne)
Vesicles are elevated, <1cm, circumscribed, filled w/clear fluid >1cm=bulla (e.g., Herpes Zoster)
11
Q
Describe plaques
A
Firm, rough, flat top surface, elevated, >1cm (e.g., psoriasis)
12
Q
Describe wheals
A
Wheals are elevated, irregular cutaneous diameter, varying in size; often red and itchy. (e.g., allergic reaction)
13
Q
Basal cell carcinoma
A
Raised border, ulcer
14
Q
Most common type of skin cancer
A
basal cell carcinoma
15
Q
How deep is an ulcer?
A
Dermis and epidermis
16
Q
Impetigo: s/sx and tx
A
yellow, honey-crusted lesions usually around mouth. Highly contagious.
Tx: Mupirocin, pens, erythromycin.
17
Q
Types of psoriasis
A
plaque. guttate. inverse pustular. erythrodermic psoriatic arthritis
18
Q
Number one cause of goiter (enlarged, contender thyroid)
A
Grave’s dz (autoimmune hyperthyroidism)
19
Q
Single thyroid nodule
A
usually cyst, benign, but need to consider malignancy
20
Q
PERRLA stands for…
A
Pupils Equal, Round and Reactive to Light and Accommodation
21
Q
Visual fields full by confrontation test
A
fingers wiggling laterally
22
Q
Extraocular movements EOM test
A
6 cardinal directions of gaze
No nystagmus (few beats, but not sustained)
No lid lag
23
Q
Define Presbyopia
A
Far-sighted (cannot see things close up–light focuses behind retina)
24
Q
Define Myopia (20/100)
A
Near-sighted (cannot see far things far away, light focuses in front of retina)
25
What might you see with cataracts?
opacity of lens
26
What might dysconjugate gaze mean? (when eyes don't follow one another in the same direction--aka lazy eye)
Diseases, injuries, or lesions affecting CNIII, IV, or VI
27
What might cause nystagmus?
Cerebellar system disorders
Drug toxicity
Vestibular disorders (ears)
28
What might cause lid lag?
exophthalmos/ hyperthyroidism
29
What might you see during the eye exam w/HTN?
AV nicking, when the vein appears to stop on either side of artery, or retinal hemorrhages.
30
What might you see during subarachnoid hemorrhage, trauma or brain mass causing increased ICP--papilledema?
Optic disc margin blurred, bulging physiologic cup.
31
Conductive hearing loss test results
Rinne test: bone conduction greater than air (air usually greater)
Weber: sound materializes to affected ear
32
Conductive hearing loss is usually impaired through....
the external or middle ear
| e.g., exudate/swelling, perforated eardrum
33
Sensorineural hearing test results
Rinne test: air conduction greater than bone (normal)
| Weber: sound materializes to NORMAL ear
34
Sensorineural hearing loss results in defect in...
the inner ear due to loud noise, aging or acoustic neuroma
35
S/sx of squamous cell carcinoma
white patch on side or undersurface of tongue=leukoplakia
| +lymph enlargement
36
S/sx of streptococcal pharyngitis
Tonsils 3+ w/white exudate
Enlarged, tender anterior cervical nodes
Erythematous pharynx
37
S/sx of allergic rhinitis
```
pale blue nasal mucosa
watery nasal d/c
Posterior pharynx
Mucoid secretions
Cobblestone appearance
```
38
Normal lung percussion
Resonant: loud, low pitch, hollow
39
Normal lung sounds
Vesicular, soft, low pitch, inspiration last longer than expiration. No adventitious sounds
40
Emphysema exam findings
Percussion: hyperresonance (very loud, low pitch, booming)
| Decreased fremitus
41
Pneumothorax exam findings
Percussion: Tympany (loud, high pitched, drum-like), decreased fremitus
42
Lobar pneumonia exam findings
Dull: soft-moderate, mod-pitch, thud. Increased fremitus and ego phony (E--> A)
43
Exam findings in large pleural effusion
Percussion is flat: soft, high-pitch, very dull; decreased fremitus
44
Normal percussion sound over liver
dull
45
Normal percussion sound over bone
flat
46
Crackles, heard during inspiration, may be fine or coarse and heard during...
bronchitis, pneumonia, early heart failure
47
Rhonchi, low-pitch, loud sound heard on inspiration and expiration due to air passing by thick secretions. May be seen in...
Pneumonia and bronchitis
48
Wheezes, heard during inspiration and/or expiration during...
Louder during expiration in asthma
Heard during asthma, COPD, or bronchitis.
Louder during expiration in asthma
49
Pleural Friction rub is dry, grating sound heard during inspiration OR expiration during...
Pneumonia, inflammation, pleurites, tumor.
50
Exam findings in COPD:
Increased AP diameter, decreased tactile fremitus
51
exam findings w/tumor in lung
Increased tactile fremitus and egophony
52
Where is the point of maximal impulse (PMI) best heard/felt?
5th intercostal space (ICS), 7-9 cm lateral to midsternal line
53
What extra cardiacsound is a normal variation in pregnancy?
S3
54
S1 is best heard at the...
apex
55
S2 is best heard at the...
base
56
S1 indicates the closure of...
closure of tricuspid and mitral valves, the start of systole
57
S2 indicates the closure of...
pulmonic and aortic valves, the start of diastole
58
S3 & S4 are best heard over the____ with the ____ of the stethoscope when the patient is supine or _________.
S3 is best heard over the APEX with the BELL of the stethoscope when the patient is supine or left lateral. (low pitch)
59
S4 may be seen in older adults or....
well trained athletes (due to forceful atrial ejection int distended ventricle)
60
S3 may be seen in 1______, 2.________, and 3._______-
children, young adults, and pregnant people. (due to rapid ventricular filling)
61
In pregnancy, one may have a D or S murmur?
Systolic murmur
62
What kind of murmur might you hear during valvular disease?
Diastolic murmur +/- clicks and snaps
63
Glandular breast tissue may feel...
bumpy
64
Only press nipple for d/c if patient reports...
nipple d/c
65
Liver span is _-__cm in R. midclavicular line.
6-12cm, edge smooth and palpable no more than 2cm below R. coastal margin.
66
Spleen is between _-__th rib and percusses ______
Spleen is between 6th and 10th rib in mid-axillary line and percusses dull. May not be palpable
67
Aorta is no more than _cm and palpated in the ____
3 cm
| Anterior, left of midline.
68
Kidneys +/-palpable?
Nontender and non-palpable-R. kidney may be more palpable.
69
Murphy's sign is sharp increase in tenderness with upward pressure under R. costal margin while inhaling and may indicate...
Cholecystitis
70
Possible signs of peritonitis
guarding, rigidity, rebound tenderness.
71
+ signs for possible appendicitis:
McBurney's point: tender in RLQ
Rovsing's sign: referred rebound tenderness when L. side is pressed
Psoas and obturator signs: irritation of R. psoas or obturator muscle.
72
S/sx of chronic arterial insufficiency
Shiny, cool, dusky red; decreased dorsals pedal and posterior tibial pulses bilaterally;
+/- ulcers on toes on points of trauma on feet.
73
S/sx of chronic venous insufficiency
Thick skin, warm, non pitting edema; brown hyper pigmentation around ankles; 2+ dorsals pulses, +/-ulcers on medial aspect of ankles
74
Motor strength is measured 0-_
0-5+
75
Normal blood pressure is
120/80
76
elevated BP:
120-129/80
77
Stage I HTN:
130-139/80-90
78
Stage II HTN:
>/= 140/90
79
Start lipid screening at __y/o and repeat q _ years
Lipid screening starts at 20+ if at increased risk for CHD and repeated q5years (more often if indicated)
80
Lipid testing should be done _________
fasting (or non-fasting, if just cholesterol & HDL)
81
Normal cholesterol, HDL, LDL and triglycerides:
```
Cholesterol<200
HDL: 40-60
LDL: <130
Tri: 35-135
MAY BE ELEVATED DURING PREGNANCY
```
82
When should you screen for DM?
+GDM q3 years
Age 45+ q3years
earlier and more often if BMI>25 & one other risk factor
83
How to test for DM?
```
Hgb A1c >6.5%
5.7-6.4% = pre=diabetes
<5 =normal
75g 2hr glucose test
--> repeat test to confirm test
```
84
+ Diagnosis for DM
A1C >6.5%
5.7-6.4% = pre=diabetes
2hr >200 mg/dL
Fasting>126 mg/dL
s/sx of hyperglycemia + random glucose of >200mg/dL
**Repeat test on subsequent day to confirm dx unless symptomatic**
85
When should A1C be checked in diabetics? And what's good control?
q3 months
| A1C<7%
86
Clinical breast exam is recommended starting at age __ Q __year(s)
40 annually
1-3years between 25-39
ACS: CBE not needed if having annual mammograms & no risk factors
87
Mammograms
- ACOG (2017)
- ACS (2015)
- USPSTF (2016)
- ACOG: 40 q 1-2 years
- ACS: 40-45 annually until 55, then q 2yrs
- USPSTF: 50-74 q 2yrs
88
Screening for +BRCA gene
Annual mammogram and MRI
89
Cervical cancer risk factors
Smoking, multiple sex partners, lack of screening, high risk HPV
90
HPV testing
21-29: q 3 years pap only
30-65: q5 years pap + HPV or q3yrs pap only
66+/hysterectomy: stop screening, unless past +HPV 20years.
91
Colon cancer risk factors
Red meat, obesity, smoking EtOH, inflammatory bowel disease, colon polyps, family hx
92
Colon cancer screening
```
Colonoscopy q10 years @ 50yrs
FIT: fecal immunochemical test annually
-Flexible sigmoidoscopy q5yrs
-CT colonography
-FIT-fecal DNA test q3yrs
```
93
_____cancer is the leading cause of cancer-related death in women
Lung
| 1/20 women
94
_____cancer is the the most prevalent type of cancer in women
breast
95
Lung cancer screening guidelines according to USPSTF, ACS
Annual low-dose CT scan ages 55-80 with a 30+ pack-year smoking history & still smoking or quit w/in 15 yrs.
96
How to calculate pack-year history?
Multiply packs per day and years smoked (1pk/d for 30 years=30py)
97
Bone mineral density screening recommendations
65+ or younger w/risk factors q2-15 years using DEXA
98
T-score interpretation
-1 to +1: normal
-1 to -2.5: low bone mass (osteopenia)
>/= -2.5: osteoporosis
99
HIV screening
EVERYONE ANNUALLY unless declined (opt-out screening)
| -Pregnant: 1st/3rd trimester
100
Screening test for HIV (rapid test using blood or oral mucosa)
EIA (enzyme immunoassay) for HIV 1 and 2 antibodies (detectable by 4wks-6 months)
101
Confirmation testing for HIV
Western blot or ISA
102
Early screening for HIV
P24 antigen: detectable 2-6 weeks after infection and declines when p24 antibodies develop (best if combined with EIA)
103
Who to risk HepC for? and how?
born 1945-1965 or with risk factors
| With ELISA test (+2wks to 12 mons) =indicates past or present infection
104
What is a hep C virus RNA (PCR) test used for?
Determine active vs. chronic infection of HepC
105
When should influenza be administered
Everyone, including children and pregnant, annually.
106
Tdap vaccine recommendations
Tdap +Td booster q10yrs
| Tdap EACH pregnancy between 27-36 weeks
107
Zoster vaccine recommendations
60y/o + regardless of history of shingles
108
Pneumococcal Vaccine recommendations
65y/o+ or immunocompromised
| Give both PCV13 and PPSV23, starting with PCV13, at least one year apart.
109
HPV vaccine--Gardasil 9 (9-valent)
covers 9 types of HPV
2-dose <15y/o (0, 6-12mons)
3-dose >/=15y/o or immunocompromised (0, 1-2mons, 6 mons)
110
Age limit for HPV
until 45 now!
111
What vaccine should be given to all 1st year college students living in dorms?
Menningococcal
112
T or F: Live attenuated vaccines, including varicella, MMR and LIAV-flu, are contraindicated in pregnancy and lactation
T-preg
| F-lactation, however LIAV-flu shot not recommended.
113
Daily recommendations for Calcium
1000-1300mg/day (higher if younger than 19, older than 51)
114
Daily recommendations vitamin D
Normal serum levels
400-800 if <51y/o
800-100 if >50
Normal serum level: >30ng or greater
115
Food sources of calcium
dairy, soybeans, sardines, salmon, OJ, cereals
- calcium citrate <500mg
- calcium carbonate (take w/food) <500mg
116
Food sources of vitamin D
sun, egg yok, fortified milk, saltwater fish, liver
117
Daily recommendations for folate (for DNA synthesis)
0.4mg/d or 4mg/d one month prior to pregnancy if at NTD risk
118
Daily recommendations for iron
14-50y/o: 15-18mg/dL per day
| 51+y/o: 8mg/dL per day
119
Sources of folate:
Dried beans, leafy vegetables, citrus fruits, fortified cereal
120
iron sources
meat, fish, cereal
121
Sodium recommendations
<2300mg/day
| <1500mg/day if 51yrs+, African American, HTN, CKD, DM
122
Fat recommendations
<20-35% total fat/day
<10% saturated fats
<300mg/d cholesterol
no trans fat
123
Max heart rate is 220-____
your age
124
Muscle strengthening > __days/week and __ days for bone strengthening
2 days/week for muscle
| 3 days for bone strengthening
125
___ minutes of moderate intensity or __ minutes of vigorous intensity aerobic activity
150 minutes
| 75 minutes
126
1. Mild asthma has symptoms
Mild asthma has symptoms =2d/wk, =2 nights/wk
127
2. Mild persistent asthma has symptoms >__days per week and more than __ days per week
2. Mild persistent asthma has symptoms >2days per week and more than 2 days per week
128
3. Moderate persistent asthma symptoms occur every day and occur more than __ day(s) per week
3. Moderate persistent symptoms occur every day and occur more than 1 day(s) per week
129
4. Severe persistent asthma symptoms occur...
4. Severe persistent asthma symptoms occur...continually during the day and frequently during the night
130
Thyroid levels should be checked q___
q4wks
131
Most common precursor to skin cancer is...
actinic keratosis, often found in areas exposed to sun. Can be removed via cryotherapy or topical meds.
132
Medications that can adversely affect thyroid function are...
GAP:
Glucocorticoids
Amiodarone
Phenytoin
133
S/sx of Zika
fever, rash, headache, joint pain
134
Congenital Zika Syndrome s/sx
1. Microcephaly, r/I partially collapsed soul
2. Decreased brain tissue w/brain damage
3. Damage to back of eye
4. Limited range of motion, clubfoot
5. Too much muscle tone restricting body movement
135
Zika last longer in sperm or vaginal d/c?
sperm (men should avoid pregnancy for 6 mons; women 8wks)
136
Testing for Zika
PCR (not recommended if no risk fxrs)
| IgG (prior to pregnancy is reasonable if risk factors)
137
Normal Hgb for pregnant, non-pregnant and NBs
Nonpregnant: 12-16
Pregnant: 10.5-14
NBs: 13-20gm/Dl
138
Normal hematocrit for non pregnant, pregnant and NBs
Nonpregnant: 37-47%
Pregnant:
NBs: 42-65%
139
Normal platelet count
150-400k/mm3
140
Normal WBC
5-10k
| up to 20k in pregnancy
141
WBCs elevated in viral infections
lymphocytes and monocytes
142
WBCs elevated in allergic reactions
basophils
143
WBCs active acute bacterial infections
neutrophils
144
Free T4 not affected by...
increased TBG
145
Renal function tests
BUN 5-20mg/dL
| Creatinine 0.5-1.1mg/dL
146
Causes of high BUN levels
Pre-renal causes: dehydration, burns, reduced cardiac fun, GI bleed, high protein, excessive catabolism (starvation)
Renal causes: renal dz, failure and nephrotoxic drugs
Post-renal causes: obstruction to urine, cancer, prostate enlargement.
147
Causes of decreased BUN levels
Pregnancy, over hydration, liver failure, malnutrition, malabsorption, nephrotic syndrome (protein loss in urine)
148
What med class could cause rhabdomyolysis (destruction of skeletal muscle)?
Statins
149
Causes of increased creatinine clearance
increased blood flow (pregnancy, exercise, high cardiac output)
150
Causes of decreased creatinine clearance
decreased blood flow to kidneys: renal dz, cardiac dysfunction, cirrhosis w/ascites, shock, dehydration
(calculated from urine)
151
Liver function tests
Bilirubin
Albumin 3.5-5
Liver enzymes: ALP, AST, GGT, LDH
152
T or F: There are no chronic HepA carriers
True, not chronic, but IgG can be + for 2 years
153
A HAI titer of 1:10 or greater for rubella indicates...
immunity
154
A HAI titer of 1:64 or greater for rubella indicates...
possible infection --> test for IgM!
155
>5mm PPD test is positive for folks who are...
- HIV +
- Immunocompromised
- Recent contact of TB case
- Fibrotic changes on Chest x-ray consistent w/old TB
156
>15mm PPD test is positive for folks who are...
healthy with no risk factors for TB
157
>10mm PPD is positive for folks who are...
- Immigrants from high-prevalence countries (<5years)
- Injection drug users
- Residents/employees of high-risk settings
158
T or F: TB blood test (interferon-gamma release assay--IRGA) is definitive.
True
159
ANA is used for...
```
systemic lupus (95%)
Sjogren's syndrome
Rheumatoid arthritis
Scleroderma
Some medications will cause false +
```
160
Diagnostic criteria for SLE
4/11 s/sx: malar/butterfly rash, photosensitivity, oral ulcers, arthritis, kidney disorder, neurologic disorder, heme abnormalities, immunologic disorders, discoid rash
+ ANA >1:40
(persistent negative ANA titer <1:40 rules out SLE)
