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170 Cards in this Set
- Front
- Back
progression of OA?
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symptomatic pain, deformation, loss of function
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herberden and bouchard nodes are painful?
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false
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x-ray often correlates with symptoms in OA?
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FALSE
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first line drug of choice for OA?
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acetaminophen
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NSAIDS alter the course of OA?
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false
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which topical agent depletes substance P and is used in OA?
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capsaicin
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glucosamine is shown to have a better effect than placedbo for OA?
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TRUE
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acupuncture is equivalent to what traditional modality in treating back and knee OA?
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oral treatment of mild symptoms
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intense inflammation of first metatarsalphalangeal joint?
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podagra
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possible etiologies of gout?
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alcohol, meats, and obesity. However, no effective preventions exist
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main lab finding in gout?
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increased serum uric acid;however this is often found in general population (20% can have it without gout)
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main pathophysiology of gout?
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decreased uric acid excretion by kidney(maybe sign of renal insufficiency)
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pseudogout has what in synovial fluid?
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calcium pyrophosphate
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WBC count in synovial fluid for gout, pseudogout?
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10-10,000 (infection are >50,000 with 95% PMN)
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classic tx. of acute gout and its side effect?
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colchicine "take till pain gone or diarrhea starts"
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chronic gout treatment?
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allopurinol and probenecid (usually for women with acute attack or one/two attacks a year)
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MOA of probenecid and limitations?
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increase uric acid excretion. contraindicated if creatinine clearance below 50mL/min or stones
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most worrisome side effect of allupurinol?
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rash
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DOC for gout prevention before surgery?
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colchicine (never use as long term prophylactic)
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RA must involve how many joints?
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three or more symmetrically
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gender preference for RA?
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women 4:1, ratio is 1:1 after menopause
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pathologic inflammatory tissue found in RA?
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pannus
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systemic involvement of RA (4)?
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fatigue, anorexia, wt. loss, and low-grade fever`
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lab finding in RA?
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elevated ESR, c-reactive protein(more specific), and positive RF
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alternative supplement used in pain reduction for RA?
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fish oil
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first choice DMARDs in RA?
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plaquinil, watch for drug deposition in eye(rare at recommended dose)
sulfasalazine well tolerate, watch for rare leukopenia and GI effects |
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standard tx. for RA?
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methotrexate (macrocytic anemia and live problems are common side effect) with plaqunil or sulfasalazine
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compication with methotrexate found in previous pulmonary patients?
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diffuse pulmonary alveolitis
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systemic symptoms of RA can be treated with?
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azathiproine GI and hemo side effects common
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rheumatoid vasculitis can be treate with?
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cyclophosphamide, marrow suppression, bladder complication and cancer is concern
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examples of TNF-inhibitors (3)?
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etanercept, adalimumab, and infliximab
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innocent bystander effect seen in RA?
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tendon and surrounding tissue involvement around inflammed joint
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general timeline for cold?
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12-14 days. congestion longer than 14 days maybe another etiology
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four common symptoms in sinusitis?
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"double-sickening", ineffectiveness of decongestant, pruluent discharge, maxillary toothache
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tx. for sinusitis?
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TMP-SMX
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age at which risk of strep throat decreases?
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20, peak between 3 and 10
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incubation period of EBV?
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5-7 weeks
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IgM test for mono (monospot) is positive how many weeks after symptom onset?
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3-4 weeks. use VGA-IgM for earilerw
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one symptom of pneumonia helpful in diffrentiating from URI?
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tachypnea
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tx for aspiration pneumonia?
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amoxi/clauvulanic acid or clinda
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additional symptoms in children with asthma?
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atopy
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confirmation of asthma using spirometry?
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12% improvement in FEV1/FVC ratio
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possible side effect of long-term steroids in children with asthma?
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decreased height
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peak flow level readings at which patient should seek medical attention?
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50-80% of peak flow require concern, less than 50% require immediate attention
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definition of chronic bronchitis?
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at least 3months for 2 consecutive years
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percentage of smokers who develop COPD?
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10-15%
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what other modality along with smoke cessation decrease mortality in COPD?
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home O2
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DOC for chronic bronchitis?
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anticholinergics such as ipratroprium
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side effects of B-agonist like albuterol?
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tachycardia, nervousness, tremor
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red flags in LBP?
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age over 50, hx. of trauma, saddle anesthesia, loss of bladder and/or bowel function, persistant fever, night pain, hx. of cancer or metabolic disorder, major muscle weakness
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timeline to see if conservative treatment works for LBP?
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4-6 weeks
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DOC for acute LBP?
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NSAIDs over muscle relaxer, combination is not shown to be anymore effective
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study results on the efficacy of acupuncture in LBP?
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good for chronic but not for acute LBP
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wt. loss of more than what percentage found in failure to thrive in elderly?
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5%
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most sensitive marker for CHF exacerbation in elderly?
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JVD
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one ddx for shoulder/hip weakness in elderly?
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polymyalgia rheumatica
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tx. time for stage 1 and 2 ulcers?
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4-8wks
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donut cushions are useful in the prevention of pressure ulcers?
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false
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data supports frequent repositioning prevents pressure ulcers?
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false
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necrotic tissue must be debrided before accurate staging. Where should this NOT be done?
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heel
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three most common complications of skin ulcers?
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cellulitis, osteo, and sepsis
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stage 2 ulcers involve which layers?
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skin, but no fascia
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best agent to clean and irrigate stage 2 ulcers?
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NSS
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three phases of postural stability?
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input, processing, output
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most sensitive screening test for balance in intermediate activity elderly?
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10sec. one leg balance better than romberg
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"up and go" test?
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rise from seat, walk 10m, turn around and come back to sit. greater than 20sec. requires PT
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functional reach test?
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stand along wall, extend fist closest to fall and lean forward without losing balance. less than 6in. indicate significant risk for falls
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relapse percentage in major depression?
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50% rate increases after each relapse
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which disease has highest co-existence with depression?
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MI
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three risk factors related to depression that cause preventable disease?
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smoking, lack of exercise, and poor diet/alcohol use
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clinical dx of major depression?
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anhedonia and depressed mood along with four other changes for 2wks or more
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timeline to see improvement in depressive sx. with meds?
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6-8weeks
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time period of anxiety necessary to dx GAD?
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6 months
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most likely organic cause of anxiety?
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alcohol and drugs
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benzo alternative for GAD?
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buspar (buspirone)
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short-term tx. of anxiety?
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benzo
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screening method for gestational diabetes?
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1hour glucose test between 10-28wks. >140 must be repeated with 3hr glucose after overnight fast. one reading must be abnormal
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what is mc etiology of dyspepsia?
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PUD
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four major causes of PUD?
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h.pylori, NSAID, idiopathic, hyperacidity
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hx. of what system disease increase risk of PUD?
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cardiac
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which common cause of dyspepsia is exacerbated by position?
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GERD
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dx. of gerd?
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treatment with PPI,
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difference in pain characteristic between tension and migraine headache?
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migrain is pulsating
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common age range for onset of primary headaches?
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20-40yrs.
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diagnosis steps in subarachnoid hemorrhage?
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CT without contrast. if neg., then LP
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three common drugs used for migraine?
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amitryptyline, propanolol, timolol
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initial tx. of cluster HA?
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oxygen, tryptan, and DHE
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most recent survey on improvement of HTN showed what?
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improvement levels have leveled off
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renal artery stenosis is likely cause of HTN at what age groups?
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initial onsent is under 20 or above 50
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caffeine and tobacco product should be avoided at least how many minutes before measurement?
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30min.
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recommended labs for pt. initial presenting with HTN?
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EKG, UA, fasting glucose, K, Creat, fasting lipid panel
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further evaluation is warranted when what treatments fail?
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triple drug therapy
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which anti-hypertensive has good effect on osteoporosis?
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thiazides
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which anti-hypertensive contraindicated in pregnancy?
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ACE and angioII inhibitors
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what are two groups of CCB and their different mech.?
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ionotropic (verapamil and diltiazam) and vasodialators(amlodipine, nifedipine,felodipine)
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which anti-HTN drug can increase risk of stroke in african americans?
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ACE-I
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which anti-HTN drug good in diabetic, previous MI, CHF, CKD?
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ACE-I
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what creat level indicated stoppage of ACE-I?
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30% above baseline
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max creat level safe for ACE-I use?
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3.0
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anti-htn drug good in ischemic heart disease?
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b-blockers
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anti-htn drug good in ASYMPTOMATIC heart failure?
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ACE-I and B-blocker
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initial reduction goal in HTN emergency?
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systolic 20-40 and diastolic 10-20
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drug of choice (3)for HTN emergency?
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ntiroglycerin, labetalol, esmolol IV
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thimersol still found in trace amounts in which vaccine?
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influenza
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medical conditions that may cause low seroconversion in HBV vaccine?
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low birth weight and immunosuprresion
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which interval in HBV vaccine said to increase seroconversion rate?
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between second and third interval
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when should pre-terms receive HBV?
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should recieve first dose after 30days if weight is less than 2kg and mother is HBsAg negative
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side effect of HBV vaccine?
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pain at site MC, along with fatigue and headache
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minimum titer value for HBV?
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greater than 10mIU/mL
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uncommon adverse reaction from DTaP?
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crying greater than 3hrs., high pitched cry, seizures, hypotonic state
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two types of pneumococcal and their mech. of action?
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23-valent polysacchride works on b-cells directly (lower seroconversion b/c it doesnt work on memory t-cell), not effective in infants.
7-valent conjugate works on t-cells, effective in infants |
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mc side effect of PCV?
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fever of 38C(100.4F) or less
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HepA immunization schedule?
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first dose at 12mo-15mo, next one 6mo later
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rota virus administration and schedule?
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orally, 2,4,6mo. do not repeat if vomiting occurs
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max age for menarche?
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less than 16y/o
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normal range of menstural cycle?
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22-45days
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definition of primary amennorhea?
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absence of menarche in less than 14y/o without secondary sex charac. or 16y/o with secondary sex charac.
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definiton of secondary amenorhea?
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6mo in regular cycle women or 12 months in irregular cycle
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mc causes of primary amenorrhea?
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gonadal dysgenesis(Turner syndrome most common) and delayed puberty
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primary amenorrhea and monthly abd. pain may indicate?
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imperforate hymen
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amenorrhea and inability to smell(anosmia)?
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kallman syndrome(failure of GnRH releasing cells migrating from olfactory bulb)
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which hormone can have FSH-like effects?
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TSH(precocious puberty in severe hypothyroidism)
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anatomical abnormality found in testicular feminization(androgen insensitivity)?
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lack of upper vagina and uterus due to mullerian duct inhibition by testes
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absence of uterus and renal anomalies?
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Rokitansky-Kuster-Hauser syndrome
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lab work up for amenorrhea in pt with normal breast and pelvic examination?
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test TSH to rule out hypothyroidism and hyperprolactonemia
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lab work up for amenorrhea in pt with abnormal breast and normal pelvic examination?
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test FSH for central or peripheral causes
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treatment for hyperprolactonemia?
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bromocriptine or cabergoline
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three ways to check ovulation?
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basal temp(increase of 0.5F), LH(home-kit), cervical mucosa(sticky white, to stretch clear)
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age when biopsy is required for any irregular bleeding?
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over 35 to rule out endometrial cancer
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most commonly diagnosed eating disorder?
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eating disorder NOS accounts for 6-10% of young women
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differences between BN and binge type AN?
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AN need to be less than 85% of ideal weight(BMI<17.5), purge amount and frequency is less
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plain x-ray indicates osteoporosis after how much bone loss percentage?
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50%
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age recommended for osteoporosis screening in women with no risk factors?
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65 and older
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T-score of more than what indicate osteopororis on DEXA?
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>2.5
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one type of med that relieve osteoporotic bone pain after fx.?
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calcitonin
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example of SERI that also treats osteoporosis?
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raloxifene works as estrogen AGONIST on bone, ANTAGONIST on breast and endometrial tissue
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definiton of chronic pain?
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pain lasting 3-6months
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mc cause of chronic pain in older adults?
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degenerative joint and disc disease
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max dose of tylenol before liver damage?
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4g/day
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advantage of tramadol over other opiods?
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lack the addictive properties
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potential high dose side effect of tramadol?q
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greater than 400mg/day can result in seizures
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type of anti-depressant that achieves greatest anesthesia?
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SNRI
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SNRI studied to improve diabetic neuropathy?
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duloxetine
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side effects of SNRI?
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HTN at high doses
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worrisome side effect of TCA?
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cardiac abnormailities
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honey colored crusted plaque that is itchy occasionally and not painful?
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impetigo (mc is staph aureus)
|
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cellulitis can follow which type of impetigo?
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non-bullous
|
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ointment tx for impetigo?
|
mupirocin(bactroban)
|
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clinical difference between alopecia areata and tinea capitis?
|
hair breaks off few mm above skin with tinea capitis
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tinea versicolor tend to be pruritic?
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no
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confirmation of tinea?
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KOH prep with hyphae from scrapings
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gold tx for tinea capitis?
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griseofulvin. topicals DO NOT work on capitis
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tx. of thrush?
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nystatin
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classic early sx of scabies?
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intense pruritis
|
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two ways to tx scabies?
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permethin cream or oral ivermectin
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which type of lice is preventable with good hygiene?
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body lice; hair and pub hair are not
|
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tx. for lice?
|
permethin cream
|
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sand paper skin around neck and moving down body and circumoral pallor around mouth indicate what disease?
|
scarlet fever
|
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6-12mo infant with sudden high fever with rash on body than to ext. after afebrile for 3days
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roseola caused by HHV-6
|
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fifth disease infectious stage?
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prodrome stage of URI-type sx. Rash is NOT contagious
|
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slap-face lesion that transiently go away and come back on body?
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parvo-virus B19(fifth disease)
|
|
complications of fetal parvo-virusB19 infection?
|
hydrops and demise
|
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three of these critieria must be met for atopic dermatitis diagnosis?
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pruritic, typical morphology, face and extensor area involvement in child and adolescent, recurrent dermatitis, FHx.
|
|
5 A's in smoking cessation?
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ask about smoking, advise to quit, assess motivation, assist in planning, and arrange to follow-up
|
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5 R's in smoking cessation?
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Relevance, Risks, Rewards, Roadblocks, Repetition
|
|
two tests used for thoracic outlet?
|
Adson(extend, rotate to side of sx. and check for decrease in radial pulse), and Roo (abduct, flex, and ext rotate 90 degrees, open and close hand for 3 min.)
|
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PE test used for cerviclal radiculopathy?
|
spurling(EStRt to sx. side, and compress head to reproduce symptoms)
|
|
shoulder pain with overhead motion with abrupt onset and tenderness of humeral tuberosity?
|
calcific tendonitis
|
|
definition of tendinosis?
|
overuse injury resulting in fluid exudation around tendon sheath
|
|
physical exam test used for dequervian's?
|
finkelstein
|