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457 Cards in this Set
- Front
- Back
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What is Strabismus?
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ocular misalignment
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Define failure to thrive.
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1. weight below 3rd or 5th percentile, or
2. decelerations of growth that have crossed 2 major growth percentiles, in a short period |
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Most common cause of amblyopia.
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Strabismus
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Name 2 required newborn screening tests.
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PKU and congenital hypothyroidism
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Name some common newborn screening tests.
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hemoglobinopathies (sickle), galactosemia
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How do you evaluate for iron deficiency in children?
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get hemoglobin or hematocrit bt 6-12 months of age
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what is the meaning of a red reflex in an ophthalmoscopic exam of a newborn
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no cataracts or retinoblastoma
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how do you test for strabismus
what do you do if the child tests positive |
asymmetric light reflex, or
cover-uncover test child focuses on object with both eyes, then cover one eye, if the uncovered eye deviates then it is a sign of strabisumus refer to ophthalmologist asap to prevent amblyopia |
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leading cause of death in children under 1yo
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SIDS
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what is the car safety law for children
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rear-facing car seat until 1yo and weighs 20 lbs
front-facing seat btw 20-40 lbs booster seat when >40lbs, with shoulder belt |
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leading cause of death of children older than 1 yo
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accidents and injuries
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contraindications to vaccines
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hx of anaphylactic reaction to vaccine or its component (regardless if having fever or not)
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sx: nasal itching, sneezing, rhinorrhea
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allegic rhinitis
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signs: nasal turbinates swollen (boggy), pale/bluish color
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allergic rhinitis
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tx for allergic rhinitis
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antihistamines, decongestants or intranasal steroids
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complications of tx for allergic rhinitis
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excess use of decongestants can cause rebound congestion
rhinitis medicamentosa |
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name sx of allergic rhinitis
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sneezing
itching (nose/eyes/ears) rhinorrhea - thin/watery postnasal drip congestion anosmia HA earache tearing/red eyes drowsiness |
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contrast the mucous secretion of rhinitis vs sinusitis
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rhinitis - thin/watery
sinusitis - thick/purulent |
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how do you test for nasal polyps
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spray a topical decongestant, the polyp does not shrink, but the surrounding nasal mucosa does
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name some 1st gen antihistamines
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diphenhydramine
chlorpheniramine hydroxyzine |
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name some 2nd gen antihistamines
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loratadine
fexofenadine cetirizine |
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why do 2nd gen antihistamines have less sedative effects than 1st gen
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less penetration into cns
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name a decongestant and its mech of action
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pseudoephredine
alpha agonst |
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why avoid oral decongestants
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may cause tachycardia, tremors, insominia
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side effects of corticosteroid nasal sprays
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nosebleeds, pharyngitis, URI
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describe urticaria
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large, irregularly shaped
pruritic erythematous wheals |
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describe angioedema
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painless
deep subcu swelling involves: periorbital circumoral |
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describe anaphylaxis
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systemic rxn:
skin findings dyspnea visceral edema hypotension |
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immediate tx for anaphylaxis
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epi
SQ or IM |
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what is asthma
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msucle spasms
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signs/sx
asthma |
wheezing
SOB cough increase airway sections increased expiratory phase |
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what 2 major triggers of asthma
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viral infx
allrgens |
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acute relief of asthma
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beta2 agonist
albuterol |
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tx for persistent asthma
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long acting b2 agonist (salmeterol)
inhaled corticosteroids |
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bacterial conjunctivitis
name them |
staph
strep hemophilus moraxella pseudomonas |
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cause of pink eye
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adenovirus
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how is conjunctivitis spread
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by direct contact
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smoking cessation interventions
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meds: buproprion
nicotine replacement: gum, patch, inhaler, nasal spray |
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5As a physician should use to assist in smoking cessation
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ask about tobacco use
advise to quit (talk about risks/benefits) assess willingness to quit assist to quit arrange follow-up/support |
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buproprion contraindicated in what kinds of pts
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seizures
eating disorders MAO-I |
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can pregnant women use the nicotine or buproprion to stop smoking
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yes
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are physicians required to report STIs?
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YES!
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what is emancipation
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legal process to declare a person under 18 a legal adult: housing, education, healthcare, conduct
but u still cannot drink EtOH, smoke or vote |
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besides emancipation, what is another way a child may consent to receive medical care w/o parents
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"Mature Minor Doctor"
court may deem the child to be "mature" |
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what are the moral principles of ethics
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autonomy - patient choice
beneficence - do right for patient nonmaleficence - do no harm justice - be fair and nonbiased |
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reliable sign of anemia in elderly
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conjunctival pallor
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general signs of anemia
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fatigue
weaknesss dyspnea |
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general signs of vit b12 def
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glossitis
decreased vibratory/positional senses ataxia paresthesia confusion dementia pearly gray hair |
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initial workup of anemia
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cbc
peripheral blood smear retic count |
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iron panel results for iron def anemia
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low iron
low ferritin high TIBC |
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how do u confirm vit b12 def
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elevated methylmalonic acid
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other diseases or conditions causing vit 12 def
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pernicious anemia
history of gastrectomy is associated w/ malabsorption (bacterial infxn, crohn dis, celiac) |
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folate def is assoc with what condition
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alcoholism
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causes of acute diarrhea
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virus
bacteria (e coli, campylobacter, shigella, salmonella, giardia) |
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causes of chronic diarrhea
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crohns
UC gluten intolerance IBS parasites |
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bacterial causes of bloody diarrhea
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e coli
yersinia shigella e histolytica |
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stool leukocytes is indicative of what orgs
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salmonella
shigella yersinia e coli c dif campylobacter e histolytica |
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travelers diarrhea
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enterotoxigenc e coli
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campers diarrhea
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giardia
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daycare diarrhea
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shigella
giardia rotavirus |
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diarrhea from nursing homes or recent hospitalization
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c dif colitis from antibiotic use
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how do u check for c dif colitis
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stool c dif toxin
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first step in tx of diarrhea
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fluid resuscitation and electrolytes
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best way to prevent viral diarrhea
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handwashing
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tx for traveler's diarrhea
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quinolone (cipro 500mg bid)
for 1-2 days or azithromycin bactrim is more resistant now so avoid it |
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bugs in each diarrhea time course:
within 6 hours 8-12 hours 12-14 hours |
s aureus
c perfringens e coli |
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how to reduce risk of developing osteoporosis
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daily Ca2+ / Vit D
weight-bearing exercise |
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how often do u do mammograms
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start at 40
every 1-2 yrs after that |
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screening for HTN in adults
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starts at 18
measure blood pressure |
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lipid screening guidelines
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lipid screen starting at 45yo for women
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how long should HRT be used
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lowest dose
as short as possible |
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when to start screening for cervical cancer
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21
or within 3 yrs of having sex |
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how is screening for osteoporosis done
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dexa scan (bone density)
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which joint is most likely to be affected in osteoporosis
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hip
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osteoporosis is present if dexa results should a t-score is below what value
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-2.5
(2.5 SD below a young woman's) |
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how do u dx osteopenia
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dexa scan
T value = -1 to -2.5 |
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mech of injury of an ankle sprain
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inversion of ankle while plantar flexed
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most commonly injured ligament in ankle sprain
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lateral ankle more injured than medial ankle
anterior talofibular ligament |
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what is a grade 1 ankle sprain
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stretching of the ATFL
(anterior talofibular ligament) pain and swelling no mechanical instability or loss of fxn |
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what is a grade 2 ankle sprain
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partial tear of ATFL
stretching of CFL (calcaneofibular lig) severe pain, swelling, bruising mild-to-moderate joint instability, pain with weight bearing, loss of ROM |
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what is a grade 3 ankle sprain
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complete tear of ATFL and CFL
partial tear of PTFL (posterior talofibular ligament) signifcant joint instability loss of fxn inability to bear weight |
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ottawa rules
when do u perform a foot x-ray |
bony tenderness over:
navicular bone (medial midfoot) base of 5th metatarsal (lateral midfoot) unable to bear weight (immed or during exam) posterior edge or tip of medial/lateral malleolus |
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management of ankle sprain
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PRICE
protection (splint/cast) rest ice (minimize swelling/pain) compression (reduce swelling) elevation (reducing swelling) NSAIDs / acetaminophen |
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how do you test for supraspinatus injury/tear
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Empty Can Test
with arm abducted, elbow extended, thumb point down patient elevates arm against resistance |
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how do you test for infraspinatus or teres minor injury/tear
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External Rotation
with elbows at side and flexed at 90 degrees patient externally rotates against resistance |
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how do you test for subscapularis tear
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Lift-Off Test
patient places dorsum of hand on lumbar back and attempts to lift hand off of back |
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how do you test for ATFL injury or tear
(Anterior Talofibular Ligament) |
Anterior Drawer
pull forward on pts heel while stabilizing lower leg excess translation of joint suggests ATFL tear |
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how do you test for CFL injury or tear
(Calcaneofibular Ligament) |
Inversion Stress Test
invert ankle with one hand while stabilizing lower leg with other excessive translation or palpable "clunk" of talus on tibia suggests ligament tear |
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how do you test for syndesmosis injury
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Squeeze Test
examiner compresses tibia/fibula at midcalf pain at anterior ankle joint (where you're squeezing) suggests syndesmotic injury |
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how do you test for ACL injury/tear
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Lachman Test or Anterior Drawer
put knee in 20 degree flexion pull forward on upper tibia |
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howd you test for MCL injury/tear
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Valgus Stress
in full extension and at 30 degree flexion, medial-directed force on knee, lateral directed on ankle look for excess translation |
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how do you test for LCL injury/tear
Lateral Collateral Ligament |
Varus Stress
in full extension and at 30 degree flexion, lateral-directed force on knee and medial-directed force on ankle |
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according to ottawa knee rules, perform knee x-ray when....
(5 things) |
age 55 orolder
isolated patella tenderness fibular head tenderness can't flex knee to 90 can't bear weight for 4 steps (then or now, regardless of limp) |
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if x-ray of joint is normal, but symptoms persist, whats the next test
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MRI
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most common cause of persistent stiff or painful joints following sprains
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inadequate rehab
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single most important risk factor for development of skin cancer
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exposure to UV radiation (sun)
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what are risk factors for skin cancer
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prior history of skin cancer
family hx of skin cancer fair skin red/blonde hair burn easily exposure to chemicals (arsenic, radium) suppressed immune system exposure to UV radiation |
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most common type of melanoma
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superficial spreading melanoma
radial growth phase is slower than vertical phase (grows into dermis and can metastasize) |
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most common type of melanoma in the elderly and hawaii
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lentigo maligna
found on chronic sun-damaged skin (face, ears, arms and upper trunk) (however this is the least of the 4 in total) |
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most common type of melanoma in african-american and asians
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acral lentiginous melanoma
found under nails soles of feet palms of hands |
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most aggressive type of melanoma
(invasive at time of dx) |
nodular melanoma
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ABCD of Melanoma
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a - asymmetry (symm vs asymm)
b - border (defined vs ragged) c - color (uniform vs variegated) d - diameter (less vs greater than 6 cm) |
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tx for benign melanoma
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monitor
educate patient |
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tx for suspicious melanoma
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excise with 2-3 mm margin
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how do you excise malignant melanomas
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5 mm margin
if on face, refer to plastic surgeon |
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what is follow-up after excising a melanoma
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annual follow-up
observe for new/changing lesions |
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most important prognostic indicator for melanoma
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thickness of tumor
(aka breslow measurement) less than 1mm thick has low rate of metastasis |
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how to prevent melanomas
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reduce exposure to UV radiation
clothe properly sun-screen |
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describe basal cell carcinomas
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pearly papules
central ulceration multiple telangiectasias bleeds or itches |
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tx for bcc
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excision
rarely metastasizes |
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which metastasizes more: scc or bcc
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scc
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describe scc
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irregularly shaped plaques or nodules with raised borders
scaly ulcerated bleed easily |
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tx for scc
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excision
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how do you image the upper urinary tract
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IV Pyelo
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how do you image the lower urinary tract
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cystoscopy
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define microscopic hematuria
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>3 RBC per HPF
from 2-3 Ua tests freshly voided morning clean catch midstream urine |
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eos in the urine
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interstitial nephritis
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how long does exercise-induced hematuria last
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less than 72 hours
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pt with hematuria, has repeat Ua showing hematuria again, what do you do next
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full work-up
Ua microsopy of urinary sediment Ucx to r/o UTI BMP to get Cr --> focus on renal cause if elevated (May need renal bx) |
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what exactly is an IVP
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x-ray of urinary tract after administration of contrast
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CT with or without contrast to look for calculi
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non-con
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complication of CT with con or IVP
risk factor for it how do you prevent it |
nephropathy
renal insufficiency premedicate with N-acetylcysteine |
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if patient has renal insuff, whats another way to evaluate for upper urinary tract
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retrograde pyelography with renal ultrasound
place catheter in the bladder and inject contrast up ureter to kidneys |
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how do you examine for transitional cell carcinoma
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cystoscopy
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patient with hematuria, but with a thorough negative work-up
what do you do now? |
do BP measurements
Ua voided urine ctyologic studies all done at 6, 12, 24 and 36 months basically you're looking for any underlying lesions, after this if they are still asymptomatic, then no further tests required however, if they still have sx (i.e. hematuria, dysuria, develops HTN, proteinuria, casts), refer to urologist |
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is radioactive iodine therapy safe in pregnant woman
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no
radioactive isotope can cross placenta and cause fetal thyroid ablation alternative: surgical removal of thyroid |
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meds for graves
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antithyroid drugs (PTU and methimazole)
beta-blockers to counter peripheral effects these are only temporary |
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definitive tx for graves
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radioactive iodine
(destroys thyroid gland) |
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signs and sx
thyroid storm |
fever
confusion restlessness psychotic-like behavior tachycardia elevated BP dysrhythmias dyspena on exertion peripheral vasoconstriction |
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signs and sx
hyperthyroidism |
nervous
palpitations wt loss fine resting tremor dyspnea on exertion difficulty with concentration |
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50% of graves has this finding
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exophthalmos
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how do you diagnose hyperthyroidism
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low TSH
high Free T4 |
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you suspect graves dz
whats your next step |
imaging with technetium-99
its a radionucleotide scan tells you active/inactive areas usually DIFFUSE uptake |
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radionucleotide scan in thyroiditis vs graves
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graves - diffuse uptake
thyroiditis - patchy uptake |
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how does PTU and methimazole work?
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inhibits organification of iodine
PTU also prevents peripheral conversion of T4 to T3 |
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side effect of PTU and methimazole
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agranulocytosis
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is PTU and methimazole safe during pregnancy
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YES
PTU is preferred however |
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for graves, when is surgery indicated
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pregnant women
cannot tolerate side effects of PTU large goiter compressing nearby structures |
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signs and sx of hypothyroidism
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lethargy
weight gain hair loss dry skin slow mentation/forgetfulness constipation intolerance to cold depression |
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in elderly, differential dx for dementia
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alzheimers
hypothyroidism |
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side effect of PTU and methimazole
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agranulocytosis
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is PTU and methimazole safe during pregnancy
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YES
PTU is preferred however |
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for graves, when is surgery indicated
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pregnant women
cannot tolerate side effects of PTU large goiter compressing nearby structures |
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signs and sx of hypothyroidism
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lethargy
weight gain hair loss dry skin slow mentation/forgetfulness constipation intolerance to cold depression |
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in elderly, differential dx for dementia
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alzheimers
hypothyroidism |
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in women, differential dx for depression
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depression
hypothyroidism |
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physical findings of hypothyroidism
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low BP
bradycardia nonpitting edema hair thinning or loss dry skin diminished relaxation of reflexes |
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most common cause of hypothyroidism
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Hashimoto thyroiditis
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what are secondary causes of hypothyroidism
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hypothalamic or pituitary dysfxn
pts received intracranial irradiation or surgical removal of a pituitary adenoma |
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dx of primary and secondary hypothyroidism
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primary:
high TSH low Free T4 secondary: low tsh and free T4 |
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how would you distinguish between hypothalamic vs pituitary hypothyroidism
|
inject TRH
if TSH increases, its a hypothalamus problem if TSH remains low, its a pituitary propblem |
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as you age, you may need to decrease levothyroxine dosage
why? |
thyroid binding to albumin decreases b/c albumin also decreases with age
monitor TSH annually in elderly |
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you find thyroid nodules on PE
what do you do next? why? |
evaluate thyroid fxn (tsh/t4)
functional adenomas with hyperthyroidism are rarely malignant to rule out malignancy in solitary nodules |
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risk factors for thyroid malignancy
|
history of head/neck irradiation
family hx of thyroid cx cervical LA recent development of hoarseness of voice |
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tx for hyperfunctioning thyroid nodules
|
surgery
radioactive ablation |
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nonfunctioning thyroid nodules
what do you do next? |
assuming you found this nodule by ultrasound or physical exam
FNA biopsy |
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FNA of thyroid nodule is INDETERMINATE
whats the next step |
you need a definitive dx by surgery only
this is b/c indeterminate means that you cannot distinguish between follicular cell malignancy from its benign equivalent |
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tx for thyroid malignancy
|
thyroidectomy
followed by radioactive ablation |
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pregnant woman with thyroid nodule
next step? |
FNA to find out what it is
thyroidectomy is SAFE radioisotope scan is CONTRAINDICATED or just wait til postpartum period b/c thyroid cancer is relatively indolent |
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tx for GBS during pregnancy
|
penicillin
others: ampicillin, cephalothin, erythromycin, clinda |
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how to confirm rupture of membranes
|
see amniotic fluid leaking from cervix
polling of amniotic fluid in vaginal fornix Nitrazine paper - pH >6.5 in vaginal fluid ferning on dried slide |
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prolonged rupture of membranes predisposes to what
|
infection
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define first stage of labor
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contractions until complete cervical dilation
latent phase active phase - starts at 4cm |
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rate of dilatation
(epidural vs nonepidural) |
NO EPIDURAL
1.2cm / hr (nulliparous) 1.5cm / hr (parous) |
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define second stage of labor
|
delivery of fetus
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normal duration of 2nd stage of labor
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2 hours (nulliparous)
1 hour (parous) epidural can prolong these times by 1 hour |
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normal duration of 3rd stage of labor
|
30 min
|
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labor depends on 3Ps
|
power (strength of contractions)
passenger (size, lie, position) pelvis (shape and size) |
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what can cause of false-positive nitrazine test
|
semen
blood bacterial vaginosis all can elevate pH |
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how do you assess fetal well being when mother is admitted to L&D
|
fetal heart rate monitoring
with a doppler ultrasound or fetal scalp electrode (requires membranes to be ruptured) |
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what 3 things do you look at in fetal heart rate tracings
|
baseline heart rate
variability heart rate changes |
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normal baseline heart rate of fetus
|
110-160
|
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normal variability of fetus
|
3-5 cycles per minute
|
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comomn causes of decreased fetal heart rate variability
|
fetus sleeping
cns depressants (narcotic analgesics) prematurity fetal acidemia 2nd to hypoxemia |
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|
define fetal heart rate accel
|
15 beats/min
15 sec |
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what causes early decels
|
compression of fetal head
|
|
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what causes late decel
|
uteroplacental insufficiency
causes: maternal hypotension (given epidural or oxytocin) maternal HTN, DM, placental abruptio |
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what causes variable decel
|
umbilical cord compression during contractions
|
|
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what do you use to monitor uterine contractions and its strength
|
external toco
strength: IUPC (need ruptured membranres) |
|
|
giving too much oxytocin during labor can result in what consequence
|
uterine hyperstimulation
late decels |
|
|
cardinal movements during labor
|
refers to movement of fetal head
flexion internal rotation (occiput to move anteriorly - symphysis) extension external rotation |
|
|
maneuvers for shoulder dystocia
|
McRoberts Maneuver (hyperflexion)
suprapublic pressure episiotomy |
|
|
most calcium is found where in the body?
|
bones - 98% of total
bound to albumin - 1% watch out for low albumin, causing low calcium (correct for this) free - 1% (active) |
|
|
formula for corrected serum calcium
|
corrected calcium =
[normal albumin - serum albumin] X 0.8(serum calcium) |
|
|
what hormone decreases serum calcium and how?
|
calcitonin
causes increased renal excretion |
|
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what hormone increases serum calcium and how?
|
PTH
increases bone resorption by activating osteoclast promotes kidney resorption promotes GI absorption through calcitriol |
|
|
most common cause of hypercalcemia
|
hyperparathyroidism
|
|
|
signs and sx
hypercalcemia |
kidney stones
bone pain (arthritis, etc) psychic (poor concentration, weakness, fatigue) abdominal (pain, constipation, NV, pancreatitis) |
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|
first thing you look at when a pt has hypercalcemia
|
look at meds they're taking
stop the suspected med |
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if a pt has hypercalcemia, what is the next step
|
order PTH
if PTH is low, feedback loop is working fine if PTH is high or normal, feedback is not fine (primary hyperparathyroidism) |
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how do you distinguish between primary hyperparathyroidism vs familial hypocalciuric hypercalcemia (FHH)
|
FHH is a genetic disorder
measure 24-hour urinary calcium FHH: low calcium level hyperparathyroidism: normal or elevated urinary calcium |
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if hypercalcemia, if PTH is low and Ca2+ is high, what lab test do you order next?
|
PTH-rP
parathyroid hormone related peptide this is produced by cancers lung, SCC of head and neck, kidney cx |
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how does PTH-rP work
|
osteoclast bone resorption
increases calcitriol (uptake in gut) inc kidney resorption |
|
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tx for primary hyperparathyroidism
|
surgical removal of the adenoma
|
|
|
activities of daily living
|
bath
dress eat toilet continence transfer from bed to chair |
|
|
instrumental activities of daily living
|
transportation
shop cook telephone manage money take meds housecleaning laundry |
|
|
leading cause of blindness in elderly
|
age-related macular degeneration
|
|
|
what is macular degeneration
|
atrophy of cells in central macular region
leading to central vision loss |
|
|
what is glaucoma
what is responsible for the disease |
increased intraocular pressure
optic neuropathy |
|
|
most common cause of blindness worldwide
|
cataracts
|
|
|
leading cause of blindness in working age adults in US
|
diabetic retinopathy
|
|
|
what is presbycusis
how does it present |
age-related hearing loss
sensorineural hearing loss results in: high-frequency loss difficulty with speech discrimination |
|
|
what is otosclerosis
|
autosomal dominant disorder of inner ear bones
loss of conduction presents in 20-40s speech discrimination is preserved |
|
|
what is CAPD and contrast it with presbycusis
|
central auditory processing disorder
(CNS dysfxn) has difficulty understanding spoken language but hears sound well |
|
|
quick cognitive screening test for dementia
|
clock draw
three-item recall |
|
|
immunizations for ppl over 65
|
annual influenza
pneumococcal once DPT booster |
|
|
acute bronchitis
which antibiotic |
none
antibiotics has not been shown to benefit |
|
|
orgs in bacterial sinusitis (adults)
|
pneumococcus
h influenzae |
|
|
orgs in bacterial sinusitis (children)
|
pneumococcus
h influenzae moraxella catarrhalis |
|
|
tx for acute sinusitis
|
first line
amoxicillin and bactrim if fail, then 2nd line amoxicillin-clavulanic acid 2nd/3rd gen cephalo quinolones macrolides (azithro) |
|
|
common causes of pharyngitis in teens/young adults
|
group A strep
mycoplasma pneumoniae chlamydia pneumonia arcanobacterium haemolyticus |
|
|
group A strep findings
|
ABRUPT onset of sore throat/fever
tonsillar/palatal petchiae tender cevical adenopathy NO COUGH sandpaperlike rash (scarlatiniform) |
|
|
signs of
infectious mono |
cervical and generalized adenopathy
HSM atypical lymphocytes on smear |
|
|
complication of infectious mono
|
splenic rupture to trauma
restrict sports |
|
|
signs and sx
epiglottitis cause? |
stridor
drooling toxic appearance leaning forward (tripod position) H influ |
|
|
differential dx of tonsillar exudates
|
GAS
EBV mycoplasma chlamydia adenoviruses note: having tonsillar exudates does not automatically mean its bacteria vs virus |
|
|
signs and sx
peritonsillar abscess |
tonsil is pushed toward midline
uvula deviation |
|
|
tx of peritonsillar abscess
|
surgical drainage
|
|
|
causes of peritonsillar abscess
|
strep
GAS |
|
|
complications of GAS
|
rheumatic fever
glomerulonephritis toxic shock syndrome peritonsillar abscess meningitis |
|
|
does tx prevent poststreptococcal glomeruloneprhitis
|
NO
you can get it either way |
|
|
tx for GAS
|
10-day course of oral penicillin
|
|
|
what is swimmer's ear and what causes it
|
otitis externa
pseudomonas aeruginosa |
|
|
common causes of otitis media
|
s pneumo
h influe m catarrhalis |
|
|
tx for otitis media
|
aomxicillin
alternative amox/clavu bactrim 2nd/3rd gen cephalosporins |
|
|
immediate tx for chest pain
|
MONA
morphine oxygen nitro aspirin beta blocker |
|
|
how does cocaine induce angina?
|
coronary artery spasm
|
|
|
patient is on clopidogrel needs bypass surgery, what do you do next?
|
withhold clopidogrel for 5-7 days before surgery
|
|
|
what is unstable angina
what is the immediate treatment |
angina at rest
give platelet inhibitors gIIb/IIIa |
|
|
how are beta blockers helpful in MIs
|
reduces infarct size
decreases mortality reduces risk of another one |
|
|
how are ace-i helpful in MIs
|
reduces shor-tterm mortality if started within 24 hours of MI
prevents LV remodeling |
|
|
hypomagnesemia increases risk of what
|
torsades de pointes
|
|
|
what is benefit of CCB in MIs
which CCB is contraindicated in MIs |
none
nifedipine - increases mortality |
|
|
diet for MI patients
|
low saturated fat and cholesterol
|
|
|
risk factors for CAD
|
DM
HLD age HTN smoking family hx of CAD Male postmenopausal LVH homocystinemia |
|
|
why give statins right after having ACS
|
decreases incidence of major adverse cardiovascular events
|
|
|
what is goal LDL if using statins after MI
|
< 70
|
|
|
minimum duration of exercise
|
30 min
|
|
|
minimum weight reduction to get benefits
|
5% minimum
|
|
|
what is the Levine Sign
|
holding fist to chest
sign of MI |
|
|
unequal upper extremity pulses is a sign of what
|
aortic dissection
|
|
|
tx for elevated potassium
|
kayexalate
insulin retention enemas |
|
|
causes of chronic renal failure
|
DM
HTN glomerulonephritis |
|
|
drugs that affect kidney fxn
|
nsaids
aminoglycosides contrast |
|
|
in chronic renal failure, what is the first step in management
|
remove anything that reduces renal perfusion:
hypovolemia (give IV fluids) hypotension infection --> sepsis drugs that lower GFR like nsaids |
|
|
goal of BP tx in chronic renal failure
|
< 130/80
|
|
|
what med do u treat BP with in chronic renal failure
|
ace-i
add diuretic if BP still not controlled |
|
|
microscopic exam of trichomonas vaginalis
|
motile
flagellated many wbcs |
|
|
tx for trichomonas vaginalis
|
flagyl 2g one dose
and for partner as well |
|
|
signs and sx
trichomonas vaginalis |
green frothy discharge
strawberry cervix |
|
|
vaginitis with recent abx use
what org is it |
candida
|
|
|
vaginitis in a DM pt
what org is it |
candida
|
|
|
describe candidal vaginitis
|
white discharge
no odor VERY itchy involves vulvar and vaginal areas (outside and inside) |
|
|
tx for candidal vaginitis
|
single dose fluconazole
or creams/vaginal suppositories |
|
|
should you treat sexual partners of women with candidal vaginitis?
|
no, unless symptomatic
|
|
|
signs / sx
gardnerella vaginalis |
pH > 4.5
positive KOH "whiff" test (fishy odor after adding KOH clue cells on wet mount |
|
|
tx for gardnerella vaginalis
|
metronidazole or clindamycin
oral or vaginal preparations |
|
|
should sexual partners of gardnerella vaginosis be treated?
|
not necessary
as it does not reduce risk of recurrent infection |
|
|
tx for gonorrhea
|
CTX
or Cipro |
|
|
tx for chlamydia
|
doxycycline x 7 days
or azithromycin ONCE and treat partners |
|
|
what is PID
|
pelvic inflammatory disease
|
|
|
signs and sx
PID |
inflammation of any of the reproductive organs
ovaries fallopian tubes uterus cervix vagina all you need for dx: cervical motion tenderness adnexal tenderness |
|
|
tx for PID in prego woman or HIV
|
admit
parenteral abx |
|
|
complications of PID
|
recurrence
tuboovarian abscess chronic abdominal pain infertility ectopic pregnancy |
|
|
diagnostic test for lower GIB
|
colonoscopy
|
|
|
what are hemorrhoids
|
dilated veins in the hemorrhoidal plexus of the anus
|
|
|
risk factors for hemorrhoids
|
chronic constipation
straining for BMs pregnancy prolonged sitting (truck drivers) |
|
|
where do diverticula mostly occur
|
where blood vessels penetrate thru muscles of the colon
|
|
|
signs and sx
diverticulosis |
painless bleeding
|
|
|
management of asymptomatic diverticulosis
|
dietary modification
high-fiber diet |
|
|
management of hemorrhoids
|
high-fiver diet
stool softeners |
|
|
contrast diverticulitis and diverticulosis
|
itis - painful inflammation
osis - not painful |
|
|
usual location of diverticulitis
|
lower left quadrant
|
|
|
complication of diveritculitis
|
perforation resulting in:
peritonitis intraabdominal abscess |
|
|
tx for diverticulitis
|
bowel rest
abx (quinolone and metro) if perforated --> surgery |
|
|
major risk factor for IBD
|
family hx
|
|
|
IBD
besides GI, what are other common manifestations |
arthritis
|
|
|
tx for IBD
|
symptomatic therapy
antidiarrheal aminosalicylates corticosteroids |
|
|
precancerous polyps
name the 3 |
in order of increasing risk
tubular adenomas tubulovillous adenomas VILLOUS ADENOMAS |
|
|
most common causes of CAP
|
pneumococcus
others h influ moraxella catarrhalis common in very young and old |
|
|
cause of pneumonia in COPD patients
|
h influ
|
|
|
atypical pneumonia
|
mycoplasma pneumonia
chlamydia pneumoniae legionalla pneumphila common in adolescent or young adults |
|
|
risk factors for hospital acquired pna
|
intubation
NG tube preexisting lung disease multisystem failure |
|
|
orgs in hospital acquired pna
|
aerobic GM-
pseudomonas klebsiella acinetobacter GM+ cocci staph aureus |
|
|
ways to reduce intubation associated pna
|
use oropharyngeal vs naso
elevate head during feeds infection control (wash hands, alcohol based disinfectants) |
|
|
pneumonia with diarrhea
what bug |
legionella
|
|
|
pneumonia after influenza
|
staph aureus
|
|
|
abrupt onset of pna
|
pneumococcus
|
|
|
sign of focal lung consolidation
|
egophony (E to A change)
|
|
|
sign of pleural effusion
|
dullness to percussion
|
|
|
cxr
ground glass infiltrates |
pneumocystis carinii
AIDS patients |
|
|
GI aspiration usually affects what lobe
|
right lower lobe
due to branching of bronchial tree |
|
|
how to diagnose legionella
|
urine antigen testing
|
|
|
tx for pneumococcus pneumonia
|
beta lactam (ctx) or macrolide (azithromycin)
|
|
|
complications of pna
|
bacteremia
pleural effusion |
|
|
tx for pleural effusion
|
if lots of fluid, do a thoracentesis with gram stain/cx
if empyema fluid, place chest tube for drainage |
|
|
differential dx
depression |
hypothyroidism
anemia substance abuse |
|
|
tx duration for depression
|
at least 6-9 months
if recurrent depression, treat for longer |
|
|
side effects
SSRI |
sexual dysfxn
weight gain GI disturbance fatigue agitation |
|
|
side effects
TCA |
sedation
dry mouth and eyes urinary retention wt gain sexual dysfxn HIGHLY TOXIC / FATAL IN OD |
|
|
side effects
MAO-I |
drug-drug interactions
SSRI and meperidine (Demerol) |
|
|
side effect
buproprion |
seizure
contraindicated in pts with seizure disorders |
|
|
side effect
trazodone |
priapism (persistent erection)
sedation (used for insomnia) |
|
|
comorbidity of panic disorders
|
depression
|
|
|
bereavement vs depression
|
bereavement < 2 months
no suicidal ideations or psychosis |
|
|
rule out what in depressed patients
|
bipolar
ask about mania |
|
|
benefits of breast feeding
|
faster return of uterine tone (reduced bleeding)
quicker return to prepregnant wt reduced incidence ov ovarian/breast cx lower cost |
|
|
what hormonal contraception is recommended in breast-feeding women
|
progestin-only "mini-pill"
avoid combined pills b/c it interferes with milk supply |
|
|
how long does uterus take to return to prepregnant size after labor
|
6 weeks
|
|
|
white/yellow discharge in weeks following labor
|
this is normal and is called lochia
|
|
|
when does ovulation and menstruation return after pregnancy
|
for non breast feeding mothers = 3 months
longer if you are breast feeding |
|
|
common causes of postpartum hemorrhage
|
4Ts
uterine atony trauma (lacerations) retained Tissue (placenta) thrombin (coagulopathies) |
|
|
most common cause of postpartum hemorrhage
|
uterine atony
|
|
|
tx for uterine atony
|
oxytocin and bimanual uterine massage
if fails, give methylergonovine (contraindicated in pts) |
|
|
sign and sx
endometritis after labor |
postpartum fever
uterine tenderdness smelly lochia |
|
|
how do u reduce risk of endometritis
|
abx prophylaxis during delivery
cover vaginal and GI flora |
|
|
duration of maternity blues
|
gone by 10 days after labor
|
|
|
tx of depression in breast-feeding mothers
|
SSRIs
|
|
|
how soon should women be allowed to breast feed after labor
|
asap
|
|
|
what is in colostrum
|
antibodies!
|
|
|
what is mastitis?
should she stop breast feeding? |
obstruction of milk glands then becomes infected
no, keep pumping away |
|
|
how long after labor to start OCPs
|
6 weeks
3 if not breast feeding |
|
|
is depo provera ok in breast feeding women
|
yes
|
|
|
how long after labor can she resume IUD or diaphragms
|
6 weeks
get re-fitted |
|
|
what is diastolic vs systolic chf
|
systolic - dilated LV and impaired contractility
diastolic - normal LV but impaired relaxation |
|
|
sensitive and specific marker for CHF
|
BNP
> 500 |
|
|
cxr finding in CHF
|
cephalization of pulmonary vasculature
|
|
|
initial management of CHF
|
ABCs
then O2 if pulmonary edema, start diuretic |
|
|
first line tx of CHF
|
ACE-I
|
|
|
CHF
what benefits do beta blockers offer |
reduce sympathetic tone
reduce cardiac muscle remodeling |
|
|
3 meds in CHF
|
ACE-I
beta blockers diuretics |
|
|
use ccb in systolic CHF?
|
NO they are contraindicated
|
|
|
when would you use ccb in CHF
|
in DIASTOLIC CHF
promotes increased cardiac output by lowering HR allows for more ventricular filling time |
|
|
benefits of combination OCPs
|
protects against ovarian/endometrial cx
protects against iron-def anemia PID fibrocystic disease |
|
|
how do combo OCPs work
4 things |
suppresses ovulation
thickens cervical mucus retards sperm entry discourages implanation |
|
|
side effects of OCPs
|
Nausea
HA breast swelling fluid retention weight gain irregular bleeding depression |
|
|
what to do if OCP pill is missed
|
take it asap
take next dose as usual |
|
|
if two pills are missed in OCP
|
take 2 pills together 2 days in a row
and use alternative contraception for 7 days |
|
|
how long does depo-provera last
|
14 weeks
so inject every 3 months |
|
|
failure rate of spermicides
how about when combined with condoms |
20-30%
down to that of OCPs |
|
|
emergency contraception
works when taken within how many hours |
72
|
|
|
in adolescents, screen them for sports participation
what are you looking for? what are signs/sx? |
hypertrophic cardiomyopathy
murmur left sternal border accentuates with activities that decrease cardiac preload and EDV of LV (i.e standing or straining with valsalva maneuver would increase murmur; while squatting would decrease murmur) |
|
|
nonpharm tx of HTN
|
DASH
Dietary Approaches to Stop HTN high K+ and Ca2+ effective as a single agent antihypertensive therapy |
|
|
goal BP for HTN
waht about for DM pts |
< 140/90
< 130/80 |
|
|
how do you diagnose HTN
|
two PROPER measurements on two occasions
|
|
|
signs and sx
intussusception |
abdominal pain
crying (infants) periods of pain-free / no crying SAUSAGE SHAPED MASS currant jelly stool (red mucousy) |
|
|
x-ray of intussusception
|
coiled spring
|
|
|
diagnostic test for intussusception
|
barium enema
its also therapeutic |
|
|
x-ray shows perforation in intussusception
whats the next step |
surgery
|
|
|
how does vomiting present in intussusception
|
vomiting gradually becomes bilious as obstruction sets in
|
|
|
where do most intussusception occur
|
right lower quadrant
ileocecal jxn |
|
|
signs and sx
malrotation in a child |
bilious vomiting and abdominal pain
|
|
|
complication of malrotation
|
twisted bowel will become necrotic
causing fluid loss and sepsis |
|
|
imaging findings on malrotation
|
misplaced duodenum or obstruction
beaklike appearance caused by volvulus |
|
|
tx for malrotation
|
surgery
|
|
|
which objects require immediate intervention in a foreign body complication
|
batteries
if both poles touch the esophageal wall, it will conduct electricity and PERFORATE |
|
|
what is aphasia
|
cannot understand words
|
|
|
what is apraxia
|
lost of muscle coordination
cannot perform complex tasks involving muscles |
|
|
what is agnosia
|
cannot recognize common objects
|
|
|
what is pseudodementia
|
depression in the elderly which "appears" as alzheimers
|
|
|
tx for alzheimers
|
cholinesterase inhibitors
donepezil rivastigmine tacrine memantine |
|
|
what is vascular dementia
|
memory loss from STROKES
|
|
|
compare vascular with alzheimers dementia
|
alzheimers - GRADUAL
vascular - SUDDEN ONSET, STEPWISE FASHION loss as subsequent infracts occur |
|
|
signs and sx
NPH |
urinary incontinence
gait disturbance dementia |
|
|
contrast lewy body vs alzheimers dementia
|
lewy body - hallucinations early on
|
|
|
tx for obesity
|
diet AND exercise....one alone is not good enough
|
|
|
metabolic syndrome
5 things |
waist > 40 in (men) or 35 in (women)
triglycerides >150 HDL < 40 (men) and 50 (women) BP > 130/85 fasting glucose > 110 |
|
|
signs and sx
migraines |
pulsating HA
unilateral photophobia phonophobia worsens with activity multiple attacks lasting hours to days NV |
|
|
diagnosis?
headache with fundoscopic showing papilledema |
increased intracranial pressure
|
|
|
when should u image a pt with migraines
|
if he/she has "red flags":
HA with head trauma - hemorrhage sudden onset HA - hemorrhage inc severity/freq - mass/hematoma HA after 50yo - temporal arteritis, mass lesion HA in AIDS pt - meningitis HA with neck stiff - meningitis HA with focal neurol signs - stroke |
|
|
tx for migraines
|
triptans
ergotamine NSAIDs |
|
|
signs and sx
tension HA |
bilateral bandlike distribution
no aggravation with activity no NV no photophobia / phonophobia |
|
|
tx for tension HA's
avoid what |
caffeine and ergotamine drugs
|
|
|
signs and sx
cluster HA |
unilateral
orbital / supraorbital / temporal PACES AROUND - unable to find a comfortable position |
|
|
contrast cluster vs migraines
|
migraines - wants to stay in one place
cluster - PACES AROUND |
|
|
what are screening recs for lipids?
|
starting at 20yo
then ever 5 yrs after that |
|
|
how do u screen for cholesterol?
|
fasting lipid panel (total, LDL, HDL, trig)
or nonfasting total and HDL with subsequent fasting lipid panel if total is > 200 or HDL < 40 |
|
|
which class of drugs are best to lower LDL
|
statins
|
|
|
which class of drugs are best to lower Triglycerides
which have no effect on triglycerides |
nicotinic acids (niacin)
fibrates (gemfibrozil) bile acids |
|
|
side effects
niacin |
facial flushing
|
|
|
side effects
statins |
muscle pain
|
|
|
side effects
bile acids |
constipation
decreased absorption of other drugs |
|
|
contraindications
niacin |
gout
DM |
|
|
contraindications
fibrates |
severe kidney or liver disease
|
|
|
bucket-handle fracture of long bones in children
|
abuse
|
|
|
circumferential hematoma of anus of child
|
abuse
|
|
|
retinal hemorrhages in child
|
shaken baby syndrome
abuse |
|
|
describe slipped capital femoral epiphysis
|
seen in overweight pts
pain with internal rotation of hip external rotation during passive flexion |
|
|
how pts with septic hip joint position their legs
|
flex at hip
abducted externally rotated |
|
|
definitive dx of septic joint
|
joint aspiration
|
|
|
most common cause of septic joint
|
< 4 mo
GBS s aureus < 5yo s aureus s pyogenes (GAS) |
|
|
what is toddler's fracture
how do you diagnose it |
spiral fracture of tibia when twisting while foot is planted
x-ray |
|
|
congenital dysplasia of hips
pain or no pain |
painless limp
|
|
|
joint complication of viral illness
|
transient synovitis
|
|
|
lab findings on transient synovitis
|
normal WBC
normal ESR |
|
|
tx for slipped capital femoral epiphysis
|
surgical pinning of femoral head
|
|
|
causes of postop fever
|
5Ws
water - uti wind - pna wound - incisional infxn walk - dvt wonder drugs |
|
|
which drugs cause wonder drugs
|
beta lactams
sulfas heparin amphoterrible |
|
|
causes of immediate postop fever
|
malignant hyperthermia
(b/c of anesthetics halothane and succinylcholine) bacteremia |
|
|
cxr findings on postop atelectasis
|
elevated hemidiaphragm
discoid infiltrate |
|
|
what kind of pain in DVT pts
what maneuver can u use |
calf pain
homan's sign pain in calf on foot dorsiflexion |
|
|
most common cause of wheezing in children
|
bronchiolitis
(RSV) |
|
|
signs and sx
bronchiolitis |
at first, rhinorrhea/wheezing
then fever then gets worst coughing starts |
|
|
define
croup |
inflammation of subglottic region
|
|
|
signs and sx
croup |
barking cough
hoarse voice |
|
|
cause of croup
|
viral
(parainflu, adeno, RSV, rhino) |
|
|
x-ray of croup
|
steeple sign
(narrowing of subglottic region) |
|
|
tx for croup
|
supportive b/c its viral
cool-mist therapy corticosteroids |
|
|
hot potato voice
|
epiglottitis
h. influ |
|
|
x-ray of epiglottitis
|
thumb sign
|
|
|
signs and sx
IBS |
constipatio
diarrhea ALTERNATING with periods of normal bowel habits |
|
|
how to diagnose
IBS |
Rome criteria
cumulative total of 12 weeks of this: abdominal pain/discomfort, PLUS relieved with BM change in freq BMs (more or less) change in stool appearance |
|
|
IBS
alarm features |
fever
anemia wt loss > 10 lb hematochezia (BRBPR) melena refractory/bloody diarrhea fam hx of colon cx or Inflamm Bowel Dis |
|
|
IBS
no alarm features, whats the workup then |
CBC
stool hemoccult colo if > 50yo |
|
|
tx for IBS
|
antaispasmodics - dicyclomine / hyoscyamine
TCA's / SSRIs tegaserod (5HT serotonin) - constipation |
|
|
CAGE questions
|
cut drinking
annoyed guilty eye opener |
|
|
at-risk drinking
|
men < 65
more than 4 drinks / day more than 14 in a week men > 65 and ALL women more than 3 drinks per day more than 7 in a week |
|
|
how effective are antidepressants in alcoholics?
|
if depression came at same time as alcoholism, then antidepressants have NO EFFECT
|
|
|
signs and sx
alcohol withdrawal |
shake/jitters
insomnia anxiety depressed mood heart palpitations severe sx: seizures hallucinations DTs (agitation/tremors) |
|
|
tx for alcohol withdrawal
|
benzodiazpines
|
|
|
complications of long QT syndrome
|
ventricular arrhythmias
sudden cardiac death (more in females) |
|
|
how long should long QT syndrome be
|
470 msec
if over 500 msec, major problemos |
|
|
features
Marfans |
scoliosis
pectus excavatum arachnodactyly high arched palate arm span greater than height mitral valve prolapse aortic aneurysm rupture |
|
|
tx for SVTs
|
carotid sinus massage
valsalva maneuver cold applications to face adenosine |
|
|
tx for local reactions of insect stings
|
supportive
ice antihistamine for itching tetanus prophylaxis if not vaccinated |
|
|
tx for delayed reaction to bee sting
|
oral steroids
tetanus prophylaxis |
|
|
tx for anaphylaxis of bee sting
|
sq or IM epi ASAP
antihistamine bronchodilators |
|
|
tx for animal bites
|
irrigate and debride it
abx for 3-5 days (amox-clav) if celllulitis - abx for 7-14 days hospitalization for more severe |
|
|
thrombolytic therapy should be started within how many hours after onset of stroke
|
3 hours
|
|
|
waht sign tells you a stroke has affected the dominant hemisphere
|
aphasia
(middle cerebral artery) |
|
|
what tests to order in a stroke pt
|
head CT noncon
EKG (MI may cause stroke) |
|
|
goal BP for stroke
|
< 185/110
|
|
|
how to prevent another stroke
|
stop smoking
drinks less treat HLD antiplatelets (aspirin) |
|
|
signs and sx following initial exposure to HIV
(6-8 weeks following exposure) |
low-grade fever
fatigue myalgias |
|
|
why do you get the symptoms of HIV?
|
seroconversion
development of antibodies to virus |
|
|
lab definition of AIDS
|
CD4 < 200
any AIDS defining illness |
|
|
prophylaxis for what when CD4 dips below 200
|
pneumocystis
bactrim |
|
|
prophylaxis for what when CD4 dips below 50
|
MAI
azithromycin |
|
|
in hyperbilirubinemia, what urinarlysis results do you get
|
elevated bilirubin in CONJUGATED because it gets excreted in urine
unconjugated is not excreted |
|
|
what is gilbert syndrome
|
unconjugated hyperbilirubinemia
|
|
|
marker for hepatitis contagiousness
|
surface antigen
|
|
|
markers for acute viral hepatitis
|
IgM to core antigen
surface antigen |
|
|
definition of chronic viral hepatitis
|
surface antigen
but no IgM to core antigen |
|
|
lab findings in alcohol abuse
|
AST >>>> ALT
200 : 1 |
|
|
how do you test for h pylori
|
urea breath test
stool antigen test serum antibodies |
|
|
in a patient with new onset dyspepsia, when should you do an upper gi endoscopy
|
wt loss
progressive dysphagia recurrent vomiting GI bleed FAMILY HX OF CANCER |
|
|
risk factors for PUD
|
h pylori
NSAID smoking personal/family hx of PUD |
|
|
in a pt over than 50 who has PUD or melena, what else should you do besides upper endoscopy
|
colonoscopy
r/o cancer |
|
|
signs and sx
roseola |
fever comes then goes
then rash: trunk --> arms |
|
|
waht causes roseola
|
HHV6
|
|
|
tx for roseola
|
nothing
limited |
|
|
dewdrops on a petal
|
chickenpox
|
|
|
diagnosis for chickenpox
|
tzanck smear
|
|
|
tx for chickenpox
|
acyclovir
valacyclovir |
|
|
complication of parvovirus B19 in pregnancy
|
fetal hydrops
abortion |
|
|
describe skin findings of neisseria meningitis
|
erythematous maculopapular
then becomes petechiae |
|
|
describe skin findings on rocky mountain spotted fever
|
maculopapular rash starts on WRISTS and ANKLES
|
