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132 Cards in this Set

  • Front
  • Back
Screening age 50 and above
Colon cancer
Mammogram
Screening age 35
Lipid disorders for men

45y/o for women

20y/o if cardio dz rfs
U/S stomach screen
65 and up
Smoking hx

Rf: AAA
Colon Cancer screens (level A)
FOBT
Sigmoidscopy/barium enema
Colonoscopy
Tobacco level___?

level b?
Level A

Level B:
alcohol misuse
bmi,
symptomtic DM,
depression,
Ranson Criteria
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
Initial visit
Blood, infection/vaccine,
Pap, ua, gono+chlamydia,
down syndrome, u/s, CVS (opt)
16-20wk visit
Quad screen: afp, hcg, inhibin, estriol
U/S for anatomy
Amniocentesis
IBS
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
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)
26-28wks visit
Diabetes
RhoGAM
CXR if PPD+
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
34-38wks visit
Cbc
Vrdl
Opt: gon, chlaymidia
GBS
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
culture differences

Native Americans chronic issues
ask about culture defining illness
greet in respective language

NA: DM, fat, EtOh, Suicide
Uninsured ethnic group?
Hispanics
Lowest health risks
Lowest mortality ethnicity
Asians<whites<AA, hispanics, natives
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
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)
Calcium Pyrophosphate Dehydrate
Calcium hydroxyapatite
calcium Oxalate
CPD: rod shape, rhomboid, weak
CHA: EM, nonbirefringment
CO: bipyramidal, positive birefringment
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.
preoperative cardiovascular risk
severe aortic stenosis ONLY
greatest cardiac risk procedures v. intermediate v. lowest
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
require preoperative testing conditions
CHF
DM2
hyperlipidemia,
Poor functional capacity
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
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
Gynecomastia w/u
-puberty v. Not
P: no w/u
Not: hepatic, renal, thyroid studies
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
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
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
Fibrocyst v fibroadenoma v. Palpable mass
Adenoma: rubbery, smooth, well-circumscribed, nontender, mobile

P: if (-)mammogram and after aspiration, then u/s and biopsy
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
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
Scoliosis
<20: xrays every 6 mos
>20: orthopedic specialist
Progsssion: bracing

Most thoracic curves to the R, evalute L mri
BI-RADS scoring
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
Low back red flags
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
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
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
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<
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
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
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
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
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
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
chronic constipation,
strain for bowel mvmts,
pregnancy,
truck drivers
HEMORRHOIDS
pain, irritation, palpable lump
tx. high-fiber diet, stool softners, sx
Lower GI Bleed evaluation
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
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
Dukes system of stage of colon cancer
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
GI bleeding causes
FAMED CHIMP GUM
Fistula, Avm, Mallory-weiss, Esophageal varices, Diverticulosis, Cancer, Hemorrhoids, Infectious diarrhea, Mesenteric ischemia, Pud, Gastritis, Uc, Meckel's
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
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
HCOM
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
Guidelines for Adolescent Preventive Services (GAPS)
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
Sports physical
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
Early endoscopy reasons
Progressive dysphagia
Recurrent vomit
GI bleed
Wt loss
Fhx cancer
Older than 55y/o and any blood found
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
Colonoscopy
50 y/o
Blood in stool
Peptic ulcer
Essential tremor
Hands, head, lower extremities
Tx. Etoh, Propanolol, primidone, gabapentin (monitor SE's), brain simulation,
Ventral intermediate nucleus of thalamus
Ddx, wilson dz
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
Drug interactions
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
OCPs problems
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
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
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
Shortness of breath palliative care
-lung cancr
-choking/suffocation sensation
-bronchial spasm
Lung cancer: opiods
Choking/suffocation sensation: anxiolytics
Bronchial spasm: albuterol, steroids
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
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
HPV males
Anal dysplasia and cytologic screen that can lead to Anal cancer
Lesbians v. Heterosexual dz
Lesbians: bacterial vaginosis, hiv

Heterosexuals: genital warts, herpes, cervical cancer

Same breast cancer risk
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 .
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
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
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
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.
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
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
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
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
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
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
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
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"
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
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
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
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
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<
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
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)
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
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
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
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
HyperPRL meds
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).
Progestin challenge by provera
+bleed= E to menustrate d/t annovulation

-bleed=neoplasm, turners, ashermans; outflow obstruction or anatomical defect
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)
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
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
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
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
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
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
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
Ottowa ankle rule
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
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
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
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
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
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
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!,
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
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
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
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)
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
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
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
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
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
Bulimia v anorexia nervosa
B: sense a lack of control over eating during episodes of binging, unlike anorexia nervosa
ADHD
Fhx
Childhood dx continue to adulthood
Meds inhibit DA and NE reuptake
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
After found, then radionucleotide imaging
-hot
-nL
-cold
Hot: benign, graves, adenomas
NL: factitiuous
Cold: cysts, tumors, neurofibromas, thyroiditis

#1 FNA
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