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281 Cards in this Set

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Hep B vaccine schedule
birth
1-2 mo
6-18 mo
Is vzv more effective in over 13 or under?
under; therefore 2 doses requ'd if over 13, and given 4-8 wks apart
is zoster more common among natural infected or immunized w/ vzv vaccine?
naturally infected
hep B vaccine for?
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
when not give rubella vaccine for woman?
if preg
if planning to be preg in 4 wks.
give directly after delivery
are Td booster shots req'd for clean minor wounds?
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?
age 35 or younger if fam hx or other risk factors
when start crc screening?
age 50 or 10 y/ before age of death of family member from crc (ie if father died at 50, start at age 40)
age to start mammogram screening?
every 1-2 years starting at 40;
every 1 yr from 50 on
when start cerv cxr screening (pap smears)? when discontinue?
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
major predictors of perioperative CV risk?
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
obesity causes what adverse post operative outcomes?
Doesnt!
those that do include:
low fxnal capacity of lungs
type 2 DM
Hyperlipidemia
Congestive heart failure
pre operative creatinine levels should be takenf or whom?
surgery w/ high risk of bleeding
pt over 50
chance of hypotension
nephrotoxic meds given
age for preoperative ECG to be done?
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?
heart disease
then:
accidents,
etc
recommended prophylaxis for traveler's diarrhea?
NOT ab's but
cautionary measures
for TX, give cipro
legally required vaccines for travelers?
Yellow fever ( if going where it's endemic)
Polio (inactivated) if going where it's endemic
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?
live ones:

Yoo Must not give:

Yellow fever
Oral Polio
Oral Typhoid
MMR
if pt has contionuing elevated BP after starting combination oral contraceptives, what to do?
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?
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!
progesting-only pill and ectopic preg?
think: like IUD:
lower overall rate of ectopic preg b/c lower rate of preg; but IF preg, higher risk of ectopic
don't give IUD to whom?
woman w/ multiple sexual partners
what to give to woman over 35 smoker who wants contraception but cant have IUD b/c has multiple sexual partners?
progestin-only pill or long-acting progestin form
Does emergency contraception disrupt an already implanted pregnancy?
no...also do not cause birth defects
3 types of emergency contraception?
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)
what are contraindications to emergency contraception?
none except: allergy/hypersensitivity to pill components
Open or closed questions lead to most accurate info?
open
if pt is extremely angry, what should you say to him?
"you seem furious"
is "better" thank
you seem a little angry (may make things worse)
??
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?
Diabetes
Obesity
Suicide
Alcoholism
what type illnesses are homeless children more likely to get than normal pop?
acute ie ear infections
what ethnicity is highest percent of uninsured?
hispanics; 1/3 , and is growing
uninsured have more or less chronic health conditions?
less
mental health disorders are dx'd more or less frequently in minorities?
More, but have more misdiagnoses of mental health in minorities too due to inaccurate screening/ language barriers/ etc
tx for uncomplicated UTI ? in pregger?
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?
dementia
st john's wort is used to tx what alternatively?
depression
saw palmetto is used to tx what alternatively?
BPH - works as good as finesteride, but doesn't shrink its size
what can st john's wort cause?
serotonin syndrome if mixed w/ SSRI like paroxetine, etc
what adverse effect can gingko biloba cause?
antiplatelet and bleeding if taken with aspirin
when should you ever use fentanyl patch in pt who hasn't yet tried opoids?
never
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)
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?
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?
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?
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
prevention of pain crisis in sickle cell? tx if crisis?
maintain adequate O2 and hydration; for Tx, give analgesics and hydration too
intensely itching papules in between fingers, toes, buttocks, elbows, waist area, genital area, and under the breasts in women
scabies
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
chigger bites
diff b/w fibroadenmoas and breast cysts of fibrocystic changes?
fibroadenomas arent usually tender
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
diff b/w sx of asthma and PE in a young woman?
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
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?
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?
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
twisting of knee, + "pop" + swelling but can still bear weight?
ACL tear
direct force to knee and post drawer sign?
PCL tear
knee injury causing pain plus locking, catching, or giving way ?
= meniscus injury
knee instability + lateral/medial vallus/ valgus movement beyond expected?
lat or med COLLATERAL LIGAMENT tear
McMurray's test?
tests for meniscus tear: flex and extend knee while int/ext rotating the tibia
Ottawa ankle rules indicate xray for what findings?
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
ischemia may present as what in a diabetic?
silent mi! think about sx of diaphoresis, syncope as possible sx of MI in diabetic
when do tilt-table testing for syncope?
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
tx for vag candidiasis?
topical -azoles
m/c cause of recurrent vag candidiasis
reinfection from partner
strawberry cervix...plus yellow green frothy vag discharge?dx?
trichomonas vaginalis
moth-eaten cells (pseudo-clue cells) on vag saline prep?
acid-base disturbance of vagina
HPV genital inf...tx?
imiquimod = imodulating agent to
wheeze, slight cough, and mild fever in 18 mo old?
acute viral resp tract infection!!!!!!!!!
ONLY blitis if pt also has breathlessness
any ACUTE sob + tachypnea...what must you rule out?
PE!!
first episode of wheezing must get what in workup?
CXRAY!!
recurrent wheezing and vomiting after feeding in baby...dx?
infant GERD
test for asthma pt coming in for increased SOB despite using his asthma meds...
peak flow testing - helps monitor status of lung fxn...pfts are good but require a pft lab
decreased sexual interest..what lab test?
FREE testosterone
causes of EJAC dysfxn?
any sympathetic system antag...ie b blocker, or alpha blockers (terazosin)
tx for prem ejac? ejac dysfxn?
use something that raises threshold for orgasm...fluoxetine...
tx for erectile dysfx?
alprostadil (PGE2)
sildenafil (viagara = pde inhibitor)
tx for ejac dysfxn?
sex therapy
proven factors in substance abuse?
GENDER - men
AGE - younger
EMPLOYMENT - unemployed
EDUCATION - less eduacated
MARITAL - single status
most sensitive lab enzyme elevated in alcohol abuse?
GGT
alc abuse tx causing adverse rxn when pt drinks?
disulfiram
tx for alcohol abuse that reduces the 'reinforcing' effect of alcohol, not allowing ppl to get drunk?
naltrexone ( is also a tx for opoid abuse b/c blocks ALL opoid receptors)
intense hunger is sieen in w/drawal from what?
amphetamines
w/drawal causes irritability, anxiety, DEPRESSED mood, restlessness
cigarrettes
fastest nicotine releasing medication?
nasal spray
w/drawal is very little physiologic...- depression and extreme fatigue . psych craving
think that movie...
cocaine
opiate w/drawal sx? is it life-threatening?
sweating, tearing, then restlessness, irritability, bone pain, nausea, DIARRHEA (think heroin = constip)...abd cramps,
marijuana w/drwawal?
not clinically significant
drugs c/i'd in asthma pt?
bblockers!!!
and
aspirin (blocks pg synth)
joint aspirate in OA vs RA?
both = 2-10k wbc's
but RA = >50% PMN's,
OA = <50% PMN's
lupus joint involvement vs RA
rarely as symmetrical as RA
extraarticular involvement of RA?
nodules all over, pulm interstit disease = cough, dyspnea, vasculitis, dry eyes, mouth, etc.
tx for enviro factors of asthma?
keep humidity under 50% in house;
enclose bed spring,mattress in covers,
wash bed covers w/ hot water,
remove carpeting
if pt asthma is intolerant of s/e's of inhaled c/s's, what give?
give pt leuk inhib instead...not LA b/c LA doesnt work well unless with inhaled CS
m/c cause of lower back px in under 26 y/o's?
spondylolisthesis
eval of scoliosis in adolescent?
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)
positive straight leg raising test (px b/w30-60deg)?
Is NOT back strain (should not have pos test)
but radicular px = nerve compression
any back/joint px/injury not w/ normal xrays but not responsive to 6 wks of conservative tx...?
MRI!!
what NSIM if pt got in accident and now can't rotate head 45deg left or right?
cervical spine xrays...
first line tx for copd?
ipratropium and short acting B2Ags
give theophylline especially for what disease?
cor pulmonale ( also increases heart fxn
first lab change indicating CKD
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
when is nephrology referral indicated? when is dialysis started
stage III renal failure and below...
dialysis starts at <15 GFR
poor prognosis in pt with Primary biliary cirrhosis?
rising bilirubin levels
hepatotoxic drugs?
TAMALAN
Tca's
AntiDM drugs
Muscle relaxants
Antifungals
Lipid lowering (statins)
Anticonvulsants
NSAIDS!!!!!!
m/c cause of death in cirrhosis?
bleeding varices!!!!
absolute c/i's to liver tplant?
portal vn thrombosis,
severe medical illness
malignancy, hepatobiliary sepsis,
lack of pt understanding
hepatojug reflex description if heart failure?
heart cannot respond to incr venous return, so jug vein expands DURING and IMMEDIATELY AFTER right upper quad compressoin
NYHA classes:
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
in what class heart failure pts should you give spironolactone?
CLASS iii OR iv
if have to add a second diuretic for volume overload heart failure, what should you add?
metalozone = a thiazide
who to give hydralazine or nitrates to in heart failure?
PPL WHO CAN'T tolerate ACE I's or ARB's OR in blacks w/ stage III, IV
bblockers to be given to and will decr morbidity in what classes?
II-IV
diff b/w dementia and delirium/depression on testing?
testing = good effort w/ dementia (but wrong answers)
del and dep = poor effort on testing
early signs of dementia? later signs?
loss of conversational output; loss of memory; loss of calculating abilities and drawing...
late = loss of appropriate social behavior
regular workup for suspected dementia?
CBC, biochem, THYROID, B12, and MRI...
others if clinical presentation indicated include toxic screen, syphilis, HIV, CSF, etc
3 drugs for alzheimer's?
donepezil
galantamine
rivastigmine

may have behavioral / cognitive fxn increases, but do NOT slow the progresseion of neurodegeneration
dementia of Lewy body type? what NOT to use in tx?
= 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
how often to screen ppl for diabetes?
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
m/c cause of blindness in US?
DM retinopathy
dm retinopathy worsens w/ worsening what?
HBA1c levels
first line anit htn tx for diabetic pt?
ACE Inh
only diet that has been proven to improve glycemic control?
high fiber
what to give pt who needs more glycemic control but has renal failure?
thiazolinediones-safe for renal failure pts.
wt influences of two diabetic drugs?
thiazolinediones (rosiglitazone) may cause edema and wt gain,
incretins ie exenatide cause wt loss
onset of each insulin? peak of each?
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
longest acting insulin?how long?
ultralente =24-32 hrs
if just adding insulin to dm type II's diet b/c need further control, how much to add?
only add .1 u / kg / day
metformin's side effect...when must stop metformin in pt?
s/e = lactic acidosis.
stop if pt going under surgery or
getting any radiocontrast dye, b/c will predispose to developoing lactic acidosis
what changes occur in lipid profile during fasting?
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
smoking cessation will change what in lipid profile?
incr hdl by 5-10mg/dL
tx for flushing caused by niacin?
give niacin with aspirin..!!
which statins will cause less drug interactions?
rosuvastatin (crestor),pravastatin, and fluvastatin
how does omega 3 work?
decreases TG secretion by the liver
how do fibrates work? Niacin? Ezetemibe? bile acid sequestrant?
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)
what tests when for detecting HIV?
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
how to tx HIV pt with PCP?
give TMPSMX , AND give cs's if PaO2 drops to below 70.
signs of secondary htn?
abd /flank masses (POCD),
abd bruits (rasten)
tc/flushing/sweating (pheo)
pigmented striae (cushing's)
thyroid mass (hyperth)
absent fem pulses (coa of aorta)
routine tests for newly dx'd htn pt?
NOT thyroid...unless clinical eval indicates...
but :
Hb, Hct, K, creatinine, fasting glu, Ca, fasting lipid, urinalysis, resting ECG
what has been shown to lower the bp the MOST?
DASH diet = diet rich in fruits , vegges, in low in sat and total fat
what htn drugs to give post-stroke pt?
give combo of thiaz and captopril
when do thallium scan?
ie if pt who would normally do ecg stress test can't b/c he has baseline ecg abnormalities
what is goal dose for beta blocker
enough to reach hr of 50-60
what disease may be associated w/osteoporeosis?
Graves,
cushing's
only absolute c/i's to estrogen therapy for osteoporosis in postmenopauslal woman?
abnormal genital bleeding
pt hx of br cxr
pt hx of est dep cxr
hx of TEmbolism disorder
pharm tx for acute Osteoporosis fracture iv VB fracture/ colles fracture? what other effect does this drug have?
calcitonin
also has an analgesic effect!!!
to prevent relapse, ho long should tx with antidep be started for?
6-9 months continuously
how to distinguish anorex from bulimia?
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)
major risk factor for ADHD?
family hx of ADHD
(also OSA is a rf)
do most kids w/ ADHD continue w/ sx into adulthood?
up to 60% do
painless enlargement of thyroid after giving birth, that starts w/hyperth then leads chronic hoth in 50% of cases...no markers pos for hashimotos?
subacute painless lymphocytic thyroiditis
thyroid swelling, painful, after viral inf?
subacute granulomatous thyroiditis (M/C cause of painful thyroid gland)...does not usually lead to permanent hypothyroidism
m/c cause of goiter in states, also has pain?
hashimotos
gradually increasing firm, nontender thyroid
fibrous invasive thyroiditis
elevated TSH, T4, and T3 ?
think Thyroid resistance (at end organs, causing entire pathway to be stimulated to be elevated)
what tests diffs grave's disease from OTHER hyperthyroid conditions?
AB's to Thyroid receptor
definitive dx for a "hot nodule" after radioisotope scan?
do FNA