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159 Cards in this Set

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  • Back
What provides immediate passive immunity?
Immune globulin.
What does it mean when HBsAG is positive?
Infection with Hep B.
If a child is born to a mother positive for Hep B what should be administered to the child?
Hep B vaccin and Hep B immune globulin. **** (This baby will need a special dose of Hep B)
What do you see with anticholergic overdose?
Blind as a bat, mad as a hatter, red as a beet, hot as hell, dry as a bone, the bowel and bladder lose their tone, and the heart runs alone.
Seen with antihistamines, antiparkinsons. antidepressants, scopolamine, atropine, etc.
First line therapy for acne vulgaris?
Benzoyl peroxide
What is a major side effect of Retin A
sensitive to sun
How long does it take to see improvement in acne when treating with oral antibiotics?
6-8 weeks. Needs new layer of skin (entire dermal turnover cycle)
When is accutane indicated?
Cystic lesions that have shown minimal to no improvement with other treatment modalities.
What precautions need to be taken with female patients when prescribing accutane?
Regularly monthly visits, pregnancy testing, 2 forms of birth control, and informed consent.
What is a serious concerning side effect of Accutane?
Risk for sucicide. Must carefully monitor mood with this medication as per FDA.
What is the CRAFFT screening test for?
Adolescent susbtance abuse. Car, relax, alone, forget, family and trouble. Yes to 2 answeres is a problem.
What does the hemogram look like in iron deficiency anemia?
Microcytic and hypochromic.
Small due to lack of hemoglobin and pale from the same.
What is the ratio of Hemoglobin to Hematocrit?
1:3
What should you suspect when you see (sudden) confusion and incontinence in an elder?
UTI or urosepsis
What is active immunity?
Resistance developed in response to an antigen (infecting or vaccine) and usually characterized by the presence of an antibody produced by the host.
Ex) contract the disease or vaccine
What is passive immunity?
Immunity conferred by an antibody produced in another host, acquired naturally by an infant from mother or artificially by administration of an anitbody-contiang preparation (antiserum or immune globulin)
Ex) mother to baby or IgG
What vaccines are contraindicated with a allergy to baker's yeast?
Hepatitis B
What vaccines are contraindicated with a allergy to Egg?
Influenza - nasal spray and injected
When should epinephrine be given for an anaphylactic reaction?
SC or IM every 5 minutes if symptoms persist or increase. Anaphylaxis often has a biphasic response.
What is the CAGE questionaire?
Alcohol screening.
Cut down. Anooyed by your drinking. Guilty. Eye-opener.

Positive reponse to 3 items + problem
What is causes AST elevation?
Alcohol, statins, tylenol
What causes ALT elevation?
Avandia/Actos, liver and toxins
When you see elevated AST and macrocytosis, what should you suspect?
When AST level is elevated with normal ALT level, coupled with mild macrocytosis (MCV > 100 fL, seen in about 30% to 60% of men who drink five or more drinks per day and in women at a threshold of three or more drinks per day), long-standing alcohol abuse is the likely cause.
How do you calculate a pack year history?
number of packs per day multiplied by the number of years smoked
Who has more completed acts of suicide, males or females?
males
Who attempts suicide most often?
females
Completed suicide is most common in elder or youth?
Elder
How should you begin a sentace when using theraputic communication techniques?
"I"
I am here to help you
I am concerned
How to we screen for colorectal cancer?
colonoscopy q10 years and annual FOB after age 50.
Depending on risk factors may need to start before age 50 and screen more often depending on disease entitity and degree of history.
When should DRE exam routinely be preformed?
Not currently supported by ACS.
Otherwise routinely done in med starting at age 50 years annually.
What is erythropoiesis?
Is the process by which red blood cells (erythrocytes) are produced. It is stimulated by decreased O2 in circulation, which is detected by the kidneys, which then secrete the hormone erythropoietin, which further stimulates the production of RBC's.
Where does erythropoetin come from ?
90% renal 10% hepatic
Decreased in advanced renal failure when GFR<49
What is a reticulocyte?
Immature red blood cell.
See elevated in reponse to anemia.
Absence of this response = inadequate bone marrow.
What remains unaffected by hydration status... Hemoglobin or hematocrit?
Hemoglobin
What is the ratio of hemoglobin to hematocrit?
1:3
What are the causes of anemia?
1- blood loss (acute-hemorrhage & chronic- erosive gastritis, menorrhagia)
2- decreased RBC production (lack of b12, folic acid, iron, bone marrow suppression, or anemia of chronic disease)
3- premature destruction of RBC's (hemolysis, decreased life span)
What is the normal blood volume in an average human being?
5L
What is the average life span of an RBC?
90-120 days
What is MCV?
Mean corpuscle volume. Normal value is 80-96. It describes the average size of the red blood cell
What is MCH?
Mean cell hemoglobin.
Normal 31-37.
Describes the color of the RBC (aka the hemoglobin because that's what gives it it's color)
What is RDW?
RBC distribution width.
If high means that the new cells are different from the old cells.
Abnormal at > 15%.
Earliest sign of evolving anemia.
What is the reticulocyte count?
A normal response to anemia in an attempt to correct the loss by increase the amount of new RBC's.
What are the most common causes of erosive gastritis?
ASA, steriods, ETOH & Stress
What ethnic groups are at risk for ALPHA Thalassemia minor?
African and Asian
What ethnic groups area at risk for BETA thalaseemia minor?
Afreican , Mediterranean and Middle Eastern
What is Thalassemia?
Anemia of genetic origin that results in reduced rate of synthesis or no synthesis of one of the globin chains that make up hemoglobin. This can cause the formation of abnormal hemoglobin molecules, thus causing anemia, the characteristic presenting symptom of the thalassemias.
PROBLEM IN THE PRODUCTION OF HEMOGLOBIN!
Sometimes treated with Chelation or blood transfusion.
What is Thalassemia?
Anemia of genetic origin that results in reduced rate of synthesis or no synthesis of one of the globin chains that make up hemoglobin. This can cause the formation of abnormal hemoglobin molecules, thus causing anemia, the characteristic presenting symptom of the thalassemias.
PROBLEM IN THE PRODUCTION OF HEMOGLOBIN!
Sometimes treated with Chelation or blood transfusion.
Which type of anemia is nomocytic, normochromic and normal RDW?
Blood loss. Most commonly hemorrhage, or anemia of chronic disease.
What type of anemia is microcytic, normochromic with elevated RDW?
Iron deficiency. Cells are small and pale, and new cells are smaller that the old. Chronic blood loss as well- b/c no hemoglogin available as it is not being recycled. Therefore, new cells are small because being created withinsufficient hemoglobin.
What type of anemia is microcytic, hypochromic, with and normal RDW.?
Thalassemia. Small pale cells that are the same size to due genetics (all the cells are being produced the same way)
What is pernicious anemia?
lack of intrinsic factor which leads to impaired intestinal absoprtion of b12 and therefore anemia. Macrocytic, normochromic, with increased RDW.
What type of anemia is macrocytic, normochromic with and increased RDW?
B12, folic acid (folate or b9) or pernicious anemia. Really big cells are seen because DNA syntheisis goes unchecked and develops really large cells.
What is the most likely cause of an elevated MCV, in absence of anemia?
Drug induced. Tegretol, Dilantin, Depakote, ETOH or AZT. Reversible upon stopping medication but it is not an idication to do so.
What is Epoetin (EPO, Procrit)?
Treatment for anemia, particularly in advanced kidney disease.
What is the most common type of anemia in childhood?
Iron deficiency
What is the most common type of anemia during pregnancy?
Iron deificiency
What is the most common type of anemia in childbearing years?
Iron deficiency
What is the most common type of anemia in elderly?
Anemia of chronic disease and then iron deficiency is #2.
What is the most important source of the body's iron supply?
Recycled iron contents from aged red blood cells. 80%
You advise a person who is a vegan to supplement their diet with what?
Vitamin b12.
Plenty of A and folic acid in fruits and veggies.
A 78 year old woman presents with fatigue, spoon shaped nails, and the following labs:
hg-9 rbc-2.4 mcv-70 rdw-19%. A critical diagnosis to consider is.....
Gastrointestinal blood loss.
Signs of pernicous anemia?
Triad of paraesthesias, sore tongue and weakness, this is not the chief symptom complex. The patient may complain of fatigue, depression, forgetfulness, difficulty concentrating, low-grade fevers, nausea and gastrointestinal symptoms (heartburn), weight loss. Because PA may affect the spinal cord, the patient may also complain of impaired urination, loss of sensation in the feet, unsteady gait, weakness, and clumsiness. Anemia may cause tachycardia (rapid heartbeat) and cardiac murmurs, along with a waxy pallor. In severe cases, the anemia may cause evidence of congestive heart failure.
In evaluating a person with a microcytic anemia, the next step in the lab testing includes a serum _______.
Ferritin level. This will reflect the iron stores.
What test is run when suspecting hemolytic anemia?
Haptoglobin.
Binds to hemoglobin in recycle process so doesn't send hemoglobin to kidney. The hemolysis shows an elevation in this.
When are the signs and symptoms of anemia very profound?
When HgB is less than 8
Name a macrocytic anemia?
B12
What is a hemic murmur?
Cause by disturbances from anemia. Resolves with treatmemt of anemia. May also be caused by thyroids, fever, and 3rd trimester pregnancy (hemodilution).
What is Cooley anemia?
Thalassemia MAJOR. Don't often survive childhood with this. requires transfusions.
What is an important aspect to remember about a pt with alpha thalassemia minor?
Genetic couseling prior to pregnancy. Alpha male with an alpha female has 1 in 4 chance of having baby with thal MAJOR. Difference from MAJOR = 4 genes, MINOR - 2 genes.
Has a very high stillbirth rate.
3 macrocytic anemias
1- b12
2- folate, b9 folic acid
3- pernicious
What does anemia of chronic disease look like on hemogram?
Normochromic, normocytic, normal RDW low RBC, hg/hct
What does it mean if the reicutulocyte count in low?
The body is make no attempt to correct the anemia or insult.
What does the hemogram look like in iron deificiency anemia?
Microcytic, hypochromic, increased RDW, low hg, hct and rbc.
How should iron pills be taken?
On empty stomach.
Do not mix with metals- AL, MG & CA because they wil chelate each other.
What is leukemia?
Monoclonal disorder with progressive accumulation of functionally incompetent lymphocytes.
What are the symptoms of leukemia?
Insidious onset, occasionally diagnosis is made as an incidentallaboratory finding.
Fatigue, Predisposition to repeated infection (pneumonia, herpes
simplex, herpes zoster), Pallor, Early satiety, abdominal discomfort if splenomegaly, Mucocutaneous bleeding, petechiae if thrombocytopenia, Localized or generalized lymphadenopathy (usually not as pronounced as with lymphoma),Splenomegaly (30-40%)
What lab value is elevated in leukemia?
WBC >50,000
Symtomatic @ 200,000-1,000,000
What is non-hodgkins lymphoma?
Tumors originating from lymphoid tissues, primarily lymph nodes. Progressive clonal expansion of B cells or T cells and/or natural
killer (NK) cells. Viral, genetic factors implicated
Signs and symptoms of non-hodgkins lymphoma?
* Painless Lymphadenopathy!!!
Presentation variable but usually includes:
Slowly progressive, painless peripheral most common,
with spontaneous node regression possible
Splenomegaly in ~ 40%
Hepatomegaly
Fever, night sweats, weight loss, fatigue, malaise not
common in early disease but can be seen in advanced
disease.
What lab values are elevated in non-hodgkin's lymphoma?
Anemia, thrombocytopenia, elevated lactate dehydrogenase.
What is the difference between Hodgkins and Non-Hodgkins?
Both are in the lymphocytes the difference is the lymphocyte involved.
Hodgkin's- Reed Sternberg cells, less common, and more sensitive to radiation.
Non HL- Most common, and grows more aggressively.
what are the second generation antihistamines?
Loratadine (claritin), desloratadine (clarinex), zyrtec, allegra

have drying anticholinergic effect
What kind of cancer do you suspect in pt with 60 pk year history and firm non-tender madibular node?
Squamous cell carcinoma.
90% of oral cancers are SCC.
What does cranial nerve I innervate?
olfactory.
test by smell
What does cranial nerve II innervate?
Optic
test with visual acuity
What does cranial nerve III innervate?
Oculomotor
Test with EOM.
"keeps your eyelid open"
Innervates most EOM's
What does cranial nerve IV innervate?
Trochlear
Test EOM.
Superior oblique
"cross eyes"
What does cranial nerve V innervate?
Trigeminal
Test chew, mouth, face, touch and pain. Test 3 areas on forehead, cheek and chin to evaluated bilateral sensation.
What does cranial nerve VI innervate?
Abducens
Test EOM
Lateral eye movement
What does cranial nerve VII innervate?
Facial
Test facial expressions.
Tears, saliva and taste.
What does cranial nerve VIII innervate?
Acoustic
Hearing, equlibrium sensation
What does cranial nerve IX innervate?
Glossopharyngeal
Taste, caroptid blood pressure.
What does cranial nerve X innervate?
Vagus
Blood pressure, heart rate, digestion and taste.
What does cranial nerve XI innervate?
Accessory
Swallowing and head and neck movements.
What does cranial nerve XII innervate?
Hypoglossal
Tongue movements
When do you see papilledema?
Late manifestation of increased intracranial pressure- appears as bulging disc (opposite of appearance of glaucoma)
When do you see hemorrhagic lesions in the eye?
DM, HTN, and head trauma
What are the layers of the skin?
Epidermis- outer layer, protects, has keratin and melanocytes
Dermis- connective tissue, glands, folicles and nerve endings
Hypodermis-anchors skin to unerlying structure (bone/muscles)
What is vitiligo
autoimmunity against melanocytes
Seen with RS, lupus, DM and other autoimmune diseases.
Flat nonpalpable area of skin discoloration. >1 cm
What is a plaque?
rasied lesion, same of different color from surrounding skin can resutl from a coalescence of papules
ex. psoriasis
What type of skin lesion would a frecle be?
Macule- totally flat, non-palpable discoloration
What are purpura?
Flat red-purple discoloration cuased by RBC"s lodges in the skin.
if <1cm = petechaie
usually cause = thrombocytopenia (acute leukemia, meningitis)
Do purpura blanche?
No. Vacular lesions will blanche, purpura will not.
Does ring worm blanche?
No
What is a bluebrry muffin rash?
Seen with meningitis. Looks like exploded blueberries
When you see a rash on the wrist or nape of the neck what should you suspect?
Nickel allergy - contact dermatitis
What do you suspect when you lichenification in the AC?
Eczema
What is an annular rash?
Ring shaped
ex. erythema migrans- lymes - bull's eye rash with a central clearing
What is an acneform rash?
clustered, comedones, papulopustules, cysts, or nodules that resemble acne vulgaris
seen with lithium, iodine and dilantin- not a reason to stop medicine
What rashes occur in a linear pattern?
Contact dermatitis caused by pioson ivy- will see linear vesciles
What is erythema infectosum?
Rash seen with 5th's disease. Lacey rash on cheek that appears in retiuclar pattern (net-like cluster0
What are the most important differentials to consider when you see a painless oral ulcer?
Syphillis, squamous cell carcinoma
What are the most important differentials to consider when you see a painless oral ulcer?
Syphillis, squamous cell carcinoma
What are the most important differentials to consider when you see a painless oral ulcer?
Syphillis, squamous cell carcinoma
Prior to the appearance of shingles you will have pain or itching for how many days?
2 days before eruption
What is a pyogenic granuloma?
Capillary hemangioma, seen in 1st trimester of pregnancy (increased rate of growth due to hormonal changes)
What is erythema nodosum?
Panniculitis, inflammation of fat cells, fever, joint pain, red tender lumps, seen in both shins most commonly. Evolve to purplish brown/bruise.
Usually self limiting. tx with Nsaids.

In about 30-50% of cases, the cause of EN is unknown.[10] EN may be associated with a wide variety of diseases, including infections (e.g., hepatitis C, tuberculosis, streptococcal, Mycoplasma pneumoniae, Yersinia, and Epstein-Barr virus), Coccidioides immitis, sarcoidosis, autoimmune disorders (e.g., Inflammatory bowel disease or Behçet's disease), pregnancy, medications (sulfonamides, oral contraceptives, bromides), and cancer
What is erythema multiforme?
Rash with pink red ring around pale center that starts on the extremities. Itchy and blotchy. SYMMETRICAL
Usually from infection or drug exposure.
Steven's Johnsons
What is toxic epidermal necrolysis?
Cell death causes the epidermis to separate from the dermis. The syndrome is thought to be a hypersensitivity complex that affects the skin and the mucous membranes. Although the majority of cases are idiopathic (without a known cause), the main class of known causes is medication, followed by infections and, rarely, cancers.
Steven's Johnson's is considered the milder form of this.
Lesions usually begin on the mucus membranes.
What are the differences of chicken pox vs. small pox?
Both 2-mm vesciles.
Chicken: starts on trunk and then spreads to limbs, lesions are at a variety of stages, pt s are more "miserable than sick"
Small: no pattern to lesions, lesions present all in the same stage, pt's have a severe illness with > 35 % mortality rate
What is actinic keratoses?
Dry crusty rash that appears on sun exposed area of skin. red brown, scal and often tedner. Can feel when running finger over skin.
Most common precancerous lesion, possible early stage squamous cell carcinoma.
Topical cream (imiquimod 5-flourouracil, cryotherapy.
What is a keratoacanthoma?
Rapidlu evolving rash on sun exposed areas, skin colored or slightly reddish at firs then develops to a smooth dome haped and then grows into a crates with crusted out rim.
tx-surgical removal or cream.
(looks like a crusty wart-eww like on a witch's nose)
What is the difference between basal cell carcinoma and squamous cell carcinoma?
Both: sun exposed areas
Basal: more common, arises from nothing, papule/nodule with pearly waxy appearance, telangiectasia (circulation visible). low risk for metastases
SCC: less common, can come from AK or de novo, red conical hard lesions, no distinct borders, greater metastatic risk (esp if on lip, oral cavity or genitalia)
True or false: Most melanomas come from new lesions?
true
What are the ABCDE's of melanoma?
A- asymmetric
B- borders are irregular
C- color is not uniform
D- diameter > 6mm
E- evolving- new or change in old -or- elevated
What do you treat scabies with?
Premetharin (elemite)
What do you treat verruca vulgaris with?
imiquimod (aldara)
What do you treat keratosis pilaris with?
Ammonium lactate
(bumps on arm where keratin has plugge the folicles)
What do you treat psoriasis with?
vitamin D, corticosteriods
With what rash to do you see a herald patch?
Pityriasis rosea
What is molluscum contagiosum?
Viral self limiting rash. Contagious untill rash disappers.
Flesh colored, dome shaped and pearly in apperance.
What rash typically presents on the anterior surface of the knees?
Psorasis vulgaris
Which rash typically presents over the waistband area?
sacbies- and web folds of fingers looks like worms from the burrows
With what rash to you see a christmas tree pattern of distribution?
Pityriasis rosea
What is the most common cause of ulcerating skin lesions?
MRSA
they try to make you think it is spider bites
What are the signs of a brown reculse spider bite?
Blue at center, then white ring and outer ring is red.
Central blistering with surrounding gray to purple discoloration at the site fo the bite. Surrounded by a ring of blanched skin surrounded large are of redness.
what is rock mountain spotted fever?
tick bourne disesease from bacteric Rickettsia. Triad of fever, rash and tic bite.
1-2 wks after bite presents with flu like illness and then rash presents. Rash starts on extremities and then spreads to trunk. Small flat non-itchy macules. can be on palms and soles.
Tx: Doxy is DOC
What is the drug of choice for lymes?
Doxy.
10 days normally
with arthtitis = 30 days
A single 200-mg dose of doxycycline given within 72 hours after an I. scapularis tick bite can prevent the development of Lyme disease.
Treatment of lymes in pregnant breastfeeding or <8 years old
Amoxicillin or cefuroxime
Signs and symptoms of hypothyroid?
Dry skin, hung up patellar reflex, hyporeflexes, thoughts slower, increased weight, constipation, heavy menses, cold
What are the signs and symptoms of hyperthyroid?
skin is smooth and silky and moist, hyperreflexes, mind racing, weight loss, low volume loose stolls, olgiomeorrhea, hot
What are the most common causes of hypothyroidism?
Hashimoto thyroiditis - autoimmune
Post radioactive iodine - cells destroyed
medication use- lithium, amidarone, interferon, others
What are the most common causes of hyperthyroidism?
Grave's disease
toxic adenoma- metabolically active lesion
thyroiditis- can be viral, immune or post partum ( mom is jittery 2-3 months post preg, 2-4 months hypothyroid and 1 year later normalizes)
medication use- amiodarone, interferon
What is the single most reliable test to dx hypo or hyper thyroid?
TSH
produced by anterior pituitary
elevated in hypo
decreased in hyper
What is free T4
unbound metabolically active portion of thyroxine.

If test total T4 then often have false +
What is free T3
unbounde metabolically active portion of T3. When compared with T4, T3 is four times more metabolically active.
What is antiperoxidase?
Detects autoimmune thyroid disease.
Tests for an antibody to peroxidase- which is an enzyme within the thyroid.
AKA- TPO or TPOab
What is the goal in hypothyroidism for TSH?
1.2 (population norm)
Why is iodine important to the thyroid?
Needed to make thyroid hormone.
T4 T3
T4 converts to T3
What should you suspect with the following labs:
TSH= 84
Free T4= 3
untreated hypothyroidism
What is the normal value for TSH?
0.4 - 4.0

free t4= 10-27 (want this test, part of feedback loop)
free t3= 3.5 7.7 (best for hyperthyroid)
What do you use to treat hypothyroidism?
Synthroid-levothyroxine (bioidentcal to T4)
1.6 mcg/kg adults
1.0 mcg/ke elderly
4.0 mcg/kg children

increased dose by 50% in pregnancy
How often do you check TSH to determine effective treatment with synthroid?
8-12 weeks, but no soon than 6-8 weeks
due to long half life
How many half lives does it take for a drug to reach a steady state?
3-5 half lives
How many half lives does it take for a drug to be eliminated?
3-5 half lives
Can synthroid be taken with other mediations?
yes, but caution with metals it will lead to lower doses of synthroid, and be subtherapeutic
There are your labs, what do you suspect?
TSH <0.15
Free T4 79
untreated hyperthyroidism
Graves
How do you treat hyperthyroidism?
Beta blocker
Antithryroid med- PTU, methimazole
Radioactive iodine- thryoid ablation (may lead to hypothyroidism)
There are your labs, what do you suspect?
TSH 8.9
Free T4 15
elevated antithyroid antibodies?
subclinical hypothyroidism

Treat if TSH >5 if have goiter or anitbodies present. Also you can treat if the pt doesn't have these but is symptomatic.

antithyroid antibodies normal <1:1,000