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132 Cards in this Set
- Front
- Back
Screening age 50 and above
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Colon cancer
Mammogram |
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Screening age 35
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Lipid disorders for men
45y/o for women 20y/o if cardio dz rfs |
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U/S stomach screen
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65 and up
Smoking hx Rf: AAA |
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Colon Cancer screens (level A)
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FOBT
Sigmoidscopy/barium enema Colonoscopy |
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Tobacco level___?
level b? |
Level A
Level B: alcohol misuse bmi, symptomtic DM, depression, |
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Ranson Criteria
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GA-LAW: Glucose>200, Ast>250, Ldh>350, Age>55, WBC>16k
initial 48 hrs: Calvin & HOBBeS: Ca<8, Hct dec>10%, O2<60, Bun>5, Basedeficit>4, Sequestrationfluid>6L |
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Initial visit
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Blood, infection/vaccine,
Pap, ua, gono+chlamydia, down syndrome, u/s, CVS (opt) |
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16-20wk visit
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Quad screen: afp, hcg, inhibin, estriol
U/S for anatomy Amniocentesis |
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IBS
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Symptoms for at least 12 weeks (not necessarily consecutive) in 12 months. Characterized by two of the following symptoms:
• Relief with defecation • Onset associated with a change in stool frequency • Onset associated with a change in stool appearance Women<35y/o |
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IBD pharm tx
-mild pain/infreuent -severe pain -anxiety/depression -constipation -diarr hea -pain |
Mild pain/infrequent= dicyclomine, hyoscyamine
Severe pain= TCAs Anxiety/depression=SSRIs Constipation= psyllium, lubiprostone (inc Cl channel) Diarrhea= loperamide (binds opiod-r, stops peristalsis) Pain= alostron/lotronox (5-ht3-r antagonist) |
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26-28wks visit
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Diabetes
RhoGAM CXR if PPD+ |
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COPD severity
Stage, classification, findings, tx |
1st episode of wheeze=CXR then peak flow
0. Cough, sputum, nL; vaccines, stop smoke 1. MILD FEV1/FVC<.7; albuterol, ipratropium 2. MOD. FEV1 50-80%; salmeterrol, tiotropium, methylxanthiones 3. SEV. FEV1 30-50%; steroids 4. V SEV: FEV1<30% or <50%w/chronic hypoxemia; O2 therapy; <89% at rest or <55mmHg |
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34-38wks visit
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Cbc
Vrdl Opt: gon, chlaymidia GBS |
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COPD culprits bact
Alpha1 antitrypsin |
Pneumococcus, h. Influenzae, moraxella catarrhalis
Severre: g(-) kleb, pseudo Theophylline: improves idchemic cardiac muscle A: nonsmokers <50y/o w/fhx; cxr w/emphysematous blebs |
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culture differences
Native Americans chronic issues |
ask about culture defining illness
greet in respective language NA: DM, fat, EtOh, Suicide |
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Uninsured ethnic group?
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Hispanics
Lowest health risks |
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Lowest mortality ethnicity
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Asians<whites<AA, hispanics, natives
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Autonomy
Social justice Competent Honesty |
A= pt's decision (intubation after death), mist be competent
SJ= no discrimination C= up to date H= accept mistakes |
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Gout
RA OA Septic |
G: etoh alters uric acid excretion; M 30-50y/o; F 50-70y/o d/t thiazides
RA: 6wks of symptoms; vasculitis, dry eyes, dyspnea, cough; REFER to rheumatologist (nsaids, glucocorticoids, dmards, methotrexate, anticytokines, topical analgesics) OA: initally nL xrays Inc. WBC: 100k infective arthritis (low glucose); OA (PMNs<50% WBC); 2-60k RA (PMNs>50% WBCs) Septic joint: no ROM (unlike cellulitis) |
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Calcium Pyrophosphate Dehydrate
Calcium hydroxyapatite calcium Oxalate |
CPD: rod shape, rhomboid, weak
CHA: EM, nonbirefringment CO: bipyramidal, positive birefringment |
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W/d
Cocaine Marijuana Ectasy Bzd |
Cocaine, craving is intense.
MJ not physio-logically significant. Ecstasy depression Benzodiazepine mimics alcohol withdrawal, hypertension, tachycardia, and possibly seizures. |
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preoperative cardiovascular risk
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severe aortic stenosis ONLY
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greatest cardiac risk procedures v. intermediate v. lowest
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High-risk: emergent operations, aortic or other major vascular surgeries, peripheral artery surgery, or prolonged surgeries with large anticipated fluid shifts.
Intermediate: carotid endarterectomies, head and neck surgeries, intrathoracic and intraperitoneal surgeries, orthopedic surgeries and prostate surgeries. Low: not require additional cardiac preoperative testing= endoscopic |
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require preoperative testing conditions
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CHF
DM2 hyperlipidemia, Poor functional capacity |
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selective lab tests preoperative
hgb electrolytes glucose creatintine UA |
hgn/hct: expected major blood loss
electrolytes:hx diuretic use glucose/ua: not recommended. creatinine: major Sx w/expected use of hypotn nephrotoxic drugs or >50y/o |
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Acne tx
-open/close comedones -inflammatory=pustules/erythema -severe nodular/cystic |
C: topical retinoids
I: antibiotic alone or w/topical retinoids or benzoyl peroxide S: oral isoretinoin |
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Gynecomastia w/u
-puberty v. Not |
P: no w/u
Not: hepatic, renal, thyroid studies |
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Vaginitis
-3types hx -3d/c |
Antibiotics= candida
DM= yeast Multiple Partners+frothy+erythematous= trichomonias tx partner Thick d/c+itchy=fungal (KOH) tx partner if ballonitis Thin d/c+odor=bacterial (wet mount) Clear d/c= allergy |
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Pap Smear logarithm
"atypical squamous cells of undetermined significance (ASCUS)" or "atypical glandular cells (AGC)" |
(-)HPV: 1 yr to repeat Pap
(+)HPV or LSIL or atypical glandular cells: colposcopy unavailable HPV: colposcopy or repeat Pap 4-6mos AGC+endometrial origin: endometrial biopsy Every 2 yrs b/w 21-30 >30 with nL, every 3yrs last pap at 55y/o if nL |
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Polymenorrhea
Menorrhagia Hypermenorrhea Oligomehorrhea Metrorrhagia Menometrorrhagia |
P: <21 days
Men: >7days, >80mL nL intervals Hyper: like men but regular not nL intervals O: >35days Met: irregular Menome: combo of menorrhagia+ metrorrhagia |
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Fibrocyst v fibroadenoma v. Palpable mass
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Adenoma: rubbery, smooth, well-circumscribed, nontender, mobile
P: if (-)mammogram and after aspiration, then u/s and biopsy |
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Low back pain
-event or not -elderly -straight leg test -releif by bend over/sitting -osteoporosisor chronic steroid use Tx |
No event, young: spondylolisthesis
Event: low back strain Elderly: OA Straight leg teet: disc herniation (inc. w/valsalva, sneeze, cough, no mri) Relief by bend over or sitting: spinal stenosis (steroid epidural) Osteoporosis or chronic steroid use: vertebral compression (localized, sudden mvmts, xrays, calcitonin, aledronate) Tx if mild: NSAIDs and return to work or muscle relaxants; then opiods/steroids PT then individualized exercise program No imaging 1st month |
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Postpartum hemorrhage defined
Causes |
>500mL 1st 24hrs
>1000mL c/s Uterine atony (#1), genital tract trauma, retained placental tissue, uterine inversion, uterine rupture, cervical carcinoma |
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Scoliosis
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<20: xrays every 6 mos
>20: orthopedic specialist Progsssion: bracing Most thoracic curves to the R, evalute L mri |
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BI-RADS scoring
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0: incomplete testing req another test
1: nothing 2: benign mammogram 3: benign but repeat mam 6 mos <2% 4: suspicious, need tissue dx/biopsy 2-95 5: >95% malignancy! Appropriate action 6: malignant |
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Low back red flags
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Unrelenting nt pain or at rest
Neuromotor deficit Fever Loss of bowel/bladder control: causa equina Suspicion of ankylosing spondylitis Trauma Hx or suspicion of cancer Osteoporosis Chronic corticosteroid use Immunosuppression Drug/etoh use |
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Low back pain
-infection -cancer -visceral |
I: cbc, esr, mri, antibiotics, Sx drainage
C: same but MRI and/or bone scan from multiple myeloma or mets from prostate, boobs, lungs |
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Framingham Heart Study
|
Major:
-neck: jvd, cvp>16cm h2o -heart: cardiomegaly, S3 gallop, circulation time of 25s, -lungs: paroxysmal nocturnal dyspnea, JVD, rales, PE -tummy: heaptojugular reflex, wt loss of 4.5kg over 5 days of tx Minor: bilateral ankle edema, nocturnal cough, DOE, hepatomegaly, pleural effusions, decreased vital capacity, tachy |
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american heart association (a-d)
New york association fx classification of angina (0-4) |
A, -: none, rfs
B, 1: strenuous activity (loop) B, 2: prolong or slighlty more vigoruus acitvity (ACEi) C, 3: daily (b-block, spironolactone) D, 4: rest (spironolactone, cardiac resynchronization therapy) Unstable: new, minimal exertion, crescendo 12-lead+CXR, then doppler 2-D echo BNP: 100-500pg/mL #1 Dyspnea on exertion #1 DRG among hospitalized 65y/o< |
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CP tx
Then protocol of screening |
1st MONA, b-adrenergic antagonists, gp2b/3a inhibitors(abciximab, eptifibatide, tirofibran), acei, mgso4
2nd ekg+cxr 3rd labs Cbc, electrolytes, bun, creatinine, PT/PTT/INR, glucose, CK, CK-MB, troponin T & I every 6-10 hrs for 3 cycles Later: fasting lipids, liver fx, mg, homocysteine, urine drug, ua, myoglobin Bruce stress test Reduce saturated fat and cholesterol |
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CP 2ndary
RF Tx |
RF: DM, htn, dyslipidemia, homocystineuria, >40y/o men, Postmenopause women, tobacco, lvh, fhx premature cad
Tx: NHBA asa, nitrates, b-adrenergic, hmg-coa (LDL<70) 30mins exercise and minimum 5% weight reduction |
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Angina
MI Pericarditis Aortic dissection HF PE Anxiety Herpes zoster |
A: <30mins, dec with rest&NTG
MI: >30mins, new gallops, radiate, diaphoresis, n/v, pressure,worst, not if pleuritic, cessation of acitivity, previous htn P: radiates to traps, incr with resp, relief if sit up and lean fwd AD: unequal carotid or UE pulses (ct, tee, mri) HF: displaced apical impulse, edema, jvd, cardiac gallop, murmurs PE: d-dimer, V/Q scan, abrupt sob cough Anx: tightness, sob, tachy, anxiety and panic screen HZ: pain before rash, unilateral |
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CAD risks
LDL goals |
SHIFT MAID: smoking, htn, insulin, fhx, triglycerrides, male, age, inacitivity, diet
<160: 1 cad risk <130: 2 or more rf <100: multiple rfs, elderly, very high LDL |
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Chronic kidney dz+ tx
vs. ESRD |
>2mos; Compensate: hyper/hypoNa, hyperK, inc. uric acid, metabolic acid; hyperPTH;
tx K w/NaPolystyrene sulfonate,insulin w/glucose, retention enemas ESRD: Jvd, sob, rales, pulm edema, edema, GFR<15 |
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Evaluate CKD and values
24hr urine Tx reversible causes, more stuff, stage3-5, anema Consult? |
MDRD or Cockgraft-Gault eq
GFR nL 100-200; 1 <90; 2 60-89; 3 30-59; 4 <15 24hr urine: age/wt extremes, malnutrition, skeletal muscle dz, paraplegia, quadraplegia, vegetarian prt-to-crt ratio analysis if >200, need dx evalua+tx Tx reversible causes; 130/80; prt excrete 500-1000mg/d; ACEi or ARB (dilitizem, verapamil, b-block) Dec diet 0.8-1mg/kg/d; LDL<100 or 70 if cardio risks; low K+ diet; NaBicarb, diet phosphate restrictions Stage 3-5: oral P binders and <2000 Ca++, referral Anemia: epo exogenous #1 change Cr>1.2 or 1.5= consult |
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chronic constipation,
strain for bowel mvmts, pregnancy, truck drivers |
HEMORRHOIDS
pain, irritation, palpable lump tx. high-fiber diet, stool softners, sx |
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Lower GI Bleed evaluation
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colonoscopy
or sigmoidscopy w/air-contrast barium (if neg, do a colonoscopy; if both neg, do a panedoscopy) ORAL SULFATE to clear bowel and easily Dx bleeding sites angiography & tc191 label NG tube for upper GI |
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diverticula
diverticulitis |
-cula: painless; low Hct; endoscope or bowel imagin studies
-->high-fiber diet but symptomatic=Sx resection -litis: fever, N/D, constipation, high WBC; -->bowel rest, quinolone, metronidazole, Sx |
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Dukes system of stage of colon cancer
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penetration, LN, mets
A: submucosa, no Sx B1: muscularis propria B2: through it C1: B1 plus nodes C2: B2 plus nodes D: not curable; Sx, chemorad |
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GI bleeding causes
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FAMED CHIMP GUM
Fistula, Avm, Mallory-weiss, Esophageal varices, Diverticulosis, Cancer, Hemorrhoids, Infectious diarrhea, Mesenteric ischemia, Pud, Gastritis, Uc, Meckel's |
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Pneumonia Severity Index
Types -pneumonitis -CAP -atypical -HAP -PCP |
PneumoniaSevereityIndex: age, comorbid, specific exam, labs;
High RF: neoplastic, liver, renal dz, chf, diabetes. 3-4 hospitalized -Pneumonitis: chemicals, blood, radiation, autoimmune -CAP: s. pneumoniae, h. Influenza, moraxella catarrhalis--- rust color, lobar focal infiltrate -Atypical: mycoplasma, chlamydia, legionella (diarrhea)--- bilateral, diffuse -HAP: pseudomonas, klebsiella, acinetobacter, s. auerus (postinfluenza pneumoniae)-- d/t intubation, ng tube, peexisting lung dz, multisystem failure -pneumocystitis jiroveci: ground glass |
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Pneumonia tx
-healthy -macrolide resist -hospitalized no icu -f/u -HAP Time Complications |
Heal: macrolide
M: levoflaxcin, moxifloxacin or combo of b-lactam+macrolide Hosp: cefuroxime, cefotaxime, ceftriaxone, amp-sulbactam AND macrolide or IV fluroquinolone F/u: 3-4 days w/cxr (bronchogenic carcinoma) -HAP: b-lactam + fluroquinolone/aminoglycoside 72hrs for s. pneumoniae 2 weeks for s. aureus, pseudomonas, kleb, anaerobes, m. Pneumoniae, c. Pneumoniae, legionella Compl: bacteremia, parapneumonic pleural effusion, empyema (chest tube, sx), thoracentesis w/gram stain, pleural fluid |
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HCOM
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AD: Murmur inc w/stand/valsalva, dec w/squat (opp to aortic stenosis)
Worsen with exertion, boot shape heart Marfans Continuous HoloSystolic murmur 3/6 Asymptomatic Diastolic Tx. B-blocker, Sx mymectomy or pacemaker placement |
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Guidelines for Adolescent Preventive Services (GAPS)
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3 PE's
- 11-14, 15-17, 18-21 y/o HEEAADDSS: Home, Education, Eating, Activity, Abuse, Drugs (no routine tox screen), Depression, Suicide, Sex Htn, eating disorder/obesity ONLY Screen lipid and TB If sexually active, cervical sample females and leukocyte esterase for males |
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Sports physical
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Marfans, general apperance
Heat illness Bp, Congenital cardiac anomalies=#1 w/hcom Asthma, pulm disorders, ortho injuries, missing 1 of paired organ Eating disorders, body weight, menorrhagia |
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Early endoscopy reasons
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Progressive dysphagia
Recurrent vomit GI bleed Wt loss Fhx cancer Older than 55y/o and any blood found |
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Causes of peptic ulcers
S/s Test |
Steroids, bisphophonates, KCl, IV FU
ZE syndrome, Lymphomas, lung cancers Stress S/s: improve with food, pain few hrs after eating, nocturnal symptoms, epigatric tenderness, gi bleed, anemia signs Dx: stool ag test, PPI for 2wks, serologic test for anti-h.pylori abs (not distinguish active from inactive), urea breath test, endoscoy w/biopsy(gold) May need fluid resuscitation |
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Colonoscopy
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50 y/o
Blood in stool Peptic ulcer |
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Essential tremor
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Hands, head, lower extremities
Tx. Etoh, Propanolol, primidone, gabapentin (monitor SE's), brain simulation, Ventral intermediate nucleus of thalamus Ddx, wilson dz |
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Tx
Parkinson Tourette Huntington |
P: balsa
T: haloperidol, clonidine, guanfacine HCG H: target s/s by reserpine (unwant mvmts), tetrabenazine, clonazepam, ssri's, haloperidol H-RCT |
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Drug interactions
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2ndary to enzymatic effects, prt binding, renal & hepatic interactions, pharm interactions
Additive effects Chemical interactions Beers criteria Cr clearance: [(140-age)*(ideal body wt kg)]*(0.85 women)/72*serum Cr mg/dL |
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OCPs problems
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Dec estrogen to dec bp
Irregular bleeding leads to cessation POP need to be taken daily or else need an alternative for two days Smokers>35 no ocps, no rings, no patches; give injectable long acting p More than 1 partner NO iud |
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CAM
Saw palmetto Ginko biloba Garlic St John warts Glucosamine |
Women
saw palmetto....BPH. not result in a decreased prostate volume. Gingko biloba... dementia, SE Antiplatelet garlic...heart disease. St. John's wort....depression. SE serotonin syndrome Glucosamine...arthritis symptoms. 70% not report use and 5% only use CAM exclusively |
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Palliative care
Terminal pt Shingles Fatigue |
5mg of immediate release morphine sulfate every 4 hours, with a dose every 2 hours as needed?
Terminal pt who require higher opiod dose are building TOlerance not addiction Shingles/neuropathic pain: short term opiods, then TCAs, anticonvulsants, antihistamines Fatigue: methylphendidate |
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Shortness of breath palliative care
-lung cancr -choking/suffocation sensation -bronchial spasm |
Lung cancer: opiods
Choking/suffocation sensation: anxiolytics Bronchial spasm: albuterol, steroids |
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Near death
|
NOT DEMENTIA
Remaining bedbound • Confusion • Cool and mottled extremities • The “death rattle” • Decreased hearing/vision • Difficulty swallowing • Decreased conversation • Decreased oral intake • Disorientation to time • Drowsiness progressing to somnolence for extended periods • Dry mouth • Hallucinations • Increased distance from all but a few intimate others • Decreased attention span • Profound weakness |
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Meds for near death
-death rattle -pain -restlessness -agitation, hallucinations |
Atropine can decrease secretions and help the “death rattle.”
scopolamine, glycopyrolate, mycosamine, or morphine. Ketorolac pain, lorazepam may help restlessness, haloperidol and thorazine agitation and hallucinations |
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HPV males
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Anal dysplasia and cytologic screen that can lead to Anal cancer
|
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Lesbians v. Heterosexual dz
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Lesbians: bacterial vaginosis, hiv
Heterosexuals: genital warts, herpes, cervical cancer Same breast cancer risk |
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Transgendr
Cross dressers Bigender Transvestites Transexuals |
Transgender: group of people who cross culturally defined gender categories. Assigned at birth
Cross dressers wear the clothes of the other gender, but not completely identify with that gender. Bigender individuals identify with both genders. Transvestites dress as another gender, but no surgery . Transexuals wish to change their sex, and consid-ered or undertaken surgery . |
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LVH test after ekg
Typical angina and quick releif Stress test preparations med continuance v cessation |
LVH: Stress echo, not stress ekg
Typ: exercise ekg Stress: continue hydrochlorothiazide, no metoprolol for 2 days |
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Cough causes
Tx pertussis, acute bronchitis |
Asthma, bronchitis, aspiration, irritants, allergies, uncomplicated pneumonia, posnasal drip, viral upper resp, gerd, acei, lung cancer (other symptoms)
Tx pertussis azithromycin 5days or erthromycin 14d Tx acute bronchitis w/oral or inhaled steroid |
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Diarrhea: acute v chronic
Norwalk Salmonella Tx travelers diarrhea Foods to avoid w/virus |
Acute: <14 days
Salmonella: meat Norwalk: water, salads, shellfish Travel: fluroquinolone then tmp/smx or azithromycin Food: dairy, etoh, caffeine |
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A. Hematemesis and pneumediatinum
B. projectile, nonbilious C. FTT D. Beaklike appearance E. hx of meckel, polyps, adenovirus/rotavirus, henoch-schonlein purpora, intestinal lymphoma, celiac dz, CF and elongated mass F. V, sweat, lacrimation, diarrhea |
A. FB, immediate rmvl of battery/sharp stuff, Sx after 3 days
B. pyloric stenosis, hungry baby, hypoCl hypoK metabolic alkalosis, visible peristalsis, olive, double track sign w/barium C. Malrotation, hypotn, peritonitis, shitty look, Sx D. Volvulus E. intussception: currant jelly, if perf=Sx, not=u/s, coiled spring, barium enema, ileocecal jx mainly F. Insecticide ingestion, antihistamines, tcas, insecticides, nicotine |
|
"dizziness"
-vertigo -orthostasis -presyncope -disequilibrium -lightheadedness |
V= room spins (audiometry for cochlear or retrocochlear)
O=lightheadness upon arising. P=feeling of impending faint. MRI or MRA for central/peripheral D= unsteadiness, or a loss of balance, problem is in the feet. L= “floating” sensation. |
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vestibular neuronitis
benign positional vertigo acoustic neuroma meniere's dz cerebellar tumor |
V=severe vertigo over ~7days and improves over wks
B=only w/position changes (+dix-hallpike) A=Unilateral tinnitus, HL; slow; vertigo, facial weakness, ataxia (brainstem evoke audiometry) M=attacks last ~7hrs, N/V, HL, tinnitus C=dysequilibrium not tinnitus ALL PERIPHERAL CAUSES b/c delayed dix-hallpike maneuver unlike STROKE Tx. suppress the vestibular end organ receptors and inhibit activation of the vagal response: Meclizine25 mg/ diphenhydramine50 mg orally 4–6 hours |
|
CHILDREN wheezing
Acute Viral infection Asthma Bronchiolitis Pneumonia Congenital Heart Dz GERD |
AV: 50% of wheezing episodes<2y/o
Asth:recurrent episodes of wheezing. B&P: wheezing, not recurrent. C: dyspnea and even cyanosis with exertion, no wheezes; BNP>80 GERD: 24hr pH |
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acute bacterial cystitis
urethritis Recurrent utis pyelonephritis interstitial cystitis vulvovaginitis tx asymptomatic? acute prostatitis |
aBc: frequency, hematuria, dysurian, back pain; UA & culture when suspected
u: gradual onset r: tx single dose post sex p: aBc w/fever i: chronic, hematuria, NO back pain, cystoscopy v: vaginal irritation/discharge only tx asymptomatic bacteriuria in PREGNANCY ap: boggy, tender, warm prstate |
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Acute otitis media Rfs
Hearing impairment Effusions TMJ OM, vaccine College athlete/swimmer |
RFs: 6-7mos, NA, eskimos, cleft palate, down syndrome, daycare, smoking parents
H: OM, eustachian tube, tinnitus, vertigo, OE, barotrauma E: reassurance, not OM T: nsaids, bite guard O: vaccine only reduces by 10% C: OE, topical antibiotics |
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Cervical cancer classification
|
I. Cervix only
IA. Microscope IA1. <3mm, <7mm wide IA2. 3-5mm IB. W/o microscope IB1. <4cm IB2. >4cm II. Beyond cervix but not across walls IIA. Cervix, upper 1/3vagina IIA1. <4cm IIA2. >4cm IIB. Surrounding tissue III. Lower 1/3 vagina, pelvic wall, kidney IIIA. Lower 1/3 IIIB. Pelvic wall, block ureters, LNs kidney IV. Mets IVA. Bladder, rectal wall, LN IVB. Pelvic, pelvic LNs, ab, liver, intestines, lungs, bones, distant LNs |
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Edema causing meds
Lipedema |
Antihypertensives, rosiglitazone, Hormones, corticosteroids, and nons-teroidal antiinflammatory agents
NOT SSRIs, ACEi, or thiazide diuretics Lipdema: spares feet, not edema |
|
EDEMA
Chf like Ascites Nothng Unilateral/bilateral |
C: cxr then echo
A: LFTs N: UA then sediment Unilateral: no ACEi, diuresis, or Na+restrict; no u/s if trauma or infection |
|
Enuresis
-d/t -tx nonpharm, pharm |
2ndary after 6 mos of dryness
D/t maturational delay, F, Fhx, stop same age as parent Tx. Eneursis alarms (wks-mos, no gender diff), motivational therapy, no punishment, then ddavp, tcas, oxybutryn, tolterodone |
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abuse
|
recommend to be alert to physical or behavioral s/s and then ask appropriate questions
d/t unintended pregnancy, depression, anxiety, panic, somatoform, ptsd, suicide, chronic pain, frequent ab/pelvic pain, substance abuse or eating disorder children: aggressive, anxious, bedwetting, depression corner/bucket-handle fx of metaphysis of LONG bones, posterior rib, scapular fx, etc |
|
INFANT LIMP
Discitis Hip Septic Arthritis unsuspected fx Toddler's Fx Undx congenital dysplasia of hip Transient synovitis Legg-Calve Perthes Slipped Femoral Epiphysis Malignancy |
D: walks stiffly
H: trendelenburg gait, claw toes or cavus deformity; IR cause cap pressure w/in acetabulum<30deg, pain during leg roll, FABER Septic: high ESR CRPmonoarticular, fever, infant=crying irritable poor feed; ambul=no more mvmt; hip flx Ab ER; <4mos=s.aureus GBS; <5yrs=s. aureus, s. pyogenes Unsus: lower leg or foot injury Todd: tibia spiral fx from twisting w/planted foot Undx: painless limp when learn to walk; xray shows abnl hip align; splint or Sx Trans: self-limit; boys post viral infection; almost like septic joint but nL labs L: AVN of femoral head boys after trauma/infection unknown; nL early xray; Later xray shows collapse flat, wide femoral head; bone scans/mri; conservative Slipped: femoral head medial/posterior displace; limited IR and obligate ER w/hip passively flex; early xray=widen; later xray=slipp; Sx pin; closely followed M: night pain unless no pathology then growing pain |
|
Fatigues
-physiological psychological physical |
Physio: overwrk, lack of sleep, pregnancy, physical stress
Physical: infections, endocrine imbalances, anemia, cardiovascular, cancr Psychological: stress, depression, anxiety, adjustment If more than 6mos, progression is related to physical cause (not inc stress, overwrk, etoh) |
|
Postoperative Fever
-days -RF |
1-2 wind, 3-5 water, 4-6 walk, 5-7 wound, +7 wonder drug
RF: perioperative trauma, ASA>2, 2nd postop onset, WBC>10k, BUN>15, chills, rigors Tx. NSAIDs, steroids, acetaminophen Malignant hyperthermia d/t halothane or succinylcholine, tx dantrolene G(-) bactermia Bowel injury w/leak of GI: B-hemolytic strep or clostridium Least common is TSS by s. aueus Atelectasis: loss fx residual capacity, dec vital capacity; CXR has discoid infiltrate&elevqted hemidiaphragm d/t hx and lifestyle; leads to pneumonia, aspiration and tx via g(-) cov + pseudomonas cov Sx Site Infecton: lengthy procedure, blood transfusion, malnourished, DM, orthopaedic sx Drug fevers Lines for more than 72-96 hrs Not laparoscopic procedure, cardiac sx=ALL pleural effusions, ab=abscess, pancreatitis, urilogic=prostate, perinephric abscesses, GU sx= uti, neuroSx= menigitis and high risk of DVT d/t immobilized and less anticoagulated |
|
Acure wheezing Children
-FBAO -Bronchiolitis -Croup -Epiglottis -Trachitis -Retrooharyngeal Abscess -Peritonsillar Abscess |
#1 is acute viral infection
FBAO: nonvisibile object=heimlich maneuver B: viral infection (RSV, parainfluenza, adenovirus, mycoplasma, metapneumonvirus), wheezing+om, irritability, variable cxr, nL cbc, only hospitalized if serious other findings, ONLY supplemental O2+care, RSV IVIG/palicizumnab for high risk C: viral (parainfluenza, adeno, rsv), STEEPLE sign, closely monitor if major symptoms or just keep child away from stimulant factors, Supportive care, Seal-bark cough E: h. Infleunzae, h. Parainfluenza, s. pneumoniae, s. aureus, B-hemolytic strep, THUMB sign, leukocytosis, neutrophilia, bandemia, tx oxacillin nafacillin cefazolin, clindamycin airway management T:severe s. aureus, SUBGLOTTIC narrowing R: penetrate instrument fb; fever, drool, dysphagia, stridor, resp distress, tender enlarged lymphadenopathy, cervical spine ROM limitation, stridor, wheeze, LATERAL neck films, ceph/pcn P: teens, muffled voice, drooling, trismus, neck pain, cervical adenopathy, deviated uvula, CT, s pyogenes s aureus, anaerobes, tx PCN or Ampicillin-sulbactam, i&d, aw obstruction, septicemia, aspirationm jvd |
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Alcohol dependence/substance abuse
-4wks abstinence -w/d -standards -intervention |
Abuse: failure to fulfill obligation, physical hazordness, alcohol-related problems, social/interpersonal problems v dependance
inter: 5-10mins, rapport, permission, feedback, readiness, motivation/negotiate/advise, recommend to decrease if not ready for major intervention >4wks abstinence is other potential cause of depressions; substance rlated if post w/d W/d: seizures6-48hrs; hallucinations12-48hrs; DTs48-72hrs, tx bzd or phenobarbital Stan: 14g; 12ozbeer, 5ozwine, 1.5ozspirits, men2, women1, elderly less than 1 per day; men: 14/week or 4/pccasion; women7/wk or 3/occasion |
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Rectum Bleed
-meckel's diverticulum -diverticulosis -thrombosed external hemorrhoid -anal fissure |
upper endoscopy needed
M: #1 for children (T99m study) D: spontaneously resolve, not d/t food, subtotal colectomy if too severe H: visible on exam, excision w/local anesthesia; if internal, then rubber band ligation/sclerotherpay (int=pain if thrombosed) A: after hard BM w/excruciating pain, "ache/spasm" |
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insect or animal or human bite
-local, delayed, or anaphylaxis -Animal |
remove stingers rapidly w/card
tetanus for all L: histmaine-like rxn; ice, anti-histamines D: IgE: oral steroids Anaphy: 0.3-0.5mL 1:1000 sol Epi, antihistamines, steroids, bronchodilators; no perfumes, bright clothing, barefoot A: cleaning, irigation, debridement; close if less than 24 hrs ago; 5-7days Augmentin |
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HEADACHES
migraine tension cluster radio imaging |
m: nausea! Unilateral, zigzag, tx: nsaids+triptans; prophylaxis=b-blockers+TCAs; maybe verapamil, caffeine; not narcotics
t: dx of exclusion, later in workday=stress/fatigue, bilateral precranial muscle tenderness; photophobia or phonophobia; NO aggravation; tx nsaids; NO caffeine c: trigger by etoh/vasodilator intake; stabbing eye, ear, sweat, horner's syndrome; tx o2, sumatriptan, inhaled anesthetics(lidocaine) or pacing around; prophylactic: ergotamine, verapamil, lithium, divalproex, methysergide, prednisone RAD: steadily more severe, not fit any primary classifications; no respond to 1st-line tx; neuro abnLs |
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TIA
-dx studies -RF -tx protocol (asa, thrombolytics) |
TIA: <24hrs resolved w/in a hr; CT w/o contrast, EKG, amaurosis fugax=blindness, anosognosia (no awareness); more than 3 hrs since onset=no thrombolytic activity; then MRI, CTA, carotid doppler activity; (RIND=24hrs-3wks); HTN=#1, DM, age, male, fhx, dyslipidemia, smoking, sickle cell
antiHTN 220/120; thrombolytics to 185/110 (labetalol, nicardipine, NaNitroprusside); ASA w/in 48hrs; early mobilization CTw/o contrast: excludes intracranial hemorrhage, tumors, abscess quickly, but not show ischemia w/in 72 hrs Heart: echo Embolisms: transesophageal echo for MI, endocarditis, rheumatic heart dz, valvular prostheses, atrial septal defects Carotid doppler study: carotid plaques/stenosis Carotid Endarterectomy: previous TIA/CVA and carotid artery stenosis >70% but sometimes 50%. tx. noninvasive carotid ballon angiopalsty/stenting 20mmHg above nL bp |
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No Alert
Vertebrobasilar MCA ACA PCA cerebellum stroke tests |
No Alert: hemispheric infarct, basilar a. occlusion, cerebellar stroke w/edema
V: motor/sensory of all 4 limbs, nystagmus, dysarthria, dysphagia, crossed signs, disconjugate sign MCA: aphasia, contralateral hemiparesis, sensory loss, spatial neglect, contralteral impaired conjugate gaze ACA: foot, leg deficits PCA: coma, locked-in, CN palsies, drop attacks cerebellum=ipsilateral limb ataxia, gait ataxia tests: <50/new age= B12/folate, RPR, CRP, TSH, lipid, HbA1c, urine tox, hypercoag, sickle cell |
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stroke RF
-HEADACHES -7Cs |
HEADACHES: Htn, Elderly, Afib, DM, Atherosclerosis, Cardiac defect, Hyperlipidemia, Excess wt, Smoking
Young pt 7C's: Cocaine, Cancer, Cardiogenic emboli, Coagulation excess, CNS infection, Congenital vascular lesion, Consanguinity (genetic dz) tx only if 220/120< |
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HIV
-Postexposure Prophylactic -primary infection -categorization -diagnosis -late -tx |
PEP: no defined time limit; ideally 2 hrs
P: self-limit, nonspecific 6-8wks,LYMPHADENOPATHY, decline helper T-cell C: cd4 1=500<; 2=200-499; 3=<200; A=persistent generalized lymphadenopathy (inguinal nodes+2other sites); B=symptomatic; oral candidiasis; C=AIDS defining illness, <200; candida of bronchi/lungs/trachea dx: ELISA+western(r/i dz); local health authroties; HIV RNA levels(best to r/o); CD4 every 3-6mos, CBC, CMP, UA, screen for other STDs; HepA&B vacs, PPD annually, Pap L: every organ affected; TB, Pneumonia, Candida, Kaposi sarcoma; low T-cell; HIV-related dementia+nephropathy; AIDS Tx: antiretroviral, dz symptoms, pregnant; annual Flu vacine, pneumonoccal TMP-SMX PCP if <200 Azithromycin/clarithromycin Mycobaterium <75 HAART: saquinavir+ AZT/ddI/3TC/D4T |
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Jaundice
-Unconjugated -Conjugated |
U: Gilbert (congenital w/incr) or hemolysis (anemia by spherocytosis, thalassemias, sickle, malaria, TTP, HUS)
C: tx hep w/a-INF; Hep A (2-8wks inc; 2-3wks trans; incr conjugated+transaminases+serology); Hep B (hepatocellular carcinoma, Anti-HBs=resolve/vac; antiviral therapy), early in life=chronic dz; HBs=1st; HBe=active Hep C (chronic liver dz; 1-3wks exp, 4-12wks detect; asymptomatic; cirrhosis, hepatocellular carcinoma, antiviral therapy); Hep D (mediterreanean, middle east, south america); Hep E (2nd/3rd trimesters); Alcohol abuse (AST>ALT 2:1); Physical Obstruction (gallstones so U/S, CT, MRI, ERCP) |
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HEMATURIA
-meds -cystitis -nephrolithiasis -pyelonephritis -bladder cancer -STD -Micturition bleed -pediatric -<40y/o w/only moderate blood and nL everything else |
beets
M: PCN, cephs, sulfonamides, phenytoin, cyclophosphamide, mitotane, anticoagulants, nitrofurantoin C: suprapubic pain, dysuria, urgency, frequency in women N: no dysuria or frequnecy P: systemic infection B: asymptomatic, male, smoking, prining/leather dye STD: no hematuria but dysuria or frequency Mi: throughout=bladder/renal; terminal=bladder neck/prostatic urethral Ped: poststreptococcal infection/glomeurlonephritis=#1 <40: reassurance; if over, then cystoscopy/renal biopsy |
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INCONTINENCE
Stress Urge Overflow Total Functional Not a RF nL Postvoid |
S: coughing, laughin, strain; DxT: stand stress/cototn swab, urethroscopy, cystometrogram; Tx: kegel exercise (pseudoephedrine)
U: bladder capacity dec w/age (detrusor hyperactivity); dribble/leak, neuro dz, idiopathic, UTIs, FB/irritants; cystometrogram; tx: anticholinergics, b-agonists, SM relaxants (oxybutynin, tolterodine) O: "hard to release"; epidural anesthesia/neuro dz, DM/etoh/disk dz/prostate uroflowmetry w/large residual vol.; tx: a-agonists T: continous leak; pelvic Sx/radiation/ PID; tx: find fistula and Sx F: bed rest, paralysis, severe dementia Not: bacteriua nL: <50mL in bladder; >200=abnL |
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DYSMENORRHEA
Gonadal dysgenesis Hypothalamic failure/functional Pituitary failure PCOS Constitutinal delay Pregnancy |
PrimaryAmenorrhea: d/t Pg release and tx by NSAIDs, pain days before period though few yrs after began menses
G: primary amenorrhea d/t XO H: anorexia nervosa, incr exercise, chronic/systemic illness P: decr GnRH stimulation d/t head trauma, shock, infiltrate process, pituitary adenoma, craniopharyngoma PCOS: nL breast C: only boys Preg: #1 2ndary |
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BLEEDS
Annovulatory bleed Ovulatory bleed Pregnancy Leioyoma/polyps Older lady |
A: unopposed E stimulation, no P from CL, #1 dysf(x) bleed <20y/o+ 2yrs near menopause
O: fluctuate e+p R/o pregnancy Leiomyomas+Polyps= older age Older: endometrial biopsy then u/s |
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HyperPRL meds
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leading to amenorrhea, less than 100 ng/mL.
BZDs, SSRIs, TCAS, phenothiazines, and bus-pirone. sumatriptan, valproate, and ergot derivatives. Estrogens and contraceptives cardiovascular drugs (atenolol, ver-apamil, reserpine, and methyldopa). |
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Progestin challenge by provera
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+bleed= E to menustrate d/t annovulation
-bleed=neoplasm, turners, ashermans; outflow obstruction or anatomical defect |
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Undigested food w/ N/V
-meds -psychogenic vomit -CNS malignancy -viral gastroenteritis -V before eating -Vestibular -Gastroparesis -Pancreatitis -Pyloric Stenosis |
M: metoclopramide (causes extrapyramidal rxns)
Pysch: social stress or in patients w/past hx of psychiatric disorder CNS: V+nutritional deficit Vir: resolve w/in 5 days V: pregnancy, uremia, alcohol w/drawal, inc ICP Vest: not w/meals or time of day G: n/v delayed >59mins after eating; nonbilious & undigestd food Pan: pain+nausea after meals Pyl: before 7wks of age (never breast milk allergies) |
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PALPITATIONS
-cardiac cause -a. fib -Ventricular Premature beats -exercise arrhythmia |
C: male, "irregular heartbeat", personal hx of heart dz, event >5mins
Afib: flutter sensation only (hyperthyroid would have other symptoms) Vent: "flip-flopping" sensation Exer: stress test |
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Pelvic Pain
-Ovarian cyst -PID -Ectopic pregnancy -Uterine Leiomyoma -Appendicitis -Endometriosis -Mass <15y/o |
O: unilateral
PID: fever, vag d/c (CBC, ESR) Ec: like PID but abnL menses+inc pain L: enlarged uterus En: cyclic pain, unable to conceive A: nausea, anorexia (CBC) 15: mostly malignant; transvaginal u/s and Sx >15y/o: commonly cysts; monitored if <6cm by U/S |
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Sore Throat
-Posterior cervical adenopathy -Anterior adenopathy -Laryngitis w/pharygitis |
Post: EBV (also exudative pharyngitis like GAS incorrect ebv tx gives maculopalpular rash after pcn
GAS: uveal edema; tx fluroquinolone/clindamycin Ant: viral or bacterial Lw/P: viral infection=supportive |
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ACNE
-RF -Tx -rosacea -psoriarisis -pityriasis rosacea -hot tub folliculitis -HSV -shingles -enterovirus -tinea |
RF: hormones, keratinazation, immune response, Stress
Tx: tretinoin topical (d/c lead to worsen acne/scarring), maybe additional benzoyl peroxide for resistant propionibacterium acnes; oral antibiotics last not cephs, some women ocps, topical steroids R: no comedo form(acne vulgaris), eye involvement, no topical steroids, tx tetracyclines P: tx corticosteroids, calcipotriene (Vit d derivative that induces epidermal differentiation+inhibits keratinocyte prolif) PR: papulosquamous, antihistmaines or corticosteroids Hot: self-limiting HSV: lip w/burning and eruption of vesicle, fever, malaise, TEnder ADEnopathy, trigger by uv/infection, tx valcyclovir 1g daily S: any antiviral preferably w/in 72hrs, no antiviral resistance E: hand foot mouth dz T: griseofulvin |
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EYE REDness
-viral conjunctivitis -bacterial conjunctivitis -gonococal conjunctivitis -pain -scleritis -episcleritis -corneal abrasion -acute glaucoma -irititis -keratitis |
V: palapable LN (#1 adenovirus=self-limit), no coritcosteroids
B: gritty, d/c, pain, photophobia, no corticosteroids, gentamycin (g- rods=contacts) or tmp-smx for everything else G: emergency lead to ulcer/perf, clean and reforms immediately, IV cefriaxone w/topical fluroquinolone/tobramycin Pain: not conjunctivitis but corneal abrasion etc S: unilateral pain, dec vision, boring, HA w/RA+wegner's E: mild irritation CA: dec visions, intense pain, tearing, trauma AG: pain, dec vision, redness, dilated pupil I: like AG but constricted pupil K: contacts, discharge, dec vision |
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Rcurrent sinusitis
-clinical rhinosinusitis -most common -#1 bug -nasal decongestanf |
RC: persistence greater than 7-10days
MC: allergic rhinitis #1: s. pneumoniae or h. Influenzae; chronic=polymicrobial and tx w/fluroquinolone/augmentin for 2-3wks N: topical nasal steroids |
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INJURIES SPORTS
-stinger/burner -major clavicle separation -patellofemoral syndrome -acl -pcl -mcl |
S: symptoms resolve (notPT), return to play unless both sides=image;
C: Sx if >50%; if less, then sling, early ROM until pain subsides to return P: patella tracking laterally to vasta lateralis; so strengthen medialis; pain with leg held in flexion for lengthy time! Not acute d/t Female Q angle A: popsensation, immediate effusion, instability P: lateral blow to knee M: locking, catching, giving way, +mcmurrays test |
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Ottowa ankle rule
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Not walk 4 steps
Tenderness over distal 6cm of tibia/fibula and malleoli Mid-foot/navicular tenderness Proximal 5th metatarsal tenderness RICE+early mobilization. >48hrs NSAIDs. Then PT |
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Syncope
-worst to experience? -test needed -exrtional dyspnea/diaphoresis, what test? -tilt table test |
Carido is worst
Test: ekg, ck, glucose, carotid massage, orthostatic bp, pulse evaluation If exertional dyspnea/diaphoresis, need stress testing Tilt: unexplained recurrent syncope when arrythmias have been r/o. Then a psych evaluation |
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Cirrhosis
-non-etoh -bilirubin -hepatic fx v. A ute hepatocellular injury -hepatotoxic meds -#1 death -transplant c/i |
Non-etoh: splenomegly
Bilirubin=nonspecific and sometimes nL in cirrhosis High ADH=hypoNa+ confirm dx: liver biopsy Hepatic fx: albumin,pt, bilirubin Acute: ast, alt, lactate dehydrogenase, alkaline phosphatase Meds: tcas, muscle relaxants, lipid lowering, antidiabeticm antifungals, anticonvulsants, nsaids #1: bleeding varices T: portal vein thrombosis, severe medical illness, malignancy, hepatobilliary sepsis, lack of pt understanding |
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CHF tx of Systolic v. Diastolic
Nonpharm Not routinely required Quit this to fx improve heart 2nd diuretic ACEi problems |
S: 1st=ACEi, if needed b-blockers (not volume overload cause), diuretics
D: diuretics, CCB, b-blockers, NTG, antiarrhythmias Hepatojugulae Reflex: expansion of jugular vein during and immediately after RUQ compression Listen for s3 with bell over apical with L lateral decubitus Holter monitor is not routinely required Stop drinking improves heart 2nd: metolazone=thiazide Nonpharm: wt loss, Na restriction<2g/day, fluid restriction <1.5L/day ACE: cough then angioedema... Give arb |
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Alzheimers
-path -test -tx -lewy body tx Depression Delirium Dementia |
Path: Loss of synapses=lossof ACh
Social propiety and interpersonal skills maintained until late Test: cbc, cmp, thyroid, b12, mri Tx: donepezil, galantamine, rivastigmine L: no antipsychotics Dem: insidiuous, memory loss; great effort but wrong answers Del: acute, loss of concentration, Dep: psychomotor slowing, Vascular dementia=stepwise loss compares to alzh, parkin, etoh and depression |
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DIABETES screen
-dx -dm1 -RF for earlier screen than 45 every 3 yrs -DM2 -2hr glucose tolerance -1hr -3hr -UA -ESRD decisions -w/hyperlipidemia |
Dx: 2 200mg/dl+signs, fasting 126, >200mg/dl 2hr after 75g glucose load
1: low c-peptide RF: fhx, htn, obesity, ethnic groups, previous impaired glucose intolerance, abnL lipids, gestational diabetes, or delivery of 9lb baby DM2: fasting 2hr: more specific, costly, time consuming 1hr: pregnant 3hr: if tested positive UA: highly specific, low sensitivity ESRD: ACEi until macroabuminia and elevated creatinine for nephr referral L: statin (+niacin) HIGH FIBER DIET |
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DM2 Tx
-biguanides/metformin -sulfonyureas -metglinides -thiazolidnediones -a-glucosidase inhibitors -exenatide -sitagliptin |
B: not used if Cr>1.5, 1st line
Sulf: tolbutamide, glyburide, glipizide, 2nd to metformin; inc insulin, dec glucagon, dec gastric empty, dec appetite/food intake, expand beta-cell M: inc insulin, before meals, best with combo, renal safe; 2ndary to met T: dec insulin resistance (se: edema, wt gain) A: not use if Cr<2, monotherapy/dm1 E: ineffective tx with metformin+sulfonylureas, modest wt +hba1c reduction Stig: dpp-4inhibitor combo w/metformin+thiazolidinedione, less wt gain+hypogly, cancer risk!, |
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Insulin onset to max to duration
-aspart -regular -lente -ultralente Glargine dosage NPH dosage |
Onset, max, duration
A: 15-30mins x2, 3-5hrs R: 30-60mins x3, 4-12hrs L: 1-2hrs x4, 10-12hrs U: 2-4hrs x5, 24-32hrs G: 50% of total daily insulin intake NPH: 0.1 unit/kg of body wt |
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DM complications
1 v 2 Retinopathy tx Nephropathy tx Neuropathy tx Macrovascular tx |
DM1: 5 I's= iatrogenic (etoh, corticostroids,thiazide diuretics), intra-ab process (pancreatitis, cholecystitis), insulin deficiency, rubella, coxsackie, mumps
DM2: stress, dehydration R: laser photocoagulation, tight control hba1c N: ACEi's Neu: foot care, analgesics, TCAs M: #1 death cause |
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HIGH CHOLESTEROL
-inc hdl -fasting -niacin -statin drugs -omega3 -gemfibrozil/fibrates -ezetemibe |
HDL: stop etoh; best predictor of adverse outcome; smoking cessation only affects hdl
FAst: TG dec, incr of hdl and ldl; 50mg/dl postprandiol N: take w/asa S: pravastatin, fluvastatin, rosuvastatin not metabolized by cyt p450 O: dec secretions of triglycerides by liver G: changes hepatic metabolism of lipoproteins E:lowers cholesterol absorption in gut; preferably hooked up with low-dose statin |
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HTN
-stage2 -2ndary htn cause -newly dx -DASH diet |
2: require combo if >160/90
2nd: ab/flank masses(polycystic kidneys=u/s), no femoral pulses (coarctation=cxr), tachy/flushing/diaphoresis (pheo=UA), ab bruits (renal artery stenosis= captopril renal scan), pigmented striae(cushings), enlarged thyroid (fna) New: hgb/hct, K+, Cr, fasting glucose, Ca++, fasting lipids, UA, Rest EKG for end stage organ DASH: fruits, vegs, low dairy fats foods; high K, Ca, Mg (then wt loss, Na restrict, aerobics, etoh) |
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ANGINA
-typical -atypical -anginal equivalent -nonanginal -atypical nonanginal pain Cardiac ischemia test Nitrates consideration B-blockers |
T: heaviness<30mins, radiation, N/V, dec w/rest+ exertion
A: angina or exertion not both, DM, E: dyspnea is the sole or major manifestation, no CP or hx but same angina symptoms N: not the quality or precipitants; asthma, stabbing, shooting, knifelike, jabbing, tingling, AN: chest pain Ischemia: thallium exercise treadmill test Nitrates: develop tolerance; 10-12hrs w/o, use w/b-blockers, ccb B-block: use enough to keep hr50-60 |
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Obesity
-complications -calories to lbs -meds |
C: htn, DM, cancers(breast), dyslipidemias, arthritis, depression, cholelithiqsis, coronary artery dz, sleep apnea
3500 calories=1lb M: adjunct to diet and exercise; if lifestyle mods not made, then meds useless after cessation |
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Osteoporosis
-rf -best activities -best screen -estrogen replacement c/i -tx w/analgesics |
RF: caucasian/asian, hyperthyroidism
A: wt bearing, walking, jogging, wt lifting, aerobics, stair climbing, field sports, racquet sports, court sports, dancing Screen: bone density imaging; T-score of -2.5 (compared to youth) ERT: breast cancer, estrogen-depend cancer, undiagnoses/abnL TBE Tx: calcitonin, alt to ert, rx for pts w/acute osteoporotic fx, directly inhibitis osteoclasts |
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Depreession
-dx -tx no sex effects |
Dx: anhedonia or everydayfor 2wks
Tx: bupropion (da and ne reuptake inhibitor), ect if no rsponse to meds+counseling |
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Depression drugs c/i
-liver dz -hypersomnia, motor retardation -seizure -agitation, insomnia -obesity |
L: venlafaxine
H: nefazodone, mirtazapine S: mirtazapine, buproprion A: buproprion, venlafaxine O: mirtazapine, tcas |
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Bulimia v anorexia nervosa
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B: sense a lack of control over eating during episodes of binging, unlike anorexia nervosa
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ADHD
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Fhx
Childhood dx continue to adulthood Meds inhibit DA and NE reuptake |
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Thyroid
-tender, hypothyroid -nontender, hypothyroid -viral illness, tender -bacterial illness, tender -increasing and firm, nontender |
Tender: hashimoto
Non: subacute lymphocytic thyroiditis Virus: subacute granulomatous Bacteria: supporative, rare, fever Firm: invasive fibrous thyroiditis |
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After found, then radionucleotide imaging
-hot -nL -cold |
Hot: benign, graves, adenomas
NL: factitiuous Cold: cysts, tumors, neurofibromas, thyroiditis #1 FNA |
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INCONTINENCE
Stress Urge Overflow Total Functional Not a RF nL Postvoid |
S: coughing, laughin, strain; DxT: stand stress/cototn swab, urethroscopy, cystometrogram; Tx: kegel exercise (pseudoephedrine)
U: bladder capacity dec w/age (detrusor hyperactivity); dribble/leak, neuro dz, idiopathic, UTIs, FB/irritants; cystometrogram; tx: anticholinergics, b-agonists, SM relaxants (oxybutynin, tolterodine) O: "hard to release"; epidural anesthesia/neuro dz, DM/etoh/disk dz/prostate uroflowmetry w/large residual vol.; tx: a-agonists T: continous leak; pelvic Sx/radiation/ PID; tx: find fistula and Sx F: bed rest, paralysis, severe dementia Not: bacteriua nL: <50mL in bladder; >200=abnL |