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281 Cards in this Set
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- Back
Hep B vaccine schedule
|
birth
1-2 mo 6-18 mo |
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Is vzv more effective in over 13 or under?
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under; therefore 2 doses requ'd if over 13, and given 4-8 wks apart
|
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is zoster more common among natural infected or immunized w/ vzv vaccine?
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naturally infected
|
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hep B vaccine for?
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nonimmune ppl at high risk:
men having sex w/men sex workers drug users prison inmates hemodialysis households of carriers h/c workers endemic regions |
|
Hep A vaccine for?
|
men having sex w/men
illegal drug users |
|
meningitis vaccine for?
|
functional asplenic
travelers to endemic areas college aged |
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when not give rubella vaccine for woman?
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if preg
if planning to be preg in 4 wks. give directly after delivery |
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are Td booster shots req'd for clean minor wounds?
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no ; but for
contaminated or deep wounds, if last Td was given over 5 y/ago if no vacc history or history unclear, give immunoglobulin also |
|
when start lipid screening?
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age 35 or younger if fam hx or other risk factors
|
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when start crc screening?
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age 50 or 10 y/ before age of death of family member from crc (ie if father died at 50, start at age 40)
|
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age to start mammogram screening?
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every 1-2 years starting at 40;
every 1 yr from 50 on |
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when start cerv cxr screening (pap smears)? when discontinue?
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age 21 or 3 yrs after first sexual activity
discontinue at 70 or if had 3 documented normal smears and no abnormal findings in past 10 yrs |
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major predictors of perioperative CV risk?
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severe heart valve disease
MI recent unstable/severe angina decompensated heart failure high grade A/V block symptomatic arrhythmias with underlying disease SVT's w/ poorly controlled ventricular rate |
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obesity causes what adverse post operative outcomes?
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Doesnt!
those that do include: low fxnal capacity of lungs type 2 DM Hyperlipidemia Congestive heart failure |
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pre operative creatinine levels should be takenf or whom?
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surgery w/ high risk of bleeding
pt over 50 chance of hypotension nephrotoxic meds given |
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age for preoperative ECG to be done?
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men over 45
women over 55 (and for any underlying cv disease or disease related to CV ie DM, etc) |
|
m/c cause of death in international travelers?
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heart disease
then: accidents, etc |
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recommended prophylaxis for traveler's diarrhea?
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NOT ab's but
cautionary measures for TX, give cipro |
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legally required vaccines for travelers?
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Yellow fever ( if going where it's endemic)
Polio (inactivated) if going where it's endemic |
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yellow fever may cause?
|
complications of encephalitis or syndrome resembling wild-type yellow fever...
|
|
what vaccines do you not give to preggers or i/c pts?
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live ones:
Yoo Must not give: Yellow fever Oral Polio Oral Typhoid MMR |
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if pt has contionuing elevated BP after starting combination oral contraceptives, what to do?
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stop OC's....bp should return to normal
|
|
m/c reason for stopping OC's?
|
irregular bleeding -
(but this usually stops after 3 months) |
|
progestin-only pill use?
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use for any pt with hx of dm, venous thrombosis, pulm embolism, obesity, or htn, bc these pills do NOT increase risk for TE..!
but must give w/NO hormone free period: contraception may be compromised if even 3 hr delay in taking pill! |
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progesting-only pill and ectopic preg?
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think: like IUD:
lower overall rate of ectopic preg b/c lower rate of preg; but IF preg, higher risk of ectopic |
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don't give IUD to whom?
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woman w/ multiple sexual partners
|
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what to give to woman over 35 smoker who wants contraception but cant have IUD b/c has multiple sexual partners?
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progestin-only pill or long-acting progestin form
|
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Does emergency contraception disrupt an already implanted pregnancy?
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no...also do not cause birth defects
|
|
3 types of emergency contraception?
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Progestin only pill (levonorgesterol, one large dose)
Yuzpe method (2 large doses of e and p, 12 hrs apart; thought to be less effective as above) Mifepristone = RU486 if given before implantation (but not approved in US b/c can ALSO disrupt implantation therefore is ALSO an abortifacient if given after / around implantation) |
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what are contraindications to emergency contraception?
|
none except: allergy/hypersensitivity to pill components
|
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Open or closed questions lead to most accurate info?
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open
|
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if pt is extremely angry, what should you say to him?
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"you seem furious"
is "better" thank you seem a little angry (may make things worse) ?? |
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how to begin telling person bad news?
|
say "I'm afraid I have some bad news for you"
helps them prepare for it rather tahn asking: what do you know about (HIV)? is essentially giving them the dx w/o letting them prepare. |
|
illnesses of native americans?
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Diabetes
Obesity Suicide Alcoholism |
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what type illnesses are homeless children more likely to get than normal pop?
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acute ie ear infections
|
|
what ethnicity is highest percent of uninsured?
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hispanics; 1/3 , and is growing
|
|
uninsured have more or less chronic health conditions?
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less
|
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mental health disorders are dx'd more or less frequently in minorities?
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More, but have more misdiagnoses of mental health in minorities too due to inaccurate screening/ language barriers/ etc
|
|
tx for uncomplicated UTI ? in pregger?
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ciproflox or tmp-smx
in pregger don't give! give: cephalexin = first gen ceph |
|
3 principles of professionalism in medicine
|
primacy of pt welfare
social justice pt autonomy |
|
gingko is used to tx what alternatively?
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dementia
|
|
st john's wort is used to tx what alternatively?
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depression
|
|
saw palmetto is used to tx what alternatively?
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BPH - works as good as finesteride, but doesn't shrink its size
|
|
what can st john's wort cause?
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serotonin syndrome if mixed w/ SSRI like paroxetine, etc
|
|
what adverse effect can gingko biloba cause?
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antiplatelet and bleeding if taken with aspirin
|
|
when should you ever use fentanyl patch in pt who hasn't yet tried opoids?
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never
|
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when to introduce patient-controlled opoid analgesics?
|
only when pain is severe; b/c involves iv/ subq admin
|
|
oalliatave tx for pain, not responsive to analgesics / nsaids?
|
give morphine sulfate, immediate release, to detmn baseline need, then titrate for most effective dose or add sustained release after
|
|
whats the specific limit to opoid use? what's more common, tolerance or addiction to opoids in terminal pts?
|
there is none;
both are UNCOMMON...don't fear giving more opoids to terminal pt unless is a previous drug user. |
|
neruopathic pain relief ( ie dm neuropathy or vzv shingles long term px?)
|
give anticonvulsants OR TCA's (amitryptiline) OR SNRI's (not ssri's)
|
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dyspnea due to cxr ie lung, may be txed with?
|
opoids!
|
|
excessive fatigue due to cxr may be tx'd with?
|
psychostimulant ie methylphenidate
or steroids |
|
"most useful sx" to detmn depression in terminal cxr pt?
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anhedonia
other sx ie insomnia, fatigue may be due to meds or disease; sadness may be expected |
|
what's a better indication of impending death? delirium or decreased attention span?
|
delirium is not, b/c can be caused by meds. decr attention span, decr oral intake, decr hearing, etc are.
|
|
tx for death rattle (labored breathing before death)?
for pain before death? for agitation/hallucinations before death? for restlessness before death? |
atropine, scopolamine, or morphine
px = ketorolac agitation/hallucinations = haloperidol, thorazine restlessness= benzodiazepine |
|
tx for anal HPV warts in homosexual men?
|
cytol screening for anal mucuosa dysplasia.
Not valcyclovir = tx for Herpes |
|
gay men have incr incidence of what cancer?
|
anal = due to HPV infection, dysplasia, etc like cervical cxr
|
|
what disease is more common among lesbians than heterosexuals?
|
bact vaginosis.
|
|
do lesbians have higher/lower rates of HIV than heterosexuals?
|
higher
|
|
br cxr rates among lesbians?
|
same as that among heterosexuals
|
|
transgender vs transsexual?
|
transgender = anyone trying to cross gender line in a culture ( ie crossdressing, etc counts)
transsex = someone wishing to change sex and undergoing surgery for it |
|
elderly with bilat mild lower abd px, and fever...dx?
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acute appendicitis!
in elderly, only 20% present with classic signs |
|
renal calculi may radiate to where?
|
shoulder (while gallstones = shoulder blade/scapula)
|
|
which is more specific, lipase or amylase?
|
lipase; if > 3x normal, is sens and specific
|
|
tx of hpv benign veneral warts?
|
aldara (imiquimod) = immune modulator
|
|
ASCUS finding on pap smear...what next?
|
either :
1) repeat 4-6 mo then if + --> colposcopy if - --> repeat in 4-6 mo --> if - go back to annual pap smearing 2) do HPV dna test: if + --> colp 3) proceed direclty to colp |
|
if ASCUS + LGIL, what next?
|
colposcopy
|
|
If Atypical Glandular Cells on pap smear, what next?
|
check what origin - if endom = do endom biopsy; if endocerv, ok
|
|
ice craving in woman?
|
iron def
|
|
things that inhibit iron absorption?
|
basic materials like antacids, calcium,
tannins of tea, wine, and soy proteins |
|
distinguish iron def anemia from thalassemia?
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both have anemia, low MCV, but IDA has INCREASED RDW (mix of norm and microcytic) and low RBCs while Thal has LOW-NORM RDW and high RBC count
|
|
glossitis seen in what anemias?
|
macrocytic = folate or B12;
if also neurolog def, = B12 |
|
only type of diet that can really cause vit B12 def outside of malabsorption, fish tapeworm, etc?
|
vegan
|
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prevention of pain crisis in sickle cell? tx if crisis?
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maintain adequate O2 and hydration; for Tx, give analgesics and hydration too
|
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intensely itching papules in between fingers, toes, buttocks, elbows, waist area, genital area, and under the breasts in women
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scabies
|
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small bites on warm areas of body, ie areas covered by socks and shoes, behind the knees and around the groin are often trouble spots
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chigger bites
|
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diff b/w fibroadenmoas and breast cysts of fibrocystic changes?
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fibroadenomas arent usually tender
|
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which is more indic of cxr: breast discharge that's bloody or spontaneous discharge?
|
spontaneous is worse, (but still workup a bloody discharge)
|
|
BIRADS numbers after mammography mean what?
|
0 = test incomplete
1, 2 = benign 3 = probably benign, need mammogram in 6 mo 4,5 = suggest cancerous = needs tissue sample |
|
cat bite = what common bacteria?
|
pasteurella multicoda
|
|
hot tub folliculitis = what bact?
|
pseudomonas
|
|
use benzoyl peroxide for what type acne?
|
Inflammatory, not for just open/closed comedones = just use topical retinoids
|
|
where does tinea cruris appear?
|
groin
|
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diff b/w sx of asthma and PE in a young woman?
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pain is abrupt onset in PE
|
|
what drugs must be stopped before stress test, and for how long?
|
any BBlockers; for 4-5 halflives = 48 hrs
|
|
if bronchodilator and antitussives don't work, how to tx acute bronchitis?
|
inhaled CS's or oral tapered Cs's, NOT AB's
|
|
tx of pertussis?
|
azithro for 5 days...doesnt shorten course but prevents transmission
|
|
vertigo vs disequilibrium sensattion?
|
v = room spinning around pt
d = unsteadiness |
|
acoustic neuroma sx vs vestibular neuronitis vs benign positional vertigo vs Meniere's disease??
|
an = starts w/unilat hearing loss and tinnitis, then gradual lfacial weakness, ataxia, and vertigo
vnitis=acute sever vertigo lasting days, then improving over weeks bpv= v w/position changes only Md= discrete attacks of vertigo for hours, + nauseas, vomiting, hearing loss, and tinnitis. |
|
what is one of the only causes of central vertigo?
|
stroke
|
|
tx for peripheral vertigo
|
antihistamine ie diphenydramine or meclizine: suppress vagal response (anticholinergic effect)
then antiemetics if nausea, vomiting also |
|
BNP levels and CHF?
|
if < 80pg/mL, can say w/ up to 99% certainty that CHF is NOT cause of sx
|
|
when to get urine culture and when not to for symptomatic female?
|
if urine dipstick is neg or inconclusive, then DO culture to confirm.
if dipstick is + or microscopic analysis is +, don't need to do culture, just tx |
|
tx for recurrent uti, that is susc to ab tx?
|
give single dose ab's directly after sexual intercourse (85% of utis occur directly after intercourse)
if this doesn't work, give prophylactic single dose daily ab's for 3-6 mo |
|
recurrent dysuria + hematuria, small bladder capacity, urge to void on very small volume , ulceration and fissure on cystoscopy?
|
interstitial cystitis ;
|
|
cause of dysuria in female post menopausal? pre?
|
post = bladder atrophy
pre = irritant ie caffeine, acid in urine; if + hematuria = interstitial cystitis |
|
back px, fever, frequency, urgency in male?
|
think acute bacterial prostatitis before pyelonephritis/cystitis or urethritis
|
|
tx for TMJ?
|
NSAIDS, rest from chewing, etc ;
if this doesn't work, refer to dentist for bite-guard |
|
reliable vs unreliable findigns for acute otitis media?
|
reliable: bulging, impaired motility, opacity (loss of light reflex; indicating purulent effusion)
purulent discharge unreliable: redness of tm (could be just due to crying) |
|
pathogen of otitis externa? tx?
|
m/c caused by staph / strep. I f swimmer's ear, pseudomonas.
tx = topical AB's +/- flushing |
|
diabetic drugs that cause peripheral edema?
|
rosiglitazone = insulin secretagogue
|
|
is a disorder of adipose tissue distinguished by five characteristics: 1) it can be inherited; 2) it occurs almost exclusively in women; 3) it can occur in women of all sizes, from the seriously underweight to the morbidly obese; 3) it involves the excess deposit and expansion of fat cells in an unusual and particular pattern – bilateral, symmetrical and usually from the waist to a distinct line just above the ankles; and 4) unlike the “normal” fat of obesity, lthis fat cannot be lost through diet and exercise. Surgery is highly controversial, and in many cases, can make the condition worse.
|
lipedema = SPARES the feet
|
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bilateral edema workup ina woman?
|
other sx of chd -> echo
+ ascities --> chekc lft's if not, check urine for albumin/protein...if increased = notic syndrom or ATN doppler --> venous insufficiency or if unilat : doppler --> DVT if erythema --> cellulitis |
|
tx of unilateral edema w/o other sx of chf, no trauma, or inflammation?
|
=venous insufficiency. does NOT respond to diuretics or AI's...tx: give pt elastic stockings
|
|
what percent of 5 y/o's are bedwetters? family hx and enuresis?
|
25%, decr 15 % every year after.
if 1 parent did it, 40% chance... if 2 parents did it, 70% chance |
|
should motivational measures with neg consequences be used for bedwetting?
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no...positive reinforcements ok.
|
|
if pt wets bed, what look for first?
|
check for constipation...if tx, it often tx's the enuresis.
|
|
const delay
vs familial short stature in bone age vs height age? |
in const delay, bone age = ht age, and both are < actual age
in familial shortness, bone age = chron age, while height age is behind |
|
growth curves for kids: const delay, familial shortness, ftt, and hypothyroidism differences?
|
familial shortness = ht and wt drop off together.
const delay and ftt: wt drops off before ht. |
|
most common cause of fatigue in primary care? (this presents as fatigue w/o weakness or hypersleeping)
|
depression...
thenk look for pregancy, sleep apnea, anemia, hypoth, etc.. |
|
rash after mono was incorrectly txed with amp; amoxy for strep?
|
due to having mono and tx, NOT a pen / amp -allergy!!
|
|
55 y/o african american male w/ fatigue w/ no explanation...what is included in workup?
|
age/gender appropriate CXR screening!!
ie prostate screenw ould be approporiate ?? |
|
painless, significant bleeding in 2 y/o?
|
meckel's (#1 cause of significant bleed in children
|
|
family clinic tx of internal hemorrhoid? external that's thrombosed (bleeding, very painful, nodular)
|
internal = rubber band ligation or sclerotherapy
external = excision, under local anasthesia |
|
cluster vs migraine vs tension?
|
migraine = usually more assoc w/ nausea...also may have aura. 4 hrs - 3 days
cluster - rhinorrea, sweating., 15 mins - 3 hrs tension = no nausea, no vomiting, = 3hrs - 7 days; MOST COMMON both may be unilat, or |
|
migraine prevention? migraine tx?
|
prevention: amitryptiline or Bblocker.
tx: nasal triptan, ergotamine tx |
|
what tx should you never give for migraine?
|
narcotics...
|
|
what is the only ca ch blocker that may help prophylactically against migraine?
|
verapamil
|
|
cluster hache tx?
|
long term- nifedipine during sx
for acute sx: INHALED ergotamine or injected sumatriptan or lidocaine during sx...not oral meds b/c takes too long to kick in |
|
red flags for headache?
what to do if red flag?/ |
don't respond to first line tx
getting worse and worse sudden onset don't fit clinical causes of hache w/ neurol deficits ...if red flag, send for imaging |
|
medications that may cause hematuria?
|
penicillins, sulfonamides, phenytoin, cp, anticoags, nitrofurantoin.
NSAIDS cause kid probs but not hematuria (but wouldnt nsaid-induced TIN cause hematuria?-->no, would cause fever, oliguria, rash, and ARF; pyelonephritis causing TIN would cause hematuria, though) |
|
painless hematuria = m/c presentation of what?
|
bladder carcinoma!!
|
|
nephrolithiasis vs urinary stones sx?
|
n = no pain, just hematuria (stones are inside kids)
u stones = pain, hematuria, etc |
|
what is terminal hematuria?
|
bleeding just at the end of micturition = bladder neck or prostatic urethral lesion, NOT renal/bladder/ or even lower urethral lesion as all these would bleed throughout micturition
|
|
tx for pt w/ hematuria, but normal IVP and urinalysis/creatinine, and urine culture?
|
just reassurance and periodic monitoring, unless over 40 = do cystoscopy or renal biopsy
|
|
causes of urinary incontinence w/ age?
|
total bladder contractiliy decreases w/ age (overflow incont)
invol bladder contractions increase with age (detrusor hyperactivity = urge incont = m/c incont in elderly) increased urogenital atrophy = decreased internal urethral sphincter sensitivity |
|
does asx bacteriuria cause incontinence in elderly?
|
no, but sx bacteriuria may , as well as diuretics, stool impaction, atrophic vaginitis as well
|
|
m/c type of incont in elderly
|
urge incont (detrusor hypractivity)
|
|
therapy for incont if behav approach is ineffective? for urge inc? for stress inc?
|
urge:
anticholinergics = urinary retention. give oxybutynin (ditropan) or tolterodine stress: pseudoephedrine prostatitis: tmpsmx prostatic hyperplasia: finasteride, terazosin (alpha blocker to shrink prostate) |
|
m/c cause of primary amenorrhea
|
gonadal dysgenesis ie turners
|
|
m/c cause of 2ndary amenorrhea?
|
pregnancy, then PCOS, hypoth dysfxn ie anorrexia, rapid wt loss, rig exercise, then hypoth (causes incr prolactin) or hyperprolactinemia
|
|
tx for primary dysmenorrhea?
|
nsaids, then if doesnt work, 2nd line = OCP's
|
|
meds that may cause hyperprolactinemia
|
benzos, ssri's, tca's, phenothiazines, buspirone, sumatriptan, valproate, ergot deriv's, atenolol, verapamil, mdopa, estrogens, and contraceptives..!!!
|
|
if woman found to have high testosterone and dhea, what next?
|
check for blind pouch vagina or no uterus = testicular feminization. if not, :
CT scanning of adrenals and US of ovaries to rule out neoplasm |
|
when is secondary dysmennorhea normal
|
is not...is usually pathological
|
|
describe px of endometriosis?
|
starts several days before menses, amay last entire cycle!
|
|
sx of leiomyomas?
|
usually asx...except for bloating, mass, and excess bleeding (menorrhagia/metorrhagia). NOT pain usually
|
|
how do OCP's tx dysmenorrhea?
|
cause endom hypoplasia, and suppress menstrual fluid vol and pg release,
|
|
abrupt onset is more indic of delirium or dementia?
|
deliriium
|
|
hyperalert confusion is sign of what w/drawal?
psychomotor slowing? |
alcohol w/d
amphetamine w/d |
|
person has vomiting 1-2hrs post meal, with non-bilious food still undigested coming back up? dx? tx?
|
gastroparesis
tx = metoclopramide = antiemetic AND gastroprokinetic |
|
abd obstruction has what finding on phys exam?
|
hypERactive bowel sounds +/- distension proximal to obstr
|
|
vomiting early in the morning before eating...think what?
|
incr ic pressure ie meningitis, space occupying lesion;
uremia alcohol w/d pregnancy! |
|
phenothiazine- waht is it for?
|
is antipsych (ie chlorpromazine) and antihistamine
use as antiemetic in low doses causes drowsiness, dry mouth, and dizziness |
|
side effect of prokinetic drug metoclopramide?
|
works on 5HT3 and D2 receptors;
extrapyrimidal s/e's include: tardive dysk, parkinsonism in addition to diarrhea (is prokinetic!), drowsiness |
|
if suspect ectopic preg, what would be changed w/ menses?
|
no menses / abnormal bleeding instead
|
|
posterior cervical lad is usually signifying what?
|
EBV mono
|
|
GAS may be distinguished from viral infection by what changes?
|
more intense course;
plus UVEAL EDEMA |
|
to CLEAR a pt from chronic GAS colonization, what AB's to use?
|
oral respiratory quinolone or oral clindamycin
|
|
only outside factor that has been proven to play a role in acne?
|
stress
|
|
use to tx acne?
|
FIRST LINE: **RETINOID (keratolytic)
...benzoyl per, or topical AB's NOT first line; oral AB's may work OC's may work topical CS's may help |
|
side effect of retinoid may be?
|
worsening acne! if so, stop ;
other s/es = jt pain, dry skin |
|
acne rosacea often affect what other organ? how tx?
|
eye involvment ie styes, blepharitis, corneal surface disease.
tx w/ oral tetracycline |
|
pharm for psoriasis?
|
topical cs's
dovonex = calcipotriene, = vit D derived keratocyte proliferation inhibitor |
|
tx for pityriasas rosea?
|
cs's, antihist's
|
|
tx for hot tub folliculitis?
|
no AB!s...is self-limiting
|
|
sx's of primary HSV1 inf? 2ndary?
|
primary = gingivostomatitis, w/wo perioral skin lesions, fever, malaise, tender lad
secondary = perioral , crusting vesicular lesions; LESS severe |
|
tx for genital herpes?
|
either tx each outbreakor use chronic suppression ie : DAILY valcyclovir (valtrex)
|
|
in whom should tx for shingles be given if after 72 hours post sx started?
|
in over 50, I/C, or eye involvement, still give.
|
|
what does antiviral for vzv zoster do?
|
shortens dur, DECR's PAIN..
|
|
tinea capitis tx?
|
Griseofulvin
|
|
palpable preauricular l/n and pink eye?
|
viral (adenovirus) conjunctivitis - is hihgly contagious but self-limited
|
|
what is contraindicated in conjunctivitis tx?
|
cs's
|
|
vzv zoster eye inf?
|
oral valcyclovir + antiviral eye drops!
|
|
tx for viral conjunctivitis (non vzv/herpes)
|
supportive, cold compresses, lubrication drops
|
|
only conj that is medical emergency?
|
gonorrheal conj...can lead to corneal ulceration or perforation w/in 24 hrs!!
|
|
tx for subconjunctival hemorrhages
|
actually outpatient, supportive, no drugs. should subside in days- week
|
|
what sx is more suggestive of serious problem in conjunctivitis?
|
pain
|
|
tx for bact conjunctivitis (2)?
|
1) normally = strep/staph = tx w/ tmpsmx ointment 3xday for 3 days
2) if pt wears contact, is probably gram -, so use gentamicin ointment |
|
bugs causing: otitis media, bact conjunctivitis, or sinusitis?
|
All = SAME and same order = Strep pneum, staph, h. influenzae (not-typed = vacc doesn't cover), and Moraxella Catarrhalis, then Pseudonomas
|
|
sx to suspect gonococcal conjunctivitis? NSIM?
|
wiping away purulent d/c and it immediately forms again.
ophth referral immediately |
|
red eye, boring eye pain, and surrounding headache?
|
scleritis,associated w/ rheumatoid arthritis, wegeners granulomatosis
|
|
acute eye px, decr vision, and redness, dilated pupil? same but constricted pupil?
|
acute glaucoma
iritis |
|
most specific sx for rhinosinusitis?
|
Not sinus pain or dental pain!!
duration > 10 days is MORE specific! |
|
m/c bug for chronic sinusitis?
|
polymicrobial
|
|
def of chronic sinusitis?tx?
|
sx > 3 mo
tx = cipro or amoxi/clav for 2-3 wks |
|
best drug for nasal congestion?
|
topical nasal steroids
|
|
AC type IV-VI requires what therapy?
type I-III? |
surgery b/c is full dislocation = more than 50% separation of the joint with a posterior displacement of clavicle.
types I-III may be tx'd with sling immobilization, exercises, and pain management |
|
what is patellofemoral syndrome? tx?
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M/C injury to knee in under 40 y/o's!
due to biomechanical tracking of patella lateral to the vastus lateralis muscle. tx = strengthening of vastus MEDIALIS and stretching of hamstrings to improve biomechanics |
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twisting of knee, + "pop" + swelling but can still bear weight?
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ACL tear
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direct force to knee and post drawer sign?
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PCL tear
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knee injury causing pain plus locking, catching, or giving way ?
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= meniscus injury
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knee instability + lateral/medial vallus/ valgus movement beyond expected?
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lat or med COLLATERAL LIGAMENT tear
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McMurray's test?
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tests for meniscus tear: flex and extend knee while int/ext rotating the tibia
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Ottawa ankle rules indicate xray for what findings?
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can't bear weight on ankle
bone tenderness over distal 6 cm of tibia, fibula, or malleoli mid foot or navic tenderness tenderness over prox 5th metatarsal |
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ischemia may present as what in a diabetic?
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silent mi! think about sx of diaphoresis, syncope as possible sx of MI in diabetic
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when do tilt-table testing for syncope?
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After workup for cardiac syncope (ecg, holter, ) and orthostat BP's are all done and normal.
If tilt table is -, think psychogenic and do psych workup |
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tx for vag candidiasis?
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topical -azoles
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m/c cause of recurrent vag candidiasis
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reinfection from partner
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strawberry cervix...plus yellow green frothy vag discharge?dx?
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trichomonas vaginalis
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moth-eaten cells (pseudo-clue cells) on vag saline prep?
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acid-base disturbance of vagina
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HPV genital inf...tx?
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imiquimod = imodulating agent to
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wheeze, slight cough, and mild fever in 18 mo old?
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acute viral resp tract infection!!!!!!!!!
ONLY blitis if pt also has breathlessness |
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any ACUTE sob + tachypnea...what must you rule out?
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PE!!
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first episode of wheezing must get what in workup?
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CXRAY!!
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recurrent wheezing and vomiting after feeding in baby...dx?
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infant GERD
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test for asthma pt coming in for increased SOB despite using his asthma meds...
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peak flow testing - helps monitor status of lung fxn...pfts are good but require a pft lab
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decreased sexual interest..what lab test?
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FREE testosterone
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causes of EJAC dysfxn?
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any sympathetic system antag...ie b blocker, or alpha blockers (terazosin)
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tx for prem ejac? ejac dysfxn?
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use something that raises threshold for orgasm...fluoxetine...
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tx for erectile dysfx?
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alprostadil (PGE2)
sildenafil (viagara = pde inhibitor) |
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tx for ejac dysfxn?
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sex therapy
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proven factors in substance abuse?
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GENDER - men
AGE - younger EMPLOYMENT - unemployed EDUCATION - less eduacated MARITAL - single status |
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most sensitive lab enzyme elevated in alcohol abuse?
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GGT
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alc abuse tx causing adverse rxn when pt drinks?
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disulfiram
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tx for alcohol abuse that reduces the 'reinforcing' effect of alcohol, not allowing ppl to get drunk?
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naltrexone ( is also a tx for opoid abuse b/c blocks ALL opoid receptors)
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intense hunger is sieen in w/drawal from what?
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amphetamines
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w/drawal causes irritability, anxiety, DEPRESSED mood, restlessness
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cigarrettes
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fastest nicotine releasing medication?
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nasal spray
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w/drawal is very little physiologic...- depression and extreme fatigue . psych craving
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think that movie...
cocaine |
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opiate w/drawal sx? is it life-threatening?
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sweating, tearing, then restlessness, irritability, bone pain, nausea, DIARRHEA (think heroin = constip)...abd cramps,
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marijuana w/drwawal?
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not clinically significant
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drugs c/i'd in asthma pt?
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bblockers!!!
and aspirin (blocks pg synth) |
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joint aspirate in OA vs RA?
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both = 2-10k wbc's
but RA = >50% PMN's, OA = <50% PMN's |
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lupus joint involvement vs RA
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rarely as symmetrical as RA
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extraarticular involvement of RA?
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nodules all over, pulm interstit disease = cough, dyspnea, vasculitis, dry eyes, mouth, etc.
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tx for enviro factors of asthma?
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keep humidity under 50% in house;
enclose bed spring,mattress in covers, wash bed covers w/ hot water, remove carpeting |
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if pt asthma is intolerant of s/e's of inhaled c/s's, what give?
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give pt leuk inhib instead...not LA b/c LA doesnt work well unless with inhaled CS
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m/c cause of lower back px in under 26 y/o's?
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spondylolisthesis
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eval of scoliosis in adolescent?
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if <20deg curve, follow w/ 6 mo xrays...if progressive changes, bracing may help...if >20 deg, refer to orthopedist. ANY curve to left--> send to MRI (90% are to right)
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positive straight leg raising test (px b/w30-60deg)?
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Is NOT back strain (should not have pos test)
but radicular px = nerve compression |
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any back/joint px/injury not w/ normal xrays but not responsive to 6 wks of conservative tx...?
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MRI!!
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what NSIM if pt got in accident and now can't rotate head 45deg left or right?
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cervical spine xrays...
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first line tx for copd?
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ipratropium and short acting B2Ags
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give theophylline especially for what disease?
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cor pulmonale ( also increases heart fxn
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first lab change indicating CKD
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anemia...b/c erythropoetin prod drops after GFR drops lower than 60 (norm = 90); hyponat, hypokal, met acid, etc sets in when GFR drops lower than 30
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when is nephrology referral indicated? when is dialysis started
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stage III renal failure and below...
dialysis starts at <15 GFR |
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poor prognosis in pt with Primary biliary cirrhosis?
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rising bilirubin levels
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hepatotoxic drugs?
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TAMALAN
Tca's AntiDM drugs Muscle relaxants Antifungals Lipid lowering (statins) Anticonvulsants NSAIDS!!!!!! |
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m/c cause of death in cirrhosis?
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bleeding varices!!!!
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absolute c/i's to liver tplant?
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portal vn thrombosis,
severe medical illness malignancy, hepatobiliary sepsis, lack of pt understanding |
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hepatojug reflex description if heart failure?
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heart cannot respond to incr venous return, so jug vein expands DURING and IMMEDIATELY AFTER right upper quad compressoin
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NYHA classes:
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I = no dsypnea on any activities
II = dsypnea on "ordinary" or "normal " activities III = dyspnea on daily activities ie around house IV dyspnea at rest and increased with any movement |
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in what class heart failure pts should you give spironolactone?
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CLASS iii OR iv
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if have to add a second diuretic for volume overload heart failure, what should you add?
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metalozone = a thiazide
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who to give hydralazine or nitrates to in heart failure?
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PPL WHO CAN'T tolerate ACE I's or ARB's OR in blacks w/ stage III, IV
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bblockers to be given to and will decr morbidity in what classes?
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II-IV
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diff b/w dementia and delirium/depression on testing?
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testing = good effort w/ dementia (but wrong answers)
del and dep = poor effort on testing |
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early signs of dementia? later signs?
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loss of conversational output; loss of memory; loss of calculating abilities and drawing...
late = loss of appropriate social behavior |
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regular workup for suspected dementia?
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CBC, biochem, THYROID, B12, and MRI...
others if clinical presentation indicated include toxic screen, syphilis, HIV, CSF, etc |
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3 drugs for alzheimer's?
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donepezil
galantamine rivastigmine may have behavioral / cognitive fxn increases, but do NOT slow the progresseion of neurodegeneration |
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dementia of Lewy body type? what NOT to use in tx?
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= presents with parkinsonism signs and visual hallucinations.
thus, don't use antipsychotic to tx, b/c of long term neur. damage that it can cause |
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how often to screen ppl for diabetes?
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start at 45, every 3 yrs, but start earlier if fam hx or high risk ethnicities, or previous abnormal labs, or woman w/hx of gest dm
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m/c cause of blindness in US?
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DM retinopathy
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dm retinopathy worsens w/ worsening what?
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HBA1c levels
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first line anit htn tx for diabetic pt?
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ACE Inh
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only diet that has been proven to improve glycemic control?
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high fiber
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what to give pt who needs more glycemic control but has renal failure?
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thiazolinediones-safe for renal failure pts.
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wt influences of two diabetic drugs?
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thiazolinediones (rosiglitazone) may cause edema and wt gain,
incretins ie exenatide cause wt loss |
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onset of each insulin? peak of each?
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ONSET PEAK
aspart 15-30mins 30-60mins reg 30-60 2-3hrs lente or glargine 1-2 hrs 4-8* ultralente 2-4 hrs 8-20hrs *= glargine (lantus) has NO peak |
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longest acting insulin?how long?
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ultralente =24-32 hrs
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if just adding insulin to dm type II's diet b/c need further control, how much to add?
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only add .1 u / kg / day
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metformin's side effect...when must stop metformin in pt?
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s/e = lactic acidosis.
stop if pt going under surgery or getting any radiocontrast dye, b/c will predispose to developoing lactic acidosis |
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what changes occur in lipid profile during fasting?
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fasting = lower TG's, which causes LDL to rise and therefore total Chol to rise (HDL doesn't change)
thus, LDL and total Chol is highest during fasting lipid profile |
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smoking cessation will change what in lipid profile?
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incr hdl by 5-10mg/dL
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tx for flushing caused by niacin?
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give niacin with aspirin..!!
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which statins will cause less drug interactions?
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rosuvastatin (crestor),pravastatin, and fluvastatin
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how does omega 3 work?
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decreases TG secretion by the liver
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how do fibrates work? Niacin? Ezetemibe? bile acid sequestrant?
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upregulate LPL causing increased TG clearance by the liver
Niacin - reduces liver's release of VLDL Ezet- decr chol absorpt in gut Bile Acid Resin = cholestyramine = "Bar's Bile's" reabs in gut so stim's liver must USE more chol to make more (so slighly incr's TG's) |
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what tests when for detecting HIV?
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if primary infection and suspect HIV, do HIV RNA quantitative test.
otherwise, if past primary inf stage, do ELISA first, then confirm w/ WESTERN BLOT |
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how to tx HIV pt with PCP?
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give TMPSMX , AND give cs's if PaO2 drops to below 70.
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signs of secondary htn?
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abd /flank masses (POCD),
abd bruits (rasten) tc/flushing/sweating (pheo) pigmented striae (cushing's) thyroid mass (hyperth) absent fem pulses (coa of aorta) |
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routine tests for newly dx'd htn pt?
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NOT thyroid...unless clinical eval indicates...
but : Hb, Hct, K, creatinine, fasting glu, Ca, fasting lipid, urinalysis, resting ECG |
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what has been shown to lower the bp the MOST?
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DASH diet = diet rich in fruits , vegges, in low in sat and total fat
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what htn drugs to give post-stroke pt?
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give combo of thiaz and captopril
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when do thallium scan?
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ie if pt who would normally do ecg stress test can't b/c he has baseline ecg abnormalities
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what is goal dose for beta blocker
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enough to reach hr of 50-60
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what disease may be associated w/osteoporeosis?
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Graves,
cushing's |
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only absolute c/i's to estrogen therapy for osteoporosis in postmenopauslal woman?
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abnormal genital bleeding
pt hx of br cxr pt hx of est dep cxr hx of TEmbolism disorder |
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pharm tx for acute Osteoporosis fracture iv VB fracture/ colles fracture? what other effect does this drug have?
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calcitonin
also has an analgesic effect!!! |
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to prevent relapse, ho long should tx with antidep be started for?
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6-9 months continuously
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how to distinguish anorex from bulimia?
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anorexics always have control over eating, bulemics often express lack of control during binges
(binging may be seen in anorexia subtype, so is not indicative of bulimia only) |
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major risk factor for ADHD?
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family hx of ADHD
(also OSA is a rf) |
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do most kids w/ ADHD continue w/ sx into adulthood?
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up to 60% do
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painless enlargement of thyroid after giving birth, that starts w/hyperth then leads chronic hoth in 50% of cases...no markers pos for hashimotos?
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subacute painless lymphocytic thyroiditis
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thyroid swelling, painful, after viral inf?
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subacute granulomatous thyroiditis (M/C cause of painful thyroid gland)...does not usually lead to permanent hypothyroidism
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m/c cause of goiter in states, also has pain?
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hashimotos
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gradually increasing firm, nontender thyroid
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fibrous invasive thyroiditis
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elevated TSH, T4, and T3 ?
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think Thyroid resistance (at end organs, causing entire pathway to be stimulated to be elevated)
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what tests diffs grave's disease from OTHER hyperthyroid conditions?
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AB's to Thyroid receptor
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definitive dx for a "hot nodule" after radioisotope scan?
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do FNA
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