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my NPLEX II > wild brilliance cases > Flashcards

wild brilliance cases Flashcards

1
Q

chronic cholecystitis can be due to

A

food allergy

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2
Q

biliary dyskinesia can be due to

A

lack of exercise - causing sludge and stone

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3
Q

what does WBC in post-prostate exam urine suggest

A

inflammation of the prostate

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4
Q

what herb is very specific for pelvic pain, esp accompanied by anxiety

A

piper methysticum (kava)

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5
Q

foeniculum vulgare

A

fennel

carminative: relieves flatulence

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6
Q

trifolium pratense

A

red clover

phytoestrogen and anticancer

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7
Q

often, the root cause of chronic pelvic pain syndrome is _____ which is best treated by ___

A
  • increased intestinal permeability : food intolerance triggering inflammation and causing urothelial permeability
  • removing the triggers and healing leaky gut
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8
Q

levofloxacin

A

antibiotic - floroquinolone

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9
Q

chron’s disease medications

A

budesonide and mesalamine oral medications

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10
Q

what is associated with ileal chrons disease more than chrons of the colon

A

cigarette smoking

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11
Q

centella asiatica

A

GOTU KOLA

immunomodulator and antifibrotic

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12
Q

artemisia annua

A

wormwood

antimalarial and antiparasitic

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13
Q

lobelia inflata

A

indian tobacco
strong spasmolytic
alkaloids:
wet cough

do not use with dry cough , hypertension, pregnancy or lactation

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14
Q

what has been showed to decrease vitamin D activation

A

obesity

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15
Q

herbs that help with glucose control

A

-cinnamon
-panax quinquefolius
(american ginseng)
-gymnema
-vanadium : elemental: diabetes

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16
Q

insulin sensitizing

A

berberine

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17
Q

high CRP and high ferritin

A

increased systemic inflammation

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18
Q

bells palsy/facial nerve palsy

A

dropping in the corner of the mouth, facial asymmetry, eyebrow droop, loss of forehead and nasolabial folds, tearing, inability to close the eye and hold lips together, difficulty eating and talking, facial muscle atrophy

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19
Q

worry of new onset intermittent tinnitus

A

acoustic neuroma,

early and small could be missed on MRI

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20
Q

where do acoustic neuromas most commonly occur

A

internal auditory canal of temporal bone

-can compress facial nerve

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21
Q

what do trigenimal nerve palsies typically cause

A

loss of sensation

signs of otitis media - hearing loss, fullness in ear

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22
Q

hypoglossal nerve palsy

A

rare and cause tongue to deviate to side of lesion
tongue atrophy
severely impaired speech

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23
Q

ramsay hunt syndrome

A

conplication of shingles
affects facial nerve
painful red rash with fluid filled blisters in and around one ear

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24
Q

hypericum perforatum

A

st johns wort

  • antiviral
  • herpes simplex virus
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25
Q

treatment for patients with idiopathic bells palsy

A

corticosteroids

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26
Q

both sides of brain control what part of face

A

upper

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27
Q

right side of brain controls what side of face

A

left lower side

left side of brain controls right lower side

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28
Q

lower motor lesion of facial nerve impairs

A

upper facial function

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29
Q

what type of paralysis is classic for upper motor lesion

A

spastic paralysis

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30
Q

what is the criteria used to diagnose IBS

A

ROME III

abdominal pain at least 3d/mon in the past 3 months associated with change in stool form and frequency with onset more than 6 months prior to diagnsosi
frewuent bloatinf and loose stools

food intolerance usually associated

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31
Q

what is testing for Chrons disease

A

colonoscopy

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32
Q

what is helpful for infectious diarrhea

A

geranium : astringent

lactoferrin: iron binding protein

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33
Q

IBS-D

A

foeniculum (fennel) : carminative/spasmolytic

topical heat to calm gut

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34
Q

centella asiatica (pennywort)

A

relaxing/anxiolytic adaptogen

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35
Q

lomatium dissectum

A

immune stimulating antimicrobial

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36
Q

taraxacum

A

dandelion

bitter hepatic herb

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37
Q

what diseases are associated with type I diabetes

A

dermatitis herpetiformis: autoimmune skin condition

which is associated with CELIAC disease

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38
Q

what is the LONG acting form of insulin

A

insulin GLARGINE (LANTUS)

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39
Q

rapid acting insulin in 10-20 mins

A

insulin ASPART AND LISPRO

use before a meal : lasts 3 hours

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40
Q

regular insulin

A

short acting effect after about 30-60 mins, and lasts about 5 hours

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41
Q

SULPHUR remedy

A

skin rashes : worse after bathing
worse after warmth of bed , esp at night
worse from scratching, itching and burning of the eruptions

people are confident in communication, direct answering and good eye contact

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42
Q

what other diseases is dermatatitis herpetaformis associated with

A

SLE
sarcoidosis
type I diabetes

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43
Q

what to avoid with dermatitis herpetaformis

A

wheat and gluten

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44
Q

omeprazole

A

PPI

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45
Q

what do you see in stool with E. COLI o157:h7 infection

A

bloody stool

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46
Q

recent travel to mexico

A

salmonellis : sudden onset with self-limited duration

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47
Q

proteinuria on urinalysis with infection

A

infecgtion involved kidneys and requires antibiotic

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48
Q

rose-colored papules on chest

A

biopsy and culture to isolate

s. typhi vs
s. paratyphi

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49
Q

what to avoid in infectious gastroenteritis

A

anti-diarrheal because it will back up the toxins and could be lethal (toxic megacolon)

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50
Q

LOPERAMIDE

A

anti diarrheal

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51
Q

AMPICILLIN

A

used often when cause is not known

active against a wide range of bacterial groups, including Staphylococcus aureus, Enterobacteriaceae, and anaerobic bacteria.

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52
Q

CEFTRIAXONE

A

broad spectrum

gonorrhea , PID, meningitis

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53
Q

allium sativum

A

antimicrobial

can assist in speeding recovery

54
Q

rumex

A

laxative and can worsen diarrhea

55
Q

Pancytopenia

A

low counts for all three types of blood cells: red blood cells, white blood cells, and platelets

usually due to bone marrow problem

bone marrow biopsy next step

56
Q

myelodysplastic syndrome

A

dysfunctional blood cell production in the bone marrow, leading to low levels of red blood cells, white blood cells, and platelets

57
Q

anticancer

A

fasting would be most likely to offer the greatest benefit for immune modulation and protection against the progression of his disease.

58
Q

what is a potential adverse side effect of having the patient suddenly stop taking high-dose oral prednisone

A

adrenal failure

high-dose prednisone causes feedback response from the adrenal glands to reduce endogenous production of cortisol. sudden withdrawal of prednisone can leave the pt with low cortisol level

59
Q

ulcerative colitis/proctitis diagnostic

A

sigmoidoscopy/colonoscopy with biopsy

60
Q

ulcerative colitis/ proctitis

A

inflammatory condition -prednisone would suppress inflammatory process

61
Q

mitral valve stenosis

A

reduced cardiac output with left ventricular hypertrophy

blood backs up into lungs and causes pulmonary hypertension

62
Q

rheumatic fever

A

strep antibodies
hx of arthritis

heart valve disorder

63
Q

patient with an atrial septal defect

A

congenital disorder involving left to right shunt with volume overload on the right side of the heart

usually asymptomatic untiol age 20 when signs of pulmonary hypertension can develop

cardiac exam findings: split S2 and systolic murmur

64
Q

cardiac temponade

A

emergent condition involving effusion into the pericardium= diminished ability of heart to fully expand and contract

sxs: low blood pressure, jugular venous distension, diminished heart sounds

65
Q

Ricinus communis oil-

what is it?

A

castor oil

purgative laxative when taken internally, and historically has been used in cases of gastroenteritis to expel undigested food that is causing inflammation or discomfort. Now it is usually used topically in the form of castor oil packs over the liver, pelvis, or intestines to reduce inflammation and pain. Ricinus oil topically could be helpful for this patient if administered in this way.

66
Q

diverticulitis treatment

A

ciprofloxacin in combination with metronidazole is commonly used to treat the infection that is causing inflammation and pain in diverticulitis.

67
Q

sucralfate

A

ulcer medication

68
Q

zolpidem

A

(ambien)
o Nonbenzo hypnotic
o Undergoes hepatic oxidation by CYP450 thus rifampin shortens the half-life
o SE: nightmares, agitation, anterograde amnesia, HA, GI upset, dizziness, daytime drowsiness

69
Q

Valsartan

A

angiotensin receptor blocker

angiotensin II receptor blocker (ARB). It works by blocking a substance in the body that causes blood vessels to tighten.

combined with HCTZ

ARB Tx HF, DM neph AE: hyperK, photosens, cough| Ksparing duiret, ACEI, Preg D

70
Q

diverticulitis diet

A

rich in soluble fiber, and free of nuts and seeds, is best for prevention of diverticulitis in people with known diverticulosis. Immediately after diverticulitis, a low fiber diet is best for one month until inflammation is totally resolved.

71
Q

bells palsy

A

sudden onset, unilateral facial drooping, and no other systems affected

72
Q

ACONITUM

A

Anxious restlessness with a subjective sensation of burning of the face indicates Aconitum. Aconitum can treat sudden-onset neurological conditions, such as numbness, after exposure to cold wind.

73
Q

IBS HERB

A

Mentha x piperita

Peppermint leaf tea or capsules can be very helpful as a gentle carminative botanical for people with IBS.

74
Q

Hypothyroidism

A

fatigue, digestive irregularity, and weight gain, it is essential to rule this out as a possible cause.

75
Q

A spinal cord injury is said to be complete if:

A

‘complete’ if it includes loss of motor and sensory function at the level of S4-S5. Many clinicians consider a spinal cord injury to be complete if there is total loss of function below the level of injury, but the official definition is that of loss of function at the lowest possible level of the spinal cord.

76
Q

A neurologic examination to define the level of the neurologic injury must include:

A

Neurological testing must include motor and sensory testing, bilaterally, in upper and lower extremities. Voluntary control of rectal muscles measures function of S2-S4.

77
Q

Tanacetum parthenium

A

FEVERFEW
MIGRAINES

Some have reported oral ulcers or contact dermatitis with its use. This has mostly been in people who have chewed the fresh leaves.

78
Q

Giant cell arteritis (temporal arteritis)

A

type of vasculitis that affects the large vessels that supply the face and eyes.

associated with polymyalgia rheumatica, which causes the aching pain in his shoulders and hips

79
Q

Early recognition and treatment of temporal arteritis is critical to prevent which complication?

A

monocular or binocular blindness due to ischemia

80
Q

BELLADONNA headache

A

rush of blood to his head, making him feel hot and flushed, and the pain is throbbing in character. It is worse from jarring motion, from stooping, and worse at midnight and 3 pm.

81
Q

definitive diagnosis of tempral arteritis or giant cell arteritis

A

biopsy of the temporal artery, showing inflammation associated with vasculitis.

82
Q

medication most increase risk of colorectal cancer

A

Cyclosporine

is an immunosuppressant agent and can diminish the body’s ability to fight infections, and can increase the risk of cancer due to immune dysregulation.

83
Q

Studies supported by the National Cancer Institute and the National Institutes of Health demonstrated that calcium intake of 1200 mg or more can decrease risk of

A

developing colon polyps, but calcium supplementation has NOT been shown to cause decreased risk of colon cancer in human studies

84
Q

biggest risk factor for colorectal cancer?

A

Cigarette smoking increases a person’s risk of colorectal cancer by about 20%. A low-fiber diet that is high in saturated fat or processed food is also a risk factor

85
Q

small mass on the posterior wall of the rectum at the very limit of your fingers reach. It is non-tender and somewhat mobile

A

adenomatous polyp is most likely, and common. An internal hemorrhoid is likely as well, but an external hemorrhoid would have been painful on examination. A rectocele can be present in women; it is from a weakened area in the vaginal tissue, allowing the anterior aspect of the rectum to bulge into the vaginal wall.

86
Q

screening recommendations for CRC

A

fecal occult blood test (FOBT) should be performed annually or a colonoscopy should be performed every 10 years. Colonoscopy can screen for both adenomatous polyps and cancer; FOBT can only screen for likelihood of cancer. Positive FOBT screening must be followed with a colonoscopy.

87
Q

Causticum

A

often be very sympathetic and care deeply about justice, similar to some cases of Phosphorus, Carcinosin, or Staphysagria. Causticum symptoms are aggravated by cold wind, especially in neurological complaints.

88
Q

carbamazepine

A

anticonvulsant. It works by decreasing nerve impulses that cause seizures and nerve pain, such as trigeminal neuralgia and diabetic neuropathy.

**must not be used in patients with a history of bone marrow disease. It is unsafe during pregnancy, and must not be taken within 2 weeks of taking MAOIs. This drug typically causes much more fatigue and sleepiness than insomnia or restlessness.

89
Q

Wolff-Parkinson-White SYndrome

A

arrythmia causing tachycardia
slurred upstroke of QRS (delta wave) is characteristic sign of condition

low blood pressure and pallor

*seen in infancy, childhood , or young adolescence

*

90
Q

digitalis purpura

A

cardiac glycoside

positive inotrope: increasing pumping strength of heart
negative chronotrope: decreasing heart rate

can promote AFIB and anterograde signal conduction

dont use in WPW! wolf parkinson white

91
Q

vagus nerve stimulation to reduce tachycardia

A

massage carotid sinus to slow heart rate

92
Q

Amiodarone (class III antiarrhythmic k+ blocker)

A

unstable tachycardia in emergent situation

90% effective for treating narrow complex arrhythmias

93
Q

digoxin contraindicated in

A

wolff-parkinson-white

favors antegrade signal conduction and can INCREASE RISK OF V-FIB

94
Q

diet that increases risk of appendicitis

A

low fiber

high fiber and veg are protective

95
Q

acute appendicitis

A

positive psoas sign= retrocecal orientation

96
Q

Asthma is often associated with elevations in

A

eosinophil count. There is also usually decreased FEV1, increased residual lung volume, and hyperinflated lungs on chest x-ray.

97
Q

FUROSEMIDE is a

A

loop diuretic

98
Q

furosemide and aspirin interaction

A

If aspirin is taken with furosemide, the two drugs compete for elimination in the kidneys. This can lead to higher blood levels of aspirin, and potential aspirin toxicity.

99
Q

CHF

A

Symptoms of dyspnea on exertion, B-type natriuretic peptide (BNP) elevation, and prolonged QRS

evaluate the severity of the congestive heart failure, an echocardiogram and chest X-ray are helpful diagnostic tools.

100
Q

Pagets disease of the breast

A

always associated with underlying ductal carcinoma

itching, burning plaque surrounding the nipple, with serosanguinous discharge, especially unilaterally, skin dimpling, and firm lymph nodes

101
Q

next step to confirming Pagets disease

A

mammogram with image-guided biopsy

102
Q

Phenelzine

A

MAOI antidepressant

avoid tyramine-containing foods, such as cheese, red wine, beer, and chocolate, because of the associated potential for hypertensive crisis with this drug-nutrient interaction

103
Q

Pagets disease of the bone

A

osteitis deformans

causes an increased rate of bone turnover in localized areas, leading to elevated ALK PHOS, increased localized bone density, and bony enlargement. This disease is entirely separate from Paget’s disease of the breast, despite being named by the same physician.

104
Q

high risk HPV

A

16 and 18

105
Q

major risk factor for cervical dysplasia

A

smoking

106
Q

nutrition for prevention and treatment of cervical dysplasia

A

folic acid

vitamin A

107
Q

CIN I follow- up?

A

low grade dysplasia

HPV testing should be performed to determine presence of high-risk or low-risk HPV.

If high-risk HPV is found: a colposcopy should be performed.

With low-risk HPV: start treatment, and a pap or thin prep should be repeated in 6 months to evaluate efficacy of your treatment and to rule out development of further dysplasia.

108
Q

Anti-HPV botanical for women with cervical dysplasia

A

THUJA : can be used internal and external

C/I pregnancy

109
Q

centella

A

gingko

adaptogen and alterative

110
Q

Arctostaphylos uva-ursi

A

urinary antiseptic primarily for alkaline UTI

phenolic glycoside called arbutin, which converts to the antiseptic compound hydroquinone in an alkaline environment.

111
Q

Dioscorea

A

antispasmodic

analgesic

112
Q

Serial beta-HCG

A

if pregnancy is still viable, should triple within 3 days

113
Q

bleeding during first 20 weeks of pregnancy

A

25%

114
Q

HSV-6 causes

A

ROSEOLA INFANTUM

rash usually lasts 24-48 hours
& then resolves without complication

115
Q

COXSACKIE VIRUS A16 CAUSES

A

hand foot and mouth disease

116
Q

PARVOVIRUS B19 causes

A

ERYTHEMA INFECTIOSUM

117
Q

PARAMYXOVIRUS causes

A

measles and mumps

118
Q

melissa officianalis

A

viral infections, as well as anxiety, IBS

can block thyroid antibodies from binding to the thyroid gland, and also inhibit binding of TSH to thyroid cell membranes, which leads to less production of circulating thyroid hormones.

119
Q

Hyperthyroid herbs:

A

Melissa
Lithospermum
Leonurus
Lycopus

120
Q

Roseola infantum

A

fever and 3 days of general malaise, then the fever rapidly resolves (phantom/ghost), and a light pink lacy rash appears on the trunk

common in infants 9–12 months of age. Febrile seizures may occur in some children with a high fever

121
Q

Erythema infectiosum (5th disease)

A

blotchy pink rash on the cheeks, occurring in 5–7-year-old children mostly; this rash will also resolve spontaneously.

122
Q

Measles

A

presents with a fever and the 3 Cs: cough, coryza, and conjunctivitis. Measles also classically has Koplik’s spots on the oral mucosa and a maculopapular rash spreading from the head downward.

123
Q

Rubella

A

causes a mild fever, malaise, and a less intense version of a measles rash. The primary concern about rubella is the possibility of a pregnant mother contracting the illness, because it can result in birth defects in congenital infections.

124
Q

Pathognomonic sign for pyelonephritis

A

white blood cell casts in urine

lower uti: WBC without casts

casts= kidney

125
Q

RBC casts in urine

A

glomerulonephritis

126
Q

Fatty casts

A

nephrotic syndrome

127
Q

waxy casts

A

chronic renal failure

128
Q

most common tx for pyelonephritis

A

CIPROFLOXACIN

broad-spectrum AB

129
Q

Trimethoprim/sulfamethoxazole (TMP/SMX)

A

commonly used for UTI

do not use in sulfa allergy

130
Q

Phenazopyridine

A

urinary analgesic

can be used for painful UTI

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