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547 Cards in this Set
- Front
- Back
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Basal calorie calculation
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IBW x 10
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Patient self-determination act of 1990 requires that all pts may exercise what right?
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to have an advanced directive
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best screening test for acromegaly
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somatocedine C level
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which med to be given preop for pheocromocytoma
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alpha adrenergic blocker
- phenoxybenzamine (Dibenzyline) |
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Infx associated with GB
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Campylobacter
CMV EBV HSV |
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Phenytoin ( Dilantin) O/D
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coma
unsteady gait slurred speech confusion nausea hypothermia fever hypotention resp depression tx: supportive |
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CN II
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Otic nerve
-exam visual fields -eye chart - fundoscopic eval |
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CN III
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Occulomotor
-eye movement up/down/inward -narrowing and dilation of pupils to light |
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CN IV
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Trochlear
-eye movement down/inward |
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CN V
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Tigeminal
facial sensation, chewing, crainal reflex |
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CN VI
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Abducens
-abductor muscles, outward movement |
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CN VII
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Facial
- facial expression, taste |
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Cushings Triad
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Hyperglycemia
Hypernatremia Hypokalemia |
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reed sternberg cell
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Hodgkins lymphoma
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tx of cluster H/A
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oxygen therapy
Ergotamine inhalation Sumatriptan + O2 |
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murphy's sign
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Abrupt cessation of inspiration of on palpatin of the gallbladder
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Weber
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Tuning fork to midline head
normal: there is no latealization conductive hearing loss--> lateralization to affected ear sensorineural hearing loss--> lateralization to unaffected ear |
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Rinne
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Noraml = AC > BC (2:1)
conductive hearing loss = BC>AC in affected ear Sensorineural loss = AC >BC in affected ear |
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hering-breuer reflex
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pulmonary stretch receptors in bronchial wall that prevent overdistention of lung.
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1st line tx for stress incontinence
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weight loss
kegle exercises alpha adrenergic agonist - pseudoephedrine |
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most common cause of septic joint
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gooccocol arthritis
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varacity
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duty to be truthful with the patient
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leading cause of cancer morbidity in men
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prostate CA
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leading cause of cancer morbidity in women
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breast CA
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managed care
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collaborative approach to provide health care to a DEFINED population
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case management
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collaborative process of assessment planning, facilitation to meet INDIVIDUAL's health needs
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drug fever
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has no consistent diurnal variation like bacterial fever:
lowest in the morning and highest at end of day. |
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post op fever
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give fluids + improve atelectasis
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left shift
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Neutrophils > 70%
ANC > 7,000/mm3 Bands >4% |
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(ANC) absolute neutrophil count
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ANC = WBC x neutrophil count
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uveitis
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inflammation of uveal tract
- seen in CMV, herpes, toxoplasmosis, syphillis, SLE, RA |
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which flouroquinolone should not be used for UTI
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Moxifloxacin
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acid base distrubance in pt with Pulmonary embolus
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respiratory alkalosis
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BEST way to diagnosie and quantify pulmonary HTN
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cardiac cath
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decreased ICP during intubation
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lidocaine (Xylocaine)
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obstructive lung disease
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characterized by reduced airflow rates
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restrictive lung disease
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characterized by reduced volumes
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What is the t1/2 Amiodarone
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40 days, Largest Vd
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Drug drug reaction between gemfibrozil and Statin drugs?
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Rhabdomyolysis worsens
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What is carbamazapine the DOC for?
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trigeminal neuralgia
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Rule of 9's
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9% each arm
9% head 18% each leg 18% front torso 18% back torso 1% pal 1% groin |
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Parkland formula
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fluid requirements for the first 24 hrs =
% BSA burned x 4 x KG Give 1/2 fluid over 1st 8 hours Then given 2nd half over next 16 hours |
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What is the radiographic pattern in SBO?
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horizontal pattern
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What is the radiographic pattern in LBO?
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frame pattern
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Syphlis: screening/dx
stages/Tx |
Screening --> rapid plasma reagin
Dx --> Treponemal Test primary: painless shanker, lymph nodes secondary: generalized lymphadenopathy, mascular rash on arms tertiary: granulomas, neuro s/s TX: IV PCN |
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How do you dx gonorrhea?
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Gram + dipplococci
grows on Thayer Martin or Transgrow media * CDC reportable* * Tx pt for chlamydia too* |
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Findings in SIADH
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serum osmol <270
serum Na < 135 urine osmol > 400 urine Na >20 |
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Diabetes Insipidus findings
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serum Na > 135
Serum osmol >290 urine osmol < 250 urine Na <10 Tx: replace fluid DDAVP/vasopressin |
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Acute suppurative thyroiditis
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caused by bacterial invasion with inflammation of thyroid.
s/s: unilateral neck pain with possible radiation to ear fever diaphoresis |
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Tx for malignant hyperthermia
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Dantrolene: muscle relaxent
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IV insulin rate during DKA
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0.1 units/kg/hr
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average fluid deficit in DKA
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5 liters
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Drugs that cause hypoglycemia
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Sulfonylureas
Repaglinide (Prandin) Neteglinide (Starlix) Pramlinitide (Symlin) Exenatide (Byetta) |
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Metformin is a _______ that increases _____
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Biguanide
decreases hepatic glucose release |
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Metformin is contraindicated in...
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renal dysfunction
CHF pregnancy |
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what are SE of metformin
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GI upset, D/N/V, abdominal bloating, flatulence, anorexia, lactid acidosis
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Sulfonylureas stimulate....
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insulin release
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Synthroid dosage
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1.6 mcg/kg/day
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diagnosis of pheocromocytoma
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increased urinary metanephrines
AND VMA |
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What is the dawn phenomenon?
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A morning rise in blood sugar in response to waning insulin and a growth hormone surge (that further antagonizes insulin).
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What is the somogyi effect?
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A rebounding high blood sugar that is a response to low blood sugar
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What does the serum fructosamine level measure?
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the approximate glycemic control in the past 2 to 3 week period.
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A patient in VFib is failing to convert after repeat defib attempts. Which underlying endocrine d/o most likely does this patient have?
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Cushings disease 2 to hypokalemia
hyperglycemia leukocytosis |
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How does immobility affect urine output in the otherwise health young adult?
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It increases then decreases.
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Who are candidates for DEXA screening?
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- any woman > 65, or >60 w/ increased risk factors
- any man >65 w/ increase risk factors - any pt w/ pathologic fx |
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risk factors for Osteoporosis
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Age
Female Body structure: petit/thin Ethnicity: white/asian Family Hx Meds: steroids |
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pre-renal ARF BUN/Cr ratio
is characterized by? |
wider BUN/Cr ratio
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Concomitant UTI with
nephrolithiasis is a..... |
medical emergency
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What is the most common bacterial STD in the US?
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Chlamydia
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What is the most common viral STD in the US?
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HPV
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What is the goal of HIV therapy?
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To have an undetectable viral load (this measures the actual viral replication)
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HIV pt should receive tx...regardless of CD4 count or viral load.
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with any signs of AIDS-defining illness.
AND CD4 count <350 |
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Herpes is characterized by
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grouped vesicles, characterized by serous drainage followed by crusting.
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Fever, elevated ESR, normal WBC, reduced vision, H/A, jaw claudication
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giant cell arteritis
dx: biopsy |
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arcus senilis
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a white or gray ring around the iris --> results from cholesterol deposits
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What are the 2 ways to definitively confirm H. pylori infection?
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1) fecal antigen
2) biopsy |
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Hep B susceptible
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Neg - HBsAg
Neg - anit-HBc Neg - anti-HBs |
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HBeAg positve serolgy suggests?
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A highly infectious patient.
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Thalassemia is diagnosed by?
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hemoglobin electrophoresis
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In pernicious anemia, what is elevated before serum B12 declines?
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Methylmalonic level (MMA)
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Uremic coagulopathy
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PLT inactived
tx of bleeding --> DDAVP |
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Success is indicated in what rising level, during DIC?
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Fibrinogen
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The philedelphia chromosome is associated with?
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CML chronic myelagenous lekeumia
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How is vitamin B12 deficiency best treated?
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Vitamin B12 injections weekly for 4-6 weeks
then monthly for life |
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What type of pain is seen in a tension type headache?
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pressing, non-pulsatile, bilateral pain
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Migraine without aura ususally lasts how long?
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4 -72 hours
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characteristics of migrainge H/A without aura
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unilateral location
pulsating quality aggravated by walking N/V photophobia phonophobia |
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Migraine w/out aura % of family hx
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positvie family hx in 70-90% of cases
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First line therapy for migrain H/A
MOA |
Sumatriptan
MOA--> bind to serotonin 5-HT1B and 5-HT1D receptors in cranial blood vessels (causing constriction) and inhibition of pro-inflammatory neuropeptide release. |
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prophylactic therapy for migraine H/A
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beta adrenergic antagonist
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Cluster H/A
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tendencey of h/a to occur daily in clusters/groups.
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What is the most commone type of headache?
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Tension type headache.
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How long do cluster H/A lasts?
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for several weeks to months, and then dissapear for months to years.
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"alarm clock H/A"
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Cluster Headache- commonly occurs 1 hour into sleeping
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Where do cluster H/A usually occur.
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behind the eye "hot poker"
sever pain increscendo pattern lasting 15 -3 hours. |
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Cluster H/A characteristically have what type of autonomic signs associated with them?
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Ipsilateral lacrimation, conjunctiva injection
ptosis nasal stuffiness |
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female:male ratio seen in Cluster Headaches?
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1:3 to 1:8
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% family history in cluster Headache
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20%
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Tx of cluster H/A
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100% oxygen
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What is the maximum amount one should lower the BP of a hypertensive patient?
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Decrease Bp by only 15-25% in the first 24 hours
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Which medication should improve Myasthenia Gravis symptoms?
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Edrophium (Tensilon)-->
reversible acetylcholinesterase inhibitor Prednisone 60-80mg/day 1-2 weekns Plasmapharesis or Immune globulin |
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Symptoms of Brown-Sequard's Syndrome
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-Ipsilateral loss --> motor and proprioception.
- contralateral loss --> pain and temp appreciation |
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What is the most common cause of mitral stenosis?
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rheumatic fever
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What is a favorable HDL:total cholesteral ratio?
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4.5 : 1
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Which antiarrhythmic drug mediates its effect by interferring with calcium through the SLOW CHANNEL?
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Calcium channel blocker
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What does the
a wave x wave c wave represent? |
a wave - left atrial contraction
x descent - atrial relaxation c wave - mitral valve closure (usually not visible) |
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A spontaneous pneumothorax in a menturating woman.
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catamenial pneumothorax
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Cancers associated with cigarette smoke:
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1) bladder
2) lung 3) esophageal |
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What is the initial tx for pt with pulmonary HTN?
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oxygen therapy
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What does a patient with the following suggest?
hemoptysis dyspnea fatigue lung cavitation |
Aspergilloma
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Tx option for aspergilloma?
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pulmonary resection
amphotericin B embolization of bronchial arteries |
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which factors may increase the clearance of Theophylline?
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Rifampin
smoking ETOH |
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What is Goodpasture's Syndrome associated with?
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-alveolar hemorrhage
- glomerulonephritis Antibody mediated,attacking the basement membrane. |
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How is dx made for Goodpasture's Syndrome?
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renal biopsy
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Tx of Goodpasture's Syndrome?
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- plasmapharesis
-corticosteroids - Cyclophosphamide |
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pulsus paradoxsus
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blood pressure declines as one inhales, and increases as one exhales.
seen in COPD, Asthma, tamponade, sleep apnea |
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what is the most common deep fungal infection seen in AIDS patients?
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cryptococcsis
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cystic fibrosis is diagnosed by?
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- elevated sweat chloride levels >60 mcg/L x2
- 2 CF mutations - abnormal transepithelial potential readings |
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Typical pathogens found in Cystic fibrosis?
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- Staph aureus
- H. influenzae - P aeruginosa - Burkhoderia species |
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phrenic nerve injury may cause
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unilateral diaphragmatic paralysis
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asthma induce asthma manifestations include?
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- nasal congestion
-rhinorrhea - acute asthma attack |
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What is the most common comlication of Diabetes
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retinopathy
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Obesity is defined as?
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a body mass index >20% above ideal body weight.
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What is the most common cause for abdnormal uterine bleeding in pt >40 yrs old?
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anovulation
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what is the most frequest cause of chronic hypocalcemia?
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hypoalbuminemia
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Where is the most common area of ulnar entrapment?
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the elbow
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If patient presents with tremor, ask them?
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Is it symmetrical or asymmetrical.
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Medications associated with TREMOR
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- beta adrenergic blockers
- stimulants - theophylline - lithium |
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How is a tremor associated with doing a specific task best treated?
|
with botulinum toxin -->
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symtoms of botulism
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diplopia
ptosis blurred vision dysphagia dysarthria dilated fixed pupils no fever, normal MS, normal pulse, no sensory deficits |
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How do you diagnose myasthenia gravis?
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Tensilon Test
--> edrophonium administration IV, 10mg, see if neuro function improves |
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absence of blinking signifies a problem with which CN?
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CN VII
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MCA stroke s/s
|
hemiplegia
hemianopsia parasthesia deviation of eyes toward side of lesion Broca's aphasia |
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How long does a Reversible Ischemic Neurologic Disability (RIND) occur?
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>24hrs < 3 weeks
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lab finding and diagnostic measures and treatment of choice for temporal arteritis?
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Elevated Sedimentation Rate
Artery biopsy Prednisone |
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What is a scissors gait associated with?
Describe scissors gait. |
spastic cerebal paulsy
Stiff, spastic paresis of the legs with short steps. "marionette" in appearance |
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What is hypertensive encephalopathy and key features?
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Neurologic dysfunction induced by malignant hypertension.
See in eclampsia, acute nephritis, acute crisis in essential HTN. - H/A - restlessness - seizures, - papilledema - pheocromocytoma - cushing's syndrome - renal artery stenosis |
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Which (2) medications may slow the progression of diabetic nephropathy in patients with
HTN and Diabetes? |
1) ACE inhibitors
2) calcium channel blocker |
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What medication given in the post-transplant period may contribute to hyperlipidemia?
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Corticosteroids.
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diagnosis of acute gout is made by?
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synovial fluid analysis
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the Bicepts reflex tests which segmental level of the spine?
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Cervial 5,6
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Tx options for myasthenia gravis include?
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1) Pyridostigmine (Mestinon)
2) Asathiprine (Imuran) 3) Prednisone |
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Hypovolemic Hyponatremia
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- total body water decreases
- totaly body sodium decreased to a greater extent - total extracellular body volume decreased 1) |
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Euvolemic Hyponatremia
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Total body water increases, while the total body sodium remains normal
1) |
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Hypervolemic Hyponatremia
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- Total body water incrase.
- Total body sodium increases to a greater extent. |
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Three causes of renovascular HTN
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1) fibromuscular displasia
2) vasculitis 3) atherosclerosis |
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This disease may lead to
dementia blindness aortic insufficiency |
Syphlilis
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What is the most common orgnaism in a brain abcess?
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streptococcus
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What are complications associated with MVP?
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1) severe mitral regurgitation
2) TIA's 3) arrhythmias |
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What is diastasis recti?
|
separation of the two rectus abdominis muscles
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Cuases of hypercalcemia include:
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1) Thiazide diuretic therapy
2) Hyperparathyroidism 3) Immobolization |
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Intrarenal acute renal failure is characterized by a BUN:Cr ratio of?
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20:1
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These medications are used to tx diastolic dysfunction.
|
BB: Coreg, lopressor
CCB: Cardizem |
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the most frequent complication after thoracoabdominal aneurysm repair is?
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pulmonary insufficiency
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renal tubular acidosis has which electrolyte abnormality?
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hypokalemia
|
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human chorionic gonadotropin is a tumor marker for?
|
testicular cancer
|
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What is the risk of contracting HIV from a blood transfusion?
|
1: 300,000
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What ECG finding is associated with hypocalcemia?
|
prolonged PR interval
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What is the most common serious complication after lap choly?
|
bile duct injury
|
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What is the incidence of breast cancer in women?
|
1 in 10
holy SHIT |
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What are the finding on bone marrow aspirate in pt with ITP?
|
increased number of megakaryocytes
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Before an elective splenctomy, pt should receive these immunizations....
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1) haemophilus influenzae
2) pneumococcal 3) meningococcal |
|
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What is a duodenal ulcer characterized by?
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epigastric pain that occurs 2 hours after eating, the pain is relieved with eating or taking antacids.
|
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S/S of hyperphosphatemia
|
muscle weakness
|
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which acid base abnormality is seen inCOPD pt.?
|
metabolic acidosis
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Innocent cardiac murmurs are usually....
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early to mid systolic murmurs
|
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causes of peristant hiccups include....
|
1) pericarditis
2) hiatal hernia 3) subdiaphragmatic abscess |
|
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a hepatic venous hum indicates
|
protal venous hypertension
|
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Tumor lysis syndrome is usually associated with which electrolyte abnormality?
|
hypocalcemia
|
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T/F Do you use digoxin in treating diastolic faliure?
|
False
|
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When is the epidemic period of influenza?
|
Oct- Dec
|
|
|
Incupation for chicken pox
|
10 -21 days
|
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Which immunixzation is contraindicated in pregnancy?
|
varicella
-it is live (attenuated) vaccine |
|
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Tx of a pt with ALL is at risk for?
|
Acute tumor lysis syndrome
|
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A distal bowel obstruction will cause?
|
Early distention and late vomiting
|
|
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A proximal bowel obstruction will cause?
|
Minimal or late distention with early vomiting
|
|
|
Toxic megacolon is characterized by....
|
colonic dilation of greater than 6 cm on plain films with signs of toxicity.
|
|
|
First line tx of uncomplicated Chron's disease
|
Olsalazine 500 mg
|
|
|
Diarrhea that begins 1-6 hours after ingesting food suggests...
|
staphylococcus
|
|
|
Diarrhea that begins 8-48 hours after ingesting contaminated food suggest
|
Shigella
or Salmonella |
|
|
gold standard for Cdiff
|
Cytotoxin B stool assay
|
|
|
The gastrin level will be increased with:
gastric ulcer or duodenal ulcer |
gastric ulcer
|
|
|
Oral drug that helps prevent gastric uclers with people on chronic NSAID use
|
misoprostol
|
|
|
What is the appropriate heart rate for a febrile response?
|
10 beats per min increase
for every degree over 101 |
|
|
Women who have their first term pregnancy after 30 have increased risk of....
|
breast cancer
|
|
|
At what age should these women by screened for glaucoma?
African american women? Caucasian women? |
AA: after age 40
C: after age 50 |
|
|
How long should one wait after MI to have an elective surgery?
|
6 months
|
|
|
Stats of quiting smoking
|
- 1/3 of risk for ischemic HD is elimated within 2 years of stopping smoking
- any additiona lrisk is eliminated 10-14 years after smoking cessation |
|
|
red plaques on elbows, kneews with scaliness in scap
|
psoriasis
|
|
|
Psoriasis may be associated with this type of pain....
|
psoritic arthritis and
Auspitz sign: the finding of blood droplets when scale is removed |
|
|
A macular rash that resembles pityriasis rosea
|
secondary syphyllis
|
|
|
CURB - 65 criteria
you 2 out of 5 |
Confusion
Uremia Bun > 19 Resp Rate > 30 Blood Pressure <90 Age > 65 |
|
|
All patients in the ICU with pneumonia and conincident effusions need-->
|
thoracentesis
|
|
|
When is antiretroviral therapy indicate in AIDS?
|
- CD4 count < 350
- AIDS defining illness regardless of CD4 count - pregnancyy |
|
|
What should be done for an AIDs patient whose therapy is initiated or changed?
|
Genotype and phenotype testing.
|
|
|
RA pattern of inflammation
|
symmetrical
pain in the morning Xray bilateral soft tissue swelling gentle movement may relieve pain |
|
|
This has a higher sensitivity than RF factor in the diagnosis of RA?
|
anti-CPP
It is positive in up to 40% of patients. |
|
|
Should treatment be delayed for temoral artery biopsy?
|
No the patient with elevated ESR, fever, and normal WBC, with jaw pain should immediately get Prednisone
|
|
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Pheocromocytoma S/S
|
severe attacks of H/A
palpitations, tachycardia, profuse sweating vasomotor changes, precordial or abdominal pain, irritability, increasing nervouseness. May have cardiac enlargment ******** |
|
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How do you differentiate b/w dawn phenomenom and somoggyi effect?
|
order 3 am glucose
|
|
|
This mineralcorticoid is given in adrenicortical crisis.
What are signs that the medication should be turned down? |
Fludrocortisone 05 mg three x week and titrated up slowly
Fluid overload: HTN/ edema |
|
|
Potential S/E of potassium sparing diuretics
|
1) Hyperkalemia
2) endocrine problems: gynecomastia 3) anti androgen |
|
|
What are byproducts of nitroprusside
|
thiocyanate and cyanide ions
|
|
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What drugs cause gignival hyperplasia
|
1) Phenytoin
2) Nifedipine 3) Cyclosporin |
|
|
Haldol may cause...
|
muscle spasms
|
|
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Crisis intervention is which form of prevention?
|
secondary
|
|
|
What is the BEST way to diagnose a perforated gastric ulcer?
|
CT scan
|
|
|
Duchenne's muscular dystrophy is characterized by?
|
- absence of dystrophin in muscle membrane.
-atrophy -weakness OCURRS ONLY IN MEN (usually fatal in snd 3rd decade from --> infections, cardiac, pumonary complications) |
|
|
What are argyll-robertson pupils associated with?
|
neurosyphilis
--> pupils that accomodate but don't react to light |
|
|
decerebrate rigidity manifestations include?
|
- neck extension
- rigidity of jaw - extension of elbows and pronation of arms - plantar flexion |
|
|
location of lesion with decerebrate rigidity?
|
midbrain or pons
or associated with metabolic derrangements |
|
|
Do simple partial seizure patients lose consciousness?
|
NO
|
|
|
Unsteadiness during Romberg's maneuver
with eyes open--> with eyes closed --> |
eyes open --> cerebellar lesion
eyes closed --> posterior lesion |
|
|
What is the first line tx for tonic-clonic SZ
|
depakote (valpraote)
|
|
|
Does a medulloblastoma gorw fast or slow?
|
rapidly growing tumur in cerebellum
|
|
|
where does a astocytoma grow?
|
the pineal area of the brain.
|
|
|
Most common cause of gross hematuria is men > 60
|
BPH
|
|
|
Tx of dispepsia for patient of end stage renal disease on hemodialysis?
|
aluminum hydroxide (amphojel)
|
|
|
What is the mean urinary protein excretion?
|
50 mg/d
|
|
|
Tx of hyperphosphatemia in patients with chronic renal failure?
|
calcium citrate TID
|
|
|
Most bladder carcinomas are?
|
transitional cell carcinomas
|
|
|
what is the most common pathogen in bacterial peritonitis?
|
staphylococcus epidermis
|
|
|
What is the most common cause of glumerulonephritis?
|
IgA nephropathy
|
|
|
Primary tx for uncomplicated cystitis in young woman
|
Oral flouroquinalone
(ciprofloxacin, levofloxacin, moxifloxacin, gemfloxacin) |
|
|
Management of nephrotic syndrome includes:
|
Decreasing proteinuria
- ACE inhibitors -NSAID's - dietary protein restriction |
|
|
What is the clinical presentation for pt with diverticulitis
|
LLQ abdominal tenderness
left sided tenderness on rectal exam fever anorexia constipation |
|
|
Causes of constipation include:
|
- hypercalcemia
- hypokalemia - opiotes - IBS |
|
|
What is the gold standard test for assessment of chronic hepatits patients?
|
liver biopsy
|
|
|
What is the most important lab value in pancreatitis diagnosis?
|
Amylase
|
|
|
Which med is best for pancreatitis patient for pain control?
|
Demerol --> b/c it has the least spasmodic effect on the sphincter of Oddi.
|
|
|
Carcinoid syndrome is characterized by?
|
Diarrhea
cramping with defecation Facial flushing post eating Palpitations |
|
|
What is the most common viral organism that causes diarrhea in the US?
|
Rotovirus
|
|
|
What should be given for a Hep B needle stick?
|
1) HBIG --> provides immediate passivley acquired anti-hepatits B immunity
2) hepatitis B vaccine --> offers long term immunity |
|
|
S/S of lead poisoning
|
- colicky abdominal pain
- fever - nausea - aching in arm and leg muscles (looks like bowel obstruction) |
|
|
Which test is used to diagnose pernicious anemia?
|
The Shilling Test
--> it measures the absorption of ingested radioactve cobalamin. |
|
|
Treatment of elevated homocysteine levels?
|
Folate 1mg/day
elevated levels have been associated with cardiovascular and thrombotic disease |
|
|
Tx of ITP
|
1) Steroid
2) IVIG 3) Splenectomy |
|
|
Guidelines for G-CSF therapy?
|
- hx of prolonged fever
- prolonged neutropenia - advanced malignancy - extensive chemotherapy - pre-existing neutropenia |
|
|
What is the t1/2 of Coumadin?
|
36 to 42 hours
|
|
|
Tx options for leukocytosis >100,000 in ALL patients include:
|
- leukopharesis
- chemotherapy |
|
|
Leukocytosis > 100,000
|
Is considered an oncologic emergency
|
|
|
Definition of Neutropenic fever
|
Temperature > 38.5 C orally in a patient with ANC < 1,000mL
|
|
|
Normal PSA level
|
4.0 ng/ml
|
|
|
What is the most common presenting symptom in
hemochromatosis? |
Lethargy --> seen in 90%
- abdominal pain (liver/pancreas) - bronzing of skin - SOB (CHF) |
|
|
What should be ordered for a patient suspected of hemochromatosis?
|
Transferrin saturation.
Normal level < 50% |
|
|
Recommendation for pt with Afib < 65 and no major risk factors
|
Aspirin
|
|
|
What is the equivalency of oral morphine to IV morphine?
|
3:1
|
|
|
What is the chemotherapeutic agent most commonly associated with peripheral neuropathy?
|
Vincristine
|
|
|
Hairy cell leukemia common features:
|
1) pancytopenia
2) bone marrow infiltration 3) splenomegaly |
|
|
Tx of acute hemolytic transfusion reaction: TO prevent renal failure.
|
- Sodium bicarbinate alkalizes blood to decrease renal damage.
|
|
|
Mainstay treatment for Alzheimer's
|
AChE inhibtors
(Donepezil- Aricept) (Tacrine-Cognex) |
|
|
What is the classic radiologic sign of pancreatitis?
|
air filled loops of small bowel in the LUQ
|
|
|
Which pneumonia causing organism usually follows the flu?
|
staph
|
|
|
what part of the heart does the LAD supply?
|
anterior intraventricular septum
|
|
|
urine analyisis seen in ATN
|
muddy granular casts
|
|
|
How should cat bites be tx?
|
amoxicillin/clavulenate
|
|
|
which cancer is most commonly associated with tumor lysis syndrome?
|
Burkitt's
|
|
|
pathophysiology of diverticulosis
|
increase in intraluminal pressure-->outpoaching of inner layer of colon through weakness in the wall -->
|
|
|
How much fluid is required for pleural effusion to be detected on xray?
|
250 mL
|
|
|
urine analysis of AIN
|
WBC casts
eiosinophils |
|
|
diagnostic test for ostesomyeolitis
|
MRI
|
|
|
What lab findings might suggest PCP?
|
high LDH
|
|
|
Clinical features of TTP
|
-Neuro
-Fever -Thrombocytopenia -Renal Failure hyaline microthrombi occluding small blood vesselss EMERGENCY |
|
|
Organism that causes whooping cough
|
B. pertussis
|
|
|
First test to diagnosis urinary obstruction
|
renal U/S
|
|
|
What does a normal lymph node contain?
|
- low endothelial venules
- a germinal center - primary follicles |
|
|
Common antiviral drug in AIDS tx.
AE |
AZT: Zidovudine
- bone marrow suppression - myalgia - tremors - H/A - Seizures - Nausea - Anorexia |
|
|
What viral load should you start treatment?
|
> 10,000
|
|
|
Negri bodies are pathognomic for what?
|
Rabies
|
|
|
What is the histologic marker of CMV infection?
|
Inclusion bodies
|
|
|
Donor transplant from another species is a?
|
Xenograft
|
|
|
Donor transplant from an identical twin.
|
Isograft
OR Syngraft |
|
|
Donor transplant from one individual to another from the same species.
|
Allograft
|
|
|
A graft transplant from one area of the body to another in the same individual
|
Autograft
|
|
|
The trnsfer of bacterial DNA from one cell to another by mean of virus vehicle.
|
Transduction
|
|
|
Organism in Lyme disease
|
Borrelia burgdorferi
|
|
|
What is the route of infection for cryptococcus?
|
inhalation
|
|
|
Bony enlargements of PIP seen in osteoarthritis.
|
Bouchard's nodes
|
|
|
Bony enlargements of the distal interphalangeal joints of the hands.
|
Heberden's nodes
|
|
|
Which part of the shoulder has the highest incidence of degenerative arthritis?
|
acromioclavicular joint
|
|
|
What finding supports Dx of sprained ankle?
|
inversion AND plantar FLEXION of the foot cause pain
|
|
|
After lung surgery, pt should be taght to do arm exercises to prevent?
|
adhesive capsulitis
i.e. frozen shoulder |
|
|
Characteristics of a Herniated lumbar disc
|
1) flattening of the lumbar curve
2) decreased spinal mobility 3) lumbar muscle spasm |
|
|
IV Colchicine
an anticipate adverse effect another bad AE |
anticipated: Diarrhea
Monitor for bone marrow suppression |
|
|
What is the most common cause of death in Duchenne's dystrophy?
|
Cardiomyopathy
|
|
|
Colle's fracture
|
fx of the distal radius
tx: external reduction and immobilization |
|
|
common lab finding in Multiple Myeloma
|
bence jones protein in urine
|
|
|
This is a serious complication associated with SLE that may lead to vision loss.
|
Cerebritis
|
|
|
What is found in RA synovial fluid?
|
Ragocytes
|
|
|
Golfer's elbow is....
how is pain elicited? |
inflammation of the medial epicondyle.
- by asking to raise the elbow with palms facing down |
|
|
How do you assess motor function of the ulnar nerve?
|
spreading fingers
|
|
|
most frequest part of GI tract involved in scleroderma?
|
esophagus
|
|
|
This level will be high in polymyositis
|
serum creatine kinase
|
|
|
ankylosing spondylosis is associated with which heart valve d/o
|
aortic insufficieny
|
|
|
Ectropion
|
outward turning of the eye
|
|
|
Dacryocytis
|
inflammation of th lacrimal sac
|
|
|
Opthalmic findings in cataracts..
|
cloudy view of the optic nerve and retinal vessels
- loss of red reflex |
|
|
A high cup to disc ratio seen in
|
open angle glaucoma
|
|
|
Papilledema and retinal vein occlusion may show....
|
optic disc blurring
|
|
|
Hypertenisve retinopathy occular exam associated with..
|
- cotton-wool spots
- arteriovenous nicking - copper-wire appearance - papilledema |
|
|
classic presentation of acute otitis media
|
- otalgia
- fever - hearing loss |
|
|
The treatment of choice for acute streptoccocol pharyngitis is?
|
Penicillin V 500 mg PO TID x 10 days
|
|
|
Adie's pupil
|
A tonic pupil that fails to constrict in response to accomodation or light.
|
|
|
Argyll Robertson pupil
|
A pupil that constricts in response to accomodation but NOT light
|
|
|
Horner's syndrome
|
drooping of the upper eyelid and constriction of the pupil on the effected side.
|
|
|
Blue sclerae may be associated with....
|
osteogenta imperfecta
Or iron deficiency anemia |
|
|
A symptom seen in a pt. with a blowout fracture of the orbit.
|
diplopia when looking upward.
|
|
|
What is cheilosis?
|
Reddening and cracking of one or both of the angles of the mouth.
Seen in: - folate,thiamine, iron deficiency |
|
|
Sjogren's syndrome is characterized by....
|
An autoimmune disorder with infiltration of the salivary and lacrimal galnd.
-Dry eyes - Dry mouth |
|
|
What is a dry mouth?
|
Xerostoma
associated with Sjogren's syndrome |
|
|
Organism in toxic shock syndrome
|
Staph aureas
|
|
|
Tx of toxic shock syndrome
|
Vancomycin
|
|
|
Definition of FUO
|
Fever of > 100.9 for 21 days, without a known diagnosis after 1 week in the hospital
|
|
|
Fever with bradycardia
|
usually seen in
- Typhoid - Drug induced fever |
|
|
Janeway lesions...
Roth spots... Osler nodes... |
Janeway: soles of feet
Roth: eyes Osler: fingers/hands |
|
|
Anterior hip dislocation is associated with....
Posterior hip dislocation is associated with... |
Anterior: rotated & abducted leg
Posterior: adduction with flexion, internal rotation, & leg shortening |
|
|
The oxycodone to morphine conversion =
|
1:1
|
|
|
This treats extrampyramidal side effects (muscle rigidity and hand tremors)
|
Bentropine (Cogentin)
|
|
|
Polyuria associated with Lithium is treated with.....
|
Amiloride (Midamor)
|
|
|
TCA's are contraindicated in _____patients because of their anticholinergic effects.
|
patients with narrow angle glaucoma
|
|
|
horizontal diplopia is seen in which CN?
|
CN VI
|
|
|
Which meds should be given to contacts of meningoccocal meningitis?
|
Rifampin 600 mg BID x 2 days
|
|
|
The normal intake of potassium daily
|
50-100 mEq/L daily
|
|
|
Werner's Syndrome
|
rare age of onset b/w 20-30
- DM - Bilateral cataracts - Premature aging |
|
|
Leriche's syndrome is characterized by?
|
- Claudication
- Impotence (aortoiliac occlusive disease secondary to atherosclerosis) |
|
|
thymoma is commonly associated with...
|
myasthenia gravis
|
|
|
Sarcoidosis is associated with....
|
- bilateral hilar adenopathy
- fatigue - splenomegaly - pigmented paulonodular rash - anemia - elevated LFT's |
|
|
This is the organism in walking pneumonia
Tx. |
Mycoplasma pneumonaie
Tx: erythromycin |
|
|
This is necessary in Tinea diagnosis.
|
A wood's lamp
|
|
|
Major Jones criteria for diagnosis of rheumatic fever include:
|
1) Polyarthritis
2) Carditis 3) Erythema marginatum **interesting it's not a fever** |
|
|
Tinea versicolor is caused by...
|
Pityrosporum
|
|
|
This is an acute Group A strep infection of the skin associated with an URI.
|
Erysipelas
|
|
|
This is the most common bullous disease.
|
Erythema multiforme
|
|
|
Human bite wound organism.
|
Streptococcus
|
|
|
This is the most common cutaneous skin malignancy
|
basal cell carcinoma
|
|
|
The most common cause of bloody nipple discharge
|
intraductal papilloma
|
|
|
These things predispose eldery women to UTI
|
- increased vaginal pH
- decreased vaginal glycogen - decreased functional ability - decreased bladder emptying - decreased prostatic secretions in men |
|
|
First drug of choice for depression in the elderly.
|
Desipramine (TCA)
|
|
|
Which antibiotic should be avoided in transplant?
|
Erythromycin
b/c it inhibits CYP 3A4 and increases cyclosporine levels--> toxicity |
|
|
A cardiac transplant pt with bradycardia should not get this med...
|
Atropine
b/c their heart is denervated so the medication is ineffective. |
|
|
Amiodarone may do this after cardiac transplant
|
cause bradycardia
|
|
|
Reasons for liver transplant
|
Hemochromatosis
Wilson's diease alpha 1-antitrypsin deficiency |
|
|
Hallmark of pancreatic graft rejection
|
Hypoamylasuria
|
|
|
This was the first state to recognize prescriptive authority in 1975
|
North Carolina
|
|
|
What did the Federal 1999 Balance Budget Act allow?
|
Medicare reimbursement for APRN's
|
|
|
Certification is the process of....
|
a nongovernmental agency certifies that an individual licenced to practice as a professional has met certain criteria predetermined by the standards of that profession.
|
|
|
Lisencure is the ...
|
granting of permission by an agency to individuals accountable for the practice of a profession and the forbidding of all others from doing so legally
|
|
|
Medicare part B covers...
|
outpatient prescription plans
- dental care - routine physicals - preventive care - health care provider charges - eye care |
|
|
Medicare part A covers
|
- nursing home care
- private duty nursing |
|
|
This is a health care plan where NP's and MD's are employed directly by the health plan
|
Staff model HMO
|
|
|
What are immediate adverse reactions to muromonoab-CD3 (Orthoclone OKT3)?
|
S/S analphylaxsis
- pulmonary edema - fever - rigors |
|
|
Test results seen in menopause
|
- high follicle-stimulating hormone (FSH)
- high letuenizing hormone (LH) |
|
|
At which age should all women have a baseline mammogram?
|
between age 35 - 40
|
|
|
What is the duration of treatment for prostatitis?
|
14 days
|
|
|
Reversible cardiomyopathy can be seen in which scenarios?
|
- alcohol
- pregnancy - thryroid disease - stimulant use - chronic uncontrolled tachycardia |
|
|
What is the most common type of vaginal infection?
|
bactertial vaginosis
|
|
|
Lsit the 4 diastolic murmurs
|
Mitral stenosis
Tricuspid stenosis Aortic regurgitation Pulmonic regurgitation |
|
|
List the 4 systolic murmurs
|
Mitral regurgitation
Tricuspid regurgitation Aortic stenosis Pulmonic stenosis |
|
|
Which artery could erode after tracheotomy placement
|
Innominate artery
|
|
|
What is the most common adverse effect of cyclosporine?
|
nephrotoxicity
|
|
|
What is the most common arrhythmia associated with myocardial contusion?
|
supraventricular tachycardia
|
|
|
What are the typical migraine S/S?
How long do they last? |
unilateral temporal headaches
- attacks may be precipitated by stress and foods that contain tyramine. - propanalol for prophylaxisis S/S nausea vomitting photophobia They last between 4-72 hours |
|
|
A common side effect of methotrexate?
|
bone marrow suppression
|
|
|
What is a variocele
S/S |
An abnormal enlargement of the vein in the scrotum that drains the testicles.
- aching or heaviness in the scrotum - visible or palpable vein in scrotum "like a bag of worms" |
|
|
What is the most common cause of unilateral scrotal swelling?
|
variocele
|
|
|
What are CEA measurements used for?
|
After tumor resection, the CEA marker is check to see if tumor has returned.
--> it is usually elevated in metestatic colon cancer |
|
|
What is the BEST modality for assessing renal size?
|
ultrasound
|
|
|
reed sternberg cells on biopsy indicates?
|
Hodgkin's lymphoma
|
|
|
What is the most common cause of male infertility?
|
Variocele
|
|
|
What is the joint that is most likely to be affected in DJD?
|
hip
|
|
|
What is the MOA of Aminocaproic acid (Amicar)
|
inhibits plasminogen
|
|
|
What may occur as a late complication of SAH?
|
hydrocephalus
|
|
|
What should be checked before putting a patient on lithium?
|
TFT's
|
|
|
Tx of SEVERE hyperkalemia
|
- calcium gluconate: it directly antagonizes the membrane action potential of potassium.
|
|
|
Tx of hyperkalemia with ECG changes AND circulatory compromise?
|
calcium chloride
|
|
|
What can nitroprusside do in pt. with ischemic heart disease?
|
coronary steal syndrome
|
|
|
What is the major drwaback of NTG infusion?
|
TOLERANCE
|
|
|
Tx of cardiogenic shock to help Cardiac output?
|
Dopamine
|
|
|
NTG produces what inorganic nitrate?
|
methemoglobin
ethanol propylene glycol |
|
|
In WPW syndrome, what drugs are contraindicated in the tx of Afib?
What drug should be given to tx AFib? |
contraindicated -->
- CCB and Digoxin Tx --> - electrical cardioversion OR - procainamide |
|
|
What is MAT associated with?
|
- lung disease
There are multiple p waves and variable PR intervals. |
|
|
Which pt. should NOT get adenosine?
|
Pt. with asthma.
|
|
|
Overfeeding (giving more calories) causes
|
hypercapnea in pt with lung disease
|
|
|
Causes of hyperlactatemia?
|
- thiamine deficiency
- sepsis - circulatory shock - propylene glycol - lactid alkalosis |
|
|
These (3) tests are all sensitive and specific tests to identify renal artery stenosis:
|
1) Renal arteriogram (most sen/Spec)
2) arterial digital subtraction arteriogram 3) nuclear renogram using DTPA arteriogram |
|
|
Tx of fibromuscular displasia of the renal arteries...
|
renal angioplasty
|
|
|
SE of cyclosporine.
|
HTN
increased serum Cr increased susceptibility to infx due to immuosuppression |
|
|
This electrolye abnormality can be seen with these drugs:
- ASA - NSAIDS - ACEi |
hyperkalemia
|
|
|
A persistant urinary pH < 5.0 suggests what type of urinary caliculi?
|
uric acid
or cystine stone |
|
|
A persistant urinary pH > 7.5 suggests what kind of urinary stone??
|
struvite stone
|
|
|
What is the the normal urinary pH?
|
5.58
|
|
|
What is postmenopausal bleeding and a softened, enlarged uterus consitent with?
|
endometrial CA
|
|
|
This disease is characterized by the overproduction of M protein immuneglobulins
|
multiple myeloma
|
|
|
multiple myeloma dx made by?
|
- bone marrow biopsy showing > 10% plasma cells increase
- presence on M protein in urine or serum - bence jones protein |
|
|
"punched out" lesions on bone survey
|
multiple myeloma 2/2 destructive osteolytic lesions
|
|
|
S/S of Acute Lymphocytic Leukemia (ALL)
|
** Lymphadenopathy**
- Neutropenia with circulating lymphoblasts - anemia - thrombocytopenia - hyperuricemia |
|
|
B symptoms
|
- fever
- malaise - night sweats - weight loss - pruritis |
|
|
Physical findings in Hodgkins disease
|
- lyphadenopathy
- wheezing - superior vena cava syndrome - hepatosplenomegaly - jaundice - acites |
|
|
Complications of radiation therapy:
|
- Sterility
- Myelosuppression - Hypothyroidism - Pericarditis - pneumonitis |
|
|
Complications with chemotherapy
|
- myelosuppression
- nausea/ vomiting - parasthesias - pulmonary fibrosis - cardiomyopathy - alopecia |
|
|
teardrop cells seen in
|
myeloproliferative disease
|
|
|
Faconi's anemia
|
hereditary aplastic anemia
|
|
|
What is curative in aplastic anemia?
|
Bone marrow transplant.
|
|
|
Drugs that can cause decreasd folate levels...
|
1) Phenytoin
2) Antimalarials 3) Cholarmphenicol 4) Estrogen 5) Phenobarbitol |
|
|
Peripheral smear for folate deficiency
|
megaloblastic cells
oval macrocytes |
|
|
This is an inherited red cell enzyme deficiency that causes hemolysis after exposure to oxidants or infection
S/S/ PE |
abdominal/ back pain
dark urine - infection - jaundice - splenomegaly - ankle ulcers |
|
|
lab findings for microangipathic hemolytic syndromes
|
- decreased serum Haptoglobin
- Schistocytes, helmet cell, and burr cell --> peripheral smear |
|
|
teardrop cells seen in
|
myeloproliferative disease
|
|
|
Faconi's anemia
|
hereditary aplastic anemia
|
|
|
What is curative in aplastic anemia?
|
Bone marrow transplant.
|
|
|
Drugs that can cause decreasd folate levels...
|
1) Phenytoin
2) Antimalarials 3) Cholarmphenicol 4) Estrogen 5) Phenobarbitol |
|
|
Peripheral smear for folate deficiency
|
megaloblastic cells
oval macrocytes |
|
|
This is an inherited red cell enzyme deficiency that causes hemolysis after exposure to oxidants or infection
S/S/ PE |
abdominal/ back pain
dark urine - infection - jaundice - splenomegaly - ankle ulcers |
|
|
Drugs to avoid in G6PD deficiency
|
1) Sulfa drugs
2) Primaquine phosphate 3) Quinacrine 4) Nitrofurantoin 5) Nalidixic acid 6) Pyridium |
|
|
lab findings for microangipathic hemolytic syndromes
|
- decreased serum Haptoglobin
- Schistocytes, helmet cell, and burr cell --> peripheral smear |
|
|
teardrop cells seen in
|
myeloproliferative disease
|
|
|
Faconi's anemia
|
hereditary aplastic anemia
|
|
|
What is curative in aplastic anemia?
|
Bone marrow transplant.
|
|
|
Drugs that can cause decreasd folate levels...
|
1) Phenytoin
2) Antimalarials 3) Cholarmphenicol 4) Estrogen 5) Phenobarbitol |
|
|
Peripheral smear for folate deficiency
|
megaloblastic cells
oval macrocytes |
|
|
This is an inherited red cell enzyme deficiency that causes hemolysis after exposure to oxidants or infection
S/S/ PE |
abdominal/ back pain
dark urine - infection - jaundice - splenomegaly - ankle ulcers |
|
|
Drugs to avoid in G6PD deficiency
|
1) Sulfa drugs
2) Primaquine phosphate 3) Quinacrine 4) Nitrofurantoin 5) Nalidixic acid 6) Pyridium |
|
|
lab findings for microangipathic hemolytic syndromes
|
- decreased serum Haptoglobin
- Schistocytes, helmet cell, and burr cell --> peripheral smear |
|
|
teardrop cells seen in
|
myeloproliferative disease
|
|
|
Faconi's anemia
|
hereditary aplastic anemia
|
|
|
What is curative in aplastic anemia?
|
Bone marrow transplant.
|
|
|
Drugs that can cause decreasd folate levels...
|
1) Phenytoin
2) Antimalarials 3) Cholarmphenicol 4) Estrogen 5) Phenobarbitol |
|
|
Peripheral smear for folate deficiency
|
megaloblastic cells
oval macrocytes |
|
|
This is an inherited red cell enzyme deficiency that causes hemolysis after exposure to oxidants or infection
S/S/ PE |
abdominal/ back pain
dark urine - infection - jaundice - splenomegaly - ankle ulcers |
|
|
Drugs to avoid in G6PD deficiency
|
1) Sulfa drugs
2) Primaquine phosphate 3) Quinacrine 4) Nitrofurantoin 5) Nalidixic acid 6) Pyridium |
|
|
lab findings for microangipathic hemolytic syndromes
|
- decreased serum Haptoglobin
- Schistocytes, helmet cell, and burr cell --> peripheral smear |
|
|
teardrop cells seen in
|
myeloproliferative disease
|
|
|
Faconi's anemia
|
hereditary aplastic anemia
|
|
|
What is curative in aplastic anemia?
|
Bone marrow transplant.
|
|
|
Drugs that can cause decreasd folate levels...
|
1) Phenytoin
2) Antimalarials 3) Cholarmphenicol 4) Estrogen 5) Phenobarbitol |
|
|
Peripheral smear for folate deficiency
|
megaloblastic cells
oval macrocytes |
|
|
This is an inherited red cell enzyme deficiency that causes hemolysis after exposure to oxidants or infection
S/S/ PE |
Glucose - 6 - phosphate dehydrogenase deficiency
abdominal/ back pain dark urine - infection - jaundice - splenomegaly - ankle ulcers |
|
|
Drugs to avoid in G6PD deficiency
|
1) Sulfa drugs
2) Primaquine phosphate 3) Quinacrine 4) Nitrofurantoin 5) Nalidixic acid 6) Pyridium |
|
|
lab findings for microangipathic hemolytic syndromes
|
- decreased serum Haptoglobin
- Schistocytes, helmet cell, and burr cell --> peripheral smear |
|
|
Severe scrotoal pain, relieved by elevation and fever is characteristic of what disease?
|
Epididymitis
|
|
|
What is the earliest radiographic feature of DJD?
And the other signs later in the disease? |
joint space narrowing
- virtually no space between two bones - thickened bone and bony nodules |
|
|
What does "punched out" erosions suggest on radiography?
|
late stages gout
|
|
|
Carpal Tunnel Syndrome symptoms?
What is the BEST test to confirm dx? |
burning, tingling pain that radiates up the forearm
worse when you wake up in the morning. - electromyography |
|
|
When s/o presents with lower back pain, what is the most important diagnostic tool?
|
thorough H + P, usually pain stems from musculoskeletal or radiculopathy --> so imaging is not indicated
|
|
|
What situations is it important to provide empiric antibiotics?
|
1) If there is high concurrent risk factors: such as an immunocompromised pt (neutropenia OR concomittant high - dose steroid use)
2) Situations where the pt is at risk for poor outcomes (hemodynamic instability) |
|
|
What is the most common acid-base abnormality post surgery?
Tx: |
metabolic alkalosis 2/2 fluid losses
Tx: give NS because of the losses of chloride and HCO3- will be excreted by the kidney. |
|
|
What is stocking glove parasthesia?
|
It is a common consequence of Respiratory Alkalosis
s/s hand and feet are tingling and numb Reassure the patient that the sypmtoms are 2/2 to anxiety. |
|
|
Calculation of anion gap
|
( NA+K) - (Cl+HCO3)
|
|
|
Why should chronic COPD retainers not have their CO2 corrected to normal when they are intubated and maintaine on mechanical ventilation?
|
b/c a corrected Co2 will cause a state of uncompensated metabolic alkalosis (because the bicarb was high to compensate before)
|
|
|
Dosage of N-acetylcysteine?
Time frame for administration when it is most effective? |
140 mg/kg
within 16-24 hours of ingestion |
|
|
S/S of hypercalcemia?
|
decreasing level of conciousness
lethargy |
|
|
How much does a 12 oz botlle of beer raise the blood alcohol level in a 70 kg man?
|
25mg/dL
|
|
|
What is a lethal BAC?
|
350-900 mg/dL
|
|
|
What should a pt receive to get protection from tetanus if they don't know their immune status?
|
Tetanus immune globulin (TIG 250 units)
--> to confer immediate coverage AND Tetanus toxoid (tdap) 0.5cc --> to confer long term immunity note ( pt needs Td booster every 10 years) |
|
|
Classic signs of DI?
|
- diuresis of very dilute urine
**with normal serum glucose** |
|
|
An important complication of inadequetly treated acute hyponatremia would be?
|
cerebral edema
|
|
|
What two side effects should be monitored in a patient taking ACEi?
|
Hyperkalemia
and Proteinuria |
|
|
Contraindications to DPL
(diagnostic peritoneal lavage) include: |
1) previous abdominal surgery
2) pregnancy 3) operator inexperience |
|
|
S3
|
noted with systolic dysfunction
--> CHF S3 occurs during early diastole, when blood flowing into an overfilled, non-compliant left ventricle suddenly decelerates. In patients over 40, it indicates valvular regurgitation or systolic heart failure. In young people without symptoms of heart disease, an S3 can be normal finding. |
|
|
S4
|
noted with diastolic dysfunction
--> poorly controlled HTN --> recurrent myocardial ischemia S4 is heard in late diastole, when atrial contraction pushes blood into the ventricle, and indicates the ventricle is abnormally stiff, due to hypertrophy or fibrosis. An S4 should not be present in the setting of atrial fibrillation or flutter. |
|
|
absence of blinking
|
probelm with CN VII Facial
|
|
|
CN XII
|
Hypoglossal
- tongue movement "stick out your tongue" |
|
|
Diagnostic Peritoneal Lavage (DPL)
positive result? |
+ Bile
Hct >2 ml/dl Enteric contents (food stool) RBC's >100,00/ml WBC > 500/ml Amylase > 175 IU |
|
|
CN VIII
|
Vestibulocochlear
- hearing - balance |
|
|
Pre- icteric S/S of Hep C
|
fatigue, malaise, anorexia, N/V, H/A
|
|
|
organophosphate poisoning S/S
|
THINK excessive acetylcholine:
Salvation Lacrimation Urination Defecation GI motility Emesis -blurred vision, miosis (constriction), bradycardia |
|
|
combo options for H. pylori eradication
|
One Week TRIPLE Therapy
2 antibiotics (clarithromycin & Amoxicillin) Flagyl if Pcn allergy + PPI or Bismuth |
|
|
aortic regurg
|
diastolic blowing high pitched murmur
|
|
|
mitral stenosis
|
mid-late diastolic
low rumble |
|
|
Medications to add for different stages of COPD
|
Stage 1: Albuterol (short acting bronchodilator prn) + flu vaccine + active reduction of risk factors
Stage 2: Add long acting bronchodilator Tiotropium (Spiriva) ipratropium bromide(Atrovent) salmeterol (Srevent) formoterol (Foradil) arformoterol (Brovana) and rehabilitation Stage 3: Inhailed corticosteroid Stage 4: long term O2 therapy |
|
|
COPD Stage 0: At risk
|
at risk- chronic symptoms, exposure to risk factors, normal spirometry
|
|
|
COPD Stage 1: Mild
|
FEV1/FVC <70%
FEV1 > 80% with/without symptoms |
|
|
COPD Stage II: Moderate
|
FEV1/FVC < 70%
FEV1 50-80% with/without symptoms |
|
|
COPD Stage III: Severe
|
FEV1/FVC <70%
FEV1 30-50% with/without symptoms |
|
|
COPD Stage IV: Very Severe
|
FEV1/FVC<70%
FEV1, 30% predicted plus chronic resp failure |
|
|
Conn's Syndrome
|
Hyperaldosteronism
HTN, polyuria, weakness, tetany - Hypokalemia - Alkalosis -Hypernatremia tx: adrenalectomy aldactone |
|
|
aortic stenosis
|
heard best RIS MCL, when pt is leaning forward.
systolic loud harsh crescendo-decrescendo murmur -->radiation to neck -->associated w thrill (angina caused by increased metabolic demands) |
|
|
mitral regurgitation
S/S |
holosystolic & blowing heard best at apex left lateral position
--> radiation to left axilla exertional substernal CP fatigue palpations dizziness SOB syncope |
|
|
fremitus
- decreased - increased |
decreased: pneumo
asthma emphysema increased: PNM HF Tumur |
|
|
1st line tx urge incontinence
|
bladder training
- anticholinergics - oxybutynin (Ditropan) |
|
|
RA
|
autoimmune rx in synnovial fluid --> phagocytosis--> callagen breakdown--> edema--> pannus formation
- loss of articular surface -loss of joint motion - tendon/ligament degeneration |
|
|
acute (narrow /closed) angle glacoma
Tx S/S |
Severe pain, ipsilateral h/a, blurry vision, "halos", abdominal pain, vomiting
PE: decreased visual acuity, corneal/sclera injection, cloudy cornea, mid-dialted nonreactive pupil, firm globe Elevated IOP >10-20 tx: Acetazolamide 500mg IV followed by 500mg PO topical beta blockade laser peripheral irdectomy |
|
|
Which TB med should you check visual acuity and red/green color discrimination.
And Why? |
Ethambutal (Myambutol)
b/c optic neuritis (demeilinating inflammation of the optic nerve) |
|
|
lab findings in COPD
|
chronic resp acidosis
hypokalemia hypochloremia increased serum bicarbinate |
|
|
CURB - 65 criteria
|
2-3 admit pt for PNM tx.
- confusion - uremia BUN >19 - RR > 30 - BP <90 age > 65 |
|
|
BEST way to diagnose AAA
|
spiral CT
|
|
|
What drug is used for tx of absence seizures?
|
Ethosuximide (Emeside) --> Anticonvulsent
|
|
|
A head injury patient has a BP of 120/60, ICP 18 mmHg, HR 120.
What is the CPP? |
CPP = MAP - ICP
MAP = (2 x DP) + SP / 3 CPP = 62 |
|
|
Tx options for gonococcol congunctivits
|
1) Ceftriaxone
2) Ciprofloxacin 3) Tobramycin 4) Doxycycline |
|
|
What are the medical treatments for increased intraoccular pressure?
|
Acetazolamide, timilol, apraclonidine, mannitol
|
|
|
which lipoprotein is elevated in diabetes?
|
VLDL
|
|
|
Initial test for nephrolithiasis?
|
KUB
|
|
|
Kidney stone dx confirmation with?
|
helical CT scan
|
|
|
Which regimen should be given to a pt. before cystoscopy for infectious endocarditis prophylaxis?
|
Amoxicillin 2 gram one hour before the procedure.
|
|
|
Drugs that cause SLE reaction
|
HIP
Hydralazine Isoniazid Procainamide |
|
|
S/S of drug induced lupus like reaction
|
fatigue
arthralgia (joint pain) myalgia (muscle pain) pericarditis pleuritis anti-histone antibodies |
|
|
radiographic changes of osteoarthritis include:
|
- unequal narrowing of joint space
- thick, dense, subcondral bone - bony cysts |
|
|
What are the pathologic changes is rheumatoid arthritis?
|
- Joint fluidity > 3.5cc
- Elevated serum RF - radiographic soft-tissue swelling |
|
|
This test is used to evaluate Zollinger Ellison syndrome.
|
A secretin stimulation test will show increased serum gastrin levels >200 pg.ml
|
|
|
Triptans contraindicated in which patients?
|
CAD and uncontrolled HTN
they may cause coronary spasm |
|
|
Description of Guillain-Barre Syndrome
|
acute demyelinatination of ascending peripheral nerves, resulting in progressive symmetrical paralysis.
|
|
|
Management of Guillain Barre Syndrome
|
IV immune globulin
Plasmapharesis recovery usually complete and spontaneous |
|
|
Location of injury in
Autonomic Dysreflexia Cause--> |
Injury above T6
cause--> traumatic injury |
|
|
symptoms of Autonomic Dysrelfexia
|
- exaggerated autonomic responses to a stimulus
- diaphoresis/flushing above site of injury - chills/vasoconstriction below site of injury hypertension bradycardia headache nausea |
|
|
Treatment of Autonomic Dysreflexia
|
Remove the stimulus
manage autonomic manifestations |
|
|
Findings in coarctation of the aorta...
|
Both systolic and diastolic pressures and elevated proximal to the coarctation
|
|
|
diansosis of aoritc dissection should be with?
|
MRI
95% sens / spec |
|
|
First line blood pressure control in aoritc dissection?
|
Esmolol (Brevibloc)
|
|
|
Tx for Mycoplasma pneumonia
SE of antibiotic |
Erythromycin
Macrolide Antibiotic SE: prolonged QTC induces CYP 450 GI upset |
|
|
serum cold agglutinins may be used as a diagnostic test for?
|
Mycoplasma
|
|
|
What is Q fever?
|
It is caused by Coxiella burnetti.
--> orgnaism seen in sheep, goats, cattle |
|
|
The streprococcus most frequestly associated with
Subacute bacterial endocarditis |
- Strep virdans
|
|
|
Which medication should be administered with activated charcoal?
|
magnesium citrate
|
|
|
What are the (3) cardinal signs of polycythemia vera?
|
1) increased red blood cell mass
2) increased O2 sat > 92% 3) splenomegaly |
|
|
What is a fibroadenoma?
|
IT is a painless, well-circumscribed, freely mobile lesion in the breast.
- it is common in young women and is the most frequent solid beign tumor of the breast |
|
|
These meds are associated with hyperphosphatemia
|
Neutraphos
vitamin D supplements Fleet's enema |
|
|
What are potential complications of mumps?
|
- orchitis
- deafness - encephalitis |
|
|
This is an influenzae like illness that affects pet shop owners
|
Psittacosis
|
|
|
Niacin deficiency is associated with?
|
- dermatitis
- diarrhea - delerium |
|
|
Tx of histoplasmosis
|
Amphotericin B
|
|
|
"meniscus" sign
|
This is the classic angigraphic finding in mecenteric artery occlusion 2/2 embolus
-4-6 cm from origin of superior mescenteric artery |
|
|
Primary Biliary cirrhosis is seen in ______, age ____.
what is it? |
A chronic disease manifested by cholestasis in women 40-60.
- high Alk Phos - complicated by portal HTN |
|
|
What are the most common manifestations of nicotine w/d?
|
drowsiness, H/A, increased appetite, sleep disturbance, GI complaints
|
|
|
When do nicotine w/d symptoms occur?
|
within 24hrs of stopping smoking
|
|
|
Medications for osteoporosis with established osteopenia and osteoporosis?
|
Alendronate
|
|
|
Recommended calcium intake
|
1500 mg/day
|
|
|
race with the highest incidence of prostate cancer?
|
African Americans
|
|
|
Common complaints of advanded prostate Ca include:
|
pain in the --> back, hip, bladder, perineal, rectal
PSA levels useful to check for recurrence |
|
|
Person who has been immunized against Hep B
|
+ HbsAg
|
|
|
Person who has conferred natural immunity to Hep B
|
+ HbsAg
+HbcAg +HbeAg |
|
|
Herpes zoster acute tx
Tx after acute episode has resolved? |
acyclovir or valcyclovir
- Zostivax vaccine |
|
|
What should be given to all patients with pneumococcal meningitis?
|
A dose of dexamethasone prior to, or concomitant with, the first antibiotic dose
|
|
|
Is lumbarsacral strain pain affected by position?
|
yes
|
|
|
People living in communal settings and healthcare workers, their PPD is considered positive at?
|
10 mm induration
|
|
|
Hypertensive urgency
|
Any Bp > 140/90 with progressive target oragn damage (renal dysfunction --> microalbuminuria, retinopathy, LVH)
|
|
|
Hypertensive emergency
|
Any BP > 140/90 in the setting of avut target organ dmage
i.e. (acute MI, eclampsia, dissecting aortic aneurysm, hypertensive enxephalopathy) |
|
|
Screening for SLE should begin with?
|
ANA with sensitivity of 90%...
but not specific... If patients rule in with ANA they need more confirmatory testing with --> anti-dsDNA |
|
|
What is the incubation period for Hep A?
what does the Hep A profile look like? |
+ antii-HAV IgM
+ HBsAg |
|
|
What is the incubation period for Hep B and C?
|
6 weeks to 6 months
|
|
|
S/S Hep A infection?
|
fatigue
profound nausea mild, non specific upper abdominal discomfort to palpation possibly icterus |
|
|
This predictor plus one of which 5 criteria are independant predictors of acute liver failure?
|
First: PT >100 seconds
1) age < 10 yrs or >40 yrs 2) fulminant hepatic failure 2/2 to non-A, non-B, non-C hepatitis halothane hepatitis idosyncratic drug reactions 3) jaundice present longer than 1 week before onset of encephalopathy 4) PT > 50 sec 5) serum bilirubin > 300 mmol/L (17.5 mg/dL) |
|
|
What is thoracic outlet syndrome?
|
- an abnormailty of first rib which may put pressure on subclavian artery or brachial plexus
- sensory loss or weakness in hand - color changes |
|
|
What is the most common symtom of vertibrobasilar insufficiency?
|
1) Vertigo
other symptoms - tinitus -diplopia -perioral nubmness -dysphagia -visual field disturbances -motor deficits |
|
|
normal range of CPP is?
|
50 - 130 mmHg
|
|
|
organism responsible for epididymitis
|
chlamydia trachomatis
or Neisseria gonorrhea |
|
|
What is rapidly progressive glomerulonephritis?
|
A syndrome in the kidney with rapid loss of renal function w/ usually a 50% decline in GFR (1/2 are idopahic, 1/2 are related to underlying disease: SLE)
s/s: hematuria, proteinuria, red cell casts Dx: crescent formation of renal biopsy Tx: plasmapharesis, glucoccorticoids, cyclophosphamide |
|
|
During the first 6 months after renal transplant, the most common viral infection is?
|
CMV
|
