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Flashcards in Test 4 Deck (371):
1

anaphylaxis pathophysiology

bronchoconstriction, coronary vasoconstriction, peripheral vasodilation

2

First diagnostics for anaphylactic reaction

pulse ox and EKG

3

epinephrine works on

alpha and beta adrenergic agonist receptors

4

epinephrine dosing for adults

0.2-0.5 mg IM, repeat every 5-15 min with max dose of 1 mg

5

epinephrine dosing for children

0.01 mg/kg IM repeat every 20 min- 4 hours with max dose of 0.5 mg

6

preferred injection site for epinephrine

vastus lateralis

7

other medications that can be used for anaphylaxis

diphenhydramine, beta2 agonists

8

delayed reaction to insect bites can occur

10-14 days after bite with fever, malaise, rash, lymphadenopathy

9

Local wound care for insect bites

removal of stinger, ice packs, anithistamines, topical steroids, NSAIDs, atbx if needed

10

There people should be given a medical warning tag, epi pen, and referral for venom immunotherapy

anaphylactic reaction to bees or wasps

11

common types of spider bites

brown recluse or black widow

12

Commonly found in the central Midwest south to the Gulf of Mexico. They travel in boxes and packages. They are also found in warm, dry areas such as abandoned buildings, woodpiles, and cellars

brown recluse spider

13

bite is usually painless with a mild erythematous lesion that may either heal spontaneously or become necrotic

brown recluse

14

healing time for brown recluse bites

6 weeks to 4 months

15

systemic symptoms that may occur within 24-48 hours of brown recluse spider bite

fever, chills, N/V, myalgias

16

treatment for brown recluse spider bite

no medication or antivenom;
tetanus prophylaxis
analgesics

17

Most venomous spider bite

female black widow

18

It is most common in the South and West. They tend to live in basements, gardens, woodpiles, and garages.

black widow spider

19

The bite is mildly to moderately painful with erythema, swelling, and muscle cramps beginning within 30 minutes to 12 hours.

black widow spider

20

bite from black widow can mimic

acute abdomen/peritonitis

21

complication of black widow bite

hypertension

22

black widow bite is fatal in

children and elderly

23

treatment for black widow bite

wound care,
tetanus prophylaxis,
analgesics,
antivenom is only indicated for severe bite b/c of risk of anaphylaxis

24

antivenom is only available for this kind of spider bite

black widow

25

venomous snakes includ

pit vipers and coral snakes

26

most snake bites occur between

april and october

27

venomous rattlesnakes and coral snakes have

fangs

28

the presentation of no envenomation from snake is

minimal pain and swelling

29

Minimum envenomation from snake presents with

local swelling less than 6 in with no systemic symptoms

30

Moderate envenomation from snake presents with

local swelling of 6-12 in with systemic s/s

31

Coral snake bites resemble

scratch marks and are painful

32

presenting s/s of coral snake bites

neurologic: tremor, dysarthia, dysphagia, diplopia

33

physical exam for all spider bites

ABCs,
vitas,
examination of bite and extent to envenomation,
tissue damage,
neuro exam

34

diagnostics for snake bite

CBC, CMP, coags, UA, ECG

35

Management for snake bites

Go to ER for antivenom,
immobilize and elevate extremity ,
observe respiratory status

36

management for scorpion bites

supportive care

37

teaching to avoid snake bites

walk with stick tapping ahead;
wear loose, long pants with thick boots,
shine a flashlight

38

atbx is recommended for these kinds of bites

hand and cat bites. Treat with Augementin

39

treatment for human or dog bites

Augmentin or clindamycin can be given prophylactically, must be given within 12 hours of bite

40

common carriers of rabies virus

raccoons, bats, skunks, foxes

41

most common bacteria from human bites

staph aureus

42

a bite history includes

time of bite, rabies vaccination of animal, current immunization status, hx of splenectomy or liver disease

43

assess for this with any bite

compartment syndrome: paresthesias, pain, pallor, paralysis

44

Management for any kind of bite

irrigate with at least 150 mL of normal saline,
debride tissue, clots, foreign bodies

45

Wounds involving the hand or foot should be

elevated for 1-3 days

46

treatment for infected bites

Augmentin 500 mg tid x 5-7 days;
clindamycin + doxycycline;
TMP/SMZ;
ciprofloxacin

47

can assist in the diagnosis of corneal abrasion

fluorescein dye; abrasion appears as a bright green area

48

treatment for corneal abrasion

erythromycin or Polysporin ointment, oral analgesics

49

when to refer for corneal abrasion

if foreign body cannot be easily removed by a cotton tip applicator

50

most common symptom of corneal abrasion

sever eye pain

51

risk factors for epistaxis

nasal trauma, rhinitis, drying of mucosa from low humidity, deviation of septum, alcohol, anticoagulant meds

52

Most nosebleeds occur from the

anterior plexus (Kiesselbach's plexus)

53

initial management of epistaxis

sit straight up, tilt head forward, apply firm pressure to anterior aspect of nose for 15 min

54

medication for epistaxis

phenylephrine 0.125% 1-2 sprays that acts as a vasoconstrictor, silver nitrate

55

When to refer for epistaxis

bleeding does not resolve in 15 min

56

teaching for epistaxis

avoid ASA, vigorous exercise, hot/spicy foods for a week

57

GCS variables

eye opening, motor response, verbal response

58

immediate ER referral for head trauma with

AMS;
paralysis or paresthesia;
Raccoon's sign;
Battle's sign;
blood in external auditory canal

59

in elderly, the first sign of head trauma is

confusion, change in behavior

60

The neuro exam for head injury should include

pupillary response, EOM, Romberg test, gait, finger-to-nose test, memory, and concentration.

61

diagnostic for head injury

cervical x-ray, head CT,
CBC, CMP, UA, ABG, coags

62

immediate treatment for head injury

ABCs,
cervical spine stabilization,
assess GCS

63

high risk patients for heat-related mortalities

those less than 10 and older than 50, those with underlying heart/lung disease or diabetes

64

quick method to determine TBSA

back of the hand is 1% TBSA

65

Only involves the epidermis

first-degree

66

involves the epidermis and portions of the dermis

second-degree (partial thickness)

67

may look like first degree burns initially, but may show blistering 12-24 hours later. May present as dull or glossy with pink, red, or white pigmentation. Heal spontaneously in less than 3 weeks.

superficial partial-thickness burn

68

extend into the lower layers of the dermis and can cause scar formation. They usually heal in 3-9 weeks. However, they can cause hypertropic scarring and impaired joint function. These burns are best treated by excision and grafting.

Deep partial thickness

69

Involve all layers of the dermis and often underlying adipose tissue

third-degree (full-thickness)

70

Area appears matte with eschar

third-degree

71

Treatment for mild burns

irrigate with cool tap water, apply thin layer or antimicrobial (sulfadiazine), cover with nonadherant

72

Management of intact blisters in burns

Do not rupture as they maintain protection

73

treatment for moderate burns

irrigate with NS, chlorhexidine, debrided, cover with antimircobial, cover with nonadherant.

74

these kinds of dressings are preferred because they promote re-epithelialization

moist

75

burns that should be referred

partial-thickness burns greater than 10% TBSA;
Burns on face, hands, feet, genitalia, or major joints;
electrical/chemical burns

76

immediate referral to a plastic surgeon for

hand and face wounds

77

wounds involve the epidermis and dermis and may extend through the subcutaneous tissue into muscle and bone

full thickness wounds

78

diagnostics for lacerations

x-ray to identify bone/tendon involvement;
MRI to r/o osteomyelitis;
CBC

79

assess this with all lacerations

vascular, neurologic, and musculoskeletal function

80

wounds with smooth edges that is not grossly contaminated can be

approximated with steri-strips

81

These kinds of wounds should NOT be closed

crush injuries, bites to hand and feet, cat/human bites, puncture wounds, wounds more than 12 hours old (24 for face)

82

Should be administered if Tdap status is unknown or if patients has not completed 3 injections

Td and tetanus immune globulin

83

Td can be given if Tdap has been given within

5 years

84

these wounds do not need tetanus shot

less than 6 hours old

85

suggested suture size for scalp, trunk, arms, and legs is size

4-5

86

suggested suture removal for scalp

7-14 days

87

suggested suture removal for trunk and upper extremities

7 days

88

wounds that require atbx therapy

wounds more than 8 hours old;
crushing injuries;
wounds in patients with diabetes

89

infected wounds can be treated with

TMP/SMZ DS 160/800 bid or clindamycin 300-450 mg tid

90

acromegaly results from excessive secretion of

growth hormone and insulin-like growth factor (IGF-1)

91

most common cause of acromegaly is

adenoma of the anterior pituitary

92

feedback of GH hormone

GHRH and somatostatin secreted from hypothalamus --> GHRH stimulates GH secretion; somatostatin inhibits GH secretion

93

factors that affect GH secretion

sleep, stress, meals, aging

94

Manifested as excessive bone and soft tissue growth

acromegaly

95

common s/s of acromegaly

facial puffiness, enlarged jaw, swelling of hands and feet, hirsuitism

96

onset of acromegaly is

slow, about 12 years

97

diagnostics of acromegaly

IGF-1 is a direct indicator of GH levels, oral glucose tolerance test, MRI of pituitary gland

98

oral glucose tolerance test in those with acromegaly

oral glucose does not suppress GH secretion as it normally should.

99

complications of acromegaly

diabetes, HTN, sleep apnea, colon cancer

100

This disease has a high risk of colon cancer

acromegaly

101

feedback of adrenal glands

hypothalamus secretes CRH--> pituitary gland secretes ACTH --> adrenal glands secrete cortisol, aldosterone, and androgens

102

most common manifestation of adrenal crisis is

hypotension

103

primary adrenal insufficiency most commonly presents with

shock, abd tenderness, fever

104

in primary adrenal insufficiency this is NOT common

hypoglycemia

105

when adrenal glands produce too little cortisol (adrenal cortical hypofunction)

Addison's disease

106

s/s of addison's disease

chronic malaise, weight loss, abd pain, muscle cramps, hyperpigmentation, salt craving

107

Addison's disease is characterized as

low glucocorticoids, mineralcorticoids, and androgens

108

Complication of Addison's disease

adrenal crisis d/t low mineralcorticoids

109

Diagnostics of Addison's disease

low levels of cortisol; high ACTH

110

when adrenal glands produce too much cortisol (adrenal cortical hyperfunction)

Cushing's disease

111

common cause of Cushing's

long-term use of steroids suppress ACTH suppression from anterior pituitary

112

when steroids can caused HPA suppression and Cushing's

more than 15 mg/day for more than 3 weeks

113

s/s of cushing's

weight gain, loss of menses, HTN, glucose intolerance, insomnia, "moon face", "buffalo hump", muscle wasting, hirsuitism, striae

114

diagnostic for Cushing's

elevated cortisol in 24-hour urine collection

115

treatment for Cushing's

daily ketoconazole; it competes with steroids

116

A catecholamine-secreting tumor of chromaffin cells, mostly found in the adrenal medulla.

pheochromocytoma

117

pheochromocytoma causes an abnormal production of

epinephrine and norepinephrine

118

symptoms of pheochromocytoma are

headache, sweating, tachycardia, HTN

119

episodes of pheochromocytoma

episodic, last 15-30 minutes, precipitated by position change, Valsalvia, exercise, anxiety

120

risk factor for pheochromocytoma

family hx

121

diagnosis of pheochromocytoma

high levels of metanephrines and catecholamines in 24-hour urine collection

122

most tumors in pheochromocytoma are found in

abdomen or pelvis

123

most common symptom of primary hyperparathyroidism is

hypercalcemia

124

the kidney's role in calcium and phosphorus balance

PTH hormone causes kidneys to reabsorb calcium and excrete phosphorous

125

primary hyperparathyroidism is the inappropriate secretion of PTH in the setting of

hypercalcemia

126

primary hyperparathyroidism is mostly caused by

parathyroid adenoma

127

Excess PTH effect on the bone

increases release of calcium and phosphorus from the bone, causing weak bones

128

Excess PTH effect on the kidney

increase calcium resorption and phosphorus excretion; eventually causing nephrolithiasis

129

s/s of primary hyperparathyroidism

weakness, fatigue, anxiety, HTN, CAD, short QT interval, kidney stones, hyporeflexia

130

band keratopathy, a white cloudiness at the nasal and temporal borders of the cornea is seen in

primary hyperparathyroidism

131

diagnostics for primary hyperparathyroidism

PTH, serum calcium, albumin, and vitamin D, fasting phosphorus;
Bone mineral density of distal radius;
renal US;
24-hour urine collection for calcium and creatinine

132

complications of primary hyperparathyroidism

osteoporosis, nephrolithiasis, CVD

133

criteria for parathyroidectomy

age less than 50;
serum calcium greater than normal;
GFR less than 60;
Tscore less than -2.5

134

management of primary hyperparathyroidism

monitor calcium and creatinine annually; bone density every 1-2 years; keep vitamin D > 20 ng/mL;
weight bearing activities;
adequate fluid intake

135

hypercalcemia is serum calcium greater than

5.3 mg/dL

136

PTH dependent hypercalcemia is d/t

primary hyperparathyroidism, the parathyroid is nonsuppressed.

137

hypocalcemia is serum calcium less than

4.4 mg/dL

138

hypocalcemia can result from

increased calcium loss in circulation, decreased entry of calcium, or inadequate PTH produciton

139

s/s of hypocalcemia

muscle weakness, seizures, AMS, hyperreflexia, coarse/dry hair and nails

140

carpal spasm occurring after occlusion of the brachial artery with a BP cuff for 3 minutes

Trousseau's sign with hypocalcemia

141

contraction of the facial muscle in response to tapping of the facial nerve against the bone anterior to the ear

Chvostek's sign in hypocalcemia

142

Diagnostics in hypocalcemia

high phosphate, low calcium, low vitamin D

143

treatment for hypocalcemia

vitamin D

144

hypernatremia is sodium greater than

145 mEq/L

145

secretion of ADH

water loss, high osmolality --> stimulate thirst receptors, ADH secreted from posterior pituitary --> stimulates renal absorption of sodium and water

146

s/s of hypernatremia

neuro signs are intially seen: agitation, irritability, confusion;
muscle tremor, hyperreflexia, dehydration

147

treatment for hypernatremia

hypotonic saline (0.45% NaCl or D5W)

148

those at high risk for hypernatremia

elderly, those on diuretics/laxatives

149

hyponatremia is serum sodium less than

135 mEq/L

150

response of ADH to hyponatremia

usually ADH is suppressed to allow diuresis

151

chronic hyponatremia causes

fluid to seep into the cells leading to swelling.

152

meds that can caused hyponatremia

ACEI, thiazide diuretics, NSAIDs, SSRIs

153

excess production of ADH leading to hyponatremia and increased urine osmolality

SIADH

154

s/s of hyponatremia

headache, blurred vision, lethargy, weakness

155

Refer to ER is serum sodium is less than

125 mEq/L

156

If asymptomatic with serum sodium greater than 125 mEq/L, management consists of

fluid restriction (1000-1500 mL/day), dietary sodium restriction, and loop diuretics.

157

hyponatremia is common in

elderly, endurance runners

158

feedback of thyroid hormones

hypothalamus secretes TRH --> anterior pituitary secretes TSH ---> thyroid secretes T3 and T4.

159

The synthesis of T3 and T4 requires

iodine intake

160

Most T3 and T4 is

bound to proteins; but free T4 is always maintained at a constant level.

161

Hyperthyroidism is characterized by TSH less than

0.3

162

Graves disease is most common in

women 20-40

163

When thyroid stimulating antibodies or immunoglobulins compete with TSH for TSH receptors on the thyroid and increase the production of thyroid hormones.

Grave's disease

164

Subacute thyroiditis is caused by

postviral illness

165

majority of causes of subclinical hyperthyroidism is caused by

nodules or multinodular goiters

166

Diagnostics for hyperthyroidism

thyroid peroxidase (TPO), thyroid US, radioactive iodine reuptake scan

167

Normal or high radioactive uptake during the scan indicates

Grave's disease or toxic multinodular goiter

168

Decreased or zero radioactive uptake during the scan indicates

thyroiditis

169

symptomatic treatment of hyperthyroidism is treated with

beta blockers

170

major side effect of antithyroid drugs

agranulocytosis, liver failure

171

instructions about radioactive iodine

no kissing or sharing food for 5 days;
wash dishes in dishwasher;
no close contacts with kids less than 8 for five days;
flush toilets twice

172

complications of hyperthyroidism

afib, angina, osteoporosis

173

s/s of thyroid storm

fever, profuse sweating, tachycardia, confusion

174

causes of goiter

Grave's, iodine deficiency/excess, thyroiditis

175

Nontoxic goiter is mostly caused by

autoimmune thyroiditis

176

meant when thyroid nodules are "hot"

concentrate iodine

177

meant when thyroid nodules are "cold"

don't concentrate iodine

178

in goiter, lab studies may show

high or normal TSH

179

when the thyroid gland enlarges in response to increased TRH and TSH production

nontoxic goiter

180

treatment is only necessary when goiter

is symptomatic

181

treatment for goiter

levothyroxine (T4) can suppress TSH, although controversial

182

hypothyroidism is characterized as TSH of

greater than 4

183

most common cause of hypothyroidism

chronic autoimmune thyroiditis where autoantibodies destroy thyroid tissue

184

drugs that can cause hypothyroidism

amiodarone, lithium, IV contrast

185

tender thyroid gland is suggestive of _____; whereas a nontender thyroid gland is suggestive of _______

subacute thyroiditis; chronic autoimmune thyroiditis

186

treatment for hypothyroidism

synthetic T4 (levothyroxine)

187

average T4 replacement for hypothyroidism

1.6 mcg/kg/body weight per day (about 50 mcg/day)

188

those who should be started on a lower dose of levothyroxine

heart disease or afib

189

dosing instructions for levothyroxine

taken on an empty stomach

190

steady state of TSH when taking levothyroxine is not seen for

at least 6 weeks

191

Dessicated thyroid (Armour) is

combination of T3 and T4

192

dessicated thyroid (Armour) has a black box warning not recommending it for

weight reduction

193

subclinical hypothyroidism is

elevated TSH with normal T4.

194

treated for subclinical hypothyroidism is indicated when

TSH greater than 10

195

complication of congenital hypothyroidism (Cretinism)

mental retardation

196

risk factors for thyroid cancer

hx of head or neck radiation, family hx, age younger than 20 or older than 60, male

197

____ has been associated with an increased risk of malignant transformation of a thyroid nodule

elevated TSH

198

characteristics of a malignant thyroid nodule on ultrasound

increased vascular flow to nodule, hypoechoic, irregular margins

199

gynecomastia is caused by an increase in the ratio of

estrogen to androgen

200

gynecomastia is diagnosed as a palpable mass of tissue at least _____ in diameter

0.5 cm

201

Gynecomastia differs from female breast development in that there is no

progesterone

202

drugs that can cause gynecomastia

spironolactone, cimetidine, ketoconazole, 5-alpha-reductase inhibitors

203

characteristics of gynecomastia

bilateral, centrally located to nipple area, symmetrical, tender

204

breast development

thelarche

205

Tanner stages

thelarche, pubarche, menarche

206

first sign of puberty in males

testicular enlargement at 11 years average

207

Precocious puberty is defined as the onset of secondary sexual development before the age of ___ in girls and ___ in boys.

8; 9

208

Gonadotropin-dependent precocious puberty (central precocious puberty) is

caused by early maturation of the HPA axis

209

Gonadotropin-independent precocious puberty is

caused by excess secretion of sex hormones by tumor

210

In Gonadotropin-dependent precocious puberty, the LH levels are

elevated

211

In Gonadotropin-independent precocious puberty, the LH levels are

normal or low

212

If secondary sexual findings is noted, then next step is

radiographic assessment of bone age; abnormal if bone age is more than 20% older than age

213

Delayed puberty is the absence of sex characteristics by the upper 95th percentile age for boys which is ___ and girls which is ____

14; 12

214

delayed puberty is usually caused by

defective gonadotropin secretion from anterior pituitary

215

feedback of GnRH secretion

hypothalamus secretes GnRH --> anterior pituitary secretes LH and FSH --> stimulate testosterone, estrogen, and progesterone release

216

primary hypogonadism shows FSH and LH levels that are

high

217

secondary hypogonadism shows FSH and LH levels that are

low or normal

218

causes of secondary hypogonadism

constitutional delay, congenital GnRH deficiency, hypothyroidism, hyperprolactinemia.

219

the physical exam for delayed pubtery

height, weight, arm span, secondary sex characteristic staging

220

Patients with constitutional delay of puberty typically have bone ages of

12 to 13.5 years but rarely progress beyond this age.

221

therapy for delayed puberty should be restricted to

boys older than 14 and girls older than 12

222

those with hirsuitism needs this to be ruled out

ovarian or adrenal tumors

223

An indicator of severe hirsuitism (hyperandrogenism)

virilization: deepening voice, balding, increased muscle mass, clitoromegaly

224

diagnostics for hirsuitism

serum total testosterone

225

oral contraceptive role in hirsuitism

inhibit LH secretion, this reducing testosterone

226

Vitamin D of less than 20 ng/mL can be a cause of

secondary hyperparathyroidism

227

vitamin D insufficiency is levels less than ___; vitamin D deficiency is levels less than ____

30 ng/mL; 20 ng/mL

228

dosages of vitamin D

50,000 IU of vitamin D3 three times a week for 4 weeks

229

Obstructive symptoms of BPH

urinary hesitancy, dribbling, decreased force of stream

230

irritative symptoms of BPH

frequency, urgency, nocturia

231

drugs that can cause symptoms of BPH

anticholinergics and sympathomimetics

232

physical exam with BPH

enlarged, nontender, smooth prostate

233

diagnostics for BPH

bladder ultrasound to determine post-void residual

234

BPH is not a risk factors for

prostate cancer

235

Progression of BPH and risk of prostate cancer can be decreased by

finasteride

236

Work by lowering bladder neck and ureteral resistance in BPH

alpha adrenergic antagonist therapy

237

direct alpha adrenergic antagonist

tamsulosin;
only act on smooth muscle of the prostate

238

indirect alpha adrenergic antagonist

doxazosin;
act on all smooth muscle causing vasodilation

239

shrink prostate gland by decreasing DHT levels

5alpha-reductase inhibitors: finasteride

240

these two meds showed a higher risk reduction in BPH symptoms than when used alone

doxazosin and finasteride

241

causes of acute and chronic prostatitis

gram negative: E. coli, Proteus, Klebsiella

242

s/s of acute prostatitis

fever, chills, malaise, arthralgias, urinary sympoms

243

s/s of chronic prostatitis

may be asymptomatic; may have recurrent UTI or urogenital symptoms

244

physical exam with acute prostatitis

prostate is enlarged and tender. Avoid massaging to minimize risk of bacteremia.

245

physical exam with chronic prostatitis

may have normal prostate; may feel tender.

246

this should not be checked as it may appear elevated with prostatitis

PSA level

247

diagnostic for prostatitis

acute: UA will show pyuria; Urine culture

chronic: prostatic specimen through urologist

248

treatment for acute prostatitis

TMP/SMZ or fluoroquinolone for 2-6 weeks

249

treatment for chronic prostatitis

TMP/SMZ or fluoroquinolone for at least 6 weeks

250

teaching for prostatitis

sitz baths; avoid coffee, tea, alcohol; stool softeners; use condoms during therapy

251

risk factors for prostate cx

men older than 65, Black, family history

252

most common type of prostate cancer

adenocarcinoma

253

difference between symptoms of BPH and prostate cancer

symptoms increase in intensity in 1-2 month intervals with prostate cancer whereas in BPH it is slow progression

254

physical exam with prostate cancer

firm, indurated, asymmetric nodule on prostate

255

screening for prostate cancer

recommended in all men starting at 50; 45 for black men; 40 for men with family hx

256

PSA levels with prostate cancer

If less than 2.5 normal;
greater than 4 is abnormal- refer for biopsy;
greater than 10 indicative of cancer

257

risk factors for renal cell carcinoma

tobacco use;
black;
leather tanning and shoe-making;
exposure to asbestos, gas, petroleum;
family hx

258

risk factors for bladder cancer

white male;
smoking;
ingestion of red meat

259

symptoms of renal tumor

flank pain, hematuria, renal mass; however most are not diagnosed until it has metastasized

260

occurs in those ages 3-4 and is usually unilateral

Wilms tumor

261

s/s of bladder cancer

painless hematuria that continues throughout urination

262

trx for bladder cancer

transurethral resection of bladder tumor

263

diagnostic for bladder/renal cancer

UA, urine cytology, CBC, diagnostic ultrasound, cystoscopy, spiral CT

264

loss of urine associated with activities that increased intra-abdominal pressure such as coughing, sneezing.

stress incontinence

265

involuntary loss of urine usually preceded by a strong, unexpected urge to void.

urge incontinence

266

an involuntary loss of urine associated with incomplete emptying

overflow incontinence

267

DIAPPERS for incontinence

Delirium;
Infection;
Atropic vaginitis;
Pharmaceuticals;
Psychological;
Excess urinary output;
Restricted mobility;
Stool impaction

268

Diagnostics for urinary incontinence

UA, C&S, BUN/creatinine, postvoid residual, cystoscopy

269

a PVR greater than ____ is considered abnormal

100 mL

270

treatment for incontinence

time void every 2 hours, smoking cessation, pelvic muscle exercises, pessary placement;

271

meds for stress incontinence

alpha adrenergic agonist (Sudafed), estrogen, tricyclic antidepressant

272

meds for urge incontinencne

anitcholinergic/antimuscarinic agents: Detrol & Oxybutynin

273

Meds for overflow incontinence

alpha adrenergic blockers (doxazosin or tamsulosin); alpha5 reductase inhibitors (finasteride)

274

BPH can cause this type of incontinence

overflow

275

risk factors for stone formation

family history;
insulin-resistance;
HTN;
gout;
primary hyperparathyroidism (high calcium);
obesity;
dehydration

276

Foods that can cause uric acid stones

seafood, meats

277

foods that can cause oxalate stones

cola, chocolate

278

Meds that can cause stone formation

HCTZ, antacids

279

Most common type of urinary calculi in women

calcium oxalate stone

280

Most common type of urinary calculi in men

uric acid stones

281

s/s of nephrolithiasis

N/V, hematuria, dysuria, renal colic

282

s/s of urolithiasis

dysuria, frequency, urgency, hematuria

283

diagnostics for urolithiasis

UA, urine C&S, serum calcium, intact PTH

284

urine pH less than 6.5 indicates what type of stone

calcium oxalate

285

with urolithiasis, urine pH greater than 6.5 indicates

infection and f/u culture is necessary

286

diagnostic for nephrolithiasis

renal ultrasound, KUB, noncontrast CT

287

differential diagnosis for urolithiasis

gastroenteritis, appendicitis, abd aneurysm, ectopic pregnancy, peptic ulder

288

Urinary stones less than ___ pass spontaneously, whereas urinary stones greater than ____ need surgical intervention

4 mm; 6-8 mm

289

treatment for calcium oxalate stones

thiazide diuretic;
low calcium, protein, and sodium diet

290

treatment for uric acid stones

allopurinol;
decrease purine intake;
increasing fluids

291

In post-streptococcal glomerular nephritis, it is usually preceded by a hx of

GABHS skin or throat infection 1-3 weeks prior

292

post-streptococcal glomerular nephritis is most common in

children 5-12 years old; those older than 60

293

symptoms of post-streptococcal glomerular nephritis

edema, gross hematuria & proteinuria, HTN

294

diagnostic for post-streptococcal glomerular nephritis

UA;
streptozyme test that measure 5 different streptococcal antibodies

295

treatment for post-streptococcal glomerular nephritis

control HTN;
sodium and water restriction;
Loop diuretics

296

Proteinuria is defined as urinary protein excretion of more than

150 mg/day

297

Drugs that can cause proteinuria

lithium, cyclosporine, NSAIDs

298

Diagnostic for proteinuria

1+ protein on urine dipstick x 2;
CBC, CMP, lipid panel;
24-hour protein and creatinine urine collection

299

those with proteinuria should be tested for

Bence Jones proteins to r/o multiple myeloma

300

Those with proteinuria need to be started on

ACEI or ARB, low sodium diet

301

these people have high rates of hematuria

long distance runners

302

Oliguria is defined as urine output of less than

400 mL in 24 hours

303

Anuria is defined as urine output of less than

200 mL in 24 hours

304

Prerenal ARF is caused by

dehydration and hypotension

305

Intrarenal ARF is caused by

nephrotoxins (IV contrast, aminoglycosides

306

postrenal ARF is caused by

BPH, bladder dysfunction or strictures, nephrolithiasis

307

All patients with acute renal failure should be

hospitalized

308

ESRD is a GFR of less than

15%

309

Most common indicator of CKD is

proteinuria

310

Best measure of kidney function

GFR

311

Stage II kidney disease is GFR

60-89 mL/min

312

Stage III kidney disease is GFR

30-59 mL/min

313

Diet education for those with CKD

protein and phosphorus restriction; avoid salt substitutes as they contain high amount of potassium;
glycemic control;
increase calcium

314

Vitamin D deficiency with CKD

give 50,000 IU of vitamin D2 monthly for 6 months

315

testicular torsion is most commonly seen in

the left testicle

316

s/s of testicular torsion

extremely painful, N/V, abdominal pain

317

physical exam with testicular torsion

swollen and red scrotum, tender spermatic cord, absent cremasteric reflex

318

Diagnostic for testicular torsion

Doppler US shows diminished blood flow

319

Treatment for testicular torsion

must be sent to ER and treated within 6 hours

320

testicular cancer is common in men ages

20-39 years old

321

risk factors for testicular cancer

Caucasian;
cryptorchidism;
family hx;
scrotal trauma

322

S/S of testicular cancer

testicular mass; swelling; sensation of fullness

323

common causes of epididymitis in young men

Chalmydia and gonorrhea

324

common causes of epididymitis in men older than 35

gram negative organisms;
TURP

325

S/S of epididymitis

fever, chills, penile discharge, lower abd pain

326

Physical exam with epididymitis

scrotum is red, enlarged, and tender.

327

When pain is relieved with scrotal elevation (Prehn's sign)

epididymitis

328

Doppler US with epididymitis shows

normal blood flow

329

medication for orhcitis and epididymitis

ceftriaxone, doxycycline, or levofloxacin

330

education for epididymitis

scrotal elevation

331

complication of epididymitis and orchitis

infertility

332

Systemic, blood-borne infection that results in an acute inflammation of one or both testicles.

orchitis

333

orchitis has similar signs and symptoms as

epididymitis

334

causes of orchitis

may coexist with prostatitis or epididymitis; STDs

335

The major classes of drugs that can affect erectile function are

antihypertensives, antidepressants, alcohol

336

medications used to facilitate erection

PDE5 inhibitors:
sildenafil (Viagra),
vardenafil (Levitra),
tadalafil (Cialis)

337

PDE5 inhibitors are contraindicated in those taking

nitrates

338

Education for sildenafil (Viagra) and vardenafil (Levitra)

have a short duration of action; take on empty stomach; avoid taking with high fat meal

339

Education for tadalafil (Cialis)

longer half-life for 24-36 hours. No dietary restrictions

340

Patients taking SSRIs who have side effects of sexual dysfunction

take with buproprion

341

most common organisms in UTI

gram negative : E. coli, Klebsiella, Enterobacter

342

Any UTI in a male less than 50 years old is

considered complicated`

343

common causes of urethritis

chlamydia and gonorrhea

344

s/s of urethritis in males

dysuria, burning on urination

345

Discharge with gonococcal urethritis is most often ___, whereas that with NGU tends to be ____.

purulent; clear or mucoid

346

complicated UTIs occur in those

with urologic abnormalities, underlying disease (DM, renal failure), pregnancy, catheter, advanced age

347

Four variables predict the presence of UTI

cloudy urine, malodorous urine, dysuria, nocturia

348

UA in UTIs show

pyuria, high nitrates, hematuria

349

avoid this medication pyelonephritis is suspected

nitrofurantoin

350

Medication for UTI

nitrofurantoin x 5 days, TMP/SMZ DS x 3 days, fluoroquinolones x 3 days

351

Recommended treatment duration for those with UTI who have DM.

10-14 days

352

medication for UTI in children

third generation cephalosporins (cefexime, cefdinir); aminoglycosides

353

Not recommended for trx of UTI in children d/t high resistance

amoxicillin and ampicillin

354

s/s of pyelonephritis

UTI symptoms with fever, chills, flank pain, CVA tenderness, N/V

355

Diagnostic for pyelonephritis

UA and Urine culture

356

treatment for pyelonephritis

fluoroquinolones or TMP/SMZ for 7 days

357

asymptomatic bacteruria refers to a colony count of at least ___ in the absence of symptoms

100,000/mL

358

diagnosis of asymptomatic bacteruria in women

two clean catch urine specimens with more than 100,000 of bacteria

359

risk factors for asymptomatic bacteruria

advanced age;
nursing home;
incontinence;
women with diabetes;
pregnancy

360

screening and treatment is indicated in these people with asymptomatic bacteruria

pregnant women and those undergoing urologic surgery

361

avoid these eye drops with corneal abrasions

steroids

362

where to avoid giving lidocaine and epi

fingers, toes, penis, nose

363

treatment for most typical spider bites

supportive

364

important to differentiate spider bites from

MRSA

365

home remedy for bee/wasp stings

meat tenderizer paste

366

s/s of UTI in elderly

confusion, AMS

367

foods to avoid with incontinence

alcohol, caffeine, carbonated, spicy foods

368

avoid these drugs with renal failure

NSAIDs, amnioglycosides, IV contrast

369

blood under the finger or toe

subungual hematoma

370

suggested suture removal for lower extremities

8-10 days

371

suggested suture removal for face

5 days