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Psych/Infectious disease/Heme Flashcards

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1
Q

Alcohol dependence withdrawal (pharm tx)

A
  1. IV benzo
  2. IV fluids + suppleemnts = Thiamine/magnesium
  3. Avoid meds that decrease seizure threshold (bupropion, haloperidol, anticonvulsants, clonidine, BB)
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2
Q

Alcohol use disorder (pharm tx)

A

Disulfiram = First line

Naltrexone = opioid antagonist to reduce cravings and ETOH induced euphoria

Gabapentin = topiramate

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3
Q

ADHD (hx and pe)

A

Difficulty paying attention, controlling behaviors, hyperactivity

Sx onset = before age 12 and present at least 6 months

Sx must occur in at least 2 settings (home + school)

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4
Q

Conduct disorder, breath-holding (clinical intervention)

A

Family counseling w/ parents + child

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5
Q

Persistent depressive disorder (hx and pe)

A

Chronic depressed for at least 2 years in adult; 1 year child

Lasts most of day, more days than not, patient is not sx free for >2 mo at a time

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6
Q

Histrionic personality (FMLD)

A

Hey look at me - attention seeking
Hissy fits - temper tantrums
Hyperinflated - believes they are more important than others

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7
Q

Postparum depression (pharm tx)

A

SSRI

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8
Q

Schizoaffective disorder (FMLD)

A

Schizo + mood disturbance (MDD or manic)

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9
Q

Schizoid personality (FMLD)

A

Voluntary social withdrawl, loner, hermit, reclusive, isolated, anhedonia/introvert

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10
Q

Schizophrenia (Hx and PE)

A

> 6 mo of illness with 1 month of acute dx with functional decline

Decreased CNS gray matter, increased size of ventricles, increased CNS dopamine receptors

Ask about positive vs negative sx

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11
Q

Schizophreniform disorder (FMLD)

A

Meets criteria for schizophrenia but less than 6 mo duration

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12
Q

Tardive dyskinesia (pharm tx)

A
  1. Switch to second generation antipsychotic
  2. Deutetrabenazine
  3. Valbenazine
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13
Q

Ascariasis (FMLD)

A

Small worm load = asx

Large worm load = Vague abd pain,

High load = migrate to pancreatic duct, bile duct, appendix

Patient may c/o of cough, wheezing, hemoptysis, abdominal pain, diarrhea

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14
Q

Bartonellosis (cat-scratch dx) Pharm tx

A

Azitrho = first line

Doxy preferred if optic neuritis or neurologic disease

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15
Q

Chancroid (scientific concept)

A

STI cause by bacteria = Heamophyllis ducreyi

PAINFUL ulcer vs syphillis is painless chancre

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16
Q

Dengue fever (FMLD)

A

Biphasic fever (high then remission, then second fever)

Joint pain, HA, sore throat

Biphasic rash

Hemorrhagic fever in children

Tourniquet test - Purpura from the pressure of the tourqniuet placed on arm

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17
Q

Diptheria (pharm tx)

A

Diptheria antitoxin (horse serum) supplied by CDC + erythromycin or PCN x 2 weeks

Clinda or Rifampin are alternatives

PCR confirms diptheria

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18
Q

Dengue fever prevention (maint + prevention)

A

Pemethrin on clothes, DEET on body

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19
Q

HIV disease (Dx and labs)

A
  1. Antibody testing = ELISA = SCREENING
  2. Western Blot = CONFIRMS

HIV RNA Load = Used to monitor infectivity

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20
Q

HIV/AIDS (Maint + prevention)

A

Avoid IV drug use/sharing needles

Post exposure prophy = High risk people best started within 72hrsof incident, earlier the better

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21
Q

HIV/AIDS, Cytomegalovirus (scientific concepts)

A

MC virus in AIDS patient

CMV Retinitis if CD4 less than 50

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22
Q

Shigella infection (hx and pe)

A

Mild abd pain to severe diffuse colicky abd pain with mucoid diarrhea preceding BLOODY diarrhea, fever, N/V, anorexia

PE = Tachycardic, hypotensive, abd distention, tenderness with HYPERACTIVE bowel sounds

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23
Q

Lumbricoides infestation (scientific concepts)

A

GIANT roundworm ; MC intestinal helminth worldwide

Contaminated soil

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24
Q

Lyme disease (FMLD)

A

Hx of tick bite;

early localized= erythema migrans

Early disseminated = arthritis + HA, CN7/Facial palsy, AV heart block

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25
Malaria (dx and labs)
Gemsa stain peripheral smear (thin and thick) parasites in RBC
26
Malaria (scientific concepts)
RBC disease caused by plasmodium calciparaum Transmitted by female anophele mosquito Sickle cell trait + thalassemia trait = Protective against malaria
27
Mumps (clinical intervention)
Supportive Anti-inflammatory; Sx lasts 7-10 days
28
Neurosyphillis (pharm tx)
PCN IV x 10-14days
29
Primary syphillis (dx and labs)
1. Darkfield microscopy 2. Screening tests = RPR, VDRL 3. Confirm = FTA- BS (fluoroscent treponemal antibody absorption)
30
Ramsey Hunt - (FMLD)
Triad Ipsilateral facial paralysis (bells palsy) Ear pain Vesicles of auditory canal Decreased hearing, tinnitus, hyperacusis, lacrimation in some patients
31
Rocky mountain spotted fever (FMLD)
Fever + HA a few days after rash Rash = small spots of bleeding starts at ankles/wrist then palms/soles before spreading centrally over 2-3 days
32
Rubella (Maint + Prevention)
Generally no complications in children with rubella Teratogenic in 1st trimester part of TORCH Blueberry muffin rash
33
Schistosomiasis (FMLD)
Tropical = Swimming, wading in fresh or salt water Pruritic rash due to cercarial dermatitis aka swimmer itch Fever, lethargy, malaise, myalgia
34
Sepsis, bacterial (hx and pe)
Fever + Hypotension + Increased RR
35
Toxic shock syndrome (hx + pe)
Sudden onset of high fever, tachycardia, hypotension, rash like sunburn includes palms/soles
36
Toxoplasmosis (FMLD)
Primary infection= usually asx Mono-like illness, cervical LAD, encephalitis and chorioretinitis if immunocompromised TORCH syndrome Triad: Chorioretinitis Intracranial calcifications Hydrocephalus
37
Trichinellosis (FMLD)
Hx of wild boar, bear, or cougar hunting Diarrhea, N/V, fever, fatigue, abd discomfort
38
Typhoid fever (FMLD)
Caused by salmonella (s.typhi) Cephalic phase - HA, constipation, pharyngitis, cough PEA SOUP STOOLS Fever, bradycardia, hepatosplenomegaly, ROSE SPOTS
39
Alpha thal (Dx and labs)
1. CBC = hypochromic, microcytic anemia 2. Peripheral smear = TARGET cells, basophillic stipling; HEINZ BODIES in hemoglobin H dz 3. Hb electro = normal Some or all of the 4 genes that make hemoglobin (the alpha-globin genes) are missing or damaged
40
Anemia, hemolytic, secondary to renal failure (pharm tx)
Iron supplementation and ESA (recombinant EPO and darbepoetin alfa)
41
Aplastic anemia (dx and labs)
CBC, peripheral smear, Hbg electrophoresis, serology for hepatitis Fluorescent labeled inactive toxin testing Kidney and liver testing Bone marrow biopsy
42
Autoimmune hemolytic anemia (clinical intervention)
1. Warm (IgG Ab) Steroids = first line then splenectomy then immunosuppressants 2. Cold (IgM) Avoid cold exposurer, Rituximab if tx is needed Coombs (+) distinguishes between hereditary spherocytosis
43
Autoimmune hemolytic anemia (health maint and prevention)
Cold (IgM) = Stay away from cold temp, wear gloves Warm (IgG) = periodic blood transfusions, splenectomy *G6PD = avoid triggers (fava beans, napthalene)
44
Beta thal (FMLD)
1. Beta thal - trait aka *MINOR* = asx, only 1 defective gene 2. Beta thal Intermedia = Assoaciated with anemia, hepatosplenomegaly and bony disease 3. Beta thal major *COOLEYS* anemia = usually asx at birth but become symptomatic at 6 mo; frontal bossing; maxillary overgrowth; hepatosplenomegaly; SEVERE HEMOLYTIC anemia, osteopenia, iron overload and pigmented gallstones
45
Beta thal (Dx and labs)
1. CBC = hypochromic, microcytic anemia (decreased MCV); normal or increased RBC count and serum iron 2. Peripheral smear = TARGET cells, teardrop cells, basophillic stipling 3. Hgb electrophoresis = B thal trait (minor) = low HbA, HbA2, HIGH Hbf 3. Hgb electrophoresis = B Major (cooleys) = High HgbF, increased HgbA2, little to no HgbA Skull Xray = BOSSING with hair on end due to extramedullary hematopoeisis
46
Beta thal (scientific concepts)
Decreased production of beta chains leds to excess alpha chains MC in mediterranean (greek/italian) and africans
47
Protein C coagulation Defect (Pharm tx)
Heparin = Anticoag for life
48
Protein C coagulation defect (scientific concepts)
Protein C is a Vitamin K dependent anticoagulation protein (produced in liver) that stimulates fibrinolysis and clot lysis Increased risk of recurrent DVT and PE Autosomal dominant inherited hypercoaguable disorder
49
Factor V leiden mutation (pharm tx)
High risk = Indefinitive anticoagulation; may need thromboprophylaxis during pregnancy to prevent miscarriage Moderate risk (thrombotic event with a prothrombotic stimulus or asx) = Prophylaxis during high risk procedures
50
Goodpastures Syndrome (FMLD)
G + P = Glomerular + Pulmonary Glomerulonephritis + Pulmonary hemorrhage
51
Goodpasture syndrome (clinical intervention)
1. Steroids + Cyclophosphamide 2. Plasmapheresis
52
Goodpastures syndrome (dx and studies)
Biopsy = Linear IgG deposits in glomeruli or alveoli on immunofluoresence, anti-GBM Ab
53
Goodpasture syndrome (scientific concepts)
IgG antibodies against type IV collagen of the alveoli and glomerular basement membrane of the kidney
54
Hemochromatosis (hx and pe)
Bronzing of the skin;deep tak color associated with insulin insufficiency
55
Hemochromatosis (clinical intervention)
Phlebotomy weekly until depletion of iron
56
Hemolytic anemia (pharm tx)
Two means of reducing antibody production Steroids and cytotoxic drugs
57
Hemolytic anemia secondary to renal failure (pharm tx)
Intravascular hemolysis can produce ATN = muddy brown casts Sx = Red/brown urine and plasma; low haptoglobin; high LSL; deteriorated renal function; fraction excretion of sodium less than 1% Tx = DIALYSIS
58
Hemolytic uremic syndrome (FMLD)
Suspect in kid with GI sxs (E.coli, shigella, slamonella) Anemia + kidney damage + petechiae/bruising
59
Hemophilia A (scientific concepts)
Deficiency of Factor VIII (8) Aiiiight Affects INTRINSIC pathway = failure to form hematomas; occurs almost exclusively in males
59
Hemophilia A (scientific concepts)
Deficiency of Factor VIII (8) Aiiiight Affects INTRINSIC pathway = failure to form hematomas; occurs almost exclusively in males
60
Hereditary hemochromatosis (dx and labs)
1. Increased serium iron, increases serum transferrin; NORMAL/Decreased TIBC 2. Increased LFTs,genetic testing for HFE gene, increased risk of hepatocellular carcinoma 3. Liver biopsy = GOLD STANDARD = increased liver parenchymal HEMOSIDERIN
61
Hereditary spherocytosis (dx and labs)
1. Blood smear = hyperchromic microcytic 2.Osmotic fragiltity test = POSITIVE ; Coombs = negative
62
Herediatry spherocytosis (FMLD)
Hemolysis leading to anemia, jaundice, hepatosplenomegaly PIGMENTED black gallstones (calcium bilirubinate)
63
Hodgkin disease (FMLD)
Patient 20 or 50 - BIMODAL Painless lymphadenopathy in upper body Alcohol may induce lymph node pain *Reed-sternberg owl-eye appearance Associated with EBV
64
Idiopathic thrombocytopenic purpura (clinical intervention)
Splenectomy
65
Paroxysmal nocturnal hemoglobinuria (clinical intervention)
Eculizumab (anit-complement CD5 Ab) Prednisone decreases hemolysis Marrow transplant
66
Paroxysmal nocturnal hemoglobinuria (FMLD)
Unexplained hemolytic anemia associated sxs including fatigue, jaundice , and red/pink/black urine. Decreased bone marrow function in some individuals may further exacerbate anemia and cause other cytopenia
67
Pernicious anemia (scientific concepts)
Autoimmune destruction loss of gastric parietal cells that secrete intrinsic factor leading to B12 deficiency
68
Polycythemia vera (dx and labs)
Screening test = Hbg >16 Hct less than 48% Diagnostic test = Subnormal EPO and either Jak2 peripheral blood mutation or exon 12 mutation
69
Secondary polycythemia (FMLD)
Increased hematocrit as a response to another process Sxs related to underlying precipitating cause (COPD) cyanosis, clubbing, HTN, hepatosplenomegaly +/- heart murmur
70
Thalassemia (scientific concepts)
Inherited blood disorderr that causes the body to have less hemoglobin than normal leading to anemia and fatigue Broken down into classifications = 4 subtypes of alpha (silent, carrier, major, Hgb H disease) 3 subtypes of beta (minor, intermedia, major)
71
Thalassemia (FMLD)
Microcytic anemia with normal/elevated serum iron or no response to iron treatment Associated with severe anemia and abnormal peripheral smear for a given Hct count
72
Thrombotic thrombocytopenic purpura (TTP) (FMLD)
PENTAD Thrombocytopenia Microgangiopathic hemolytic anemia Kidney failure Neurlogic sxs Fever *Increased incidence with HIV FAT RN F is for fever, A is for anemia, and T is for thrombocytopenia. R in RN is for renal dysfunction, while the N is for neurologic abnormalities.
73
EMTALA
Professional practice If you work at a facility that accepts Medicare/Medicaid you are required to perform a medical screening exam on every person that comes in No refusal Civil penalties if you are in violation ER must treat everyone - Anti-dumping law
74
Legal/ethical informed consent
Required documentation by joint commission Provider educates patient about risks, benefits, alternatives of a given procedure, intervention, or medication Patient must be competent to make voluntary decision about procedure or intervention and sign form
75
Medical informatics : medical record documentation
Accurate for biling and coding purposes
76
Patient care and communication: informed
Patients must be informed of risks and benefits and alternatives in all situations Patients are allowed to ask questions about procedures and interventions before consenting to ensure they are comprehending the information we give them

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