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212 Cards in this Set
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- Back
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Influenza vaccine given annually to whom?
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ALL kids 6mo-18y/o,
ALL adults over 50; ALL ppl with chronic cv, lung, kid disease I/C pts pregant women healthcare workers ppl living in close quarters ie prisons, nursing homes, dorms |
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criteria for effective screening test?
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1 disease is of high enough prevalence to make screening worthwhile
2 time frame exists when pt is asx but rf or disease can be identified 3 cost effective test 4 sufficient sens/ spec of test 5 acceptable to patients 6 intervention/ tx must exist that will reduce morb/mort if dis detected early with screening test |
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what test is recommended (level B) for men 65-75 smokers?
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U/S to assess for abd ao aneurysm
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FOB screening test requirements?
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3 consecutive bm's collected at home
test annually |
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screening tests for CRC and time frames?
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FOBT - annually OR
sigmoidoscopy - 3-5 yrs OR barium enema - 3-5 yrs OR colonoscopy 10 yrs |
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Which is recommended annually? PSA or rectal digital exam for prostate?
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neither (improves detection but no change in outcomes)
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psa levels indicating cxr?
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0-4 = BPH
4-10 = GRAY ZONE/OVERLAP >10 = HIGH PREDICTIVE OF P CXR |
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PROGNOSIS OF PROSTATE CXR?
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w/tx, >90% live over 15 yrs (most die of other causes)
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is cxray indicated for screening for lung cxr?
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NO..! insufficient evidence (level I)
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is screening for DM II in asx adults indicated?
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NO. But is recommended for adults with HTN or hyperlipidemia
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when is Td booster indicated?
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in all adults, every 10 yrs. if no hx of primary series, give 2 Td vacc inj's 4 weeks apart, a 3rd inj 6 mo later, then boosters every 10 yrs
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pneumovax indicated for whom?
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adults over 65,
all asplenic pts of fxnal asplenic (ie sickle cell disease, etc) all chronic liv, kid, cv, dm, or i/c pts |
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when is a 1-time revaccination shot of pneumovax indicated?
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after 5 years from first shot
in these pts: chronic kid, liv, i/c, asplenic pts |
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In whom is hep B vacc indicated?
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healthcare workers,
workers exposed to blood, dialysis pts, IV drug users, multiple sex partners ; recent std hx, men having sex w/ men |
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In whom hep A vacc indicated?
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chronic liver dis, pts receiving clotting factors, workers w/exposure to Hep A, IV drug users, men having sexw/men, travellers to Hep A endemic countries
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in whome is varicella vacc indicated?
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those w/ no hx of chicken pox,
those seronegative for varicella, those at risk for exposure |
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In whom is meningococcal vacc indicated?
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complement deficiencies,
asplenic or fxnal asplenic pts, travelers to endemic countries, etc. |
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has counseling pts to exercise been shown consistently to increase number of pts who exercise?
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no!!
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dx and tx of COPD:
1 acute exacerbation 2 mild COPD (stage I) 3 mod COPD (stage II) 4 severe COPD (stage III) 5 very severe (stage IV) |
exacerbation: ABC's, O2, B2 ags ie albut (for immediate action), *SYSTEMIC (oral,IM, or IV) STEROIDS* (kick in hrs after...reduce underlying inflamm), and AB's if signs of inf ie incr sputum or purulent sputum
**ALL STAGES of COPD have FEV1/FVC < .7 by definition** Stage I: FEV1>80% tx = SABA's STage II: FEV1 50-80% = SABA's + LABA's Stage III : FEV1 30-50% = SABA's + LABA's + inhaled C/S's Stave IV: FEV1 <30% or <50% + hypoxia = same as stage III tx + O2 if O2sat <88% or PaO2 < 55% |
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#1 sx of COPD; #1 presenting sx?
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#1 sx = cough
#1 presenting sx = dyspnea |
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dyspnea means what change in lung fxn has occurred in copd?
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= Fev1 has already been halved! and
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what does stopping smoking do for lung function tests?
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NO change but will decr rate of further deterioration and risk of cxr, cvd.
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tx for acute gout?
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NSAID + / - colchicine; NOT allopurinol or probenicid
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ca oxalate crystals look like?
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POSITIVE birefringence; seen in end stage renal disease pts;
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Ca pyrophosphate crystals look like?
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positive birefringence, rod shaped, rhomboid, cause chondrocalcinosis (pseudogout)
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septic vs crystal arthritis wbc counts from joint aspirate?
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septic: >100,000 wbc's, w/ >90% PMN's
crystal: 2-60,000 wbc's, <90% PMN's |
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bact infections of joints occur most commonly in what ppl?
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ppl w/ underlying rheum arthritis!! (steroid use predisposes them to staph inf's)
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septic jt vs bursitis, cellulitis, or osteomyelitis?
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only septic jt will have decr ROM
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dx criteria for RA?
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1) Morning stiffness
2) 3+ jt involvement 3) hand jt involvement 4) rheum nodules 5) positive RF 6) erosions or decalcif's on xray (first 4 true if present for >6 wks) Any 4 of these = RA dx. |
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other lab test changes seen in RA?
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low albumin = correlates w/ severity
high ESR / CRP Anemia Tcytosis |
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Tx for recurrent gout?
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Probenecid: (incr UA urinaryclearance)
Allopurinol: decr gout production |
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tx for septic jt?
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surgical drainage + IV Ab's
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Tx for OA?
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mobility exercises, wt loss, exercise w/ less wt bearing activity, intermittent steroid inj of jts may be used
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RA drugs?
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DMARDS:
Sulfasalazine, Mtx ANTI CYTOKINES: infliximab, etanercept (combo of et + mtx = better than either alone for RA) |
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how does mtx work?
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folate antagonist = decr dna prod; decr lcyte proliferation = slows erosions in jts caused by inflamm cells
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what is cornerstone of tx for RA if NSAIDS don't work?
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MTX +/- DMARD
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m/c side effects of MTX?
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mucuosal ulcers, nausea;
also do lft's b/c cirrhosis CAN occur |
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any pt > 50 w/ lower back px...NSIM? if abnormal...do what?
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do lumbar spine xray (even tho musculoskeletal source is 95% cause)...if abnormal xray, do MRI
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when do urgent MRI for lower back px?
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saddle distribution sx,
bladder/bowel sphincter involvement (cauda equina syndrome) |
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tx for lower back px w/ no red flags, and pt < 50y/o?
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conservative tx, nsaids, local heat, exercises.
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tx for pt with sudden loss of feeling in saddle region +/- urinary incontinence, etc.?
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cauda equina syndrome = if sudden, needs surgical decompression to prevent long term nerve damage.
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when is u/s indicated in pregnancy?
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not indicated!! not mandatory for low risk pts according to ACOG..!!
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initial prenatal visit tests to be done?
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CMV/RPR//HB surf Ag/ HIV serologies/ Rubella/Blood type + Rh/ Pap smear, cerv swab for gonnh, chlamydia
Toxo if pt has cats if age not clear - U/S |
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what is max rads for xray in preggo?
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max is .5 (dental xray = .00017)
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amt of folic acid for
1 Mom w/previous child w/ n tube defects? 2 Mom w/ DM or epilepsy 3 Normal Mom |
1 4mg daily
2 1 mg daily 3 400ug daily |
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cvs vs amnio risk for spont abortion?
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cvs = 1.0-1.5%
amnio = .5% |
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ACOG: when do women get GBS screening by vagino rectal culture?
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for ALL womein at 35-37 wks gest...if pos culture, give AB's at time of ROM or labor init. OR for ANY woman with bacteriuria anytime during pregnancy (indicates heavier colonization)
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first vs second vs 3rd trim US accuracy for gest age dating?
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first trim U/S = accurate to w/in +/- 1 week,
second = +/- 2 weeks, third= =/- 3 weeks |
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what vaccs to give in third trim?
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influenza (if third trim is in flu season); tet toxoid if needed; DON:T give varicella or rubella (live vaccines)
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what screening of newby's required? of 1 y/o's?
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PKU , cong hypothyroidism; auditory bstem response (hearing); red-reflex for cong cat's and rb; screening for all newbies;
screening for lead levels universal in all 9-12 mo'/olds living high risk areas. |
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what preconception genetic screenings of moms should be done?
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french can or ashk jewish = Tay Sachs
Black = sickle cell anemia southeast asian and middle eastern = thallasemia |
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what NSIM if detect strabismus?
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immediate referral to ophthalmologist as early intervention results in reduced incidence of ambylopia
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what ages and what types of car seats go together?
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car seat facing backward: until 1 yr and weighs 20 lbs
car seat facing forwards: over 1 year and b/ween 20-40lbs booster chair and seatbelt: over 40lbs over 4 feet tall and over 60lbs: no booster |
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Major milestones at 1 month?
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eye contact
regards human face |
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Major milestones at 2 month?
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social smile, eyes follow to midline
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Major milestones at 4 month?
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eyes follow past midline, rolls over, laughs/squeals
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Major milestones at 6 month?
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"Six strangers switch sittings"
6 mo = recognize strangers switch object from hand to hand sits unsupported +babbles |
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Major milestones at 9 month?
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Nine months to be a "mama"
mama/dada Pincer grasp+ Crawls/Cruises/Explores : imagine pinching couch to walk |
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Major milestones at 12 month?
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"walking away from mom causes anxiety"
stranger / separation anxiety walking Knows 1 word at 1 year |
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Major milestones at 2 yrs?
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2 words 2gether at 2; 2/4 of speech understood by strangers
2-3 word phrases Runs |
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Major milestones at 3 yrs?
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tricycle, 3 cubes, 3 numbers, 3 colors, 3 kids make a group
3/4 of speech understood by strangers build a bridge of 3 cubes recognize 3 colors repeats 3 numbers copies a circle |
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Major milestones at 4 yrs?
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4/4 speech understood by strangers;
"Head and shoulder, knees and toes" = can identify 4 body parts Uses past tense Cross and square (4 sides/ 4 lines) |
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Major milestones at 5 yrs?
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copies a triangle
catches a ball writes name |
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Major milestones at age 6?
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6yrs: skips, shoe-tying, 6-part person (drawing)
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mediators that are immeidately released in allergy? delayed release?
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immediate = histamine, tryptase, chymase, kinase
delayed = leukotrienes, PGD2 --> these recruit LMNE's to mucosa over next 4 hrs |
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what supports diagnosis of allergic rhinitis?
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response to antihistamines
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thick and purulent secretions from nasal turbinates vs thin and watery?
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thick/pur = sinusitis
watery/thin = allergic rhinitis |
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how to tell if you see a nasal polyp?
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spray with decongestant: rest of nasal mucosa will shrink; polyp will not
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what are Dennie Morgan lines?
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Increased creasing below lower eyelid = sign of allergic rhinitis
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first line therapy for acute exacerbation of copd?
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Ipratropium inhaled/nebulizer
steroids IV or PO or IM then SA, O2, and AB's = amoxy or tmpsmx to cover for H.I and M. catarrhalis, Spneum. |
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pharmacotherapy for allergic rhinitis?
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1) first try avoidance of allergens in enviro
2) if need pharm, give first antihistamines (H1R comp antag) = diphenhydramine, chlorpheniramine, hydroxyzine... second line = loratadine, fexofenadine, and cetirizine (less pen into CNS and therefore less sedation; but more expensive) 3) then give decongestants = pseudoephedrine (alpha adrenoreceptor ag) 4) salt nasal sprays 5) then give CS nasal sprays = fluticasone (flonase), or beclomethasone (beconase) but side effects = URTI's, nosebleeds, pharyngitis 6) oral cs's only for severe allergies 7) last resort = desensitization via repeated inj w/ increasing titers of allergen |
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first suspicion of anaphylaxis, what give?
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Epi IM or subcut 1:1000, .2-.5 mL
Plus rapid IV fluids for Bronchospasm, give Epi also or terbutaline monitor 24 hrs |
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acute Airway obstruction lasting for days/weeks?
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status asthmaticus
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prolonged use of alpha adrenergic receptor agonist (ie ephedrine, pseudoephedrine ) decongestants?
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rebound nasal congestions often occurs after discontinuing after prolonged use
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mech of b2 agonistis?
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relaxes bronchial sm, AND
reduces mast cell mediator release and increases mucociliary transport |
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def of mild intermittent asthma?
tx? |
</= 2 d/week
</= 2 night/month tx = SA only for sx |
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def of mild persistent asthma?
tx? |
3-6 d/week
3-4 night/month tx = Inh CS low dose + SA |
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def of moderate persistent asthma?
tx? |
Daily sx
>/=5 night/month tx = Inh CS Low-Med dose + LA + SA |
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def of severe persistent asthma?
tx? |
Daily, *Continual* sx
Frequent nights/ month tx = Inh CS High dose +LA +SA +/- systemic CS's (tabs or syrup) |
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what classification asthma may you give Leukotrine modifier or theophylline, or cromolyn?
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give for mild persistent or mod persistent asthma
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def of chronic bchitis?
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chronic cough + sputum for at least 3 mo over the past 2 yrs.
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5 pharm agents for smoking cessation?
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bupropion ( for depress or smoking cessation; advantage: does NOT decr sex fxn)
nicotine gum nicotine patch nicotine inhaler nicotine nasal spray |
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mech of buproprion
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thought to work by blocking r/u of dop and nor
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best drug to use for preggo to quit smoking?
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buproprion (cat B)
or nic patch (cat C) |
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what must you do with every communicable STD?
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Must report STD's to state agency for surveillance and health control. It will then contact her and contact her partners
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emancipated minor def?
mature minor def? |
req's: pt must be of certain age, self-supportign, not living at home, married, pregnant or a parent, in military, or declared em by judicial system (minor goes to court and gets judge to approve that her parents no longer have legal duty to support minor and she now has ability to make medical decisions for herself w/o informing them (excluding abortion) )
mature minor doctrine means that child/adolescent patient may be given status of self-consent to medical therapy w/o parent consent, if doctor assesses and documents that pat has adequate maturity level to do so. this was established by Belcher Vs. CAMC...but like the lst form of emancipation, still needs court approval that patient is mature minor ="judicial bypass" |
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what ethical principle will failure to maintain confidentiality break, in dealing with a patient ie adolsecent?
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Will break the principle of non-maleficience "do no harm" b/c will do emotional /psych harm
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examples of situations where confidentiality may be broken in order to maintian "beneficience" = to do the right thing/best interest of patient?
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ie when adolescent wants confidentiality but expresses homicidal or suicidal ideation, or has serious chemical dependence, or is involved in abuse/being abused.
However, disclosure to other party must only be done if life of patient or other must be protected |
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is pregnancy/preg-related condition required to notify parents?
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state-by-state...but ie texas:
doc is not required to tell parents, but also doesnt need patient's consent to tell parents if he deems it necessary |
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In all but 7 states, what is ruling concerning parental consent for their child getting an abortion?
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in all but 7, at least 1 parent's consent is necessary for child to get an abortion. But if child gets emancipated, or is declared mature via judicail bypass, doesnt then need parental consent.
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65 y/o with worsening dyspnea, palpitations over 1 week + conj palolor and guiac positive stool...NSIM?
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admit
do CBC for anemia (plus iron, vB12, folic acid levels for type of anemia) card enzymes + ekg for new onset angina / mi/ chf/ afib EGD and colonscopy b/c of pos guiac test, for ulcer, gi cxr, etc PT and PTT for coag abnorms |
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m/c cause of increased homocysteine in US?
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decreased folate intake
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cause of B12 induced neropathy?
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decreased conversion of methylmalonyl CoA to succinyl CoA = decreased fatty acid prod = demyelination of nerves.
causes peripheral neuropathy (sensori + motor dysfxn) Post column dysfxn (vibrio, proprio ception problems) Dementia Lat corticospinal tract demyelnation = in the SC = central = Babinski signs |
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Any dementia pt, what tests must you do and why?
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must do TSH for hypoth and B12 for b12 def
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signs of b12 def or folate def anemia on blood smear
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1 Pancytopenia and megaloblasts due to decr DNA synth = cells cant divide
2 macrocytic anemia 3 hypersegmented neutrophils |
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what is the only microcytic anemia with an increased RDW?
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iron def anemia b/c is a mixture of normocytic (early stage iron def anemia) and microcytic cells
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def of anemia?
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m: < 13 Hb
w: < 12 Hb |
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Other b12 or folate def signs?
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glossitis, pearly gray hair at early age, ataxia, confusion, dementia.
(folate w/o neurological signs) |
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prophylactic AB or AB to give immediately after first diarrhea while traveling?
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Ciprofloxacin (quinolone) 500mg bid for 2 days
or azithromycin, single 1000mg dose |
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bloody diarrhea pathogens?
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Shigella (not salmonella = only leukocytes in stool, not blood)
Yersini E hemolyticia Enterohemorrhagic Ecoli |
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leuk's in stool with diarrhea...pathogens?
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e hemolytica
salmonella shigella c.difficile ecoli campy yersinia |
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conj pallor in elderly...what workup?
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strong enough to indicate workup for anemia
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alcoholic - what type of workup should you always give?
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workup for B12 and folate...
but important to decipher which is present (in any macrocytic anemia) because treatment with only folate will make anemia sx go away, but will still allow neuropathy to continue!! |
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over what age should women be screened for:
htn Lipids |
htn - over 18
lipids - over 45 |
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annual mammography for women over what age?
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over 50
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OP in men may be due to what 3 conditions?
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increased/chronic CS use
CKD - low Vit D prod; altered hormone levels COPD - altered hormone levels low test. levels |
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what screen for OP, what age?
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hip bone density (DXA=dual energy xray absorptiometry) - is the best predictor of hip fracture!
at age over 65 or over 60 in women with high risk of OP related fractures |
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recommendation tx for OP?
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weight bearing and muscle strengthening exercise
vD 400-800 IU Ca 1200mg daily Vision check, med check for drugs causing any imbalance, change enviro to prevent falls at home, hip protectors if high risk, meds: Bisphosphonates (alendronate = fosalan), calcitonin, |
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m/c s/e of bisphoshonates?
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esophagitis, gastritis
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Selective Estrogen Receptor Modulator? example? tx for? s/e?
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ie Raloxifene (Evista) tx for Osteoporosis; s/e = hot flashes, palpitatiosn, wt gain, dvt/pe
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how to treat onycchomycosis?
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give terbinafine (lamisil) orally or topically;
works by inhibiting ergesterol synthesis s/e = rash, headaches, gi irrit/arthralgia/myalgia/ rarely-hepatotox /neutropenia |
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low ,int, high risk 10 yr risk is divided by what? OR what percents?
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low = 0 - 1 risk factor
OR <10% 10 yr risk int = 2+ rf's OR 10-20% 10 yr risk high = DM, past MI, established CVD, PVD, stroke, or AAA "very high" = 2 or more of above high risks or 1 with 2+ other RF's |
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arcus senilis may be assoc w/?
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hyperlipidemia ; familial hyperlipidemia
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what is pterygium? when requires surg?
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connx tissue covering part of sclera
- only req's surg if impedes vision |
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what age must you culture for strep throat suspicion?
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5-15
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Order what to distniguish B vs a thalassemia clinical lab profile?
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Hb + iron + RDW
B thal will have tons of Hb F on ephor...alpha won't have much |
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causes of plantar fasciitis?
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jobs that require a lot of walking on hard surfaces, shoes with little or no arch support (is caused by excessive wear to plantar aponeurosis OR excessive pronation of foot)
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tx of plantar fasciitis?
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DONT walk on balls of feet (causes extra tension on plantar aponeurosis)
NSAIDs - CS's |
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what may you see in chronic plantar fasciitis?
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Calcium spurs
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sx of plantar fasciitis?
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pain on first few steps of morning, then later in the evening
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how to treat onycchomycosis?
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give terbinafine (lamisil) orally or topically;
works by inhibiting ergesterol synthesis s/e = rash, headaches, gi irrit/arthralgia/myalgia/ rarely-hepatotox /neutropenia |
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low ,int, high risk 10 yr risk is divided by what? OR what percents?
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low = 0 - 1 risk factor
OR <10% 10 yr risk int = 2+ rf's OR 10-20% 10 yr risk high = DM, past MI, established CVD, PVD, stroke, or AAA "very high" = 2 or more of above high risks or 1 with 2+ other RF's |
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arcus senilis may be assoc w/?
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hyperlipidemia ; familial hyperlipidemia
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what is pterygium? when requires surg?
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connx tissue covering part of sclera
- only req's surg if impedes vision |
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what age must you culture for strep throat suspicion?
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5-15
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lab req's for thalassemia?
b thal vs a thal? |
Hb + RDW + Iron
B thal will have lots of Hb F on ephor; a wont |
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cause of plantar fasciitis?
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excessive strain of plantar aponeurosis OR excessive pronation ie: walking long distances or w/o arches in shoes
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sx of p fasciitis?
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px first steps in am, then later in evening
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tx of plantar fasciitis?
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Don't walk on balls of feet! use arched support:
PRICE NSAID's +/- CS injection |
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post - bleeding ulcer management?
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give Iron + vit C to incr absorption
Hb in 2 weeks...look for reticulocytosis = new RBC prod |
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2 groups of pts with anemia that also will require EPO?
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Ca pts
CKD pts |
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Falling w/hand outstretched...what injuries?
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rot cuff tear
scaphoid (navicular bone) |
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causes of 2ndary OP (seen as <-2.5 on Z score)?
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Vit d def
hyperPTHism CS therapy/ other drugs Malabsorption |
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When must you re-vaccinate kid even though already got chicken pox??\
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if got cpox while <1 y/old you must still revaccinate
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3 main S/E's of long term steroid use?
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Hyperglycemia
OP Gastritis / PUD Others: Cushings Adrenal insuff after w/draw Muscle Wasting Psychosis/euphoria from steroids Infection risk |
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Tx for T. versicolor?
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ketoconazole oral + topical
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what is pityriasis alba?
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autoimmune rx to melanin; NOT a fungus.
Tx = none...will subside after age 18 ...if not, steroid cream |
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P450 interactions
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Induce P-450: GTQ CRABS Griseofulvin, Tetracycline, Quinidine, Carbamazepine, Rifampin, Alcohol, Barbiturates, Sulfa drugs (e.g. TMP-SMX etc.)
Inhibit P-450: IQ SMACKD Isoniazid (a.k.a. INH), Quinolones, Spironolactones, Macrolides, Amiodarone, Cimetidine, Ketoconazole, Dapsone P-450 Dependent: WETPhD Warfarin, oEstrogen, Phenytoin, Theophylline, Digoxin |
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Tx for H Pylori inf?
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Amoxi
clarithro + Omepradex 10 days |
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Why avoid giving steroids to CHD pt?
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can cause salt = fluid retention...so don't wanna give if pt has CHD
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Tx for severe CoPD Exac
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systemic CS's
SA w/ nebulizer (every 20 mins) O2 every 20 mins (rotate w/ SA) If send away, give inhaler of ( LA Bag + CS ) ALSO redbook says Ipratropium is first line for copd exac ALSO give prophylactic omeprazole to any older pt you're also giving CS's (to prevent PUD) |
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changes in LDL or HDL percents causing what changes in % 10 yr risk?
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if LDL decr by 1%, 10yr risk decr by 1%
if HDL incr by 1%, 10 yr risk for CHD decr by 3 %!! |
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What amt of statin must you give to gt antiinfllamm effect also?
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Must give LARGER dose ie for simvastatin, > 40mg if you want to achieve the antinflamm effect in addition to the anti-lipid effect.
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drug eluting stent vs Bare metal stent?
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drug eluding = requires LIFELONG antiplatelet ie clopedogrel, but stays open
non-drug eluting stent (bare metal) will restenose in a matter of years, maybe months |
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If htn is not controlled with 2+ drugs, what must you consider?
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secondary HTN
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causes of atypical lymphocytosis?
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Mono (EBV), CMV, viral Hepatitis, Toxo,
OR drugs ie Phenytoin |
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submental l/n enlargement?
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if submental = think bacterial pharyngitis, or herpes on mouth, or dental abscess
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Paroxysmal nocturia is also seen in?
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OSA
(remember, if elderly person w/ urin freq + mental changes ie dementia, think OSA!!) |
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For pt receiving chemo ie Cisplatin + Paclitaxel for Ov cxr, what must give the night before?
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must give steroids ant anti-emetic
to prevent vomiting that always occurs post-chemo |
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what are natural moisturizers?
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Urea is one of three natural moisturising factors (NMF) in the outer horny layer of our skin. The other two NMF are lactic acid and amino acids
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tx for hyperkeratosis?
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urea- is hygroscopic = water loving = draws h20 into skin
is also keratolytic b/c softens horny layer of skin = allows dead skin to be released also is regenerative and prevents drying |
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dupytren's contracture vs trigger finger?
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dupytren's = inflamm/fibrosis of palmar fascia causing contraction of single or multipl fingers; assoc with trauma, diabetes, alcoholism, epilepsy therapy with phenytoin and liver disease
tx = needle aponeurotomy trigger finger = nodule on tendon or inflamm of sheath = idiopathic; tx = c/s inj of sheath, or sheath -ectomy |
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bilat tooth px,what dx?
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think about sinusitis
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mech of Dpp4 inhibitor (sitaglyptin)?
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DPP4 inhibits GLP1 (incretin), an inhibitor of glucagon release. Thus, a DPP4 inhibitor causes increased GLP1 = increased insulin release and glucagon inhibition.
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3 drugs causing hothism
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Li
Amiodarone |
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when is kid no longer contagious after being tx'd for Strep pharyngitis?
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after 24 hrs of tx...can go back to class
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How long after first onset of Strep sx until Rh disease may set in?
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9 days.
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amitryptyline side effects
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(use to tx DM periph neuropathy) = TCA so side effects will be anticholinergic =
constipation, ur retention, weight gain, dry mouth, loss of appetite, drowsiness, muscle stiffness, nausea, nervousness, dizziness, blurred vision, urinary retention and insomnia. |
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clonidine tx for?
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(is alpha agonist causing VC)
migraine, menopausal flushing |
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clonex is what?
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benzodiazepine
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DM neuropathy drugs?
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Amitryptyline (TCA)
cymbalta (SNRI) Pregabaline (gabapentin = neuronal Ca blocker / GABA stimulator = inhib in brain) |
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what to follow after thyroid cxr thyroidectomy?
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follow Thyroglobulin levels = tumor marker
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drug to tx OA that stimulates cartilage formation in wt bearing joints?
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Deaserin
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1 sided eye pain + photophobia?
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1) glaucoma - puplis very small
2) uveitis - 3) keratitis - foreign body; tear of cornea; contact lens irritation |
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F/u for bone scan for OP?
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2 yrs after tx initiation, o another bone scan ( if OP still worsens, consider 2ndary cause of OP)
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Amaurosis fugax? causes?
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monocular vision loss, transient.
cuased by ie TIA due to atherosclerotic carotids or ophth artery, cardiac emboli, giant cell arteritis, etc |
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otitis media findings on otoscopy?
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very red, loss of light reflex; can't see the malleus, etc...loss of anatomy
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What must youcheck if you suspect subacute thyroiditis?
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ESR!
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How can you tell diff on US between BPH and prostate cxr?
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cant!
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2 reasons for surgery for BPH?
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pt can't urinate anymore
pt can't stand sx ie nocturia, etc. |
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lower back px upon waking in AM...cant' straighten back for few mins, then gets better?
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OA
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Officer shoulder = ?
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sign of anterior dislocation
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2 types of dislocation of shoulder?
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ant = see humerus anteriorally
post = see coracoid protruding anteriorally |
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ottawa rules for xray in pt with ankle injury
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no other disease/ no other medical condition or injury present;
if: 1 Localized bone tenderness 2 pt cannot support his weight then send to xray (pt is high risk for fracture) |
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myelodysplastic syndrome?
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pre-leukemia (pre-AML) = pancytopenia with dimorphic (macro and micro ) Rbc pop; ringed sideroblasts; myeloblasts <20% (if over 20% = progressing to AML)
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tx for Myeloprolif disorder and for essential thrombocytosis?
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hydroxyurea = antineoplastic drug
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m/c cause of persistent stiffness fo joints after sprains?
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inadequate rehab
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|
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what are ottawa rules? whena pplicable?
|
1) O rules = if bony tenderness w/in 6 cm of malleoli, or if can't bear weight, then should do xray
2) apply in non preg adults w/ normal mental status, w/ no other concurrent injury, and w/in 10 days of injury |
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if suspect limited ROM is just due to pain, not actual tear, etc...what do?
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inject lidocaine, and if ROM returns, b/c just due to px
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|
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what defines an adequate joint xray?
|
at least 2 views at 90 deeg to each other
|
|
|
what phase of growth is slower in melanoma?
|
superficial (horiz) is slower; vertical/deep is faster
|
|
|
m/c melanoma found in afro americans and asians? where found?
|
acral lentiginous melanoma ; found under nails, soles of fett, palms of hnds, etc
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|
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least common of melanomas ?
|
lentigo maligna
|
|
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4 types melanoma? m/c?
|
lentigo
acral lentiginous melanoma nodular melanoma superficial spreading (m/c) |
|
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benign mole excision border? malignant melanoma?
|
2-3mm;
5 mm |
|
|
m/c of all cancers?
|
basal cell carcinmoas
|
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|
def of microscopic hematuria?
|
3+ rbc/hpf on 2+ properly collected urinalyses
|
|
|
lower vs upper utract imaging?
|
lwoer = cystoscopy
upper = IVP or CT |
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|
glomerular bleeding vs lower uti bleeding?
|
glom = 80% dysmorphic RBC's
lower = 80% normal RBC's |
|
|
glom disease vs interstitial nephritis on urinalysis?
|
g = RBC casts + dysmorphic rbc's
TIN = Tubular casts + eosinophils |
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|
tx pre - CT or IVP procedure to upper urinary tract?
|
N-acetylcystein to reduce contrast neprhopathy
|
|
|
tender/boggy prostate + hematuria?
|
prostatitis
|
|
|
what finding excludes microscopic hematuria from ddx?
|
if UTI.
|
|
|
if after hematuria, no source is found, nsim?
|
routine f/u for 3 yrs w/ bp, urinalysis , urine cytology every 6 moetc
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|
|
most appropriate imaging study for hyperthyroidism?
|
nucl medicine thyroid scan with uptake
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|
|
10% of hyperthyroid pts get what heart condition?
|
atrial fib
|
|
|
tx often given to pregnant pts w/ hyperthyroidism (graves)
|
surgical ablation (b/c cant take radioactive iodine ablation)
|
|
|
specific diagnostic test for graves'?
|
detection fo serum antithyroidR AB's
|
|
|
anti thyroid drugs? use to tx whom?
|
PTU, methimazole, and carbimazole...use to tx adolescents or acute tx in thyroid storm (w/ bblockers)
|
|
|
m/c cause of hypoth in US? 2nd?
|
iatrogenic;
hashimoto's |
|
|
incidence of malignancy in solitary thyrhoid nodules?
|
6%
|
|
|
nodules in thyr...nsim?
|
1- do uptake scan
2- if non-hot (non-fxning) measure size by U/S 3) if >1cm =do biopsy by fna |
|
|
what can't be dx'd by fna?
|
follicular cell malignancy vs beningn; thus need to do surg bx
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|
|
tx of thyroid cxr?
|
thectomy follwoed by radioactive ablation
|
|
|
tx of thyr cxr during preg?
|
observe until preg completeed...if nec, do surg. NO radioactive iodine!!!
|
|
|
recommended managment for preggers in labor w/ GBS colonized vag?
|
IV penicillin
|
|
|
rates expected for active labor?
|
cerv dil = 1.5 cm/ hr (1.2 first time)
|
|
|
normal length of 2nd stage labor?
|
1 hr (2 if first time)
|
|
|
how does epidural change length of labor?
|
lengthens 2nd stage by 1 hr
|
|
|
normal ph of vag? of amniotic fluid?
|
vag = <5.5
af = >6.5 |
|
|
m/c cause of fetal tachycardia?
|
maternal fever
|
|
|
Otalgia (6T's)
|
Tooth
Tongue Tonsils TMJ Thyroid Trigeminal Neuralgia also C1,C2 involvement |
